Form 119 - Bankruptcy Petition Preparer'S Notice, Declaration, And Signature
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1
2Fill in this information to identify the case:
Debtor 1
__________________________________________________________________
First Name
Middle Name
Last Name
Debtor 2
________________________________________________________________
(Spouse, if filing)
First Name
Middle Name
Last Name
__________ District of __________
__________
_________
United States Bankruptcy Court for the:
District of
Case number
___________________________________________
Chapter ____________
(If known)
Official Form 119
Bankruptcy Petition Preparer’s Notice, Declaration, and Signature
12/15
Bankruptcy petition preparers as defined in 11 U.S.C. § 110 must fill out this form every time they help prepare documents that are filed in the
case. If more than one bankruptcy petition preparer helps with the documents, each must sign in Part 3. A bankruptcy petition preparer who
does not comply with the provisions of title 11 of the United States Code and the Federal Rules of Bankruptcy Procedure may be fined,
imprisoned, or both. 11 U.S.C. § 110; 18 U.S.C. § 156.
Part 1:
Notice to Debtor
Bankruptcy petition preparers must give the debtor a copy of this form and have the debtor sign it before they prepare any documents for
filing or accept any compensation. A signed copy of this form must be filed with any document prepared.
Bankruptcy petition preparers are not attorneys and may not practice law or give you legal advice, including the following:
whether to file a petition under the Bankruptcy Code (11 U.S.C. § 101 et seq.);
whether filing a case under chapter 7, 11, 12, or 13 is appropriate;
whether your debts will be eliminated or discharged in a case under the Bankruptcy Code;
whether you will be able to keep your home, car, or other property after filing a case under the Bankruptcy Code;
what tax consequences may arise because a case is filed under the Bankruptcy Code;
whether any tax claims may be discharged;
whether you may or should promise to repay debts to a creditor or enter into a reaffirmation agreement;
how to characterize the nature of your interests in property or your debts; or
what procedures and rights apply in a bankruptcy case.
The bankruptcy petition preparer ________________________________________________________________ has notified me of
Name
any maximum allowable fee before preparing any document for filing or accepting any fee.
8
___________________________________________________________________________________
Date _________________
Signature of Debtor 1 acknowledging receipt of this notice
MM / DD / YYYY
8
___________________________________________________________________________________
Date _________________
Signature of Debtor 2 acknowledging receipt of this notice
MM / DD / YYYY
Official Form 119
Bankruptcy Petition Preparer’s Notice, Declaration, and Signature
page 1
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