B 201B (Form 201B) (12/09)
U
S
B
C
NITED
TATES
ANKRUPTCY
OURT
__________ District Of __________
In re ___________________________________
Case No. _______________
Debtor
Chapter ________________
CERTIFICATION OF NOTICE TO CONSUMER DEBTOR(S)
UNDER § 342(b) OF THE BANKRUPTCY CODE
Certification of [Non-Attorney] Bankruptcy Petition Preparer
I, the [non-attorney] bankruptcy petition preparer signing the debtor’s petition, hereby certify that I delivered to the debtor the
attached notice, as required by § 342(b) of the Bankruptcy Code.
_____________________________________________
_______________________________________
Printed name and title, if any, of Bankruptcy Petition Preparer
Social Security number (If the bankruptcy petition
Address:
preparer is not an individual, state the Social Security
number of the officer, principal, responsible person, or
partner of the bankruptcy petition preparer.) (Required
X_______________________________________________
by 11 U.S.C. § 110.)
Signature of Bankruptcy Petition Preparer or officer,
principal, responsible person, or partner whose Social
Security number is provided above.
Certification of the Debtor
I (We), the debtor(s), affirm that I (we) have received and read the attached notice, as required by § 342(b) of the Bankruptcy
Code.
_________________________________________
X______________________________________________
Printed Name(s) of Debtor(s)
Signature of Debtor
Date
Case No. (if known) ________________________
X______________________________________________
Signature of Joint Debtor (if any)
Date
___________________________________________________________________________________________________
Instructions: Attach a copy of Form B 201A, Notice to Consumer Debtor(s) Under § 342(b) of the Bankruptcy Code.
Use this form to certify that the debtor has received the notice required by 11 U.S.C. § 342(b) only if the certification has
NOT been made on the Voluntary Petition, Official Form B1. Exhibit B on page 2 of Form B1 contains a certification by the
debtor’s attorney that the attorney has given the notice to the debtor. The Declarations made by debtors and bankruptcy
petition preparers on page 3 of Form B1 also include this certification.
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