Exhibit B-3 to Appendix 5005: If filing schedules/statements subsequent to petition date or amendments of petition, matrix, schedules or
statements.
IN THE UNITED STATES BANKRUPTCY COURT
FOR THE EASTERN DISTRICT OF TEXAS
IN RE:
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§
____________________________
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Case No. _________________
§
Debtor(s)
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Chapter _____
DECLARATION FOR ELECTRONIC FILING OF AMENDED PETITION,
ORIGINAL/AMENDED BANKRUPTCY STATEMENTS AND SCHEDULES,
AND/OR AMENDED MASTER MAILING LIST (MATRIX)
As an individual debtor in this case, or as the individual authorized to act on behalf of the
corporation, partnership, or limited liability company named as the debtor in this case, I hereby declare
under penalty of perjury that I have read
G
the original statements and schedules to be filed electronically in this case
G
the voluntary petition as amended on the date indicated below and to be filed electronically
in this case
G
the statements and schedules as amended on the date indicated below and to be filed
electronically in this case
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the master mailing list (matrix) as amended on the date indicated below and to be filed
electronically in this case
and that the information provided therein is true and correct. I understand that this Declaration is to be
filed with the Bankruptcy Court within seven (7) business days after such statements, schedules, and/or
amended petition or matrix have been filed electronically. I understand that a failure to file the signed
original of this Declaration as to any original statements and schedules will result in the dismissal of my
case and that, as to any amended petition, statement, schedule or matrix, such failure may result in the
striking of the amendment(s).
G
[Only include if petitioner is a corporation, partnership or limited liability company] –
I hereby further declare under penalty of perjury that I have been authorized to file the statements,
schedules, and/or amended petition or amended matrix on behalf of the debtor in this case.
Date: __________________
_________________________
________________________
, Debtor
, Joint Debtor
Soc. Sec. No. ________________
Soc. Sec. No. ________________
OR
, Position/Capacity
Effective 12/1/2003