Declaration Form For Electronic Filing Of Bankruptcy Petition And Master Mailing List (Matrix)

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Exhibit B-2 to Appendix 5005: If filing “bare-bones” petition, matrix, & 20 largest unsecured list.
IN THE UNITED STATES BANKRUPTCY COURT
FOR THE EASTERN DISTRICT OF TEXAS
IN RE:
§
§
____________________________
§
Case No. _________________
§
Debtor(s)
§
Chapter _____
DECLARATION FOR ELECTRONIC FILING OF
BANKRUPTCY PETITION AND MASTER MAILING LIST (MATRIX)
PART I: DECLARATION OF PETITIONER:
As an individual debtor in this case, or as the individual authorized to act on behalf of the
corporation, partnership, or limited liability company seeking bankruptcy relief in this case, I hereby
request relief as, or on behalf of, the debtor in accordance with the chapter of title 11, United States Code,
specified in the petition to be filed electronically in this case. I have read the information provided in the
petition and in the lists of creditors to be filed electronically in this case and I hereby declare under
penalty of perjury that the information provided therein, as well as the social security information
disclosed in this document, is true and correct. I understand that this Declaration is to be filed with the
Bankruptcy Court within seven (7) business days after the petition and lists of creditors have been filed
electronically. I understand that a failure to file the signed original of this Declaration will result in the
dismissal of my case.
G
[Only include for Chapter 7 individual petitioners whose debts are primarily consumer debts] –
I am an individual whose debts are primarily consumer debts and who has chosen to file under
chapter 7. I am aware that I may proceed under chapter 7, 11, 12, or 13 of title 11, United States
Code, understand the relief available under each chapter, and choose to proceed under chapter 7.
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 petition and
lists of creditors on behalf of the debtor in this case.
Date: _____________
___________________________
___________________________
, Debtor
, Joint Debtor
Soc. Sec. No. ________________
Soc. Sec. No. ________________
OR
, Position/Capacity
PART II: DECLARATION OF ATTORNEY:
I declare under penalty of perjury that: (1) I will give the debtor(s) a copy of all documents
referenced by Part I herein which are filed with the United States Bankruptcy Court; and (2) I have
informed the debtor(s), if an individual with primarily consumer debts, that he or she may proceed under
chapter 7, 11, 12, or 13 of title 11, United States Code, and have explained the relief available under each
such chapter.
Date: ______________
_________________________
, Attorney for Debtor
Effective 12/1/2003

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