REVISED 12/15
UNITED STATES BANKRUPTCY COURT
DISTRICT OF MINNESOTA
In re: Case No.
Debtor(s).
SIGNATURE DECLARATION
PETITION, SCHEDULES & STATEMENTS
CHAPTER 13 PLAN
VOLUNTARY CONVERSION, SCHEDULES & STATEMENTS
AMENDMENT TO PETITION, SCHEDULES & STATEMENTS
MODIFIED CHAPTER 13 PLAN
OTHER: PLEASE DESCRIBE:
I [We], the undersigned debtor(s) or authorized representative of the debtor, make the following declarations
under penalty of perjury:
1. The information I have given my attorney for the electronically filed petition, statements, schedules,
amendments, and/or chapter 13 plan, as indicated above, is true and correct;
2 The Social Security Number or Tax Identification Number I have given to my attorney for entry into
the court’s Case Management/Electronic Case Filing (CM/ECF) system as a part of the electronic
commencement of the above-referenced case is true and correct;
3. [individual debtors only] If no Social Security Number was provided as described in paragraph 2
above, it is because I do not have a Social Security Number;
4 I consent to my attorney electronically filing with the United States Bankruptcy Court my petition,
statements and schedules, amendments, and/or chapter 13 plan, as indicated above, together with
a scanned image of this Signature Declaration;
5. My electronic signature contained on the documents filed with the Bankruptcy Court has the same
effect as if it were my original signature on those documents; and
6. [corporate and partnership debtors only] I have been authorized to file this petition on behalf of
the debtor.
Date:
x
Signature of Debtor 1 or Authorized
Representative
Printed name of Debtor 1 or Authorized
Representative
x
Signature of Debtor 2
Printed Name of Debtor 2
