Declaration Re Electronic Filing For Individual Debtor Not Represented By Counsel {1A}

LOCAL BANKRUPTCY FORM NO. 1A IN THE UNITED STATES DISTRICT COURT FOR THE UNITED STATES VIRGIN ISLANDS, BANKRUPTCY DIVISION In Re: Debtor(s) BANKRUPTCY NO. CHAPTER NO. DOCUMENT NO. DECLARATION RE: ELECTRONIC FILING OF PETITION, SCHEDULES & STATEMENTS FOR INDIVIDUAL DEBTOR NOT REPRESENTED BY COUNSEL I, _________________________________________, and I, _________________________________________, the undersigned debtor, certify that the Bankruptcy petition, statements, schedules and mailing matrix presented to the Clerk for filing is true and correct. I understand that this DECLARATION RE: ELECTRONIC FILING is to be submitted to the Clerk once all schedules have been filed but, in any event, no later than 15 days following the date the petition was filed unless the time is extended by order of court. I understand that failure to timely submit the signed original of this DECLARATION will result in dismissal of my case pursuant to 11 U.S.C. § 707(a)(3) without further notice. Check box if debtor is a servicemember as defined by the Servicemembers Civil Relief Act of 2003. If debtor becomes entitled to protections from the Act during the bankruptcy case, he shall file an affidavit advising the Court within fifteen (15) days of the date of his change in status. Check box if Debtor (and Joint Debtor if a joint petition was filed) were not required to file a Federal income tax return under applicable law for the tax year that ended immediately before this case was filed. If this box is checked, Debtor(s) will provide trustee with the required documentary proof of income. I declare under penalty of perjury that the information provided in this petition and the social security number(s) listed below are true and correct: _____________________________ Signature of Debtor _____________________________ Signature of Joint Debtor Debtor has a social security number and it is: ________________________ Check here if Debtor does not have a social security number: 9 Joint Debtor has a social security number and it is: ________________________ Check here if Joint Debtor does not have a social security number: 9 _________________________________ Address _________________________________ Phone No. Dated: _______________________ American LegalNet, Inc. www.FormsWorkflow.com