UNITED STATES BANKRUPTCY COURT NORTHERN DISTRICT OF GEORGIA In Re: : : : : : Debtor(s) Case No. Chapter Adversary No. DECLARATION AND REQUEST TO FILE DOCUMENT ON CD The undersigned declares under penalty of perjury as follows: With this declaration, I have submitted the document(s) described below to the Clerk of the Court on a CD and request that the document(s) be filed and entered on the docket of this case or proceeding. If the document(s) is a Verified Paper as defined in BLR 9001-1, I possess the entire original of the document and accept the responsibility to maintain the original document under my care, custody and control and subject to the Court's Local Rules and General Orders. Case No. / Name Document Title Verified (Yes/No) Date: Attorney Signature: _________________________ Print Name: Bar Number: Attorney for: Address: Phone: Email: American LegalNet, Inc. www.FormsWorkFlow.com
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