Free Signature Declaration - Minnesota

UNITED STATES BANKRUPTCY COURT DISTRICT OF MINNESOTA In re:

SIGNATURE DECLARATION Debtor(s). Case No. ______________ ___ ___ ___ ___ ___ ___ PETITION, SCHEDULES & STATEMENTS CHAPTER 13 PLAN SCHEDULES AND STATEMENTS ACCOMPANYING VERIFIED CONVERSION 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: · The information I have given my attorney and provided in the electronically filed petition, statements, schedules, amendments, and/or chapter 13 plan, as indicated above, is true and correct; The information provided in the "Debtor Information Pages" submitted as a part of the electronic commencement of the above-referenced case is true and correct; [individual debtors only] If no Social Security Number is included in the "Debtor Information Pages" submitted as a part of the electronic commencement of the above-referenced case, it is because I do not have a Social Security Number; 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 and the completed "Debtor Information Pages," if applicable; and [corporate and partnership debtors only] I have been authorized to file this petition on behalf of the debtor.

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Date:

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Signature of Debtor or Authorized Representative

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Signature of Joint Debtor

Printed Name of Debtor or Authorized Representative

Printed Name of Joint Debtor

Form ERS 1 (Rev. 10/03)