LF 9011 (9/07) United States Bankruptcy Court Eastern District of Washington
In re:
Debtor(s)
) ) ) ) )
Case No. STATEMENT OF WITNESS TO SIGNING OF DOCUMENT
The undersigned states under penalty of perjury that he/she witnessed the signing of the following document(s) by the person(s) indicated thereon. Voluntary Petition Declaration Concerning Debtor's Schedules Statement of Affairs Other:
Dated:
Witness Signature
Witness Name (printed or typed)
Address:__________________________________ __________________________________ __________________________________