Free Local Form 3. - Louisiana

UNITED STATES BANKRUPTCY COURT MIDDLE DISTRICT OF LOUISIANA (Local Form 3) IN RE: CASE NO.:

DECLARATION OF ELECTRONIC FILING FOR PERSONS OTHER THAN DEBTORS [ ] Proof of Claim [ ] Reaffirmation Agreement [ ] Other _______________________________________________________ (1) I have reviewed the information contained in the documents designated in this declaration to be electronically filed in this bankruptcy case or proceeding (the "Documents"). I have authorized the electronic filing of these Documents. I agree that I shall retain all original, signed Documents filed in this case or any proceeding related to this case for five years after the closing of the case or proceeding in which the Documents were filed. My electronic signature on the Documents is my signature for all purposes authorized or required by law, and my electronic signature on the Documents shall have the same effect as my signature on the original Documents.

(2) (3)

(4)

I certify under penalty of perjury that the foregoing are true and correct. Signed on _________________, 20___.

Signed: ___________________________________