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MOW 1009-1.2 (05/07)

UNITED STATES BANKRUPTCY COURT WESTERN DISTRICT OF MISSOURI

IN RE:

Debtor(s)

) ) ) ) ) )

Case No.

VERIFICATION OF MAILING MATRIX The above-named Debtor(s) hereby verifies that the attached list of creditors is true and correct to the best of my knowledge and includes the name and address of my ex-spouse (if any).

Date: ____________________

_____________________________________________ Signature of Debtor

_____________________________________________ Signature of Joint Debtor

Instructions: Include in voluntary petition package if matrix is filed at case opening. File as a separate document when a matrix or amended matrix is uploaded after the date the petition is filed. ECF Event: When filed separately, Bankruptcy>Other>Verification by Debtor