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MOW 1009-1.1 (05/07)

IN THE UNITED STATES BANKRUPTCY COURT FOR THE WESTERN DISTRICT OF MISSOURI

IN RE:

Debtor(s)

) ) ) ) )

Case No.

VERIFICATION OF SCHEDULES (OR AMENDED SCHEDULES) AND SUMMARY OF SCHEDULES

I/We, , named as the debtor(s) in this case, declare under the penalty of perjury that I/we have read the foregoing Summary and Schedules or Amended Schedules, consisting of pages, and that they are true and correct to the best of my/our knowledge, information, and belief.

Date: Signature of Debtor

Signature of Joint Debtor

Instructions: File with original schedules or amended schedules. ECF Event: If not filed with the schedules but filed as a separate document­ Bankruptcy>Other>Verification by Debtor