IN THE UNITED STATES BANKRUPTCY COURT FOR THE

WESTERN DISTRICT OF MISSOURI

IN RE: Enter debtor(s) name	)

)

)

Debtor(s)	)	Case No. Enter Case No.

)

VERIFICATION BY DEBTOR(S)

I/We, Enter debtor(s) name, named as the debtor(s) in this case, declare under the penalty of perjury that I/we have read the

☐	Schedule(s) A-J insert all that apply

☐	Amended Schedule(s) A-J insert all that apply

☐	Conversion Schedules A-J insert all that apply

☐	Statement/Amended Statement of Financial Affairs

☐	Statement/Amended Statement of Intent

☐	Statement/Amended Statement of Current Monthly Income

☐	Matrix

☐	Amended Matrix

and that they are true and correct to the best of my/our knowledge, information, and belief.

Date: Enter date	Enter signature

Signature of Debtor

Enter signature

Signature of Joint Debtor

Instructions: File with original schedules or matrix not filed with the original petition or amended schedules/statements/matrix. Must be prepared as a separate document and must contain image of the debtor(s)’ signature(s). Docket as a separate event or as a separate attachment to the schedules/statements/matrix.

ECF Event: If not filed as an attachment to the schedules/statements/matrix, but filed as a separate document use the event – Bankruptcy>Other>Verification by Debtor