AFFIDAVIT TO ACCOMPANY PETITION FILED PRO SE. PLEASE PRINT.
UNITED STATES BANKRUPTCY COURT
NORTHERN DISTRICT OF GEORGIA
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CASE NO. _____________________ |
NAME OF DEBTOR(S) |
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___________________________ |
TELEPHONE NO. ________________ |
ADDRESS |
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___________________________ |
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CITY, STATE, ZIP |
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PRO SE AFFIDAVIT TO ACCOMPANY PETITION FOR ORDER OF RELIEF
I, the undersigned, being under oath and declare under penalty of perjury, that I do not have an attorney to represent me in this case, that I represent myself in this case, that I am the petitioner in the above-stated bankruptcy case under Title 11 of the United States Code, and that the answers given below are true according to the best of my knowledge, information and belief.
Did anyone assist you in any way in the preparation of this petition?
If someone did assist you, list their name and address:
______________________________
NAME
______________________________
ADDRESS
______________________________ |
__________________________ |
CITY, STATE, ZIP CODE |
TELEPHONE NUMBER |
Did the person assisting you charge or collect any money for helping you in any way?
ANSWER: YES ( ) NO ( ) IF "YES", HOW MUCH ($_______)
Have you filed a bankruptcy case in the past?
If you have filed a bankruptcy case in the past, list the case number, chapter and judge:
___________________________________________
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___________________________________ |
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PRO SE PETITIONER |
Subscribed and sworn to before me on the ____ day of ______________,______ |
_________________________________ |
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NOTARY PUBLIC |
DEPUTY CLERK |