UNITED STATES BANKRUPTCY COURT MIDDLE DISTRICT OF LOUISIANA (Local Form 1) IN RE CASE NO. MAILING LIST Verification Penalties for making a false statement or for concealing property are a fine of up to $5000.00 or imprisonment for up to five (5) years, or both. (18 U.S.C. ยง 152 and 3571). DECLARATION We declare under penalty of perjury that the foregoing mailing list, comprising _____ pages, is true and correct. Signed on ___________________, 20___.
Signed: (DEBTOR) Signed: (JOINT DEBTOR) Signed: (ATTORNEY FOR THE DEBTOR)