UNITED STATES BANKRUPTCY COURT EASTERN DISTRICT OF MISSOURI ____________DIVISION
In re
DEBTOR NAME,
Debtor(s).
) ) ) )
Case No.___-________-___ Chapter ___
Verification of Creditor Matrix The above named debtor(s) hereby certifies/certify under penalty of perjury that the attached list containing the names and addresses of my creditors (Matrix), consisting of _____ page(s) and is true, correct and complete.
__________________________________________ Debtor
__________________________________________ Joint Debtor
Dated: ___________________
(L.F. 2 Rev. 05/03)