Certification Of Business Debtor Page 3
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3YOU MUST SUPPLY THE FOLLOWING DOCUMENT(S) WITH THIS CERTIFICATION OF BUSINESS DEBTOR:
PROVIDE THE CORPORATE DISSOLUTION OR LIQUIDATION (Form 966) FROM THE IRS or CERTIFCATE OF
CANCELLATION (Form L-109) OR CERTIFICATE OF DISSOLUTION (Form C-159) FROM THE STATE OF NEW
JERSEY.
PROVIDE COPIES OF THE LAST TWO (2) FILED TAX RETURNS, ALONG WITH ALL SUPPORTING SCHEDULES
AND STATEMENTS. NOTE: Please redact SS#s (XXX-XX-1234), dependent(s)' names, and birth date.
PROVIDE COPIES OF ALL BANK STATEMENTS FOR THE THREE (3) MONTHS PRIOR TO FILING. IF THE
ACCOUNT HAS BEEN CLOSED WITHIN THE LAST THREE (3) MONTHS, PROVIDE THE LAST STATEMENT
SHOWING THE ACCOUNT CLOSED or A LETTER FROM THE BANK INDICATING SAME. NOTE: Bank statements
should include all pages and have all account numbers redacted except for the last four digits. A computer printout will not
be accepted.
I declare, as the Debtor(s) named above, under penalty of perjury that the foregoing information is true and correct.
I have attached all required documents requested (i.e. Certificate of Cancellation, Tax Returns, Bank Statements.)
I read and acknowledge Responsibilities as a Business Debtor ( ).
I understand that filing this documents under the Trustee's Filing System (T.F.S.) constitutes the Participant's
signature for purposes of signing the document under Fed. R. Bankr. P. 9011.
/s/ Print Debtor's Name:
/s/ Print Co-Debtor's Name:
Dated (mm/dd/yyyy):
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