Interrogatories and Affidavit in Lieu of Appearance at Section Hearings

IN THE UNITED STATES BANKRUPTCY COURT WESTERN DISTRICT OF MISSOURI In Re: Case No. Chapter DEBTORS' INTERROGATORIES IN LIEU OF ATTENDANCE AT SECTION 341 MEETING OF CREDITORS The undersigned being first duly sworn upon her/his oath, states and alleges that the answers to the following interrogatories are true and correct to the best o f her/his knowledge and belief and that they are submitted as her/his sworn testimony in lieu o f her/his personal appearance at the first meeting o f creditors in the above captioned bankruptcy. QUESTION 1: ANSWER: State your f l name, social security number and current address. u QUESTION 2: D o you understand that you are under oath? ANSWER: QUESTION 3: Have you read the Bankruptcy Information Sheet provided by the United States Trustee? ANSWER: QUESTION 4: Did you s i g n the petition, schedules, statements, and related documents you filed with the court? ANSWER: QUESTION 5: Did you read the petition, schedules, statement, and related documents before you signed them? ANSWER: QUESTION 6: Are you personally familiar with the information contained in the petition, schedules, statements and related documents? ANSWER: QUESTION 7: To the best o f your knowledge, i s the information contained in the petition, schedules, statements, and related documents true and correct? ANSWER: QUESTION 8: Are there any errors or omissions to bring to my, or the court's attention at this time? ANSWER: QUESTION 9: ANSWER: Are all o f your assets identified on the schedules? QUESTION 10: Have you listed all o f your creditors on the schedules? ANSWER: QUESTION 11: Have you filed bankruptcy before? (Ifyes, state the case number, when filed, what location and whether or not a discharge had been granted.) ANSWER: QUESTION 12: Personal appearance by all debtors i s required at the U.S.C. $341 creditors meeting. Non-appearance i s acceptable in few instances. They are military service, incarceration and extreme medical conditions (medical conditions require doctor's statement). What i s your reason for non appearance? ANSWER: DEBTOR STATE OF COUNTY 1 ) ) ss: , o f lawful age, being first duly sworn, on his oath states: That he i s the debtor above-named; that h has read the above and foregoing Interrogatories in Lieu e ofthe $341 meeting, andknows the contents therein, and that all the statements therein made are true and correct. Subscribed and sworn to before me this day o f 9- NOTARY PUBLIC My appointment Expires: AFFIDAVIT REGARDING DEBTOR IDENTIFICATION (For use when debtor/debtors do not appear) STATE OF MISSOURI COUNTY OF I swear as follows: 1 ) ss: ) 1) Mynameis: (Print or type) My address is: 3) The photo identification Ihave provided to prove my identity i s as follows: (Please complete blanks OR attach copies) Drivers License (State & number) State Identification (State & number) Passport (Country, number, Expiration Date) Military identification (branch & ID number) Legal resident alien card (number) Other (Describe, attach copy) 4) My social security number is: - - 5) The proof o f security number Ihave provided i s as follows: (Please attach a copy if available) social security card w2 form Recent payroll earnings statement employers health card other (document which shows name and social security number) I swear under penalty o f perjury that all o f the above i s true and correct. Signature Subscribed and sworn to before me this day o f > Notary Public (Please return the original to the Chapter 7 or Chapter 13 trustee assigned in this case, with a copy to the United States Trustee) ver. 04/09/04