Instructions for Completion of Form, Pro Se Debtors 

Local Rule 1009-1(a) requires that, whenever lists, schedules or statements are amended, an affidavit must be filed which sets forth the changes (additions, deletions, corrections) which have been made.

In re. Name(s) of debtor(s) as it/they appear on the petition.

Case No. The bankruptcy case number assigned at the time of filing of the petition, including the three-digit judge code. EXAMPLE: 197-10345-260

Chapter. The bankruptcy chapter under which relief is being sought (7, 9, 11, 12, 13 or 15).

Debtor. Name(s) of debtor(s) signing affidavit.

Filed petition under chapter. Re-enter chapter.

Filed petition on. Date petition was filed.

Amendment to. Specify list(s), schedule(s) or statement(s) affidavit relates to (e.g., Schedule D, E/F, Statement of Financial Affairs for Individuals Filing for Bankruptcy, or Statement of Financial Affairs for Non-Individuals Filng for Bankruptcy)

Listing. Attach a listing of all changes, and specify the nature of each change.

EXAMPLE: Schedule F has been amended to add the following creditor:

Discover 7/93 $2,235.35PO Box 8003Hilliard, OH 43026

Matrix. If creditors have been added or deleted, or if address corrections have been made, a revised creditor mailing matrix must be submitted, reflecting only changes adding or deleting creditors.

Signature. The form must be signed by the debtor(s) and notarized. The date of the signing must be indicated at the prompt on the lower left of the form.

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FEE: A $34 fee is due if the nature of the amendment is to add or delete creditors from the schedules, or to make changes as to amount owed, nature of debt, etc. Acceptable forms of payment include cash, money orders and bank checks. Make money order or bank check payable to Clerk, U.S. Bankruptcy Court. Debtors' personal checks cannot be accepted. Do NOT send cash through the mail.

SERVICE: If creditors have been added, you are responsible for mailing to each such creditor a copy of the notice that the Court issued (and which you should already have received a copy of) advising of the filing of the case, the meeting of creditors and the fixing of certain deadlines. You should file a certificate of service of the notice along with the schedules. (A certificate of service form is available at the Clerk’s Office)

IMPORTANT: No amendment of schedules is effective until proof of service in accordance with EDNY LBR 1009-1(b) has been filed with the Court.