UNITED STATES BANKRUPTCY COURT

EASTERN DISTRICT OF MISSOURI

____________DIVISION

In re:	)

____________________	)	Case No.___-________-___

)

____________________	)	Chapter ___

)

Debtor(s).	)

)

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 Signature

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Joint Debtor Signature (If applicable)

Dated: ___________________