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Appendix A

UNITED STATES BANKRUPTCY COURT
SOUTHERN DISTRICT OF INDIANA

 

(Put caption of case or adversary proceeding here)

 

DECLARATION THAT PARTY WAS UNABLE TO FILE IN A TIMELY
MANNER DUE TO TECHNICAL DIFFICULTIES

Please take notice that (plaintiff/defendant, name of party) was unable to file his/her (title of document) in a timely manner due to technical difficulties. The deadline for filing the document was (filing deadline date).  The reason(s) that I was unable to file the document in a timely manner and the good faith efforts I made prior to the filing deadline to both file in a timely manner and to inform the Court and the other parties that I could not do so are set forth below.

[Statement of reasons and good faith efforts to file and to inform (including dates and times)]

I declare under penalty of perjury that the foregoing is true and correct.

 

/s/ (Typewritten Name of E-Filer)*
(Name of E-Filer)
(Address)
(City, State, ZIP Code)
(Phone: (xxx) xxx-xxxx)
(Fax: (xxx) xxx-xxxx)
(E-mail: xxx@xxx.xxx)

 

*(Note:  Signature format acceptable if filed electronically; if not electronically, a wet signature is required.)


History of Changes

11/15/2011 - Formatting changes made to document.