(Put caption of case or adversary proceeding here)

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.

*(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.