FLNB Local Form 9

UNITED STATES BANKRUPTY COURT
Northern District of Florida

	In Re:						)	Case No. (xx-xxxxx-xxx)
							)	Chapter (x)
	[Name of Debtor(s)],				)
							)
					Debtor(s)	)

AFFIDAVIT IN SUPPORT OF MOTION TO (EXTEND OR IMPOSE) THE AUTOMATIC STAY PURSUANT TO 11 U.S.C. §362(c)(3) [or (4)]

The debtor(s), in support of the Motion to (Extend or Impose) the Automatic Stay, state as follows:

1.	I filed this bankruptcy petition on (date).

2.	I previously filed bankruptcy, (case number), under Chapter (#) on (date).That case was dismissed on (date).

If you have filed more than one bankruptcy case in the past year: 
I also previously filed another bankruptcy case, (case number), on (date), and that case was dismissed on (date).

3.	I have had no other pending bankruptcy cases in the past year. 

4.	I have had a substantial change in my financial or personal affairs since the dismissal of the last case; those changes are:

(Describe in detail.)

5.	I have not had any prior case(s) dismissed in the past year for any of the following reasons:

•	failure to file or amend other required documents without substantial excuse,
•	failure to provide adequate protection as ordered by the Court, or 
•	failure to perform the terms of a plan confirmed by the Court.

6.	I believe that this case will result in my being granted a discharge (if a Chapter 7) or result in a confirmed plan (if a Chapter 11 or 13) that I will be able to perform.

I affirm under penalty of perjury that the information in this Affidavit is true and correct.  

Signature of Debtor

Signature of Joint Debtor