Debtors Electronic Noticing Request (DeBN)

U.S. BANRUPTCY COURT SOUTHERN DISTRICT OF INDIANA In re: Debtor(s) Case No. DEBTOR'S ELECTRONIC NOTICING REQUEST (DeBN) Check only ONE box for the applicable section below: INITIAL REQUEST: (Check this box to begin receiving notices and orders from the U.S. Bankruptcy Court via email) Pursuant to Bankruptcy Rule 9036, I hereby request receipt of court notices and orders via email, instead of U.S. mail, from the Bankruptcy Noticing Center (BNC) through the U.S. Bankruptcy Court's Debtor Electronic Bankruptcy Noticing (DeBN) program. I understand that this request is limited to receipt of only notices and orders issued by the U. S. Bankruptcy Court. I will continue to receive documents filed by all other parties, such as the trustee and creditors, via U.S. mail or in person pursuant to court rules. I understand that I will receive electronic notice of any documents issued by the court in any current or future bankruptcy or adversary case from any bankruptcy court district in which I am listed with the same name and address, including cases where I am listed as a creditor. I understand that the first time the BNC receives an email bounce-back (undeliverable email); my DeBN account will be automatically disabled. I will then receive notices and orders via U.S. mail, and I must file an updated request form if I wish to reactivate my account. I understand that enrollment in DeBN is completely voluntarily, and I may file a request to deactivate my account at any time. UPDATE TO ACCOUNT INFORMATION: (Check this box to make changes to your existing DeBN account) I request the following update(s) to my DeBN account: (check one) I have a new email address as indicated BELOW I request review of my existing DeBN account to verify name and address information is correct. I request reactivation of my DeBN account so that I may receive court notices and orders via email, instead of U. S. mail. REQUEST TO DEACTIVATE ELECTRONIC NOTICING: (Check this box to request deactivation of your DeBN account) I request deactivation of my DeBN account. I understand that by deactivating my account, I will begin receiving notices and orders issued by the U.S. Bankruptcy Court via U.S. mail, instead of email. I understand that I will continue to receive electronic notices until such time as the Court has deactivated my account. I am a debtor in this bankruptcy case, or the debtor's authorized representative if the debtor is a business, and I have read the applicable section check-marked above and understand and agree to the terms and conditions set forth therein. Neither the U.S. Bankruptcy Court nor the BNC bears any liability for errors resulting from the information I have submitted on this form. I understand my account will be activated within 48 hours of the filing of this form. JOINT DEBTORS MUST FILE SEPARATE FORMS Signature: ____________________________________________ Printed Name (and title if not the debtor): Email Address (type or print clearly): Date For more information about the DeBN program, visit the Court's website at: www.insb.uscourts.gov American LegalNet, Inc. www.FormsWorkFlow.com (3/15)