Statement Of Petition Preparer Pursuant to FRBP 2016(c)

12/01/03 UNITED STATES BANKRUPTCY COURT FOR THE EASTERN DISTRICT OF MICHIGAN In re: Case No. Chapter Hon. Debtor(s) / STATEMENT OF PETITION PREPARER PURSUANT TO F.R.BANKR.P. 2016(c) The undersigned, pursuant to Fed.R.Bankr.P.2016(c) states that: 1. The undersigned is the petition preparer for the Debtor(s) in this case. 2. The compensation paid or agreed to be paid by the Debtor(s) to the undersigned is: A. For petition preparer services rendered in contemplation of and in connection with this case, exclusive of the filing fee paid B. Prior to filing this statement, received C. The unpaid balance due and payable is 3. $ of the filing fee has been paid. 4. In return for the above-disclosed fee, I have agreed to render the following services in the bankruptcy case, including: A. B. C. D. 5. The source of payments to the undersigned was from: A. Debtor(s) earnings, wages, compensation for services performed B. Other (describe, including the identity of payor) Dated: Bankruptcy Petition PreparerAgreed: Debtor Debtor