FORM A
DECLARATION OF DEBTOR
I hereby declare that all prepetition bank accounts of debtor,
as listed below:
Acct No.: ____________________ At: _______________________
Acct No.: ____________________ At: _______________________
Acct No.: ____________________ At: _______________________
Acct No.: ____________________ At: _______________________
____ have been closed as of 19___
OR
____ that I have contacted the bank and initiated
closing procedures as of ______________, 19__,
and that the accounts will be closed as soon as
the bank completes the closeout process/procedure.
I further declare that all monies have been transferred to debtor
in possession at ____________________ depository, consisting of the
following accounts:
General Checking Account No.___________________________
Payroll Checking Account No.___________________________
Tax Checking Account No. ___________________________
Cash Collateral Account No. ___________________________
Other ___________________________
The information provided above is true to the best of my knowledge
and belief.
Dated: ________________, 19___ __________________________
Debtor
__________________________
Title
(Revised 6/92)