Official Form 119 "Bankruptcy Petition Preparer's Notice, Declaration, and Signature"

What Is Official Form 119?

This is a legal form that was released by the United States Bankruptcy Court on December 1, 2015 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on December 1, 2015;
  • The latest available edition released by the United States Bankruptcy Court;
  • Easy to use and ready to print;
  • Yours to fill out and keep for your records;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Official Form 119 by clicking the link below or browse more documents and templates provided by the United States Bankruptcy Court.

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Download Official Form 119 "Bankruptcy Petition Preparer's Notice, Declaration, and Signature"

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Fill in this information to identify the case:
Debtor 1
__________________________________________________________________
First Name
Middle Name
Last Name
Debtor 2
________________________________________________________________
(Spouse, if filing)
First Name
Middle Name
Last Name
__________ District of __________
__________
_________
United States Bankruptcy Court for the:
District of
Case number
___________________________________________
Chapter ____________
(If known)
Official Form 119
Bankruptcy Petition Preparer’s Notice, Declaration, and Signature
12/15
Bankruptcy petition preparers as defined in 11 U.S.C. § 110 must fill out this form every time they help prepare documents that are filed in the
case. If more than one bankruptcy petition preparer helps with the documents, each must sign in Part 2. A bankruptcy petition preparer who
does not comply with the provisions of title 11 of the United States Code and the Federal Rules of Bankruptcy Procedure may be fined,
imprisoned, or both. 11 U.S.C. § 110; 18 U.S.C. § 156.
Part 1:
Notice to Debtor
Bankruptcy petition preparers must give the debtor a copy of this form and have the debtor sign it before they prepare any documents for
filing or accept any compensation. A signed copy of this form must be filed with any document prepared.
Bankruptcy petition preparers are not attorneys and may not practice law or give you legal advice, including the following:
whether to file a petition under the Bankruptcy Code (11 U.S.C. § 101 et seq.);
whether filing a case under chapter 7, 11, 12, or 13 is appropriate;
whether your debts will be eliminated or discharged in a case under the Bankruptcy Code;
whether you will be able to keep your home, car, or other property after filing a case under the Bankruptcy Code;
what tax consequences may arise because a case is filed under the Bankruptcy Code;
whether any tax claims may be discharged;
whether you may or should promise to repay debts to a creditor or enter into a reaffirmation agreement;
how to characterize the nature of your interests in property or your debts; or
what procedures and rights apply in a bankruptcy case.
The bankruptcy petition preparer ________________________________________________________________ has notified me of
Name
any maximum allowable fee before preparing any document for filing or accepting any fee.
8
___________________________________________________________________________________
Date _________________
Signature of Debtor 1 acknowledging receipt of this notice
MM / DD / YYYY
8
___________________________________________________________________________________
Date _________________
Signature of Debtor 2 acknowledging receipt of this notice
MM / DD / YYYY
Official Form 119
Bankruptcy Petition Preparer’s Notice, Declaration, and Signature
page 1
Fill in this information to identify the case:
Debtor 1
__________________________________________________________________
First Name
Middle Name
Last Name
Debtor 2
________________________________________________________________
(Spouse, if filing)
First Name
Middle Name
Last Name
__________ District of __________
__________
_________
United States Bankruptcy Court for the:
District of
Case number
___________________________________________
Chapter ____________
(If known)
Official Form 119
Bankruptcy Petition Preparer’s Notice, Declaration, and Signature
12/15
Bankruptcy petition preparers as defined in 11 U.S.C. § 110 must fill out this form every time they help prepare documents that are filed in the
case. If more than one bankruptcy petition preparer helps with the documents, each must sign in Part 2. A bankruptcy petition preparer who
does not comply with the provisions of title 11 of the United States Code and the Federal Rules of Bankruptcy Procedure may be fined,
imprisoned, or both. 11 U.S.C. § 110; 18 U.S.C. § 156.
Part 1:
Notice to Debtor
Bankruptcy petition preparers must give the debtor a copy of this form and have the debtor sign it before they prepare any documents for
filing or accept any compensation. A signed copy of this form must be filed with any document prepared.
Bankruptcy petition preparers are not attorneys and may not practice law or give you legal advice, including the following:
whether to file a petition under the Bankruptcy Code (11 U.S.C. § 101 et seq.);
whether filing a case under chapter 7, 11, 12, or 13 is appropriate;
whether your debts will be eliminated or discharged in a case under the Bankruptcy Code;
whether you will be able to keep your home, car, or other property after filing a case under the Bankruptcy Code;
what tax consequences may arise because a case is filed under the Bankruptcy Code;
whether any tax claims may be discharged;
whether you may or should promise to repay debts to a creditor or enter into a reaffirmation agreement;
how to characterize the nature of your interests in property or your debts; or
what procedures and rights apply in a bankruptcy case.
The bankruptcy petition preparer ________________________________________________________________ has notified me of
Name
any maximum allowable fee before preparing any document for filing or accepting any fee.
8
___________________________________________________________________________________
Date _________________
Signature of Debtor 1 acknowledging receipt of this notice
MM / DD / YYYY
8
___________________________________________________________________________________
Date _________________
Signature of Debtor 2 acknowledging receipt of this notice
MM / DD / YYYY
Official Form 119
Bankruptcy Petition Preparer’s Notice, Declaration, and Signature
page 1
Debtor 1
_______________________________________________________
Case number
_____________________________________
(if known)
First Name
Middle Name
Last Name
Part 2:
Declaration and Signature of the Bankruptcy Petition Preparer
Under penalty of perjury, I declare that:
I am a bankruptcy petition preparer or the officer, principal, responsible person, or partner of a bankruptcy petition preparer;
I or my firm prepared the documents listed below and gave the debtor a copy of them and the Notice to Debtor by Bankruptcy Petition
Preparer as required by 11 U.S.C. §§ 110(b), 110(h), and 342(b); and
if rules or guidelines are established according to 11 U.S.C. § 110(h) setting a maximum fee for services that bankruptcy petition
preparers may charge, I or my firm notified the debtor of the maximum amount before preparing any document for filing or before
accepting any fee from the debtor.
________________________________ ______________________
_______________________________________________________
Printed name
Title, if any
Firm name, if it applies
______________________________________________________
Number
Street
____________________________________ __________ ______________
______________________________
City
State
ZIP Code
Contact phone
I or my firm prepared the documents checked below and the completed declaration is made a part of each document that I check:
(Check all that apply.)

Voluntary Petition (Form 101)
Schedule I (Form 106I)
Chapter 11 Statement of Your Current Monthly

Income (Form 122B)
Statement About Your Social Security Numbers
Schedule J (Form 106J)
Chapter 13 Statement of Your Current Monthly
(Form 121)
Declaration About an Individual Debtor’s

Income and Calculation of Commitment Period
Summary of Your Assets and Liabilities and
Schedules (Form 106Dec)
(Form 122C-1)
Certain Statistical Information (Form 106Sum)
Statement of Financial Affairs (Form 107)
Chapter 13 Calculation of Your Disposable

Schedule A/B (Form 106A/B)
Income (Form 122C-2)
Statement of Intention for Individuals Filing
Schedule C (Form 106C)
Under Chapter 7 (Form 108)
Application to Pay Filing Fee in Installments
(Form 103A)
Chapter 7 Statement of Your Current
Schedule D (Form 106D)
Monthly Income (Form 122A-1)
Application to Have Chapter 7 Filing Fee
Schedule E/F (Form 106E/F)
Waived (Form 103B)
Statement of Exemption from Presumption
Schedule G (Form 106G)
of Abuse Under § 707(b)(2)
A list of names and addresses of all creditors
(Form 122A-1Supp)
(creditor or mailing matrix)
Schedule H (Form 106H)
Chapter 7 Means Test Calculation
Other _____________________________
(Form 122A-2)
Bankruptcy petition preparers must sign and give their Social Security numbers. If more than one bankruptcy petition preparer prepared the documents
to which this declaration applies, the signature and Social Security number of each preparer must be provided. 11 U.S.C. § 110.
8
_______________________________________________________________
___ ___ ___ ___ ___ ___ ___ ___ ___
Date
_________________
Signature of bankruptcy petition preparer or officer, principal, responsible
Social Security number of person who signed
MM / DD / YYYY
person, or partner
_______________________________________________________________
Printed name
8
_______________________________________________________________
___ ___ ___ ___ ___ ___ ___ ___ ___
Date
_________________
Signature of bankruptcy petition preparer or officer, principal, responsible
Social Security number of person who signed
MM / DD / YYYY
person, or partner
_______________________________________________________________
Printed name
Official Form 119
Bankruptcy Petition Preparer’s Notice, Declaration, and Signature
page 2
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