(Attorney Name)

(Firm Name)

(Address)

(City, State, Zip)

Telephone: ( )

Fax: ( )

Email: ( )

Attorney for: ( )	AK LBF 12

[11/15]

UNITED STATES BANKRUPTCY COURT

FOR THE DISTRICT OF ALASKA

In re:

(Debtor's Name) and

(Joint Debtor's Name),

Debtor(s).

Case No. ( )

Chapter ( )

Certificate of Service

Comes now (Name) , and states that:

On the (Date) day of (Month) , (Year) , I did deposit in the mail of the United States, First Class Postage pre-paid, an envelope containing a copy of the (Name of Document) , a copy of which is attached hereto, to each of the names and addresses set forth on the attached list.

I, (Name) , above named in the foregoing, declare under penalty of perjury that the foregoing is true and correct.

Dated: ( )
(Firm Name)

Attorney for ( )

By: _________________________________

(Attorney Name)