Attorney Name #Bar Address City, State Zip Code Telephone: # Facsimile: # Email Law Office Name

In the United States Bankruptcy Court
For the District of Arizona

In re: DEBTOR A DEBTOR B Debtor(s)	CHAPTER 13 PROCEEDINGS Case No. 4:##-bk-#####-BMW or SHG AFFIDAVIT REGARDING TAX RETURNS

I / We, DEBTOR A and DEBTOR B, am /are the Chapter 13 debtor(s) in the above-captioned case. After being duly sworn, I / We do hereby declare under penalty of perjury the following:

The last Federal and State Income tax return I / We were required to file by applicable tax law was for the tax year ending .

I have not filed a tax return for tax year’s . I was not required to file tax returns for tax year’s for the following reason: (state reason for non-filing).

Submitted this day of , 20 .

DEBTOR A

DEBTOR B

SUSCRIBED AND SWORN BEFORE ME this day of ,

by__________________________________.

__________________________________

Notary Public

My Commission Expires: