郭文贵破产案 · ECF #249-3

| Fill in this information to identify your case: | | | | | |-----------------------------------------------------------------|-------------|-------------|-----------|--------------------------| | Debtor 1 | Ho Wan Kwok | | | | | | First Name | Middle Name | Last Name | | | Debtor 2 | | | | | | (Spouse if, filing) | First Name | Middle Name | Last Name | | | United States Bankruptcy Court for the: DISTRICT OF CONNECTICUT | | | | | | Case number | 22-50073 | | | | | (if known) | | | | D<br>Check if this is an | | | | | | amended filing |

## Official Form 106Dec Declaration About an Individual Debtor's Schedules

12/15

If two married people are filing together, both are equally responsible for supplying correct information.

You must file this form whenever you file bankruptcy schedules. Making a false statement, concealing property, or obtaining money or property by fraud in connection with a bankruptcy case can result in fines up to \$250,000, or imprisonment for up to 20 years, or both. 18 U.S.C. §§ 152, 1341, 1519, and 3571.

| Sign Below | | |------------------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------| | Did you pay or agree to pay someone who is NOT an attorney to help you fill out bankruptcy forms? | | | No | | | Yes. Name of person | Attach Bankruptcy Petition Preparer's Notice,<br>Declaration, and Signature (Official Form 119) | | Under penalty of perjury, I declare that I have read the summary and schedules filed with this declaration and<br>that they are true and correct.<br>Ho Wan Kwok | X<br>Signature of Debtor 2 | | Signature of Debtor 1<br>22<br>0<br>20<br>Date | Date |

Official Form 106Dec

## Declaration About an Individual Debtor's Schedules

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