For In-person or
Phone Counseling
CALL US
888.577.2227

  
For Online
Bankruptcy Counseling
CLICK HERE

OR
  
For Online Budget and
Debt Counseling
CLICK HERE
  
OR
   
For Any Questions
CONTACT US

  
LSS Financial Counseling is a service of Lutheran Social Service of Minnesota which serves all people regardless of race, color, creed, religion, national origin, sex, sexual orientation, disability or age.
 

 

LSS FINANCIAL COUNSELING SERVICE
A CONSUMER CREDIT COUNSELING SERVICE PROGRAM

    

 

Affidavit for Bankruptcy Pre-Discharge Education
(On Line Classes)

If you are married and both are filing for bankruptcy, you must complete and submit separate Affidavit forms.

* Indicates required information

*My full legal name is:
(First)	(MI)	(Last)	(Jr. Sr.III)
*My current address is:
Address 1		Address 2
City
State	Zip
*My daytime phone number is:
*My evening phone number is:
*My email address is:
*My attorney's name is:
*My attorney's address is: (please provide at least the City and State)
Street		City
State	Zip
My attorney's phone number is:
*My bankruptcy case number is:
*For security purposes, please provide us with the last four digits of your Social Security number:
*I filed in the following location:
City and State
Acknowledgement

I certify that all the information on this affidavit is true, correct and complete and made in good faith. I also certify that I personally will complete the counseling and or education services. I understand that knowingly making a false or fraudulent statement or misrepresentation about my identity or completion of the counseling or services is a violation of the requirements of Federal law.