A Bankruptcy and Debt Relief Lawyer and Attorney Andy Miofsky

2249 Pontoon Road, Granite City Illinois 62040

An Illinois Bankruptcy Lawyer and Attorney 618-931-1313 Offering Chapter 7 and Chapter 13 Bankruptcy Attorney information in Madison, St Clair & Southern Illinois counties

DRA Receipt

I acknowledge, affirm and certify that I have received from Andrew J. Miofsky, A Bankruptcy Lawyer,
and Andy Miofsky, and I have read a copy of all of the following documents:

1. Consultation Agreement
2. Notice Mandated By Section 342(b) (1) and 527(a)(1) of the Bankruptcy Code
3. Notice Mandated By Section 527(a) (2) of the Bankruptcy Code
4. Notice Mandated By Section 527(b) of the Bankruptcy Code
5. Notice Mandated By Section 342(b) (2) of the Bankruptcy Code

If my spouse was not present when I received a copy of these notices, I hereby also acknowledge
receipt of said notices on behalf of my spouse, and promise to provide my spouse with either a copy
of these notices or the opportunity to read and review the copy I received.

Dated: _____________________                     _________________________________
                                                                                             Prospective Client

                                                                                Prospective Co-Client (if present)
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