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B 4170Optional

Declaration of Inmate Filing

Federal · United States Courts · Effective December 1, 2018

This form is a declaration used by an inmate to tell the court that they are sending a document in a bankruptcy case through the institution's internal mail system. It confirms that the filing is being done under penalty of perjury.

The court describes it as: This is a Director's Bankruptcy Form. Director’s Bankruptcy Forms are issued under Bankruptcy Rule 9009 by the Director of the Administrative Office of the United States Courts. The use of Director’s Forms may be required by local court rules or general orders, but otherwise exist for the convenience of the parties.

Open the official PDFfrom United States Courts

Where this fits in a case

Hearing

Stage: Hearing

This form is used when a person who is currently an inmate needs to file a document in a bankruptcy case.

Either party may file.

Common questions

Who should fill out this form?
This form is for an inmate who is confined in an institution and needs to file a document in a case. The form is titled 'Declaration of Inmate Filing.'
What does the form confirm?
The form confirms that the person is depositing a specific document in the case using the institution's internal mail system. It also includes a declaration under penalty of perjury.

Revision history

No changes recorded since we started tracking this form on October 9, 2026. The current version took effect December 1, 2018.

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