On or about the _______day of _______ , in the ___________District
of
__________,
JOHN DOE, defendant herein, knowingly and
fraudulently made a material false declaration, certificate and verification
under the penalty of perjury, as permitted under Section 1746 of Title 28,
in and
in relation to a case under Title 11, In re John Doe No._________, by
submitting Schedules of Assets and Liabilities and a Statement of Financial
Affairs, in which the defendant fraudulently omitted to disclose all bank
accounts he had maintained within two years immediately preceding the filing
of
the bankruptcy petition, property held by third persons in which he had an
interest, including two Rembrandt paintings, and the fact that he had
previously
filed bankruptcy within the past six years.