UNITED STATES BANKRUPTCY COURT for the NORTHERN DISTRICT OF CALIFORNIA IN RE: CHAPTER 13 CASE: DEBTOR'S CERTIFICATIONS IN SUPPORT OF DISCHARGE AND NOTICE OF OPPORTUNITY FOR HEARING Debtor(s) I, (debtor's name), certify (mark one choice for each numbered section): 1. ____ I HAVE/_____ HAVE NOT completed an instructional course concerning personal financial management described in 11 U.S.C. §111 and have filed a Certification of Completion of Instructional Course Concerning Financial Management. ____ I HAVE been excused from completing an instructional course concerning personal financial management described in 11 U.S.C. §111 pursuant to _____ 11 U.S.C. § 1328 (g)(2) or____ court order. 2. ____ I HAVE NOT been required to pay a domestic support obligation as that term is defined in 11 U.S.C. §101(14A) by any order of a court or administrative agency or by any statute. ____ I HAVE/____ HAVE NOT paid all required domestic support obligations as that term is defined in 11 U.S.C. §101(14A) that have become due on or before the date of this certification (including amounts due before the petition was filed, but only to the extent provided for by the plan) under any order of a court or administrative agency or under any statute. 3. ____ I AM/ _____AM NOT a party to a pending proceeding in which I may be found guilty of a felony of a kind described in §522(q)(1)(A) or found liable for a debt of the kind described in §522(q)(1)(B). 4. ____ I HAVE/____ HAVE NOT received a discharge in a Chapter 7, 11 or 12 bankruptcy case filed within four (4) years prior to filing this Chapter 13 case and I HAVE NOT received a discharge in another Chapter 13 bankruptcy case filed within two (2) years prior to filing this Chapter 13 case. 5. I understand that my discharge may be deferred until I complete any required instructional course referred to in paragraph 1 or until I am current on any required domestic support obligations referred to in paragraph 2. Declaration Under Penalty of Perjury I declare under penalty of perjury that the above statements are true or correct to the best of my knowledge, information and beliefs. Date:______________ _________________________ Debtor American LegalNet, Inc. www.FormsWorkflow.com NOTICE TO ALL PARTIES IN INTEREST NOTICE IS HERBY GIVEN that B.L.R. 9014-1 of the United States Bankruptcy Court for the Northern District of California, prescribes the procedures to be followed and that any objection to the requested relief, or a request for a hearing on the matter, in either case, grounded only on any material inaccuracy in the above certification, must be filed and served upon the initiating party within 20 days of mailing of the notice. A request for a hearing must be accompanied by any declarations or memorandum of law the requesting party wishes to present in support of its position. If there is no timely objection to the requested relief or a request for a hearing, the Court may enter an order granting the relief by default; and the initiating party will give at least 10 days written notice of the hearing to the objecting or requesting party, and to any trustee, in the event an objection or request for hearing is timely made. Dated: _________________________________ Debtor American LegalNet, Inc. www.FormsWorkflow.com