IN THE UNITED STATES BANKRUPTCY COURT FOR THE DISTRICT OF DELAWARE ) ) ) ) ) ) In re: Chapter 11 Case No. ________________ Debtor(s). DEBTOR(S) CERTIFICATION OF PLAN COMPLETION AND REQUEST FOR DISCHARGE Debtor(s) hereby certifies under penalty of perjury the following is true and correct: 1. All plan payments have been completed and the Debtor(s) is entitled to a discharge under 11 U.S.C. Section 1141(d)(5); and 2. That Debtor(s) has (or does not have any liability for) domestic support obligations as defined at 11 U.S.C. § 101(14A) (alimony, child support, etc.), and all applicable written notices have been provided to the holder of the claim and the appropriate State child support enforcement agency pursuant to 11 USC Section 1106(c)(1). 3. The Debtor(s) certifies, if applicable, that all Court fees and United States Trustee fees have been paid as of this date. 4. The provisions of 11 U.S.C. Section 522(q)(1) are not applicable to this case, pursuant to 11 U.S.C. Section 1141(d)(5)(C). 5. There are no proceedings pending against the undersigned debtor(s) of the kind described in 11 U.S.C. Section 522(q)(1)(A) or 522(q)(1)(B), pursuant to Section 1141(d)(5)(C). 6. The debtor(s) has successfully completed an approved instructional course concerning personal financial management described in 11 U.S.C. Section 111. I/We request that a discharge be granted in accordance with 11 U.S.C. Section 1141. Dated: _________________ /s/ Debtor signature /s/ /s/Debtor signature /s/ Attorney for Debtor: Firm Name and Address: Email for Attorney: Local Form 104A 755016-WILSR01A - MSW American LegalNet, Inc. www.FormsWorkFlow.com