UNITED STATES BANKRUPTCY COURT SOUTHERN DISTRICT OF FLORIDA www.flsb.uscourts.gov In re: Case No. Chapter 11 (or 12) Individual Debtor(s) / Notice of Deadline to Object to Debtor's Statement Re: 11 U.S.C. §522(q)(1) Applicability, Payment of Domestic Support Obligations, and [For Chapter 11 Cases Only] Applicability of Financial Management Course and Statement Regarding Eligibility to Receive a Discharge NOTICE: Any interested party who fails to file and serve a written objection to this statement within 30 days after the date of service of this statement shall, pursuant to Local Rule 2082-1(B), for chapter 12 cases or Local Rule 3022-1(B), for chapter 11 cases, be deemed to have consented to the entry of an order of discharge if the court determines that all other requirement for discharge of the debtor(s) have been met. The Debtor(s), as follows: , in the above captioned matter certify(ies) A. Compliance with 11 U.S.C. §1141(d)(5)(C) (chapter 11) or 11 U.S.C. §1228(f) (chapter 12): [select one] 1. The Debtor has not claimed an exemption under 11 U.S.C. §522(b)(3) in an amount in excess of $155,675 in property of the kind described in 11 U.S.C. §522(q)(1) [generally the Debtor's homestead]; or 2. The Debtor has claimed an exemption under 11 U.S.C. §522(b)(3) in an amount in excess of $155,675 in property of the kind described in 11 U.S.C. §522(q)(1) but there is no pending proceeding in which the Debtor may be found guilty of a felony of a kind described in 11 U.S.C. §522(q)(1)(A) or found liable for a debt of the kind described in 11 U.S.C. §522(q)(1)(B). Page 1 of 3 LF-1 (rev. 12/01/13) American LegalNet, Inc. www.FormsWorkFlow.com B. Certificate Regarding Payment of Domestic Support Obligations: The debtor(s) in the above captioned matter certify(ies) regarding payment of all postpetition domestic support obligations that: (select one). _____ 1. Since the filing of this bankruptcy, the debtor has not been required by a judicial or administrative order, or by statute to pay any domestic support obligation as defined in 11 U.S.C. §101(14A); or As required by 11 U.S.C. §1129(a)(14) for chapter 11 cases or 11 U.S.C. §1225 (a)(7) for chapter 12 cases, the debtor has paid, either directly or through the assigned trustee, all amounts that are required to be paid under a domestic support obligation and that first became payable after the date of the filing of the petition if the debtor is required by a judicial or administrative order, or by statute, to pay such domestic support obligation. _____ 2. C. [Chapter 11 individual debtors only] Certification regarding completion of financial management course: (select one): _____ 1. Completion of the Postpetition Instructional Course Concerning Personal Financial Management" is not required because one or both of the following statements apply: Statement 1: The confirmed plan does not provide for the liquidation of all or substantially all of the property of the estate; or The debtor is engaging in business after consummation of the plan. Statement 2: _____ 2. Completion of the Postpetition Instructional Course Concerning Personal Financial Management" is required because both of the following statements apply: Statement 1: The confirmed plan provides for the liquidation of all or substantially all of the property of the estate; and The debtor does not engage in business after consummation of the plan. Statement 2: LF-1 (rev. 12/01/13) Page 2 of 3 American LegalNet, Inc. www.FormsWorkFlow.com D. [Chapter 11 individual debtors only] Statement Regarding Eligibility To Receive A Discharge (select one): _____ 1. I am eligible to receive a discharge because: (all must apply for the debtor to receive a discharge): a) All payments under the plan have been completed; b) If required by (C) above, I have filed Official Bankruptcy Form B23 "Debtor's Certification of Completion of Postpetition Instructional Course Concerning Personal Financial Management" (unless the course provider filed a certificate of completion of the financial management course on my behalf); c) 11 U.S.C. §1141(d)(3) does not apply to me; and d) There are no pending objections to discharge and no order denying discharge has been entered in this case. _____ 2. By separate motion, I am seeking entry of a discharge under 11 U.S.C. §1141(d)(5). I am not eligible for and am not seeking a discharge in my case. _____ 3. I declare under penalty of perjury that the information provided in this Certificate is true and correct. A certificate of service shall be filed as provided by Local Rule 2002-1(F). Debtor's Signature Dated: Joint Debtor's Signature (if applicable) LF-1 (rev. 12/01/13) Page 3 of 3 American LegalNet, Inc. www.FormsWorkFlow.com