United States Bankruptcy Court Northern District of Texas In re____________________, Debtor(s) Case No.________________ Chapter_________________ REQUEST FOR THIRTY-DAY EXTENSION OF TIME TO RECEIVE CREDIT COUNSELING AND FILE CERTIFICATE OF SAME (This form must be completed in its entirety.) Pursuant to 11 U.S.C. § 109(h)(3)(A), I/we hereby request a 30-day extension of time to receive credit counseling from an approved nonprofit budget credit counseling agency and to file the certificate(s) regarding same. I/we certify that I/we am/are the debtor(s) in the above styled bankruptcy case and I/we did not receive credit counseling required by 11 U.S.C. § 109(h)(1) within the 180 days prior to the filing of this petition. I/we certify that, prior to the filing of this petition, I/we requested credit counseling services from an approved nonprofit budget and credit counseling agency known as: (provide name, address, phone, number, website of the credit counseling agency) _____________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ on ____________________(date), but were unable to obtain counseling within 7 days following my request for the following reasons: ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ I/we certify the exigent circumstances1 that merit a 30-day extension of the time to receive credit counseling and file with the court a certificate of completion of credit counseling are: ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ If the Court allows additional time to receive credit counseling, I/we agree to take the counseling required by 11 U.S.C. § 109(h)(1) and file with the court a certificate from an approved nonprofit budget and credit counseling agency. I/we agree to take the credit counseling and file the required certificate within 30 days from the petition date or by such additional time as the court may order. I/we agree and understand that failure to comply with any order of the court made pursuant to this request may result in this case being dismissed. I/we declare under penalty of perjury that the foregoing is true and correct. ________________________________________ Signature of Debtor Date _________________________________________ Signature of Joint Debtor Date 1 Exigent circumstances: "Situations that demand unusual or immediate action," Black's Law Dictionary, Sixth Edition (West 1990). American LegalNet, Inc. www.FormsWorkFlow.com