LOCALFORM283 UNITEDSTATESBANKRUPTCYCOURTEasternDistrictOfWisconsinInreCaseNo. DebtorCHAPTER12DEBTOR222SCERTIFICATIONSREGARDING(1)DOMESTICSUPPORTOBLIGATIONS,(2)SECTION522(q),AND(3)COMPLETIONOFCHAPTER12PLANPAYMENTSPartI.A.CertificationRegardingDomesticSupportObligations(checknomorethanone)Pursuantto11U.S.C.Section1228(a),Icertifythat:IowednodomesticsupportobligationwhenIfiledmybankruptcypetition,andIhavenotbeenrequiredtopayanysuchobligationsincethen.Iamorhavebeenrequiredtopayadomesticsupportobligation.Ihavepaidallsuchamountsthatmychapter12planrequiredmetopay.Ihavealsopaidallsuchamountsthatbecameduebetweenthefilingofmybankruptcypetitionandtoday.PartI.B.IfyoucheckedthesecondboxinPartI.A.,youmustprovidetheinformationbelow.Mycurrentaddress: Mycurrentemployerandmyemployer222saddress: American LegalNet, Inc. www.FormsWorkFlow.com LOCALFORM283 PartII.CertificationRegardingSection522(q)(checknomorethanone)Pursuantto11U.S.C.Section1228(f),Icertifythat:Ihavenotclaimedanexemptionpursuantto247522(b)(3)andstateorlocallaw(1)inpropertythatIoradependentofmineusesasaresidence,claimsasahomestead,oracquiredasaburialplot,asspecifiedin247522(p)(1),and(2)thatexceeds$160,3751invalueintheaggregate.Ihaveclaimedanexemptioninpropertypursuantto247522(b)(3)andstateorlocallaw(1)thatIoradependentofmineusesasaresidence,claimsasahomestead,oracquiredasaburialplot,asspecifiedin247522(p)(1),and(2)thatexceeds$160,3751invalueintheaggregate.PartIII.CertificationRegardingDebtor222sCompletionofAllPaymentsUnderthePlanPursuantto11U.S.C.Section1228(a),Icertifythat:Icompletedallpaymentstothetrusteerequiredbymychapter12plan.Checkoneofthefollowing:Mychapter12plandidnotrequiremetomakeanypaymentsother thanpaymentstothetrustee.Mychapter12planrequiredmetomakepaymentstooneormoreentitiesotherthanthetrustee.Ihavepaidallsuchamountsthatmychapter12planrequiredmetopay,otherthanpaymentstoholdersofallowedclaimsprovidedunder2471222(b)(5)or1222(b)(9).PartIV.Debtor222sSignatureIcertifyunderpenaltyofperjurythattheinformationprovidedinthesecertificationsistrueandcorrecttothebestofmyknowledgeandbelief.Executedon DateDebtor 1Amountsaresubjecttoadjustmenton4/01/19,andevery3yearsthereafterwithrespecttocasescommencedonorafterthedateofadjustment. American LegalNet, Inc. www.FormsWorkFlow.com