Local Form 23 (1/11) UNITED STATES BANKRUPTCY COURT FOR THE EASTERN DISTRICT OF WISCONSIN In re: Chapter _________________ Case No. ________________ Debtor. DEBTOR'S STATEMENT REGARDING COMPLETION OF A COURSE IN PERSONAL FINANCIAL MANAGEMENT Every individual debtor in a chapter 7, chapter 11 in which § 1141(d)(3) applies, or chapter 13 case must file this certification. If a joint petition is filed, each spouse must complete and file a separate certification. Complete one of the following statements and file by the deadline stated below: I / We,________________________________________________________________________, the debtor in the above!styled case hereby certify that on _____________________(date), I /We completed an instructional course in personal financial management provided by ______________________________________________ (Name of Provider), an approved personal financial management provider. If the provider furnished a document attesting to the completion of the personal financial management instructional course, a copy of that document is attached. Certificate No. (if any): ____________________________________________________ OR, I / We, _______________________________________________________________________, the debtor in the above!styled case, hereby certify that no personal financial management course is required because: Incapacitated or disabled as defined in 11 U.S.C. §109(h); or Active military duty in a military combat zone. Signature of Debtor: _______________________________________________ Date: ____________________________ Signature of Joint Debtor: __________________________________________ Date: _____________________________ Instructions: Do NOT file this form at the same time that you file your bankruptcy petition; you are not eligible to take the course in personal financial management until after you have filed your bankruptcy petition. Use this form only to certify whether, after the date you filed your bankruptcy petition, you completed a course in personal financial management. Do NOT use this form to file the certificate you received from your pre!petition credit counseling provider. Filing Deadlines: In a chapter 7 case, file this statement within 60 days of the first date set for the meeting of creditors under § 341 of the Bankruptcy Code. In a chapter 11 or 13 case, file this statement no later than the last payment made by the debtor as required by the plan or the filing of a motion for a discharge. American LegalNet, Inc. www.FormsWorkFlow.com