This form is mandatory. It has been approved for use in the United States Bankruptcy Court for the Central District of California. December 2016 F 3015-1.8.DISCHARGE.APPLICATION Pa g e 1 Attorney or Party Name, Address, Telephone & FAX Nos., State Bar No. & Email Address FOR COURT USE ONLY Individual appearing without an attorney Attorney for Debtor(s) UNITED STATES BANKRUPTCY COURT CENTRAL DISTRICT OF CALIFORNIA - In re: CASE NO.: CHAPTER: DEBTOR222S CERTIFICATE OF COMPLIANCE UNDER 11 U.S.C. 247 1328(a) AND APPLICATION FOR ENTRY OF DISCHARGE (In a joint bankruptcy case, each co-debtor must file a separate Certificate of Compliance and Application for Entry of Discharge) Debtor(s). The Debtor in the above-captioned bankruptcy case certifies: 1. I have completed all payments required by my confirmed plan, including all domestic support obligations, if any. 2. I have made all domestic support payments required by a judicial or administrative order, or by statute which havecome due since the filing of this case. 3. My address is: . 4. My most recent employer222s name and address are: 5. The following creditors hold debts which have been determined to be nondischargeable under 11 U.S.C.247523(a)(2) or (a)(4): 6. The following creditors hold debts which I have reaffirmed in writing: This form is mandatory. It has been approved for use in the United States Bankruptcy Court for the Central District of California. December 2016 F 3015-1.8.DISCHARGE.APPLICATION Pa g e 2 7. I have not executed a written waiver of discharge in this case. 8. I have not received a discharge in a case filed under chapter 7, 11, or 12 during the 4-year period preceding the date of the order for relief under chapter 13 in the present case. 9. I have not received a discharge in a case filed under chapter 13 during the 2-year period preceding the date of the order for relief under chapter 13 in the present case. 10. Since the filing of this case: I have completed an instructional course concerning personal finance management approved by the United States Trustee. I have been excused from compliance with the requirement to complete an instructional course concerning financial management approved by the United States Trustee. 11. I have not exempted more than $155,675 in any of the following: a.real or personal property used as a residence by me or any of my dependents, ORb.in a cooperative that owns property used as a residence by me or any of my dependents, ORc.in a burial plot for me or any of my dependents, ORd.in any real or personal property in which I or any of my dependents have claimed as a homestead 12.You must answer the following inquiries ONLY if you have exempted more than $155,675 in property described inquestion 11 above.a.The Property is reasonably necessary for my support and the support of my dependents. b. I was not convicted of a felony before the filing of this case. I was convicted of a felony before the filing of this case. I have been convicted of a felony during the pendency of this case. I am not aware of any pending proceeding in which I may be found guilty of a felony. Describe the circumstances (attach additional sheet if necessary) c.I owe a debt arising from one or more of the following: a violation of federal or state securities laws or regulations or orders issued under federal or state securities laws; fraud, deceit or manipulation in connection with the sale or purchase of any registered security; a criminal act, intentional tort, or willful or reckless misconduct that caused serious physical injury or death to another individual in the preceding 5 years. none of the above. d.I am not aware of any pending proceeding in which I may be found liable for a debt of the kind described instatement number 12(c) above. I declare under penalty of perjury under the laws of the United States that the foregoing is true and correct. Date Printed Name Signature