Attorney or Party Name, Address, Telephone & FAX Numbers, and California State Bar Number FOR COURT USE ONLY G Individual appearing without counsel G Attorney for: UNITED STATES BANKRUPTCY COURT CENTRAL DISTRICT OF CALIFORNIA In re: CHAPTER 13 CASE NO.: Debtor DEBTOR'S CERTIFICATION OF COMPLIANCE UNDER 11 U.S.C. § 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.) The debtor in the above-captioned bankruptcy case certifies: 1. G 2. G 3. G 4. G I have completed all payments required by my confirmed plan, including all domestic support obligations, if any. I have made all domestic support payments required by a judicial or administrative order, or by statute which have come due since the filing of this case. My address is: _____________________________________________________. My most recent employer's name and address are: __________________________________________________________________________________ __________________________________________________________________________________ The following creditors hold debts which have been determined to be nondischargeable under 11 U.S.C. §523(a)(2) or (a)(4): __________________________________________________________________________________ __________________________________________________________________________________ The following creditors hold debts which have I have reaffirmed in writing: __________________________________________________________________________________ __________________________________________________________________________________ I have not executed a written waiver of discharge in this case. 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. 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. 5. G 6. G 7. G 8. G 9. G Revised September 2007 Page 1 of 2 Debtor's Certification of Compliance Under 11 U.S.C. § 1328(a) and Application for Entry of Discharge 2007 USBC, Central District of California In re (SHORT TITLE) Debtor CHAPTER 13 CASE NO.: 10. G Since the filing of this case: G I have completed an instructional course concerning personal financial management approved by the United States Trustee. G I have been excused from compliance with the requirement to complete an instructional course concerning financial management approved by the United States Trustee. 11. G I have not exempted more than $125,000 in any of the following: (a) real or personal property used as a residence by me or any of my dependents, OR (b) in a cooperative that owns property used as a residence by me or any of my dependents, OR (c) in a burial plot for me or any of my dependents, OR (d) in any real or personal property in which I or any of my dependents has claimed as a homestead. 12. You must answer the following inquiries ONLY if you have exempted more than $125,000 in property described in Question 11 above. A. The property is reasonably necessary for my support and the support of my dependents. B. G G G G 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. Please describe the circumstances: __________________________________________________________________________________ __________________________________________________________________________________ (additional sheet may be attached if necessary) C. I owe a debt arising from one or more of the following: G a violation of federal or state securities laws or regulations or orders issued under federal or state securities laws; G fraud, deceit or manipulation in connection with the sale or purchase of any registered security; G a civil remedy under section 1964 of title 18; or G 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. G 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 in Statement No. 12(C) above. I declare under penalty of perjury that the foregoing is true and correct. Date:_________________ Debtor's Signature ___________________________________________ Revised September 2007 Page 2 of 2