UNITED STATES BANKRUPTCY COURT for the NORTHERN DISTRICT OF CALIFORNIA OAKLAND, SAN FRANCISCO & SANTA ROSA DIVISIONS IN RE: CHAPTER 13 CASE: CERTIFICATION OF DOMESTIC SUPPORT OBLIGATION PAYEES Debtor(s) To Trustee: I have been required by a judicial or administrative order, or by statue to pay a domestic support obligation, as defined in 11 U.S.C. §101(14A), whether prior to or after I filed this case. I certify that prior to the date of this certification, I have paid all amounts due under any Court ordered domestic support obligation, as defined in 11 U.S.C. §101(14A). All Court ordered domestic support obligation payees are as follows: Name: Address: Date: ____________________ _________________________________ Debtor Rev. July 2007 American LegalNet, Inc. www.FormsWorkflow.com