UNITED STATES BANKRUPTCY COURT for the NORTHERN DISTRICT OF CALIFORNIA IN RE: CHAPTER 13 CASE: DEBTOR'S CERTIFICATION IN SUPPORT OF DISCHARGE Debtor(s) I, ( ) certify (mark one choice for each numbered section): 1. ____ I HAVE completed an instructional course concerning personal financial management described in 11 U.S.C. §111 and have filed a Certification of Completion of Instructional Course Concerning Financial Management. ____ I HAVE NOT completed an instructional course concerning personal financial management described in 11 U.S.C. §111 pursuant to____ §11 U.S.C. 1328 (g)(2) or____ court order. 2. ____ I HAVE NOT been required to pay a domestic support obligation as that term is defined in 11 U.S.C. §101(14A) by any order of a court or administrative agency or by any statute. ____ I HAVE paid all domestic support obligations as that term is defined in 11 U.S.C. §101(14A) that have become due on or before the date of this certification (including amounts due before the petition was filed, but only to the extent provided for by the plan) under any order of a court or administrative agency or under any statute. 3. ____ I DID NOT claim an exemption in excess of the adjusted amount set forth in 11 U.S.C. §522(q)(1), therefore 11 U.S.C. §1328(h) is inapplicable. ____ I DID claim exemptions in excess of the adjusted amount set forth in 11 U.S.C. §522(q)(1). All creditors and other interested parties requesting special notice in this case have or are being served by the court with a statement as to whether there is pending a proceeding in which I may be found guilty of a felony of a kind described in §522(q)(1)(A) or found liable for a debt of the kind described in §522(q)(1)(B). 4. ____ I HAVE NOT received a discharge in a Chapter 7, 11 or 12 bankruptcy case filed within four (4) years prior to filing this Chapter 13 case and I HAVE NOT received a discharge in another Chapter 13 bankruptcy case filed within two (2) years prior to filing this Chapter 13 case. Declaration Under Penalty of Perjury I declare under penalty of perjury that the foregoing is true and correct. Date:______________ _________________________ Debtor American LegalNet, Inc. www.FormsWorkflow.com