CSD 2120 [08/01/11] Name, Address, Telephone No. & I.D. No. UNITED STATES BANKRUPTCY COURT SOUTHERN DISTRICT OF CALIFORNIA 325 West F Street, San Diego, California 92101-6991 In Re BANKRUPTCY NO. Debtor. CERTIFICATION OF ELIGIBILITY FOR DISCHARGE Pursuant to 11 U.S.C. § 1328(a), the above named Debtor certifies: Check one box only. If you have a Domestic Support Obligation and are not current, do not proceed further and do not file this form with the court. BOX 1: There is no judicial or administrative order or statute that requires Debtor to pay a domestic support obligation. BOX 2: There is a judicial or administrative order or statute that requires Debtor to pay domestic support obligations, and all amounts payable that are due as of this date have been paid (including amounts due before the petition to the extent provided for by the plan). I understand that I have completed my plan payments and may now be eligible for a discharge. I understand that failure to complete and return this Certification to the court within fourteen (14)1 days of the service of the Notice of Trustee’s Final Interim Report may cause my case to be closed without entry of my discharge. I further understand that the Court is relying on the truth and accuracy of these statements and, if any statement is false, the Court may revoke my discharge. I declare under penalty of perjury that the information contained within this certification is true and correct. If BOX 2 is checked: I further declare that on this date a copy of this Certification was served upon the following Domestic Support Obligation Holders, applicable state child support enforcement agency, and/or the persons as indicated below (include names(s) and full mailing address): [ x ] UNITED STATES TRUSTEE Department of Justice 402 West Broadway, Suite 600 San Diego, CA 92101 [ ] For ODD numbered Chapter 13 cases: THOMAS H. BILLINGSLEA, JR., TRUSTEE 530 "B" Street, Suite. 1500 San Diego, CA 92101 [ ] For EVEN numbered Chapter 13 cases: DAVID L. SKELTON, TRUSTEE 525 “B” Street, Suite 1430 San Diego, CA 92101-4507 DATED: Signature of Debtor Signature of Co-Debtor (if any) 1 If you were served electronically or by mail, you have three (3) additional days to take the above-stated actions as calculated by Fed. R. Bankr. P. 9006(f). CSD 2120 SEE INSTRUCTIONS PRINTED ON REVERSE SIDE American LegalNet, Inc. www.FormsWorkFlow.com CSD 2120 (Page 2) [08/01/11] INSTRUCTIONS TO DEBTOR The trustee appointed to your case has filed a Final Report indicating that you have completed the plan payments and may now be eligible for a discharge. A copy of the Final Report is enclosed. Please read the following instructions carefully, complete the Certification of Eligibility for Discharge form provided and return it to the court. STEP 1. Immediately prepare the Certification. You must file the Certification with the court not less than 14 days (2 weeks) from the date of service of the Trustee’s Final Report. You may use the Trustee’s signature date to calculate the 2-week period or call the court at (619) 557-5620 for the precise deadline. STEP 2. Check BOX 1 if you have never been ordered or are no longer obligated to pay either current or past due domestic support. Consult with your attorney if you have any questions. Court staff may not provide legal advice. Date and sign the Certification. Proceed to STEP 4. OR STEP 3. Check BOX 2 if you remain under the obligation to pay support but are current in your payments as of the date you sign the Certification. EXCEPTION: IF YOU ARE NOT CURRENT WITH YOUR OBLIGATIONS, DISREGARD THESE INSTRUCTIONS. DO NOT COMPLETE OR RETURN THE CERTIFICATION TO THE COURT. ! Insert the name and address of all domestic support obligation holders in the space provided. You must include any applicable state child support enforcement agency collecting on their behalf. If additional space is needed, continue on a separate page and attach to the Certification. ! Check the name of the trustee appointed to your case. ! Date and sign the Certification. ! Mail copies of the completed form to: • United States Trustee • Chapter 13 Trustee • All Domestic Support Obligation Holders • Any applicable state child support enforcement agency collecting on behalf of a Domestic Support Obligation Holder STEP 4. Mail or personally file the original Certification with the court at the following address: United States Bankruptcy Court Southern District of California 325 West “F” Street San Diego, California 92101-6991 IF YOU QUALIFY FOR A DISCHARGE, FAILURE TO COMPLETE AND RETURN THIS CERTIFICATION TO THE COURT MAY CAUSE YOUR CASE TO BE CLOSED WITHOUT A DISCHARGE. TO ENTER YOUR DISCHARGE, YOU WOULD BE REQUIRED TO FILE A NOTICE OF MOTION AND MOTION TO REOPEN YOUR CASE AND PAY THE REQUIRED FEE. THIS FEE MAY NOT BE WAIVED. CSD 2120 American LegalNet, Inc. www.FormsWorkFlow.com