CHAPTER 11 INDIVIDUAL DEBTOR222S REQUEST FOR DISCHARGE, CERTIFICATIONS REGARDING DOMESTIC SUPPORT OBLIGATIONS AND SECTION 522(q) Part I. Certification Regarding Eligibility to Receive a Discharge Pursuant to 11 U.S.C. 2471141, I (we) certify that one of the following statements applies: BOX 1: I (we) am eligible to receive a discharge because (all must apply): a.All payments have been completed under the plan; b.2471141(d)(3) does not apply; c.No order denying discharge has been entered in this case.BOX 2: BOX 3: I (we) are seeking entry of discharge by motion under 2471141(d)(5)(B) I (we) are not eligible for and am not seeking entry of discharge. Part II. Certification Regarding Domestic Support Obligations (check no more than one) Pursuant to 11 U.S.C.2471129(a)(14), I (we) certify that: BOX 4: I (we) owed no domestic support obligations when this bankruptcy petition was filed, and I (we) have not been required to pay any such obligations since then. BOX 5: I (we) have been required to pay a domestic support obligation. I (we) have paid all such amounts that my (our) chapter 11 plan required me (us) to pay. I (we) have also paid all such amounts that became due between the filing of my (our) bankruptcy petition and today. American LegalNet, Inc. www.FormsWorkFlow.com Part III. If you checked Box 5 in Part II, you must provide the information below. My (our) current address: My (our) current employer and my (our) employer222s address: Names and addresses of all domestic support obligation holders. (If additional space is needed, continue on a separate sheet and attach to the Certification.) Part IV. Certification Regarding Section 522(q) (check no more than one) Pursuant to 11 U.S.C. 2471141(d)(5)(C), I (we) certify that: BOX 6: BOX 7: I (we) have not claimed an exemption pursuant to 247522(b)(3) and state or local law (1) in property that I (we) or a dependent of mine (ours) uses as a residence, claims as a homestead, or acquired as a burial plot, as specified in 247522(p)(1), and (2) that exceeds $1,5271 in value in the aggregate. I (we) have claimed an exemption in property pursuant to 247522(b)(3) and state or local law (1) that I (we) or a dependent of mine (ours) uses as a residence, claims as a homestead, or acquired as a burial plot, as specified in 247522(p)(1), and (2) that exceeds $1,5271 in value in the aggregate. Part V. Certification Regarding Completion of Financial Management Course I (we) certify that: BOX 8: If 11 U.S.C. 2471141(d)(3) applies, I (we) have completed a course concerning personal financial management and have filed with the Bankruptcy Court Clerk222s office, Official Form 23 226 Certification Financial Management. BOX 9: 11 U.S.C. 2471141(d)(3) does not apply and I (we) are not required to complete a course concerning personal financial management. American LegalNet, Inc. www.FormsWorkFlow.com Part VI: Debtor222s Signature I certify under penalty of perjury that the information provided in these certifications is true and correct to the best of my (our)knowledge and belief. CertificationThis fee may not be waived American LegalNet, Inc. www.FormsWorkFlow.com