CSD 2122 [/1/1] Name, Address, Telephone No. & I.D. No. UNITED STATES BANKRUPTCY COURT SOUTHERNDISTRICTOF CALIFORNIA 325 West F Street, San Diego, California 92101-6991 In Re Debtor, BANKRUPTCY NO. CHAPTER 12 INDIVIDUAL DEBTOR222S CERTIFICATIONS REGARDING DOMESTIC SUPPORT OBLIGATIONS, SECTION 522(q) AND ELIGIBILITY FOR DISCHARGE Part I. Certification Regarding Domestic Support Obligations (check no more than one) Pursuant to 11 U.S.C. 2471228(a), I (we) certify that: BOX 1: 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 2: I (we) have been required to pay a domestic support obligation. I (we) have paid all such amounts that my (our) chapter 12 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. Part II. If you checked the second box in Part I, 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.) American LegalNet, Inc. www.FormsWorkFlow.com CSD 2122 (Page 2) [/1/1] Part III. Certification Regarding Section 522(q) (check no more than one) Pursuant to 11 U.S.C. 2471228(f), I (we) certify that: BOX 3: BOX 4: 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 $10,35271 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 $10,35271 in value in the aggregate. Part IV: Debtor222s Signature I (we) understand that I (we) have completed my (our) plan payments and may now be eligible for a discharge. I (we) understand that failure to complete and return this Certification to the Court within 14262 days of the service of the Trustee222s Final Report may cause my (our) case to be closed without entry of my (our) discharge. I (we) 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 (our) discharge. If BOX 2 is checked: I (we) 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 name(s) and full mailing address): DAVID L. SKELTON, TRUSTEE 525 B Street, Suite 1430 San Diego, CA 92101-4507 UNITED STATES TRUSTEE Department of Justice , Suite 0 San Diego, CA 92101 I (we) 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. Executed Date Signature of Debtor Signature of Co-Debtor (if any) If you quality 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. . 271Amounts are subject to adjustment on 4/01/20, and every 3 years thereafter with respect to cases commenced on or after the date of adjustment. 262 CSD 2122 American LegalNet, Inc. www.FormsWorkFlow.com