L.B.F . 3015 - 1.6 (12/1 8 ) Page 1 Fill in this information to identify your case UNITED STATES BANKRUPTCY COURT DISTRICT OF COLORADO Debtor 1 : Case #: First Name Middle Name Last Name 13 Debtor 2: Chapter : First Name Middle Name Last Name Local Bankruptcy Form 3015 - 1.6 C heck applicable boxes a nd complete applicable sections. I , certify that: I have completed all payments and obligations required by my c hapter 13 p lan , including if applicable all direct payments to secured creditors. I have no domestic support obligations. During the pendency of this bankruptcy case, I have paid all domestic support obligations that have become du e under any order of a court, administrative agency, or by any statute. I have provided the chapter 13 trustee with the information required for notice by 11 U.S.C. 247 1302(d)(1)(c). I previously filed a Motion for Valuation of Collateral and Determination of Secured Status Under 11 U.S.C. 247 506 (the [#] ) as to the real property described be low. The Motion was granted on [month/day/year], (docket no. [#] ). [Provide property description if applicable.] [ If the debtor seeks a specific order extinguishing the lien subject to the Motion, the debtor must submit the attached proposed order. ] I have been convicted of a felony, as defined in 18 U.S.C. 247 3156. See 11 U.S.C. 247 522(q)(1)(A). There are pending proceedings in which I may be found guilty of a felony of the kind described in 11 U.S.C. 247 522 (q)(1)(A) or liable for a debt of the kind described in 11 U.S.C. 247 522 (q)(1)(B). I have not been convicted of a felony, as defined in 18 U.S.C. 247 3156. See 11 U.S.C. 247 522(q)(1)(A). And there are no pending proceedings in which I may be found guilty of a felony of the kind described in 11 U.S.C. 247 522 (q)(1)(A) or liable for a debt of the kind described in 11 U.S.C. 247 522(q)(1)(B). Part 1 Plan Payments Part 2 Domestic Support Obligations Part 3 Valuation of Collateral Pursuant to 11 U.S.C. 247 506 Part 4 Felony convictions under 11 U.S.C. 247 522(q)(1) and 11 U.S.C. 247 1328(h). Part 5 Personal Financial Management Course American LegalNet, Inc. www.FormsWorkFlow.com L.B.F . 3015 - 1.6 (12/1 8 ) Page 2 I have completed an instructional course in personal financial management and the certification of completion has been filed. Dated: By: Signature Bar Number (if applicable): Mailing Address: Telephone number: Facsimile number: E - mail address: I declare under penalty of perjury that the foregoing is true and correct. Dated: By: Signature of d ebtor Mailing Address: Telephone number: Facsimile number: E - mail address: Commentary Pursuant to 11 U.S.C. 247 1328, this form is to be completed as soon as practicable after completion by the Debtor of all payments under the plan. This form must be completed and filed with the C ourt in order for the D ebtor to receive a discharge. In joint cases, each Debtor must file a separate form. L.B.F. 3015 - 1.6 must be served on the following: the chapter 13 trustee, the United States Trustee, all parties who have requested notice, and secured creditors . Part 6 Part 7 Verification of Debtor American LegalNet, Inc. www.FormsWorkFlow.com L.B.F . 3015 - 1.6 (12/1 8 ) Page 3 Form of Order Extinguishing Lien after Discharge UNITED STATES BANKRU PTCY COURT FOR THE DISTRICT OF COLORADO In re: , Debtor. Bankruptcy Case No. Chapter ORDER EXTINGUISHING LIEN AFTER DISCHARGE on to Obtain Discharge (docket n o. [#] Secured Status (docket n o. [#] ). This Court previously ordered that the lien held by (name of creditor) on (description of property) is valued at zero ($ IT IS HEREBY ORDERED that the lien held by [name of credit or] on [description of property] is extinguished. DATED BY THE COURT: United States Bankruptcy Judge American LegalNet, Inc. www.FormsWorkFlow.com