UNITED STATES BANKRUPTCY COURT SOUTHERN DISTRICT OF FLORIDA www.flsb.uscourts.gov DIVISION: In re: Case No. Chapter 13 Debtor(s) / DEBTOR’S CERTIFICATE OF COMPLIANCE, MOTION FOR ISSUANCE OF DISCHARGE AND NOTICE OF DEADLINE TO OBJECT NOTICE OF TIME TO OBJECT Any interested party who fails to file and serve a written response to this motion within 21 days after the date of service of this motion shall, pursuant to Local Rules 4004-3(A)(3) and 9013-1(D), be deemed to have consented to the entry of an order of discharge. The debtor(s)*, as follows: , in the above captioned matter certifies 1. The chapter 13 trustee has issued a Notice of Completion of Plan Payments on . The debtor is requesting the court issue a discharge in this case. 2. The debtor has completed an instructional course concerning personal financial management described in 11 U.S.C. §111 and has filed the requisite certificate on . 3. Compliance with 11 U.S.C. §101(14A): _____ A. The debtor has not been required by a judicial or administrative order, or by statute to pay any domestic support obligation as defined in 11 U.S.C. §101(14A) either before this bankruptcy was filed or at any time after the filing of this bankruptcy, or * All further references to “debtor” shall include and refer to both of the debtors in a case filed jointly by two individuals, unless any information is noted as specifically applying to only one debtor. LF-97A (rev. 12/01/11) Page 1 of 3 American LegalNet, Inc. www.FormsWorkFlow.com _____ B. The debtor certifies that as of the date of this certification, the debtor has paid all amounts due under any and all domestic support obligations as defined in 11 U.S.C. §101(14A), required by a judicial or administrative order or by statute, including amounts due before, during and after this case was filed. The name and address of each holder of a domestic support obligation is as follows: (NAME) (ADDRESS) 4. The debtor’s most recent address is as follows: (ADDRESS) 5. The name and address of the debtor’s most recent employer is as follows: (NAME) (ADDRESS) 6. The following creditors hold a claim that is not discharged under 11 U.S.C. §523(a)(2) or (a)(4) or a claim that was reaffirmed under 11 U.S.C. §524(c): (NAME) (NAME) 7. Compliance with 11 U.S.C. §1328(h): A. The debtor has not claimed an exemption under §522(b)(3) in an amount in excess of $146,450 in property of the kind described in §522(q)(1) [generally the debtor’s homestead]; or B. LF-97A (rev. 12/01/11) The debtor has claimed an exemption under §522(b)(3) in an amount in excess of $146,450 in property of the kind described in §522(q)(1) but there is no pending proceeding in which the debtor 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). Page 2 of 3 American LegalNet, Inc. www.FormsWorkFlow.com 8. The debtor has not received a discharge in a case filed under chapter 7, 11, or 12 during the 4 year period preceding the filing of the instant case or in a case filed under chapter 13 during the 2 year period preceding the filing of the instant case. I declare under penalty of perjury that the information provided in this Certificate is true and correct. /s/ Debtor /s/ Debtor CERTIFICATE OF SERVICE Attach or file separately a Local Rule 2002-1(F) certificate of service reflecting manner and date of service on parties in interest. If the debtor is appearing pro-se, the clerk’s office will serve this Certificate and Motion. LF-97A (rev. 12/01/11) Page 3 of 3 American LegalNet, Inc. www.FormsWorkFlow.com