UNITED STATES BANKRUPTCY COURT SOUTHERN DISTRICT OF FLORIDA www.flsb.uscourts.gov In re: Case No. Chapter 11 Debtor / INDIVIDUAL DEBTOR CERTIFICATE FOR CONFIRMATION REGARDING PAYMENT OF DOMESTIC SUPPORT OBLIGATIONS AND [FOR CHAPTER 11 CASES] FILING OF REQUIRED TAX RETURNS As required under Local Rule 3020-1(B), the debtor in the above captioned matter certifies as follows: 1. Payment of all postpetition domestic support obligations (check which paragraph applies). _____ A. Since the filing of this bankruptcy, 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); or _____ B. As required by 11 U.S.C. §1129(a)(14) for chapter 11 cases or 11 U.S.C. §1225(a)(7) for chapter 12 cases, the debtor has paid, either directly or through the assigned trustee, all amounts that are required to be paid under a domestic support obligation and that first became payable after the date of the filing of the petition if the debtor is required by a judicial or administrative order, or by statute, to pay such domestic support obligation. 2. [If a chapter 11 case] As required by section 1228(b) of the Bankruptcy Abuse Prevention and Consumer Protection Act of 2005, all requested tax documents have been filed with the court. I declare under penalty of perjury that the information provided in this certificate is true and correct. Debtor's Signature Dated: Joint Debtor's Signature (if applicable) LF-71 (12/01/09) American LegalNet, Inc. www.FormsWorkFlow.com