United States Bankruptcy Court Central District of Illinois In re: Case No._______________ ___________________________________ (Debtors) Certification of Domestic Support Obligations (Required to Obtain a Discharge) I certify (check one): _____ During the pendency of this bankruptcy case, I have paid all domestic support obligations that have become due under any order of a court or administrative agency or under any statute. _____ During the pendency of this bankruptcy case, I have not paid all domestic support obligations that have become due under any order of a court or administrative agency or by any statute. DECLARATION UNDER PENALTY OF PERJURY I declare under penalty of perjury that I have read the foregoing statement and that it is true and correct to the best of my knowledge, information and belief. ____________________________ Signature of Debtor ________________ Date ____________________________ Name of Debtor(Printed) _________________ Date Note: This form must be completed and filed with the court in order for the debtor to receive a discharge. In joint cases, the form must be completed and filed by each debtor. American LegalNet, Inc. www.FormsWorkflow.com