UNITED STATES BANKRUPTCY COURT FOR THE WESTERN DISTRICT OF KENTUCKY IN RE: CASE NO. Debtor(s) _______________________________________ MOTION FOR EXEMPTION FROM CREDIT COUNSELING Debtor, by counsel, hereby moves the Court pursuant to 11 U.S.C. §109(h)(4) for an exemption from the requirement to obtain credit counseling. In support of said Motion, debtor states: [Describe the circumstances that merit the exemption and provide a brief history or statement indicating whether you are claiming incapacity, disability, or active military duty in a military combat zone. Reference any supporting documentation and attach as an exhibit.] Wherefore, the debtor respectfully requests that the Court grant the debtor an exemption from the requirement to obtain credit counseling. Dated: Debtor's Attorney Address Phone CERTIFICATION The undersigned certifies under penalties of perjury, that I have read the foregoing motion, and certify that the statements therein contained are true and complete to the best of my knowledge, information and belief. Dated: Debtor's Signature Local Form O American LegalNet, Inc. www.FormsWorkFlow.com NOTICE Any objections to this Motion for Exemption from Credit Counseling must be filed within fourteen (14) days from the date this Motion was filed. If no written objection is received, an Order approving the Motion may be entered. CERTIFICATE OF SERVICE I certify that a copy of this Motion for Exemption from Credit Counseling was served upon , this day of , 20 . Debtor's Attorney Local Form O American LegalNet, Inc. www.FormsWorkFlow.com UNITED STATES BANKRUPTCY COURT FOR THE WESTERN DISTRICT OF KENTUCKY IN RE: CASE NO. Debtor(s) ORDER Notice having been given and no objections having been filed, IT IS HEREBY ORDERED that the debtor be granted an exemption from the requirement to obtain credit counseling in accordance with 11 U.S.C. §109(h)(4). Tendered by: Local Form O American LegalNet, Inc. www.FormsWorkFlow.com