UNITED STATES BANKRUPTCY COURT District of Maine IN RE : Case No. Chapter 13 Date: Certification Regarding Domestic Support Obligations or Lack Thereof I, Debtor Name (enter full name) , having made the final payment under my Chapter 13 Plan on (Date) , do hereby certify that: I am not required by a judicial or administrative order to pay a domestic support obligation; or I am required by a judicial or administrative order to pay a domestic support obligation and all amounts payable under such order or such statute that were due on or before this date (including amounts due before the petition was filed, but only to the extent provided for by the plan) have been paid. ______________________________________________________________________________ I declare under penalty of perjury that the foregoing is true and correct _______________________________________ Signature of Debtor _______________________ Date Penalty for making a false statement: Fine up to $250,000 or imprisonment for up to 5 year, or both. 18 U.S.C.§152 and §3571 American LegalNet, Inc. www.FormsWorkFlow.com