IN THE UNITED STATES BANKRUPTCY COURT FOR THE DISTRICT OF MARYLAND at IN RE: Debtor Case No. Chapter 11 CHAPTER 11 FINAL REPORT AND MOTION FOR DISCHARGE AND FINAL DECREE [For Individual Debtor] The following is the report of payments made pursuant to the Plan, confirmed by this Court on . TOTAL DISTRIBUTION PERCENTAGE OF CLAIMS PAID OR PROPOSED TO BE PAID TO THE GENERAL CLASS OF UNSECURED CREDITORS WITHIN THE PLAN % A. Gross Cash Receipt B. Priority Payments of Expenses of Administration Other Than Operating Expenses: 1. Trustee222s commission (if any) Paid Proposed Total 2. Fee and expenses, Trustee222s counsel C. Other Professional Fees and Expenses: 1. Fees and expenses, Accountants 2. Fees and expenses, Auctioneers and Appraisers 3. Fees and expenses, Attorneys for Debtor 4. Other professional fees (specify) 5. Taxes, fines, penalties, etc. Local Bankruptcy Form N2262 American LegalNet, Inc. www.FormsWorkFlow.com 6. Other expenses of administration (must be itemized: includes bond premiums, settlement costs, other expenses) Paid Proposed Total 7. Total D. Payments to creditors: (totals under each category sufficient) 1. Payment to secured creditors 2. Payment to priority creditors 3. Payments to unsecured creditors 4. Payments to equity security holders E. Other payments: (including surplus payments to debtor) F. AMOUNT TO BE PAID UNDER PLAN TOTAL DISTRIBUTION The Plan Administrator, (or Trustee if appointed) hereby avers that all provisions of the Plan have been substantially consummated, and plan payments have been completed. Furthermore, the Debtor hereby certifies, under penalty of perjury that the following statements are true and correct: 1. Debtor has completed all payments under the Plan. 2. If 11 U.S.C. 2471141(d)(3) applies, Debtor has completed an instructional course concerning financial management as described in 11 U.S.C. 247111. 3. Debtor did not have, either at the time of filing this bankruptcy or at the present time, equity in excess of $125,000 if the case was filed before April 1, 2007, or $136,875 if the case was filed on or after April 1, 2007 and before April 1, 2010, or $146,450 for a case filed on or after April 1, 2010 and before April 1, 2013, or $155,675 if the case was filed on or after April 1, 2013 in the type of property described in 11 U.S.C. 247522(p)(1) [generally the debtor's homestead]. 4. There is not currently pending any proceeding in which the Debtor may be found guilty of a felony of the kind described in 11 U.S.C. 247522(q)(1)(A) or liable for a debt of the kind described in 11 U.S.C. 247522(q)(1)(B). Local Bankruptcy Form N2262 Page Two American LegalNet, Inc. www.FormsWorkFlow.com Debtor: Date: Debtor: Date: Wherefore, the Plan Administrator (or Trustee), having fully administered this estate, prays for entry of an Order of Discharge and the entry of a Final Decree. DATE: Attorney for Plan Administrator (or Trustee) At a minimum, the following parties should be served with a copy of this report: Creditors222 Committee or Counsel, 20 Largest Unsecured Creditors, and United States Trustee. Local Bankruptcy Form N2262 Page Three American LegalNet, Inc. www.FormsWorkFlow.com CERTIFICATE OF SERVICE I hereby certify that on the day of , 20 , I reviewed the Court222s CM/ECF system and it reports that an electronic copy of the Chapter 11 Final Report and Motion for Discharge and Final Decree will be served electronically by the Court222s CM/ECF system on the following: Name of Attorney Representing Creditor's Committee Name of Attorney U.S. Trustee I hereby further certify that on the day of , 20, a copy of the Chapter 11 Final Report and Motion for Discharge and Final Decree was also mailed first class mail, postage prepaid to the 20 Largest Unsecured Creditors: Name of Party Address of Party City, State Zip Name of Party Address of Party City, State Zip Name of Party Address of Party City, State Zip Signature Local Bankruptcy Form N-2 Page Four American LegalNet, Inc. www.FormsWorkFlow.com