OLF3 B (Official Local Form 3B ) UNITED STATES BANKRUPTCY COURT DISTRICT OF MASSACHUSETTS In re: Case No. Chapter 13 Debtor(s) Instructions: This form must be used if in the Plan the debtor(s) request s: (1) to limit, modify, or determine the v alue of a secured claim (the debtor(s) checked the box in Part 1, Line 1.1); and/or (2) to avoid a lien or security interest 1.2 ). Service must be made pursuant to Fed. R. Bankr. P. 7004. Please note, service made by personal service , by residence service, or pursuant state law must be made by a person at least 18 years of age who is not a party to this proceeding. Attach hereto a list of the parties served indicat ing for each which of the types of service were utilized . AFFIDAVIT OF SERVICE OF CHAPTER 13 PLAN I, (name), certify that service of a copy of this Plan was made on the creditors and in the manner set forth in the attached list on (date) . If service was made by personal service, by residence service, or pursuant to state law, I further certify that I am, and was at all times during the service of a copy of this Plan, not less than 18 years of age and not a party to the matter concerning which service was made. I declare that the foregoing is true and correct under penalty of perjury. Dated: Signature Print name : BBO Number (if applicable): Firm name (if applicable): Address: Telephone: Email Address: American LegalNet, Inc. www.FormsWorkFlow.com