OFFICIAL LOCAL FORM 12 UNITED STATES BANKRUPTCY COURT DISTRICT OF MASSACHUSETTS In re Chapter Bankruptcy No. , Debtor(s) MOTION FOR ENTRY OF DISCHARGE I, ___________________________, hereby move for an entry of a Chapter 13 discharge and certify as follows: 1. I have paid all domestic support obligations payable under any judicial or administrative order, or required by statute including: a. child support and spousal maintenance and alimony, that were due on or before the date of the motion, including all payments due under the plan for amounts due before the petition was filed; and b. any domestic support obligations that arose after the filing of the petition; 2. I have completed a financial management course pursuant to 11 U.S.C. § 1328(g)(1) and filed a certification of completion with the Court; and 3. I have a. not claimed a homestead exemption in excess of the $125,000 cap described in § 522(q)(1), or b. claimed a homestead exemption in excess of $125,000 but there is no proceeding pending in which the debtor may be found guilty of a felony of the kind described in § 522(q)(1)(A) or liable for a debt of the kind described in § 522(q)(1)(B). I hereby declare under the penalty of perjury that the foregoing is true and correct. Dated: _______________ Name: ____________________________________________________________ Address: ___________________________________________________________ Signature: __________________________________________________________ American LegalNet, Inc. www.FormsWorkflow.com