OLF21A (Official Local Form 21A) EXHIBIT 4 UNITED STATES BANKRUPTCY COURT DISTRICT OF MASSACHUSETTS In re Case No. Debtor(s) Chapter 13 ORDER AVOIDING LIEN IMPAIRING EXEMPTION* Upon consideration of 1) the Chapter 13 Plan (the Plan ), through which the Debtor(s) made a request t o avoid the lien of [name of creditor] pursuant to 11 U.S.C. 247 522(f) as impairing the exemption of the Debtor(s); 2) the calculation of impairment set forth in Exhibit 3 to the Plan; 3) the Schedule of Exemptions filed by the Debtor(s); 4) the absence of an objection to the avoidance of the lien or the Court having overruled any and all objections to the request for lien avoidance in the Plan; 5) the entire record of proceedings in this case; 6) the Confirmation Order; and 7) the provisions of 11 U.S.C. 247 522(f)(1) and (2), Fed. R. Bankr. P. 4003 and M LBR 4003 - 1, The Court hereby orders and decrees that the lien of [ name of creditor] recorded on [ date] at [registry or recording authority, as applicable] at [book, page, certificate number, or filing number reference] impairs the Debtor(s) exemption in [address of property or other description] (the Exempt Property ) and declares that the lien covering the interest in exempt property of the De btor(s) is avoided in its entirety [or avoided in part]. Pursuant to 11 U.S.C. 247 349(b)(1)(B), the avoided lien shall be reinstated if the case is dismissed unless the Court, for cause, orders otherwise. By the Court, United States Bankruptcy Judge *This Exhibit may be modified to address each lien listed in Table American LegalNet, Inc. www.FormsWorkFlow.com