United States Bankruptcy Court Western District of Michigan One Division Ave., N. Room 200 Grand Rapids, MI 49503 IN RE: Debtor(s) (name(s) used by the debtor(s) in the last 8 years, including married, maiden, trade, and address): Case Number Chapter Honorable Debtor(s) DEBTOR'S CERTIFICATION REGARDING DOMESTIC SUPPORT OBLIGATION PURSUANT TO 11 U.S.C. § 1328(a) The debtor(s) in the above−referenced matter certify as follows: ___ The debtor has not been required by a judicial or administrative order, or by statue to pay any domestic support obligation as defined in 11 U.S.C. § 101(14A) either before this proceeding was filed or at any time after the date of filing. −OR− ___ The debtor has paid all amounts due under any and all domestic support obligations as defined in 11 U.S.C. § 101(14A), required by a judicial or administrative order or by statue, including amounts due before, during and after this proceeding was filed. I declare under penalty of perjury that the information provided in the Certificate is true and correct. Date: ______________________ ___________________________ Debtor Date: ______________________ ___________________________ Joint Debtor(if applicable) American LegalNet, Inc. www.FormsWorkflow.com