LOCAL FORM 4004-1B283 (FORM 283) () UNITED STATES BANKRUPTCY COURTDISTRICT OF MINNESOTAIn re:Case No.Debtor(s).CHAPTER 12 or 13 DEBTOR222S CERTIFICATIONS REGARDING DOMESTIC SUPPORT OBLIGATIONS AND SECTION 522(q)Part I. Certification Regarding Domestic Support Obligations (check no more than one)Pursuant to 11 U.S.C. Section 1228(a) or 1328(a), I certify that:I owed no domestic support obligation when I filed my bankruptcy petition, and I have notbeen required to pay any such obligation since then.I am or have been required to pay a domestic support obligation. I have paid all suchamounts that my chapter 12 or 13 plan required me to pay. I have also paid all suchamounts that became due between the filing of my bankruptcy petition and today.Part II. If you checked the second box, you must provide the information below.My current address: My current employerand my employer222saddress: Part III. Certification Regarding Section 522(q) (check no more than one) I have not claimed an exemption pursuant to 247 522(b)(3) and state or local law (1) in property that Ior a dependent of mine uses as a residence, claims as a homestead, or acquired as a burial plot, asspecified in 247 522(p)(1), and (2) that exceeds $* in value in the aggregate.I have claimed an exemption in property pursuant to 247 522(b)(3) and state or local law (1) that I or adependent of mine uses as a residence, claims as a homestead, or acquired as a burial plot, asspecified in 247 522(p)(1), and (2) that exceeds $* in value in the aggregate. Part IV. Debtor222s SignatureI certify under penalty of perjury that the information provided in these certifications is true andcorrect to the best of my knowledge and belief.Executed on: Date Debtor*Amounts are subject to adjustment on 4/1/2019 and every 3 years thereafter with respect to cases commenced on orafter the date of adjustment.Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com