Name, Address, Telephone No., Bar Number, Fax No. & E-mail address UNITED STATES BANKRUPTCY COURT DISTRICT OF NEVADA In re ) ) ) ) ) ) ) ) ) ) ) ) ) ) Bankruptcy No.: Chapter: 13 DEBTOR'S CERTIFICATE OF COMPLIANCE W ITH CONDITIONS RELATED TO MOTION FOR HARDSHIP DISCHARGE W ITH NOTICE THEREON NO HEARING REQUIRED IN THE ABSENCE OF A W RITTEN OBJECTION BEING FILED W ITHIN 15 DAYS FOLLOW ING SERVICE OF THE DEBTOR'S CERTIFICATIONS Debtor(s)* The Debtor has filed or intends to file a M otion for a Chapter 13 Hardship Discharge pursuant to 11 U.S.C. § 1328(b). In connection with this Motion, the Debtor hereby certifies as follows: 1. Pursuant to 11 U.S.C. § 1328(g)(1) and Fed. R. Bankr. P. 1007(b)(7), the Debtor has completed an instructional course concerning personal financial management described in 11 U.S.C. § 111 and has filed Official Form 423 or has requested an exemption from this requirement. The current name and address of each holder of a domestic support obligation is as follows: Debtor Joint Debtor 2. 3. The Debtor's current address is: Debtor Joint Debtor 4. The name and address of the Debtor's most recent employer is: Debtor Joint Debtor American LegalNet, Inc. www.FormsWorkFlow.com 5. The following creditors hold claims that will not be discharged under 11 U.S.C. § 523(a)(2) or (a)(4) or claims that were reaffirmed under 11 U.S.C. § 524(c): 6. Compliance with 11 U.S.C. § 1328(h): a. The Debtor has not claimed an exemption under 11 U.S.C. § 522(b)(3) in an amount in excess of $160,375.00 in property of the kind described in 11 U.S.C. § 522(p)(1); or The Debtor has claimed an exemption under 11 U.S.C. § 522(b)(3) in an amount in excess of $160,375.00 in property of the kind described in 11 U.S.C. § 522(p)(1) but there is no pending proceeding in which the Debtor may be found guilty of a felony of a kind described in 11 U.S.C. § 522(q)(1)(A) or found liable for a debt of the kind described in 11 U.S.C. § 522(q)(1) (B). b. 7. The Debtor has not received a discharge in a case filed under Chapter 7, 11, or 12 during the 4 year period preceding the filing of this Chapter 13 case or in a case filed under Chapter 13 during the 2 year period preceding the filing of this Chapter 13 case. I declare under penalty of perjury that the information provided in this Certificate is true and correct. Dated: Debtor Joint Debtor NOTICE OF DEBTOR'S CERTIFICATE OF COM PLIANCE WITH CONDITIONS RELATED TO M OTION FOR HARDSHIP DISCHARGE NOTICE IS HEREBY GIVEN that the "Debtor's Certificate of Compliance with Conditions Related to Motion for Hardship Discharge" has been filed with the court on . Any objections to said Debtor's Certificate of Compliance must be in writing stating the grounds of the objection and filed within 14 days following service of the Certificate. Any objection must be filed with the Clerk, United States Bankruptcy Court, Foley Federal Building, 300 Las Vegas Boulevard South, 3 rd Floor, Las Vegas, Nevada 89101. Timely filed objections to the Debtor's Certifications will be considered with the Debtor's Motion for Hardship Discharge. In the event an objection is timely filed, the objecting party shall serve a copy of the objection upon the Trustee, Kathleen A. Leavitt, at 201 Las Vegas Boulevard South, #200, Las Vegas, Nevada 89101 pursuant to Local Rule 9014. Dated: Attorney for Debtor A Certificate of Service for this document must be filed in accordance with the Local Rules. NV_5009.1(HardshipDebtorsCertificateofCompliance4/16KL).wpd American LegalNet, Inc. www.FormsWorkFlow.com