Case No: Chapter: 13 Judge: CERTIFICATION IN SUPPORT OF MOTION TO CANCEL AND DISCHARGE: MORTGAGE LIEN OTHER (SPECIFY) I , debtor(s) in this case hereby certify: 1. The Chapter 13 plan confirmed in this case contained a motion to: Avoid lien under 11 U.S.C. 247522(f), Avoid lien and reclassify claim from secured to completely unsecured. 2. A Certification of Service concerning the Chapter 13 Plan and Motions and the Notice of Chapter 13 Plan Transmittal filed with the Court at the time the Plan was filed. 3. Description of Real Property: Location (Street Address) 4. Description of Mortgage/Judgment Lien: a. Original Mortgagee/Lienholder: UNITED STATES BANKRUPTCY COURT DISTRICT OF NEW JERSEY Caption in Compliance with D.N.J. LBR 9004-1(b) In Re: American LegalNet, Inc. www.FormsWorkFlow.com 2 b. Current Assignee: c. Current Servicer: d. Date of Mortgage/Lien: e. Date of Recordation: f. Place of Recordation: i. Mortgage Book: ii. Page: g. Original Principal Balance of Mortgage/Lien: $ 5. I have successfully completed a Chapter 13 Plan, which provides for the discharge and cancellation of record of the Mortgage or Lien referenced above. I have also filed with the Court a Certification in Support of Discharge and the Standing Chapter 13 Trustee has filed a Plan Complete Letter. 6. I am entitled to have the Mortgage or Lien referenced above discharged and cancelled of record. 7. I request that the Court enter an order directing that a certified or exemplified copy of the Order on Motion to Cancel and Discharge the Mortgage or Lien shall be recorded by the Clerk or Register of Deeds with whom the original mortgage or lien was recorded. I certify under penalty of perjury that the above is true. Date: Debtor Date: Joint Debtor rev.12/1/17 American LegalNet, Inc. www.FormsWorkFlow.com