UNITED STATES BANKRUPTCY COURT DISTRICT OF NEW JERSEY Caption in Compliance with D.N.J. LBR 9004-1(b) In Re: Case No.: Chapter: ___________________ 13 Hearing Date: ___________________ Judge: ___________________ CHAPTER 13 TRUSTEE'S CERTIFICATION OF DEFAULT ______________________________, Chapter 13 Trustee in this case certifies: 1. The Order Confirming Chapter 13 Plan or Order Regarding Chapter 13 Standing Trustee's Motion to Dismiss, ordered the debtor to perform as follows: To make plan payments in under the terms of the confirmation order. If the debtor failed to make a plan payment to the trustee for a period of more than 30 consecutive days, the trustee was authorized to file a certification of default with notice of said certification to the debtor (s) and debtor's attorney, if any. To continue regular monthly payments of $ _____________. If the debtor failed to make a payment for a period of more than 30 consecutive days, the trustee was authorized to file a certification of default with notice of said certification to the debtor (s) and debtor's attorney, if any. To file with the court an Order to Employer to Pay the Chapter 13 Trustee not later than 30 days from the date of the Order Regarding Chapter 13 Standing Trustee's Certification of Default or Motion to Dismiss. American LegalNet, Inc. www.FormsWorkFlow.com 2. The debtor(s) has not performed as ordered by the court in that: The debtor is in arrears in plan payments in the amount of $ ________________. The debtor's last payment was made on ______________________ in the amount of $ _________________. To date the debtor or the debtor's attorney, if any, has not submitted an Order to Employer to Pay the Chapter 13 Trustee. 3. I make this Certification in support of the entry of an order dismissing this case. 4. I certify under penalty of perjury that the above is true. Date: _______________________ _______________________________ Chapter 13 Trustee rev.8/1/15 2 American LegalNet, Inc. www.FormsWorkFlow.com