UNITED STATES BANKRUPTCY COURT District of New Jersey In Re: : : : : : __________________________________________: Case No.: _________________ Chapter: _________________ Judge: _________________ REQUEST FOR EXEMPTION FROM PARTICIPATION IN FINANCIAL MANAGEMENT COURSE REQUIRED UNDER 11 U.S.C. § 727(a)(11) or 1328(g)(1) I ___________________________________, a debtor in the above captioned case, hereby request that I be granted an exemption from attending a Financial Management Course. My request is based on the following: ‘ I am incapacitated. For purposes of making this request, incapacitated means impaired by reason of mental illness of mental deficiency as to be incapable of realizing and making rational decisions with respect to financial responsibilities. ‘ I am disabled. For purposes of making this request, disabled means physically impaired as to be unable, after reasonable effort, to participate in an in-person, telephone or internet briefing. ‘ I am engaged in active military service in a military combat zone. In the space provided below, please furnish a detailed explanation setting forth the basis for your request. Attach any documentation that will assist the court in making a determination. (Use a separate sheet if necessary) ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ American LegalNet, Inc. www.FormsWorkflow.com I certify under penalty of perjury that the foregoing is true and correct. Dated: ______________________ By: ______________________________ Debtor CERTIFICATION OF SERVICE I, ______________________________________, the debtor in this matter, certify under penalty of perjury that I mailed this request to the United States Trustee at the following address on ________________________________. Office of the United States Trustee One Newark Center Suite 2100 Newark, NJ 07102 Dated: ____________________ By: ______________________________ Debtor NOTE TO DEBTORS: If both debtors in a joint case are requesting an exemption, each debtor must file a separate request with the court. rev.4/3/07..jml American LegalNet, Inc. www.FormsWorkflow.com