Exhibit 1 UNITED STATES BANKRUPTCY COURT MIDDLE DISTRICT OF NORTH CAROLINA In Re: DEBTOR ) ) XXX-XX-XXXX ) ) ) ) Debtor(s) ) Case No.: DEBTOR'S DISCLOSURE OF INFORMATION REGARDING DOMESTIC SUPPORT OBLIGATIONS The Chapter 13 Debtor provides the following information to the Chapter 13 Trustee for the purpose of obtaining a discharge under 11 U.S.C. §1328. Debtor's Current Address:_______________________________________________________________ Debtor's Current Employer:______________________________________________________________ Debtor's Current Employer's Address:______________________________________________________ ____________________________________________________________________________________ Name and Address of Each Holder of a Domestic Support Obligation is as follows: Name ____________________________ ____________________________ Address _____________________________________________ _____________________________________________ List of debts not discharged under Paragraph 2 or 4 of 11 U.S.C. §523(a):__________________________ ____________________________________________________________________________________ List of debts reaffirmed under 11 U.S.C. §524(c):_____________________________________________ ____________________________________________________________________________________ I declare under the penalty of perjury that the information provided in this disclosure is true and accurate: Dated:____________________ Mail to: Chapter 13 Trustee, (address). _____________________________________________ Debtor American LegalNet, Inc. www.FormsWorkFlow.com