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Debtors Certification And Affidavit 341(a) Meeting Form. This is a North Carolina form and can be use in USBC Western Federal.
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Tags: Debtors Certification And Affidavit 341(a) Meeting, 7, North Carolina Federal, USBC Western
Local Form 7
July 2007
UNITED STATES BANKRUPTCY COURT
FOR THE WESTERN DISTRICT OF NORTH CAROLINA
[insert correct division name] DIVISION
IN THE MATTER OF:
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SSN: xxx-xx-_______
SSN: xxx-xx-_______
Case Number___________________
Debtor(s)
DEBTOR(S) CERTIFICATION AND AFFIDAVIT – 341(a) MEETING
The undersigned, being the Debtor(s) referenced above, do hereby certify under oath
administered by the Standing Trustee at the 341 meeting of creditors conducted on the date
noted below, the following (Check the appropriate option, filling in the information requested as
needed.)
DOMESTIC SUPPORT OBLIGATION CERTIFICATION
Male
Female
1.
( )
( )
I am not presently required by any judicial or administrative order or
statute to pay any domestic support obligation (as defined in 11 U.S.C. Section 101(14A)); or,
2.
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I am required to pay under a domestic support order, and the full
information as required by law as to the identity of the holder of this claim is already included in
my petition, including the name and full mailing address of the holder, and ages and custodian
of any children relating to the support order, and,
3.
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As of the date of this affidavit, I am current under any obligation created
therein; and I agree to notify my trustee should I miss any payments due or otherwise become
delinquent under any support obligation from this day until my confirmation order is entered.
4.
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I am presently in arrears as of the date of this Affidavit as follows:
( )
I have only those arrears as listed in my petition, and, I am
current postpetition through today; or,
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In addition to any arrears listed in my petition, I have incurred the
following postpetition arrearage:
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TAX RETURN CERTIFICATION
Male
Female
1.
( )
( )
I was not required to file any Federal, State or local tax returns for the 4year period ending on the date of the filing of my Chapter 13 petition for the following reason(s):
____________________________________________________________________________.
2.
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( )
I was not required to file Federal, State or local tax returns for the
following years during the 4-year period ending on the date of the filing of my Chapter 13
petition for the following reason(s):
____________________________________________________________________________
_
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3.
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I was required to file Federal, State and local tax returns for the 4-year
period ending on the date of the filing of my Chapter 13 petition and I have filed all of the returns
that I was required to file during that 4-year period.
4.
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( )
I was required to file Federal, State and local tax returns for the 4-year
period ending on the date of the filing of my Chapter 13 petition but I have not filed the following
required return(s):
____________________________________________________________________________
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CERTIFICATION OF WAGES
Male
Female
1.
( )
( )
My Chapter 13 petition contains valid and accurate information as
regards the payment of wages to me by my employer for the 60-day period ending on the date
of the filing of my petition, and my petition contains valid and accurate information as to my
average income for the six-month period ending on the last day of the calendar month
immediately preceding the filing of my petition; or,
2.
( )
( )
The information as contained in my petition has changed as follows:
____________________________________________________________________________
____________________________________________________________________________
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By signing this affidavit, I acknowledge that all of the statements contained herein are
true and accurate, and the Trustee and Court may rely on these statements for purposes
of determining if confirmation of my proposed Plan is allowed under the provisions of
the Bankruptcy Code. Any inaccuracy in this affidavit may be grounds for revocation or
denial of my confirmation.
Dated this the _____ day of ___________________, 200__.
________________________________
Male Debtor
________________________________
Female Debtor
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