FORM 4004-1 () (Chapter 13) UNITED STATES BANKRUPTCY COURT NORTHERN DISTRICT OF OKLAHOMA IN RE: , Debtor(s). Case No. Chapter CERTIFICATION AND REQUEST FOR ISSUANCE OF DISCHARGE Debtor(s) hereby certify under penalty of perjury that the following statements are true and correct: 1.The Chapter 13 Trustee has filed a Notice of Plan Completion or Notice of Early PlanCompletion stating that the Debtor(s) paid sufficient funds to the Trustee to meet allobligations required by the plan or to pay all claims in full even though the term of the planhas not expired. (Select One) 2.The Debtor(s) completed, after the filing of this case, the Personal Financial Management course required by 11 U.S.C. 247 1328(g)(1) and filed the requisitecertification (Official Form 23: Debtor's Certification of Completion ofInstructionalCourse Concerning Personal Financial Management).or The Debtor(s) are not able to complete the requirements set forth above because of incapacity, disability, or active military duty in a military combat zone. Specify: . (Select One) 3.Debtor(s) have not been required by a judicial or administrative order, or by statute, topay any domestic support obligation, as defined in 11 U.S.C. 247 101(14A), either priorto the date the petition was filed or any time after the petition date. or Prior to the date of this certification, Debtor(s) paid all amounts due under a domestic support obligation, as defined in 11 U.S.C. 247 101(14A) and required by a judicial or administrative order, or by statute (including amounts due before the petition was filed, but only to the extent provided for by the Plan) in accordance with 11 U.S.C. 247 1328(a). If you checked the second box, you must provide the information below. My current address: American LegalNet, Inc. www.FormsWorkFlow.com FORM 4004-1 (4/19) (Chapter 13) * Dollar amounts are adjusted on April 1 every third year, and the adjusted dollar amount applies to cases commenced on or after the date of adjustment. 2 My current employer and my employer's address: 4. If the Debtor(s) claim a homestead exemption in excess of the dollar amount listed in 11 U.S.C. 247 522(q)(1)* at the time of commencement of the case, there is no proceeding pending in which the Debtor(s) may be found guilty of a felony of the kind described in 11 U.S.C. 247 522(q)(1)(A) or liable for a debt of the kind described in 11 U.S.C. 247 522(q)(1)(B). Debtor(s) declare under penalty of perjury that the foregoing statements are true and correct to the best of my/our knowledge, information and belief, and that the Court may rely on the truth of each statement in determining whether to grant a discharge in this case. Debtor(s) further understand(s) that the Court may revoke the discharge if such order of discharge was procured by fraud. Dated: s/ Debtor s/ Debtor NOTICE OF OPPORTUNITY TO OBJECT Any objections to the accuracy of the Certification must be filed within fourteen (14) days of the date of filing of this document. If no objections are filed, the Court will consider entering the discharge in this case without further notice or hearing. s/ Signature of Debtor or Debtor222s Attorney Name/OBA#/Address/Telephone #/Email American LegalNet, Inc. www.FormsWorkFlow.com