UNITED STATES BANKRUPTCY COURT DISTRICT OF OREGON In re ) ) ) ) ) ) ) Case No.________________ Notice of Motion for Hardship Discharge; Statement Re 11 USC §522(q)(1) Applicability; and Fixing Times for Filing Objections, Complaints, and Motions; and Order and Notice Thereon Debtor(s) 1. The undersigned certifies the debtor(s) has not completed all plan payments, but instead filed the attached motion for a "hardship" discharge under either 11 USC §1328(b) if a Chapter 13 case or 11 USC §1228(b) if a Chapter 12 case, supported by affidavit(s)/declaration(s) executed by the debtor(s) under penalty of perjury, and demonstrating that: (1) the debtor's failure to complete the plan payments is due to circumstances for which the debtor(s) should not justly be held accountable, (2) unsecured creditors have received payments that equal or exceed the total payments which they would have received in a Chapter 7 liquidation, and (3) modification of the plan is not practicable. 1378 (12/1/12) Page 1 of 2 *** SEE NEXT PAGE *** American LegalNet, Inc. www.FormsWorkFlow.com 2. The undersigned also certifies that there IS IS NOT (CHECK ONE) a pending proceeding in which the debtor(s) may be found guilty of a felony or liable for a debt of a kind described in 11 USC §522(q)(1). 3. The name/service address for debtor copies are: _______________________________________________ ___________________________________________________________________________________________ DATE: ___________ ___________________________________________________________ Signature AND Debtor's Taxpayer I.D.# (last 4 digits) ___________________________________________________________ Debtor's Address STOP: BEFORE SERVING COPIES, SUBMIT THE NOTICE AND ATTACHMENTS TO OBTAIN A JUDGE'S SIGNATURE! CERTIFICATE OF SERVICE I certify that on _________ copies of this motion and order thereon, any Notice of Hearing prepared by the court per the judge's order, and the debtor's motion and affidavit(s)/declaration(s), were served on the debtor(s), trustee, U.S. Trustee and all creditors. __________________________________________________ Signature & Relation to Debtor IMPORTANT: After service, complete the "Certificate of Service" above using a copy of this document that includes the court's order, and then promptly file the Certificate (WITHOUT any attachments). 1378 (12/1/12) Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com