R.I. Local Form 1007 - 1.4 UNITED STATES BANKRUPTCY COURT (Rev. 10/3/16) FOR THE DISTRICT OF RHODE ISLAND - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - * In re: : : BK No. Debtor(s) Chapter : - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - * BRIEFING AND /OR FINANCIAL MANAGEMENT COURSE I/We, the debtor(s) in this case, certify under penalty of perjury as follows: I/We move for a waiver of the requirements to receive a credit counseling briefing (11 U.S.C. 247109(h)) and /or ( ) [check if applicable] complete a personal financial management course (11 U.S.C. 247727(a)(11)) because [Check and fully complete the paragraph that applies]: I am/We are incapacitated or dis abled, as defined in 11 U.S.C. 247109(h)(4) 1 , as follows (desc ribe fully) (If available, a copy of a medical or judicial determination of incapacity or disability should be filed under seal ): and such disability or incapacity is unlikely to change within the time periods of the requirement to file the completion of the financial management course certificate. I am/We are on active military duty in a military combat zone (Indicate rank, service unit, and where and when deployed). I/We certify under penalty of perjury that the foregoing is t rue and correct. Execution on [date] at [location]. Debtor Joint Debtor 1 Under 11 U.S.C. 247109(h)(4), incapacitated mental deficiency so that he is incapable of realizing and making rational decision s with respect to his financial disabled effort, to participate in an in American LegalNet, Inc. www.FormsWorkFlow.com