IN THE UNITED STATES BANKRUPTCY COURT FOR THE NORTHERN DISTRICT OF TEXAS IN RE: ____________________________ Debtor ' ' ' ' ' ' ' ' CASE NO.: _______________________ DEBTOR(S) CERTIFICATION AND MOTION FOR ENTRY OF CHAPTER 13 DISCHARGE PURSUANT TO 11 U.S.C. § 1328(a) The Debtor(s) move for entry of discharge under 11 U. S. C. § 1328(a) of the Bankruptcy Code. 1. By signing below, the Debtor(s) certify under penalty of perjury under the laws of the United States of America that the following statements are true and correct: A. I have completed the personal financial management instructional course from an agency approved by the United States Trustee. A copy of Official Form 23 is attached as Exhibit 1. B. If I owe a debt arising from (a) any violation of any state or federal securities laws, regulations or orders; (b) fraud, deceit or manipulation in a fiduciary capacity or in connection with the purchase or sale of any security; (c) a civil remedy under § 1964 of title 18; or (d) a criminal act, intentional tort, or willful or reckless misconduct that caused serious physical injury or death to another individual in the preceding five years, then I have not claimed an exemption for my residence in an amount in excess of $125,000. C. All amounts payable by me on a domestic support obligation, that are due through this date (including amounts due before the petition was filed in this case, but only to the extent provided for by the plan) have been paid. D. I have not received a discharge in a case filed under chapter 7, 11, or 12 of the Bankruptcy Code during the four-year period before the date that my petition was filed in this case. E. I have not received a discharge in a case filed under chapter 13 of the Bankruptcy Code during the two-year period before the date that my petition was filed in this case. Debtor(s) Certification and Motion For Entry of Chapter 13 Discharge Page 1 of 2 American LegalNet, Inc. www.FormsWorkflow.com F. No criminal proceeding is pending against me alleging that I am guilty of a felony. G. No civil case is pending against me alleging that I am liable for any (a) violation of the Federal securities laws, and State securities law, or any regulation or order issued under Federal securities laws or State securities laws; (b) fraud, deceit or manipulation in a fiduciary capacity or in connection with the purchase or sale of any security; (c) civil remedy under § 1964 of title 18; or (d) criminal act, intentional tort, or willful or reckless misconduct that caused serious physical injury or death to another individual in the preceding five years. 2. I have made all payments required by my confirmed chapter 13 plan. Signed: __________________________ Debtor Signed: _____________________________ Joint Debtor [SIGNATURE BLOCK FOR ATTORNEY] NOTICE UNLESS A RESPONSE IS FILED WITH THE CLERK OF THE UNITED STATES BANKRUPTCY COURT BEFORE CLOSE OF BUSINESS TWENTY (20) DAYS FROM THE DATE OF SERVICE HEREOF, A HEARING MAY NOT BE CONDUCTED. ANY RESPONSE MUST BE FILED WITH THE CLERK, AND A COPY MUST BE SERVED UPON COUNSEL FOR THE MOVING PARTY PRIOR TO THE DATE AND TIME SET FORTH HEREIN. IF A RESPONSE IS FILED, A HEARING WILL BE HELD WITH NOTICE TO (1) ANY PERSON TO WHOM A DEBTOR HAS BEEN ORDER TO PAY SUPPORT (EITHER SPOUSAL SUPPORT OR CHILD SUPPORT), (2) THE CHAPTER 13 TRUSTEE, (3) THE UNITED STATES TRUSTEE, AND (4) ALL CREDITORS. IF NO RESPONSE IS TIMELY FILED, THE RELIEF REQUESTED SHALL BE DEEMED TO BE UNOPPOSED, AND THE COURT MAY ENTER AN ORDER GRANTING THE RELIEF SOUGHT. Debtor(s) Certification and Motion For Entry of Chapter 13 Discharge Page 2 of 2 American LegalNet, Inc. www.FormsWorkflow.com