U. S. BANKRUPTCY COURTWESTERN DISTRICT OF VIRGINIAFORM 3015-3AUNITED STATES BANKRUPTCY COURTFOR THE WESTERN DISTRICT OF VIRGINIAIN RE:CHAPTER 13Case No.Debtor(s)AFFIDAVIT OF DEBTOR(S) REQUESTING CONFIRMATION OF PLAN 1.The undersigned affirm(s) that the statements below are true as of the date hereof andcertifies that they will be true as of the date of confirmation of my/our chapter 13 plan and may berelied upon by the court unless notice in writing to the contrary is given to the trustee and the courtat or prior to such time.2.I/We have made all payments to secured creditors, personal property lessors and taxingauthorities which have come due since the date on which this case was filed and which I/we wererequired to make directly to such creditor, lessor or taxing authority. I/we understand that suchpayments include all mortgage payments, car payments or other secured debts being paid directly,personal property leases, real estate taxes, personal property taxes, federal income taxes, and stateincome taxes which have come due since this case was filed.3.Select either A. or B.:A.Since the filing of this bankruptcy case, I/we have not beenrequired by a judicial or administrative order, or by statute, to pay any domesticsupport obligation [as that term is defined in 11 U.S.C. section 101(14A)].B.I/We have paid all amounts that first became due and payable afterthe filing of this bankruptcy case which I/we were required to pay under a domesticsupport obligation [as that term is defined in 11 U.S.C. section 101(14A)] required bya judicial or administrative order or by statute.4.I/we have filed all federal, state, and local tax returns required by law to be filed for all taxable periods ending during the four year period ending on the date of the filing of thisbankruptcy case. American LegalNet, Inc. www.FormsWorkFlow.com By signing this affidavit requesting confirmation of chapter 13 plan, I/we acknowledge that all of the above statements are true and accurate and that the Court may rely upon the truth of each of these statements in determining whether to confirm my/our Chapter 13 Plan. I/We understand that the Court may revoke confirmation of the Chapter 13 Plan if the statements relied upon are not accurate. Signed:/s/ Debtor/s/ DebtorSubscribed and sworn to before me, a Notary Public, by the debtor(s) named in this affidavit this day of , 20./s/ Notary PublicMy commission expires: American LegalNet, Inc. www.FormsWorkFlow.com