UNITED STATES BANKRUPTCY COURT WESTERN DISTRICT OF WASHINGTON In re Bankruptcy Case No. Debtor APPLICATION FOR EXTENSION OF TIME TO COMPLETE CREDIT COUNSELING I/We, the debtor(s) in this case, certify under penalty of perjury that: 1. I/We requested the briefing services referred to in 11 U.S.C. § 109(h)(1) from ____________________________ [name of approved credit counseling agency] on _________________ [date] by _________________ [in person, telephone, or internet]. I/We could not obtain the briefing services during the 5-day period beginning on the date upon which I/we made that request because (explain fully): I/We have a pending appointment to obtain those briefing services scheduled on _______________________ [date]. 2. I/We merit an extension of time under 11 U.S.C. §109(h)(3) because of the following exigent circumstances (describe fully): 3. I/We understand that this application will be accepted by the Clerk’s Office, but if the Page 1 of 2 American LegalNet, Inc. www.USCourtForms.com court does not find this application satisfactory, the court may (i) dismiss the case without a hearing, or (ii) enter an order to show cause why the case should not be dismissed, which will set a hearing on this application, and may require me/us to file further documentation. 4. I/We understand that even if the court finds this certification satisfactory, the requirement to obtain credit counseling services is waived only for 30 days after the petition is filed, unless I/we ask for and receive a further 15-day extension.** I/We certify under penalty of perjury that the foregoing is true and correct. Executed on ___________________________[date] at _________________________[location] Debtor Address:_______________________ Telephone:_____________________ Joint Debtor ** NOTICE: You must act promptly in filing this application. The court is only permitted to grant you an extension of 30 days from the petition date plus a further extension of 15 days for cause to meet the credit counseling requirement. The requirement that you take a personal financial management course after you file your petition is a separate requirement. (04/03/06) Page 2 of 2 American LegalNet, Inc. www.USCourtForms.com