[Local Bankruptcy Form 13-4, eff. 12/17] 1 UNITED STATES BANKRUPTCY COURT WESTERN DISTRICT OF WASHINGTON In re: Case No. CHAPTER 13 PLAN Original Amended Debtor(s). I. Disclosure of Nonstandard Provisions and Modification of Secured Debt: A. Does this plan contain any nonstandard provisions (check one)? Yes No B. Does this plan limit the amount of a secured claim based on a valuation of the collateral for the claim (check one)? Yes No C. Does this plan avoid a security interest or lien (check one)? Yes No If the Debtor has either or made no selection, any nonstandard provision or language in this plan purporting to limit the amount of a secured claim based on a valuation of the collateral or to avoid a security interest or lien is void. 1.C, the Debtor may seek to limit the amount of a secured claim based on a valuation of the collateral for the claim or avoid a security interest or lien through a motion or an adversary proceeding. II. Means Test Result and Plan Duration: The Debtor is (check one): a below median income debtor with a 36 month applicable commitment period. an above median income debtor with a 60 month applicable commitment period. Tgth shall not be less than the Dunless the plan either provides for payment in full of allowed unsecured claims over a shorter period or is modified post-confirmation. If the Debtor is below median income, then the plan length shall automatically be extended up to 60 months after the first payment is due if necessary to complete the plan. III. Plan Payments to the Trustee: No later than 30 days after the order for relief, the Debtor shall commence making payments to the Trustee as follows: A. AMOUNT: $ B. FREQUENCY (check one): Monthly Twice per month Every two weeks Weekly C. TAX REFUNDS: The Debtor (check one): commits all tax refunds to funding the plan. Committed refunds shall be paid in addition to the plan payment amount stated above. does not commit all tax refunds to funding the plan. If no selection is made, tax refunds are committed. D. PAYMENTS: Plan payments shall be deducted from the D wages unless otherwise agreed to by the Trustee or ordered by the Court. E. OTHER: American LegalNet, Inc. www.FormsWorkFlow.com [Local Bankruptcy Form 13-4, eff. 12/17] 2 IV. Distribution of Plan Payments by the Trustee: Upon confirmation of the plan, the Trustee shall disburse funds received in the following order and creditors shall apply them accordingly, provided that disbursements for domestic support obligations and federal taxes shall be applied according to applicable non-bankruptcy law: A. ADMINISTRATIVE EXPENSES: 1. Trustee: The percentage set pursuant to 28 U.S.C. 247 586(e). 2. Other administrative expenses: As allowed pursuant to 11 U.S.C. 247247 507(a)(2) or 707(b). 3. The DAttorney's Fees: Pre-confirmation attorney fees and/or costs and expenses are estimated to be $. $ was paid prior to filing. Approved attorney compensation shall be paid as follows (check one): Prior to all creditors. Monthly payments of $. All remaining funds available after designated monthly payments to the following creditors:. Other: . If no selection is made, approved compensation will be paid after the monthly payments specified in Sections IV.B and IV.C. B. CURRENT DOMESTIC SUPPORT OBLIGATIONS: Creditor Monthly Amount $ $ C. SECURED CLAIMS: Only creditors holding allowed secured claims specified below or provided in Section X will receive payment from the Trustee. Unless ranked otherwise, payments to secured creditors will be disbursed at the same level. Secured creditors shall retain their liens until the earlier of payment of the underlying debt, determined under nonbankruptcy law, or discharge under 11 U.S.C. 247 1328. Secured creditors shall not assess any late charges, provided payments from the plan to the secured creditor are current, The interest rates in the plan control for a claim secured by a mortgage or deed of trust on real property shall control, unless otherwise provided in Section X or ordered following an objection to a proof of claim or in an adversary proceeding. If the interest rate is left blank, the interest rate shall be 12% except that the interest rate for arrearages on claims secured by a mortgage or deed of trust on real property shall be 0%. For claims secured by personal property, the monthly payment amounts in the plan control. and notice of payment change control unless otherwise provided in Section X. If overall plan payments are sufficient, the Trustee may increase or decrease post-petition installments for x holding accounts based on changes in interest rates, escrow amounts, dues and/or property taxes. 1. Payments on Claims, or Non-Escrowed Postpetition Property Tax Holding Accounts, Secured (Interest included in payments at contract rate, if applicable): Ongoing Payments: Rank Monthly Payment Creditor Collateral $ $ $ $ American LegalNet, Inc. www.FormsWorkFlow.com [Local Bankruptcy Form 13-4, eff. 12/17] 3 Cure Payments: Monthly Arrears to be Interest Rank Payment Creditor Collateral Cured Rate $ $ % $ $ % $ $ % $ $ % 2. Payments on Claims, or Non-Escrowed Postpetition Property Tax Holding Accounts, Secured by : Ongoing Payments: Rank Monthly Payment Creditor Collateral Interest Rate $ $ $ % % % Cure Payments: Monthly Arrears to be Interest Rank Payment Creditor Collateral Cured Rate $ $ % $ $ % $ $ % 3. Payments on Claims Secured by Personal Property: a. 910 Collateral: The Trustee shall pay the contract balance stated in the allowed proof of claim for a purchase-money security interest in any motor vehicle acquired for the personal use of the Debtor within 910 days preceding the filing date of the petition or in other personal property acquired within one year preceding the filing date of the petition as specified below. The Debtor stipulates that pre-confirmation adequate protection payments shall be paid by the Trustee in -Confirmation Adequate Protection Monthly , if blank, in the amounts stated as specified below after the creditor files a proof of claim. Pre-Confirmation Monthly Adequate Protection Interest Rank Payment Creditor Collateral Monthly Payment Rate $ $ % $ $ % $ $ % $ $ % b. Non-910 Collateral: The Trustee shall pay the value of collateral stated in the proof of claim, unless otherwise provided in Section X or ordered following a timely objection to a proof of claim or in an adversary proceeding, for a security interest in personal property which is non-910 collateral. The Debtor stipulates that pre-confirmation adequate protection payments shall be paid by the Trustee in the a-Confirmation as specified below after the creditor files a proof of claim. Rank Monthly Payment Creditor Value of Collateral Collateral Pre - Confirmation Adequate Protection Monthly Payment Interest Rate American LegalNet, Inc. www.FormsWorkFlow.com [Local Bankruptcy Form 13-4, eff. 12/17] 4 $ $ $ $ $ $ $ $ $ $ $ $ % % % % D. PRIORITY CLAIMS: Payment in full, on a pro rata basis, of filed and allowed claims entitled to priority in the order stated in 11 U.S.C. 247 507(a). E. NONPRIORITY UNSECURED CLAIMS: No funds shall be paid to nonpriority unsecured creditors until all secured, administrative and priority unsecured creditors are paid in full, provided that no claim shall be paid before it is due. The Trustee shall pay filed and allowed nonpriority unsecured claims as follows (check one): 100% At least $ . The Trustee shall pay the following specially classified nonpriority unsecured claims prior to other nonpriority unsecured claims: Amount of Percentage Reason for Special Rank Creditor Claim To be Paid Classification $ % $ % V. Direct Payments to be made by the Debtor and not by the Trustee: The following claims shall be paid directly by the Debtor according to the terms of the contract or support or withholding order, and shall receive no payments from the Trustee. (Payment stated shall not bind any party.) A. DIRECT PAYMENT OF DOMESTIC SUPPORT OBLIGATIONS: Creditor Current Monthly Support Obligation Monthly Arrearage Payment $ $ $ $ $ $ B. OTHER DIRECT PAYMENTS: Creditor Nature of Debt Amount of Claim Monthly Payment $ $ $ $ $ $ VI. Secured Property Surrendered: The secur