Free Debtor's Declaration Regarding Domestic Support Obligations - Illinois

UNITED STATES BANKRUPTCY COURT
Northern District of Illinois
In re
Debtor

Case No. ______________ DEBTOR'S DECLARATION REGARDING DOMESTIC SUPPORT OBLIGATIONS DISCHARGE) (REQUIRED(REQUIRED CHAPTER 13 DISCHARGE UNDER §1328(a)) TO OBTAIN TO OBTAIN
I certify (check one): During the pendency of this bankruptcy case, I have not been required to pay a domestic support obligation by any order of a court or administrative agency or by any statute. During the pendency of this bankruptcy case, I have paid all domestic support obligations that have become due under any order of a court or administrative agency or under any statute. If you checked the second box, you must provide the information below. My current address: _____________________________________________ _____________________________________________ _____________________________________________ My current employer and my employer's address: _____________________________________________ _____________________________________________ _____________________________________________ DECLARATION UNDER PENALTY OF PERJURY

I declare under penalty of perjury that I have read the foregoing statement and that it is true and correct to the best of my knowledge, information, and belief. _____________________________________ Signature of Debtor _____________________________________ Name of Debtor (Printed) Note: This form must be completed and filed with the court in order for the debtor to receive a discharge under §1328(a). In joint cases, the form must be completed and filed by each debtor.
Revised 05/01/09,

_________________________ Dated

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