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UNITED STATES BANKRUPTCY COURT
MIDDLE DISTRICT OF PENNSYLVANIA

LOCAL BANKRUPTCY FORMS

Effective: January 1, 2005
(Modified: March 12, 2009)

TABLE OF CONTENTS
FORM 1017-2 ­ Notice to Parties re: Motion to Dismiss Case . . . . . . . . . . . . . . . . . . . . . . . . . . 3 FORM 2016-1 ­ Summary Cover Sheet - Fees and Expenses Application . . . . . . . . . . . . . . . . . 4 FORM 3007-1 ­ Notice to Claimant of Objection to Claim . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 FORM 3015-1 ­ Chapter 13 Model Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 FORM 3015-2(a) ­ Certification Regarding Service of Amended Chapter 13 Plan (Altering Treatment of Claims) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 FORM 3015-2(b) ­ Certification Regarding Service of Amended Chapter 13 Plan (Altering Funding or Making Technical Amendments) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 FORM 3015-3(a) ­ Debtor's Pre-Confirmation Certification with Post Petition Obligations . . 17 FORM 3015-3(b) ­ Certification Regarding Domestic Support Obligation(s) . . . . . . . . . . . . . . 18 FORM 3015-5 ­ Debtor's Certification In Support of Discharge . . . . . . . . . . . . . . . . . . . . . . . . 19 FORM 3017-1 ­ Certification Regarding Amended Disclosure Statement . . . . . . . . . . . . . . . . 20 FORM 3018-1 ­ Section 1126 Ballot Report Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 FORM 3019-1 ­ Certification Regarding Amended Plan of Reorganization . . . . . . . . . . . . . . . 22 FORM 4001-1 ­ Post-Petition Payment History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 FORM 4008-1(a) ­ Reaffirmation Agreement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 FORM 4008-1(b) ­ Order on Reaffirmation Agreement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 FORM 9004-2 ­ Contested Matter Caption . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 FORM 9004-3 ­ Adversary Caption . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 FORM 9013-4 ­ Request to Continue Trial/Hearing with Concurrence . . . . . . . . . . . . . . . . . . . 37 FORM 9019-1 ­ Request to Remove from Hearing/Trial List . . . . . . . . . . . . . . . . . . . . . . . . . . 38

LOCAL BANKRUPTCY FORM 1017-2 IN THE UNITED STATES BANKRUPTCY COURT FOR THE MIDDLE DISTRICT OF PENNSYLVANIA IN RE: : : : : : : : : : : CHAPTER CASE NO. -bk-

Debtor(s) UNITED STATES TRUSTEE Movant vs. Respondent

NOTICE TO PARTIES IN INTEREST NOTICE IS HEREBY GIVEN THAT: The United States Trustee has filed a Motion to Dismiss the above-referenced case for failure to file schedules and statements. Objections to the Motion must be filed with the Clerk, United States Bankruptcy Court for the Middle District of Pennsylvania, Pennsylvania, on or before . , 20 , ,

A hearing on timely objections will be held at o'clock .M., in

Pennsylvania. If no objections are filed, an Order may be entered by the Court without further notice.

Dated:

Office of the United States Trustee P.O. Box 969 Harrisburg, PA 17108

LOCAL BANKRUPTCY FORM 2016-1 IN THE UNITED STATES BANKRUPTCY COURT FOR THE MIDDLE DISTRICT OF PENNSYLVANIA IN RE: : : : : : CHAPTER ____ CASE NO. -bk-

Debtor(s)

SUMMARY COVER SHEET FEES AND EXPENSES APPLICATION a. Your applicant was appointed on based on an application filed b. c. Your applicant represents This application is a (state whether interim or final application). d. The total amount of compensation for which reimbursement is sought is ________ and is for the period from e. to _______________. and is for . . ,

The total amount of expenses for which reimbursement is sought is the period from to .

f. g.

The dates and amounts of any retainer received are ________________. The dates and amounts of withdrawals from the retainer by the Applicant are _________________.

h.

The dates and amounts of previous compensation allowed are: .

i.

The dates and amounts of previous compensation paid are: .

j.

There are/are no objections to prior fee applications of Applicant that have not been ruled upon by the Court in this bankruptcy case. Applicant's Signature

DATED:

LOCAL BANKRUPTCY FORM 3007-1 IN THE UNITED STATES BANKRUPTCY COURT FOR THE MIDDLE DISTRICT OF PENNSYLVANIA IN RE: : : : : : : : : : : CHAPTER ____ CASE NO. -bk-

Debtor(s)

Objectant v.

Claimant

TO:

("Claimant") NOTICE TO CLAIMANT OF OBJECTION TO CLAIM Attached to this notice is an objection to your proof of claim.

Your claim may be reduced, modified, or eliminated. You should read this notice and the objection carefully and discuss them with your attorney, if you have one. The purpose of this notice is to advise you of the following rights: (a) Within thirty (30) days after the date of this notice you are required to file one of the following with the Clerk of the Bankruptcy Court: (1) (2) (3) an amended proof of claim; a response to the objection; or a request for a hearing.

(b) If you send your amended proof of claim, response or request for a hearing by mail or by delivery service, you must send it so that the Clerk of the Bankruptcy Court receives it by the deadline at the following address: Clerk, United States Bankruptcy Court Middle District of Pennsylvania Third and Walnut Streets P.O. Box 908 Harrisburg, PA 17108 or

Clerk, United States Bankruptcy Court Middle District of Pennsylvania 274 Max Rosenn U.S. Courthouse 197 S. Main Street Wilkes Barre, PA 18701 You are required concurrently to serve a copy of the amended proof of claim, response to the objection , or request for a hearing upon counsel for the objecting party at the following address: _____________________________ _____________________________ _____________________________ If you do not file an amended proof of claim, a response to the objection, or a request for a hearing within thirty (30) days after the date of this notice, the Court may grant the relief requested in the objection and disallow or modify your claim without further notice or hearing. (c) You are entitled to a hearing on the objection if you file either a written response to the objection or a written request for a hearing with the Court within thirty (30) days after the date of this notice. You may request that the hearing on the objection be conducted by telephone. A request that the hearing be conducted by telephone must be made at least five (5) days before the date on which the hearing is scheduled to take place. The court, in its discretion, may allow you to participate in the hearing by telephone. You may have other rights not referred to in this Notice.

(d)

(e)

This notice is not intended to advise you of all your rights regarding your claim and is not intended to provide legal advice. If you decline to obtain counsel regarding the attached objection, you do so at your own risk. IF YOU FAIL TO RESPOND IN ACCORDANCE WITH THIS NOTICE, THE COURT MAY GRANT THE RELIEF REQUESTED BY THE OBJECTION WITHOUT FURTHER NOTICE OR HEARING. This Notice was mailed to you by: Date of Notice and Date of Mailing: ________________, 20___

(2)

Rev. 03/12/09

LOCAL BANKRUPTCY FORM 3015-1 IN THE UNITED STATES BANKRUPTCY COURT FOR THE MIDDLE DISTRICT OF PENNSYLVANIA IN RE: : : : : : : : : : : : CHAPTER 13 CASE NO. -bk-

Debtor(s)

CHAPTER 13 PLAN (Indicate if applicable) ( ) MOTION TO AVOID LIENS ( ) MOTION TO VALUE COLLATERAL ( ( ) ORIGINAL PLAN ) AMENDED PLAN (Indicate 1ST, 2ND, 3RD, etc.)

YOUR RIGHTS WILL BE AFFECTED If you oppose any provision of this plan you must file a timely written objection. This plan may be confirmed and become binding on you without further notice or hearing unless a written objection is filed before the deadline stated on the Notice issued in connection with the filing of the plan

PLAN PROVISIONS DISCHARGE: ( ( ) ) (Check one)

The debtor will seek a discharge of debts pursuant to Section 1328(a). The debtor is not eligible for a discharge of debts because the debtor has previously received a discharge described in Section 1328(f). (Check if applicable)

NOTICE OF SPECIAL PROVISIONS: ( )

This plan contains special provisions that are not included in the standard plan as approved by the U.S. Bankruptcy Court for the Middle District of Pennsylvania. Those provisions are set out in the OTHER PLAN PROVISIONS section of this plan.

1.

PLAN FUNDING AND LENGTH OF PLAN A. Payments by the debtor of $ per month for months. This monthly plan payment will begin no later than 30 days following the date of the filing of the bankruptcy petition or the date of conversion to Chapter 13.

Rev. 03/12/09

B.

In addition to the above specified plan payments, the debtor agrees to dedicate to the plan the estimated amount of sale proceeds as follows: $ from the . sale of property (describe property) All sales will be completed by . Other lump sum payments shall be paid to the trustee as follows: Other payments from any source (describe specifically) shall be paid to the trustee as follows:

C.

For amended plans: (1) The plan payments by the debtor shall consist of the total amount previously paid ($ ) added to the new monthly payment in the amount of $ for the remaining months of the plan for a total base amount, as amended, of $ , plus other payments and property stated in Paragraph B above. (2) (3) The payment amount shall change effective .

The debtor shall take appropriate action to ensure that all wage attachment payments are adjusted to conform to the terms of the amended plan.

D. 2.

The debtor is responsible for funding the plan.

SECURED CLAIMS A. Adequate Protection Payments under Section 1326. Adequate protection payments in the following amounts will be paid by the debtor to the trustee. The trustee will disburse pre-confirmation adequate protection payments for which a proof of claim has been filed as soon as practicable after receipt of said payments from the debtor.
Address Account # $ Payment

Name of Creditor

$

B.

Mortgages and Other Direct Payments by Debtor. Payments will be made outside the plan according to the original contract terms, with no modification of contract terms and with liens retained.

2

Rev. 03/12/09 Contractual Monthly Payment $ $ Principal Balance of Claim Contract Rate of Interest %

Name of Creditor

Description of Collateral

$

$

%

$

$

%

$

$

%

C.

Arrears.
Pre-petition Arrears to be Cured $ Interest Rate % $ Total to be paid in plan

Name of Creditor

Description of Collateral

$

% $

$

% $

$

% $

D.

Secured Claims Paid According to Modified Terms. These amounts will be paid in the plan according to modified terms, and liens retained until entry of discharge. The excess of the creditor's claim will be treated as an unsecured claim. Any claim listed as "NO VALUE" in the "Modified Principal Balance" column below will be treated as an unsecured claim. THE LIENS WILL BE AVOIDED OR LIMITED IN THE PLAN OR AN ADVERSARY ACTION WILL BE FILED UNDER SECTION 506(a) TO DETERMINE THE EXTENT, VALIDITY, AND PRIORITY OF THE LIEN (Select method in last column):
Description of Collateral Modified Principal Balance $
Interest Rate

Name of Creditor

Total Payment

Plan* or Adversary Action

% $

3

Rev. 03/12/09 $ % $

$

% $

* PLAN INDICATES THAT THE DEBTOR PROPOSES TO AVOID OR LIMIT THE LIEN OF THE CREDITOR IN THIS PLAN. CONFIRMATION OF THE PLAN SHALL CONSTITUTE A FINDING OF VALUATION PURSUANT TO SECTION 506(a). NO ADVERSARY COMPLAINT OR MOTION WILL BE FILED AND THE LIEN WILL BE AVOIDED. IF THE CREDITOR WISHES TO CONTEST THE AVOIDANCE OF THE LIEN, THE CREDITOR MUST FILE AN OBJECTION TO THIS PLAN. OTHERWISE CONFIRMATION OF THE PLAN WILL AVOID THE LIEN. E. Other Secured Claims.
Principal balance of Claim $ Interest Rate % $ Total to be paid in plan

Name of Creditor

Description of Collateral

$

% $

$

% $

F.

Surrender of Collateral:
Name of Creditor Description of Collateral to be Surrendered

G.

Lien Avoidance. The debtor moves to avoid the liens of the following creditors pursuant to Section 522(f):
Name of Creditor Description of Collateral

4

Rev. 03/12/09

H.

Payment of claim secured by mortgage/ lien. The debtor owns real property , used as a principal residence located at which is subject to one or more mortgages/liens. All mortgage and/or long-term lien claim balances survive the plan if not paid in full under the plan. The trustee shall distribute the amount of pre-petition arrearages set forth in the allowed proof of claim to each secured creditor. If the debtor and/or the trustee objects to a proof of claim and the objection is sustained, or if the plan provides for payment of amounts greater than the allowed proof of claim, the creditor's claim will be paid in the amount allowed by the court.

3.

PRIORITY CLAIMS A. Allowed unsecured claims entitled to priority under section 507 will be paid in full with the exception of certain assigned Domestic Support Obligations that may be paid less than 100% pursuant to section 1322(a)(4):
Name of Creditor
$ $ $

Total Payment

B.

Administrative Claims: (1) Trustee fees. Percentage fees payable to the trustee will be paid at the rate fixed by the United States Trustee, not to exceed 10%. Attorney fees. In addition to the retainer of $ debtor, the amount of $ already paid by the in the plan.

(2)

4.

UNSECURED CLAIMS A. Claims of Unsecured Nonpriority Creditors Specially Classified. Includes unsecured claims, such as co-signed unsecured debts, that will be paid in full even though all other unsecured claims may not be paid in full.
Reason for Special Classification $ Amount of Claim Interest Total Payment Rate % $

Name of Creditor

$

% $

5

Rev. 03/12/09

B.

Claims of General Unsecured Creditors. The debtor estimates that a total of $ will be available for distribution to unsecured creditors. The debtor must be paid to unsecured creditors in calculates that a minimum of $ order to comply with the liquidation test for confirmation and the debtor calculates that a minimum of $ must be paid to unsecured, non-priority creditors in order to comply with the Means Test.

5.

EXECUTORY CONTRACTS AND UNEXPIRED LEASES. The following executory contracts and unexpired leases are assumed (and pre-petition arrears to be cured in the plan) or rejected (so indicate):
Name of Creditor Description of Collateral Monthly Interest Pre-petition Payment Rate Arrears $ $ % $ % $ $ $ Total Payment Assume/ Reject

6.

REVESTING OF PROPERTY: (Check One) ( ( ) ) Property of the estate will vest in the debtor upon confirmation. Property of the estate will vest in the debtor upon closing of the case.

7. ( )

OTHER PLAN PROVISIONS A. Optional provision regarding duties of certain mortgage holders and servicers. Property of the estate vests upon closing of the case, and debtor elects to include the following provisions. (Check if applicable) Confirmation of the plan shall impose an affirmative duty on the holders and/or servicers of any claims secured by liens, mortgages and or/deeds of trust on the principal residence of the debtor to do the following: (1) Apply the payments received from the trustee on the pre-petition arrearage, if any, only to such arrearage. For purposes of this plan, the "pre-petition arrearage" shall include all sums included in the "allowed" proof of claim and shall have a "0" balance after both: (1) the Discharge Order in this case has been entered; and (2) payment in full of the allowed proof of claim has been made. Deem the pre-petition arrearage as contractually current upon confirmation of the plan, thereby precluding the imposition of late payment charges or other default-related fees and services based solely on the pre-petition default or defaults. Apply the post-petition monthly mortgage payments made by the debtor to 6

(2)

(3)

Rev. 03/12/09

the post-petition mortgage obligations as provided for by the terms of the underlying mortgage note. Late charges may be assessed on post-petition payments as provided by the terms of the mortgage and note. (4) Notify the debtor and the attorney for the debtor, in writing, of any changes in the interest rate for any non-fixed rate or adjustable rate mortgages and the effective date of any such adjustment or adjustments not less than 60 days in advance of such change or at such time as the change becomes known to the holder if the change is to be implemented in less than 60 days. Notify the debtor, and the attorney for the debtor, in writing, of any change in the property taxes and/or the property insurance premiums that would either increase or reduce the escrow portion, if any, of the monthly mortgage payments and the effective date of any such adjustment or adjustments not less than 60 days in advance of such change or at such time as the change becomes know to the holder if the change is to be implemented in less than 60 days. Within 60 days after receipt of a written request made by the debtor to the servicer or mortgage lender, with a copy served upon its counsel, the servicer or mortgage lender shall provide debtor and his counsel a statement detailing the following amounts paid by the debtor post-petition: (1) all payments applied to the principal balance; (2) all payments applied to interest; (3) all payments applied to any escrow account; (4) all payments applied to any pre-petition arrearage claim and the remaining balance; and (5) all fees and charges alleged to have accrued post-petition, along with an explanation thereof. The statement may be in the form of a post-petition ledger prepared by the servicer or lender provided the documents used to prepare same are also provided. The debtor may (i) challenge this information by filing a motion with the court, to be served upon the holder and the Trustee, (ii) propose a modified plan to provide for payment of additional amounts that the debtor acknowledges or the court determines are due, or (iii) take no action at all. To the extent that amounts set forth are not determined by the court to be invalid or are not paid by the debtor through a modified plan, the rights of the holder to collect these amounts will be unaffected.

(5)

(6)

(

)

B.

Other provisions. (Check if applicable. Describe below.)

7

Rev. 03/12/09

8.

ORDER OF DISTRIBUTION:

Payments from the plan will be made by the trustee in the following order: Level 1: Level 2: Level 3: Level 4: Level 5: Level 6: Level 7: Level 8: If the above Levels are not filled-in, then the order of distribution of plan payments will be determined by the trustee using the following as a guide: Level 1: Adequate protection payments. Level 2: Debtor's attorney's fees. Level 3: Domestic Support Obligations. Level 4: Priority claims, pro rata. Level 5: Secured claims, pro rata. Level 6: Specially classified unsecured claims. Level 7: General unsecured claims. Level 8: Untimely filed unsecured claims to which the debtor has not objected. GENERAL PRINCIPLES APPLICABLE TO ALL PLANS All pre-petition arrears and cramdowns shall be paid to the trustee and disbursed to creditors through the plan. If a pre-petition creditor files a secured, priority or specially classified claim after the bar date, the trustee will treat the claim as allowed, subject to objection by the debtor. Claims filed after the bar date that are not properly served on the trustee will not be paid. The debtor is responsible for reviewing claims and filing objections, if appropriate. Dated: ___________________________ Attorney for Debtor

Debtor

Joint Debtor

8

Rev. 06/23/08

LOCAL BANKRUPTCY FORM 3015-2(a) IN THE UNITED STATES BANKRUPTCY COURT FOR THE MIDDLE DISTRICT OF PENNSYLVANIA IN RE: : : : : : CHAPTER 13

Debtor(s)

CASE NO.

-

-bk-

CERTIFICATION REGARDING SERVICE OF AMENDED CHAPTER 13 PLAN (Altering Treatment of Claims) The undersigned, counsel for the above-captioned Debtor(s), hereby certifies that the Amended Chapter 13 Plan filed on proposes to alter the treatment

of the claims of the following creditors included in the confirmed Chapter 13 Plan:

I further certify that notice of the filing of the

Amended Chapter 13 Plan has

been served on the above listed creditors and the Chapter 13 trustee and that no other party, other than the creditors listed above, will be affected by the provisions of the Chapter 13 Plan. Amended

Counsel for Debtor(s)

Dated:

Rev. 06/23/08

LOCAL BANKRUPTCY FORM 3015-2(b) IN THE UNITED STATES BANKRUPTCY COURT FOR THE MIDDLE DISTRICT OF PENNSYLVANIA IN RE: : : : : : CHAPTER 13

Debtor(s)

CASE NO.

-

-bk-

CERTIFICATION REGARDING SERVICE OF AMENDED CHAPTER 13 PLAN (Altering Funding or Making Technical Amendments) The undersigned, counsel for the above-captioned Debtor(s), hereby certifies that the Amended Chapter 13 Plan filed on proposes to alter the funding

of, or to make technical amendments to, the Chapter 13 Plan confirmed on _________________, but does not affect the treatment of the claims of any creditors included in the confirmed Plan, including the amounts to be paid, the timing of the payments or the treatment of collateral: I further certify that the Amended Chapter 13 Plan has been served on the

Chapter 13 trustee, and because none of the claims provided for in the plan will be affected by the provisions of the Amended Chapter 13 Plan, no further notice is required.

Counsel for Debtor(s)

Dated:

LOCAL BANKRUPTCY FORM 3015-3(a) IN THE UNITED STATES BANKRUPTCY COURT FOR THE MIDDLE DISTRICT OF PENNSYLVANIA IN RE: : : : : : CHAPTER ____ CASE NO. -bk-

Debtor(s)

DEBTOR'S PRE-CONFIRMATION CERTIFICATION OF COMPLIANCE WITH POST PETITION OBLIGATIONS I, 1. , upon oath or affirmation, hereby certify as follows: That the below information is being supplied for compliance with the confirmation hearing date on ___________________________. That all post-petition amounts that are required to be paid under any and all Domestic Support Obligations have been paid. That all applicable Federal, State, and local tax returns, as required by 11 U.S.C. Section 1308 have been filed. If the confirmation hearing date stated in Paragraph 1 is adjourned for any reason, that an updated Certification will be filed with the Court prior to any subsequent confirmation hearing date in the event any of the information contained in this Certification changes. If this Certification is being signed by counsel for Debtor(s), that the Debtor(s) was/were duly questioned about the statements in this Certification and supplied answers consistent with this Certification.

2.

3.

4.

5.

I hereby certify that the foregoing statements made by me are true. I am aware that if any of the foregoing statements made by me are willfully false, I am subject to punishment for perjury. DATED:__________________ BY:______________________________ Counsel for Debtor(s) BY:______________________________ Debtor BY:______________________________ Debtor

DATED:__________________

DATED:__________________

Rev. 12/19/08

LOCAL BANKRUPTCY FORM 3015-3(b) IN THE UNITED STATES BANKRUPTCY COURT FOR THE MIDDLE DISTRICT OF PENNSYLVANIA IN RE: : : : : : CHAPTER ____ CASE NO. -bk-

Debtor

CERTIFICATION REGARDING DOMESTIC SUPPORT OBLIGATION(S)
If there are domestic support obligation claims in a case, the Bankruptcy Abuse Prevention and Consumer Protection Act of 2005 requires the trustee to provide written notice to the holder of the claim and to the applicable state child support enforcement agency. In order for the trustee to comply with the Act, the Debtor/Obligor must complete the following information and verify the information is true and correct by signing at the bottom of this form. 1. Name of Domestic Support Obligee Claim Holder ______________________________________________________________________ Last Name First Middle Initial 2. Address of Domestic Support Obligee Claim Holder __________________________________________________________________ Street City __________________________________________________________________ State Zip County 3. Telephone Number of Domestic Support Obligee Claim Holder ________________________________ (Area Code) Phone Number 4. If you are paying a Domestic Support Obligation pursuant to a Court Order, provide the following: _______________________________________________________________ Name of Court _______________________________________________________________ Address of Court _______________________________________________________________ PACSES Number Docket Number The undersigned hereby certifies that the foregoing statements are true and correct under penalty of perjury. DATED: _____________________ BY: ______________________________ Debtor

LOCAL BANKRUPTCY FORM 3015-5 IN THE UNITED STATES BANKRUPTCY COURT FOR THE MIDDLE DISTRICT OF PENNSYLVANIA IN RE: : : : : : CHAPTER 13 CASE NO. -bk-

Debtor(s)

DEBTOR'S CERTIFICATION IN SUPPORT OF DISCHARGE I, follows: 1. My current address is: ___________________________ ___________________________ ___________________________ The name and address of my current employer is: _______________________________________ _______________________________________ _______________________________________ _______________________________________ _____ I am not required to pay any Domestic Support Obligations, or _____ I am required to pay Domestic Support Obligations and I have paid any amounts payable under a Court Order or Statute that were due on or before the date of this Certification. If this Certification is being signed by counsel for Debtor(s), that the Debtor(s) was/were duly questioned about the statements in this Certification and supplied answers consistent with this Certification. , upon my oath according to law, hereby certify as

2.

3.

4.

I hereby swear or affirm under penalty of perjury under United States laws that the foregoing statements made by me are true and correct (28 U.S.C. Section 1746; 18 U.S.C. Section 1621.) DATED:__________________ BY:_______________________________ Counsel for Debtor(s) BY:_______________________________ Debtor BY:_______________________________ Debtor

DATED:__________________

DATED:__________________

LOCAL BANKRUPTCY FORM 3017-1 IN THE UNITED STATES BANKRUPTCY COURT FOR THE MIDDLE DISTRICT OF PENNSYLVANIA IN RE: : : : : : CHAPTER ____ CASE NO. -bk-

Debtor(s)

CERTIFICATION REGARDING AMENDED DISCLOSURE STATEMENT The undersigned counsel for the plan proponent in the above-captioned case, hereby certifies that the Amended Disclosure Statement, filed ____________________, contains changes to the Disclosure Statement, filed ______________, of such nature and degree that: 1. ________ notice must be circulated as if an original Disclosure Statement; 2. ________ notice need be sent only to the objectors to the last filed Disclosure Statement; 3. ________ no further notice is required and the Amended Disclosure Statement can be approved as submitted.

Dated: _________________

______________________________ Counsel for Plan Proponent

LOCAL BANKRUPTCY FORM 3018-1 IN THE UNITED STATES BANKRUPTCY COURT FOR THE MIDDLE DISTRICT OF PENNSYLVANIA IN RE: : : : : : CHAPTER ____ CASE NO. __-___ -bk-_________

Debtor(s)

SECTION 1126 BALLOT REPORT FORM
# BALLOTS CAST CLASS I # ACCEPTING # REJECTING $ ACCEPTING $ REJECTING CLASS ACCEPTING CLASS REJECTING

CLASS II

CLASS III

CLASS IV

The following classes are impaired:

.

Copies of all ballots not accepted are attached. An explanation of why the ballots were rejected, if applicable, is attached.

PLAN ACCEPTED

YES

NO

The foregoing Report is accurate and complete.

Dated: Counsel for Plan Proponent

LOCAL BANKRUPTCY FORM 3019-1

IN THE UNITED STATES BANKRUPTCY COURT FOR THE MIDDLE DISTRICT OF PENNSYLVANIA IN RE: : : : : : CHAPTER 11 CASE NO. -bk-

Debtor(s)

CERTIFICATION REGARDING AMENDED PLAN OF REORGANIZATION The undersigned counsel for the plan proponent in the above-captioned case, hereby certifies that the Amended Plan of Reorganization, filed ____________________, contains changes to the Plan of Reorganization, filed ______________, of such nature and degree that: 1. 2. 3. notice must be circulated as if an original Plan of Reorganization; notice need be sent only to the objectors to the last filed Plan of Reorganization; no further notice is required and the Amended Plan of Reorganization can be confirmed as submitted. All pending objections to confirmation of the Plan of Reorganization have been resolved or settled by the modifications included in the Amended Plan of Reorganization, and the Amended Plan of Reorganization complies with the requirements of 11 U.S.C. § 1123 and § 1129.

Dated: _________________

______________________________ Counsel for Plan Proponent

LOCAL BANKRUPTCY FORM 4001-1 IN THE UNITED STATES BANKRUPTCY COURT FOR THE MIDDLE DISTRICT OF PENNSYLVANIA IN RE: : : : : : CHAPTER 13

CASE NO.

-

-bk-

Debtor(s)

POST-PETITION PAYMENT HISTORY NOTE AND MORTGAGE DATED ______________________ Recorded on __________, in ___________________ County, in Book _____, at Page______. Property Address: __________________________________________________________________ Mortgage Servicer: __________________________________________________________________ Post-petition mailing address for Debtor(s) to send payment: __________________________________________________________________ Mortgagor(s)/Debtor(s): ____________________________________________________________ Payments are contractually due: Monthly____ Semi-monthly_____ Bi-weekly______ Other _______________

Each Monthly Payment is comprised of: Principal and Interest....... ____________________ R.E. Taxes...................... ____________________ Insurance........................ ____________________ Late Charge.................... ____________________ Other.............................. ____________________ (Specify: ______________________) TOTAL......................... ____________________ POST-PETITION PAYMENTS (Petition was filed on ________________)

Payment amount due

Date payment was due

Date payment was received

Amount received

Check number

How payment was applied (mo./yr.)

[Continue on attached sheets if necessary] TOTAL NUMBER OF _________________. POST-PETITION PAYMENTS PAST DUE: _____________as of

TOTAL AMOUNT OF POST-PETITION ARREARS: _______________ as of _______________.

Dated: _________________

______________________________ Counsel

______________________________ Mortgage Company

(2)

G Presumption of Undue Hardship G No Presumption of Undue Hardship (Check box as directed in Part D: Debtor's Statement in Support of Reaffirmation Agreement)

LOCAL BANKRUPTCY FORM 4008-1(a) IN THE UNITED STATES BANKRUPTCY COURT FOR THE MIDDLE DISTRICT OF PENNSYLVANIA IN RE: : : : : : CHAPTER ____ CASE NO. -bk-

Debtor(s)

REAFFIRMATION AGREEMENT [Indicate all documents included in this filing by checking each applicable box.] G Part A; Disclosures, Instructions, and Notice to Debtor (pages 1­5) G Part B: Reaffirmation Agreement G Part D: Debtor's Statement in Support of Reaffirmation Agreement G Part E: Motion for Court Approval

G Part C: Certification by Debtor's Attorney [Note: Complete Part E only if debtor was not represented by an attorney during the course of negotiating this agreement. Note Also: If you complete Part E, you must prepare and file Order on Reaffirmation Agreement (L.B.F. 4008-1(b)] PART A: DISCLOSURE STATEMENT, INSTRUCTIONS AND NOTICE TO DEBTOR 1. DISCLOSURE STATEMENT

Before Agreeing to Reaffirm a Debt, Review These Important Disclosures: SUMMARY OF REAFFIRMATION AGREEMENT This Summary is made pursuant to the requirements of the Bankruptcy Code. AMOUNT REAFFIRMED The amount of debt you have agreed to reaffirm $

The amount of debt you have agreed to reaffirm includes al fees and costs (if any) that have accrued as of the date of this disclosure. Your credit agreement may obligate you to pay additional amounts which may come due after the date of this disclosure. Consult your credit agreement.

P.2 ANNUAL PERCENTAGE RATE [The annual percentage rate can be disclosed in different ways, depending on the type of debt.] a. If the debt is an extension of "credit" under an "open end credit plan," as those terms are defined in § 103 of the Truth in Lending Act, such as a credit card, the creditor may disclose the annual percentage rate shown in (i) below or, to the extent this rate is not readily available or not applicable, the simple interest rate shown in (ii) below, or both. (i) The Annual Percentage Rate disclosed, or that would have been disclosed, to the debtor in the most recent periodic statement prior to entering into the reaffirmation agreement described in Part B below or, if no such periodic statement was given to the debtor during the prior six months, the annual percentage rate as it would have been so disclosed at the time of the disclosure statement: %. ­ And/Or ­ (ii) The simple interest rate applicable to the amount reaffirmed as of the date this disclosure statement is given to the debtor: %. If different simple interest rates apply to different balances included in the amount reaffirmed, the amount of each balance and the rate applicable to it are: $ $ $ @ @ @ %; %; %;

b. If the debt is an extension of credit other than under an open end credit plan, the creditor may disclose the annual percentage rate shown in (i) below, or, to the extent this rate is not readily available or not applicable, the simple interest rate shown in (ii) below, or both. (i) The Annual Percentage Rate under §128(a)(4) of the Truth in Lending Act, as disclosed to the debtor in the most recent disclosure statement given to the debtor prior to entering into the reaffirmation agreement with respect to the debt or, if no such disclosure statement was given to the debtor, the annual percentage rate as it would have been so disclosed: %. ­ And/Or ­ (ii) The simple interest rate applicable to the amount reaffirmed as of the date this disclosure statement is given to the debtor: %. If different simple interest rates apply to different balances included in the amount reaffirmed,

P.3 the amount of each balance and the rate applicable to it are: $ @ %; @ %; $ $ @ %; c. If the underlying debt transaction was disclosed as a variable rate transaction on the most recent disclosure given under the Truth in Lending Act: The interest rate on your loan may be a variable interest rate which changes from time to time, so that the annual percentage rate disclosed here may be higher or lower. d. If the reaffirmed debt is secured by a security interest or lien, which has not been waived or determined to be void by a final order of the court, the following items or types of items on the debtor's goods or property remain subject to such security interest or lien in connection with the debt or debts being reaffirmed in the reaffirmation agreement described in Part B. Item or Type of Item Original Purchase Price or Original Amount of Loan

Optional -- At the election of the creditor, a repayment schedule using one or a combination of the following may be provided: Repayment Schedule: Your first payment in the amount of $ is due on (date), but the future payment amount may be different. Consult your reaffirmation agreement or credit agreement, as applicable. - - - Or - - Your payment schedule will be: (number) payments in the amount of $ each, payable (monthly, annually, weekly, etc.) on the (day) of each (week, month, etc.), unless altered later by mutual agreement in writing. - - - Or - - A reasonably specific description of the debtor's repayment obligations to the extent known by the creditor or creditor's representative.

P.4 2. INSTRUCTIONS AND NOTICE TO DEBTOR

Reaffirming a debt is a serious financial decision. The law requires you to take certain steps to make sure the decision is in your best interest. If these steps are not completed, the reaffirmation agreement is not effective, even though you have signed it. 1. Read the disclosures in this Part A carefully. Consider the decision to reaffirm carefully. Then, if you want to reaffirm, sign the reaffirmation agreement in Part B (or you may use a separate agreement you and your creditor agree on). 2. Complete and sign Part D and be sure you can afford to make the payments you are agreeing to make and have received a copy of the disclosure statement and a completed and signed reaffirmation agreement. 3. If you were represented by an attorney during the negotiation of your reaffirmation agreement, the attorney must have signed the certification in Part C. 4. If you were not represented by an attorney during the negotiation of your reaffirmation agreement, you must have completed and signed Part E. 5. The original of this disclosure must be filed with the court by you or your creditor. If a separate reaffirmation agreement (other than the one in Part B) has been signed, it must be attached. 6. If the creditor is not a Credit Union and you were represented by an attorney during the negotiation of your reaffirmation agreement, your reaffirmation agreement becomes effective upon filing with the court unless the reaffirmation is presumed to be an undue hardship as explained in Part D. If the creditor is a Credit Union and you were represented by an attorney during the negotiation of your reaffirmation agreement, your reaffirmation agreement becomes effective upon filing with the court. 7. If you were not represented by an attorney during the negotiation of your reaffirmation agreement, it will not be effective unless the court approves it. The court will notify you and the creditor of the hearing on your reaffirmation agreement. You must attend this hearing in bankruptcy court where the judge will review your reaffirmation agreement. The bankruptcy court must approve your reaffirmation agreement as consistent with your best interests, except that no court approval is required if your reaffirmation agreement is for a consumer debt secured by a mortgage, deed of trust, security deed, or other lien on your real property, like your home.

P.5 YOUR RIGHT TO RESCIND (CANCEL) YOUR REAFFIRMATION AGREEMENT You may rescind (cancel) your reaffirmation agreement at any time before the bankruptcy court enters a discharge order, or before the expiration of the 60-day period that begins on the date your reaffirmation agreement is filed with the court, whichever occurs later. To rescind (cancel) your reaffirmation agreement, you must notify the creditor that your reaffirmation agreement is rescinded (canceled).

Frequently Asked Questions: What are your obligations if you reaffirm the debt? A reaffirmed debt remains your personal legal obligation. It is not discharged in your bankruptcy case. That means if you default on your reaffirmed debt after your bankruptcy case is over, your creditor may be able to take your property or your wages. Otherwise, your obligations will be determined by the reaffirmation agreement which may have changed the terms of the original agreement. For example, if you are reaffirming an open end credit agreement, the creditor may be permitted by that agreement or applicable law to change the terms of that agreement in the future under certain conditions. Are you required to enter into a reaffirmation agreement by any law? No, you are not required to reaffirm a debt by any law. Only agree to reaffirm a debt if it is in your best interest. Be sure you can afford the payments you agree to make. What if your creditor has a security interest or lien? Your bankruptcy discharge does not eliminate any lien on your property. A "lien" is often referred to as a security interest, deed of trust, mortgage, or security deed. Even if you do not reaffirm and your personal liability on the debt is discharged, because of the lien your creditor may still have the right to take the security property if you do not pay the debt or default on it. If the lien is on an item of personal property that is exempt under your State's law or that the trustee has abandoned, you may be able to redeem the item rather than reaffirm the debt. To redeem, you make a single payment to the creditor equal to the current value of the security property, as agreed by the parties or determined by the court. NOTE: When this disclosure refers to what a creditor "may" do, it does not use the word "may" to give the creditor specific permission. The word "may" is used to tell you what might occur if the law permits the creditor to take the action. If you have questions about reaffirming a debt or what the law requires, consult with the attorney who helped you negotiate this agreement reaffirming a debt. If you don't have an attorney helping you, the judge will explain the effect of reaffirming a debt when the hearing on the reaffirmation agreement is held.

P.6 PART B: REAFFIRMATION AGREEMENT I (we) agree to reaffirm the debts arising under the credit agreement described below. 1. Brief description of credit agreement.

2. Description of any changes to the credit agreement made as part of this reaffirmation agreement:

SIGNATURE(S): Borrower: Accepted by creditor:

(Print Name)

(Print Name of Creditor)

(Signature) Date:

(Address of Creditor)

(Signature)
Co-borrower, if also reaffirming these debts:

__________________________________________
(Printed name and Title of Individual Signing for Creditor)

_________________________ (Print Name) _________________________ (Signature) Date: ________________

Date of creditor acceptance: _____________________

P.7 PART C: CERTIFICATION BY DEBTOR'S ATTORNEY (IF ANY). [Check each applicable box.] 9 I hereby certify that (1) this agreement represents a fully informed and voluntary agreement by the debtor; (2) this agreement does not impose an undue hardship on the debtor or any dependent of the debtor; and (3) I have fully advised the debtor of the legal effect and consequences of this agreement and any default under this agreement. 9 [Check box, if applicable and the creditor is not a Credit Union.] A presumption of undue hardship has been established with respect to this agreement. In my opinion, however, the debtor is able to make the required payment.

Printed Name of Debtor's Attorney: Signature of Debtor's Attorney: Date:

P.8

PART D: DEBTOR'S STATEMENT IN SUPPORT OF REAFFIRMATION AGREEMENT [Read and complete numbered paragraphs 1 and 2, OR, if the creditor is a Credit Union and the debtor is represented by an attorney, read section 3. Sign the appropriate signature line(s) and date your signature. If you complete sections 1 and 2 and your income less monthly expenses does not leave enough to make the payments under this reaffirmation agreement, check the box at the top of page 1 indicating "Presumption of Undue Hardship." Otherwise, check the box at the top of page 1 indicating "No Presumption of Undue Hardship."] 1. I believe this reaffirmation agreement will not impose an undue hardship on my dependents or me. I can afford to make the payments on the reaffirmed debt because my monthly , and my actual current income (take home pay plus any other income received) is $ monthly expenses including monthly payments on post-bankruptcy debt and other reaffirmation agreements total $ , leaving $ to make the required payments on this reaffirmed debt. I understand that if my income less my monthly expenses does not leave enough to make the payments, this reaffirmation agreement is presumed to be an undue hardship on me and must be reviewed by the court. However, this presumption may be overcome if I explain to the satisfaction of the court how I can afford to make the payments here: _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ (Use an additional page if needed for a full explanation.) 2. I received a copy of the Reaffirmation Disclosure Statement in Part A and a completed and signed reaffirmation agreement. Signed: (Debtor) (Joint Debtor, if any) Date:
-- Or --

[If the creditor is a Credit Union and the debtor is represented by an attorney] 3. I believe this reaffirmation agreement is in my financial interest. I can afford to make the payments on the reaffirmed debt. I received a copy of the Reaffirmation Disclosure Statement in Part A and a completed and signed reaffirmation agreement. Signed: (Debtor)
Date:

(Joint Debtor, if any)

P.9

PART E: MOTION FOR COURT APPROVAL [To be completed only if the debtor is not represented by an attorney during the course of negotiating this agreement.] MOTION FOR COURT APPROVAL OF REAFFIRMATION AGREEMENT I (we), the debtor(s), affirm the following to be true and correct: I am not represented by an attorney in connection with this reaffirmation agreement. I believe this reaffirmation agreement is in my best interest based on the income and expenses I have disclosed in my Statement in Support of this reaffirmation agreement, and because (provide any additional relevant reasons the court should consider):

Therefore, I ask the court for an order approving this reaffirmation agreement under the following provisions (check all applicable boxes): G 11 U.S.C. § 524(c)(6) (debtor is not represented by an attorney during the course of the negotiation of the reaffirmation agreement) G 11 U.S.C. § 524(m) (presumption of undue hardship has arisen because monthly expenses exceed monthly income

Signed: (Debtor)

(Joint Debtor, if any) Date:

LOCAL BANKRUPTCY FORM 4008-1(b) IN THE UNITED STATES BANKRUPTCY COURT FOR THE MIDDLE DISTRICT OF PENNSYLVANIA IN RE: : : : : : CHAPTER ____ CASE NO. -bk-

Debtor(s)

ORDER ON REAFFIRMATION AGREEMENT Debtor(s) having filed a motion for approval of the reaffirmation agreement dated _____________ between creditor, __________________________________________, and Debtor(s) and a hearing as required by 11 U.S.C. § 524(d) on notice to Debtor(s) and the creditor having been held on ___________________. It is hereby ORDERED that: G The Court grants the motion of Debtor(s) under 11 U.S.C. § 524(c)(6)(A) and approves the reaffirmation agreement described above as not imposing an undue hardship on Debtor(s) or a dependent of Debtor(s) and as being in the best interest of Debtor(s). G The Court grants the motion of Debtor(s) under 11 U.S.C. § 524(k)(8) and approves the reaffirmation agreement described above. G The Court disapproves the reaffirmation agreement under 11 U.S.C. § 524(m). G The Court does not approve the reaffirmation agreement.

LOCAL BANKRUPTCY FORM 9004-2 [Contested Matter Caption] IN THE UNITED STATES BANKRUPTCY COURT FOR THE MIDDLE DISTRICT OF PENNSYLVANIA IN RE: JOHN DOE Debtor(s) XYZ MORTGAGE CO. Movant vs. JOHN DOE Respondent : : : : : : : : : : : : CHAPTER ____ CASE NO. -bk(judge's initials)

MOTION OF XYZ MORTGAGE CO. FOR RELIEF FROM THE STAY

LOCAL BANKRUPTCY FORM 9004-3 [Adversary Proceeding Caption] IN THE UNITED STATES BANKRUPTCY COURT FOR THE MIDDLE DISTRICT OF PENNSYLVANIA IN RE: JOHN DOE Debtor(s) XYZ MORTGAGE CO. Plaintiff vs. JOHN DOE Defendant : : : : : : : : : : : : :

CHAPTER CASE NO. -bk(judge's initials)

COMPLAINT TO DETERMINE DISCHARGEABILITY OF DEBT

ADVERSARY NO.

-

-ap-

MOTION OF XYZ MORTGAGE CO. FOR SUMMARY JUDGMENT

LOCAL BANKRUPTCY FORM 9013-4 IN THE UNITED STATES BANKRUPTCY COURT FOR THE MIDDLE DISTRICT OF PENNSYLVANIA IN RE: : : : Debtor(s) : : : Plaintiff(s)/Movant(s) : vs. : : : Defendant(s)/Respondent(s) : : CHAPTER CASE NO. -bk-ap-

ADVERSARY NO. (if applicable) Nature of Proceeding:

Document #:

REQUEST TO CONTINUE HEARING/TRIAL WITH CONCURRENCE1 This request must be filed at least twenty-four (24) hours prior to the hearing. All requests must be approved by the Court. Submitting a request is not an automatic continuance. The undersigned hereby requests a continuance with the concurrence of the opposing party (parties). This is a first request for a continuance.2 Reason for the continuance.

Contemporaneous with the filing of this request, the undersigned has served a copy of this request upon all counsel participating in this proceeding. Dated:______________________ _______________________________________ Attorney for_____________________________ Name: Phone Number:

1 2

No alterations or interlineations of this document are permitted. If this is not a first request for a continuance, then a Motion to Continue must be filed.

LOCAL BANKRUPTCY FORM 9019-1 IN THE UNITED STATES BANKRUPTCY COURT FOR THE MIDDLE DISTRICT OF PENNSYLVANIA IN RE: : : : Debtor(s) : : : Plaintiff(s)/Movant(s) : vs. : : : Defendant(s)/Respondent(s) : : CHAPTER CASE NO. -bk-ap-

ADVERSARY NO. (if applicable) Nature of Proceeding: Pleading: Document #:

REQUEST TO REMOVE FROM THE HEARING/TRIAL LIST* CHECK ONE: G The undersigned hereby withdraws the above identified pleading with the consent of the opposition, if any. G The undersigned counsel certifies as follows: (1) A settlement has been reached which will be reduced to writing, executed and filed within (please check only one). Thirty (30) days. G G Forty-five (45) days. G Sixty (60) days. (2) If a stipulation is not filed or a hearing requested within the above-stated time frame, the Court may dismiss the matter without further notice. (3) Contemporaneous with the filing of this request, the undersigned has served a copy of this request upon all counsel participating in this proceeding. Dated:______________________ _____________________________________ Attorney for___________________________

*No alterations or interlineations of this document are permitted. This request must be filed twenty-four (24) hours prior to the hearing.