United States Bankruptcy Court
Eastern District of Virginia
In re Case No. Chapter Debtor
DEBTOR'S CERTIFICATION OF COMPLETION OF INSTRUCTIONAL COURSE CONCERNING PERSONAL FINANCIAL MANAGEMENT
[Complete one of the following statements.] I/We, __________________________________________________, the debtor(s) in the
(Printed Name(s) of Debtor and Joint Debtor, if any)
above-styled case hereby certify that on _______________________ I/we completed an
(Date)
instructional course in personal financial management provided by ________________________________________________________________________,
(Name of Provider)
an approved personal financial management instruction provider. If the provider furnished a document attesting to the completion of the personal financial management instructional course, a copy of that document is attached. I/We, __________________________________________________, the debtor(s) in the
(Printed Names of Debtor and Joint Debtor, if any)
above-styled case, hereby certify that no personal financial management course is required because: [Check the appropriate box.] I am/We are incapacitated or disabled, as defined in 11 U.S.C. ยง 109(h); I am/We are on active military duty in a military combat zone; or I/We reside in a district in which the United States trustee (or bankruptcy administrator) has determined that the approved instructional courses are not adequate at this time to serve the additional individuals who would otherwise be required to complete such courses.
___________________________________
Signature of Debtor ______________________________________ Signature of Joint Debtor (if any)
________________________
Date __________________________ Date
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