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UNITED STATES BANKRUPTCY COURT WESTERN DISTRICT OF KENTUCKY IN RE:

CASE NO: CHAPTER 12

Debtor(s).

CERTIFICATION OF DEBTOR INFORMATION REGARDING REQUEST FOR HARDSHIP DISCHARGE

The above-captioned debtor certifies under penalty of perjury that the following are true and correct: 1) 2) All of the requirements of 11 U.S.C. §1228(b) have been met and the debtor is entitled to a hardship discharge. Pursuant to 11 U.S.C. § 1228(a), all amounts payable for domestic support obligations due on or before the date set forth below (including any amounts due before the filing of the bankruptcy petition to the extent provided for by the plan) have been paid. The provisions of 11 U.S.C. § 522(q)(1) are not applicable to this case under 11 U.S.C. § 1228(f) and there are no proceedings pending against the debtor of the kind described in 11 U.S.C. § 522(q)(1)(A) or 522(q)(1)(B).

3)

DATE: Debtor(s)

Local Form W