Free IN THE UNITED STATES BANKRUPTCY COURT - Maryland

IN THE UNITED STATES BANKRUPTCY COURT FOR THE DISTRICT OF MARYLAND ____________Division In Re: | | | | | |

Bankruptcy Case No. Chapter 13

Debtor

DEBTOR'S AFFIDAVIT REQUESTING DISCHARGE
***IN JOINT FILINGS, A SEPARATE AFFIDAVIT MUST BE COMPLETED BY EACH DEBTOR IN ORDER TO BE ELIGIBLE FOR A DISCHARGE*** The Chapter 13 Trustee has filed a notice of completion in my case and I am hereby requesting that the Court issue a discharge. I testify under penalty of perjury to the following: (Complete all sections and provide all required information.)

1. The following creditors hold a claim that is not discharged under 11 U.S.C. §523 (a)(2) or (a)(4) or a claim that was reaffirmed under 11 U.S.C. §524(c): (provide name, address, and telephone number of each such creditor) _______________________________ _______________________________ _______________________________

2. ____

I have not received a discharge in a Chapter 7, 11 or 12 bankruptcy case

that was filed within 4 years prior to the filing of this Chapter 13 Bankruptcy. 3. _____ I have not received a discharge in another Chapter 13 bankruptcy case that

was filed within 2 years prior to the filing of this Chapter 13 bankruptcy.

4. A. _____ I did not have either at the time of filing this bankruptcy or at the present time, equity in excess of $125,000 in the type of property described in 11 U.S.C. §522(p)(1) [generally the debtor's homestead]

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B. _____ There is not currently pending any proceeding in which I may be found guilty of a felony of the kind described in 11 U.S.C. §522(q)(1)(A) or liable for a debt of the kind described in 11 U.S.C. §522(q)(1)(B). 5. COMPLETION OF INSTRUCTIONAL COURSE CONCERNING PERSONAL FINANCIAL MANAGEMENT PURSUANT TO 11 U.S.C. §1328(g)(1) [Complete one of the following statements] ___ I, ____________________________________, the debtor in the above-styled
(printed name of debtor)

case hereby certify that on _______________ I completed an instructional
(date)

course in personal financial management provided by _________________________,
(Name of Provider)

by an approved personal financial management instruction provider. ____ Official Form 23 was filed previously with the court; OR ____ A document attesting to my completion of the personal financial management instruction course is attached. ___ I____________________________________, the debtor in the above-styled
(printed name of debtor)

case, hereby certify that no personal financial management course is required because: [check the appropriate box.] I am incapacitated or disabled, as defined in 11 U.S.C. § 109(h)(4); I am on active military duty in a military combat zone; or I reside in a district in which the United States Trustee 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. 6. CERTIFICATION REGARDING DOMESTIC SUPPORT OBLIGATIONS PURSUANT TO 11 U.S.C § 1328(a) [Complete one of the following statements] ___ I, ____________________________________, the debtor in the above-styled
(printed name of debtor)

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case, hereby certify that I am not currently required, nor at any time during the period of this bankruptcy have I been required, by a judicial or administrative order, or by statute, to pay a domestic support obligation.

___ I, ____________________________________, the debtor in the above-styled
(printed name of debtor)

case am required by judicial or administrative order, or by statute, to pay a domestic support obligation as defined in 11 U.S.C. § 101(14A). (This refers to a debt owed to or recoverable by a spouse, former spouse or child of the debtor or such child's parent, legal guardian or responsible relative or a governmental unit in the nature of alimony, maintenance or support.) The name and address of each holder of a domestic support obligation follows: _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ [check the appropriate box.] ____ I hereby certify that all amounts payable under such order or such statute that are due on or before the date of this affidavit (including amounts due before the petition was filed, but only to the extent provided for the by plan) have been paid; or I have executed, and the court has approved, a written waiver of discharge pursuant to 11 U.S.C. § 1328(a).

____

My current address is: _______________________________ _______________________________ _______________________________ Page 3 of 4

The name and address of my most recent/current employer is: _______________________________ _______________________________ _______________________________ _______________________________ I declare under penalty of perjury that all of the above statements are true and correct to the best of my knowledge, information, and belief, and that the Court may rely on the truth of each statement in determining whether to grant me a discharge in this case. I further understand that the court may revoke my discharge if such order of discharge was procured by fraud.

Signature of Debtor:_____________________________

Date: _________________

NOTICE OF OPPORTUNITY TO OBJECT Any objections to the accuracy of this affidavit must be filed with in fifteen (15) days of the date of service of this Affidavit. If no objection is filed, the Court will consider entering a discharge order in this case without further notice or hearing.

CERTIFICATE OF SERVICE I hereby certify that this affidavit was served this ______ day of ____________, 2006, electronically to those recipients authorized to receive a Notice of Electronic Filing by the Court, and/or first class mail, postage prepaid to: Chapter 13 Trustee All creditors and parties in interest. _____________________________

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