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UNITED STATES BANKRUPTCY COURT DISTRICT OF NEW MEXICO In re

, Debtor. Case No. ____________________

MOTION BY INDIVIDUAL DEBTOR FOR DETERMINATION THAT DEBTOR IS UNABLE TO COMPLETE REQUIREMENTS FOR BUDGET AND CREDIT COUNSELING Pursuant to 11 U.S.C. § 109(h)(4), debtor, ,1 asks the Court to determine that the budget and credit counseling requirements of 11 U.S.C. § 109(h)(1) not apply to debtor because of the reason checked below: Incapacity. (Defined in 11 U.S.C. § 109(h)(4) as impaired by reason of mental illness or mental deficiency so as to be incapable of realizing and making rational decisions with respect to financial responsibilities); Disability. (Defined in 11 U.S.C. § 109(h)(4) as physically impaired to the extent of being unable, after reasonable effort, to participate in a credit counseling briefing in person, by telephone, or through the Internet); Active military duty in a military combat zone. The specifics of the debtor's situation are as follows:

. I certify under penalty of perjury that the information provided above is true and correct. Debtor Signature Typed name of debtor: Debtor address: Debtor telephone: Note: Filing of motion required by NM IBR 1007(b)(3)(D) and (c).

1

If the circumstances apply to each debtor in a joint case, submit a separate motion for each debtor.
USE OF THIS FORM IS REQUIRED BY OCTOBER 14, 2005, COURT ORDER

NM Form 505 for self-represented debtor
F:\FORMS\BY NUMBER\NM Form 505 selfrep rev 111907.wpd