Free Ch. 13 - 341 Certification and Affidavit - North Carolina

Local Form 7 UNITED STATES BANKRUPTCY COURT FOR THE WESTERN DISTRICT OF NORTH CAROLINA [insert correct division name] DIVISION IN THE MATTER OF: ) ) ) ) ) ) Debtor(s)

July 2007

Case Number___________________

SSN: xxx-xx-_______ SSN: xxx-xx-_______

DEBTOR(S) CERTIFICATION AND AFFIDAVIT ­ 341(a) MEETING The undersigned, being the Debtor(s) referenced above, do hereby certify under oath administered by the Standing Trustee at the 341 meeting of creditors conducted on the date noted below, the following (Check the appropriate option, filling in the information requested as needed.) DOMESTIC SUPPORT OBLIGATION CERTIFICATION Male Female

1. ( ) ( ) I am not presently required by any judicial or administrative order or statute to pay any domestic support obligation (as defined in 11 U.S.C. Section 101(14A)); or, 2. ( ) ( ) I am required to pay under a domestic support order, and the full information as required by law as to the identity of the holder of this claim is already included in my petition, including the name and full mailing address of the holder, and ages and custodian of any children relating to the support order, and, 3. ( ) ( ) As of the date of this affidavit, I am current under any obligation created therein; and I agree to notify my trustee should I miss any payments due or otherwise become delinquent under any support obligation from this day until my confirmation order is entered. 4. ( ) ( ) ( ) ( ) I am presently in arrears as of the date of this Affidavit as follows: I have only those arrears as listed in my petition, and, I am current postpetition through today; or, In addition to any arrears listed in my petition, I have incurred the following postpetition arrearage:

TAX RETURN CERTIFICATION Male Female

1. ( ) ( ) I was not required to file any Federal, State or local tax returns for the 4year period ending on the date of the filing of my Chapter 13 petition for the following reason(s):

____________________________________________________________________________. 2. ( ) ( ) I was not required to file Federal, State or local tax returns for the following years during the 4-year period ending on the date of the filing of my Chapter 13 petition for the following reason(s): ____________________________________________________________________________ _ .

3. ( ) ( ) I was required to file Federal, State and local tax returns for the 4-year period ending on the date of the filing of my Chapter 13 petition and I have filed all of the returns that I was required to file during that 4-year period. 4. ( ) ( ) I was required to file Federal, State and local tax returns for the 4-year period ending on the date of the filing of my Chapter 13 petition but I have not filed the following required return(s): ____________________________________________________________________________ . CERTIFICATION OF WAGES Male Female

1. ( ) ( ) My Chapter 13 petition contains valid and accurate information as regards the payment of wages to me by my employer for the 60-day period ending on the date of the filing of my petition, and my petition contains valid and accurate information as to my average income for the six-month period ending on the last day of the calendar month immediately preceding the filing of my petition; or, 2. ( ) ( ) The information as contained in my petition has changed as follows:

____________________________________________________________________________ ____________________________________________________________________________

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By signing this affidavit, I acknowledge that all of the statements contained herein are true and accurate, and the Trustee and Court may rely on these statements for purposes of determining if confirmation of my proposed Plan is allowed under the provisions of the Bankruptcy Code. Any inaccuracy in this affidavit may be grounds for revocation or denial of my confirmation. Dated this the _____ day of ___________________, 200__.

________________________________ Male Debtor

________________________________ Female Debtor

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