Debtors Certification Requesting A Waiver Or Extension Of Credit Counseling Requirement {4}

LOCAL BANKRUPTCY FORM NO. 4 IN THE UNITED STATES DISTRICT COURT FOR THE UNITED STATES VIRGIN ISLANDS, BANKRUPTCY DIVISION In Re: Debtor(s) BANKRUPTCY NO. CHAPTER NO. DOCUMENT NO. DEBTOR'S CERTIFICATION REQUESTING A WAIVER/EXTENSION OF CREDIT COUNSELING REQUIREMENT [Complete one of the following numbered statements.] 1. 9 I/We, ___________________________________, the debtor(s) in the (Printed Names of Debtor and Joint Debtor, if any) above case, hereby certify under penalty of perjury that no credit counseling is required because: [Check the appropriate box.] 9 9 9 9 I am/We are incapacitated or disabled, as defined in 11 U.S.C. §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 has determined that the approved credit counseling agencies are not adequate at this time to serve the additional individuals who would otherwise be required to seek credit counseling. I/We, ___________________________________, the debtor(s) in the (Printed Names of Debtor and Joint Debtor, if any) above case, hereby request an extension of the time to complete the credit counseling requirement pursuant to 11 U.S.C. §109(h)(3), based upon the following exigent circumstance(s): 2. __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ American LegalNet, Inc. www.FormsWorkflow.com 3. 9 I/We, ____________________________________, the debtor(s) in the (Printed Names of Debtor and Joint Debtor, if any) above case, do not qualify for a waiver pursuant to #1 above, and have no exigent circumstances as to why credit counseling has not been completed. I(We) are not filing a Certificate of Credit Counseling with the petition. I understand that if I check this box my case will be dismissed immediately. I/We also understand that even if the Court find this certification satisfactory, the requirement to obtain budget and credit counseling services is waived only for 30 days after the petition is filed, unless I ask for and receive a 15-day extension of the waiver period. I/We certify under penalty of perjury that the foregoing is true and correct. Signature of Debtor: ___________________________________ Executed On: _____________ Address of Debtor: _____________________________________________________________ Signature of Joint Debtor: _______________________________ Executed On: _____________ Address of Joint Debtor: ________________________________________________________ American LegalNet, Inc. www.FormsWorkflow.com