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Debtors 11 USC 1328 Certificate EDC 3-190 - California
| Debtors 11 USC 1328 Certificate Form. This is a California form and can be used in EDC Forms USBC Eastern Federal . |
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UNITED STATES BANKRUPTCY COURT EASTERN DISTRICT OF CALIFORNIA IN RE ) ) ) ) Debtor(s). ) CASE NO. CHAPTER 13 [Instructions: Each Debtor must complete this Certificate in order to receive a discharge. All sections of the Certificate must be completed. The completed Certificate must be filed with the Clerk of Court and served on the Trustee no later than 30 days after the date of form EDC 5-200, Notice to Debtor of Completed Plan Payments and of Obligation to File Documents. In joint cases, each spouse must complete and file a separate Certificate. Therefore, joint debtors may wish to photocopy this form before completing it.] DEBTOR'S 11 U.S.C. § 1328 CERTIFICATE I declare under penalty of perjury that the information provided in this Certificate is true and correct. A. DOMESTIC SUPPORT OBLIGATIONS [check the appropriate box] G 1. During the time this bankruptcy case has been pending, I have not been required to pay a domestic support obligation (such as child support, maintenance or alimony) by any order of a court or administrative agency or by any statute. During the time this bankruptcy case has been pending, I have paid all domestic support obligations (such as child support, maintenance or alimony) as required under any order of a court or administrative agency or under any statute. During the time this bankruptcy case has been pending, I have not paid all domestic support obligations, such as child support, maintenance or alimony, as required by an order of a court or administrative agency or by statute. G 2. G 3. If you were obligated to pay a domestic support obligation, please complete the information below. If not, skip to B. Prior Chapter 7, 11, or 12 Bankruptcy Discharge. Name and address of each holder of a domestic support obligation: Name:______________________________ Address:____________________________ ___________________________________ ___________________________________ My Current Address is: Address:____________________________ ___________________________________ ___________________________________ ___________________________________ Name:______________________________ Address:____________________________ ___________________________________ ___________________________________ My Current Employer is: Name:______________________________ Address:____________________________ ___________________________________ ___________________________________ American LegalNet, Inc. www.FormsWorkFlow.com EDC 3-190 (Rev. 9/13/12) Page 1 of 2 B. PRIOR CHAPTER 7, 11, OR 12 BANKRUPTCY DISCHARGE [check the appropriate box] G G 1. I have NOT received a discharge in a Chapter 7, 11 or 12 bankruptcy case filed within four (4) years prior to filing this case. I have received a discharge in a Chapter 7, 11 or 12 bankruptcy case filed within four (4) years prior to filing this case. 2. C. PRIOR CHAPTER 13 BANKRUPTCY DISCHARGE [check the appropriate box] G G 1. I have NOT received a discharge in another Chapter 13 bankruptcy case filed within two (2) years prior to filing this case. I have received a discharge in another Chapter 13 bankruptcy case filed within two (2) years prior to filing this case. 2. D. 11 U.S.C §522(q) EXEMPTIONS [check the appropriate box] G 1. I have NOT claimed exemptions in real property, personal property, or a cooperative used as a residence or claimed as a homestead, or in a burial plot, that exceed in the aggregate $146,450. See 11 U.S.C. § 522(p)(1)(A), (B), (C), & (D). I have claimed exemptions in real property, personal property, or a cooperative used as a residence or claimed as a homestead, or in a burial plot, that exceed in the aggregate $146,450 but I owe no debts of the type described in 11 U.S.C. § 522(q). I have claimed exemptions in real property, personal property, or a cooperative used as a residence or claimed as a homestead, or in a burial plot, that exceed in the aggregate $146,450 even though I owe debts of the type described in 11 U.S.C. § 522(q). If this box is checked, I have filed with this Certificate form EDC 3-191, Certificate of Chapter 13 G 2. G 3. Debtor Regarding 11 U.S.C. § 522(q) Exemptions. By signing this Certificate, I acknowledge that all of the statements contained herein are true and accurate and that the Court may rely on the truth of each of these statements in determining whether to grant me a discharge in this case. The Court may revoke my discharge if my statements are not accurate. Date:__________________ Signed: Printed Name: _____________________________ Debtor EDC 3-190 (Rev. 9/13/12) Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com
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