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Chapter 12 Individual Debtors Certifications Regarding Domestic Support Obligations CSD 2122 - California

Chapter 12 Individual Debtors Certifications Regarding Domestic Support Obligations Form. This is a California form and can be used in General USBC Southern Federal .
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CSD 2122 [04/01/14] Name, Address, Telephone No. & I.D. No. UNITED STATES BANKRUPTCY COURT SOUTHERN DISTRICT OF CALIFORNIA 325 West "F" Street, San Diego, California 92101-6991 In Re Debtor, Bankruptcy No. CHAPTER 12 INDIVIDUAL DEBTOR'S CERTIFICATIONS REGARDING DOMESTIC SUPPORT OBLIGATIONS, SECTION 522(q) AND ELIGIBILITY FOR DISCHARGE Part I. Certification Regarding Domestic Support Obligations (check no more than one) Pursuant to 11 U.S.C.§ 1228(a), I (we) certify that: BOX 1: I (we) owed no domestic support obligations when this bankruptcy petition was filed, and I (we) have not been required to pay any such obligations since then. BOX 2: I (we) have been required to pay a domestic support obligation. I (we) have paid all such amounts that my (our) chapter 12 plan required me (us) to pay. I (we) have also paid all such amounts that became due between the filing of my (our) bankruptcy petition and today. Part II. If you checked the second box in Part I, you must provide the information below. My (our) current address: My (our) current employer and my (our) employer's address: Names and addresses of all domestic support obligation holders. (If additional space is needed, continue on a separate sheet and attach to the Certification.) American LegalNet, Inc. www.FormsWorkFlow.com CSD 2122 (Page 2) [04/01/14] Part III. Certification Regarding Section 522(q) (check no more than one) Pursuant to 11 U.S.C. § 1228(f), I (we) certify that: BOX 3: I (we) have not claimed an exemption pursuant to § 522(b)(3) and state or local law (1) in property that I (we) or a dependent of mine (ours) uses as a residence, claims as a homestead, or acquired as a burial plot, as specified in § 522(p)(1), and (2) that exceeds $155,675¹ in value in the aggregate. BOX 4: I (we) have claimed an exemption in property pursuant to § 522(b)(3) and state or local law (1) that I (we) or a dependent of mine (ours) uses as a residence, claims as a homestead, or acquired as a burial plot, as specified in § 522(p)(1), and (2) that exceeds $155,675¹ in value in the aggregate. Part IV: Debtor's Signature I (we) understand that I (we) have completed my (our) plan payments and may now be eligible for a discharge. I (we) understand that failure to complete and return this Certification to the court within fourteen (14)² days of the service of the Trustee's Final Report may cause my (our) case to be closed without entry of my (our) discharge. I (we) further understand that the Court is relying on the truth and accuracy of these statements and, if any statement is false, the Court may revoke my (our) discharge. If BOX 2 is checked: I (we) further declare that on this date a copy of this Certification was served upon the following Domestic Support Obligation Holders, applicable state child support enforcement agency, and/or the persons as indicated below (include name(s) and full mailing address): UNITED STATES TRUSTEE Department of Justice 402 West Broadway, Suite 600 San Diego, CA 92101 DAVID L. SKELTON, TRUSTEE 525 "B" Street, Suite 1430 San Diego, CA 92101-4507 I (we) certify under penalty of perjury that the information provided in these certifications is true and correct to the best of my (our) knowledge and belief. Executed Date Signature of Debtor Signature of Co-Debtor (if any) IF YOU QUALIFY FOR A DISCHARGE, FAILURE TO COMPLETE AND RETURN THIS CERTIFICATION TO THE COURT MAY CAUSE YOUR CASE TO BE CLOSED WITHOUT A DISCHARGE. TO ENTER YOUR DISCHARGE, YOU WOULD BE REQUIRED TO FILE A NOTICE OF MOTION AND MOTION TO REOPEN YOUR CASE AND PAY THE REQUIRED FEE. THIS FEE MAY NOT BE WAIVED. ¹Amounts are subject to adjustment on 4/01/2016, and every 3 years thereafter with respect to cases commenced on or after the date of adjustment. ²If you were served electronically or by mail, you have three (3) additional days to take the above-stated actions as calculated by Fed. R. Bankr. P. 9006(f). American LegalNet, Inc. www.FormsWorkFlow.com CSD 2122
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