Debtor'S Affidavit Requesting Discharge Page 2
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4B. ______ There is not currently pending any proceeding in which I may be found guilty of a
felony of the kind described in 11 U.S.C. § 522(q)(1)(A) or liable for a debt of the kind
described in 11 U.S.C. § 522(q)(1)(B).
5. COMPLETION OF INSTRUCTIONAL COURSE CONCERNING PERSONAL
FINANCIAL MANAGEMENT PURSUANT TO 11 U.S.C. § 1328(g)(1)
[Complete one of the following statements]
___ I, ____________________________________, the debtor in the above-styled
(printed name of debtor)
case hereby certify that on _______________ I completed an instructional
(date)
course in personal financial management provided by _________________________,
(Name of Provider)
by an approved personal financial management instruction provider.
____ Official Form 23 was filed previously with the court; OR
____ A document attesting to my completion of the personal financial management
instruction course is attached.
___ I,____________________________________, the debtor in the above-styled
(printed name of debtor)
case, hereby certify that no personal financial management course is required
because: [check the appropriate box.]
G
I am incapacitated or disabled, as defined in 11 U.S.C. § 109(h)(4);
G
I am on active military duty in a military combat zone; or
G
I reside in a district in which the United States Trustee has determined that the
approved instructional courses are not adequate at this time to serve the additional
individuals who would otherwise be required to complete such courses.
G
CERTIFICATION REGARDING DOMESTIC SUPPORT OBLIGATIONS
PURSUANT TO 11 U.S.C § 1328(a)
[Complete one of the following statements]
___ I, ____________________________________, the debtor in the above-styled case,
(printed name of debtor)
hereby certify that I am not currently required, nor at any time during the period of this
bankruptcy have I been required, by a judicial or administrative order, or by statute, to pay a
domestic support obligation.
Local Bankruptcy Form P
Page Two
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