Certification Of Noncompliance With 11 Usc Request For Exemption Page 2

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Undersigned requests that the Court order an exemption under 11 U.S.C. § 109(h)(3)
and allow Undersigned additional time to obtain the required credit counseling. If the Court
allows additional time to obtain credit counseling, Undersigned agrees to obtain the credit
counseling required by 11 U.S.C. § 109(h)(1) and file with the Court a certificate from an
approved nonprofit budget and credit counseling agency that Undersigned has completed the
required credit counseling. Undersigned agrees to obtain the required credit counseling and
file the required certificate within thirty (30) days from the Petition Date or by such other
time as the Court may order, which may be shorter than thirty (30) days from the Petition
Date.
Undersigned agrees and understands that failure to comply with any order of the
Court made pursuant to this request may result in this case being dismissed with prejudice,
as to any Chapter under Title 11, for a period of one-hundred eighty (180) days.
UNDERSIGNED EACH SO CERTIFY TO THE TRUTHFULNESS AND
ACCURACY OF THE REPRESENTATIONS MADE HEREIN.
_______________________________
(Debtor’s Signature)
_______________________________
(Co-Debtor’s Signature)
__________________, 200__

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