United States Bankruptcy Court Debtor'S 11 U.s.c. 1328 Certificate (Page 2 of 2) in pdf

United States Bankruptcy Court Debtor'S 11 U.s.c. 1328 Certificate Page 2

My Current Employer is:

Name:________________________________

Address:______________________________

_____________________________________

B. G 1. I have NOT received a discharge in a Chapter 7, 11 or 12 bankruptcy case

filed within 4-years prior to filing this case.

G 2. I have received a discharge in a Chapter 7, 11 or 12 bankruptcy case filed

within 4-years prior to filing this case.

C. G 1. I have NOT received a discharge in another Chapter 13 bankruptcy case filed

within 2-years prior to filing this case.

G 2. I have received a discharge in another Chapter 13 bankruptcy case filed within

2-years prior to filing this case.

By signing this Notice, 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:__________________

/s/______________________________

Debtor

DEBTOR’S 11 U.S.C. § 1328 CERTIFICATE

United States Bankruptcy Court Debtor'S 11 U.s.c. 1328 Certificate Page 2