Transcription

1 Sample Forms

2

3

4

5

6

7

8

9 Edited by Fixit Reader Copyright(C) by Foxiest Software Company, For Evaiuaticn Only. B 1 (0m ia1fm-m 1,uxmmn)(nz/ns) UNITED STATES BANKRUPTCY COURT In re Jane Anne Doa Dcbwr Case Nu. nflmown) EXHIBIT D - INDIVIDUAL DEBTOR S STATEMENT OF COMPLIANCE WITH CREDIT COUNSELING REQUIREMENT Warning: You must be able to check truthfully une of the live statements regarding credit counseling listed below. Iffy cannot dn. sn, you are not eligible tu file 2 bankruptcy case, and the court can dismiss any case you da tile. If that happens, y0u will l0se whatever filing fee you paid, and your creditors will be able to resume collection activities against you. If your case is dismissed and you me another bankruptcy case later, you may be required t0 pay a second idling fcc and you may have tan take extra steps to stop crcdit0rsʼ collection activities. Every individual debtor mustfle this Exhibit D. U a joint petition is filed, each spouse must complete underlie zz separate Exhibit D. Check une uf the five statements below and attach any documents as directed B l. Within the 180 days before the tiling of my bankruptcy case, {received a briefing from 21 credit counseling agency approved by the United States trustee or banlquptcy administrator that outlined the opportunities for available credit counseling and assisted me in perfuming a related budget analysis, and I have a certificate from the agency describing the services provided to mc, Attach a copy of the certwcate and a copy of any debt repayment plan developed through the agency. El 2, Within theca 180 days before theca filing of my bankruptcy case, I received a briefing from a credit counseling agency approved by the United States trustee or bankruptcy administrator that outlined theca opportunities for available credit counseling and assisted me in performing a related budget analysis, but I do not have a certificate from the agency describing the services provided to mc. You must/ile a copy oaf Crete;/icurefmm the agency describing the services provided to you and a copy offend debt repuymentplan developed through the agency no later than I5 days aj?er your bankruptcy case isjileal

10 B nm (umm rum 1, mho D) (12/may 7 cm Page 2 El 3, I certify that I requested credit counseling services &0m an approved agency but was unable to obtain the services during theca five days from the time I made my request, and the following exigent circumstances merit a temporary waiver of theca credit counseling requirement so I can file my banknmtcv case now. [Summarize exigent circumstances here, I If your certification is satisfactory to the court, you must still obtain the credit counseling briefing within the first 30 days after you Iilc yup bankruptcy petition and promptly file a certificate from the agency that provided the counseling, together with a copy 0f any debt management plan developed through the agency. Failure to fulfill these requirements may result in dismissal uf your case. Any extension of the 30-day deadline can be granted only fur cause and is limited to a maximum uf 15 days. Your case may also be dismissed if the court is not satisfied with your reasons for tiling your bankruptcy cask without first receiving 2 credit counseling briefing. EI 4. I am not required to receive a credit counseling briefing because of: [Check the applicable statement.] [Must be accompanied by a motion for determination by the court.] U Incapacity. (Defined in ll U.S.C. 109(h)(4) as impaired by reason of mental illness or mental deficiency sc. as to bcd incapable: ofrcalizing and making rational decisions with respect to financial responsibilities.); lj Disability. (Defined in l I U4S,C. l()9(h)(4) as physically impaired to the extent of being unable, after reasonable effort, to participate in a credit counseling briefing in person, by telephone, or through the Intimate.); EI Active military duty in a military combat zone. EI 5. The United States trustee or bankruptcy administrator has determined that the credit counseling requirement of ll U.S.C. 109(h) docs not apply in this district. I certify under penalty of perjury that the information provided above is true and correct. Sigrmtnuc of Debtz pv Date: 10/20/2009 j

11 [JANE INCLUDES HER CREDIT COUNSELING CERTIFICATE HERE. ITIS DATED FOR AILE/$51 ONE DA YPRIOR T0 HER FILING AND NOT MORE THAN 180 DA YS PRIOR T0 FILING. ] CERTIFICATION OF COMPLETION OF CREDIT COUNSELING COURSE This certificate confirms that]8.1'1! A. Doc completed her Credit Counseling course online with ABC Agency on OCtOb I` 19, 2009,... (Your real jbrm will be more elaborare than this,.)

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

32

33

34

35

36

37

38

39

40

41

42

43

44

45

46

47

48