United States Bankruptcy Court District of Maryland
In re	John Doe		Case No.	12-XXXXXX
	Debtor(s)		Chapter	13

DEBTOR’S AFFIDAVIT REQUESTING DISCHARGE

***IN JOINT FILINGS, A SEPARATE AFFIDAVIT MUST BE COMPLETED BY

EACH DEBTOR IN ORDER TO BE ELIGIBLE FOR A DISCHARGE***

The Chapter 13 Trustee has filed a notice of completion in my case and I am hereby requesting that the Court issue a discharge. I testify under penalty of perjury to the following: (Complete all sections and provide all required information.)

1. The following creditors hold a claim that is not discharged under 11 U.S.C. § 523 (a)(2) or (a)(4) or a claim that was reaffirmed under 11 U.S.C. § 524(c): (provide name, address, and telephone number of each such creditor)

None

2. I have not received a discharge in a Chapter 7, 11 or 12 bankruptcy case that was filed within 4 years prior to the filing of this Chapter 13 Bankruptcy.

3. I have not received a discharge in another Chapter 13 bankruptcy case that was filed within 2 years prior to the filing of this Chapter 13 bankruptcy.

4. A. I did not have either at the time of filing this bankruptcy or at the present time, equity in excess of $125,000 in the type of property described in 11 U.S.C. §522(p)(1) [generally the debtor’s homestead].

B. 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,	John Doe			, the debtor in the above-styled case, hereby certify that on
		(printed name of debtor)
July 16, 2012			I completed an instructional course in personal financial management provided by
(date)
Credit Management				, by an approved personal financial management instruction provider.
(Name of 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 case, hereby certify that
		(printed name of debtor)
no personal financial management course is required because: [check the appropriate box.]
		I am incapacitated or disabled, as defined in 11 U.S.C. §109(h)(4);
		I am on active military duty in a military combat zone; or
		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.

6. CERTIFICATION REGARDING DOMESTIC SUPPORT OBLIGATIONS PURSUANT TO 11 U.S.C. §1328(a)

[Complete one of the following statements]

	I,	John Does	, the debtor in the above-styled case, hereby certify that I am
		(printed name of debtor)
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.
	I,		, the debtor in the above-styled case, am required by judicial
		(printed name of debtor)
or administrative order, or by statute, to pay a domestic support obligation as defined in 11 U.S.C. §101(14A). (This
refers to a debt owed to or recoverable by a spouse, former spouse or child of the debtor or such child’s parent, legal
guardian or responsible relative or a governmental unit in the nature of alimony, maintenance or support.)

The name and address of each holder of a domestic support obligation follows:

I hereby certify that all amounts payable under such order or such statute that are due on or before the date of this affidavit (including amounts due before the petition was filed, but only to the extent provided for by the plan) have been paid; or

I have executed, and the court has approved, a written waiver of discharge pursuant to 11 U.S.C. §1328(a).

My current address is:

	John Doe
	123 ABC Court
	Baltimore, MD 21234

The name and address of my most recent/current employer is:I declare under penalty of perjury that all of the above statements are true and correct to the best of my knowledge, information, and belief, and that the Court may rely on the truth of each statement in determining whether to grant me a discharge in this case. I further understand that the court may revoke my discharge if such order of discharge was procured by fraud.

Signature of Debtor:

/s/ John Doe

Date:

August 6, 2014

NOTICE OF OPPORTUNITY TO OBJECT

Any objections to the accuracy of this affidavit must be filed within fifteen (15) days of the date of service of this Affidavit. If no objection is filed, the Court will consider entering a discharge order in this case without further notice or hearing.

CERTIFICATE OF SERVICE

I hereby certify that this affidavit was served this August 6, 2014, electronically to those recipients authorized to receive a Notice of Electronic Filing by the Court, and/or first class mail, postage prepaid to:

Chapter 13 Trustee

All creditors and parties in interest.

	/s/ Joh Doe
	John Doe