UNITED STATES BANKRUPTCY COURT

DISTRICT OF NEW MEXICO

In re

Debtor.	Case No.

DEBTOR'S CERTIFICATION AND STATEMENTS

IN SUPPORT OF ENTRY OF CHAPTER 13 DISCHARGE

1.	Pursuant to 11 U.S.C. section 1328(a), I certify that:

[ ]	I owed no domestic support obligations when I filed my bankruptcy petition, and I have not been required to pay any such obligation since then.

OR

[ ]	I am or have been required to pay domestic support obligations. I have paid all such amounts that my chapter 13 plan required me to pay. I have also paid all such amounts that became due between the filing of my bankruptcy petition and today. To assist the trustee in complying with the provisions of 11 U.S.C. section 1302(d)(1)(C), I provide this information:

My current address: ________________________________________________

My current employer and my employer's address: ________________________

_________________________________________________________________

If you were or are required to pay domestic support and either have not paid such amounts as required or you are not current on payments, DO NOT SUBMIT THIS FORM because you will not receive a discharge.

2.	Pursuant to 11 U.S.C. sections 522(q) and 1328(h)(1), and Fed. R. Bankr. P. 1007 (b)(8), I state:

[ ]	I have not elected under section 522(b)(3) to exempt property under state or local law that I or a dependent of mine uses as a residence, claims as a homestead, or acquired as a burial plot, as specified in section 522(p)(1), and that exceeds in the aggregate $155,675 in value.

OR

[ ]	I have elected under section 522(b)(3) to exempt property under state or local law that I or a dependent of mine uses as a residence, claims as a homestead, or acquired as a burial plot, as specified in section 522(p)(1), and that exceeds in the aggregate $155,675 in value.

3.	Pursuant to 11 U.S.C. sections 522(q) and 1328(h)(2), and Fed. R. Bankr. P. 1007(b)(8), I state:

[ ]	There is not pending against me a proceeding in which I may be found guilty of a felony of a kind described in 11 U.S.C. section 522(q)(1)(A) or liable for a debt of the kind described in section 522(q)(1)(B).

OR

[ ]	There is pending against me a proceeding in which I may be found guilty of a felony of a kind described in 11 U.S.C. section 522(q)(1)(A) or liable for a debt of the kind described in section 522(q)(1)(B).

4.	I certify under penalty of perjury that the information provided is true and correct.

Date: _______________

________________________________________

Debtor's signature

Address:

Telephone:

Fax: ____________________________________

E-mail: _________________________________

Debtor

In accordance with Fed. R. Bankr. P. 9036, NM LBR 9036-1(b) and Fed. R. Civ. P. 5(b)(3), I certify that service of this document was made the day this document was filed, via the notice transmission facilities of the Bankruptcy Court's case management and electronic filing system on persons/entities listed on the notice of electronic filing associated with this document. I further certify that the persons/entities listed on the notice of electronic filing as not having received the notice electronically were served via first class mail postage prepaid the day this document was filed.

Attorney name

Attorney for party

Address

Telephone:

Fax:

E-mail: ________________________________