IN THE UNITED STATES BANKRUPTCY COURT

FOR THE WESTERN DISTRICT OF VIRGINIA

IN RE: [(Debtor=s Name)]{.underline} Case No.
0\_\_-\_\_\_\_\_\_\_\_\_\_\_

> Soc. Sec. \# XXX-XX-\_\_\_\_\_\_\_\_\_\_\_\_
>
> [(Debtor=s Name)]{.underline} Chapter 13
>
> Soc. Sec. \# XXX-XX-\_\_\_\_\_\_\_\_\_\_\_\_
>
> Debtor(s)

**[AFFIDAVIT BY DEBTOR(S) REQUESTING CONFIRMATION OF PLAN AND CERTIFYING
COMPLIANCE WITH REQUIREMENTS OF 11 U.S.C. SECTION 1325]{.underline}**

STATE OF VIRGINIA

CITY/COUNTY OF \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

1\. **THE UNDERSIGNED AFFIRM(S) THAT THE STATEMENTS BELOW ARE TRUE AS OF
THE DATE HEREOF AND CERTIFIES THAT THEY WILL BE TRUE AS OF THE DATE OF
CONFIRMATION OF MY/OUR CHAPTER 13 PLAN AND MAY BE RELIED UPON BY THE
COURT UNLESS NOTICE IN WRITING TO THE CONTRARY IS GIVEN TO THE TRUSTEE
AND THE COURT AT OR PRIOR TO SUCH TIME.**

> 2\. I/We have made all payments to secured creditors, personal
> property lessors and taxing authorities which have come due since the
> date on which this case was filed and which I/we were required to make
> directly to such creditor, lessor or taxing authority. I/we understand
> that such payments include all mortgage payments, car payments or
> other secured debts being paid directly, personal property leases,
> real estate taxes, personal property taxes, federal income taxes, and
> state income taxes which have come due since this case was filed.
>
> 3\. Select either A. or B.:
>
> \_\_\_\_ A. Since the filing of this bankruptcy case, I/we have not
> been
>
> required by a judicial or administrative order, or by statute, to pay
> any domestic support obligation \[as that term is defined in 11 U.S.C.
> section 101(14A)\].
>
> \_\_\_\_ B. I/We have paid all amounts that first became due and
> payable after
>
> the filing of this bankruptcy case which I/we were required to pay
> under a domestic support obligation \[as that term is defined in 11
> U.S.C. section 101(14A)\] required by a judicial or administrative
> order or by statute.
>
> 4\. I/we have filed all Federal, State, and local tax returns required
> by law to be filed
>
> for all taxable periods ending during the four year period ending on
> the date of the filing of this bankruptcy case

**[By signing this affidavit requesting confirmation of chapter 13 plan,
I/we acknowledge that all of the above statements are true and accurate
and that the Court may rely upon the truth of each of these statements
in determining whether to confirm my/our Chapter 13 Plan. I/We
understand that the Court may revoke confirmation of the Chapter 13 Plan
if the statements relied upon are not accurate.]{.underline}**

Signed:

[/s/]{.underline}

Debtor

[/s/]{.underline}

Debtor

Subscribed and sworn to before me, a Notary Public, by the debtors named
in this affidavit this \_\_\_\_\_ day of
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_, 200\_\_\_.

[/s/]{.underline}

Notary Public

My commission expires:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**[(If debtor(s) represented by an attorney): Attorney=s
Certification]{.underline}**

I certify that I am counsel of record for the debtor(s) and that I have
reviewed this Affidavit requesting confirmation of Chapter 13 plan with
the debtor(s). Further, I certify that I have complied with this Court's
Standing Order #10 regarding Chapter 13 Instructions. I am filing a copy
of this Affidavit with the Court and with the Chapter 13 Trustee this
\_\_\_\_\_\_\_ day of \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_, 200
\_\_\_.

[/s/]{.underline}

Attorney for debtor(s)

**[(If debtor(s) not represented by an Attorney): Debtor=s(s=)
Certification]{.underline}**

> Yes No (circle one) I have viewed the DVD of the court's Chapter 13
> Instructions.
>
> Yes No (circle one) I have received, read and understand the Court's
> written Chapter 13 Instructions.

I certify that I am filing via first class mail or via the Court=s
CM/ECF system a true copy of this Affidavit requesting confirmation of
Chapter 13 plan with the Court and with the Chapter 13 Trustee this
\_\_\_\_\_\_\_ day of \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_, 200
\_\_\_.

[/s/]{.underline}

Debtor

**[Notes to AAffidavit by Debtor(s) Requesting Confirmation of Plan
and]{.underline} [Certifying Compliance with Requirements of 11 U.S.C.
section 1325\"]{.underline}**

The attached Affidavit was proposed by the Chapter 13 Trustees in
October 2005 as a document which will allow the Debtor(s) to comply with
new confirmation requirements of 11 U.S.C. section 1325 that were
enacted in 2005. While this form is not mandatory, it will allow the
Debtor(s) to provide the information required by that section without
having to appear and testify in person or provide other appropriate
documentation. If the Debtor(s) do not file this affidavit with the
Court in a timely manner prior to the confirmation hearing (at least 10
days prior to the hearing), confirmation may be delayed or denied absent
compliance with section 1325 in some other appropriate manner.

This Affidavit was revised in March 2007 to comply with Standing Orders
9 and 10.