UNITED STATES BANKRUPTCY COURT

EASTERN DISTRICT OF MISSOURI

In re:	)

)	Case No.

DEBTOR NAME,	)

)	Chapter

Debtor.	)

CERTIFICATION OF

DOMESTIC SUPPORT OBLIGATIONS

The undersigned Debtor hereby certifies under penalty of perjury: (check appropriate box).

I have paid all amounts due under a domestic support obligation order as provided in 11 U.S.C. §1328(a) or §1228(a), as applicable, as of the date of this certification;

I did not have a domestic support obligation when I filed my bankruptcy petition, and I

have not been required to pay any such obligation since then.

By signing below, I further certify that the information contained in this certification is true and accurate under penalty of perjury and, if required, that I served (mailed) a copy of this document to each person entitled to receive domestic support obligations from me. Those persons are listed below.

Dated:	_______________	Signed:	________________________________

Debtor's Printed

Name:	________________________________

(In a joint debtor case, each debtor must sign and file a separate form.)

Domestic Support Recipient(s):

Name:	______________________________

Address:	______________________________

______________________________

Name:	______________________________

Address:	______________________________

______________________________

8/2013