(Attorney Name)

(Firm Name)

(Address)

(City, State, Zip)

Telephone: (Telephone Number)

Fax: (Fax Number)

Email: (Email Address)

Attorney for: (Client Name)	AK LBF 5B

[11/15]

UNITED STATES BANKRUPTCY COURT

FOR THE DISTRICT OF ALASKA

In re:

(Debtor's Name) and

(Joint Debtor's Name),

Debtor(s).

Case No. (Case Number)

Chapter (Chapter Number)

Certification of Payments Made

Directly to Creditors/Lessors

[11 U.S.C. §1326(a)]

I (We) (Name) and (Name) , hereby declare under penalty of perjury that the I (we) have made all payments for the month of (Month) , (Year) required to be made under § 1326(a)(1)(B) or (C) of the Bankruptcy Code and all domestic support payments as stated in the Schedule of Direct Payments to Creditors attached to the Chapter 13 Plan dated (Date) and filed herein.

Attached hereto are copies of the receipts/checks/money orders/other documentation evidencing to whom the payment was made, the date and amount of the payment made.

Dated: (Date)

(Debtor)

(Co-Debtor)