UNITED STATES BANKRUPTCY COURT
NORTHERN DISTRICT OF FLORIDA
www.flnb.uscourts.gov

In re:
[Name of Debtor(s)]				Case No. ___________ 
						Chapter 		 
				/
AFFIDAVIT IN SUPPORT OF MOTION FOR WAIVER OF REQUIREMENT TO TAKE FINANCIAL MANAGEMENT COURSE 

I hereby certify that the above-captioned debtor, whose full name is     					, in accordance with 11 U.S.C. § 109(h)(4) is not required to complete a course in personal financial management (see, Fed. R. Bankr. P. 1007(b)(7)) for the following reason(s): 
	 Incapacity.	       Disability.	  Active Military Duty in a Combat Zone.
I affirm under penalty of perjury that the information in this Affidavit is true and correct. 
FOR AFFIDAVIT SIGNED BY DEBTOR*
					
Signature of Debtor
					
Debtor’s street/mailing address

City, State, Zip Code

Notarization of Signature of Debtor

STATE OF ___________ COUNTY OF ______________. This Affidavit was subscribed and sworn to before me this ______ day of _______________, 20____ by (print name) ______________________________________________, who signed the Affidavit and is  personally known to me, or  provided                                                               as identification. 

WITNESS my hand and official seal.
	Notary Public _________________________		
                                    				(SEAL)
State of _______________________________                                      
My commission expires: __________

FOR AFFIDAVIT SIGNED BY DEBTOR’S COUNSEL
DUE TO DEBTOR’S INCAPACITY*

Signature of Debtor’s Counsel
					
Counsel’s street/mailing address

City, State, Zip Code

Notarization of Signature of Debtor’s Counsel

STATE OF ___________ COUNTY OF ______________. This Affidavit was subscribed and sworn to before me this ______ day of _______________, 20____ by (print name) ______________________________________________, who signed the Affidavit and is  personally known to me, or  provided                                                               as identification. 

WITNESS my hand and official seal.
	Notary Public _________________________		
                                    				(SEAL)
State of _______________________________                                      
My commission expires: __________

*NOTARIZATION LANGUAGE IS TO BE ADJUSTED TO COMPLY WITH APPLICABLE STATE STATUTES AND REQUIREMENTS BASED ON STATE IN WHICH AFFIDAVIT IS SIGNED.