UNITED STATES BANKRUPTCY COURT

FOR THE EASTERN DISTRICT OF KENTUCKY

DIVISION

IN RE:

CASE NO.

DEBTOR(S)

CERTIFICATION REGARDING

CHAPTER 13 RIGHTS AND RESPONSIBILITIES

The undersigned attorney certifies that a copy of the Rights and Responsibilities of Chapter 13 Debtors and Their Attorneys in the United States Bankruptcy Court for the Eastern District of Kentucky has been provided to the debtor(s); has been reviewed with the debtor(s); and has been agreed to by the debtor(s) and counsel as setting forth the responsibilities of the debtor(s) and the minimum standards of practice expected of counsel for the debtor(s).

/s/ Attorney electronic signature.

ATTORNEY FOR DEBTOR(S)

Insert Attorney’s Address, Phone, Email

DATED: