Chapter 7 Bankruptcy Forms for Filing Without an Attorney

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1 Chapter 7 Bankruptcy Form for Filing Without an Attorney Addre: United State Bankruptcy Court 126 U.S. Courthoue 517 Eat Wiconin Avenue Milwaukee, Wiconin Office Hour: 8:30a.m. to 4:30p.m., M-F Main Office Phone Number: (414) Bankruptcy Help Dek: Staffed by volunteer attorney on Thurday morning from 9:00 a.m. to 10:30 a.m. The Help Dek I in Room 153 at the above courthoue addre. Diclaimer: Thi packet of form and related Information ha been put togetherto oit individual who ore conidering filing ban/1ruptcy without an attorney. The Bankruptcy Court doe not guarantee that thi pocket contain all the form or information you need to file bankruptcy. The information In thi packet hould not be a ubtitute for the advice of competent legal counel. The taff of the Bankruptcy Court cannot provide /ego/ advice. Such advice may be obtoinedfram a competent attorney.----

2 z TO: ALL PERSONS FILING BANKRUPTCY A tmtee will be aigned in every Chapter 7 and 13 cae. The name and addre of the trutee will be given in the Notice of Banlauptcy Cae Filing (alo called the 341 Notice). That Notice will alo give the date, time, and place of the "Section341 Meeting of Creditor." Attendance at thi meeting i required of all debtor. The N.otice will be ent to the Debtor and all creditor lited on the mailing matrix within 7 to 1 0 buine day. A. No later than 7 dav before the Section 34 I Meeting of Creditor. vou are required to provide the trutee with copie of the following reguired document (do not end original. malce a copy for the tmtee): 1. Title to all vehicle; 2. Recorded deed and land contract for all real etate; 3. Recorded mortgage for all renl etate; 4. The mot recent real etate tax bill for nil real etate; 5. The preceding two (2) year igned federal and tate income tax return and all chedule or trancript of the return. 6. Payment advice (e.g. pay tub) or other evidence of payment received by the debtor from any employer within 60 day befure filing the petition. 7. The name, addre and telephone number of each holder of a Dometic Support Obligation; and, 8. Any other document requeted by the trutee. 9. Tax return and payment advice or other evidence of payment provided to the trutee under paragraph (a)(5) and (a)(6) above, hall not be filed with the court unle otherwie ordered, B. At the Meeting of Creditor. you mut produce the following: 1. Pictnre identification iued by a govemmental unlt (driver' licene, county id card or the like), howing your name and picture identification. 2. Social Security card orrecent W-2 or 1099 howing your Social Security number. C. In addition. you mut provide to the trutee any additional document the Trutee requet at leat even (7) dav before the meeting of Creditor: If any of thee document are not provided a requeted, the cae may have to be adjourned from the initial meeting date. lf any of thee matter are not applicable, pleae o indicate in your repone. If you have any quetion regarding the requet, pleae contact the Trutee,

3 Warning Regarding Petition Prepnrer Only an attorney i autl10rized to give you legal advice regarding a bankruptcy cae or proceeding. So-called "petition preparer" are not autl1orized to give debtor legal advice, Their role i trictly that of a typing ervice trancribing for a minimal fee tl1e information a client provide, For example, they cannot: Malee uggetion regarding what paper are legally appropriate Advie you regarding what i legally required when a form elicit infmmation :from you Explain the meaning of a particular tatutory proviion or rule Provide advice on the bet procedure to accomplih a particular goal Explain tlie reult oftaldng or not taldng action in a cae Explain who hould receive proper notice or ervice Mot of tl1e required form in a bankruptcy cae are available for free, and mot are in pdffillable form o that they can be completed uing a keyboard. If you do not have a computer, check at the Clerk' intake couoter regarding tbe availability of a computer you may ue, free of charge, for the purpoe of filling out the reqtrired form. Given!he availability on the internet of pdf-fill able form, there i little or no reaon for a debtor to pay a non-attorney "petition preparer" to obtain the form. Properly completing thoe form, however, may require advice ofcompetent legal coune~ a petition preparer may not give you uch legal advice. Waming to Petition Preparer: Section]] 0 of the Bankruptcy Code provide civil penaltie for peron, other than an allorney or an employee ofan.attomey, who negligently orfi audzilent/y prepare bankruptcy petition or any other document for filing by a debtor in connection with a banlrr:uptcy cae. All petition preparer hall comply with the requitement of 11 U.S. C. II 0. Failure to comply with II 0 may reult in civil enforcement action by the United State Trutee or ubject the preparer to criminal proecution under I8 U.S. C. 156,

4 Farm 200 (Chaptl!r7, Individual! What form do I need to file bankruptcy?* A. To open a Chapter 7 bankruptcy cae, you need to file thee form and deal with the filing fee today, If you are o buine/corporation and want to file Chapter 7, you mut hove on attorney. D Voluntary Petition B 1 D Creditor Mailing Matrix 0 Exhibit D B 1D D Credit Couneling Certificate Don't have your credit couneling certificate? D I took a credit couneling coure, but do not have the certificate. (You have 14 day to ubmit it.) D I requeted, but could not obtain the couneling, and I have an emergency and need to file banltruptcy before I can take the coure. (The judge may allow a 30 or45-day extenion, depending on the explanation you provide.) D I am not required to get credit couneling. {See intruction in Exhibit D) D Statement of Social Security Number Lccal Form 21 D 299 filingfee, or Can'_t affa~d the filing fee? d You may be able to pay in intalirnemt B 3A D You maybe able to have your fee waived B 38 D Did a petition preparer help you? If o, you will need to file: D Notice to Debtor by Bankruptcy Petition Preparer B 19 D Dicloure of Compenation for a Bankruptcy Petition Preparer B 280 B. The following form are alo needed in your cae. They are due in 14 day. If you do not ubmit them within 45 day, your cae will be dimied. D D D Schedule D Schedule A- Real Property D Schedule B- Peronal Property D Schedule C- Property Claimed a Exempt D Schedule D- Creditor Holding Secured Claim D Schedule E- Creditor Holding Unecured Priority Claim D Schedule F- Creditor Holding Unecured Non priority Claim D Schedule G- Executory Contract and Unexpired Leae D Schedule H-Co-debtor D Schedule 1- current Income D Schedule J -current Expenditure of individual Debtor() with Statement of Monthly Net Income Statement of Financial Affair Statement of Current Monthly Income and Mean Tet Calculation B 6A B 6B B 6C 8 6D 86E 8 6F H J B7 822A.C. Thee form alo need to be ubmitted within 14 day, D ummary of Schedule D Statitical Summary B 6, page 1 B 6, page 2 * STOP! Have you filed Chapter 7 in the lat8 year and received a dicharge? If o, you mut wait to file unti/8 year and 1 day after your lat petition wa filed. 4

5 m com 1 F IC!n arm n C41JOJ 1upe:! Vohmtnry Petition Nume of DebloJ(): (nli paf!e m11.rt be cump/t!idri and filed flll!i'iu1' c:nt!,) AIIJ'rlnr llnnltnmlc\' Cne lilletl WIUtht l..ltl B Vcnr.> (If more limn nvo. nttoch utlditionnl.heet.) Lncnt!an Cuc Number: DnteFiled: Where Filed: J..acutlon C115e Number. DuteFiled; Where Filed: l'cmlln 1 Dnnltrllpt~ Cuc Fll~d h~ nny S 1nuc, l'nrtuer, ur Mfillnll! nflhi!i Debtot Ofmnrellum nne, nllm::h nddilionul heet.) Nnme ofoehtor. Cme Number: Dote Fllctl: DiSirict Relntionhip: Jttdgc; E:rhlbll A [fo bu complcle:tl Jftlubtor i required to file periodic rcpon (c.c., fmm IOK ond IOQ) \\1Ut the Sucurilie und Exclmnge Commiion puruant to SecJ.ion 13 or l5(d} of the Securitii!S 8tchnnge Act or 19J4 und i requi!sting relief under ehnpter II,) Exhlhh n {To bo completed If debtor i on individual wltne debt nro primllri]y con.umer debt,) 1, lhl! nuamcy for lhe petilloner nnmed in the foregoing petition, duclnrc that I hove infonned!he pethloner lim\ [he or he] mny proceed undi!r chnplor7, II, 12, or 13 ortltle II, United Stute Code, and hove expln\ned Ute rclicfomllnble under encb uch thnpter. 1 further certify thnt I hove dalivorcd to the debtor the notice required hl' II U.S.C. 342(b). 0 Eli.hlbit A i nltncber.l und 111nde n part ofthl petilion. X Signature of Attorney for Dcbtor() {Dote) Exhibit c Doe.'i the debtor own or hnve poeion of nny property tlun poe or I alleged to poen thrco\ of lmmln~:nt nnr.lltlentifioblll hnrm lo public henllh or nfety'} 0 Ye, and ExhlbitC i aunched ond mude n pnrtofthi pethion, 0 No. Exblbll D ffo be tompi!!u!d b)' CVCI)' individual debtor. Ifnjoint petition i nlcd, ench pouie mut complete nnd ntlnth nepnrnte Exhibit D.) 0 E x.hiblt 0 completed nnd igned by the debtor i nunc bed nnd mntle n pnrt of liti petition. If thi I a joint pc.tllion: 0 Exhibit D alo completed nnd igned by the joint debtor i ntmchcd nnd mndc. n port ofthi petiliorl 0 Infnnnnllnn Rcgnrdlng lhll Debtor- Vcuuc (Check nny nppticable bd:t.} Debtor hn been domlnlh~d or hn had o ll!sirlencc, prlncipnl place ofbtuim:, or principal net In thi Ditrict for lbo day immcdlntcl} pre~:eding the tlnle of lbi petition or for n longer port nfueh 180 dny thou in nny othllr Ditrict. 0 Them i 11 bankruptcy CllSC concaming: debtor' nffilintll, gnncrnl pnrtner, or pnrtm:rhip pending iil thi Ditrict. 0 Dlilitor i n dl!blor In o foreign proceeding ond hll!i it princlpnl pluce of buine or pdncipnl net in the Unllllti Stole in thi Ditrict, or l1n no prlnclpnl place ofbuirit:s or nl!t in the Unlt~:d Stnle but i n dert:ndnnt innn action or procectlinn [in o fcdcml or tntc court] In thi Di!rlct. or!he Interet oflh.c pnrlie will be crvl!d In rcgortlto Uu~ n:licfoughi in thir. Ditrict, Ccrtlfi~!nlion b)' II Dei.Jtor Who Rchlcit 11 Tenon I urreldenllnl i'rnpcrty (Chct:i; u\1 ilpplicnblc bo:te.) 0 Lnmllord hn njutlgm~:nt ognhlttbe debtor for pd.seiun of debtor' reidcn~ (lfbox chile ked, complete the following.) {Nome or Jnndlord tltnl obtnincdjudgmcnt) (Addre oflundlord) 0 Debtor cluims thnl under npplicnble nonbnnl;rup!cy Jnw, them n~ circumetnnce under which the debtor\vould be permitted to cure Ute entire monetnry defuuh thnt gnvc rise to the judgment forpct!iion. ofier the judgment forpoi!ssion wn entered, nnd 0 Debtor hd5 included wlll1lhi p!!lllion the depoit wltlt the court ofnny rent liml would become due dtiring the 30-dny pcriod nflcr the filing ofu c pelitiun. 0 Debtor ccnlfie Lbnl he/he hll!l erved tltu Lnrn1Jord with thi c:rtlficotion. (II U.S.C. Jli2(1)), 5

6 B I (Offitiul Fom1) I {4/1 0) Voluntni'Y }lctitlon (f/ti;r puxv 1111t.~l he compici/t!d a/ltl.!ift!d ijii!i'l!/j' ccuu.} Slgnnture() ofucblur{} (lndlviduni/,joinl) Slgnnture Numl! of Dcbtor(}: Slguntnru or11 Furclgn Rtprt!.!il!lttnlh c Pnge.J I dl!clnrc undl!r pnnnlty of peljury thnt the inrormntion prnvldi!ll in thi pnlithm i true I detlnre under pcnnll}' or pnrjmy lhnlthll informntion provided In thi pctilion l5 nud correcl true and cdrrcct, thnt I nm the fo~ign repreentutive of u debtor in n foreign fif petitioner i nn lndividuui whoe debt nrc primarily conumer debt and hn pmt:~:eding, nnd thnt I om uuthoriwd Je thi petition. choen to file under chnptcr 7J I om D\YllTC thnt 1 mil}' procm:d undru chnpter 7, II, I:! or 13 oflitll! II, United Stntc Code, undcrtnnd d1ll rcliefnvullnblc under cnclt uclt {Chtck only unu box.) chnpter,nnd clmoc to proceed under chupter 7. D I requet relief in uccordnnce with chapter \5 oft!tlc II, United Stole Code. [If no ouonh!)' repreent me nntlno bankruptcy petition prepnrer ign tlte polltion} I CllrtUicd copie of the document required b)' II U.S.C nru nunched. hnvu obtninetlnnd rend the notice required b.y II U.S. C..342{b}. D Purlliln\to 11 U,S,C. 1511,1 requet relief in occordnnce with the I requet relief in nccordrmcu with lite clmptcr of title II, United Stnte Code, clmptcroftlllc II pecllied in thi petition. A cenitiecl copy orthc peclrietl in thi petition. order grnnling rucognition of the foreign mnin proceeding i~ ounched. X Sigmuuro ofdcbtor X (Sigmuure of Foreign Reprer:ntntive} X Signature of Joint Debtor (Printed Nome of Foreign Rcpr!CI11Dllvc} Telephone Number {if not repreented by nllomey) Dote Slgunture or Attnn1el'"' Dote Slunnlure ofnou-aitorney Bnnltnlptcy Petitlnu Prepnrer X Slnntureuf Allomcy for DebiDr() Printed Nnme of Allomc~ for Oebtor{) Finn Nome Addre Telephone Number I dl!l:lnrc under penni!.} or pejjuty thnt: (I} l om n bnnliruptcy pelition prcpnrer u defined in 11 U,S,C, 110; (2) I prepared lhl document for compcnntlon nnd hove provided the debtor with n copy of thi document nnd 1he notice and infommuon required under II U.S.C, JIO[b), II OQ1), nnd 342(b); and, (3) If rule or guideline hove bean promulgnted purunnt to II U.S.C.!i 11 O{h) etting o maximum fee. for ervice chnrg~oble by bankruptcy petition prepnn:r, I hove given the debtor notice of the mnximum nmount before preparing llnl' dm:ument for filing for n debtor or nct!!!pung ony fcc from the debtor, n required in lhnl ection. Official Fonn 19l nunched. Printed Nnme nnd tille, ifnn), ofbnnkruptcy Petition Prepnn:r Dote Social-Security number {If the bnnltruptt:y pctillnn prcpnrcr I not nn individual, tole the Socini Sccurity number or the officer, principal. 'In n ctl5c in which jj 7D7{b)(<I)(D) nppll~, thi ignntw-t: alo contitult: u ICSpoll!ilble peron or punnar of tln.! bnnkruptcy pt:tllian prcpnrer.) (Required cenificnticn thntlhe nuomey hn no btowlcdc nficr nn lnquhy lhntthcinfonnntion by 11 u..c. 110.) in the. chedule i im:orrc:cl Signature of Debtor (Corponlllonll'nrlncrhlp) I declare underpcnnlty ofpeljul}' lhot the information provided In thi petition l true nod correct, ond llmt. I have bean oul11orized to filn thi petition on behalf or the debtor. X Addre The debtor requet the rellr:r in uccortlom:c-wlth the. choptcr of title II, United Stute Code, pecified in thi pl!lltion. X Signature or Authortzerllndlvitlunl Printed Nnme Of AulhoriU.!d lndlvldunl Tille omuthnrized lndlviduol Dntc Dall: Signoture of bnnltruptcy. petition prcpnn:r or officer, princlpnl, reponible peron, or partner WhD!!u Soclni Set:urhy number i provided ubovc. Nnme nod Boclnl Sccurlly number of oil other indlvidunl who prepnrcd or nitt:d in propnrlng thili docuintnl unle!l!llhe bllnkruplcl' petllion prupnrur i not nn Jndlviduol, If mere thnh one per_on prepnrctl llii document, Dttnch odd!uonnl heet conforming to the npproprlntc off' mini fonn fer cnch ptr.;on. A bt111atilplcy.pctftfon prepa~' jaifllre to -complj will _ihe provi.foll of Iiiii.! J J a11p tile Federal Rule af Bonkillptcy Procedure Jllttl' rc.nlt in]llit!s or lmpriotlllu!lll or bath. 1 I.u.. c. JJfJ: 111 U.S.C.9 l:i6.

7 Jmwt L, Mrullut. li Clerk nfctjlij't 126 U.S. Cuul'thoue 517 E. Wi~ c:umiin rjve...ll:lilwnulir!e 1 WI www. wieb.ucourt.gov Uni/l!d State Bankruptcy Court Eatem Dltrict of Wicun;u Offi" nf /he Clerk REQUIREMENTS FOR FILING A LIST OF CREDITORS, CREDITOR MATRIX, OR MASTER LIST (MATRIX) In order to proce matrice more efficiently, the Clerk requet that matrice are filed electronically either by uing the File Your Creditor Matrix application which i available on the court' webite, or on the terminal in the public area of the Banlcruptcy Clerk' Office, or by atwieb matrice(alwieb.ucourt.gov. Only in extenuating circumtance will a paper matrix be accepted for filing. It i not neceary to file a verification of the creditor matrix in thi ditrict. I. Uing the File Your Creditor Matrix application (www.wieb.ucourt.gov) a. Type the name and addree of all creditor. For example: AT&T P 0Box575 Murray, UT ADT Security Service P 0 Box3490 Pittburgh, PA Sear, Roebuck & Company POBox3671 De Moine, 1A b. Wlmtlfinihed typing each creditor, click on Add Creditor. c. Wllen finihed adding all creditor, click on Submit Lit button. d. You have an opportunity to review the lit at the next window. e. Click on either Back button to edit the lit or the Submit button to accept the lit. i. Clicking on Submit will 'Send your matrix to a deputy clerk. 1

8 B ID {Offil:iul Form 1, Exhibit D}(l2/09) UNITED STATES BANKRUPTCY COURT In re ---~-, Debtor Cae No.. _-:-::--:-::---:- (iflmown) EXHIBIT D- INDIVIDUAL DEBTOR'S STATEMENT OF COMPLIANCE 'WITH CREDIT COUNSELING REQUIREMENT Warning: You mut be able to check truthfully one of the five tatement regarding credit couneling lited below. If you cannot do o, you are not eligible to file a bankruptcy cae, and the court can dimi any cae you do file. If that happen, you will loe wbatevcr filing fee you paid, and your creditor will be able to reume collection activitie againt you. If your cae i dimied and you file anotber bankruptcy cae Inter, you rnny be required to pay a econd filing fcc and you rnny have to take extra tep to top creditor' collection activitie. Eve!J' individual debtor mut file thi Exhibit D. If a joint petition i filed, eaclz poue mut complete and file a eparate Exhibit D. Check one ofthefrve tatement below and allach any document a directed Within the 180 day before tbc filing of my bankruptcy cae, I received n briefing from a credit couneling agency approved by the United State trutee or bnnlcruptcy adminitrator that outlined the opportunitie for available credit couneling and aited me in performing a related budget analyi, and I have a certificate from the agency decribing the ervice provided to me. Attaci1 a copy of the certificate and a copy of any debt repcijqnent plan developed tln ough the agency Within the 180 day bef01 e the filing of my bankruptcy cae, I received a briefing from a credit couneling agency approved by the United State trutee or banlcruptcy adminiti'btor that outlined the opportunitie for available credit couneling and aited me in performing a related budget analyi, but I do not have a certificate from the agency decribing the ervice provided to me. J'oumutfile a capy of a certificate from the agency decribing the en ice pmvided to you and a copy of anydebt repcijmrent plan developed through the agency no later than 14 dcij's after your ban/a11ptcy cae i filed

9 BID (Officilll Fcnn I, Elih. 0)(12/09)-Cunt. Pngc:! certify that I requeted credit couneling ervice from an approved agency but wa unable to obtain tl1e ervice during the even day from UJe time 1 made my requet, and the following exigent circumtance merit a temporary waiver of the credit couneling requirement o J can file my bankruptcy cae now. [Summarize e..r:igenl ch cum/ance here.] If your certilication i atifactory to the coort, you mut till obtain the credit couneling briefing within the firt 30 day after you file your bankruptcy petition and prompt!)' file a certificate from the agency that proyided the couneling, together with a copy of any debt m:magement plan developed through the agency. Failure to fulfill thee requirement mny reult in dimial of your cae. Any extenion of the 30-day deadline can be granted only for en ue nnd i limited ton maximum of 15 day. Your cae may alo be dimied if the court i not atified with your reaon for filing your bankruptcy cae 'vithout firt receiving n credit couneling briefing I am not required to receive a credit couneling briefing becaue of: [Check ihe applicable tatement.] [Mut be accompanied by a motion for determination by the courl] 0 Incapacity. (Defined in 1 I U.S.C. 109[h)[4) a impaired by reaon of mental illne or mental deficiency o a to be.incapable of realizing and making rational deciion with repect to financial reponibilitie.); 0 Diability. (Defined in J1 U.S.C. 109(h)(4) a phyically impaired to the extent of being unable, after reaonable effort, to participate in a credit couneling briefing in peron, by telephone, or tlu ough the Internet.); 0 Active military duty in a military combat zone The United State trutee or banlcruptcy adminitrator ha determined that the credit couneling reqtjirement of 11 U.S.C. I 09(h) doe not apply in thi ditrict. I certify under pennlty of perjury that the information provided nbove i true nud correct. Signature ofdebtor: Date: q

10 Locnl Fnmt11 Ue\': UNITED STATES BANKRUPTCY COURT FOR THE EASTERN DISTRICT 01' WISCONSIN lnre. Dubtor Cae No Chnplllr STATEMENT OF SOCIAL SECURITY NUMIIER(S) I. Name of Debtor (Lat, Fir~ Middle): Debtor hn a Sociul Security Number and ll i I Debtor doe not have a Social Security Number but hn un lndividuul Taxpayer-ldentificalion Number (!TIN), and it i: Debtor doe not have either n Social Security Number or an Individual Tnxpayer-ldenlification Number (!TIN). 2. Name of Joint Debtor (La~ Firt, Middle]:, I Joint Debtor ha a Social Security Number and it i I.JolnlDebtor doe not have a Social Security Number but ha an lndividunl Taxpayer-Identification Number (!TIN), and it i: LJoint Debtor doe not have either a Social Security Number or an Individual Tm:payer-ldentilication Number (!TIN]. 3. Name of Spoi!Se if not n Joint Debtor (LDS~ Firt, Middle]: Addre!:Spoue ha a Social Security Number and it i f:'ispoue doc not hnve n Socinl Security Number but hn an Individual Tnxpayer-Jdentificatian Number (!TIN], and ll i: I poue doc not hnve either a Social Security Number or an lndivlduul Taxpayer-Identificntion Number (!TIN). I deolnre under penally of perjury that the foregoing i true and correct X--~~~~~~-----~~ Signnture ofdebtor Dnte x-~~~~~~~~--- Signnture of Join! Debtor Dnte *Check the appropriate boxe abot'e and pl'dl'ide the raqrtired informal! an. *Debtor mut.pravide in[armatian[or non-filing poue. "'[f Debtor, Jdlnt Debtor or Non-Filing Spoue ha mare than one. Socia( Securib' Nrmiber, late all. Penalu'far making a fale /alemenl: Fine of up /o 250,000 or11p los yeat\r in!priaumenl or both. 18 U.S. C. /52 and /0

11 B JA {Dmclnl FonnJA) {12/07) UNITED STATES BANKRUPTCY COURT In re ;:--;-, ' Dcblol' Coc No, Chnpler APPLICATION TO PAY FILING FEE IN INSTALLMENTS I. In uccordlljlce with Fed. R. Bunkr. fl. IDOfi, I opply for Jlcnniicn to pll)' the filing fcc nmounting toc ln lnlnllment. 2 I nm unnbh: to pny llu: filing fcc except in lntn\lmcnt. J. Until Ute liung fee i pnld in full, 1 will not mnkc nny uddllionnl p11}'111ciil or tmnfer nny oddillcnni)uo(lcrt)' to nn unorney or nny other peron fnr ervice in connection with thi Cll5C. 4. l pmpoe lh~: following teml5 for the payment ofthe Filing Fee. Check one D With the filing cflhc petition, or D On or before au or before on or before on or before The number oflntnllmcnt propocdhnll not exceed four {4), nnd tl1e linn! inmllmcnthn\1 be pnyrtblc notlnlcr lljun 120 doy after filing the petition. For cuuc hown, I he court mny extend Ute time of llll)' intnlhncnl, provided the In\ irulnllment i pnid not inter thnn I 80 d11y nli.er filing U1e petition. Fed. R. Bnnkr. P. I006(b)(2). 5. I undertood lhalifl fall to pay uny inulllment when due, my bankruptt:y cae mn)' be dimied and 1 rna}' not receive a d[chnrge of my tlebt. Sigmttnrc of Attorney Dote Signature of Debtor Dnu: (In a joint cue, bou1 poue mut ign.) Name of Attamey Signature of Joint Deb lor (if nny) Date DECLARATION AND SIGNATURE DFNDN ATIDRNEY DANIGlUPTCV PETITION l'reparer (Soo II U.S,C. llo) I dco\nre under pennlly ofpcijut)' lhnc (1) I om n bankruptcy petition prcpnrer a defined in J I U.S.C. 110; (2) 1 prepllfcd tld document for compcnotlon and hnvc. provided tltc dcbtorwllh n copy of thi document ond lite notice and infcnnntion required under II U.S.C, IIO{b), IID(h), and342(ll}; (~)if ntle or guideline luwe been promulgntcd purunnt.to II U.S.C. J I D(h} ettirig n maximum fee for ervice olmrgcnb\1! by bnnkruptcy pelltion prcpnrcr, 1 It ave given the debtor notice oflho mnximum amount before preparing nny document for filing for n debtor or accepting nny fcc Trom the deb lor, n required und~r that ection~ and (4) I will not.dcccpt any additional money or outerpropcrt)ifrom lhe dehlor before the filing fee i pnld in full. PrinLcd or Typed Nnmc nnd TlUc, ifnny, ofbnnkruptcj' Petition Prepnrer.Sooini~Security No. (Required by II U.S.C. f1 0,) ljtha ba11kruptcy patltirmpraparo.r i not an Jndillldual,.rtate 1/lf! name, IIIla (ifnnj~, addre, and acial-ecut Uy nmnberojjhc officer, prlualpal, reptlltible. prtrjan, or partner who ign the dacjtmrmt: Addre ~~~~~~~~~ Signature ofbunkruplc}' Petition Prcpnrcr Dille Nnme tmd SDt:inJ-Sccurity number of nll outer individunis \Yho prepnred or nitt:tl in prcpurlng thi document, unle the bunkruptcy pclitlnn prepnrcr i no! nn individual: lfmore than r:meprwon prepanul thi document, auuchaddltiana/ igned hee.t carifomring tcnhe appropriate OffiCial Form for each peron. A hankntptc:y perilion pre.parel' ' folilwc Ia comply with the pt ovi/dijs riftille I 1 and the Ferleral Rille{]/ Bankruptr:J' Procedwe :may reu/titrflne ur imprfammmt or hath. 11 U.S.C, 1 IOi IB U,S.C; 156, \(

12 D JB (Omcinl FnnnJB)(I2/07) APPLICATION FOR WAIVER OFTiill CHAPTER 7 FILING FEE FOR INDIVIDUALS WHO CANNOT PAY THE FILING FEE IN FULL OR IN INSTALLMENTS The court fee for filing a cae under chapter 7 ofthe Bankruptcy Code i 299. lfyou cannot afford to pay the full fee at the time of filing, you may apply to pay the fee in intallment. A form, which i available li"din the bankruptcy clerk' office, mut be completed to make tlmt application. If your application to pay in intallment i approved, you will be permitted to file your petition, generally completing payment of the fee over the coure of four to ix month. If you cannot afford to pay the fee either in full at the time of filing or in intallment, you may requet a waiver of the :filing fee by completing thi application and :filing it with the Clerk of Court. A judge will decide whether you have to pay tl1e fee. By law, the judge may waive the fee onlv if your income i le than 150 percent of the official poverty line applicable to your family ize and you are unable to pay the fee in intallment. You may obtain information about the pove~ty guideline at or in the banlo uptcy clerk' office. Required information. Complete all item in the application, and attach requeted chedule. Then ign the application on the lat page. If you and your poue are filing a joint bankruptcy petition, you botl1 mut provide information a requeted and ign the application. /2-

13 D 38 (Qfficild Form JB) (12107) - ConL UNITED STATES BANKRUPTCY COURT In J'e: Deblor() Cae No. (if7k-no-l-vn"") APPLICATJON FOR WAIVER OF THE CHAPTER 7 FILING FEE FOR INDIVIDUALS WHO CANNOT PAY THE FlLING FEE TN FULL OR ln INSTALLMENTS Pnrt A. Fmnlly Size nnd Income I. Including yourelf, your pouo, and dependenl you hnve Jiled orwllllit on Schedule 1 (Current Income of lndlvlduul Debtor[)), how mllily people ure in your family? (Do not include your poue if you are epnrnted AND nre not filing a joint petition.) 2. Retate the following information that you provided, or will provide, on Line 16 of Schedule I. Altnch a completed copy of Schedule 1, if it i available. Totnl Combined Montltl)' Income (Line 16 of Schedule 1]: State the monthly net income, if any, of dependent included In Quetion 1 above. Do not Include any Income nlrendy reported in Item 2. If none, enter Add Ute "Tolal Combined Monthly Income" reported in Quetion 2 to your dependent' monthly net income from Quetion 3. '~' Do you expect the amount in Quetion 4 to Increae or decreae by more than 10% during the next 6 month? Ye No If ye, explain. Pnrt B. Monthly Expene 6. EITHER (u] nttach u eomplclud copy of Schedule J [Schedule ofmontilly Expene), and tate your total monthly expene reported on Line 18 of!hnt Schedule, DR (b) if you hove notyel completed Schedule JJ provide an etimnte of your tot11l monthly expene.. 7. Do you expecl the amount in Quetion 6 to increne or decreae by more than 10% during tlm next 6 month? Ye No lfye, explnin-.- Pnrt C. Renl nnd l 1 eronnl Property EITHER (1) attnch completed.copie of Schedule A (Reul Property) and Schedule B (Peronal Property], OR (2] if you have not yet completed thoe chedule, anwer the following quetion. 8. State the amount of cnil you hnve on hnnd. 9, State below any money you hnve In aving, chccldng, or' other account in a bank or other financlni intitution. Bonk ar Other Financial Jnlhutiun: Typo cf AccautiL5Uclt 11!i fidylng, chccklnfl CD: Amount.. /3

14 B 38 (Official Fonn3B)(I2/07) -Com I 0. Stat~ below lhe net owned by you. Do not lil ordinary houehold ru1 nihing nnd clothing. Home Addre: Vnhu::S Amount owed on mongngl nnd lhm: S Dt.ber tcnll!stnu: Ar.ltlre: Vnluc: Amount owed on mortgage and lhm: Molar vchich: ModclfYCllr. Vnlu!!!S Amottnl ower.j:s Motor vehicle Mndui/Vcnr. Vnluc; Amount owed: Otlt!!t Dccriptinuc Vnluc: Amount owed: S Stnte below any peron,. buine, organization, or governmental unit that owe you money nnd the nmount thai i owed. Nome or Peron, Bwlni!SS, or Orpnlzntion thnlowe Ynu Manny Amount Owed Pnrt D. Additionnl lnformn!lou. 12. Hnve you puid nn attorney nny money for ervice in connection with thi cae, including the completion of thi form, the bankruptcy petition, or chedule? Ye_ No_ If ye, how much have you paid? 13. Have you promied to pay or do you anticipate poying nn attorney in connection with your bnnluuptcy cd.sc? Ye_No_ If ye, how much have you promied to pny or do you nnticlpnte paying? Have you pnld nnyone other t1111n nn nt!orney (uch a a bnnlcruptcy petition prepnrer, paralegal, Lyplng ervice, or nnotller peron) nny money "for ervice In connection witl1 Uti cne, includijlgthe completion of thi iorm, the banlrruptcy petition, or chedule? Ye _No_ Jfye, how much hove you paid? Hnve you promied to pay or do you anliclpnte paying nnyonc. otlu~r thnn nil nttornc.y.(uoh a a bllrlkruplcy petition prepnrer, pnrnlegal, typing ervice, or nnotherperon) any money for ervice in connection wiu1 thi coo, including tho oomplclion of thi form, the bankruptcy petition, or chedule? Ye No lf ye, how much hove you promied to pay or do you anticipate pay lng? Hn anyone paid an attorney or other-peron or ervice. in connection with ilii elie, on your behalf? Ye No lfye, explain. 14

15 B 3B (Officinl Fonn JB) (12107) -Cont. 17. Have you previouly filed for bankruptcy relief during the pat eight year? Ye_No_ Cne Number (if known] Yenr filed Location of filing Did you obtain a dicharge? [lflmown) Ye No Don't know Ye No Don 1 1 know I H. Pleae provide any other lnfonnatlon tl1at help to explnin why you are unable to pay the filing fee in intallmenl. I 9. I (we) declnre under penalty ofpeljury thnt I (we) cannot currently afford to pny the filing fee in full or in intollmenl nnd Umt the foregoing information i true and carn:ml Executed on: Dale Date Signature ofdebtor Signature of Codebtor DECLARATION AND SIGNATURE OJ' DANICRUPTC\' l'etitidn PREI'ARER!Soe 11 U.S.C. 110) I dcclnreundcrpenully ofpctiu!j' tim!; (I) I nm n bnnkruptcy petition prcpnrc.rn defined in I I U.S.C. 110; {2) I prcpnrcd thi documenl for compcn.:ntion nnd luwe provldcu the dcblor wiu1 n copy oftl1i document nnd the notice nnd infonnnlion required under I l U.S.C. H II O(b}, J I 001}. nnd 342(b); nnd (3) If rule or guideline hnvc been promulgated purunnlto II U.S. C. I I O{h) euing n mrudmum fcc for ervice ~:ltnrgenble by bnnkrupt~:y petition prepnrer, I have given the debtor nctice.cflhll mnx.imum nmount before prcpnring nny documcnj for filing for n debtor or neccpting Wl}' fee from the debtor, n required under thnt ection. Printed or Typed Nwne nnd Title, If nny, of Bankruptcy Petition Prcpnrer Socini Sccurity No. (Rcqulrod b) II U,S,C. I to.) if tho banlmtplr:)' pelf/ion pro parer I nat an indmdjtal, tate the name, title fl( anj~, addre, and oc:ial.iet:ttrfo number of the officer, prfnclpa/, repanlble peron or partuer wit a fgnr the. dacumam. Addre X S~ig= n=n=w=re~o~f~b~nn~~==p~lcy~p~el~il"io=n P~re=p=ruo==r Dale Nnme ond Sooini~Sc~:urity number of nil outer lmlividuol who.prcporcd or nitcd Jn propitrlng thi document, unlt!s the bunlcruptcy pt:.tllinn prcpnrer i not on individual: /[mare than one prwon prepared thi document, at/ar:/1 addiliana/.igned heet cat!farming to the appropriale Official Fot mfot aach pl!l<on. A brmkrupicj' pelftlon preparnl' 'jall11re Ia comply with tim pravliou of lit/a 11 artd rlw Federal Rt~le of Bankl'llplcy Procedw c llltd' reult in fine or imprlanmrmt or both. ll U.S. C. I JO: 18 U.S. C IS

16 BIY {Dfficlnll'orm 19)(12101) United State Bankruptcy Comt lnr ~~------~ Debtor Cae No Chapter DECLARATION AND SIGNATURE OF NON-ATTORNEY BANKRUPTCY PETITION PREPARER (See 11 U.S.C. 110) I declare under penalty of perjury that: (1) I am a bankruptcy petition preparer a defined in II U.S.C. I I 0; (2) I prepared the accompanying document() lited below for compenation and have provided the debtor with a copy of the document() and the attached notice a required by 11 U.S.C. IIO(b), l!o(h), and 342(b); and (3) if rule or guideline have been promulgated puruant to 11 U.S.C. II O(h) etting a maximum fee for ervice chargeable by bankruptcy petition preparer, I have given the debtor notice of the mnximum amount before preparing any document for filing for a debtor or accepting any fee from the debtor, a required by that ection. Accompanying document: Printed or Typed Name and Title, if any, of Bankruptcy Petition Prepnrer: Social-Security No. of Bankruptcy Petition Preparer (Required by I I U.S.C. 11 0): If the banlc11rptcy petition preparer i not an individual, tate the name, Iitle (if any), addre, and ocial-ecurity numbe1 of the officer, principal, reponible peron, m pal'tner who ign thi document. Addre X Sig;;;n"'a"'ru'"r"'e"o"'r"B:r.a"n"'lcr"'t"'lp"'t"'cy""'P""et"'lr"'Jo"'n,...I"''I"' e"'p'"ar""er '"D"'a"'te, Name and ocial-ecurity number of all otiter individual who prepared or aited in preparing thi document, unle the bankruptcy petition preparer i not an individual: Q'more.than one peron prepared.thi dormment, attach add/tiona/igned heet cm!formingto the appropriate Offiriial Form for each peron. A bn il<ruptcy petition prcpn c ' failure to comply with tlw proviion of title 11 und the Fcdcr:il Rule ol'bnnl<ruptcy Procedure mny reult in fine or imprionment or both. 11 U.S.C. 110; 18 u..c lb

17 819 (Ofiiclnl Fnnn 19) {1"1/07)- Cnnt. 2 NOTICE TO DEBTOR BY NON-ATTORNEY BANKRUPTCY PETJTION PREP ARER [Mut be filed with any dacument() prupared by a banlauptcy petition preparer.] Jam a bankruptcy petition preparer. I am not an attorney and may not practice law or give legal advice, Before preparing any document for filing a defined in 11 D(a)(2) of the Bankruptcy Code or accepting any fee, I am required by law to provide you with thi notice concerning bankruptcy petition preparer. Under the law, 110 ofthebanktuptcy Code (11 U.S.C. I 10), I am forbidden to offer you any legal advice, including advice about any of the following: whether to file a petition under the Bankruptcy Code (11 U.S.C. 101 et eq.); whether commencing a cae under chapter 7, 11, 12, or l3 i appropriate; wheu1er your debt will be eliminated or dicharged in a cae under the Bankruptcy Code; whether you will be able to retain your horne, car, or otl1er property after commencing a cae under the Bankruptcy Code; the tax conequence of a cae brought underthe Bankruptcy Code; the dichargeabilily of1llx claim; whether you may or hould promie to repay debt to a creditor or enter into a reaffirmation agreement with a creditor to reaffirm a debt; how to characterize the natore of your Interet in property or your debt; or bank-ruptcy procedure and right. [The notice may pra11ide additional example of legal advice that a bankruptcy petition preparer i not authorized to give.] In addition, under 11 U.S.C. l!o(h), the Supreme Court or the Judicial Conference of the United State may promulgate rule or guideline etting a majtimurn allowable fee chargeable by a bankruptcy petition preparer. A required by law, I have notified you of thi maximum allowable fee, if any, before preparing any document for filing or accepting any fee from you. Signature of Debtor Date Joint Debtor (ifany) Dale [h1 a joint cae, bath poue mut ign.] 11

18 B2BO (Fonn 280) (10/05) United State Bankruptcy Court Ditrict Of Jnre ~~~ Dcblor c.. c No, Chapler DISCLOSURE OF COMPENSATION OF BANKRUPTCY PETITION PREFARER [l'lli.rform mils/ be filed with tim pelillan if a bankr11ptcy petit/on preparer prepare tile petition. 11 U.S. C. 11 0(11)(2).]!. Under II U.S.C. 11 O(h), 1 dcc!nrc under penally ofpetiury Utall am not an allomcy or employee ofnn allomey, that! prepared or coued to be prepared one or more document for filing by Lhcnbove-nnmcd clebtor() in connection with thi bankntptcy coe, nnd thnt cornpemllltlon pnld to me within one year before the filing of the bnnltruplcy petition, or agreed to be pu\d to me, for ervice rendered on behalf of the dcbtor() in contemplntion of or In connection with the bankruptcy cne i tis follow: For document pl'cpnration ervice I have agreed to accepl... c _ Prior to the filing of thi tntement I hove receh,cd... Bnlnnce Due... ' , I have prepared or caued to be prepnred the following document (Itemize): and provided the following ervice (Itemize): 3. The ource of the compensation paid to me wa: D Debtor D Othet (pecify) 4. The ource of compenation to be pnid to me i: D Deblor D Other (pecil)') 5. The foregoing I a complete. tntcmcnt ofnny agreement or arrangement for payment ld me for preparation of.lhc petition iiled by the debtor() In!hi bankrupltly cne, 6. To my knowledge no other peron ha prepared for comperiation a document fol' ftjing In connection wiu1 thi batiltruptcy cne except a lited below: NAME SOClAL SECURITY NUMBER Signature Printed nnmennd Litle, ll'nny, of Bankruptcy Petition Jlrcporer Addre:. Social Security number ofbnnkrupltly petition prepnrcr (lflhe bankruptcy petition prcpnrer 1 not an Jndivldunl, tate the Social Security number oft.he officer 1 principnl, reponible peron or partner oflhc bankruptcy petition prepnrer.) (Required by lj U;S.C. I 10.) Date A ba/1/a'ujj/cji pe.lition pre.parel"'faihwe to comply with the praviidjr of title 11 -t;jnd.the.fedi!rdl Rille qjbankruptcypracedw ejjlojlreuft in fine or imprionment or both. 11 U.S. C. IJD; 18 U.S, C '

19 D6 Cm cr (l'nrm 6 Cover) (12/07) FORM 6. SCHEDULES Summary of Schedule Statitical Summary of Certain Liabilitie and Related Data (28 U.S.C. 159) Schedule A- Real Property Schedule B- Peronal Property Schedule C- Property Claimed a Exempt ScheduleD - Creditor Holding Secured Claim Schedule E- Creditor Holding Unecured Priority Claim Schedule F- Creditor Holding Unecured Nonpriority Claim Schedule G -Executory Contract and Unexpired Leae Schedule H - Codebtor Schedule I -Current Income oflndividual Debtor() Schedule J- Current Expenditure of Individual Debtor() Unworn Declaration Under Penalty ofperjury GENERAL INSTRUCTIONS: The firt page of the debtor' chedule and the firt page of any amendment thereto mut contain a caption a InForm 16B. Subequent page hould be identified with the debtor' name and cae number. If UJe chedule are filed with the petition, the cae number hould be left blank. Schedule D, E, and F have been deigned for the liting of each claim only once. Even when a claim.i ecured only in pnrt or entitled to priority only in pnr~ it till bould be lited only once. A claim Which i ecured in whole or in part hould he lited on ScheduleD only, and a claim which i entitled to priority in whole or in part hould be lited on Schedule E only, Do not lit the ame claim twice. If a credftor ha more than one claim, uch a claim ariing from eparate tranaction, each claim hould be cheduled eparately, Review the pecific in!juction for each chedule before completing the chedule. 1'1

20 06A (Officinl Fonn 6A) (12J07J ln~ ~~~ D~:btut Cm;~: Nu ,o:-:-----c (lflmo\\'11} SCHEDULE A- REAL PROPERTY ENcept u directed below, lit nil renl pmp!!rty in which the d!!btor huuny Jcgnl, cquituble, or fmure interet, including n!j property owned un cull!nnnl, community property, or in which the debtor hn n life etntc. Include nny property in which the debtor bold right and power exorcianble for ~1c debtor' own bcm:fil lftln: dt!btor i married, tate whether the huband, wife, both, or the mnrilul community own tl1e property by plncing nn "H," "W," "1," or ucn In lhc column lubeled "Huband, Wife, Joint, or Community.'' If the dabtor hold no Interet in renl property, write 01 Nonc" under "Dt!Scription nod Locniion ofprop~:rty." Do nol hlchu1e intei'csl In CJil.!cutoJ y contrnct nnd 1lllt!.'tpircd lene on lid chedule. Lillhem in SclJoi.lulc G- Executory Cnnti'OclSund Unexpired Lc.nc. 1 r nn entity clnirn to have nlil:n or hold o ecured interet in nny propcrt)' 1 tnte lhc amount nflht! t.-cured cluim. Sec Schedule D. I fno enllty claim to hold n ecured Interet in the property, wrile "None" in the column lnbeletl "Amount of Secured C\uim." If the dcbjor i lul lndh idunl or Jr n ju lnt petition i Jiied, lnle the nmounl of nny eliemplion c.jnimed in the property only in Schcdull! C - Property Clnimed n Exempt. DESCIUI'TION AND LOCATION OF PROPERT\' NATURE DJi DEBTOR'S INTEREST IN PROPERTY CtJltRENTVALUE OFDEDTOR'S INTEREST IN PROPERTY, WJIDOUT OEDUCI'ING AN\' SECURED CLAIM OR EXEMPTION AMOUNT OF SECURED CLAIM zo

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