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Step 1 of 10
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Fill in this information so we can properly prepare your case:
Debtor 1
First Name
Middle Name
Last Name
Debtor 2 (Spouse, if filing)
First Name
Middle Name
Last Name
Official Form 106A/B
Schedule A/B: Property
In each category, separately list and describe items. List an asset only once. If an asset fits in more than one category, list the asset in the category where you think it fits best. Be as complete and accurate as possible. If two married people are filing together, both are equally responsible for supplying correct information. If more space is needed, attach a separate sheet to this form. On the top of any additional pages, write your name and case number (if known). Answer every question.
Part 1: Describe Each Residence, Building, Land, or Other Real Estate You Own or Have an Interest In
1. Do you own, are you buying or have you inherited any real estate of any kin? (check all that apply)
None
Residence
Other house including rental home or investment property
Building
Manufactured or Mobile Home
Condominium
Lot, land, farm, acreage or timber
Heir property
Timeshare
Other
1.1. Street address, if available, or other description
City
State
ZIP Code
County
What is the property? Check all that apply.
Single-family home
Duplex or multi-unit building
Condominium or cooperative
Manufactured or mobile home
Land
Investment property
Timeshare
Other
Who has an interest or owns the property? Check one.
Debtor 1 only
Debtor 2 only
Debtor 1 and Debtor 2 only
At least one of the debtors and another
Other information you wish to add about this item, such as local property identification number:
If you own or have more than one, list here:
1.2. Street address, if available, or other description
City
State
ZIP Code
County
What is the property? Check all that apply.
Single-family home
Duplex or multi-unit building
Condominium or cooperative
Manufactured or mobile home
Land
Investment property
Timeshare
Other
Who has an interest in the property? Check one.
Debtor 1 only
Debtor 2 only
Debtor 1 and Debtor 2 only
At least one of the debtors and another
Other information you wish to add about this item, such as local property identification number:
Check if this is community property (see instructions)
Debtor 1
1.3. Street address, if available, or other description
City
State
ZIP Code
County
What is the property? Check all that apply.
Single-family home
Duplex or multi-unit building
Condominium or cooperative
Manufactured or mobile home
Land
Investment property
Timeshare
Other
Who has an interest in the property? Check one.
Debtor 1 only
Debtor 2 only
Debtor 1 and Debtor 2 only
At least one of the debtors and another
Other information you wish to add about this item, such as local property identification number:
Check if this is community property (see instructions)
Part 2: Describe Your Vehicles
Do you own, lease, or have legal or equitable interest in any vehicles, whether they are registered or not? Include any vehicles you own that someone else drives. If you lease a vehicle, also report it on Schedule G: Executory Contracts and Unexpired Leases.
3.Do you own or are you buying any vehicles (running or not)? (check all that apply)
None
Cars
Vans
Trucks
Tractors
Sport utility vehicles
Motorcycles
3.1. Make:
Model:
Year:
Approximate mileage:
Condition (Excellent, Good, Fair, Poor)
If you own or have more than one, describe here:
3.2. Make:
Model:
Year:
Approximate mileage:
Condition (Excellent, Good, Fair, Poor)
Check if this is community property (see instructions)
Debtor 1
3.3. Make:
Model:
Year:
Approximate mileage:
Condition (Excellent, Good, Fair, Poor)
3.4. Make:
Model:
Year:
Approximate mileage:
Condition (Excellent, Good, Fair, Poor)
4. Do you own or are you buying any Watercraft, aircraft, motor homes, ATVs and other recreational vehicles, other vehicles, and accessories? (check all that apply)
None
Boats
Trailers
Motors
Personal watercraft
Fishing vessels
Snowmobiles
Motorcycles and accessories
Golf cart
Go cart
Scooter
4.1. Make:
Model:
Year:
Condition (Excellent, Good, Fair, Poor)
If you own or have more than one, list here:
4.2 Make:
Model:
Year:
Condition (Excellent, Good, Fair, Poor)
Debtor 1
Part 3: Describe Your Personal and Household Items
Do you own or have any legal or equitable interest in any of the following items?
6. Household goods and furnishings.
No
Major appliances
Furniture
Linens
China
Kitchenware
7. Electronics (check all that apply)
No
Televisions and radios
Audio, video, stereo, and digital equipment
Computers, printers, scanners
Music collections
Electronic devices including cell phones, media players, games
Cameras and accessories
8. Collection of Value (check all that apply)
No
Antique furniture
Dolls or figurines
Paintings, prints and other fine art work
Rare books
Baseball cards or other collectible cards
Sports Memorabilia (balls, jerseys, bats, helmets, etc.)
9. Equipment for sports and hobbies (check all that apply)
No
Sports equipment: basketball football softball baseball
Bicycle Mountain Bicycle Racing Bicycle
Exercise equipment: treadmill elliptical weights home gym
Pool table other game table
Canoes kayak other boats and crafts that do not have motors
Hand tools
Power tools
Golf clubs
Fishing equipment: rods, reels, tackle
Camping equipment: tent sleeping bags lanterns camp stove other
Bowling balls tennis request other racquets
Lawn and yard care equipment: lawn mower weed eater trimmer blower
Swing set
Trampoline
Above ground pool
Charcoal Grill Gas Grill Smoker
Sewing machine other craft machine craft supplies
Drones other radio controlled items
10. Firearms.
No
Pistols
Rifles
Shotguns
Ammunition
Related equipment
Hunting or other bows
11. Clothes other than every day clothes
No
Furs
Leather coats
Specialty items: hunting, skiing, etc
12. Jewelry.
No
Everyday jewelry, Costume jewelry
Engagement rings
Wedding rings
Heirloom jewelry
Watches
Gems
Gold
Silver
13. Non-farm animals
No
Dogs
Cats
Birds
Horses
Other
14. Any other personal or household items not listed above? (check all that apply)
No
Health aids: walker, hospital bed, wheelchair
Safe, Gun safe
Other
Debtor 1
Part 4: Describe Your Financial Assets
Do you own or have any legal or equitable interest in any of the following?
Current value of the portion you own? Do not deduct secured claims or exemptions.
16.Do you have any Cash. Examples: Money you have in your wallet, in your home, in a safe deposit box, and on hand?
No
Yes................................................................................................................................................................
Choose
Less then 50
100-200
200-300
Over 500
Cash: .......................
17. Do have any bank accounts or deposits of money?
No
Yes .....................
Select
Bank name
18. Do you have any? (check all that apply)
No
Stocks
Business or government bonds
U. S. Savings Bonds
Mutual Funds
Brokerage or stock trading accounts
Institution or issuer name:
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19. Do you own or operate any part of a business? (check all that apply)
No
Sole proprietor
LLC or Inc
Partnership
Joint Venture
Untitled
Name of entity:
Untitled
% of ownership:
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Debtor 1
21. Do you have any retirement or pension accounts? (check all that apply)
No
IRA
401K
Thrift Savings acct
403(b)
Profit Sharing
Stock purchase account
Other retirement savings
22. Have you made any Security deposits? (check all that apply)
No
House, Apartment or other rental unit
Utilities (Electric, gas, etc.)
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Untitled
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23. Do you own any of the following? (check all that apply)
None
No
Annuity
Education IRA or other college savings plan
Trusts
Patents, copyrights, trademarks, trade secrets, and other intellectual property
Other (unpaid wages, or benefits)
Debtor 1
24. Interests in an education IRA, in an account in a qualified ABLE program, or under a qualified state tuition program. 26 U.S.C. §§ 530(b)(1), 529A(b), and 529(b)(1).
No
Yes ....................................
25. Trusts, equitable or future interests in property (other than anything listed in line 1), and rights or powers exercisable for your benefit
No
Yes. Give specific information about them. ...
26. Patents, copyrights, trademarks, trade secrets, and other intellectual property Examples: Internet domain names, websites, proceeds from royalties and licensing agreements
No
Yes. Give specific information about them. ...
27. Licenses, franchises, and other general intangibles. Examples: Building permits, exclusive licenses, cooperative association holdings, liquor licenses, professional licenses
No
Yes. Give specific information about them. ...
28. Does anyone owe you any money? (check all that apply)
No
Tax refund (now or in the next year)
Past due support (child support, alimony or a property settlement)
Other (unpaid wages, or benefits)
29. Family support. Examples: Past due or lump sum alimony, spousal support, child support, maintenance, divorce settlement, property settlement
No
Yes. Give specific information. .............
30. Other amounts someone owes you. Examples: Unpaid wages, disability insurance payments, disability benefits, sick pay, vacation pay, workers’ compensation, Social Security benefits; unpaid loans you made to someone else
No
Yes. Give specific information. ..............
Debtor 1
31. Do you have any insurance that has cash value? (money you could get now)
No
Yes. Name the insurance company of each policy and list its value. ...
Untitled
Company name:
Untitled
32. Are you the heir of anyone’s estate that has not been probated? (That is someone has died and you are entitled to get money or property as a result.)
No
Yes. Give specific information. .............
Name of deceased
33. Do you have the right to sue anyone for any damages that they have caused you in the past?
No
Auto accident
Worker’s compensation claim
Breach of contract
34. Do you own or claim an interest in anything else of value not already listed?
No
Yes. Describe each claim. ....................
Brief description
35. Any financial assets you did not already list
No
Yes. Give specific information. ...........
Brief description
36. Add the dollar value of all of your entries from Part 4, including any entries for pages you have attached for Part 4. Write that number here ....................................................................................................................................................
Part 5: Describe Any Business-Related Property You Own or Have an Interest In. List any real estate in Part 1.
37. Do you own or have any interest in any business?
No. Go to Part 6.
Yes. Go to line 38.
38. Accounts receivable or commissions you already earned
No
Yes. Describe .......
39. Office equipment, furnishings, and supplies.
No
Business-related computers
Software
Modems
Printers
Copiers
Fax machines
Rugs
Telephones
Desks
Chairs
Electronic devices
Debtor 1
40. Machinery, fixtures, equipment, supplies you use in business, and tools of your trade
No
Yes. Describe .......
41. Inventory
No
Yes. Describe .......
42. Interests in partnerships or joint ventures
No
Yes. Describe .......
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Name of entity:
Untitled
% of ownership:
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43. Customer lists, mailing lists, or other compilations
No
Yes. Do your lists include personally identifiable information (as defined in 11 U.S.C. § 101(41A))?
No
Yes. Describe. .......
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44. Any business-related property you did not already list
No
Yes. Give specific information .........
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45. Add the dollar value of all of your entries from Part 5, including any entries for pages you have attached for Part 5. Write that number here ....................................................................................................................................................
Part 6: Describe Any Farm- and Commercial Fishing-Related Property You Own or Have an Interest In. If you own or have an interest in farmland, list it in Part 1.
46. Do you own or have any interest in a farm or commercial fishing venture?
No. Go to Part 7.
Yes. Contact Our office
Debtor 1
52. Add the dollar value of all of your entries from Part 6, including any entries for pages you have attached for Part 6. Write that number here ....................................................................................................................................................
Part 7: HOUSEHOLD BUDGET
1. Your Name:
First
Last
Untitled
2. Who lives in the same residence with you? (check all that apply)
Spouse
# of Children under the age of 19 or that you care for because they have special needs
# of Parents or other relative that you claim as a dependent on your tax returns
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3. Monthly Mortgage or rent for your home or residence
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4. Second mortgage or equity line on your residence, if you have one
Untitled
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5. Average utility Bill for:
6. Food and housekeeping supplies
7. Childcare and education (daycare, after school, etc)
8. Clothing purchases, laundry and dry cleaning
9. Personal care products and service ( hair care, etc)
10. Medical and Dental expense (co-pays, prescriptions, deductibles)
11. Transportation (gas, oil changes, tires but not car payments)
12. Recreation, entertainment, subscriptions
13. Charitable contributions, tithes and offerings
14. Insurance not deducted from your pay check or wages or included in your mortgage payment.
a. Life Insurance
b. Health Insurance
c. Auto insurance
d. Other insurance (Disability, long term care)
15. Taxes not deducted from your pay check or wages
a. Automobile
b. Quarterly income taxes
c. Other
16. Installment payments
a. Auto 1
b. Auto 2
c. furniture
d. appliance
e. other
f. other
17. Do you (or your spouse) pay any one:
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Child support
No
Yes
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Alimony
No
Yes
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18. Do you own real estate that is not your residence?
If yes Mortgage payment
Property taxes, if not included in payment
Insurance, if not included in payment
Average monthly maintenance costs
Homeowner’s association dues, if any
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19. Do you have any expense not listed above and not deducted from a paycheck
No.
Yes, Describe ..........................
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Part 8: Describe All Property You Own or Have an Interest in That You Did Not List Above
53. Do you have other property of any kind you did not already list? Examples: Season tickets, country club membership
No
Yes. Give specific information. ............
54. Add the dollar value of all of your entries from Part 7. Write that number here................................................................
Number
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