Form 106sum - Summary Of Your Assets And Liabilities And Certain Statistical Information - 2015 Page 2
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1
2Debtor 1
_______________________________________________________
Case number
_____________________________________
(if known)
First Name
Middle Name
Last Name
Part 4:
Answer These Questions for Administrative and Statistical Records
Are you filing for bankruptcy under Chapters 7, 11, or 13?
6.
No. You have nothing to report on this part of the form. Check this box and submit this form to the court with your other schedules.
Yes
What kind of debt do you have?
7.
Your debts are primarily consumer debts. Consumer debts are those “incurred by an individual primarily for a personal,
family, or household purpose.” 11 U.S.C. § 101(8). Fill out lines 8-9g for statistical purposes. 28 U.S.C. § 159.
Your debts are not primarily consumer debts. You have nothing to report on this part of the form. Check this box and submit
this form to the court with your other schedules.
From the Statement of Your Current Monthly Income: Copy your total current monthly income from Official
8.
Form 122A-1 Line 11; OR, Form 122B Line 11; OR, Form 122C-1 Line 14.
$ _________________
Copy the following special categories of claims from Part 4, line 6 of Schedule E/F:
9.
Total claim
From Part 4 on Schedule E/F, copy the following:
$_____________________
9a. Domestic support obligations (Copy line 6a.)
$_____________________
9b. Taxes and certain other debts you owe the government. (Copy line 6b.)
$_____________________
9c. Claims for death or personal injury while you were intoxicated. (Copy line 6c.)
$_____________________
9d. Student loans. (Copy line 6f.)
9e. Obligations arising out of a separation agreement or divorce that you did not report as
$_____________________
priority claims. (Copy line 6g.)
+
9f. Debts to pension or profit-sharing plans, and other similar debts. (Copy line 6h.)
$_____________________
9g. Total. Add lines 9a through 9f.
$_____________________
Official Form 106Sum
Summary of Your Assets and Liabilities and Certain Statistical Information
page 2 of 2
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