Official Form B 6i - Schedule I: Your Income
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1
2Fill in this information to identify your case:
Debtor 1
___________________________________________________________________
First Name
Middle Name
Last Name
Debtor 2
__________________________________________________________________
(Spouse, if filing)
First Name
Middle Name
Last Name
______________________
__________
United States Bankruptcy Court for the:
District of
___________________________ District of ________
Check if this is:
Case number
___________________________________________
(If known)
An amended filing
A supplement showing post-petition
chapter 13 income as of the following date:
Official Form B 6I
________________
MM / DD / YYYY
Schedule I: Your Income
12/13
Be as complete and accurate as possible. If two married people are filing together (Debtor 1 and Debtor 2), both are equally responsible for
supplying correct information. If you are married and not filing jointly, and your spouse is living with you, include information about your spouse.
If you are separated and your spouse is not filing with you, do not include information about your spouse. 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 Employment
Fill in your employment
1.
Debtor 1
Debtor 2 or non-filing spouse
information.
If you have more than one job,
attach a separate page with
Employment status
Employed
Employed
information about additional
Not employed
Not employed
employers.
Include part-time, seasonal, or
self-employed work.
__________________________________
__________________________________
Occupation
Occupation may Include student
or homemaker, if it applies.
Employer’s name
__________________________________
__________________________________
Employer’s address
_______________________________________
________________________________________
Number
Street
Number
Street
_______________________________________
________________________________________
_______________________________________
________________________________________
_______________________________________
________________________________________
City
State
ZIP Code
City
State
ZIP Code
_______
_______
How long employed there?
Part 2:
Give Details About Monthly Income
Estimate monthly income as of the date you file this form. If you have nothing to report for any line, write $0 in the space. Include your non-filing
spouse unless you are separated.
If you or your non-filing spouse have more than one employer, combine the information for all employers for that person on the lines
below. If you need more space, attach a separate sheet to this form.
For Debtor 1
For Debtor 2 or
non-filing spouse
List monthly gross wages, salary, and commissions (before all payroll
2.
deductions). If not paid monthly, calculate what the monthly wage would be.
2.
$____________
$___________
+
+
Estimate and list monthly overtime pay.
3.
3.
$___________
$____________
Calculate gross income. Add line 2 + line 3.
4.
$__________
$____________
4.
Official Form B 6I
Schedule I: Your Income
page 1
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