Debt Schedule
INSTRUCTIONS: PRINT NEATLY AND USE A BALL POINT PEN: List every debt (including
mortgages, taxes, auto loans, etc.) you own in the spaces provided below. Use one blank for
each debt, include all information asked for or the Court may not grant your bankruptcy.
Write "0" in any space that does not apply. Make copies of this sheet if you need more space.
CREDITOR:
CREDITOR:
þÿ
þÿ
Name: ______________________________
Name: ______________________________
þÿ
þÿ
Address:_____________________________
Address:_____________________________
þÿ
þÿ
____________________________________
____________________________________
City. State, Zip
City. State, Zip
þÿ
þÿ
Account # ____________________________
Account # ____________________________
CO-SIGNER:(who is not filing with you)
CO-SIGNER:(who is not filing with you)
þÿ
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Name: ______________________________
Name: ______________________________
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Address:_____________________________
Address:_____________________________
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____________________________________
____________________________________
City. State, Zip
City. State, Zip
þÿ
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Relationship to you:_____________________
Relationship to you:_____________________
THE DEBT:
THE DEBT:
When did you incur this debt, or if a credit card, when
When did you incur this debt, or if a credit card, when
did you last use it?
did you last use it?
Month
Amount
Month
Amount
þÿ
þÿ
þÿ
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& Year:__________ you owe $_______________
& Year:__________ you owe $_______________
COLLECTION AGENCY:
COLLECTION AGENCY:
List any collection agency or attorney that is
List any collection agency or attorney that is
collecting for the above creditor only:
collecting for the above creditor only:
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Name: ______________________________
Name: ______________________________
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Address:_____________________________
Address:_____________________________
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þÿ
City,St,Zip_______________________________
City,St,Zip_______________________________
ATTORNEY USE ONLY!
ATTORNEY USE ONLY!
Priority
Secured
Unsecured
Priority
Secured
Unsecured
Consideration:
Consideration:
Revolving Charge
Medical Service
Revolving Charge
Medical Service
Utility
Signature Loan
Utility
Signature Loan
Bad Check
Pay day Loan
Bad Check
Pay day Loan
Telephone
Cable
Telephone
Cable
R/E 1 R/E 2
Student Loan
R/E 1 R/E 2
Student Loan
Property Taxes
Income Taxes
Property Taxes
Income Taxes
Merchandise
Merchandise
Other:
Other:
Intention: Exempt__ Surrender___ Reaffirm ___
Intention: Exempt__ Surrender___ Reaffirm ___