Form 122a - 1supp - Statement Of Exemption From Presumption Of Abuse
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1Fill 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
__________ District of __________
__________
United States Bankruptcy Court for the:
District of __________
Case number
___________________________________________
(If known)
Check if this is an amended filing
Official Form 122A─1Supp
Statement of Exemption from Presumption of Abuse Under § 707(b)(2)
12/15
File this supplement together with Chapter 7 Statement of Your Current Monthly Income (Official Form 122A-1), if you believe that you are
exempted from a presumption of abuse. Be as complete and accurate as possible. If two married people are filing together, and any of the
exclusions in this statement applies to only one of you, the other person should complete a separate Form 122A-1 if you believe that this is
required by 11 U.S.C. § 707(b)(2)(C).
Part 1:
Identify the Kind of Debts You Have
1. Are your debts primarily consumer debts? Consumer debts are defined in 11 U.S.C. § 101(8) as “incurred by an individual primarily for a
personal, family, or household purpose.” Make sure that your answer is consistent with the answer you gave at line 16 of the Voluntary Petition for
Individuals Filing for Bankruptcy (Official Form 101).
No. Go to Form 122A-1; on the top of page 1 of that form, check box 1, There is no presumption of abuse, and sign Part 3. Then
submit this supplement with the signed Form 122A-1.
Yes. Go to Part 2.
Part 2:
Determine Whether Military Service Provisions Apply to You
2. Are you a disabled veteran (as defined in 38 U.S.C. § 3741(1))?
No. Go to line 3.
Yes. Did you incur debts mostly while you were on active duty or while you were performing a homeland defense activity?
10 U.S.C. § 101(d)(1); 32 U.S.C. § 901(1).
No. Go to line 3.
Yes. Go to Form 122A-1; on the top of page 1 of that form, check box 1, There is no presumption of abuse, and sign Part 3.
Then submit this supplement with the signed Form 122A-1.
3. Are you or have you been a Reservist or member of the National Guard?
No. Complete Form 122A-1. Do not submit this supplement.
Yes. Were you called to active duty or did you perform a homeland defense activity? 10 U.S.C. § 101(d)(1); 32 U.S.C. § 901(1).
No. Complete Form 122A-1. Do not submit this supplement.
Yes. Check any one of the following categories that applies:
If you checked one of the categories to the left, go to
I was called to active duty after September 11, 2001, for at least
Form 122A-1. On the top of page 1 of Form 122A-1,
90 days and remain on active duty.
check box 3, The Means Test does not apply now, and
I was called to active duty after September 11, 2001, for at least
sign Part 3. Then submit this supplement with the signed
90 days and was released from active duty on _______________,
Form 122A-1. You are not required to fill out the rest of
which is fewer than 540 days before I file this bankruptcy case.
Official Form 122A-1 during the exclusion period. The
exclusion period means the time you are on active duty
I am performing a homeland defense activity for at least 90 days.
or are performing a homeland defense activity, and for
I performed a homeland defense activity for at least 90 days,
540 days afterward. 11 U.S.C. § 707(b)(2)(D)(ii).
ending on _______________, which is fewer than 540 days
If your exclusion period ends before your case is closed,
before I file this bankruptcy case.
you may have to file an amended form later.
Official Form 122A-1Supp
Statement of Exemption from Presumption of Abuse Under § 707(b)(2)
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