Official Form 122a1 - Chapter 7 Statement Of Your Current Monthly Income Page 2
Download a blank fillable Official Form 122a1 - Chapter 7 Statement Of Your Current Monthly Income in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Official Form 122a1 - Chapter 7 Statement Of Your Current Monthly Income with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2Debtor 1
_______________________________________________________
Case number
_____________________________________
(if known)
First Name
Middle Name
Last Name
Column A
Column B
Debtor 2 or
Debtor 1
non-filing spouse
8. Unemployment compensation
$__________
$___________
Do not enter the amount if you contend that the amount received was a benefit
under the Social Security Act. Instead, list it here:
...............................
For you
$______________
..................................................................................
For your spouse
...................................................................
$______________
9. Pension or retirement income. Do not include any amount received that was a
benefit under the Social Security Act.
$__________
$___________
10. Income from all other sources not listed above. Specify the source and amount.
Do not include any benefits received under the Social Security Act or payments received
as a victim of a war crime, a crime against humanity, or international or domestic
terrorism. If necessary, list other sources on a separate page and put the total below.
______________________________________
$_________
$___________
______________________________________
$_________
$___________
+
+
Total amounts from separate pages, if any.
$_________
$___________
11. Calculate your total current monthly income. Add lines 2 through 10 for each
+
=
column. Then add the total for Column A to the total for Column B.
$_________
$___________
$__________
Total current
monthly income
Part 2:
Determine Whether the Means Test Applies to You
12. Calculate your current monthly income for the year. Follow these steps:
$__________
Copy your total current monthly income from line 11.
12a.
.................................................................................. Copy line 11 here
x 12
Multiply by 12 (the number of months in a year).
$__________
The result is your annual income for this part of the form.
.
12b.
12b
13. Calculate the median family income that applies to you. Follow these steps:
Fill in the state in which you live.
Fill in the number of people in your household.
$__________
Fill in the median family income for your state and size of household.
............................................................................................. 13.
To find a list of applicable median income amounts, go online using the link specified in the separate
instructions for this form. This list may also be available at the bankruptcy clerk’s office.
14. How do the lines compare?
Line 12b is less than or equal to line 13. On the top of page 1, check box 1, There is no presumption of abuse.
14a.
Go to Part 3.
Line 12b is more than line 13. On the top of page 1, check box 2, The presumption of abuse is determined by Form 122A-2.
14b.
Go to Part 3 and fill out Form 122A–2.
Part 3:
Sign Below
By signing here, I declare under penalty of perjury that the information on this statement and in any attachments is true and correct.
______________________________________
__________________________________________________________
Signature of Debtor 1
Signature of Debtor 2
_________________
_________________
Date
Date
MM / DD
/ YYYY
MM / DD
/ YYYY
If you checked line 14a, do NOT fill out or file Form 122A–2.
If you checked line 14b, fill out Form 122A–2 and file it with this form.
¯
Official Form 122A-1
Chapter 7 Statement of Your Current Monthly Income
page 2
Print
Save As...
Add Attachment
Reset
ADVERTISEMENT
0 votes
Related Articles
Related forms
Official Form 122c-1 - Chapter 13 Statement Of Your Current Monthly Income And Calculation Of Commitment Period
Legal
Official Form B 22c1 - Chapter 13 Statement Of Your Current Monthly Income And Calculation Of Commitment Period
Legal
Form B 122c-1 - Chapter 13 Statement Of Your Current Monthly Income And Calculation Of Commitment Period
Financial
Related Categories
Parent category: Legal