Official Form 108 - Statement Of Intention For Individuals Filing Under Chapter 7

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Fill 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
Check if this is an
Case number
___________________________________________
amended filing
(If known)
Official Form 108
Statement of Intention for Individuals Filing Under Chapter 7
12/15
If you are an individual filing under chapter 7, you must fill out this form if:
 creditors have claims secured by your property, or
 you have leased personal property and the lease has not expired.
You must file this form with the court within 30 days after you file your bankruptcy petition or by the date set for the meeting of creditors,
whichever is earlier, unless the court extends the time for cause. You must also send copies to the creditors and lessors you list on the form.
If two married people are filing together in a joint case, both are equally responsible for supplying correct information.
Both debtors must sign and date the form.
Be as complete and accurate as possible. 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).
Part 1:
List Your Creditors Who Have Secured Claims
1. For any creditors that you listed in Part 1 of Schedule D: Creditors Who Have Claims Secured by Property (Official Form 106D), fill in the
information below.
Identify the creditor and the property that is collateral
What do you intend to do with the property that
Did you claim the property
secures a debt?
as exempt on Schedule C?
Creditor’s
Surrender the property.
No
name:
Retain the property and redeem it.
Yes
Description of
Retain the property and enter into a
property
Reaffirmation Agreement.
securing debt:
Retain the property and [explain]: __________
______________________________________
Creditor’s
Surrender the property.
No
name:
Retain the property and redeem it.
Yes
Description of
Retain the property and enter into a
property
Reaffirmation Agreement.
securing debt:
Retain the property and [explain]: __________
______________________________________
Creditor’s
Surrender the property.
No
name:
Retain the property and redeem it.
Yes
Description of
Retain the property and enter into a
property
Reaffirmation Agreement.
securing debt:
Retain the property and [explain]: __________
______________________________________
Creditor’s
Surrender the property.
No
name:
Retain the property and redeem it.
Yes
Description of
Retain the property and enter into a
property
Reaffirmation Agreement.
securing debt:
Retain the property and [explain]: __________
______________________________________
Official Form 108
Statement of Intention for Individuals Filing Under Chapter 7
page 1

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