Official Form 206d - Schedule D: Creditors Who Have Claims Secured By Property

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Fill in this information to identify the case:
Debtor name __________________________________________________________________
______________________
_________
United States Bankruptcy Court for the:
District of
(State)
Case number (If known):
_________________________
Check if this is an
amended filing
Official Form 206D
Schedule D: Creditors Who Have Claims Secured by Property
12/15
Be as complete and accurate as possible.
Do any creditors have claims secured by debtor’s property?
1.
No. Check this box and submit page 1 of this form to the court with debtor’s other schedules. Debtor has nothing else to report on this form.
Yes. Fill in all of the information below.
Part 1:
List Creditors Who Have Secured Claims
Column A
Column B
List in alphabetical order all creditors who have secured claims. If a creditor has more than one
2.
Amount of claim
Value of collateral
secured claim, list the creditor separately for each claim.
that supports this
Do not deduct the value
claim
of collateral.
2.1
Creditor’s name
Describe debtor’s property that is subject to a lien
__________________________________________
$__________________
$_________________
___________________________________________________
Creditor’s mailing address
___________________________________________________
___________________________________________________
________________________________________________________
Describe the lien
________________________________________________________
__________________________________________________
Creditor’s email address, if known
Is the creditor an insider or related party?
No
_________________________________________
Yes
Is anyone else liable on this claim?
Date debt was incurred
__________________
No
Last 4 digits of account
Yes. Fill out Schedule H: Codebtors (Official Form 206H).
number
___ ___ ___ ___
Do multiple creditors have an interest in the
As of the petition filing date, the claim is:
same property?
Check all that apply.
No
Contingent
Yes. Specify each creditor, including this creditor,
Unliquidated
and its relative priority.
Disputed
___________________________________
___________________________________
2.2
Creditor’s name
Describe debtor’s property that is subject to a lien
__________________________________________
$__________________
$_________________
___________________________________________________
___________________________________________________
Creditor’s mailing address
___________________________________________________
________________________________________________________
Describe the lien
________________________________________________________
__________________________________________________
Creditor’s email address, if known
Is the creditor an insider or related party?
No
_________________________________________
Yes
Is anyone else liable on this claim?
Date debt was incurred
__________________
No
Last 4 digits of account
Yes. Fill out Schedule H: Codebtors (Official Form 206H).
number
___ ___ ___ ___
As of the petition filing date, the claim is:
Do multiple creditors have an interest in the
Check all that apply.
same property?
Contingent
No
Unliquidated
Yes. Have you already specified the relative
Disputed
priority?
No. Specify each creditor, including this
creditor, and its relative priority.
_________________________________
_________________________________
Yes. The relative priority of creditors is
specified on lines _____
Total of the dollar amounts from Part 1, Column A, including the amounts from the Additional
3.
$________________
Page, if any.
Official Form 206D
Schedule D: Creditors Who Have Claims Secured by Property
page 1 of ___

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