Official Form 106c - Schedule C: The Property You Claim As Exempt - 2016 Page 2

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Debtor 1
_______________________________________________________
Case number
_____________________________________
(if known)
First Name
Middle Name
Last Name
Part 2:
Additional Page
Brief description of the property and line
Current value of the
Amount of the exemption you claim
Specific laws that allow exemption
on Schedule A/B that lists this property
portion you own
Copy the value from
Check only one box for each exemption
Schedule A/B
Brief
____________________________
_________________________
$________________
$ ____________
description:
____________________________
____________________________
100% of fair market value, up to
Line from
______
____________________________
any applicable statutory limit
Schedule A/B:
Brief
____________________________
_________________________
$________________
$ ____________
description:
____________________________
____________________________
100% of fair market value, up to
Line from
______
____________________________
any applicable statutory limit
Schedule A/B:
Brief
____________________________
_________________________
$________________
$ ____________
description:
____________________________
100% of fair market value, up to
____________________________
Line from
______
____________________________
any applicable statutory limit
Schedule A/B:
Brief
____________________________
_________________________
$________________
$ ____________
description:
____________________________
____________________________
100% of fair market value, up to
Line from
______
____________________________
any applicable statutory limit
Schedule A/B:
Brief
____________________________
_________________________
$________________
$ ____________
description:
____________________________
____________________________
100% of fair market value, up to
Line from
______
____________________________
any applicable statutory limit
Schedule A/B:
Brief
____________________________
_________________________
$________________
$ ____________
description:
____________________________
____________________________
100% of fair market value, up to
Line from
______
____________________________
any applicable statutory limit
Schedule A/B:
Brief
____________________________
_________________________
$________________
$ ____________
description:
____________________________
____________________________
100% of fair market value, up to
Line from
______
____________________________
any applicable statutory limit
Schedule A/B:
Brief
____________________________
_________________________
$________________
$ ____________
description:
____________________________
____________________________
100% of fair market value, up to
Line from
____________________________
______
any applicable statutory limit
Schedule A/B:
Brief
____________________________
_________________________
$________________
$ ____________
description:
____________________________
100% of fair market value, up to
____________________________
Line from
______
____________________________
any applicable statutory limit
Schedule A/B:
Brief
____________________________
_________________________
$________________
$ ____________
description:
____________________________
____________________________
100% of fair market value, up to
Line from
______
____________________________
any applicable statutory limit
Schedule A/B:
Brief
____________________________
_________________________
$________________
$ ____________
description:
____________________________
____________________________
100% of fair market value, up to
Line from
______
____________________________
any applicable statutory limit
Schedule A/B:
Brief
____________________________
_________________________
$________________
$ ____________
description:
____________________________
____________________________
100% of fair market value, up to
Line from
______
____________________________
any applicable statutory limit
Schedule A/B:
Official Form 106C
Schedule C: The Property You Claim as Exempt
page ___ of __

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