Form B 122c-1 - Chapter 13 Statement Of Your Current Monthly Income And Calculation Of Commitment Period
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1
2
3 Fill in this information to identify your case:
Check as directed in lines 17 and 21:
According to the calculations required by
Debtor 1
__________________________________________________________________
this Statement:
First Name
Middle Name
Last Name
1. Disposable income is not determined
Debtor 2
________________________________________________________________
under 11 U.S.C. § 1325(b)(3).
(Spouse, if filing)
First Name
Middle Name
Last Name
2. Disposable income is determined
__________ District of __________
__________
__________
United States Bankruptcy Court for the:
District of
under 11 U.S.C. § 1325(b)(3).
Case number
___________________________________________
3. The commitment period is 3 years.
(If known)
4. The commitment period is 5 years.
Check if this is an amended filing
B 122C-1
Chapter 13 Statement of Your Current Monthly Income
and Calculation of Commitment Period
12/15
Be as complete and accurate as possible. If two married people are filing together, both are equally responsible for being accurate. If
more space is needed, attach a separate sheet to this form. Include the line number to which the additional information applies. On the
top of any additional pages, write your name and case number (if known).
Part 1:
Calculate Your Average Monthly Income
What is your marital and filing status? Check one only.
1.
Not married. Fill out Column A, lines 2-11.
Married. Fill out both Columns A and B, lines 2-11.
Fill in the average monthly income that you received from all sources, derived during the 6 full months before you file this
bankruptcy case. 11 U.S.C. § 101(10A). For example, if you are filing on September 15, the 6-month period would be March 1 through
August 31. If the amount of your monthly income varied during the 6 months, add the income for all 6 months and divide the total by 6. Fill in
the result. Do not include any income amount more than once. For example, if both spouses own the same rental property, put the income
from that property in one column only. If you have nothing to report for any line, write $0 in the space.
Column A
Column B
Debtor 1
Debtor 2 or
non-filing spouse
Your gross wages, salary, tips, bonuses, overtime, and commissions (before all
2.
$__________
$__________
payroll deductions).
$__________
$__________
Alimony and maintenance payments. Do not include payments from a spouse.
3.
All amounts from any source which are regularly paid for household expenses of
4.
you or your dependents, including child support. Include regular contributions from
an unmarried partner, members of your household, your dependents, parents, and
roommates. Do not include payments from a spouse. Do not include payments you
listed on line 3.
$_________
$__________
Net income from operating a business, profession, or
5.
Debtor 1
Debtor 2
farm
$______
$______
Gross receipts (before all deductions)
–
–
Ordinary and necessary operating expenses
$______
$______
Copy
Net monthly income from a business, profession, or farm
here
$__________
$______
$______
$_________
Net income from rental and other real property
Debtor 1
Debtor 2
6.
Gross receipts (before all deductions)
$______
$______
–
–
Ordinary and necessary operating expenses
$______
$______
Copy
Net monthly income from rental or other real property
$______
$______
$__________
here
$_________
B 122C-1 (Official Form 122C-1) Chapter 13 Statement of Your Current Monthly Income and Calculation of Commitment Period
page 1
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