Official Form 22c - Statement Of Current Monthly Income And Calculation Of Commitment Period And Disposable Income Page 8

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B 22C (Official Form 22C) (Chapter 13) (12/10)
8
Total adjustments to determine disposable income. Add the amounts on Lines 54, 55, 56, and 57 and enter
58
the result.
$
59
Monthly Disposable Income Under § 1325(b)(2). Subtract Line 58 from Line 53 and enter the result.
$
Part VI: ADDITIONAL EXPENSE CLAIMS
Other Expenses. List and describe any monthly expenses, not otherwise stated in this form, that are required for the health
and welfare of you and your family and that you contend should be an additional deduction from your current monthly
income under § 707(b)(2)(A)(ii)(I). If necessary, list additional sources on a separate page. All figures should reflect your
average monthly expense for each item. Total the expenses.
Expense Description
Monthly Amount
60
a.
$
b.
$
c.
$
Total: Add Lines a, b, and c
$
Part VII: VERIFICATION
I declare under penalty of perjury that the information provided in this statement is true and correct. (If this is a joint case,
both debtors must sign.)
61
Date: ________________________
Signature: ________________________
(Debtor)
Date: ________________________
Signature: ________________________
(Joint Debtor, if any)
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