Official Form 101 Voluntary Petition For Individuals Filing For Bankruptcy Page 5
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8Debtor 1
_______________________________________________________
Case number
_____________________________________
(if known)
First Name
Middle Name
Last Name
Part 5:
Explain Your Efforts to Receive a Briefing About Credit Counseling
About Debtor 1:
About Debtor 2 (Spouse Only in a Joint Case):
Tell the court whether
15.
you have received a
You must check one:
You must check one:
briefing about credit
counseling.
I received a briefing from an approved credit
I received a briefing from an approved credit
counseling agency within the 180 days before I
counseling agency within the 180 days before I
The law requires that you
filed this bankruptcy petition, and I received a
filed this bankruptcy petition, and I received a
receive a briefing about credit
certificate of completion.
certificate of completion.
counseling before you file for
Attach a copy of the certificate and the payment
Attach a copy of the certificate and the payment
bankruptcy. You must
plan, if any, that you developed with the agency.
plan, if any, that you developed with the agency.
truthfully check one of the
following choices. If you
I received a briefing from an approved credit
I received a briefing from an approved credit
cannot do so, you are not
counseling agency within the 180 days before I
counseling agency within the 180 days before I
eligible to file.
filed this bankruptcy petition, but I do not have a
filed this bankruptcy petition, but I do not have a
certificate of completion.
certificate of completion.
If you file anyway, the court
Within 14 days after you file this bankruptcy petition,
Within 14 days after you file this bankruptcy petition,
can dismiss your case, you
you MUST file a copy of the certificate and payment
you MUST file a copy of the certificate and payment
will lose whatever filing fee
plan, if any.
plan, if any.
you paid, and your creditors
can begin collection activities
I certify that I asked for credit counseling
I certify that I asked for credit counseling
again.
services from an approved agency, but was
services from an approved agency, but was
unable to obtain those services during the 7
unable to obtain those services during the 7
days after I made my request, and exigent
days after I made my request, and exigent
circumstances merit a 30-day temporary waiver
circumstances merit a 30-day temporary waiver
of the requirement.
of the requirement.
To ask for a 30-day temporary waiver of the
To ask for a 30-day temporary waiver of the
requirement, attach a separate sheet explaining
requirement, attach a separate sheet explaining
what efforts you made to obtain the briefing, why
what efforts you made to obtain the briefing, why
you were unable to obtain it before you filed for
you were unable to obtain it before you filed for
bankruptcy, and what exigent circumstances
bankruptcy, and what exigent circumstances
required you to file this case.
required you to file this case.
Your case may be dismissed if the court is
Your case may be dismissed if the court is
dissatisfied with your reasons for not receiving a
dissatisfied with your reasons for not receiving a
briefing before you filed for bankruptcy.
briefing before you filed for bankruptcy.
If the court is satisfied with your reasons, you must
If the court is satisfied with your reasons, you must
still receive a briefing within 30 days after you file.
still receive a briefing within 30 days after you file.
You must file a certificate from the approved
You must file a certificate from the approved
agency, along with a copy of the payment plan you
agency, along with a copy of the payment plan you
developed, if any. If you do not do so, your case
developed, if any. If you do not do so, your case
may be dismissed.
may be dismissed.
Any extension of the 30-day deadline is granted
Any extension of the 30-day deadline is granted
only for cause and is limited to a maximum of 15
only for cause and is limited to a maximum of 15
days.
days.
I am not required to receive a briefing about
I am not required to receive a briefing about
credit counseling because of:
credit counseling because of:
Incapacity. I have a mental illness or a mental
Incapacity. I have a mental illness or a mental
deficiency that makes me
deficiency that makes me
incapable of realizing or making
incapable of realizing or making
rational decisions about finances.
rational decisions about finances.
Disability.
My physical disability causes me
Disability.
My physical disability causes me
to be unable to participate in a
to be unable to participate in a
briefing in person, by phone, or
briefing in person, by phone, or
through the internet, even after I
through the internet, even after I
reasonably tried to do so.
reasonably tried to do so.
Active duty. I am currently on active military
Active duty. I am currently on active military
duty in a military combat zone.
duty in a military combat zone.
If you believe you are not required to receive a
If you believe you are not required to receive a
briefing about credit counseling, you must file a
briefing about credit counseling, you must file a
motion for waiver of credit counseling with the court.
motion for waiver of credit counseling with the court.
Official Form 101
Voluntary Petition for Individuals Filing for Bankruptcy
page 5
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