Official Form 101 Voluntary Petition For Individuals Filing For Bankruptcy Page 6
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8Debtor 1
_______________________________________________________
Case number
_____________________________________
(if known)
First Name
Middle Name
Last Name
Part 6:
Answer These Questions for Reporting Purposes
Are your debts primarily consumer debts?
16a.
Consumer debts are defined in 11 U.S.C. § 101(8)
What kind of debts do
16.
as “incurred by an individual primarily for a personal, family, or household purpose.”
you have?
No. Go to line 16b.
Yes. Go to line 17.
Are your debts primarily business debts?
16b.
Business debts are debts that you incurred to obtain
money for a business or investment or through the operation of the business or investment.
No. Go to line 16c.
Yes. Go to line 17.
16c. State the type of debts you owe that are not consumer debts or business debts.
_______________________________________________________________
Are you filing under
17.
No. I am not filing under Chapter 7. Go to line 18.
Chapter 7?
Yes. I am filing under Chapter 7. Do you estimate that after any exempt property is excluded and
Do you estimate that after
administrative expenses are paid that funds will be available to distribute to unsecured creditors?
any exempt property is
excluded and
No
administrative expenses
Yes
are paid that funds will be
available for distribution
to unsecured creditors?
How many creditors do
1-49
1,000-5,000
25,001-50,000
18.
you estimate that you
50-99
5,001-10,000
50,001-100,000
owe?
100-199
10,001-25,000
More than 100,000
200-999
How much do you
19.
$0-$50,000
$1,000,001-$10 million
$500,000,001-$1 billion
estimate your assets to
$50,001-$100,000
$10,000,001-$50 million
$1,000,000,001-$10 billion
be worth?
$100,001-$500,000
$50,000,001-$100 million
$10,000,000,001-$50 billion
$500,001-$1 million
$100,000,001-$500 million
More than $50 billion
How much do you
$0-$50,000
$1,000,001-$10 million
$500,000,001-$1 billion
20.
estimate your liabilities
$50,001-$100,000
$10,000,001-$50 million
$1,000,000,001-$10 billion
to be?
$100,001-$500,000
$50,000,001-$100 million
$10,000,000,001-$50 billion
$500,001-$1 million
$100,000,001-$500 million
More than $50 billion
Part 7:
Sign Below
I have examined this petition, and I declare under penalty of perjury that the information provided is true and
For you
correct.
If I have chosen to file under Chapter 7, I am aware that I may proceed, if eligible, under Chapter 7, 11,12, or 13
of title 11, United States Code. I understand the relief available under each chapter, and I choose to proceed
under Chapter 7.
If no attorney represents me and I did not pay or agree to pay someone who is not an attorney to help me fill out
this document, I have obtained and read the notice required by 11 U.S.C. § 342(b).
I request relief in accordance with the chapter of title 11, United States Code, specified in this petition.
I understand making a false statement, concealing property, or obtaining money or property by fraud in connection
with a bankruptcy case can result in fines up to $250,000, or imprisonment for up to 20 years, or both.
18 U.S.C. §§ 152, 1341, 1519, and 3571.
_____________________________
______________________________________________
Signature of Debtor 1
Signature of Debtor 2
Executed on _________________
Executed on
__________________
MM
/ DD / YYYY
MM / DD
/ YYYY
Official Form 101
Voluntary Petition for Individuals Filing for Bankruptcy
page 6
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