Form 106d -Schedule D: Creditors Who Have Claims Secured By Property printable pdf download

Fill in this information to identify your case:

Debtor 1

__________________________________________________________________

First Name

Middle Name

Last Name

Debtor 2

________________________________________________________________

(Spouse, if filing)

First Name

Middle Name

Last Name

__________ District of __________

__________

United States Bankruptcy Court for the:

District of

Case number

___________________________________________



Check if this is an

(If known)

amended filing

Official Form 106D

Schedule D: Creditors Who Have Claims Secured by Property

12/15

Be as complete and accurate as possible. If two married people are filing together, both are equally responsible for supplying correct

information. If more space is needed, copy the Additional Page, fill it out, number the entries, and attach it to this form. On the top of any

additional pages, write your name and case number (if known).

Do any creditors have claims secured by your property?



No. Check this box and submit this form to the court with your other schedules. You have nothing else to report on this form.



Yes. Fill in all of the information below.

Part 1:

List All Secured Claims

Column A

Column B

Column C

List all secured claims. If a creditor has more than one secured claim, list the creditor separately

Amount of claim

Value of collateral

Unsecured

for each claim. If more than one creditor has a particular claim, list the other creditors in Part 2.

that supports this

portion

Do not deduct the

As much as possible, list the claims in alphabetical order according to the creditor’s name.

claim

value of collateral.

If any

2.1

Describe the property that secures the claim:

$_________________ $________________ $____________

______________________________________

Creditor’s Name

______________________________________

Number

Street

As of the date you file, the claim is:

Check all that apply.

______________________________________



Contingent



Unliquidated

______________________________________



City

State

ZIP Code

Disputed

Who owes the debt?

Check one.

Nature of lien

. Check all that apply.



Debtor 1 only

An agreement you made (such as mortgage or secured



car loan)

Debtor 2 only



Statutory lien (such as tax lien, mechanic’s lien)

Debtor 1 and Debtor 2 only



Judgment lien from a lawsuit

At least one of the debtors and another



Other (including a right to offset) ____________________



Check if this claim relates to a

community debt

Date debt was incurred ____________

Last 4 digits of account number ___ ___ ___ ___

2.2

Describe the property that secures the claim:

$_________________ $________________ $____________

______________________________________

Creditor’s Name

______________________________________

Number

Street

As of the date you file, the claim is:

Check all that apply.

______________________________________



Contingent



Unliquidated

______________________________________



City

State

ZIP Code

Disputed

Who owes the debt?

Check one.

Nature of lien

. Check all that apply.



Debtor 1 only

An agreement you made (such as mortgage or secured



car loan)

Debtor 2 only



Statutory lien (such as tax lien, mechanic’s lien)

Debtor 1 and Debtor 2 only



Judgment lien from a lawsuit

At least one of the debtors and another



Other (including a right to offset) ____________________



Check if this claim relates to a

community debt

Date debt was incurred ____________

Last 4 digits of account number ___ ___ ___ ___

$________________

Add the dollar value of your entries in Column A on this page. Write that number here:

Official Form 106D

Schedule D: Creditors Who Have Claims Secured by Property

page 1 of ___

Form 106d -Schedule D: Creditors Who Have Claims Secured By Property

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