Chapter 7 Statement Of Your Current Monthly Income
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1
2Fill in this information to identify your case:
Check one box only as directed in this form and in
Form 22A-1Supp:
Debtor 1
__________________________________________________________________
First Name
Middle Name
Last Name
1. There is no presumption of abuse.
Debtor 2
________________________________________________________________
(Spouse, if filing)
First Name
Middle Name
Last Name
2. The calculation to determine if a presumption of
abuse applies will be made under Chapter 7 Means
United States Bankruptcy Court for the: ______________________
___________________________ District of ________
District of __________
Test Calculation (Official Form 22A–2).
Case number
___________________________________________
3. The Means Test does not apply now because of
(If known)
qualified military service but it could apply later.
Check if this is an amended filing
O
F
B 22A1
FFICIAL
ORM
Chapter 7 Statement of Your Current Monthly Income
12/14
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). If you believe that you are exempted from a presumption of abuse because you do not have
primarily consumer debts or because of qualifying military service, complete and file Statement of Exemption from Presumption of Abuse Under
§ 707(b)(2) (Official Form 22A-1Supp) with this form.
Part 1:
Calculate Your Current Monthly Income
1. What is your marital and filing status? Check one only.
Not married. Fill out Column A, lines 2-11.
Married and your spouse is filing with you. Fill out both Columns A and B, lines 2-11.
Married and your spouse is NOT filing with you. You and your spouse are:
Living in the same household and are not legally separated. Fill out both Columns A and B, lines 2-11.
Living separately or are legally separated. Fill out Column A, lines 2-11; do not fill out Column B. By checking this box, you declare
under penalty of perjury that you and your spouse are legally separated under nonbankruptcy law that applies or that you and your spouse
are living apart for reasons that do not include evading the Means Test requirements. 11 U.S.C. § 707(b)(7)(B).
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
2. Your gross wages, salary, tips, bonuses, overtime, and commissions (before all
$_________
$__________
payroll deductions).
3. Alimony and maintenance payments. Do not include payments from a spouse if
$_________
$__________
Column B is filled in.
4. All amounts from any source which are regularly paid for household expenses
of you or your dependents, including child support. Include regular contributions
from an unmarried partner, members of your household, your dependents, parents,
and roommates. Include regular contributions from a spouse only if Column B is not
$_________
$__________
filled in. Do not include payments you listed on line 3.
5. Net income from operating a business, profession, or farm
Gross receipts (before all deductions)
$_________
–
Ordinary and necessary operating expenses
$_________
$__________
Net monthly income from a business, profession, or farm
$_________
$_________
Copy here
6. Net income from rental and other real property
Gross receipts (before all deductions)
$_________
–
Ordinary and necessary operating expenses
$_________
Net monthly income from rental or other real property
$_________
$_________
$__________
Copy here
7. Interest, dividends, and royalties
$__________
$_________
Official Form B 22A1
Chapter 7 Statement of Your Current Monthly Income
page 1
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