Statement Of Financial Affairs Template Page 4
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6.
Assignments and receiverships
a. Describe any assignment of property for the benefit of creditors made within 120 days immediately preceding the
None
commencement of this case. (Married debtors filing under chapter 12 or chapter 13 must include any assignment by
either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not
filed.)
TERMS OF
NAME AND ADDRESS
DATE OF
ASSIGNMENT
OF ASSIGNEE
ASSIGNMENT
OR SETTLEMENT
________________________________________________________________________________________________
b. List all property which has been in the hands of a custodian, receiver, or court-appointed official within one year
None
immediately preceding the commencement of this case. (Married debtors filing under chapter 12 or chapter 13 must
include information concerning property of either or both spouses whether or not a joint petition is filed, unless the
spouses are separated and a joint petition is not filed.)
NAME AND LOCATION
DESCRIPTION
NAME AND ADDRESS
OF COURT
DATE OF
AND VALUE
OF CUSTODIAN
CASE TITLE & NUMBER
ORDER
Of PROPERTY
______________________________________________________________________________________________________
7.
Gifts
List all gifts or charitable contributions made within one year immediately preceding the commencement of this case
None
except ordinary and usual gifts to family members aggregating less than $200 in value per individual family member
and charitable contributions aggregating less than $100 per recipient. (Married debtors filing under chapter 12 or
chapter 13 must include gifts or contributions by either or both spouses whether or not a joint petition is filed, unless
the spouses are separated and a joint petition is not filed.)
NAME AND ADDRESS
RELATIONSHIP
DESCRIPTION
OF PERSON
TO DEBTOR,
DATE
AND VALUE
OR ORGANIZATION
IF ANY
OF GIFT
OF GIFT
_____________________________________________________________________________________________________
8.
Losses
List all losses from fire, theft, other casualty or gambling within one year immediately preceding the commencement
None
of this case or since the commencement of this case. (Married debtors filing under chapter 12 or chapter 13 must
include losses by either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a
joint petition is not filed.)
DESCRIPTION
DESCRIPTION OF CIRCUMSTANCES AND, IF
AND VALUE OF
LOSS WAS COVERED IN WHOLE OR IN PART
DATE
PROPERTY
BY INSURANCE, GIVE PARTICULARS
OF LOSS
______________________________________________________________________________________________________
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