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Debtor 1First NamePart 5:15.Middle NameCase number (if known)Last NameExplain Your Efforts to Receive a Briefing About Credit CounselingTell the court whetheryou have received abriefing about creditcounseling.The law requires that youreceive a briefing about creditcounseling before you file forbankruptcy. You musttruthfully check one of thefollowing choices. If youcannot do so, you are noteligible to file.If you file anyway, the courtcan dismiss your case, youwill lose whatever filing feeyou paid, and your creditorscan begin collection activitiesagain.About Debtor 1:About Debtor 2 (Spouse Only in a Joint Case):You must check one:You must check one: I received a briefing from an approved credit I received a briefing from an approved creditcounseling agency within the 180 days before Ifiled this bankruptcy petition, and I received acertificate of completion.counseling agency within the 180 days before Ifiled this bankruptcy petition, and I received acertificate of completion.Attach a copy of the certificate and the paymentplan, if any, that you developed with the agency.Attach a copy of the certificate and the paymentplan, if any, that you developed with the agency. I received a briefing from an approved credit I received a briefing from an approved creditcounseling agency within the 180 days before Ifiled this bankruptcy petition, but I do not have acertificate of completion.counseling agency within the 180 days before Ifiled this bankruptcy petition, but I do not have acertificate of completion.Within 14 days after you file this bankruptcy petition,you MUST file a copy of the certificate and paymentplan, if any.Within 14 days after you file this bankruptcy petition,you MUST file a copy of the certificate and paymentplan, if any. I certify that I asked for credit counselingservices from an approved agency, but wasunable to obtain those services during the 7days after I made my request, and exigentcircumstances merit a 30-day temporary waiverof the requirement.To ask for a 30-day temporary waiver of therequirement, attach a separate sheet explainingwhat efforts you made to obtain the briefing, whyyou were unable to obtain it before you filed forbankruptcy, and what exigent circumstancesrequired you to file this case.To ask for a 30-day temporary waiver of therequirement, attach a separate sheet explainingwhat efforts you made to obtain the briefing, whyyou were unable to obtain it before you filed forbankruptcy, and what exigent circumstancesrequired you to file this case.Your case may be dismissed if the court isdissatisfied with your reasons for not receiving abriefing before you filed for bankruptcy.If the court is satisfied with your reasons, you muststill receive a briefing within 30 days after you file.You must file a certificate from the approvedagency, along with a copy of the payment plan youdeveloped, if any. If you do not do so, your casemay be dismissed.Any extension of the 30-day deadline is grantedonly for cause and is limited to a maximum of 15days.Your case may be dismissed if the court isdissatisfied with your reasons for not receiving abriefing before you filed for bankruptcy.If the court is satisfied with your reasons, you muststill receive a briefing within 30 days after you file.You must file a certificate from the approvedagency, along with a copy of the payment plan youdeveloped, if any. If you do not do so, your casemay be dismissed.Any extension of the 30-day deadline is grantedonly for cause and is limited to a maximum of 15days. I am not required to receive a briefing about I am not required to receive a briefing aboutcredit counseling because of:credit counseling because of: Incapacity. Incapacity. Disability. Active duty.I have a mental illness or a mentaldeficiency that makes meincapable of realizing or makingrational decisions about finances.My physical disability causes meto be unable to participate in abriefing in person, by phone, orthrough the internet, even after Ireasonably tried to do so.I am currently on active militaryduty in a military combat zone.If you believe you are not required to receive abriefing about credit counseling, you must file amotion for waiver of credit counseling with the court.Official Form 101 I certify that I asked for credit counselingservices from an approved agency, but wasunable to obtain those services during the 7days after I made my request, and exigentcircumstances merit a 30-day temporary waiverof the requirement. Disability. Active duty.I have a mental illness or a mentaldeficiency that makes meincapable of realizing or makingrational decisions about finances.My physical disability causes meto be unable to participate in abriefing in person, by phone, orthrough the internet, even after Ireasonably tried to do so.I am currently on active militaryduty in a military combat zone.If you believe you are not required to receive abriefing about credit counseling, you must file amotion for waiver of credit counseling with the court.Voluntary Petition for Individuals Filing for Bankruptcypage 6

Debtor 1First NamePart 6:16.Middle NameCase number (if known)Last NameAnswer These Questions for Reporting PurposesWhat kind of debts doyou have?16a. Are your debts primarily consumer debts? Consumer debts are defined in 11 U.S.C. § 101(8)as “incurred by an individual primarily for a personal, family, or household purpose.” No. Go to line 16b.Yes. Go to line 17.16b. Are your debts primarily business debts? Business debts are debts that you incurred to obtainmoney 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.17.Are you filing underChapter 7?Do you estimate that afterany exempt property isexcluded andadministrative expensesare paid that funds will beavailable for distributionto unsecured creditors? No.I am not filing under Chapter 7. Go to line 18. Yes. I am filing under Chapter 7. Do you estimate that after any exempt property is excluded andadministrative expenses are paid that funds will be available to distribute to unsecured creditors? NoYes18.How many creditors doyou estimate that youowe? 1-49 50-99 100-199 200-999 1,000-5,000 5,001-10,000 10,001-25,000 25,001-50,000 50,001-100,000 More than 100,00019.How much do youestimate your assets tobe worth? 0- 50,000 50,001- 100,000 100,001- 500,000 500,001- 1 million 1,000,001- 10 million 10,000,001- 50 million 50,000,001- 100 million 100,000,001- 500 million 500,000,001- 1 billion 1,000,000,001- 10 billion 10,000,000,001- 50 billion More than 50 billion20.How much do youestimate your liabilitiesto be? 0- 50,000 50,001- 100,000 100,001- 500,000 500,001- 1 million 1,000,001- 10 million 10,000,001- 50 million 50,000,001- 100 million 100,000,001- 500 million 500,000,001- 1 billion 1,000,000,001- 10 billion 10,000,000,001- 50 billion More than 50 billionPart 7:Sign BelowFor youI have examined this petition, and I declare under penalty of perjury that the information provided is true andcorrect.If I have chosen to file under Chapter 7, I am aware that I may proceed, if eligible, under Chapter 7, 11,12, or 13of title 11, United States Code. I understand the relief available under each chapter, and I choose to proceedunder 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 outthis 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 connectionwith 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 1Executed onMMOfficial Form 101/ DD Signature of Debtor 2Executed on/ YYYYVoluntary Petition for Individuals Filing for BankruptcyMM / DD/ YYYYpage 7

Debtor 1First NameMiddle NameFor your attorney, if you arerepresented by oneIf you are not representedby an attorney, you do notneed to file this page.Case number (if known)Last NameI, the attorney for the debtor(s) named in this petition, declare that I have informed the debtor(s) about eligibilityto proceed under Chapter 7, 11, 12, or 13 of title 11, United States Code, and have explained the reliefavailable under each chapter for which the person is eligible. I also certify that I have delivered to the debtor(s)the notice required by 11 U.S.C. § 342(b) and, in a case in which § 707(b)(4)(D) applies, certify that I have noknowledge after an inquiry that the information in the schedules filed with the petition is incorrect. DateSignature of Attorney for DebtorMM/DD / YYYYPrinted nameFirm nameNumber StreetCityStateZIP CodeContact phoneEmail addressBar numberStateOfficial Form 101Voluntary Petition for Individuals Filing for Bankruptcypage 8

Debtor 1First NameMiddle NameFor you if you are filing thisbankruptcy without anattorneyIf you are represented byan attorney, you do notneed to file this page.Case number (if known)Last NameThe law allows you, as an individual, to represent yourself in bankruptcy court, but youshould understand that many people find it extremely difficult to representthemselves successfully. Because bankruptcy has long-term financial and legalconsequences, you are strongly urged to hire a qualified attorney.To be successful, you must correctly file and handle your bankruptcy case. The rules are verytechnical, and a mistake or inaction may affect your rights. For example, your case may bedismissed because you did not file a required document, pay a fee on time, attend a meeting orhearing, or cooperate with the court, case trustee, U.S. trustee, bankruptcy administrator, or auditfirm if your case is selected for audit. If that happens, you could lose your right to file anothercase, or you may lose protections, including the benefit of the automatic stay.You must list all your property and debts in the schedules that you are required to file with thecourt. Even if you plan to pay a particular debt outside of your bankruptcy, you must list that debtin your schedules. If you do not list a debt, the debt may not be discharged. If you do not listproperty or properly claim it as exempt, you may not be able to keep the property. The judge canalso deny you a discharge of all your debts if you do something dishonest in your bankruptcycase, such as destroying or hiding property, falsifying records, or lying. Individual bankruptcycases are randomly audited to determine if debtors have been accurate, truthful, and complete.Bankruptcy fraud is a serious crime; you could be fined and imprisoned.If you decide to file without an attorney, the court expects you to follow the rules as if you hadhired an attorney. The court will not treat you differently because you are filing for yourself. To besuccessful, you must be familiar with the United States Bankruptcy Code, the Federal Rules ofBankruptcy Procedure, and the local rules of the court in which your case is filed. You must alsobe familiar with any state exemption laws that apply.Are you aware that filing for bankruptcy is a serious action with long-term financial and legalconsequences? NoYesAre you aware that bankruptcy fraud is a serious crime and that if your bankruptcy forms areinaccurate or incomplete, you could be fined or imprisoned? NoYesDid you pay or agree to pay someone who is not an attorney to help you fill out your bankruptcy forms? NoYes. Name of Person .Attach Bankruptcy Petition Preparer’s Notice, Declaration, and Signature (Official Form 119).By signing here, I acknowledge that I understand the risks involved in filing without an attorney. Ihave read and understood this notice, and I am aware that filing a bankruptcy case without anattorney may cause me to lose my rights or property if I do not properly handle the case. Signature of Debtor 1DateSignature of Debtor 2MM / DD / YYYYDateMM / DD / YYYYContact phoneContact phoneCell phoneCell phoneEmail addressEmail addressOfficial Form 101PrintVoluntary Petition for Individuals Filing for BankruptcySave As.Add Attachmentpage 9Reset

Fill in this information to identify your case:United States Bankruptcy Court for the:District ofStateCase number (If known):Official Form 121Statement About Your Social Security Numbers12/15Use this form to tell the court about any Social Security or federal Individual Taxpayer Identification numbers you have used. Do not file thisform as part of the public case file. This form must be submitted separately and must not be included in the court’s public electronic records.Please consult local court procedures for submission requirements.To protect your privacy, the court will not make this form available to the public. You should not include a full Social Security Number orIndividual Taxpayer Number on any other document filed with the court. The court will make only the last four digits of your numbers knownto the public. However, the full numbers will be available to your creditors, the U.S. Trustee or bankruptcy administrator, and the trusteeassigned to your case.Making a false statement, concealing property, or obtaining money or property by fraud in connection with a bankruptcy case can result infines up to 250,000, or imprisonment for up to 20 years, or both. 18 U.S.C. §§ 152, 1341, 1519, and 3571.Part 1:Tell the Court About Yourself and Your spouse if Your Spouse is Filing With You1. Your namePart 2:For Debtor 2 (Only If Spouse Is Filing):First nameFirst nameMiddle nameMiddle nameLast nameLast nameTell the Court About all of Your Social Security or Federal Individual Taxpayer Identification Numbers2. All Social SecurityNumbers you haveused3. All federal IndividualTaxpayerIdentificationNumbers (ITIN) youhave usedPart 3:For Debtor 1:– –– –– –– – You do not have a Social Security number. You do not have a Social Security number.9 – –9 – –9 – –9 – – You do not have an ITIN. You do not have an ITIN.Under penalty of perjury, I declare that the informationI have provided in this form is true and correct.Under penalty of perjury, I declare that the informationI have provided in this form is true and correct.Sign Below Official Form 121 Signature of Debtor 1Signature of Debtor 2DateMM / DD / YYYYDateMM / DD / YYYYStatement About Your Social Security Numbers

Fill in this information to identify your case:Debtor 1First NameDebtor 2Middle NameLast Name(Spouse, if filing) First NameMiddle NameLast NameUnited States Bankruptcy Court for the: District of(State)Case number(If known) Check if this is anamended filingOfficial Form 106DecDeclaration About an Individual Debtor’s Schedules12/15If two married people are filing together, both are equally responsible for supplying correct information.You must file this form whenever you file bankruptcy schedules or amended schedules. Making a false statement, concealing property, orobtaining money or property by fraud in connection with a bankruptcy case can result in fines up to 250,000, or imprisonment for up to 20years, or both. 18 U.S.C. §§ 152, 1341, 1519, and 3571.Sign BelowDid you pay or agree to pay someone who is NOT an attorney to help you fill out bankruptcy forms? No Yes.Name of person . Attach Bankruptcy Petition Preparer’s Notice, Declaration, andSignature (Official Form 119).Under penalty of perjury, I declare that I have read the summary and schedules filed with this declaration andthat they are true and correct. Signature of Debtor 1Signature of Debtor 2DateDateMM /DD/Official Form 106DecYYYYMM / DD /YYYYDeclaration About an Individual Debtor’s Schedules

Fill in this information to identify your case:Debtor 1First NameDebtor 2Middle NameLast Name(Spouse, if filing) First NameMiddle NameLast NameUnited States Bankruptcy Court for the: District of(State)Case number Check if this is an(If known)amended filingOfficial Form 106SumSummary of Your Assets and Liabilities and Certain Statistical Information12/15Be as complete and accurate as possible. If two married people are filing together, both are equally responsible for supplying correctinformation. Fill out all of your schedules first; then complete the information on this form. If you are filing amended schedules after you fileyour original forms, you must fill out a new Summary and check the box at the top of this page.Part 1:Summarize Your AssetsYour assetsValue of what you own1. Schedule A/B: Property (Official Form 106A/B)1a. Copy line 55, Total real estate, from Schedule A/B . 1b. Copy line 62, Total personal property, from Schedule A/B . 1c. Copy line 63, Total of all property on Schedule A/B .Part 2: Summarize Your LiabilitiesYour liabilitiesAmount you owe2. Schedule D: Creditors Who Have Claims Secured by Property (Official Form 106D) 2a. Copy the total you listed in Column A, Amount of claim, at the bottom of the last page of Part 1 of Schedule D .3. Schedule E/F: Creditors Who Have Unsecured Claims (Official Form 106E/F) 3a. Copy the total claims from Part 1 (priority unsecured claims) from line 6e of Schedule E/F .3b. Copy the total claims from Part 2 (nonpriority unsecured claims) from line 6j of Schedule E/F .Your total liabilitiesPart 3: Summarize Your Income and Expenses4. Schedule I: Your Income (Official Form 106I)Copy your combined monthly income from line 12 of Schedule I . 5. Schedule J: Your Expenses (Official Form 106J)Copy your monthly expenses from line 22c of Schedule J .Official Form 106SumSummary of Your Assets and Liabilities and Certain Statistical Information page 1 of 2

Debtor 1First NamePart 4:Middle NameCase number (if known)Last NameAnswer These Questions for Administrative and Statistical Records6. Are you filing for bankruptcy under Chapters 7, 11, or 13? No. You have nothing to report on this part of the form. Check this box and submit this form to the court with your other schedules. Yes7. What kind of debt do you have? Your debts are primarily consumer debts. Consumer debts are those “incurred by an individual primarily for a personal,family, or household purpose.” 11 U.S.C. § 101(8). Fill out lines 8-9g for statistical purposes. 28 U.S.C. § 159. Your debts are not primarily consumer debts. You have nothing to report on this part of the form. Check this box and submitthis form to the court with your other schedules.8. From the Statement of Your Current Monthly Income: Copy your total current monthly income from OfficialForm 122A-1 Line 11; OR, Form 122B Line 11; OR, Form 122C-1 Line 14. 9. Copy the following special categories of claims from Part 4, line 6 of Schedule E/F:Total claimFrom Part 4 on Schedule E/F, copy the following:9a. Domestic support obligations (Copy line 6a.) 9b. Taxes and certain other debts you owe the government. (Copy line 6b.) 9c. Claims for death or personal injury while you were intoxicated. (Copy line 6c.) 9d. Student loans. (Copy line 6f.) 9e. Obligations arising out of a separation agreement or divorce that you did not report aspriority claims. (Copy line 6g.) 9f. Debts to pension or profit-sharing plans, and other similar debts. (Copy line 6h.)9g. Total. Add lines 9a through 9f.Official Form 106Sum Summary of Your Assets and Liabilities and Certain Statistical Informationpage 2 of 2

Fill in this information to identify your case and this filing:Debtor 1Debtor 2First Name(Spouse, if filing) First NameMiddle NameLast NameMiddle NameLast NameUnited States Bankruptcy Court for the: District of(State)Case number Check if this is anamended filingOfficial Form 106A/BSchedule A/B: Property12/15In each category, separately list and describe items. List an asset only once. If an asset fits in more than one category, list the asset in thecategory where you think it fits best. Be as complete and accurate as possible. If two married people are filing together, both are equallyresponsible for supplying correct information. If more space is needed, attach a separate sheet to this form. On the top of any additional pages,write your name and case number (if known). Answer every question.Part 1:Describe E

The bankruptcy forms use youand Debtor 1to refer to a debtor filing alone. A married couple may file a bankruptcy case together—called a joint case—and in joint cases, these forms use youto ask for information from both debtors. For example, if a form asks, "Do you own a car," the answer would be yesif either debtor owns a car.