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Appendix G Sample Bankruptcy Pleadings and Other Forms

G.1 Introduction

This Appendix contains over one-hundred-sixty consumer bankruptcy pleadings and other

forms. All captions have been deleted in favor of references to Official Forms 16A, 16B, and

16D, which are contained in Appendix D, supra. These pleadings are also found in both

Adobe Acrobat (PDF) format and Microsoft Word format on the CD-Rom accompanying this

manual. These pleadings should be edited using your word-processing program in order to fit

the particulars of an actual case.

IMPORTANT NOTE CONCERNING CAPTIONS OF PLEADINGSAND OTHER NOTICES TO CREDITORS

11 U.S.C. 342(c) requires that all notices required to be given by the debtor to a creditor

under the Code, a rule, an applicable law, or an order of court contain the debtors name,

address and the last four digits of the taxpayer identification number (usually a Social Security

Number). Official Form 16A reflects this requirement. If the notice concerns an amendment

that adds a creditor to the schedules, the notice must provide the debtors complete Social

Security Number on only the added creditors copy of any notice or summons the debtor may

serve on the creditor. Official Form 16B is available for captions of pleadings which do not

fall within the 11 U.S.C. 342(c) requirement. Official Form 16D is designated for

complaints filed by persons other than the debtor, though it should be used by debtors in

adversary proceedings as Official Form 16C is now abrogated. When used in this manner,

Official Form 16D should be altered to include the debtors address and last four digits of thedebtors Social Security Number (and the debtors complete Social Security Number on the

creditors copy). Please see Appendix D, supra, to review the Official Form captions. For

forms in this Appendix containing captions, please use the necessary revised caption.

When section 342(c) applies to a notice sent by letter, the required information should be

included in the letter. Many of the notices contained in this Appendix are not required by law

so 11 U.S.C. 342(c) does not apply. However, some lawyers, in an excess of caution, may

wish to include the debtors address and Social Security Number in all notices to be certain

of compliance.

Section 342(e) allows a creditor to file with the court and serve on the debtor an address

which it wants used for notices in a particular chapter 7 or 13 case. Any notice provided by the

debtor more than five days after such a request is served must be sent to the requested address.

IMPORTANT NOTE CONCERNING SERVICE OF PROCESS ONINSURED DEPOSITORY INSTITUTIONS

By amendment to Federal Rule of Bankruptcy Procedure 7004, contested matters and

adversary proceeding which must be served on insured depository institutions must be served

by certified mail addressed to an officer of the institution. See Fed. R. Bankr. P. 7004(h). The

rule contains exceptions which apply in certain limited situations. See generally 13.3.2.1,

supra. Note that Federal Rule of Bankruptcy Procedure 9014 makes this service rule applicable

to service of contested matters (that is, motions not otherwise governed by the Rules).

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Pleadings and Other Forms Contained in This Appendix

G.2 Pre-Filing Forms

Form 1 Pre-Filing Notification to Creditors of Representation

Form 2 Notification to Creditor Seeking Information As to Account

Form 3 Letter to Client Requesting More Information

Form 4 Initial Consultation Agreement and Acknowledgment of Receipt of Disclosures

Form 5 Notice Required by 11 U.S.C. 342(b) and 527(a)

Form 6 Notice Required by 11 U.S.C. 527(b)

G.3 Initial Forms

Form 7 Debtors Certification in Support of Temporary Waiver of Credit Counseling Re-

quirement Based on Exigent Circumstances

Form 8 Motion for Exemption from Credit Counseling and Financial Education Requirement

Based on Incapacity, Disability, or Active Military Duty

Form 9 Motion and Order for Extension of Time to File Schedules and Other Required

Documents

Form 10 Motion and Order for Extension of Time to File Chapter 13 Schedules and OtherRequired Documents

Form 11 Motion and Order for Additional Time to File Chapter 13 Schedules, Other

Documents and Information Required Under 11 U.S.C. 521(a)(1)

Form 12 Motion to Excuse Filing of Lost or Unavailable Payment Advices

Form 13 Statement Regarding Payment Advices

Form 14 Letter Advising Trustee of Special Circumstances

Form 15 Debtors Statement of Special Circumstances to Rebut Presumption of Abuse Under

11 U.S.C. 707(b)(2)

Form 16 Motion to Keep Prior Name Confidential

Form 17 Application and Order for Waiver of Miscellaneous Fees

Form 18 Debtors Chapter 13 Plan

Form 19 Order Confirming Chapter 13 PlanForm 20 Motion for Payover Order in Chapter 13

Form 21 Order to Pay Wages to the Trustee in Chapter 13

Form 22 Chapter 13 Plan Providing for Liquidation of Debtors Interest in Residence

Form 23 Chapter 13 Plan Providing for Filing of Adversary Proceeding Involving Predatory

Mortgage Lending Claims

Form 24 Chapter 13 Plan Assuming Residential Lease

Form 25 Chapter 13 Debtors Motion to Assume Lease

Form 26 Chapter 13 Bankruptcy Information Sheet and Checklist from Debtors Attorney to

Debtor

Form 27 Chapter 7 Bankruptcy Information Sheet and Checklist from Attorney to Debtor

Form 28 Debtors First Amended Chapter 13 Plan

Form 29 Debtors Amendment of Schedules

Form 30 Application and Order for Waiver of Filing Fee to Amend Debtors Schedule ofCreditors

Form 31 Statement by Debtors Attorney of Fees Charged

Form 32 Application for Counsel Fees

G.4 Automatic Stay

Form 33 Letter to Creditors Giving Notice of Stay

Form 34 Complaint Seeking Damages for Violation of Automatic Stay and Unfair Trade

Practices

Appx. G.1 Consumer Bankruptcy Law and Practice

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Form 35 Motion Seeking Relief for Violations of the Automatic Stay by Governmental

Agency

Form 36 Motion for Expedited Hearing on Contempt Motion

Form 37 Complaint Seeking Contempt Remedies and Recovery of Property from IRS

Form 38 Answer to Motion for Relief from Automatic Stay

Form 39 Motion for Sanctions Pursuant to Rule 9011 for Baseless Motion for Relief from

Automatic Stay

Form 40 Answer to Motion of Landlord for Relief from Automatic StayForm 41 Debtors Certification in Support of Extension of Automatic Stay As to Pending

Eviction Action

Form 42 Answer to Motion for Relief from Automatic Stay Raising Avoidability of Transfer

to Plaintiff

Form 43 Debtors Answer to Motion for Relief from Codebtor Stay

Form 44 Debtors Objection to Relief from the Codebtor Stay

Form 45 Answer to Application for Abandonment of Real Estate

Form 46 Motion for Continuation of Automatic Stay in Case Filed Within One Year After

Dismissal of Prior Bankruptcy Case

Form 47 Motion to Invoke Automatic Stay in Case Filed Within One Year After Dismissal

of Two Prior Bankruptcy Cases

Form 48 Motion for Relief from In Rem Order Entered in Prior Case

Form 49 Motion to Reimpose Stay After Relief from Stay Has Been Granted

G.5 Turnover of Property

Form 50 Letter Demanding Turnover of Property

Form 51 Complaint Seeking Turnover of Property

Form 52 Motion for Enforcement of Turnover Order and to Hold Defendant in Contempt of

Court

G.6 Utilities

Form 53 Letter to Utility Company Giving Notice of Stay and Requirements of 11 U.S.C.

366

Form 54 Letter to Utility Company Giving Notice of Conversion from Chapter 13 to Chapter 7

Form 55 Complaint to Enjoin Termination of Utility Service for Nonpayment of Deposit by

Debtor Current on Her Utility Payments

Form 56 Complaint Seeking Reconnection of Utility Service and Damages

Form 57 Motion for Modification of Security Deposit for Utility Service

G.7 Steps After Filing

Form 58 Letter Advising Belatedly-Added Creditor of Meeting of Creditors

Form 59 Statement Explaining Debtors Failure to Provide Tax Return to Trustee or Creditors

Form 60 Statement That Documents Required to Be Brought to Meeting of Creditors Do Not

Exist or Are Not In Debtors Possession

Form 61 Chapter 7 Section 341(a) Meeting Questions

Form 62 Section 341(a) Questions from United States Trustee Chapter 7 Handbook

Form 63 Statement of Information Required by 11 U.S.C. 341

Form 64 Chapter 13 Section 341(a) Meeting Questions

Form 65 Section 341(a) Questions from United States Trustee Chapter 13 Handbook

Form 66 Debtors Motion to Excuse Appearance and to Conduct Meeting of Creditors by

Interrogatories

Form 67 Interrogatories to Debtor in Lieu of Attendance at Meeting of Creditors

Form 68 Report of Trustee

Sample Bankruptcy Pleadings and Other Forms Appx. G.1

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G.8 Claims

Form 69 Priority Proof of Claim by Debtor

Form 70 Proof of Secured Claim by Debtor

Form 71 Proof of Unsecured Claim by Debtor

Form 72 Motion to Sell Property Free and Clear of Liens

Form 73 Debtors Motion to Redeem Property Pursuant to 11 U.S.C. 722

Form 74 Agreement for Redemption of PropertyForm 75 Objection to Proof of Claim

Form 76 Objection to Undocumented Credit Card Claim

Form 77 Order Disallowing Undocumented Claim

Form 78 Objection Seeking Reduction of Claim Amount Based on Creditors Refusal to

Negotiate Repayment Plan

Form 79 Objection to Frivolous Priority Claim and Request for Sanctions

Form 80 Complaint Objecting to Secured Claims for Failure to Comply with Truth in

Lending Act and HUD Mortgage Servicing Requirements

Form 81 Complaint Objecting to Secured Claim and Seeking to Enforce Truth in Lending

Rescission

Form 82 Alternative Complaint Objecting to Secured Claim on the Basis of Truth in Lending

RescissionForm 83 Judgment Order Disallowing Secured Claim

Form 84 Complaint Objecting to Secured Claim on the Basis of Usury and Warranty

Defenses

Form 85 Complaint or Motion to Determine Value of Security and Creditors Allowed

Secured Claim

Form 86 Qualified Written Request Under RESPA to Obtain Mortgage Loan Information

Form 87 Motion for Order Directing Claimant to Appear for Rule 2004 Examination

Form 88 Order Directing Claimant to Appear for Rule 2004 Examination

Form 89 Complaint Objecting to Mortgage Servicers Claim Based on RESPA and FDCPA

Violations

Form 90 Request for Approval of Postpetition Consumer Debt

G.9 Exemptions and Lien Avoidance

Form 91 Motion to Avoid Judicial Lien on Residential Real Estate

Form 92 Order Avoiding Lien on Residential Real Estate

Form 93 Motion to Avoid Non-Possessory, Non-Purchase Money Security Interest

Form 94 Order Avoiding Non-Possessory, Non-Purchase Money Security Interest

Form 95 Complaint to Set Aside Preference

Form 96 Complaint to Set Aside Preference and/or Setoff by Governmental Agency Re-

couping Overpayments of Benefits

Form 97 Complaint to Set Aside Foreclosure Sale for Less Than Reasonably Equivalent

Value and to Remedy Mortgagees Contempt

G.10 Litigation

Form 98 Motion for Leave to Proceed In Forma Pauperis

Form 99 In Forma Pauperis Order

Form 100 Complaint: Class Action Adversary Proceeding Raising Claims Under Stay,

Discharge, and Exemption Provisions As Well As 42 U.S.C. 1983

Form 101 Complaint to Prohibit Eviction from Public Housing Based upon Dischargeable

Debt for Rent

Form 102 Complaint Seeking Review of Administrative Action


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Form 103 Complaint Seeking Restoration of Drivers License

Form 104 Complaint Seeking Damages in Non-Core Adversary Proceeding Against a

Non-Creditor for Unfair Debt Collection Practices

Form 105 Motion for Abandonment of Property by Trustee

Form 106 Debtors Motion for Expedited Discovery

Form 107 Plaintiffs Request for Documents

Form 108 Defendants Request for Admissions

Form 109 Petition for Writ of Habeas CorpusForm 110 Application for Default Judgment

Form 111 Order for Default Judgment

Form 112 Request for Default Judgment by Clerk

Form 113 Default Judgment by Clerk

Form 114 Notice of Removal

Form 115 Plaintiffs Motion for Withdrawal of Proceeding to the District Court

Form 116 Motion for Determination That Proceeding Is a Core Proceeding

Form 117 Stipulation That Matter May Be Determined by Bankruptcy Court

Form 118 Plaintiffs Objections to Findings of Fact and Conclusions of Law

Form 119 Motion for Leave to Appeal Interlocutory Order

Form 120 Motion for Stay of Order Pending Appeal

Form 121 Stipulation for Appeal to Bankruptcy Appellate Panel

Form 122 Appellants Election Form

G.11 Discharge and Reaffirmation

Form 123 Complaint to Determine Dischargeability of Student Loan

Form 124 Debtors Answer to Complaint Seeking Determination of Nondischargeability

Form 125 Interrogatories Directed to Lender Regarding Debtors Alleged False Financial

Statement(s)

Form 126 Defendants Requests for Production of Documents in Dischargeability Case

Based on Credit Card Fraud

Form 127 Defendants Interrogatories in Dischargeability Case Based on Credit Card Fraud

Form 128 Defendants Requests for Admissions in Dischargeability Case Based on CreditCard Fraud

Form 129 Debtors Certification Regarding Domestic Support Obligations Before Receiving

Discharge

Form 130 Debtors Application for a Hardship Discharge

Form 131 Letter to Creditor Concerning Proposed Reaffirmation Agreement

Form 132 Letter to Client After Discharge

Form 133 Complaint to Recover SSI Benefits Collected by State As Reimbursement for

Prebankruptcy Welfare Debt

Form 134 Complaint Seeking Contempt Remedies for Violation of the Automatic Stay and

Discharge Injunction

Form 135 Complaint to Enjoin Discriminatory Denial of Guaranteed Student Loan

Form 136 Motion for Preliminary Relief in Complaint to Enjoin Discriminatory Denial of

Guaranteed Student LoanForm 137 Proposed Order for Preliminary Relief in Complaint to Enjoin Discriminatory

Denial of Guaranteed Student Loan

Form 138 Class Action Complaint Seeking Remedies for Coercive Collection Practices In-

volving Discharged Debt

Form 139 Motion for Order Declaring Mortgage Loan Current

Form 140 Order Declaring Mortgage Loan Current

Form 141 Complaint Challenging Misapplication of Mortgage Payments in Chapter 13 Case


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G.12 Conversion, Dismissal, and Modification of Plan AfterConfirmation

Form 142 Motion to Modify Plan After Confirmation

Form 143 Motion to Modify Plan to Terminate Plan

Form 144 Motion to Modify Plan to Surrender Vehicle

Form 145 Motion to Modify Plan to Permit Mortgage Refinancing to Pay Off Plan

Form 146 Debtors Amended Plan Permitting Mortgage Refinancing to Pay Off PlanForm 147 Debtors Notice to Convert Case from Chapter 13 to Chapter 7

Form 148 Supplemental Schedule of Debts Arising After Filing of the Petition, But Prior to

Conversion to Chapter 7

Form 149 Debtors Motion to Convert Chapter 7 Case to Chapter 13

Form 150 Debtors Motion to Dismiss Chapter 13 Case

Form 151 Debtors Motion to Dismiss Chapter 7 Case

Form 152 Debtors Motion to Reopen Case

Form 153 Debtors Motion to Reopen Case to Obtain Discharge

G.13 Consumers As Creditors

Form 154 Motion for Relief from Stay by Tenant to Raise Counterclaims to EvictionForm 155 In Forma Pauperis Petition and Memorandum of Law in Support

Form 156 Complaint to Determine Dischargeability of Tenants Claims Against Landlord

Form 157 Motion for Appointment of Committee of Tenants

Form 158 Expedited Motion for Appointment of Committee of Consumer Creditors

Form 159 Statement of Attorney Pursuant to Rule 2019

Form 160 Objection to Chapter 11 Disclosure Statement

Form 161 Objection to Confirmation of Chapter 11 Plan

Form 162 Complaint Seeking Subordination of Secured Creditors Claims

G.2 Pre-Filing Forms

Form 1 Pre-Filing Notification to Creditors ofRepresentation1

Re: [debtor(s)]

Dear Sir/Madam:

Please be advised that this office represents the above-captioned

individual(s) with respect to [his, her, their] alleged debt to [credi-

tor]. We are presently preparing a bankruptcy petition which will

shortly be filed.

We are requesting that all further communications concerning

this matter be directed to us. If you have any questions concerning

the above, please feel free to call me. Thank you for your coop-

eration in this matter.

Very truly yours,

[signature]

Form 2 Notification to Creditor SeekingInformation As to Account2

Re: [debtor(s)]

Dear Sir/Madam:

Please be advised that this office represents the above-captioned

individual(s) with respect to [his, her, their] alleged debt to [credi-

tor]. We are presently preparing a bankruptcy petition which will

shortly be filed.

Enclosed please find an Information Release Authorization for

the above-captioned individual(s). As we are interested in having

the most current and accurate information possible, please forward

the information listed in the authorization as soon as possible. It is

especially important that we know if there is any security or

1 This letter should be sent to any creditors who have been both-

ering the client, if not to all creditors. It should succeed in ending

creditor contacts with the client. If a creditor communicates with

the debtor after receipt of this letter, an unfair trade practice claim

may arise (which could be claimed as exempt if it arises before

the petition is filed). If a collection agency is involved, the

communication may give rise to damages under the Fair Debt

Collection Practices Act, 15 U.S.C. 16921692o.

2 This letter requests information for cases in which the schedules

or statement can not be completed because the debtors recordsare incomplete. An information release authorization, signed by

the debtor, may not be necessary, depending on local practices.

However, to save the necessity of another letter, it should be

included if there is some doubt as to whether the creditor or

bank will release information without it. If it is not included, the

information requested should be specified in the letter itself.

Creditors, of course, do not always cooperate in furnishing this

information. Additionally some care should be taken because

certain creditors, when they know bankruptcy is imminent, will

hasten actions (often creating preferences, see 10.4.2.6.4,

supra), which would violate the automatic stay after the filing.


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judgment for the debt owed to you, so that we may know which

debts will have to be paid after bankruptcy. If we do not hear from

you, we may have to assume there was no security for this debt.

We are requesting that all further communications concerning

this matter be directed to us. If you have any questions concerning

the above, please feel free to call me. Thank you for your coop-

eration in this matter.

Very truly yours,

[signature]

Information Release Authorization

To: [creditorbank]

This will authorize you to deliver to a full

statement with respect to the following facts concerning:

[debtor]

[address]

Account No. [number]

who is a debtor/depositor of yours.

Depositor:

Total amount of deposit and accrued interest.

Debtor:

1. Total amount borrowed;

2. Installment amount;

3. Reason owed;

4. Security interest (provide description of collateral and, if

recorded, state where and when);

5. Amounts and number of installments in arrears;

6. Present balance;

7. Interest or other costs;

8. Any assignment of debt and to whom;

9. Legal action pending and attorney involved;

10. Copies of the original contract and all papers relevant to the

transaction or transactions;11. Date debt incurred; and

12. Codebtors or cosigners.

Thank you for your cooperation in this request.

[signature]

Debtor

Form 3 Letter to Client Requesting MoreInformation3

Re: Bankruptcy No. [number]

Dear [name]:Thank you for completing your bankruptcy questionnaire and

providing most of the information we requested. However, we will

need some additional information in order to complete your bank-

ruptcy papers. Please provide information and documents for the

items checked below:

Your Household Income and Expenses

[ ] Pay check stubs for the last sixty (60) days, from [date] until

[date].

[ ] Documents that show your rental income for the past six

months.

[ ] Documents that show the amount that someone else regu-

larly contributes to your household expenses.

[ ] Documents that show the amount of your spouses incomethat is paid for his or her separate expenses and not regularly

paid towards your household expenses (such as child sup-

port payments your spouse makes to a former spouse or

payments your spouse makes on separate debts).

[ ] Copy of your auto loan or payment coupon showing when

the last payment is due.

[ ] Copies of your tax returns for the past [number] years.

Your Home, Auto and Other Property

[ ] Copies of any appraisals of your home.

[ ] Copy of the recent tax assessment of your home.

[ ] Copy of the deed for the property located at [address].

[ ] Copy of the loan and other closing documents for yourmortgage with [lender].

[ ] Any payment and escrow account statements you have

received from your mortgage company during the past

[number] months.

[ ] Copy of your auto insurance policy or a summary of the

policy (certificate of insurance) showing that you have

coverage.

[ ] Copy of your home insurance policy or a summary of the

policy (certificate of insurance) showing that you have

coverage.

[ ] Copy of a recent statement for your individual retirement

account (IRA), 401K, or other pension plan.

[ ] Copy of a recent statement for your education IRA or tuition

credit program.[ ] Copy of a recent statement for your medical savings plan.

Court Proceedings

[ ] Copies of any family court orders requiring you to pay child

support or alimony.

[ ] Documents that show you are current on your child support

and/or alimony payments.

[ ] Copies of any family court orders showing that you are

entitled to receive child support or alimony.

[ ] Copy of the eviction complaint filed against you by your

landlord.

[ ] Copy of the court complaint in the lawsuit you filed against

[defendant(s)].

If you have any questions concerning these requests, please

contact this office. As soon as this information is provided we will

complete your bankruptcy papers and schedule an appointment for

you to sign them.

[signature]

Attorney

3 This letter may be sent to clients if additional information is

needed to complete their bankruptcy schedules and other re-

quired documents. It would typically be sent after the clients

have filled out the questionnaire in Appendix F, supra.


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Form 4 Initial Consultation Agreement and Ack-nowledgment of Receipt of Disclosures

This agreement is entered into on this [date] day of [month],

2006, by and between [name of prospective client] and [name of

spouse, if prospective co-client], and the [name of law firm or

attorney] (referred to as the Attorney).

1. I (We) have requested a consultation with the Attorney to

obtain information and advice about debt issues and relief fromdebt, including the possibility of filing bankruptcy under the

federal Bankruptcy Code. The Attorney agrees to provide an initial

consultation concerning these matters. There is no charge for this

initial consultation.

2. The Attorney agrees to provide the following services at the

initial consultation, based on the information I (we) have provided:

(a) Analyze my (our) financial circumstances and advise me

(us) of possible bankruptcy and non-bankruptcy options for

responding to my (our) financial problems. I (We) under-

stand that this analysis is only preliminary, because the

Attorney does not have all of the information and docu-

ments that will be required to fully evaluate my (our)

situation.

(b) Describe the potential benefits and the disadvantages of

filing bankruptcy, and explain the relief available under

chapters 7, 11, 12 and 13 of the Bankruptcy Code.

(c) Advise me (us) of the requirements, obligations and costs

for filing a chapter 7 or 13 bankruptcy.

(d) Inform me (us) of the additional information that I (we) will

need to provide to enable the Attorney to more fully advise

me (us) of my (our) potential options and legal rights.

3. I (We) agree to provide at the initial consultation information

and documents, if any, concerning my (our) income, expenses,

assets, and liabilities. I (We) understand that in order for the

Attorney to give meaningful advice, detailed financial information

must be provided completely and accurately.

4. The Attorney will provide at this time only the servicesspecifically stated in this Agreement. If I (we) retain the Attorney

to represent me (us) and provide additional services, including the

filing of bankruptcy or other bankruptcy assistance, I (we) and the

Attorney will sign a separate retainer agreement detailing the

services and their cost, and the other terms of such representation.

5. I (We) acknowledge that the Attorney gave to me (us) at the

initial consultation copies of this agreement and several notices

required by the Bankruptcy Code listed below. If my spouse was

not present when these notices were received at the initial consul-

tation, I also acknowledge receipt of these notices on behalf of my

spouse, and agree to provide my spouse with a copy of these

notices. All of the following documents were given me (us):

(a) Initial Consultation Agreement

(b) Notice Required by Sections 342(b) and 527(a) of theBankruptcy Code

(c) Notice Required by Section 527(b) of the Bankruptcy Code

Date:

[signature] [signature]

[name of prospective client] [name of law firm or attorney]

[signature]

[name of spouse, if prospective

co-client]

Form 5 Notice Required by 11 U.S.C. 342(b)and 527(a)4

Notice to Individual Consumer Debtor Under Section 342(b)

and 527(a) of the Bankruptcy Code

In accordance with section 342(b) of the Bankruptcy Code, this

notice: (1) Describes briefly the services available from credit

counseling services; (2) Describes briefly the purposes, benefitsand costs of the four types of bankruptcy proceedings you may

commence; and (3) Informs you about bankruptcy crimes and

notifies you that the Attorney General may examine all information

you supply in connection with a bankruptcy case. You are cau-

tioned that bankruptcy law is complicated and not easily described.

Thus, you may wish to seek the advice of an attorney to learn of

your rights and responsibilities should you decide to file a petition.

Court employees can not give you legal advice.

1. Services Available from Credit Counseling Agencies

With limited exceptions, section 109(h) of the Bankruptcy

Code requires that all individual debtors who file for bank-

ruptcy relief on or after October 17, 2005, receive a briefing that

outlines the available opportunities for credit counseling and

provides assistance in performing a budget analysis. The briefing

must be given within 180 days before the bankruptcy filing. The

briefing may be provided individually or in a group (including

briefings conducted by telephone or on the Internet) and must be

provided by a nonprofit budget and credit counseling agency ap-

proved by the United States trustee or bankruptcy administrator. The

clerk of the bankruptcy court has a list that you may consult of the

approved budget and credit counseling agencies.

In addition, after filing a bankruptcy case, an individual

debtor generally must complete a financial management in-

structional course before he or she can receive a discharge. The

clerk also has a list of approved financial management instructional

courses.

4 Section 342(b) requires the clerk to give each consumer debtor,

prior to the filing of the petition, a notice describing each chapter

under which such individual may proceed, the services of credit

counseling agencies, and the possible consequences of bank-

ruptcy fraud. In addition, section 521(a)(1)(B)(iii) requires the

debtors attorney to file a certification that the attorney delivered

the notice to the debtor. This certification is part of Exhibit B in

Official Form 1, the bankruptcy petition. Based upon these pro-

visions, the debtors attorney should deliver the section 342(b)

notice, which is reprinted in Appendix E, supra, to the debtor and

sign the certification to comply with section 521(a)(1)(B)(iii). If

the debtors attorney is not a debt relief agency, for example if the

attorney works for a legal services organization, only this noticeneeds to be provided to the debtor. However, section 527 sets out

a series of notices and disclosures that debt relief agencies must

make to all assisted persons being provided bankruptcy assis-

tance. This form contains the written notice required by section

527(a)(1) and (a)(2) and is combined with the section 342(b)

notice so that they may be given at the same time. These items

must be provided within threedays of when theagency first offers

to provide bankruptcy assistance services to an assisted person. If

the notice is not provided at the time the client signs an initial

consultation agreement, see Form 4, Appx. G.2, supra, and with

a copy attached thereto, the attorney should include the certificate

of receipt and have the client sign it.


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2. The Four Chapters of the Bankruptcy Code Available to

Individual Consumer Debtors

Chapter 7: Liquidation ($245 filing fee, $39 administrative fee,

$15 trustee surcharge: Total fee $299)

1. Chapter 7 is designed for debtors in financial difficulty who

do not have the ability to pay their existing debts. Debtors whose

debts are primarily consumer debts are subject to a means test

designed to determine whether the case should be permitted toproceed under chapter 7. If your income is greater than the median

income for your state of residence and family size, in some cases,

creditors have the right to file a motion requesting that the court

dismiss your case under section 707(b) of the Code. It is up to the

court to decide whether the case should be dismissed.

2. Under chapter 7, you may claim certain of your property as

exempt under governing law. A trustee may have the right to take

possession of and sell the remaining property that is not exempt

and use the sale proceeds to pay your creditors.

3. The purpose of filing a chapter 7 case is to obtain a discharge

of your existing debts. If, however, you are found to have com-

mitted certain kinds of improper conduct described in the Bank-

ruptcy Code, the court may deny your discharge and, if it does, the

purpose for which you filed the bankruptcy petition will be de-

feated.

4. Even if you receive a general discharge, some particular debts

are not discharged under the law. Therefore, you may still be

responsible for most taxes and student loans; debts incurred to pay

nondischargeable taxes; domestic support and property settlement

obligations; most fines, penalties, forfeitures, and criminal restitu-

tion obligations; certain debts which are not properly listed in your

bankruptcy papers; and debts for death or personal injury caused by

operating a motor vehicle, vessel, or aircraft while intoxicated from

alcohol or drugs. Also, if a creditor can prove that a debt arose from

fraud, breach of fiduciary duty, or theft, or from a willful and

malicious injury, the bankruptcy court may determine that the debt

is not discharged.

Chapter 13: Repayment of All or Part of the Debts of an

Individual with Regular Income ($235 filing fee, $39 adminis-

trative fee: Total fee $274)

1. Chapter 13 is designed for individuals with regular income

who would like to pay all or part of their debts in installments over

a period of time. You are only eligible for chapter 13 if your debts

do not exceed certain dollar amounts set forth in the Bankruptcy

Code.

2. Under chapter 13, you must file with the court a plan to repay

your creditors all or part of the money that you owe them, using

your future earnings. The period allowed by the court to repay your

debts may be three years or five years, depending upon your

income and other factors. The court must approve your plan beforeit can take effect.

3. After completing the payments under your plan, your debts

are generally discharged except for domestic support obligations;

most student loans; certain taxes; most criminal fines and restitu-

tion obligations; certain debts which are not properly listed in your

bankruptcy papers; certain debts for acts that caused death or

personal injury; and certain long term secured obligations.

Chapter 11: Reorganization ($1000 filing fee, $39 administra-

tive fee: Total fee $1039)

Chapter 11 is designed for the reorganization of a business but

is also available to consumer debtors. Its provisions are quite

complicated, and any decision by an individual to file a chapter 11

petition should be reviewed with an attorney.

Chapter 12: Family Farmer or Fisherman ($200 filing fee, $39

administrative fee: Total fee $239)

Chapter 12 is designed to permit family farmers and fishermen

to repay their debts over a period of time from future earnings andis similar to chapter 13. The eligibility requirements are restrictive,

limiting its use to those whose income arises primarily from a

family-owned farm or commercial fishing operation.

3. Bankruptcy Crimes and Availability of Bankruptcy Papers

to Law Enforcement Officials

A person who knowingly and fraudulently conceals assets or

makes a false oath or statement under penalty of perjury, either

orally or in writing, in connection with a bankruptcy case is subject

to a fine, imprisonment, or both. All information supplied by a

debtor in connection with a bankruptcy case is subject to exami-

nation by the Attorney General acting through the Office of the

United States Trustee, the Office of the United States Attorney, and

other components and employees of the Department of Justice.

WARNING: Section 521(a)(1) of the Bankruptcy Code requires

that you promptly file detailed information regarding your credi-

tors, assets, liabilities, income, expenses and general financial

condition. Your bankruptcy case may be dismissed if this infor-

mation is not filed with the court within the time deadlines set by

the Bankruptcy Code, the Bankruptcy Rules, and the local rules of

the court.

In accordance with section 527(a)(2) of the Bankruptcy Code,

be advised that:

1. All information you are required to provide with a bankruptcy

petition and during a bankruptcy case must be complete, accurate,

and truthful.

2. All assets and all liabilities must be completely and accurately

disclosed in the documents filed in your case, and the replacement

value of each asset must be stated in those documents where

requested after reasonable inquiry to establish such value.

3. Current monthly income, the amounts specified in the means

test under section 707(b)(2), and disposable income in chapter 13

cases must be stated after reasonable inquiry.

4. Information that you provide during your bankruptcy case

may be audited, and the failure to provide such information may

result in dismissal of the case or other sanction, including a

criminal sanction.

Certificate of the DebtorI (We), the debtor(s), affirm that I (we) have received and read

this notice.

Date:

Case No. (if known):

[signature]

Printed Name(s) of Debtor(s)

[signature]

Signature of Joint Debtor (if any)


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Form 6 Notice Required by 11 U.S.C. 527(b)5

IMPORTANT INFORMATION ABOUT BANKRUPTCY

ASSISTANCE SERVICES FROM AN ATTORNEY OR

BANKRUPTCY PETITION PREPARER

If you decide to seek bankruptcy relief, you can represent

yourself, you can hire an attorney to represent you, or you can get

help in some localities from a bankruptcy petition preparer who isnot an attorney. THE LAW REQUIRES AN ATTORNEY OR

BANKRUPTCY PETITION PREPARER TO GIVE YOU A

WRITTEN CONTRACT SPECIFYING WHAT THE ATTOR-

NEY OR BANKRUPTCY PETITION PREPARER WILL DO

FOR YOU AND HOW MUCH IT WILL COST. Ask to see the

contract before you hire anyone.

The following information helps you understand what must be

done in a routine bankruptcy case to help you evaluate how much

service you need. Although bankruptcy can be complex, many

cases are routine.

Before filing a bankruptcy case, either you or your attorney

should analyze your eligibility for different forms of debt relief

available under the Bankruptcy Code and which form of relief is

most likely to be beneficial for you. Be sure you understand therelief you can obtain and its limitations. To file a bankruptcy case,

documents called a Petition, Schedules and Statement of Financial

Affairs, as well as in some cases a Statement of Intention need to

be prepared correctly and filed with the bankruptcy court. You will

have to pay a filing fee to the bankruptcy court. Once your case

starts, you will have to attend the required first meeting of creditors

where you may be questioned by a court official called a trustee

and by creditors.

If you choose to file a chapter 7 case, you may be asked by a

creditor to reaffirm a debt. You may want help deciding whether to

do so. A creditor is not permitted to coerce you into reaffirming

your debts.

If you choose to file a chapter 13 case in which you repay yourcreditors what you can afford over three to five years, you may also

want help with preparing your chapter 13 plan and with the

confirmation hearing on your plan which will be before a bank-

ruptcy judge.

If you select another type of relief under the Bankruptcy Code

other than chapter 7 or chapter 13, you will want to find out what

should be done from someone familiar with that type of relief.

Your bankruptcy case may also involve litigation. You are

generally permitted to represent yourself in litigation in bankruptcy

court, but only attorneys, not bankruptcy petition preparers, can

give you legal advice.

Certificate of the Debtor

I (We), the debtor(s), affirm that I (we) have received and read

this notice.

Date:

Case No. (if known):

[signature]

Printed Name(s) of Debtor(s)[signature]

Signature of Joint Debtor (if any)

G.3 Initial Forms

The Official Forms necessary to commence a case are repro-

duced in Appendix D, supra. These forms are included in Appen-

dix D as sample completed bankruptcy schedules illustrating how

to prepare an initial filing. Other Official Forms are included in

blank format. All the forms in Appendix D, supra, as well as blank

versions of the forms to institute a case can also be printed from the

CD-Rom accompanying this manual and used in actual cases. The

bankruptcy software included on the CD-Rom accompanying thismanual can also be used to complete the initial forms in either

Microsoft Word or Corel WordPerfect.

Certain other non-Official Forms may also be necessary to

commence a case, pursuant to the Federal Rules of Bankruptcy

Procedure and the Bankruptcy Code. These include a list of

creditors, codebtors, and parties to executory contracts and unex-

pired leases, with mailing addresses, required by Federal Rule of

Bankruptcy Procedure 1007(a); a disclosure of compensation,

required by Federal Rule of Bankruptcy Procedure 2016(b); and a

notice to consumer debtors, required by 11 U.S.C. 342(b). These

non-Official Forms are contained in a reproducible format in

Appendix E, supra.

In addition, check your local rules and local practice to deter-

mine if there are other forms necessary to file at the outset of a case

in your jurisdiction.

Form 7 Debtors Certification in Support ofTemporary Waiver of Credit CounselingRequirement Based on ExigentCircumstances6

[Caption: Offcial Form 16A]

Debtors Certification in Support of Waiver of Credit

Counseling Requirement

I/We, [debtor(s)], the debtor(s) in the above-styled case, herebydeclare under penalty of perjury that:

5 This form contains the written notice required by section 527(b)to be provided, to the extent applicable, by a debt relief agency

to an assisted person. It must be provided in a single document

separate from other documents and notices provided to the

client. This form provides the notice copied verbatim from the

statute, even though it includes information that may be incor-

rect. Attorneys are permitted under section 527(a)(2) to alter the

language as long as the notice provided is one that is substan-

tially similar. If the notice is not provided at the time the client

signs an initial consultation agreement, see Form 4, Appx. G.2,

supra, and with a copy attached thereto, the attorney should

include the certificate of receipt and have the client sign it.

6 This form may not be necessary if the court grants a request for

deferral of the credit counseling requirement pursuant to section

109(h)(3)(A) based on the statement provided by the debtor on

Exhibit D to the petition, Official Form 1. See Appx. D, supra.

However, for courts that require the filing of a motion, this

certification may be attached as an exhibit in support of the

motion. Although section 109(h)(3)(A) refers to this certifica-

tion as relating to a waiver or exemption from the require-

ments of section 109(h)(1), the certification provides only a


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1. On [date], we filed a petition under chapter 13 of the

Bankruptcy Code.

2. Because a foreclosure sale of our home was scheduled for the

day after the filing of the petition, we were unable to delay the

filing of the petition [describe other exigent circumstances, if any].

3. Prior to the filing of the petition, we requested credit coun-

seling services from an approved agency, [agency], but were

unable to obtain the services during the five-day period following

the request.4. We intend to obtain a credit counseling briefing within thirty

days of the filing of the petition.

Date: [signature]

Debtor

Date: [signature]

Joint Debtor

Form 8 Motion for Exemption from CreditCounseling and Financial EducationRequirement Based on Incapacity,

Disability, or Active Military Duty


Motion to Exempt Debtor from Credit Counseling

and Financial Education Requirement

Debtor hereby requests that this Court, pursuant to 11 U.S.C.

109(h)(4), exempt her from the requirement under section

109(h)(1) that she receive budget and credit counseling, the re-

quirement under 11 U.S.C. 521(b) that she file a certificate from

an approved budget and credit counseling agency, and the require-

ment under 11 U.S.C. 727(a)(11) that she complete a course on

personal financial management. In support of this motion, the

debtor states as follows:

[Alternative ADisability]

1. The Debtor is a seventy-three-year-old disabled individual

who filed bankruptcy pursuant to chapter 7 of the Bankruptcy Code

on [date].

2. Due to a stroke suffered by the Debtor after filing bankruptcy,

the Debtor is currently hospitalized, unable to travel, and has

difficulty communicating. Upon release from the hospital, it is

expected that she will be transferred to a nursing home.

3. The Debtors physical problems prevent her from participat-

ing in an in-person, telephone, or Internet credit counseling ses-

sion, or a financial management course.

[Alternate BIncapacity]

1. The Debtor is an eighty-year-old disabled individual who

filed bankruptcy pursuant to chapter 7 of the Bankruptcy Code on

[date].

2. The Debtor suffers from advanced dementia, which has

caused her to have loss of memory and difficulty performing

complex tasks. This dementia renders the Debtor incapacitated

with respect to her financial responsibilities, which is the reason

why the petition in this matter was filed by her representative

pursuant to Bankruptcy Rule 1004.1.

3. The Debtors condition prevents her from participating in an

in-person, telephone, or Internet credit counseling session, or a

financial management course.

[Alternate CActive Military Duty]

1. The Debtor filed bankruptcy pursuant to chapter 7 of theBankruptcy Code on [date].

2. Shortly after filing the petition, the debtor was called to active

military duty and is currently serving in Iraq.

WHEREFORE, the Debtor requests that this motion be ap-

proved, and that the Debtor be exempted from the credit counseling

and financial education requirements pursuant to 11 U.S.C.

109(h)(4).

Date: [signature]

Attorney for Debtor

Form 9 Motion and Order for Extension of Timeto File Schedules and Other Required

Documents7

[Caption: Offcial Form 16A]8

Motion for Extension of Time to File Schedules

and Other Documents

The Debtor moves this Court as follows:

1. On April 6, 2006, the Debtor filed a voluntary petition in

bankruptcy which halted an execution sale of his real property.

2. The schedules, statement of financial affairs, payment ad-

vices, statement of current monthly income, and means test cal-

culation are due on April 21, 2006.

3. The Debtor will need an additional twenty (20) days to

prepare and gather these documents, because of the need to gatherall the necessary information from creditors.

WHEREFORE, the Debtor requests that this Court grant an

extension of twenty (20) days, until May 11, 2006, to prepare and

file his schedules, statement of affairs, payment advices, statement

deferral of the requirements as the debtor must still obtain

counseling within thirty days of the petition date. The court may,

for cause, extend this period by an additional fifteen days. See

7.3.5, supra.

7 This form may be used if the debtor can not file schedules,

statement of affairs, payment advices, statement of current

monthly income, and means test calculation within fifteen days

of the petition as required. The application is governed by

Federal Rules of Bankruptcy Procedure 1007(c) and 3015. Any

extension of time under those rules may be granted only on

motion for cause shown, and on notice to the trustee. Use of this

form should be adapted to reflect any cause for delay in the

particular case involved.

8 Official Form 16A is contained in Appendix D, supra. Whilethis motion and several other pleadings in this Appendix may

not be required to be served by the debtor on creditors pursuant

to explicit provisions of the Code or Bankruptcy Rules, local

rules may so require. Thus, in order to comply with 11 U.S.C.

342(c), it is advisable to use Official Form 16A, which

includes the debtors address and the last four digits of the

debtors Social Security Number. The legislative history of the

amendment notes, however, that bankruptcy courts may waive

the requirement in compelling circumstances such as the need of

a domestic violence victim to conceal her residence for safety

reasons. See 140 Cong. Rec. H10,764 (daily ed. Oct. 4, 1994)

(remarks of Rep. Brooks).


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of current monthly income, and means test calculation pursuant to

Rule 1007(c) of the Federal Rules of Bankruptcy Procedure.

Date: [signature]

Attorney for Debtor


Order Granting Additional Time to File Schedules and

Other Documents9

It is ORDERED that the Debtor herein shall have until May 11,

2006, to file schedules, statement of affairs, payment advices,

statement of current monthly income, and means test calculation.

Date: [signature]

United States Bankruptcy Judge

Form 10 Motion and Order for Extension ofTime to File Chapter 13 Schedules andOther Required Documents10


Motion for Extension of Time to File Chapter 13 Schedules

and Other Documents

The Debtor moves the Court as follows:

1. On April 6, 2006, the Debtor filed a voluntary petition in

bankruptcy which halted the execution sale of his real property.

2. The chapter 13 schedules, statement of affairs, payment

advices, statement of current monthly income and disposable

income calculation, and chapter 13 plan are due on April 21, 2006.

3. The Debtor will need an additional twenty (20) days to

prepare the statement and plan, because of the need to gather all the

necessary information from creditors.

4. The Debtor requests that this Court grant an extension of

twenty (20) days, until May 11, 2006, to prepare and file his

chapter 13 schedules, statement of affairs, payment advices, state-

ment of current monthly income and disposable income calcula-

tion, and chapter 13 plan, pursuant to Rules 1007(c) and 3015 of

the Federal Rules of Bankruptcy Procedure.

Date: [signature]

Attorney for Debtor


Order Granting Additional Time to File Chapter 13

Schedules and Other Documents

It is ORDERED that the Debtor herein shall have until May 11,

2006, to file his chapter 13 schedules, statement of affairs, payment

advices, statement of current monthly income and disposable

income calculation, and chapter 13 plan.

Date: [signature]


Form 11 Motion and Order for Additional Timeto File Chapter 13 Schedules, OtherDocuments and Information RequiredUnder 11 U.S.C. 521(a)(1)11


Motion for Additional Time to File Chapter 13 Schedules,

Other Documents and Information Required Under

11 U.S.C. 521(a)(1)

Debtor, [debtor], by his attorney, respectfully represents:

1. Debtor filed a voluntary petition under chapter 13 of the

Bankruptcy Code on April 6, 2006.

2. Debtors petition was prepared and filed in an expedited

manner to stop a pending foreclosure sale of the Debtors home

scheduled for April 7, 2006. The Debtor was therefore unable to

gather all the necessary documents for completing the chapter 13

schedules, statement of affairs, plan, and other information and

documents required under section 521(a)(1) when the petition was

filed.

3. Debtor filed a Motion for Extension of Time to File Chapter

13 Schedules, Statement of Affairs and Chapter 13 Plan, and an

extension of time was granted until May 11, 2006.

4. On April 23, 2006, Debtor was hospitalized following an auto-

mobile accident. Debtor is currently recovering from surgery and is not

expected to be released from the hospital until May 15, 2006.

5. During the next few weeks, Debtor will have little ability or

opportunity to take the steps necessary to complete the chapter 13

statement and plan on time.

6. It is requested that the Court grant the Debtor an additional

period of forty-five (45) days, pursuant to 11 U.S.C. 521(i)(3) and

Rules 1007(c) and 3015(b) of the Federal Rules of Bankruptcy

Procedure, so that the Debtor may assist counsel in submitting the

necessary forms and information.

9 Most courts require a proposed order, such as this form, to

accompany the Motion for Extension of Time to File Schedulesand Statement of Affairs. In the many jurisdictions where the

debtor does not serve copies of court orders, Official Form 16B

may be acceptable as a caption.

10 This form may be used if the debtor can not file a chapter 13

statement and chapter 13 plan within fifteen days of the petition

as required. This application is governed by Federal Rules of

Bankruptcy Procedure 1007(c) and 3015. Any extension of time

under these rules may be granted only on motion for cause

shown, and on notice to the trustee. Use of this form should be

adapted to reflect the cause of delay in the particular case

involved.

11 This form may be used to seek an additional forty-five-day

period to file the information required under section 521(a)(1).

An extension of time under section 521(i)(3) may be granted onmotion for cause shown, which must be filed within forty-five

days after the filing of the petition. The granting of this motion

will prevent the case from being automatically dismissed

under section 521(i)(1) if the information required by section

521(a)(1) is not filed within forty-five days of the petition. If the

motion seeks an extension of time to file documents in addition

to those required by section 521(a)(1), it is also governed by

Federal Rules of Bankruptcy Procedure 1007(c) and 3015(b).

Any extension of time under those rules may be granted only on

motion for cause shown, and on notice to the trustee. This form

may be adapted for use in chapter 7 cases as well.


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7. This motion is not made for the purposes of delay and no

creditor will suffer any prejudice if Debtor is granted an additional

extension of time.

WHEREFORE, Debtor requests that this Court grant him an

extension of time until July 5, 2006, in which to file his chapter 13

schedules, statement of affairs, payment advices, statement of

current monthly income and disposable income calculation, chap-

ter 13 plan, and all other information and forms required by 11

U.S.C. 521(a)(1).

Date: [signature]

Attorney for Debtor


Order Granting Additional Time to File Chapter 13

Schedules and Other Documents

AND NOW, this [date] day of [month], 2006, upon consider-

ation of Debtors Motion for Additional Time to File Chapter 13

Schedules, Other Documents and Information Required Under

Section 521(a)(1), it is hereby ORDERED and DECREED that

said Motion is GRANTED. Debtor shall have until July 5, 2006 to

file his chapter 13 schedules, statement of affairs, payment advices,statement of current monthly income and disposable income cal-

culation, chapter 13 plan, and all other information and forms

required by 11 U.S.C. 521(a)(1).

Date: [signature]


Form 12 Motion to Excuse Filing of Lost orUnavailable Payment Advices12


Motion to Excuse Complete Filing of Payment Advices

Debtor, by his counsel, hereby moves that he be excused from

filing all of the payment advices received from his employer within

sixty (60) days of the petition. In support of this motion, Debtor

states:

1. Debtor filed a voluntary petition under chapter 7 of the

Bankruptcy Code on [date].

2. At the time the petition was filed, Debtor was able to locate

pay stubs from his employer covering the period thirty (30) days

before the petition date. These pay stubs are attached as Exhibit A.

3. Despite the Debtors best efforts, he has been unable to find

all of his pay stubs for the entire sixty-day prepetition period. The

Debtor believes that the missing pay stubs have been lost or

destroyed.

4. The Debtor requested that his employer provide copies of themissing pay stubs, but the employer has refused to provide them.

5. The Debtor was employed by the same employer for the

entire sixty-day prepetition period. Included with the pay stubs

attached as Exhibit A is the last pay stub received by the debtor

before filing this bankruptcy. This pay stub is for the period ending

[date], and it includes a year-to-date total of all income received by

the Debtor prior to filing the petition.

6. This Court has authority pursuant to section 521(a)(1)(B) to

modify the filing requirements under that section.

WHEREFORE, the Debtor requests that he be permitted tocomplete this case without submitting all payment advices required

by 11 U.S.C. 521(a)(1)(B)(iv).

Date: [signature]

Attorney for Debtor

Form 13 Statement Regarding PaymentAdvices13


Debtors Statement Regarding Payment Advices Required

by 11 U.S.C. 521(A)(1)(B)(IV)

I, [debtor], state as follows:14

[Check box(es) and complete sections that apply].

I have not filed with the Court or submitted to the Trustee copies

of all payment advices or other evidence of payment received from

an employer within sixty (60) days before the date of the filing of

petition because:

[ ] I was not employed during the sixty (60) days before the

date of the filing of petition.

[ ] I was not employed during the following period before

filing my petition: [beginning date] to [ending date].

[ ] I was employed during the sixty-day period before filing my

petition but did not receive any payment advices or other

evidence of payment from my employer.[ ] I was employed during the sixty-day period before filing my

petition but received payment advices only for the pay

periods from [beginning date] to [ending date], which have

been filed with the Court or submitted to the Trustee.

[ ] I was self-employed during the sixty-day period before

filing my petition and did not receive any evidence of

payment from an employer.

[ ] Other reason [Please attach an explanation if more room is

needed]:

I declare under penalty of perjury that I have read the foregoing

statement and that it is true and correct.

Date: [signature]

Debtor

12 Section 521(a)(1)(B)(iv) requires the debtor to file with the

petition all payment advices or other evidence of payment

received by the debtor from an employer within sixty days

before filing the petition, unless the court orders otherwise. This

form may be used if the debtor is unable to produce all of the

payment advices received during this period. If the debtor has

not received payment advices from an employer during the

sixty-day period, the debtor should file a statement to that effect.

See Form 13, Appx. G.3, infra.

13 This statement should be submitted if the debtor has not re-

ceived payment advices from an employer during the sixty-day

period before the petition date, or has not received payment

advices for the full sixty-day period. If the debtor has received

payment advices but they are lost or otherwise unavailable, the

debtor should file a Motion to Excuse Complete Filing of

Payment Advices. See Form 12, Appx. G.3, supra.

14 A separate form, if applicable, must be submitted by each debtor

in a joint case.


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Form 14 Letter Advising Trustee of SpecialCircumstances15

Re: [name of debtor]

Bankr. No. [number]

Dear [name of United States trustee or bankruptcy administrator]:

Please be advised that I represent [debtor]. According to the

calculations required by the Statement of Current Monthly Incomeand Means Test Calculation, the debtor checked the box on page 1

of the form indicating that a presumption of abuse arises in this

matter. To rebut this presumption, I am writing to provide you with

information supporting the debtors claim of special circumstances

that justify additional expenses and/or adjustments of current

monthly income, and/or to provide documentation for expense

items that should be deducted from my clients current monthly

income pursuant to section 707(b)(2)(A)(ii)(I).

Adjustments of Current Monthly Income

On Line 12 of Official Form 22A, the debtor stated that his

current monthly income is $[insert amount], based on the definition

provided in section 101(10A) of the Code. However, this amount

includes income that the debtor did not actually have at the time his

petition was filed, and which the debtor does not currently have. I

am enclosing the Debtors Statement of Special Circumstances

which demonstrates that the debtors actual monthly income is

$[amount]. I am also enclosing copies of my clients recent pay-

ment advices showing his actual income.

Additional Expenses

On Line [number] of Official Form 22A, the debtor listed an

expense amount of $[amount] based on the Internal Revenue

Service National or Local Standard for [expense item(s)]. I am

enclosing the Debtors Statement of Special Circumstances which

demonstrates that the debtors actual monthly expense for this item

is $[amount], and that this expense is necessary and reasonable. Iam also enclosing documentation for this expense.

In Part VII of Official Form 22A, the debtor listed the following

additional expenses: [describe expense(s)]. The debtor listed these

items which total to a monthly expense amount of $[amount],

though this amount was not deducted from his current monthly

income for purposes of determining the section 707(b)(2) presump-

tion. I am enclosing the Debtors Statement of Special Circum-

stances which demonstrates that these monthly expenses are re-

quired for the health and welfare of the debtor and the debtors

family or for the production of the debtors income. I am also

enclosing documentation for these expense items.

If the additional expenses or adjustments to income referred to

above are considered in applying the means test, a presumption of

abuse no longer arises in this case. Accordingly, my client requeststhat in lieu of filing a motion to dismiss or convert this chapter 7

case under section 707(b), you file a statement with the court, for

the reasons set forth above, that such a motion is not appropriate.

If you are in need of any additional information or documentation,

please contact me.

Date: [signature]

Attorney for Debtor

Form 15 Debtors Statement of SpecialCircumstances to Rebut Presumption ofAbuse Under 11 U.S.C. 707(b)(2)16


1. Debtors Statement of Special Circumstances

I, [debtor], the debtor in the above-styled case, hereby declare

under penalty of perjury that the following is true and correct:17

1. On [date], I filed a petition under chapter 7 of the Bankruptcy

Code, and indicated on the Statement of Current Monthly Income

and Means Test Calculation that my current monthly income is

$3250.

2. This amount was determined by taking the monthly average

of all income I had received during the six-month period ending on

the last day of the month before my bankruptcy filing.

3. For the first three months of this six-month period, I had

worked at the local General Motors plant as an assembler earning

approximately $30 per hour with overtime. In the fourth month,

General Motors unexpectedly closed the local plant and I was laid

off from my job. For the remaining three months of the six-month

period, I received only $1500 per month as severance pay.

4. Given the current market for manufacturing jobs in the

Baltimore area and the fact there are no longer any local auto

industry jobs after the General Motors plant closing, I was fortu-

nate to find my current job. However, I am now earning only $1800

per month, and my new job requires a much longer commute.

5. The Statement of Current Monthly Income and Means Test

Calculation that I filed therefore incorrectly suggests that I have an

extra $1450 per month that I am not actually receiving.

6. I also listed on the Statement of Current Monthly Income andMeans Test Calculation, based on the IRS Transportation Stan-

dards, Operating Costs and Public Transportation Costs, an amount

of $240 per month for my vehicle operation expense.

7. My new job requires me to travel an additional 120 miles

every workday, for a total of 150 miles per workday. With the

current cost of gas averaging $2.60 per gallon, I am spending

approximately $500 per month on gas alone.

15 This letter may be submitted to the trustee, United States trustee

or bankruptcy administrator by debtors counsel in an attempt to

convince them not to file a motion to dismiss under section

707(b). In some cases, a statement from the debtor may also be

submitted. See Form 15, Appx. G.3, infra.

16 To rebut a presumption of abuse arising under the means test,

section 707(b)(2)(B)(i) states that the debtor must demonstrate

that special circumstances exist that justify additional ex-

penses or adjustments of current monthly income for which

there is no reasonable alternative. To establish special circum-

stances, the debtor must itemize each additional expense or

adjustment of income and provide, accompanied by an oath asto the accuracy of any information provided, (1) documentation

for such expense or adjustment to income; and (2) a detailed

explanation of the special circumstances that make such ex-

penses or adjustment to income necessary and reasonable. This

form may be submitted to the trustee or United States trustee by

debtors counsel in an attempt to convince them not to file a

motion to dismiss under section 707(b), or it may be attached to

a response filed by the debtor if a motion to dismiss is filed.

17 The oath requirement under section 707(b)(2)(B)(iii) applies

only when the statement is used in a court proceeding, and need

not be included if used informally before a proceeding.


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8. Once again, the Statement of Current Monthly Income and

Means Test Calculation incorrectly shows that I have at least $260

in extra available income per month to pay unsecured creditors

when that amount is actually being paid for my transportation to

work.

Date: [signature]

Debtor

Form 16 Motion to Keep Prior NameConfidential18


Debtor, by her counsel, hereby moves that she be excused,

pursuant to 11 U.S.C. 107(c), from disclosing on her bankruptcy

petition a former name used within the past six years. In support of

her motion she avers:

1. Debtors former husband, with whom she lived in a different

state, was extremely abusive toward her.

2. The abuse included [ for example, a gun to her head and

threatening to kill her, and resulted in back injuries, lacerationsand bruises.]

3. The debtor obtained court orders for protection from abuse,

but the abuse nonetheless continued.

4. Eventually, the debtor obtained, in [date] a court order

changing her name to [current name] and she moved to her current

address.

5. None of the debtors debts were incurred using her former

name.

6. Debtors former husband builds computers and is a computer

hacker, and debtor is afraid that if her former name appears in any

computer database, her life and the life of her child will be in

danger.

7. No entity will be prejudiced by the failure of the debtor to

disclose her former name.WHEREFORE, the debtor prays that she be permitted to file this

case without disclosing her former name.

Date: [signature]

Attorney for Debtor

Form 17 Application and Order for Waiver ofMiscellaneous Fees


Application for Waiver of Miscellaneous Administrative Fee19

1. The debtors filed a voluntary chapter [number] bankruptcypetition contemporaneously with this application.

2. The debtors believe they are entitled to relief under chapter

[number] .

3. The debtors are indigent and are unable to pay the miscella-

neous administrative fee or give security therefor.

4. The debtors income consists of $[amount].

5. The debtors have [number] children dependent upon them for

support.

6. The debtors basic monthly expenses exceed their income.

7. The debtors do not have any stocks, bonds, bank accounts, orother liquid assets from which they can pay the miscellaneous

administrative fee.

8. The debtors own no real estate other than their residence, in

which they have no equity and which is subject to foreclosure.

9. The debtors do not own an automobile or any item of

household furnishings worth more than $200.

10. There are no family or friends who could provide funds to

the debtors for payment of the miscellaneous administrative fee.

11. The debtors rights under Title 11 will be prejudiced if the

debtors petition and schedules are not accepted for filing or if their

bankruptcy is dismissed for failure to pay the miscellaneous ad-

ministrative fee.

WHEREFORE, the debtors request that this Court waive pay-

ment of the miscellaneous administrative fee and permit them to

proceed with their bankruptcy without payment of the fee or

security therefor.

[signature]

Attorney for Debtors

VERIFICATION

I, [debtor], verify under penalty of perjury that the foregoing is

true and correct.

[signature]

Debtor

Executed on: [date]

[Caption: Offcial Form 16B]

Order to Waive Miscellaneous Administrative Fee

AND NOW, this [date] day of [month], [year], upon consider-

ation of the debtors application to waive the miscellaneous ad-

ministrative fee for the filing of their bankruptcy petition, it is

hereby ordered that the fee is waived and the debtors are permitted

to proceed with their bankruptcy without payment of the miscel-

laneous administrative fee.

Date: [signature]


18 Official Form 1, Voluntary Petition, requires the debtor to list all

names used by the debtor in the eight years prior to filing.

Section 107(c) permits the court to protect an individual from

disclosure of information that would create an undue risk of

unlawful injury. This form may be used when the debtor has a

substantial need to keep these names confidential, such as for

safety reasons relating to domestic violence.

19 A debtor whose income is below 150 percent of the poverty line

may seek a complete chapter 7 filing fee waiver under 28 U.S.C.

1930(f), and to do so should file an Application on Official

Form 3B. See Appx. D, supra; 13.6, supra. The form provided

here may be used if the debtor is not eligible for a chapter 7 fee

waiver to obtain a waiver of the $39 miscellaneous administra-

tive fee normally payable upon the filing of a chapter 7 or

chapter 13 case. The form can be modified to also seek waiver

of the $15 trustee surcharge applicable in chapter 7 cases. These

fee waivers should be available pursuant to 28 U.S.C. 1915.

See 13.6, supra. Different courts may also have varying

requirements regarding the specificity of the statement of the

debtors financial situation.


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Form 18 Debtors Chapter 13 Plan20


Debtors Chapter 13 Plan

1. If the instant estate were liquidated under chapter 7 of the

Bankruptcy Code, the allowed unsecured claimants would be paid

$0.00.21

2. Under this plan the allowed unsecured claimants will receive

not less than that amount.

3. The Debtors22 shall submit to the supervision and control of

the trustee the following sums:23

a. During the first year of the plan:24 $120 monthly;

b. During the second, third, fourth and fifth years of the plan:

$190 monthly.25

4. The various claims of the Debtors creditors shall be classified

as follows:26

a. Class one: Claims filed and allowed which are entitled to

priority under 11 U.S.C. 507.27 The administrative expenses

and the domestic support obligation owed to [governmental

unit] are the only priority claims contemplated by this plan.

The assigned domestic support obligation owed to [govern-mental unit] shall be paid the amount of $[amount] pursuant to

11 U.S.C. 1322(a)(4), which is less than the priority unse-

cured claim amount.28 This provision allowing for partial

payment of said claim will not result in a discharge of the

remaining balance of the claim or any interest accruing on the

claim during the plan. Any creditor entitled to priority under

section 507 of the Bankruptcy Code contrary to the provisions

of this plan shall be deemed to have agreed to waive any such

priority, unless such entity objects to the plan.29

b. Class two: All allowed secured claims secured by a lien which

is not avoidable by the Debtors under 11 U.S.C. 522, except

for the first mortgage held by [creditor] and any allowed

secured claim of the City of [city].30 These creditors will retain

their liens only until either the full underlying debt is paid or

20 This chapter 13 plan is a far cry from the simplicity of former

Official Form 13-6, devised for use under the old Chapter XIII.

Some of the provisions of this plan are controversial and may

not be accepted by all courts. See generally Chapter 12, supra,

for a discussion of issues arising in chapter 13 cases.

Many districts now require a form plan by local rule or

administrative order. When that is the case, provisions from this

plan can be incorporated into the required form or a supple-

mental document containing provisions from this plan may be

attached. Advocates should not allow their clients substantive

rights to be limited by a restrictive required format.

This plan is written so that most of its provisions can be used

without change in most chapter 13 cases. Cases which are out of

the ordinary may require a radically different approach. For

example, a plan may be largely funded out of the sale of specified

property of the debtor by the trustee or debtor, as provided in the

plan. 11 U.S.C. 1322(b)(8); see Form 22, Appx. G.3, infra. It

may also provide for an order that the debtors employer submit

a portion of the debtors wages to the court. Some courts may

require that such an order be part of the plan in most cases.

In some districts the debtor is required to furnish a copy of the

plan to be mailed to each creditor. Bankruptcy courts in some

districts also require a form summarizing the plan provisions to

be filed with every case. Counsel should check local rules andpractice regarding whether such a form is required. The chapter

13 plan must be filed with the petition or within fifteen days

thereafter, unless the time is extended for cause shown. See

Forms 10, 11, Appx. G.3, supra.

21 These paragraphs, while probably not absolutely necessary, give

the court the basic information necessary to decide whether the

best interests of creditors test is met. See 12.3.2, supra.

22 The plan may provide for the debtors employer, or some other

entity, to submit payments instead of the debtor.

23 The plan must provide for the submission to the trustee of such

portion of the debtors income as is necessary for the execution

of the plan. Probably, this means that at least some part of the

debtors income must be submitted. See In re Terry, 630 F.2d

634 (8th Cir. 1980).

24 There is no requirement that the same amount be submittedthroughout the plan. Section 1325(a)(5)(B)(iii) provides that if

property is to be distributed in periodic payments to secured

creditors under that section, the payments must be in equal

monthly amounts. This provision refers to the distributions to the

holder of an allowed secured claim and not to the debtors plan

payments. As long as the plan provides that the trustees distri-

butions to the holder of the allowed secured claim be made in

equal monthly amounts, the debtors plan payments need not be.

See 11.6.1.3.3.2, supra. The plan may anticipate increased

income (if it does not happen, the plan can always be modified).

However, the good faith or feasibility of a plan providing for a

large balloon payment at the end may well be questioned unless

there is a basis for expecting such a payment is likely to be

fulfilled.

25 Payments may be made at such intervals as the debtor chooses.

Payments must begin, however, within thirty days after the

petition is filed, unless the court orders otherwise. 11 U.S.C.

1326(a); see 8.3.12.1, 8.3.12.3, supra. Creditors, however,

will be paid by the trustee according to the trustees own

schedule. Many trustees make distributions only quarterly, ex-

cept that they may disburse ongoing mortgage paymentsmonthly if so provided under the plan or required by local rule.

26 See 12.4, supra, for discussion of permissible classifications

in a chapter 13 plan.

27 All priority claims must be paid in full under the plan. 11 U.S.C.

1322(a)(2). However, no interest need be provided unless

necessary under the standards of 11 U.S.C. 1325(a)(4) or

1325(a)(5). This class will normally include the trustees fees

and expenses of nine to ten percent of the amounts paid through

the trustee, as well as the fee of the debtors attorney, if that fee

is to be paid through the plan. Local practice may require the

amount of this fee to be specified in the plan.

28 The only exception to the general rule that priority claims must

be paid in full is contained in section 1322(a)(4), which provides

that support owed to the government need not be paid in full if

the debtor proposes a five-year plan committing all the debtorsdisposable income and the debtor can not pay the support

obligation in full. See 12.3.6.1, supra.

29 It is not totally clear that this sentence is permissible. A priority

creditor must be paid in full unless it agrees to different treat-

ment. See 12.3.6.1, supra. Silence may or may not constitute

such an agreement, even with this provision in the plan.

30 This class is basically that of creditors whose claims remain

secured despite the debtors avoiding powers. Normally the

debtor will want to pay these debts, because the liens thereon

will otherwise remain after the bankruptcy. However, a chapter

13 plan need not provide for every secured claim.


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the debtor receives a discharge,31 and they shall be deemed to

have accepted this plan unless they object to the plan.32

c. Class three: The allowed secured claim held by Mortgage

Co., which shall be cured pursuant to paragraph 6 below.

d. Class four: All other claims against the debtors that are

timely filed except for the first mortgage held by [creditor]

and any allowed secured claim of the City of [city].33

e. Class five: The allowed secured claims of the City of [city].34

5. The payments received by the trustee from the Debtorspursuant to this plan shall be distributed as follows:35

a. Class one claims: The amount paid by the Debtors to the

trustee shall be distributed first to the class one administrative

claims, pro rata, until they are paid in full. Any other priority

claimants shall be paid only after the class two and class four

claims are paid in full.

b. Class two and class three claims: After the application of the

appropriate amount each month to the class one administra-

tive claims, the entire amount of the monthly payment

remaining in the hands of the trustee shall be distributed in

equal monthly payments, pro rata, to the holders of the class

two claims until each such claimant shall have received

100% of the amount allowed on each claim, plus interest at

an annual interest rate of [number] percent,36 and to the

payment of arrears on the class three claim until such arrears

are paid in full.37

c. Class four claims: After the application of the appropriate

amount each month to the class one, class two and class three

claims, the entire amount of the monthly payment remaining

in the hands of the trustee shall be distributed, pro rata, to the

holders of the class four claims.38

d. Class five claims: The class five claims are not being paid

under this plan, and there shall be no distribution to the

holders of such claims.39

6. The ongoing postpetition payments on the Debtors home

mortgage will be paid by the Debtors directly40 to [creditor or

mortgage servicer] beginning with the payment due on [ first due

date under note for the month following the month in which petition

filed].41 The payments received by [creditor or mortgage servicer]

from the Debtors for ongoing postpetition payments shall beapplied and credited to the Debtors mortgage account as if the

account were current and no prepetition default existed on the

petition date and, if made timely under the terms of the note, shall

be applied and credited without penalty to the months in which the

payments are received and in the order of priority specified in the

payment application provision contained in the note and mortgage.

The [creditor or mortgage servicer] shall comply with all appli-

cable provisions of the Real Estate Settlement Procedures Act

(RESPA) and the Truth in Lending Act (TILA) during the pen-

dency of this plan, and shall make, upon notice to the Debtors,

Debtors counsel, and the trustee, appropriate adjustments to the

ongoing monthly mortgage payment amount to reflect escrow

account, adjustable mortgage interest rate, and other changes

required by the note and mortgage. If there is a deficiency or

31 See 11.6.1.3, supra.

32 There is substantial case law that a creditor who does not object

to the plan has accepted the plan. See 11.6.1.2.1, supra.

Language putting a creditor on notice of this fact would bolster

the argument that this is correct.

33 This class consists of general unsecured claims, which need bepaid only in an amount based on the debtors disposable income

and not less than the amount of the debtors nonexempt prop-

erty, an amount which may be minimal. However, some courts

have held minimal payment plans not to be in good faith. See

12.3, supra. This class may be further subdivided into small

and large claims if the debtor decides to do so in order to quickly

pay off small claims first.

34 This paragraph creates a separate class for a secured claim

which is provided for by the plan.

35 This distribution scheme pays priority claims