Official Form 106D, Schedule D: Creditors Who Have Claims Secured by Property Instructions
This form contains 196 fields organized into 18 sections. Below is a complete list of every field, its type, and what information is expected.
| Field Name | Type | Description |
|---|---|---|
| Amended Filing Checkbox | ||
| Amended Filing | Checkbox |
Check this box if the current filing is an amended version.
|
| Case Identification | ||
| Debtor 1 Name | Text |
Enter the full name of Debtor 1, including first, middle, and last name.
|
| Debtor 2 Name (Spouse, if filing) | Text |
Enter the full name of Debtor 2 (Spouse, if filing), including first, middle, and last name.
|
| Case number | Text |
Enter the case number if known.
|
| Creditor Claims Inquiry | ||
| No Claims Secured by Property | Checkbox |
Check this box if no creditors have claims secured by your property and you are submitting this form without further details.
|
| Yes Claims Secured by Property | Checkbox |
Check this box if creditors have claims secured by your property and you need to fill in additional information below.
|
| Fifth Party to be Notified | ||
| be notified for any debts in Part 1, do not fill out or submit this page | Text | |
| Fifth Party Name | Text |
Enter the full name of the fifth party to be notified. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Fifth Party Creditor Line | Text |
Provide the line number in Part 1 where the creditor for the fifth party was entered. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Fifth Party Account Number Last 4 Digits | Text |
Enter the last four digits of the account number associated with the fifth party. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Fifth Party Street Number | Text |
Enter the street number for the fifth party's address. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Fifth Party Street Name | Text |
Enter the street name for the fifth party's address. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Fifth Party City | Text |
Enter the city for the fifth party's address. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Fifth Party State | Text |
Enter the state for the fifth party's address. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Fifth Party ZIP Code | Text |
Enter the ZIP code for the fifth party's address. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| First Creditor Claim | ||
| First Creditor Claim Entry Number | Text |
Enter the sequential entry number for this first creditor claim, as instructed in the additional page notes. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| First Creditor Claim General Description | Text |
Provide a general description or type for this first creditor claim. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| First Creditor Claim Amount | Number |
Enter the total amount of this first creditor claim. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| First Creditor Claim Collateral Value | Number |
Enter the value of the collateral that supports this first creditor claim. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| First Creditor Claim Unsecured Portion | Number |
Enter the unsecured portion of this first creditor claim, if any. Fill only if 'First Creditor Claim Amount', 'First Creditor Claim Collateral Value' Amount of claim is greater than Value of collateral.
Depends on:
First Creditor Claim Amount, First Creditor Claim Collateral Value
|
| First Creditor Name | Text |
Enter the full name of the first creditor. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| First Creditor Claim Secured Property Description | Text |
Provide a detailed description of the property that secures this first creditor claim. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| First Creditor Street Address | Text |
Enter the street number and name for the first creditor's address. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| First Creditor City | Text |
Enter the city for the first creditor's address. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| First Creditor State | Text |
Enter the state for the first creditor's address. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| First Creditor ZIP Code | Text |
Enter the ZIP code for the first creditor's address. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| First Claim - Contingent | Checkbox |
This box should be checked if the first creditor claim is contingent, meaning it depends on a future event that may or may not happen. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| First Claim - Unliquidated | Checkbox |
This box should be checked if the exact amount of the first creditor claim has not yet been determined or calculated. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| First Claim - Disputed | Checkbox |
This box should be checked if the validity or amount of the first creditor claim is being challenged by one or more parties. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| First Claim - Debtor 1 only owes debt | Checkbox |
This box should be checked if only Debtor 1 is responsible for this first creditor claim. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| First Claim - Lien by agreement | Checkbox |
This box should be checked if the lien for this first creditor claim is based on an agreement made, such as a mortgage or a secured car loan. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| First Claim - Debtor 2 only owes debt | Checkbox |
This box should be checked if only Debtor 2 is responsible for this first creditor claim. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| First Claim - Debtor 1 and Debtor 2 only owe debt | Checkbox |
This box should be checked if both Debtor 1 and Debtor 2 are solely responsible for this first creditor claim. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| First Claim - Statutory lien | Checkbox |
This box should be checked if the lien for this first creditor claim is established by law, such as a tax lien or a mechanic's lien. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| First Claim - At least one debtor and another owe debt | Checkbox |
This box should be checked if at least one of the listed debtors and an additional party are responsible for this first creditor claim. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| First Claim - Judgment lien | Checkbox |
This box should be checked if the lien for this first creditor claim resulted from a court judgment due to a lawsuit. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| First Claim - Relates to community debt | Checkbox |
This box should be checked if this first creditor claim is related to a community debt. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| First Claim - Other lien | Checkbox |
This box should be checked if the nature of the lien for this first creditor claim is not covered by the other categories, including a right to offset. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| First Creditor Claim Other Lien Description | Text |
Describe the nature of the lien if it falls under the 'Other' category. Fill only if 'First Claim - Other lien' is 'Yes'.
Depends on:
First Claim - Other lien
|
| First Creditor Claim Date Incurred | Date |
Enter the date when this first creditor debt was incurred. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| First Creditor Claim Last 4 Digits of Account Number | Text |
Enter the last four digits of the account number for this first creditor claim. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| First Party to be Notified | ||
| First Party's Entry Number | Text |
Provide the sequential entry number for this first party being notified. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| First Party Name | Text |
Enter the full name of the first party to be notified. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Creditor Entry Line in Part 1 | Text |
Enter the line number from Part 1 where the original creditor was entered. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Last 4 Digits of Account Number | Text |
Enter the last 4 digits of the account number associated with the debt. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| First Party Street Address Line 1 | Text |
Enter the street number and street name for the first party's address. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| First Party Street Address Line 2 | Text |
Enter any additional street address information, such as an apartment or suite number, for the first party's address. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| First Party City | Text |
Enter the city for the first party's address. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| First Party State | Text |
Enter the state for the first party's address. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| First Party ZIP Code | Text |
Enter the ZIP code for the first party's address. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| First Secured Claim | ||
| First Secured Claim Number | Text |
Enter the sequential number for this secured claim. Fill only if 'Yes Claims Secured by Property' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| First Secured Claim Amount | Number |
Enter the total amount of the claim. Fill only if 'Yes Claims Secured by Property' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| First Secured Claim Collateral Value | Number |
Enter the value of the collateral that supports this claim. Fill only if 'Yes Claims Secured by Property' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| First Secured Claim Unsecured Portion | Number |
Enter the unsecured portion of this claim, if any. Fill only if 'Yes Claims Secured by Property' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| First Secured Claim Creditor's Name | Text |
Provide the full name of the creditor for this secured claim. Fill only if 'Yes Claims Secured by Property' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| First Secured Claim Property Description | Text |
Describe the property that secures this specific claim. Fill only if 'Yes Claims Secured by Property' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| First Secured Claim Street Address | Text |
Provide the street number and name for the creditor's address. Fill only if 'Yes Claims Secured by Property' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| First Secured Claim Contingent | Checkbox |
Check this box if the first secured claim is contingent as of the date you file. Fill only if 'Yes Claims Secured by Property' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| First Secured Claim City | Text |
Enter the city for the creditor's address. Fill only if 'Yes Claims Secured by Property' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| First Secured Claim State | Text |
Enter the state for the creditor's address. Fill only if 'Yes Claims Secured by Property' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| First Secured Claim ZIP Code | Text |
Enter the ZIP code for the creditor's address.
|
| First Secured Claim Unliquidated | Checkbox |
Check this box if the first secured claim is unliquidated as of the date you file. Fill only if 'Yes Claims Secured by Property' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| First Secured Claim Disputed | Checkbox |
Check this box if the first secured claim is disputed as of the date you file. Fill only if 'Yes Claims Secured by Property' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| First Secured Claim Debtor 1 Only | Checkbox |
Check this box if only Debtor 1 owes the first secured debt. Fill only if 'Yes Claims Secured by Property' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| First Secured Claim Lien Agreement | Checkbox |
Check this box if the nature of the lien for the first secured claim is an agreement you made (such as a mortgage or secured car loan). Fill only if 'Yes Claims Secured by Property' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| First Secured Claim Debtor 2 Only | Checkbox |
Check this box if only Debtor 2 owes the first secured debt. Fill only if 'Yes Claims Secured by Property' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| First Secured Claim Debtor 1 and Debtor 2 Only | Checkbox |
Check this box if both Debtor 1 and Debtor 2 jointly owe the first secured debt. Fill only if 'Yes Claims Secured by Property' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| First Secured Claim Statutory Lien | Checkbox |
Check this box if the nature of the lien for the first secured claim is a statutory lien (such as a tax lien or mechanic's lien). Fill only if 'Yes Claims Secured by Property' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| First Secured Claim At Least One Debtor and Another | Checkbox |
Check this box if at least one of the debtors and another party owe the first secured debt. Fill only if 'Yes Claims Secured by Property' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| First Secured Claim Judgment Lien | Checkbox |
Check this box if the nature of the lien for the first secured claim is a judgment lien from a lawsuit. Fill only if 'Yes Claims Secured by Property' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| First Secured Claim Community Debt | Checkbox |
Check this box if the first secured claim relates to a community debt. Fill only if 'Yes Claims Secured by Property' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| First Secured Claim Other Lien | Checkbox |
Check this box if the nature of the lien for the first secured claim is other (including a right to offset). Fill only if 'Yes Claims Secured by Property' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| First Secured Claim Other Lien Description | Text |
Describe any other nature of lien that applies to this claim. Fill only if 'Yes Claims Secured by Property', 'First Secured Claim Other Lien' is 'Yes', all.
Depends on:
Yes Claims Secured by Property, First Secured Claim Other Lien
|
| First Secured Claim Date Incurred | Date |
Enter the date when this debt was incurred. Fill only if 'Yes Claims Secured by Property' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| First Secured Claim Last 4 Digits of Account Number | Text |
Provide the last four digits of the account number associated with this claim. Fill only if 'Yes Claims Secured by Property' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Fourth Party to be Notified | ||
| be notified for any debts in Part 1, do not fill out or submit this page | Text | |
| Fourth Party Name | Text |
Enter the full name of the fourth party to be notified. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Fourth Party Creditor Line | Text |
Enter the line number from Part 1 where the creditor for this fourth party was originally listed. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Fourth Party Street Address | Text |
Enter the street number and street name of the fourth party's address. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Fourth Party City | Text |
Enter the city of the fourth party's address. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Fourth Party State | Text |
Enter the state of the fourth party's address. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Fourth Party ZIP Code | Text |
Enter the ZIP code of the fourth party's address. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Fourth Party Account Last 4 Digits | Text |
Enter the last 4 digits of the account number associated with this fourth party. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| General | ||
| US Bankruptcy Court | Combobox |
Provide the name of the United States Bankruptcy Court.
Southern District of Florida
Central District of California
Western District of New York
Southern District of Texas
Western District of Pennsylvania
Eastern District of Tennessee
Eastern District of North Carolina
Southern District of New York
District of Maine
Southern District of California
Southern District of Indiana
Eastern District of Kentucky
District of North Dakota
Northern District of West Virginia
Northern District of Florida
District of New Jersey
District of Idaho
District of Virgin Islands
Southern District of Iowa
Southern District of Illinois
Middle District of Pennsylvania
Middle District of Georgia
Eastern District of Texas
District of Columbia
Northern District of Ohio
Northern District of California
Southern District of Alabama
__________ District of __________
District of New Mexico
Central District of Illinois
Western District of Louisiana
Western District of Tennessee
Northern District of Mississippi
Western District of Texas
District of Nevada
District of Maryland
Southern District of Mississippi
Northern District of Iowa
Eastern District of Oklahoma
District of Vermont
Southern District of Ohio
Northern District of Oklahoma
Northern District of Alabama
Northern District of New York
Eastern District of Washington
District of Delaware
District of South Carolina
Western District of Michigan
District of Puerto Rico
Western District of Washington
District of Alaska
Northern District of Illinois
Eastern District of Pennsylvania
Eastern District of Wisconsin
Eastern District of California
District of Kansas
Middle District of Louisiana
District of Hawaii
District of Oregon
District of Minnesota
Middle District of Alabama
Eastern and Western District of Arkansas
Northern District of Georgia
Middle District of Tennessee
Eastern District of Missouri
Eastern District of New York
Southern District of Georgia
District of Guam
Northern District of Indiana
Western District of North Carolina
Middle District of Florida
District of Connecticut
Middle District of North Carolina
District of Rhode Island
District of Nebraska
District of New Hampshire
Western District of Oklahoma
District of South Dakota
District of Northern Mariana Islands
District of Arizona
District of Massachusetts
District of Montana
District of Wyoming
Western District of Kentucky
District of Utah
Northern District of Texas
Western District of Missouri
Eastern District of Louisiana
Western District of Virginia
Southern District of West Virginia
Western District of Wisconsin
Eastern District of Virginia
Eastern District of Michigan
District of Colorado
|
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| Resets the entire form | Button | |
| Page Number | ||
| Page Number | Text |
Enter the current page number. Fill only if 'Yes Claims Secured by Property' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Current Page Number | Text |
Enter the current page number of the form.
|
| Total Number of Pages | Text |
Enter the total number of pages in the form.
|
| undefined | Text | |
| undefined | Text | |
| Second Creditor Claim | ||
| Second Creditor's Name | Text |
Enter the full name of the second creditor. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Second Claim Secured Property Description | Text |
Describe the property that secures this second claim. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Second Claim Amount | Number |
Enter the total amount of the second claim. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Second Claim Collateral Value | Number |
Enter the value of the collateral that supports this second claim. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Second Claim Unsecured Portion | Number |
Enter the unsecured portion of the second claim, if any. Fill only if 'Second Claim Amount', 'Second Claim Collateral Value' Amount of claim is greater than Value of collateral.
Depends on:
Second Claim Amount, Second Claim Collateral Value
|
| Second Creditor's Street Number | Text |
Enter the street number of the second creditor's address. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Second Claim Secured Property Description (Cont.) | Text |
Continue describing the property that secures this second claim. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Second Creditor's Street Name | Text |
Enter the street name of the second creditor's address. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Second Creditor's City | Text |
Enter the city of the second creditor's address. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Second Creditor's State | Text |
Enter the state of the second creditor's address. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Second Creditor's ZIP Code | Text |
Enter the ZIP code of the second creditor's address. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Second Creditor Claim Contingent | Checkbox |
Check this box if the second creditor's claim is contingent as of the date you file. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Second Creditor Claim Unliquidated | Checkbox |
Check this box if the second creditor's claim is unliquidated as of the date you file. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Second Creditor Claim Disputed | Checkbox |
Check this box if the second creditor's claim is disputed as of the date you file. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Second Creditor Claim Debtor 1 only | Checkbox |
Check this box if only Debtor 1 owes the second creditor's debt. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Second Creditor Claim Lien - Agreement Made | Checkbox |
Check this box if the second creditor's claim is secured by an agreement you made, such as a mortgage or secured car loan. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Second Creditor Claim Lien - Statutory | Checkbox |
Check this box if the second creditor's claim is secured by a statutory lien, such as a tax lien or mechanic's lien. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Second Creditor Claim Lien - Judgment | Checkbox |
Check this box if the second creditor's claim is secured by a judgment lien from a lawsuit. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Second Creditor Claim Relates to Community Debt | Checkbox |
Check this box if the second creditor's claim relates to a community debt. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Second Creditor Claim Lien - Other | Checkbox |
Check this box if the second creditor's claim is secured by an other type of lien, including a right to offset. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Second Claim Other Lien Description | Text |
If 'Other' is selected for the nature of the lien, provide a description here. Fill only if 'Second Creditor Claim Lien - Other' is 'Yes'.
Depends on:
Second Creditor Claim Lien - Other
|
| Second Claim Date Debt Incurred | Date |
Enter the date when this second debt was incurred. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Second Claim Last 4 Digits of Account Number | Text |
Enter the last four digits of the account number associated with this second claim. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Second Party to be Notified | ||
| Second Party Sequence Number | Text |
Enter the sequence number for this second party to be notified entry. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Second Party Name | Text |
Enter the full name of the second party to be notified. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Second Party Creditor Line in Part 1 | Text |
Enter the line number from Part 1 where the associated creditor was listed. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Second Party Account Number Last 4 Digits | Text |
Enter the last four digits of the account number associated with the debt for this second party. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Second Party Street Name | Text |
Enter the street name for the second party's address. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Second Party Street Number | Text |
Enter the street number for the second party's address. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Second Party City | Text |
Enter the city for the second party's address. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Second Party State | Text |
Enter the state for the second party's address. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Second Party ZIP Code | Text |
Enter the ZIP code for the second party's address. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Second Secured Claim | ||
| First Secured Claim Creditor's Name | Text |
Enter the full name of the creditor for the first secured claim. Fill only if 'Yes Claims Secured by Property' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| First Secured Claim Amount of Claim | Number |
Provide the dollar amount of the first secured claim. Fill only if 'Yes Claims Secured by Property' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| First Secured Claim Value of Collateral | Number |
Provide the dollar value of the collateral that secures the first claim. Fill only if 'Yes Claims Secured by Property' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| First Secured Claim Unsecured Portion | Number |
Provide the dollar amount of the unsecured portion of the first claim, if any. Fill only if 'Yes Claims Secured by Property' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Second Secured Claim Creditor's Name | Text |
Enter the full name of the creditor for the second secured claim. Fill only if 'Yes Claims Secured by Property' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Second Secured Claim Property Description | Text |
Describe the property that secures the second secured claim. Fill only if 'Yes Claims Secured by Property' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Second Secured Claim Street Number | Text |
Enter the street number of the creditor's address for the second secured claim. Fill only if 'Yes Claims Secured by Property' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Contingent | CheckBox |
Depends on:
Yes Claims Secured by Property
|
| Second Secured Claim City | Text |
Enter the city of the creditor's address for the second secured claim. Fill only if 'Yes Claims Secured by Property' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Second Secured Claim State | Text |
Enter the two-letter state abbreviation of the creditor's address for the second secured claim. Fill only if 'Yes Claims Secured by Property' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Second Secured Claim ZIP Code | Text |
Enter the ZIP code of the creditor's address for the second secured claim.
|
| Unliquidated | CheckBox |
Depends on:
Yes Claims Secured by Property
|
| Disputed | CheckBox |
Depends on:
Yes Claims Secured by Property
|
| check 3_debtor#201 | CheckBox |
Depends on:
Yes Claims Secured by Property
|
| An agreement you made (such as mortgage or secured | CheckBox |
Depends on:
Yes Claims Secured by Property
|
| check 3_debtor#202 | CheckBox |
Depends on:
Yes Claims Secured by Property
|
| check 3_debtor#201#20and#202 | CheckBox |
Depends on:
Yes Claims Secured by Property
|
| Statutory lien (such as tax lien, mechanic’s lien | CheckBox |
Depends on:
Yes Claims Secured by Property
|
| check 3_One#20of#20debtors#20and#20another | CheckBox |
Depends on:
Yes Claims Secured by Property
|
| Judgment lien from a lawsuit | CheckBox |
Depends on:
Yes Claims Secured by Property
|
| Check if this claim relates to a | CheckBox |
Depends on:
Yes Claims Secured by Property
|
| Other (including a right to offset | CheckBox |
Depends on:
Yes Claims Secured by Property
|
| Second Secured Claim Other Nature of Lien | Text |
Specify any other nature of the lien for the second secured claim not listed above, including a right to offset. Fill only if 'Yes Claims Secured by Property', 'Other (including a right to offset' is 'Yes', all.
Depends on:
Yes Claims Secured by Property, Other (including a right to offset
|
| Second Secured Claim Date Debt Incurred | Date |
Enter the date when the debt for the second secured claim was incurred. Fill only if 'Yes Claims Secured by Property' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Second Secured Claim Last 4 Digits Account Number | Text |
Enter the last four digits of the account number for the second secured claim. Fill only if 'Yes Claims Secured by Property' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Sixth Party to be Notified | ||
| be notified for any debts in Part 1, do not fill out or submit this page | Text | |
| Sixth Party Name | Text |
Enter the full name of the sixth party to be notified. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Sixth Party Creditor Line Number | Text |
Enter the line number from Part 1 where the creditor for the sixth party was listed. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Sixth Party Account Last 4 Digits | Text |
Enter the last four digits of the account number associated with the sixth party. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Sixth Party Street Number and Name | Text |
Enter the street number and name for the sixth party's address. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Sixth Party Street Address Line 2 | Text |
Enter any additional street address details, such as an apartment or suite number, for the sixth party. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Sixth Party City | Text |
Enter the city for the sixth party's address. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Sixth Party State | Text |
Enter the state for the sixth party's address. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Sixth Party ZIP Code | Text |
Enter the ZIP code for the sixth party's address. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Third Creditor Claim | ||
| Third Creditor Name | Text |
Enter the full name of the third creditor for this claim. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Third Claim Amount | Number |
Enter the total amount of the third creditor's claim. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Third Collateral Value | Number |
Enter the value of the collateral that supports this third creditor's claim. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Third Unsecured Portion | Number |
Enter the unsecured portion of the third creditor's claim, if any. Fill only if 'Third Claim Amount', 'Third Collateral Value' Amount of claim is greater than Value of collateral.
Depends on:
Third Claim Amount, Third Collateral Value
|
| Third Creditor Street Address | Text |
Enter the street address for the third creditor. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Third Claim Secured Property Description | Text |
Provide a description of the property that secures the third creditor's claim. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Third Creditor Address Number | Text |
Enter the street number for the third creditor's address. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Third Creditor City | Text |
Enter the city for the third creditor's address. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Third Creditor State | Text |
Enter the state for the third creditor's address. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Third Creditor ZIP Code | Text |
Enter the ZIP code for the third creditor's address. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Third Claim is Contingent | Checkbox |
Check this box if the third creditor claim is contingent, meaning it depends on a future event that may or may not happen. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Third Claim is Unliquidated | Checkbox |
Check this box if the third creditor claim is unliquidated, meaning the exact amount of the claim has not been determined. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Third Claim is Disputed | Checkbox |
Check this box if the third creditor claim is disputed by the debtor. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Third Claim Debt Owed by Debtor 1 Only | Checkbox |
Check this box if the third creditor claim debt is owed only by Debtor 1. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Third Claim Lien - Agreement (Mortgage/Secured Loan) | Checkbox |
Check this box if the nature of the lien for the third creditor claim is based on an agreement, such as a mortgage or secured car loan. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Third Claim Debt Owed by Debtor 2 Only | Checkbox |
Check this box if the third creditor claim debt is owed only by Debtor 2. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Third Claim Debt Owed by Debtor 1 and Debtor 2 Only | Checkbox |
Check this box if the third creditor claim debt is owed only by both Debtor 1 and Debtor 2. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Third Claim Lien - Statutory (Tax/Mechanic's Lien) | Checkbox |
Check this box if the nature of the lien for the third creditor claim is a statutory lien, such as a tax lien or mechanic's lien. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Third Claim Debt Owed by At Least One Debtor and Another | Checkbox |
Check this box if the third creditor claim debt is owed by at least one of the debtors and another party. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Third Claim Lien - Judgment from Lawsuit | Checkbox |
Check this box if the nature of the lien for the third creditor claim is a judgment lien resulting from a lawsuit. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Third Claim Relates to Community Debt | Checkbox |
Check this box if the third creditor claim relates to a community debt. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Third Claim Lien - Other (Right to Offset) | Checkbox |
Check this box if the nature of the lien for the third creditor claim is other than the options listed, including a right to offset. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Third Claim Other Nature of Lien | Text |
If the nature of the lien is not listed, describe it here. Fill only if 'Third Claim Lien - Other (Right to Offset)' is 'Yes'.
Depends on:
Third Claim Lien - Other (Right to Offset)
|
| Third Claim Date Debt Incurred | Date |
Enter the date when the third creditor's debt was incurred. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Third Claim Last 4 Digits of Account Number | Text |
Enter the last four digits of the account number for the third creditor's claim. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Third Party to be Notified | ||
| be notified for any debts in Part 1, do not fill out or submit this page | Text | |
| Third Party's Name | Text |
Provide the full name of the third party to be notified. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Third Party's Creditor Line Number in Part 1 | Text |
Enter the line number from Part 1 where the creditor was listed. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Third Party's Last 4 Digits of Account Number | Text |
Provide the last four digits of the account number associated with the debt. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Third Party's Street Number and Name | Text |
Enter the street number and name of the third party's address. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Third Party's Street Address Line 2 | Text |
Provide additional street address information for the third party, such as apartment, suite, or unit number. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Third Party's City | Text |
Enter the city of the third party's address. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Third Party's State | Text |
Enter the state of the third party's address. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Third Party's ZIP Code | Text |
Enter the ZIP code of the third party's address. Fill only if 'Do any creditors have claims secured by your property?' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|
| Total Claim Values | ||
| undefined | Text | |
| undefined | Text |
Depends on:
Current Page Number, Total Number of Pages
|
| Total Column A Value | ||
| Total Column A Value | Number |
Enter the total dollar value of all entries made in Column A on this page. Fill only if 'Yes Claims Secured by Property' is 'Yes'.
Depends on:
Yes Claims Secured by Property
|