This form contains 16 fields organized into 9 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name	Type	Description
Case Information
Bankruptcy Court District	Combobox	Enter the name of the United States Bankruptcy Court district where the case is filed. Northern District of Mississippi District of Minnesota Eastern District of Oklahoma Eastern District of Pennsylvania Western District of Tennessee Northern District of New York Northern District of Iowa Middle District of Georgia District of Columbia District of New Hampshire Southern District of California Western District of Pennsylvania Eastern District of California Northern District of Alabama Eastern District of Louisiana Eastern District of Kentucky Northern District of Texas Eastern District of Tennessee Western District of Kentucky Southern District of Alabama Central District of Illinois Western District of Louisiana District of South Carolina Middle District of Tennessee District of Delaware Northern District of Florida Western District of Texas Middle District of Florida Southern District of Georgia District of Nebraska Middle District of North Carolina Western District of Missouri Central District of California District of Guam District of Oregon Southern District of New York Western District of Washington Eastern District of New York Western District of New York Southern District of Texas District of Montana District of Rhode Island District of Maryland District of Colorado District of Vermont Eastern District of Missouri Western District of North Carolina District of Nevada Middle District of Alabama Southern District of Florida Middle District of Pennsylvania Western District of Oklahoma District of Kansas Eastern District of Virginia Southern District of Illinois Western District of Michigan District of Idaho District of Wyoming District of New Jersey District of Virgin Islands Middle District of Louisiana District of Maine Western District of Virginia Southern District of West Virginia District of Massachusetts District of Hawaii District of South Dakota Eastern District of Wisconsin Northern District of Illinois District of Northern Mariana Islands Northern District of Oklahoma Southern District of Mississippi District of Alaska Northern District of Ohio District of Connecticut Eastern District of North Carolina Eastern District of Michigan District of Utah Eastern and Western District of Arkansas Eastern District of Washington District of North Dakota Northern District of West Virginia District of New Mexico Eastern District of Texas Northern District of Indiana Western District of Wisconsin Southern District of Iowa Northern District of California Southern District of Indiana Northern District of Georgia District of Arizona Southern District of Ohio __________ District of __________ District of Puerto Rico
Case Number
Case Number	Text	Enter the case number if it is known.
Debtor 1 Name
Debtor 1 Full Name	Text	Enter the full legal name of Debtor 1, including first, middle, and last names.
Debtor 2 Name
Debtor 2 First Name	Text	Enter the first name of Debtor 2.
Filing Status
Amended Filing	Checkbox	Check this box if this filing is an amendment to a previous filing.
General
Opens Print Menu	Button
Allows you to give the file a new name when saving	Button
Attach a file	Button
Resets the entire form	Button
Non-Attorney Assistance Information
No	Checkbox	Check this box if you did not pay or agree to pay someone who is NOT an attorney to help you fill out bankruptcy forms.
Yes	Checkbox	Check this box if you did pay or agree to pay someone who is NOT an attorney to help you fill out bankruptcy forms.
Non-Attorney Assistant Name	Text	Provide the name of the person who is not an attorney and assisted in filling out the bankruptcy forms. Fill only if 'Yes' is 'Yes'. Depends on: Yes
Signature of Debtor 1
Signature of Debtor 1	Text	Provide the signature of Debtor 1.
Date of Signature by Debtor 1	Date	Enter the date Debtor 1 provided their signature.
Signature of Debtor 2
Debtor 2 Signature	Text	Enter the signature of the second debtor. Fill only if 'Debtor 2 First Name' is filled. Depends on: Debtor 2 First Name
Debtor 2 Signature Date	Date	Provide the date the second debtor signed the form. Fill only if 'Debtor 2 First Name' is filled. Depends on: Debtor 2 First Name

Official Form 106Dec, Declaration About an Individual Debtor's Schedules Instructions