This form contains 12 fields organized into 6 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Case Information
Debtor Name Text
Enter the full name of the debtor.
Max length: 49 characters
Court Location Text
Provide the location or specific division of the United States Bankruptcy Court.
Max length: 19 characters
Court District State Text
Enter the state where the United States Bankruptcy Court district is located.
Max length: 6 characters
Case Number Text
Enter the case number if it is known.
Max length: 17 characters
Filing Status
Amended Filing Checkbox
Check this box if this is an amended filing.
Secured Claims Amount
Secured Claims Total Amount Number
Enter the total dollar amount of claims secured by property, copied from Column A, Amount of claim, from line 3 of Schedule D.
Max length: 12 characters
Summary of Assets
1a Real Property Value Number
Enter the value of real property copied from line 88 of Schedule A/B.
Max length: 12 characters
1b Total Personal Property Value Number
Enter the total value of personal property copied from line 91A of Schedule A/B.
Max length: 12 characters
1c Total All Property Value Number
Enter the total value of all property copied from line 92 of Schedule A/B.
Max length: 12 characters
Total Liabilities
Total Liabilities Amount Number
Provide the calculated total liabilities from lines 2, 3a, and 3b. Fill only if 'Secured Claims Total Amount', 'Priority Unsecured Claims Amount', 'Nonpriority Unsecured Claims Amount' is the sum of fields 9, 10, and 11.
Max length: 12 characters
Depends on: Secured Claims Total Amount, Priority Unsecured Claims Amount, Nonpriority Unsecured Claims Amount
Unsecured Claims Amount
Priority Unsecured Claims Amount Number
Enter the total amount of priority unsecured claims, copied from Part 1 line 5a of Schedule E/F.
Max length: 12 characters
Nonpriority Unsecured Claims Amount Number
Enter the total amount of nonpriority unsecured claims, copied from Part 2 line 5b of Schedule E/F.
Max length: 12 characters