Fill in this information to identify your case and this filing:
Debtor 1
__________________________________________________________________
First Name
Middle Name
Last Name
Debtor 2
________________________________________________________________
(Spouse, if filing)
First Name
Middle Name
Last Name
United States Bankruptcy Court for the:
__________ District of ___________
Case number
___________________________________________
q
Check if this is an
amended filing
Official Form 106A/B
Schedule A/B: Property
12/15
In each category, separately list and describe items. List an asset only
once. If an asset fits in more than one category, list the asset in the
category where you think it fits best. Be as complete and accurate as
possible. If two married people are filing together, both are equally
responsible for supplying correct information. If more space is needed,
attach a separate sheet to this form. On the top of any additional pages,
write your name and case number (if known). Answer every question.
Part 1: Describe Each Residence, Building,
Land, or Other Real Estate You Own or Have an Interest In
1.
Do you own or have any legal or equitable interest in any residence,
building, land, or similar property?
q No. Go to Part 2.
q Yes. Where is the property?
What is the property? Check all that apply.
Do not deduct secured claims or exemptions. Put
q Single-family
home
the amount of any secured claims on
Schedule D:
1.1.
_________________________________________
Creditors Who Have Claims Secured by Property.
q Duplex or
multi-unit building
Street address, if available, or other description
q
Condominium or cooperative
Current value of the
Current value of the
q Manufactured or
mobile home
entire property?
portion you own?
_________________________________________
q Land
$________________
$_______________
q Investment
property
_________________________________________
Describe the nature of your ownership
q Timeshare
City
State
ZIP Code
interest (such as fee simple, tenancy by
Other __________________________________
q
the entireties, or a life estate), if known.
Who has an interest in the property? Check one.
__________________________________________
Debtor 1 only
_________________________________________
County
Debtor 2 only
q Check if this is community property
Debtor 1 and Debtor 2 only
(see instructions)
At least one of the debtors and another
Other information you wish to add about this item, such as local
property identification number: _______________________________
If you own or have more than one, list here:
What is the property? Check all that apply.
Do not deduct secured claims or exemptions. Put
q Single-family
home
the amount of any secured claims on
Schedule D:
1.2.
________________________________________
Creditors Who Have Claims Secured by Property.
q Duplex or
multi-unit building
Street address, if available, or other description
q
Condominium or cooperative
Current value of the
Current value of the
q Manufactured or
mobile home
entire property?
portion you own?
________________________________________
q Land
$________________
$_________________
q Investment
property
________________________________________
Describe the nature of your ownership
q Timeshare
City
State
ZIP Code
interest (such as fee simple, tenancy by
Other __________________________________
q
the entireties, or a life estate), if known.
Who has an interest in the property? Check one.
__________________________________________
Debtor 1 only
________________________________________
Debtor 2 only
County
Debtor 1 and Debtor 2 only
q Check if this is community property
At least one of the debtors and another
(see instructions)
Other information you wish to add about this item, such as local
property identification number: _______________________________
Official Form 106A/B
Schedule A/B: Property
page 1
Debtor 1
_______________________________________________________
Case number (if
known)_____________________________________
First Name
Middle Name
Last Name
What is the property? Check all that apply.
Do not deduct secured claims or exemptions. Put
the amount of any secured claims on
Schedule D:
q Single-family
home
1.3.
________________________________________
Creditors Who Have Claims Secured by Property.
Street address, if available, or other description
q Duplex or
multi-unit building
Current value of the Current value of the
q Condominium or
cooperative
entire property?
portion you own?
________________________________________
q Manufactured or
mobile home
$________________
$_________________
q Land
q Investment
property
________________________________________
Describe the nature of your ownership
City
State
ZIP Code
q Timeshare
interest (such as fee simple, tenancy by
q Other
__________________________________
the entireties, or a life estate), if known.
__________________________________________
Who has an interest in the property? Check one.
________________________________________
Debtor 1 only
County
Debtor 2 only
Debtor 1 and Debtor 2 only
q Check if this is community property
(see instructions)
At least one of the debtors and another
Other information you wish to add about this item, such as local
property identification number: _______________________________
2. Add the dollar value of the portion you own
for all of your entries from Part 1, including any entries for pages
$_________________
you have attached for Part 1. Write that number here
č
Part 2:
Describe Your Vehicles
Do you own, lease, or have legal or equitable interest in any vehicles,
whether they are registered or not?
Include any vehicles
you own that someone else drives. If you lease a vehicle, also report it on
Schedule G: Executory Contracts and Unexpired Leases.
3. Cars, vans, trucks, tractors, sport
utility vehicles, motorcycles
q No
q Yes
Who has an interest in the property? Check one.
Do not deduct secured claims or exemptions. Put
3.1. Make:
______________
the amount of any secured claims on
Schedule D:
Debtor 1 only
Model:
______________
Creditors Who Have Claims Secured by Property.
Debtor 2 only
Year:
____________
Current value of the
Current value of the
q btor 1 and Debtor 2 only
entire property?
portion you own?
Approximate mileage:
____________
At least one of the debtors and another
Other information:
$________________
$________________
q Check if this is community property
(see
instructions)
If you own or have more than one, describe here:
Who has an interest in the property? Check one.
Do not deduct secured claims or exemptions. Put
3.2. Make:
______________
the amount of any secured claims on
Schedule D:
Debtor 1 only
Model:
______________
Creditors Who Have Claims Secured by Property.
q btor 2 only
Year:
____________
Current value of the
Current value of the
q btor 1 and Debtor 2 only
entire property?
portion you own?
Approximate mileage:
____________
At least one of the debtors and another
Other information:
$________________
$________________
q Check if this is community property
(see
instructions)
Official Form 106A/B
Schedule A/B: Property
page 2
Debtor 1
_______________________________________________________
Case number (if
known)_____________________________________
First Name
Middle Name
Last Name
Who has an interest in the property? Check one.
Do not deduct secured claims or exemptions. Put
3.3. Make:
______________
the amount of any secured claims on
Schedule D:
Debtor 1 only
Model:
______________
Creditors Who Have Claims Secured by Property.
Debtor 2 only
Year:
____________
Current value of the
Current value of the
q btor 1 and Debtor 2 only
entire property?
portion you own?
Approximate mileage:
____________
At least one of the debtors and another
Other information:
$________________
$________________
q Check if this is community property
(see
instructions)
Who has an interest in the property? Check one.
Do not deduct secured claims or exemptions. Put
3.4. Make:
______________
the amount of any secured claims on
Schedule D:
Debtor 1 only
Model:
______________
Creditors Who Have Claims Secured by Property.
q btor 2 only
Year:
____________
Current value of the
Current value of the
q btor 1 and Debtor 2 only
entire property?
portion you own?
Approximate mileage:
____________
At least one of the debtors and another
Other information:
$________________
$________________
q Check if this is community property
(see
instructions)
4.
Watercraft, aircraft, motor homes, ATVs and other recreational vehicles,
other vehicles, and accessories
Examples: Boats, trailers, motors, personal
watercraft, fishing vessels, snowmobiles, motorcycle accessories
q No
q Yes
Who has an interest in the property? Check one.
Do not deduct secured claims or exemptions. Put
4.1. Make:
____________________
the amount of any secured claims on
Schedule D:
Debtor 1 only
Model:
____________________
Creditors Who Have Claims Secured by Property.
Debtor 2 only
Year:
____________
Debtor 1 and Debtor 2 only
Current value of the
Current value of the
Other information:
At least one of the debtors and another
entire property?
portion you own?
q Check if this is community property
(see
$________________
$________________
instructions)
If you own or have more than one, list here:
Who has an interest in the property? Check one.
4.2. Make:
____________________
Do not deduct secured claims or exemptions. Put
the amount of any secured claims on
Schedule D:
Debtor 1 only
Model:
____________________
Creditors Who Have Claims Secured by Property.
Debtor 2 only
Year:
____________
Current value of the
Current value of the
Debtor 1 and Debtor 2 only
entire property?
portion you own?
Other information:
At least one of the debtors and another
$________________
$________________
q Check if this is community property
(see
instructions)
5. Add the dollar value of the portion you
own for all of your entries from Part 2, including any entries for pages
$_________________
you have attached for Part 2. Write that number here
č
Official Form 106A/B
Schedule A/B: Property
page 3
Debtor 1
_______________________________________________________
Case number (if
known)_____________________________________
First Name
Middle Name
Last Name
Part 3: Describe Your Personal and Household
Items
Current value of the
Do you own or have any legal or equitable interest in any of the following
items?
portion you own?
Do not deduct secured claims
or exemptions.
6. Household goods and furnishings
Examples: Major appliances, furniture, linens,
china, kitchenware
q No
q Yes. Describe
$___________________
7. Electronics
Examples: Televisions and radios; audio, video,
stereo, and digital equipment; computers, printers, scanners; music
collections; electronic devices including cell phones, cameras, media
players, games
q No
q Yes. Describe
$___________________
8. Collectibles of value
Examples: Antiques and figurines; paintings,
prints, or other artwork; books, pictures, or other art objects;
stamp, coin, or baseball card collections; other collections, memorabilia,
collectibles
q No
q Yes. Describe
$___________________
9. Equipment for sports and hobbies
Examples: Sports, photographic, exercise, and
other hobby equipment; bicycles, pool tables, golf clubs, skis; canoes
and kayaks; carpentry tools; musical instruments
q No
q Yes. Describe
$___________________
10. Firearms
Examples: Pistols, rifles, shotguns,
ammunition, and related equipment
q No
q Yes. Describe
$___________________
11. Clothes
Examples: Everyday clothes, furs, leather
coats, designer wear, shoes, accessories
q No
q Yes. Describe
$___________________
12. Jewelry
Examples: Everyday jewelry, costume jewelry, engagement rings, wedding
rings, heirloom jewelry, watches, gems,
gold, silver
q No
q Yes. Describe
$___________________
13. Non-farm animals
Examples: Dogs, cats, birds, horses
q No
q Yes. Describe
$___________________
14. Any other personal and household items you
did not already list, including any health aids you did not list
q No
q Yes.
Give specific
$___________________
information
15. Add the dollar value of all of your entries
from Part 3, including any entries for pages you have attached
$______________________
for Part 3. Write that number here
č
Official Form 106A/B
Schedule A/B: Property
page 4
Debtor 1
_______________________________________________________
Case number (if
known)_____________________________________
First Name
Middle Name
Last Name
Part 4: Describe Your Financial Assets
Do you own or have any legal or equitable interest in any of the following?
Current value of the
portion you own?
Do not deduct secured claims
or exemptions.
16. Cash
Examples: Money you have in your wallet, in
your home, in a safe deposit box, and on hand when you file your petition
q No
q Yes
Cash:
$__________________
17. Deposits of money
Examples: Checking, savings, or other financial
accounts; certificates of deposit; shares in credit unions, brokerage
houses,
and other similar institutions. If you have multiple accounts with the same
institution, list each.
q No
q Yes
Institution name:
17.1. Checking account:
_________________________________________________________
$__________________
17.2. Checking account:
_________________________________________________________
$__________________
17.3. Savings account:
_________________________________________________________
$__________________
17.4. Savings account:
_________________________________________________________
$__________________
17.5. Certificates of deposit:
_________________________________________________________
$__________________
17.6. Other financial account:
_________________________________________________________
$__________________
17.7. Other financial account:
_________________________________________________________
$__________________
17.8. Other financial account:
_________________________________________________________
$__________________
17.9. Other financial account:
_________________________________________________________
$__________________
18. Bonds, mutual funds, or publicly traded
stocks
Examples: Bond funds, investment accounts with
brokerage firms, money market accounts
q No
q Yes
Institution or issuer name:
_________________________________________________________________________________________
$__________________
_________________________________________________________________________________________
$__________________
_________________________________________________________________________________________
$__________________
19. Non-publicly traded stock and interests in
incorporated and unincorporated businesses, including an interest in
an LLC, partnership, and joint venture
q No
Name of entity:
% of ownership:
Yes. Give specific
_____________________________________________________________________
___________%
$__________________
information about
them
_____________________________________________________________________
___________%
$__________________
_____________________________________________________________________
___________%
$__________________
Official Form 106A/B
Schedule A/B: Property
page 5
Debtor 1
_______________________________________________________
Case number (if
known)_____________________________________
First Name
Middle Name
Last Name
20. Government and corporate bonds and other
negotiable and non-negotiable instruments
Negotiable instruments include personal checks,
cashiers’ checks, promissory notes, and money orders.
Non-negotiable instruments are those you cannot
transfer to someone by signing or delivering them.
q No
Yes. Give specific
Issuer name:
information about
______________________________________________________________________________________
$__________________
them
______________________________________________________________________________________
$__________________
______________________________________________________________________________________
$__________________
21. Retirement or pension accounts
Examples: Interests in IRA, ERISA, Keogh,
401(k), 403(b), thrift savings accounts, or other pension or profit-sharing
plans
q No
q Yes. List each
account separately.
Type of account:
Institution name:
401(k) or similar plan:
___________________________________________________________________
$__________________
Pension plan:
___________________________________________________________________
$__________________
IRA:
___________________________________________________________________
$__________________
Retirement account:
___________________________________________________________________
$__________________
Keogh:
___________________________________________________________________
$__________________
Additional account:
___________________________________________________________________
$__________________
Additional account:
___________________________________________________________________
$__________________
22. Security deposits and prepayments
Your share of all unused deposits you have made so that you may continue
service or use from a company
Examples: Agreements with landlords, prepaid
rent, public utilities (electric, gas, water), telecommunications
companies, or others
q No
q Yes
Institution name or individual:
Electric:
______________________________________________________________________
$___________________
Gas:
______________________________________________________________________
$___________________
Heating oil:
______________________________________________________________________
$___________________
Security deposit on rental unit:
_____________________________________________________________
$___________________
Prepaid rent:
______________________________________________________________________
$___________________
Telephone:
______________________________________________________________________
$___________________
Water:
______________________________________________________________________
$___________________
Rented furniture:
______________________________________________________________________
$___________________
Other:
______________________________________________________________________
$___________________
23. Annuities (A
contract for a periodic payment of money to you, either for life or for a
number of years)
q No
q Yes
Issuer name and description:
_______________________________________________________________________________________
$__________________
_______________________________________________________________________________________
$__________________
_______________________________________________________________________________________
$__________________
Official Form 106A/B
Schedule A/B: Property
page 6
Debtor 1
_______________________________________________________
Case number (if
known)_____________________________________
First Name
Middle Name
Last Name
24. Interests in an education IRA,
in an account in a qualified ABLE program,
or under a qualified state tuition program.
26 U.S.C. §§ 530(b)(1), 529A(b), and 529(b)(1).
q No
q Yes
Institution name and description. Separately file the records of any
interests.11 U.S.C. § 521(c):
____________________________________________________________________________________
$_________________
____________________________________________________________________________________
$_________________
____________________________________________________________________________________
$_________________
25. Trusts, equitable or future interests in
property (other than anything listed in line 1), and rights or powers
exercisable for your benefit
q No
q Yes.
Give specific
information about them
$__________________
26. Patents, copyrights, trademarks, trade
secrets, and other intellectual property
Examples: Internet domain names, websites,
proceeds from royalties and licensing agreements
q No
q Yes. Give
specific
information about them
$__________________
27. Licenses, franchises, and other general
intangibles
Examples: Building permits, exclusive licenses,
cooperative association holdings, liquor licenses, professional licenses
q No
q Yes. Give
specific
information about them
$__________________
Money or property owed to you?
Current value of the
portion you own?
Do not deduct secured
claims or exemptions.
28. Tax refunds owed to you
q No
q Yes.
Give specific information
Federal:
$_________________
about them, including whether
you already filed the returns
State:
$_________________
and the tax years
Local:
$_________________
29. Family support
Examples: Past due or lump sum alimony, spousal
support, child support, maintenance, divorce settlement, property settlement
q No
q Yes. Give
specific information
Alimony:
$________________
Maintenance:
$________________
Support:
$________________
Divorce settlement:
$________________
Property settlement:
$________________
30. Other amounts someone owes you
Examples: Unpaid wages, disability insurance
payments, disability benefits, sick pay, vacation pay, workers’
compensation,
Social Security benefits; unpaid loans you made to someone else
q No
q Yes. Give
specific information
$______________________
Official Form 106A/B
Schedule A/B: Property
page 7
Debtor 1
_______________________________________________________
Case number (if
known)_____________________________________
First Name
Middle Name
Last Name
31. Interests in insurance policies
Examples: Health,
disability, or
life insurance; health savings account (HSA); credit, homeowner’s, or
renter’s insurance
q No
q Yes. Name the
insurance company
Company name:
Beneficiary:
Surrender or refund value:
of each policy and list its value
___________________________________________
____________________________
$__________________
___________________________________________
____________________________
$__________________
___________________________________________
____________________________
$__________________
32. Any interest in property that is due you
from someone who has died
If you are the beneficiary of a living trust, expect proceeds from a life
insurance policy, or are currently entitled to receive
property because someone has died.
q No
q Yes. Give
specific information
$_____________________
33. Claims against third parties, whether or
not you have filed a lawsuit or made a demand for payment
Examples: Accidents, employment disputes,
insurance claims, or rights to sue
q No
q Yes. Describe
each claim
$______________________
34. Other contingent and unliquidated claims of
every nature, including counterclaims of the debtor and rights
to set off claims
q No
q Yes. Describe
each claim
$_____________________
35. Any financial assets you did not already
list
q No
q Yes.
Give specific information
$_____________________
36. Add the dollar value of all of your entries
from Part 4, including any entries for pages you have attached
for Part 4. Write that number here
č
$_____________________
Part 5:
Describe Any Business-Related Property You Own or Have an Interest In. List
any real estate in Part 1.
37. Do you own or have any legal or equitable
interest in any business-related property?
q No. Go to Part
6.
q Yes. Go to line
38.
Current value of the
portion you own?
Do not deduct secured claims
or exemptions.
38. Accounts receivable or commissions you
already earned
q No
q Yes.
Describe
$_____________________
39. Office equipment, furnishings, and supplies
Examples: Business-related computers, software,
modems, printers, copiers, fax machines, rugs, telephones, desks, chairs,
electronic devices
q No
q Yes. Describe
$_____________________
Official Form 106A/B
Schedule A/B: Property
page 8
Debtor 1
_______________________________________________________
Case number (if
known)_____________________________________
First Name
Middle Name
Last Name
40. Machinery, fixtures, equipment, supplies
you use in business, and tools of your trade
q No
q Yes. Describe
$_____________________
41. Inventory
q No
q Yes. Describe
$_____________________
42. Interests in partnerships or joint ventures
q No
q Yes. Describe
Name of entity:
% of ownership:
______________________________________________________________________
________%
$_____________________
______________________________________________________________________
________%
$_____________________
______________________________________________________________________
________%
$_____________________
43. Customer lists, mailing lists, or other
compilations
q No
q Yes.
Do your lists include personally identifiable information
(as defined in 11 U.S.C. § 101(41A))?
q No
q Yes. Describe
$____________________
44. Any business-related property you did not
already list
q No
q Yes.
Give specific
______________________________________________________________________________________
$____________________
information
______________________________________________________________________________________
$____________________
______________________________________________________________________________________
$____________________
______________________________________________________________________________________
$____________________
______________________________________________________________________________________
$____________________
______________________________________________________________________________________
$____________________
45. Add the dollar value of all of your entries
from Part 5, including any entries for pages you have attached
$____________________
for Part 5. Write that number here
č
Part 6:
Describe Any Farm- and Commercial Fishing-Related Property You Own or Have
an Interest In.
If you own or have an interest in farmland, list it in Part 1.
46. Do you own or have any legal or equitable
interest in any farm- or commercial fishing-related property?
q No. Go to Part
7.
q Yes. Go to line
47.
Current value of the
portion you own?
Do not deduct secured claims
or exemptions.
47. Farm animals
Examples: Livestock, poultry, farm-raised fish
q No
q Yes
$___________________
Official Form 106A/B
Schedule A/B: Property
page 9
Debtor 1
_______________________________________________________
Case number (if
known)_____________________________________
First Name
Middle Name
Last Name
48. Crops—either growing or harvested
q No
q Yes. Give
specific
information
$___________________
49. Farm and fishing equipment, implements,
machinery, fixtures, and tools of trade
q No
q Yes
$___________________
50. Farm and fishing supplies, chemicals, and
feed
q No
q Yes
$___________________
51. Any farm- and commercial fishing-related
property you did not already list
q No
q Yes.
Give specific
information
$___________________
52. Add the dollar value of all of your entries
from Part 6, including any entries for pages you have attached
$___________________
for Part 6. Write that number here
č
Part 7:
Describe All Property You Own or Have an Interest in That You Did Not List
Above
53. Do you have other property of any kind you
did not already list?
Examples: Season tickets, country club
membership
q No
$________________
q Yes.
Give specific
information
$________________
$________________
54. Add the dollar value of all of your entries
from Part 7. Write that number here
č
$________________
Part 8:
List the Totals of Each Part of this Form
55. Part 1: Total real estate, line 2
č
$________________
56. Part 2: Total vehicles, line 5
$________________
57. Part 3: Total personal and household items,
line 15
$________________
58. Part 4: Total financial assets, line 36
$________________
59. Part 5: Total business-related property,
line 45
$________________
60. Part 6: Total farm- and fishing-related
property, line 52
$________________
61. Part 7: Total other property not listed,
line 54
+
$________________
62. Total personal property.
Add lines 56 through 61
$________________
Copy personal property total č
+ $_________________
63. Total of all property on Schedule A/B.
Add line 55 + line 62
$_________________
Official Form 106A/B
Schedule A/B: Property
page 10
