Professional Documents
Culture Documents
Frazier Claiborne BK Schedule
Frazier Claiborne BK Schedule
Document Page 1 of 52
Form 6-Summary (10/06)
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SUMMARY OF SCHEDULES
Indicate as to eac h schedule whe ther that schedule is attached and state the numbe r of pa ges in each. Report the totals from Schedules A,
B, D, E, F, I, a nd J in the boxes provided. Add the amounts from Schedules A a nd B to determine the total amount of the debtor’s a ssets.
Add the amounts of all claims from Schedules D, E, and F to determine the tota l amount of the debtor’s lia bilitie s. Individual debtors must
also c omplete the "Statistical Summary of Certain Liabilities and Related Data " if they file a c ase under c ha pter 7, 11, or 13.
H - Codebtors Yes 1
Copyright (c) 1996-2007 - Best Case Solutions - Evanston, IL - (800) 492-8037 Best Case Bankruptcy
Case 08-03051-ee Doc 19 Filed 10/28/08 Entered 10/28/08 20:51:16 Desc Main
Document Page 2 of 52
Official Form 6 - Statistical Summary (10/06)
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STATISTICAL SUMMARY OF CERTAIN LIABILITIES AND RELATED DATA (28 U.S.C. § 159)
If you are an individual debtor whose debts are primarily consumer debts, as defined in § 101(8) of the Bankruptcy Code (11 U.S.C.§ 101(8)), filing
a case under chapter 7, 11 or 13, you must report all information requested below.
Check this box if you are an individual debtor whose debts are NOT primarily consumer debts. You are not required to
report any information here.
TOTAL
Copyright (c) 1996-2007 - Best Case Solutions - Evanston, IL - (800) 492-8037 Best Case Bankruptcy
Case 08-03051-ee Doc 19 Filed 10/28/08 Entered 10/28/08 20:51:16 Desc Main
Document Page 3 of 52
Form B6A
(10/05)
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Copyright (c) 1996-2007 - Best Case Solutions - Evanston, IL - (800) 492-8037 Best Case Bankruptcy
Case 08-03051-ee Doc 19 Filed 10/28/08 Entered 10/28/08 20:51:16 Desc Main
Document Page 4 of 52
Form B6B
(10/05)
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Copyright (c) 1996-2007 - Best Case Solutions - Evanston, IL - (800) 492-8037 Best Case Bankruptcy
Case 08-03051-ee Doc 19 Filed 10/28/08 Entered 10/28/08 20:51:16 Desc Main
Document Page 5 of 52
Form B6B
(10/05)
13. Stock and interests in incorporated 2/3 interest in Frazier Development, LLC - Unknown
and unincorporated businesses.
Itemize. 50% interest in Flowood Development subject to - Unknown
assignment in Oct. 2006
Copyright (c) 1996-2007 - Best Case Solutions - Evanston, IL - (800) 492-8037 Best Case Bankruptcy
Case 08-03051-ee Doc 19 Filed 10/28/08 Entered 10/28/08 20:51:16 Desc Main
Document Page 6 of 52
Form B6B
(10/05)
25. Automobiles, trucks, tra ilers, and 2008 GMC Yukon - 35,000.00
other vehicles and a ccessorie s.
30. Inventory. X
Copyright (c) 1996-2007 - Best Case Solutions - Evanston, IL - (800) 492-8037 Best Case Bankruptcy
Case 08-03051-ee Doc 19 Filed 10/28/08 Entered 10/28/08 20:51:16 Desc Main
Document Page 7 of 52
Form B6C
(4/07)
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Wearing Apparel
clother Miss. Code Ann. § 85-3-1(a) 600.00 600.00
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State the name, mailing address, including zip cod e, and last four digits of any account number of all entities holding claims secured by property of the debtor as of
the date of filing of the petition . The complete account number of any account the debtor has with the creditor is useful to the trustee and the creditor and may be prov ided
if the debtor choo ses to do so. List creditors holding all types of secured interests such as judg ment liens, garnishments, statutory liens, mortgages, deeds of trust, and
other security interests.
List creditors in alphabetical order to the extent practicable. If a minor child is a creditor, indicate that by stating "a minor child" and do not disclose the child’s
name. See 11 U.S.C. § 11 2. If "a mino r child" is stated, also include the name, address, and legal relationship to the mino r child of a person described in Fed. R. Bankr. P.
1007 (m). If all secured creditors will not fit on this page, use the con tinuation sheet prov ided.
If any entity other than a spouse in a joint case may be jointly liable on a claim, place an "X" in the column labeled "Codebtor" ,include the entity on the appropriate
schedule of creditors, and complete Schedule H - Codebtors. If a joint petition is filed, state whether the husband, wife, both of them, or the marital community may be
liable on each claim by placing an "H", "W", "J", or "C" in the column labeled "Husband , Wife, Joint, or Commun ity".
If the claim is contingent, place an "X" in the column labeled "Contingent". If the claim is unliquidated, place an "X" in the column labeled "Unliquidated". If the
claim is dispu ted, place an "X" in the column labeled "Dispu ted". (You may need to place an "X" in more than on e of these three columns.)
Total the columns labeled "Amount of Claim Without Dedu cting Value of Collateral" and "Unsecured Portion, if Any " in the boxes labeled "Total(s)" on the last
sheet of the completed schedule. Report the total from the column labeled "Amount of Claim" also on the Summary of Schedules and, if the debtor is an individual with
primarily consumer debts, report the total from the column labeled "Unsecured Portion" on the Statistical Summary of Certain Liabilities and Related Data.
Check this box if debtor has no creditors holding secured claims to report on this Schedule D.
C Husband, Wife, Joint, or Community C U D AMOUN T OF
CREDITOR'S NAME O O N I
D H DATE CLAIM WAS INCURRED, N L S CLAIM
AND MAILING ADDRESS E T I P WITHOUT UNSECURED
INCLUDING ZIP CODE, B W NATURE OF LIEN, AND I Q U PORTION, IF
T J DESCRIPTION AND VALUE N U T
DEDUCTING
AND ACCOUNT NUMBER O G I E VALUE O F ANY
(See instructions above.) R
C OF PROPERTY E D D
SUBJECT TO LIEN COLLATERAL
N A
T T
Account No. Mortgage E
D
Ergon Properties
c/o Watson & Jones, PA
P O Box 23546
-
Jackson, MS 39225
Copyright (c) 1996-2007 - Best Case Solutions - Evanston, IL - (800) 492-8037 Best Case Bankruptcy
Case 08-03051-ee Doc 19 Filed 10/28/08 Entered 10/28/08 20:51:16 Desc Main
Document Page 9 of 52
Official Form 6D (10/06) - Cont.
Copyright (c) 1996-2007 - Best Case Solutions - Evanston, IL - (800) 492-8037 Best Case Bankruptcy
Case 08-03051-ee Doc 19 Filed 10/28/08 Entered 10/28/08 20:51:16 Desc Main
Document Page 10 of 52
Official Form 6D (10/06) - Cont.
Copyright (c) 1996-2007 - Best Case Solutions - Evanston, IL - (800) 492-8037 Best Case Bankruptcy
Case 08-03051-ee Doc 19 Filed 10/28/08 Entered 10/28/08 20:51:16 Desc Main
Document Page 11 of 52
Official Form 6E (4/07)
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Check this box if debtor has no creditors holding unsecured priority claims to report on this Schedule E.
TYPES OF PRIORITY CLAIMS (Check the appropriate box(es) below if claims in that category are listed on the attached sheets)
Domestic support obligations
Claims for domestic support that are owed to or recoverable by a spou se, former spo use, or child of the debtor, or the parent, legal guardian, or responsible relative of
such a child, or a governmental unit to whom such a domestic support claim has been assign ed to the extent provided in 11 U.S.C. § 50 7(a)(1).
Deposits by individuals
Claims of individuals up to $2,425* for deposits for the purchase, lease, or rental of property or services for personal, family, or hou sehold use, that were not delivered
provided. 1 1 U.S.C. § 507(a)(7).
* Amounts are subject to adjustment on April 1, 2010, and every three years thereafter with respect to cases commenced on or after the date of adjustment.
2 continuation sheets attached
Copyright (c) 1996-2007 - Best Case Solutions - Evanston, IL - (800) 492-8037 Best Case Bankruptcy
Case 08-03051-ee Doc 19 Filed 10/28/08 Entered 10/28/08 20:51:16 Desc Main
Document Page 12 of 52
Official Form 6E (4/07) - Cont.
0.00 0.00
Account No. divorce modification award
Holly Merkh
c/o 0.00
0.00 0.00
Account No. May 2008
1
Sheet _____ 2
of _____ continuation sheets attached to Subtotal 120,000.00
Schedule of Creditors Holding Unsecured Priority Claims (Total of this page) 156,600.00 36,600.00
Copyright (c) 1996-2007 - Best Case Solutions - Evanston, IL - (800) 492-8037 Best Case Bankruptcy
Case 08-03051-ee Doc 19 Filed 10/28/08 Entered 10/28/08 20:51:16 Desc Main
Document Page 13 of 52
Official Form 6E (4/07) - Cont.
IRS
P O Box 145585 0.00
Stop 842DG
-
Cincinnati, OH 45250-5585
0.00 0.00
Account No. state taxes
0.00 0.00
2
Sheet _____ 2
of _____ continuation sheets attached to Subtotal 0.00
Schedule of Creditors Holding Unsecured Priority Claims (Total of this page) 30,540.04 30,540.04
Total 120,000.00
(Report on Summary of Schedules) 187,140.04 67,140.04
Copyright (c) 1996-2007 - Best Case Solutions - Evanston, IL - (800) 492-8037 Best Case Bankruptcy
Case 08-03051-ee Doc 19 Filed 10/28/08 Entered 10/28/08 20:51:16 Desc Main
Document Page 14 of 52
Official Form 6F (10/06)
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Check this box if debtor has no creditors holding unsecured claims to report on this Schedule F.
Adv Recovery
972 High St -
Jackson, MS 39207
0.00
Account No. 3499907298539963 Opened 5/01/02 Last Active 9/30/08
CreditCard
Amex
Po Box 297871 -
Fort Lauderdale, FL 33329
10,177.00
Account No. 003186311010336762 Opened 3/01/93
CreditCard
Amex
Po Box 297871 -
Fort Lauderdale, FL 33329
0.00
Subtotal
11 continuation sheets attached
_____ 283,195.50
(Total of this page)
Copyright (c) 1996-2007 - Best Case Solutions - Evanston, IL - (800) 492-8037 S/N:31780-070521 Best Case Bankruptcy
Case 08-03051-ee Doc 19 Filed 10/28/08 Entered 10/28/08 20:51:16 Desc Main
Document Page 15 of 52
Official Form 6F (10/06) - Cont.
Amex
Po Box 297871 -
Fort Lauderdale, FL 33329
0.00
Account No.
Baker Donaldson
4268 I-55 North -
Jackson, MS 39211
55,000.00
Account No.
Bancorp South
525 E. Capital Street -
Jackson, MS 39201
Unknown
Account No.
Bancorp South
525 E. Capital Street -
Jackson, MS 39201
Unknown
Account No. default judgment (Lafayette Co.--Van Buren
Group) for principal, interest, and attorneys
Bancorp South fees
c/o -
1,214,533.00
Copyright (c) 1996-2007 - Best Case Solutions - Evanston, IL - (800) 492-8037 Best Case Bankruptcy
Case 08-03051-ee Doc 19 Filed 10/28/08 Entered 10/28/08 20:51:16 Desc Main
Document Page 16 of 52
Official Form 6F (10/06) - Cont.
Bank First
1597 Highland Colony -
Parkway
Madison, MS 39110
200,000.00
Cbe Group
131 Tower Park Dr -
Ste 100
Waterloo, IA 50704
306.00
Account No. 4239801003590862 Opened 1/01/02 Last Active 7/01/02
CreditCard
Ccs/first National Ban
500 E 60th St N -
Sioux Falls, SD 57104
0.00
Account No. 70000000050100299 Opened 2/12/01 Last Active 10/09/07
Citz Nat Bk
P O Box 911 -
Meridian, MS 39302
0.00
Account No. 70000000050100234 Opened 8/01/99 Last Active 2/01/01
Citz Nat Bk
P O Box 911 -
Meridian, MS 39302
0.00
Copyright (c) 1996-2007 - Best Case Solutions - Evanston, IL - (800) 492-8037 Best Case Bankruptcy
Case 08-03051-ee Doc 19 Filed 10/28/08 Entered 10/28/08 20:51:16 Desc Main
Document Page 17 of 52
Official Form 6F (10/06) - Cont.
Cmi
4200 International -
Carrollton, TX 75007
1,052.00
Account No.
0.00
Account No. 340912454080 Opened 3/21/08 Last Active 9/23/08
AutoLease
GMAC
Po Box 105677 -
Atlanta, GA 30348
14,526.00
Copyright (c) 1996-2007 - Best Case Solutions - Evanston, IL - (800) 492-8037 Best Case Bankruptcy
Case 08-03051-ee Doc 19 Filed 10/28/08 Entered 10/28/08 20:51:16 Desc Main
Document Page 18 of 52
Official Form 6F (10/06) - Cont.
Gemb/banana Rep
Po Box 981400 -
El Paso, TX 79998
625.00
4,202.00
Account No. 3585218 Opened 11/01/07
CollectionAttorney Jackson Anesthesia Asso
Healthcare Financial S Pa
643 Lakeland East Dr -
Jackson, MS 39232
726.00
Account No. 2886367 Med1 02 Jackson Anesthesia Asso Pa
Hfs Svcs
643 Lakeland East Dr -
Jackson, MS 39232
1,508.00
Account No. 2804717 Med1 02 Lakeland Radiology Pa
Hfs Svcs
643 Lakeland East Dr -
Jackson, MS 39232
364.00
Copyright (c) 1996-2007 - Best Case Solutions - Evanston, IL - (800) 492-8037 Best Case Bankruptcy
Case 08-03051-ee Doc 19 Filed 10/28/08 Entered 10/28/08 20:51:16 Desc Main
Document Page 19 of 52
Official Form 6F (10/06) - Cont.
Hfs Svcs
643 Lakeland East Dr -
Jackson, MS 39232
298.00
Account No.
Hines-Phillips
Properties -
c/o Jim Martin, Esq.
388 Highland Colony
Ridgeland, MS 39157 209,580.00
Account No.
300,000.00
Account No.
75,000.00
Account No. judgment
Laws Construction Co
c/o Thomas Gerity -
Wyatt, Tarrant & Combs
P O Box 16089
Jackson, MS 39236 389,238.60
Copyright (c) 1996-2007 - Best Case Solutions - Evanston, IL - (800) 492-8037 Best Case Bankruptcy
Case 08-03051-ee Doc 19 Filed 10/28/08 Entered 10/28/08 20:51:16 Desc Main
Document Page 20 of 52
Official Form 6F (10/06) - Cont.
Margaret A. Frazier
c/o Connie Smith, Esq - X
2950 Layfair Dr.
Ste 101
Flowood, MS 39232 1,000,000.00
6,641.00
Account No. 2007
default judgment on promissory note
Mr. Billy Atwood
P. O. Box 849 -
Kosciusko, MS 39090
112,458.00
Account No.
Mr. E. R. Hines
c/o Jim Martin, Esq. -
388 Highland Colony
Parkwa
Ridgeland, MS 39157 133,250.00
Copyright (c) 1996-2007 - Best Case Solutions - Evanston, IL - (800) 492-8037 Best Case Bankruptcy
Case 08-03051-ee Doc 19 Filed 10/28/08 Entered 10/28/08 20:51:16 Desc Main
Document Page 21 of 52
Official Form 6F (10/06) - Cont.
Mr. E. R. Hines
c/o Jim Martin, Esq. -
388 Highland Colony
Parkway
Ridgeland, MS 39157 112,750.00
Omni Bank
236 E. Capital Street -
Jackson, MS 39210
45,000.00
Copyright (c) 1996-2007 - Best Case Solutions - Evanston, IL - (800) 492-8037 Best Case Bankruptcy
Case 08-03051-ee Doc 19 Filed 10/28/08 Entered 10/28/08 20:51:16 Desc Main
Document Page 22 of 52
Official Form 6F (10/06) - Cont.
Omni Bank
P O Box 468 -
Bay Springs, MS 39422
0.00
Southfins
Po Box 15203 -
Hattiesburg, MS 39407
23,973.00
Account No. indemnity lawsuit
324.00
Copyright (c) 1996-2007 - Best Case Solutions - Evanston, IL - (800) 492-8037 Best Case Bankruptcy
Case 08-03051-ee Doc 19 Filed 10/28/08 Entered 10/28/08 20:51:16 Desc Main
Document Page 23 of 52
Official Form 6F (10/06) - Cont.
Account No.
Travelers Surety
& C asualty Co. -
1080 River Oaks Dr.
Flowood, MS 39232
4,000,000.00
Account No.
Trustmark Bank
248 E. Capital Street -
Jackson, MS 39201
15,000.00
Account No. 04680-1701-9613-8812 2006
credit card
Trustmark Nat Bank
Special Assests Dept -
P. O. Box 1928
Brandon, MS 39043
1,626.78
Account No. 10119154-23084 2006
promissory note
Trustmark Nat. Bank
Jackson Main Office -
P O Box 291
Jackson, MS 39205
0.00
Copyright (c) 1996-2007 - Best Case Solutions - Evanston, IL - (800) 492-8037 Best Case Bankruptcy
Case 08-03051-ee Doc 19 Filed 10/28/08 Entered 10/28/08 20:51:16 Desc Main
Document Page 24 of 52
Official Form 6F (10/06) - Cont.
0.00
Account No. 0940700086 Opened 5/01/99 Last Active 3/31/08
CreditCard
Wash Mutual/providian
Po Box 9180 -
Pleasanton, CA 94588
0.00
Account No.
Waterproffing Systems
2193 Frisco Rd -
Memphis, TN 38114
0.00
Account No. 2006
enrolled TN judgment
Waterproofing Systems
c/o Dorsey Carson -
Burr & Forman
401 E Capital, Ste 100
Jackson, MS 39201 25,222.50
Copyright (c) 1996-2007 - Best Case Solutions - Evanston, IL - (800) 492-8037 Best Case Bankruptcy
Case 08-03051-ee Doc 19 Filed 10/28/08 Entered 10/28/08 20:51:16 Desc Main
Document Page 25 of 52
Official Form 6F (10/06) - Cont.
William Mathison, IV
c/o Robert Hutchison - X
Forman Perry LLP
P. O. Box 2608
Jackson, MS 39225 250,000.00
Account No.
Account No.
Account No.
Account No.
Copyright (c) 1996-2007 - Best Case Solutions - Evanston, IL - (800) 492-8037 Best Case Bankruptcy
Case 08-03051-ee Doc 19 Filed 10/28/08 Entered 10/28/08 20:51:16 Desc Main
Document Page 26 of 52
Form B6G
(10/05)
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Copyright (c) 1996-2007 - Best Case Solutions - Evanston, IL - (800) 492-8037 Best Case Bankruptcy
Case 08-03051-ee Doc 19 Filed 10/28/08 Entered 10/28/08 20:51:16 Desc Main
Document Page 27 of 52
Form B6H
(10/05)
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SCHEDULE H. CODEBTORS
Provide the information requested concerning any person or entity, other than a spouse in a joint case, that is also liable on any debts listed
by debtor in the schedules of creditors. Include all guarantors and co-signers. If the debtor resides or resided in a community property state,
commonwealth, or territory (including Alaska, Arizona, California, Idaho, Louisiana, Nevada, New Mexico, Puerto Rico, Texas, Washington, or
Wisconsin) within the eight year period immediately preceding the commencement of the case, identify the name of the debtor's spouse and of
any former spouse who resides or resided with the debtor in the community property state, commonwealth, or territory. Include all names used
by the nondebtor spouse during the eight years immediately preceding the commencement of this case. If a minor child is a codebtor or a creditor,
indicate that by stating "a minor child" and do not disclose the child's name. See 11 U.S.C. § 112; Fed. Bankr. P. 1007(m).
Check this box if debtor has no codebtors.
NAME AND ADDRESS OF CODEBTOR NAME AND ADDRESS OF CREDITOR
Copyright (c) 1996-2007 - Best Case Solutions - Evanston, IL - (800) 492-8037 Best Case Bankruptcy
Case 08-03051-ee Doc 19 Filed 10/28/08 Entered 10/28/08 20:51:16 Desc Main
Offi cial Form 6I (10/06)
Document Page 28 of 52
INCOM E: (Estimate of average or projected monthly income at time case filed) DEBTOR SPOUSE
1. Monthly gross wages, salary, and commissions (Prorate if not paid monthly) $ 0.00 $ N/A
2. Estimate monthly overtime $ 0.00 $ N/A
7. Regular income from operation of business or profession or farm (Attach detailed statement) $ 0.00 $ N/A
8. Income from real property $ 0.00 $ N/A
9. Interest and dividends $ 0.00 $ N/A
10. Alimony, maintenance or support payments payable to the debtor for the debtor's use or
that of dependents listed above $ 0.00 $ N/A
11. Social security or government assistance
(Specify): $ 0.00 $ N/A
$ 0.00 $ N/A
12. Pension or retirement income $ 0.00 $ N/A
13. Other monthly income
(Specify): Family contributions from parent $ 1,000.00 $ N/A
$ 0.00 $ N/A
15. AVERAGE MONTHLY INCOM E (Add amounts shown on lines 6 and 14) $ 1,000.00 $ N/A
Check this box if a joint petition is filed and debtor's spouse maintains a separate household. Complete a separate schedule of
expenditures labeled "Spouse."
1. Rent or home mortgage payment (include lot rented for mobile home) $ 0.00
a. Are real estate taxes included? Yes No X
b. Is property insurance included? Yes No X
2. Utilities: a. Electricity and heating fuel $ 0.00
b. Water and sewer $ 0.00
c. Telephone $ 175.00
d. Other $ 0.00
3. Home maintenance (repairs and upkeep) $ 0.00
4. Food $ 300.00
5. Clothing $ 100.00
6. Laundry and dry cleaning $ 50.00
7. M edical and dental expenses $ 0.00
8. Transportation (not including car payments) $ 700.00
9. Recreation, clubs and entertainment, newspapers, magazines, etc. $ 75.00
10. Charitable contributions $ 0.00
11. Insurance (not deducted from wages or included in home mortgage payments)
a. Homeowner's or renter's $ 0.00
b. Life $ 0.00
c. Health $ 0.00
d. Auto $ 90.00
e. Other $ 0.00
12. Taxes (not deducted from wages or included in home mortgage payments)
(Specify) $ 0.00
13. Installment payments: (In chapter 11, 12, and 13 cases, do not list payments to be included in the
plan)
a. Auto $ 478.00
b. Other $ 0.00
c. Other $ 0.00
d. Other $ 0.00
14. Alimony, maintenance, and support paid to others $ 0.00
15. Payments for support of additional dependents not living at your home $ 0.00
16. Regular expenses from operation of business, profession, or farm (attach detailed statement) $ 0.00
17. Other $ 0.00
Other $ 0.00
18. AVERAGE MONTHLY EXP ENSES (Total lines 1-17. Report also on Summary of Schedules and, $ 1,968.00
if applicable, on the Statistical Summary of Certain Liabilities and Related Data.)
19. Describe any increase or decrease in expenditures reasonably anticipated to occur within the year
following the filing of this document:
I declare under penalty of perjury that I have read the foregoing summary and schedules, consisting of
29 sheets [total shown on summ ary page plus 2], and that they are true and correct to the best of my
knowledge, information, and belief.
Penalty for making a false statement or concealing property: Fine of up to $500,000 or imprisonment for up to 5 years or both.
18 U.S.C. §§ 152 and 3571.
Softwa re Copyright (c) 1 996- 200 6 Best C ase Solution s, Inc. - Eva nston, I L - (80 0) 492- 803 7 Best Ca se Bankruptcy
Case 08-03051-ee Doc 19 Filed 10/28/08 Entered 10/28/08 20:51:16 Desc Main
Document Page 31 of 52
Official Form 7
(04/07)
This statement is to be completed by every debtor. Spouses filing a joint petition may file a single statement on which the information for
both spouses is combined. If the case is filed under chapter 12 or chapter 13, a married debtor must furnish information for both spouses whether or
not a joint petition is filed, unless the spouses are separated and a joint petition is not filed. An individual debtor engaged in business as a sole
proprietor, partner, family farmer, or self-employed professional, should provide the information requested on this statement concerning all such
activities as well as the individual's personal affairs. Do not include the name or address of a minor child in this statement. Indicate payments,
transfers and the like to minor children by stating "a minor child." See 11 U.S.C. § 112; Fed. R. Bankr. P. 1007(m).
Questions 1 - 18 are to be completed by all debtors. Debtors that are or have been in business, as defined below, also must complete
Questions 19 - 25. If the answer to an applicable question is "None," mark the box labeled "None." If additional space is needed for the answer
to any question, use and attach a separate sheet properly identified with the case name, case number (if known), and the number of the question.
DEFINITIONS
"In business." A debtor is "in business" for the purpose of this form if the debtor is a corporation or partnership. An individual debtor is "in
business" for the purpose of this form if the debtor is or has been, within six years immediately preceding the filing of this bankruptcy case, any of
the following: an officer, director, managing executive, or owner of 5 percent or more of the voting or equity securities of a corporation; a partner,
other than a limited partner, of a partnership; a sole proprietor or self-employed full-time or part-time. An individual debtor also may be "in business"
for the purpose of this form if the debtor engages in a trade, business, or other activity, other than as an employee, to supplement income from the
debtor's primary employment.
"Insider." The term "insider" includes but is not limited to: relatives of the debtor; general partners of the debtor and their relatives;
corporations of which the debtor is an officer, director, or person in control; officers, directors, and any owner of 5 percent or more of the voting or
equity securities of a corporate debtor and their relatives; affiliates of the debtor and insiders of such affiliates; any managing agent of the debtor. 11
U.S.C. § 101.
__________________________________________
None State the gross amount of income the debtor has received from employment, trade, or profession, or from operation of the debtor's
business, including part-time activities either as an employee or in independent trade or business, from the beginning of this calendar
year to the date this case was commenced. State also the gross amounts received during the two years immediately preceding this
calendar year. (A debtor that maintains, or has maintained, financial records on the basis of a fiscal rather than a calendar year may
report fiscal year income. Identify the beginning and ending dates of the debtor's fiscal year.) If a joint petition is filed, state income for
each spouse separately. (Married debtors filing under chapter 12 or chapter 13 must state income of both spouses whether or not a joint
petition is filed, unless the spouses are separated and a joint petition is not filed.)
AMOUNT SOURCE
$90,000.00 employment 2007
$245,000.00 employment 2006
None State the amount of income received by the debtor other than from employment, trade, profession, or operation of the debtor's business
during the two years immediately preceding the commencement of this case. Give particulars. If a joint petition is filed, state income for
each spouse separately. (Married debtors filing under chapter 12 or chapter 13 must state income for each spouse whether or not a joint
petition is filed, unless the spouses are separated and a joint petition is not filed.)
AMOUNT SOURCE
$10,000.00 family contributions (parent) 2008
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3. Payments to creditors
a. Individual or joint debtor(s) with primarily consumer debts. List all payments on loans, installment purchases of goods or services,
and other debts to any creditor made within 90 days immediately preceding the commencement of this case if the aggregate value of all
property that constitutes or is affected by such transfer is not less than $600. Indicate with an (*) any payments that were made to a
creditor on account of a domestic support obligation or as part of an alternative repayment schedule under a plan by an approved
nonprofit budgeting and creditor counseling agency. (M arried debtors filing under chapter 12 or chapter 13 must include payments by
either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.)
None b. Debtor whose debts are not primarily consumer debts: List each payment or other transfer to any creditor made within 90 days
immediately preceding the commencement of the case if the aggregate value of all property that constitutes or is affected by such
transfer is not less than $ 5,475. (Married debtors filing under chapter 12 or chapter 13 must include payments by either or both spouses
whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.)
AMOUNT
DATES OF PAID OR
PAYMENTS/ VALUE OF AMOUNT STILL
NAME AND ADDRESS O F CREDITOR TRANSFERS TRANSFERS OWING
None c. All debtors: List all payments made within one year immediately preceding the commencement of this case to or for the benefit of
creditors who are or were insiders. (Married debtors filing under chapter 12 or chapter 13 must include payments by either or both
spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.)
None a. List all suits and administrative proceedings to which the debtor is or was a party within one year immediately preceding the filing of
this bankruptcy case. (Married debtors filing under chapter 12 or chapter 13 must include information concerning either or both spouses
whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.)
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None b. Describe all property that has been attached, garnished or seized under any legal or equitable process within one year immediately
preceding the commencement of this case. (Married debtors filing under chapter 12 or chapter 13 must include information concerning
property of either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not
filed.)
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None List all property that has been repossessed by a creditor, sold at a foreclosure sale, transferred through a deed in lieu of foreclosure or
returned to the seller, within one year immediately preceding the commencement of this case. (Married debtors filing under chapter 12
or chapter 13 must include information concerning property of either or both spouses whether or not a joint petition is filed, unless the
spouses are separated and a joint petition is not filed.)
DATE OF REPOSSESSION,
NAME AND ADDRESS O F FORECLOSURE SALE, DESCRIPTION AND VALUE OF
CREDITOR OR SELLER TRANSFER OR RETURN PROPERTY
None a. Describe any assignment of property for the benefit of creditors made within 120 days immediately preceding the commencement of
this case. (Married debtors filing under chapter 12 or chapter 13 must include any assignment by either or both spouses whether or not a
joint petition is filed, unless the spouses are separated and a joint petition is not filed.)
DATE OF
NAME AND ADDRESS O F ASSIGNEE ASSIGNMENT TERMS OF ASSIGNM ENT OR SETTLEMENT
None b. List all property which has been in the hands of a custodian, receiver, or court-appointed official within one year immediately
preceding the commencement of this case. (Married debtors filing under chapter 12 or chapter 13 must include information concerning
property of either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not
filed.)
7. Gifts
None List all gifts or charitable contributions made within one year immediately preceding the commencement of this case except ordinary
and usual gifts to family members aggregating less than $200 in value per individual family member and charitable contributions
aggregating less than $100 per recipient. (Married debtors filing under chapter 12 or chapter 13 must include gifts or contributions by
either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.)
8. Losses
None List all losses from fire, theft, other casualty or gambling within one year immediately preceding the commencement of this case or
since the commencement of this case. (M arried debtors filing under chapter 12 or chapter 13 must include losses by either or both
spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.)
None List all payments made or property transferred by or on behalf of the debtor to any persons, including attorneys, for consultation
concerning debt consolidation, relief under the bankruptcy law or preparation of the petition in bankruptcy within one year immediately
preceding the commencement of this case.
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None a. List all other property, other than property transferred in the ordinary course of the business or financial affairs of the debtor,
transferred either absolutely or as security within two years immediately preceding the commencement of this case. (Married debtors
filing under chapter 12 or chapter 13 must include transfers by either or both spouses whether or not a joint petition is filed, unless the
spouses are separated and a joint petition is not filed.)
None b. List all property transferred by the debtor within ten years immediately preceding the commencement of this case to a self-settled
trust or similar device of which the debtor is a beneficiary.
None List all financial accounts and instruments held in the name of the debtor or for the benefit of the debtor which were closed, sold, or
otherwise transferred within one year immediately preceding the commencement of this case. Include checking, savings, or other
financial accounts, certificates of deposit, or other instruments; shares and share accounts held in banks, credit unions, pension funds,
cooperatives, associations, brokerage houses and other financial institutions. (Married debtors filing under chapter 12 or chapter 13 must
include information concerning accounts or instruments held by or for either or both spouses whether or not a joint petition is filed,
unless the spouses are separated and a joint petition is not filed.)
None List each safe deposit or other box or depository in which the debtor has or had securities, cash, or other valuables within one year
immediately preceding the commencement of this case. (Married debtors filing under chapter 12 or chapter 13 must include boxes or
depositories of either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not
filed.)
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13. Setoffs
None List all setoffs made by any creditor, including a bank, against a debt or deposit of the debtor within 90 days preceding the
commencement of this case. (Married debtors filing under chapter 12 or chapter 13 must include information concerning either or both
spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.)
None List all property owned by another person that the debtor holds or controls.
None If the debtor has moved within three years immediately preceding the commencement of this case, list all premises which the debtor
occupied during that period and vacated prior to the commencement of this case. If a joint petition is filed, report also any separate
address of either spouse.
None If the debtor resides or resided in a community property state, commonwealth, or territory (including Alaska, Arizona, California, Idaho,
Louisiana, Nevada, New M exico, Puerto Rico, Texas, Washington, or Wisconsin) within eight years immediately preceding the
commencement of the case, identify the name of the debtor ’s spouse and of any former spouse who resides or resided with the debtor in
the community property state.
NAME
"Environmental Law" means any federal, state, or local statute or regulation regulating pollution, contamination, releases of hazardous
or toxic substances, wastes or material into the air, land, soil, surface water, groundwater, or other medium, including, but not limited to,
statutes or regulations regulating the cleanup of these substances, wastes, or material.
"Site" means any location, facility, or property as defined under any Environmental Law, whether or not presently or formerly
owned or operated by the debtor, including, but not limited to, disposal sites.
"Hazardous Material" means anything defined as a hazardous waste, hazardous substance, toxic substance, hazardous material,
pollutant, or contaminant or similar term under an Environmental Law
None a. List the name and address of every site for which the debtor has received notice in writing by a governmental unit that it may be liable
or potentially liable under or in violation of an Environmental Law. Indicate the governmental unit, the date of the notice, and, if known,
the Environmental Law:
None b. List the name and address of every site for which the debtor provided notice to a governmental unit of a release of Hazardous
Material. Indicate the governmental unit to which the notice was sent and the date of the notice.
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None c. List all judicial or administrative proceedings, including settlements or orders, under any Environmental Law with respect to which
the debtor is or was a party. Indicate the name and address of the governmental unit that is or was a party to the proceeding, and the
docket number.
None a. If the debtor is an individual, list the names, addresses, taxpayer identification numbers, nature of the businesses, and beginning and
ending dates of all businesses in which the debtor was an officer, director, partner, or managing executive of a corporation, partner in a
partnership, sole proprietor, or was self-employed in a trade, profession, or other activity either full- or part-time within six years
immediately preceding the commencement of this case, or in which the debtor owned 5 percent or more of the voting or equity securities
within six years immediately preceding the commencement of this case.
If the debtor is a partnership , list the names, addresses, taxpayer identification numbers, nature of the businesses, and beginning and
ending dates of all businesses in which the debtor was a partner or owned 5 percent or more of the voting or equity securities, within six
years immediately preceding the commencement of this case.
If the debtor is a corporation, list the names, addresses, taxpayer identification numbers, nature of the businesses, and beginning and
ending dates of all businesses in which the debtor was a partner or owned 5 percent or more of the voting or equity securities within six
years immediately preceding the commencement of this case.
None b. Identify any business listed in response to subdivision a., above, that is "single asset real estate" as defined in 11 U.S.C. § 101.
NAME ADDRESS
The following questions are to be completed by every debtor that is a corporation or partnership and by any individual debtor who is or has
been, within six years immediately preceding the commencement of this case, any of the following: an officer, director, managing executive, or
owner of more than 5 percent of the voting or equity securities of a corporation; a partner, other than a limited partner, of a partnership, a sole
proprietor or self-employed in a trade, profession, or other activity, either full- or part-time.
(An individual or joint debtor should complete this portion of the statement only if the debtor is or has been in business, as defined above,
within six years immediately preceding the commencement of this case. A debtor who has not been in business within those six years should go
directly to the signature page.)
None a. List all bookkeepers and accountants who within two years immediately preceding the filing of this bankruptcy case kept or
supervised the keeping of books of account and records of the debtor.
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None b. List all firms or individuals who within the two years immediately preceding the filing of this bankruptcy case have audited the books
of account and records, or prepared a financial statement of the debtor.
None c. List all firms or individuals who at the time of the commencement of this case were in possession of the books of account and records
of the debtor. If any of the books of account and records are not available, explain.
NAME ADDRESS
None d. List all financial institutions, creditors and other parties, including mercantile and trade agencies, to whom a financial statement was
issued by the debtor within two years immediately preceding the commencement of this case.
20. Inventories
None a. List the dates of the last two inventories taken of your property, the name of the person who supervised the taking of each inventory,
and the dollar amount and basis of each inventory.
None b. List the name and address of the person having possession of the records of each of the two inventories reported in a., above.
None a. If the debtor is a partnership, list the nature and percentage of partnership interest of each member of the partnership.
None b. If the debtor is a corporation, list all officers and directors of the corporation, and each stockholder who directly or indirectly owns,
controls, or holds 5 percent or more of the voting or equity securities of the corporation.
None a. If the debtor is a partnership, list each member who withdrew from the partnership within one year immediately preceding the
commencement of this case.
None b. If the debtor is a corporation, list all officers, or directors whose relationship with the corporation terminated within one year
immediately preceding the commencement of this case.
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10
None If the debtor is a partnership or corporation, list all withdrawals or distributions credited or given to an insider, including compensation
in any form, bonuses, loans, stock redemptions, options exercised and any other perquisite during one year immediately preceding the
commencement of this case.
None If the debtor is a corporation, list the name and federal taxpayer identification number of the parent corporation of any consolidated
group for tax purposes of which the debtor has been a member at any time within six years immediately preceding the commencement
of the case.
None If the debtor is not an individual, list the name and federal taxpayer identification number of any pension fund to which the debtor, as an
employer, has been responsible for contributing at any time within six years immediately preceding the commencement of the case.
I declare under penalty of perjury that I have read the answers contained in the foregoing statement of financial affairs and any attachments thereto
and that they are true and correct.
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Fo rm 8
(10/05)
Lease will be
assumed pursuan t
Description of Leased to 11 U.S.C. §
Property Lessor's Name 362(h)(1)(A)
-NONE-
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Fo rm 8 Con t.
(10/05)
In re Harris Claiborne Frazier Case No. 08-03051
Debtor(s)
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United States Bankruptcy Court
Southern District of Mississippi
In re Harris Claiborne Frazier Case No. 08-03051
Debtor(s) Chapter 7
4. I have not agreed to share the above-disclosed compensation with any other person unless they are members and associates of my law firm.
I have agreed to share the above-disclosed compensation with a person or persons who are not members or associates of my law firm. A
copy of the agreement, together with a list of the names of the people sharing in the compensation is attached.
5. In return for the above-disclosed fee, I have agreed to render legal service for all aspects of the bankruptcy case, including:
a. Analysis of the debtor's financial situation, and rendering advice to the debtor in determining whether to file a petition in bankruptcy;
b. Preparation and filing of any petition, schedules, statement of affairs and plan which may be required;
c. Representation of the debtor at the meeting of creditors and confirmation hearing, and any adjourned hearings thereof;
d. [Other provisions as needed]
Negotiations with secured creditors to reduce to market value; exemption planning; preparation and filing of reaffirmation
agreements and applications as needed; preparation and filing of motions pursuant to 11 USC 522(f)(2)(A) for avoidance
of liens on household goods.
6. By agreement with the debtor(s), the above-disclosed fee does not include the following service:
Representation of the debtors in any dischargeability actions, judicial lien avoidances, relief from stay actions or any
other adversary proceeding.
CERTIFICATION
I certify that the foregoing is a complete statement of any agreement or arrangement for payment to me for representation of the debtor(s) in
this bankruptcy proceeding.
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B 201 (04/09/06 )
In addition, after filing a bankruptcy case, an individual debtor generally must complete a financial management
instructional course before he or she can receive a discharge. The clerk also has a list of approved financial management
instructional courses.
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 to
proceed 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 § 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
committed certain kinds of improper conduct described in the Bankruptcy Code, the court may deny your discharge and, if it does, the
purpose for which you filed the bankruptcy petition will be defeated.
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 restitution 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 administrative 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 before it 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 restitution 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.
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B 201 (04/09/06 )
Chapter 11: Reorganization ($1000 filing fee, $39 administrative 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
and is 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.
WARNING: Section 521(a)(1) of the Bankruptcy Code requires that you promptly file detailed information regarding your creditors,
assets, liabilities, income, expenses and general financial condition. Your bankruptcy case may be dismissed if this information 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.
Certificate of Attorney
I hereby certify that I delivered to the debtor this notice required by § 342(b) of the Bankruptcy Code.
Certificate of Debtor
I (We), the debtor(s), affirm that I (we) have received and read this notice.
Harris Claiborne Frazier X /s/ Harris Claiborne Frazier October 28, 2008
Printed Name(s) of Debtor(s) Signature of Debtor Date
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Debtor declares under penalty of perjury that debts are primarily non-consumer; therefore,
Means Test does not apply per § 707(b)(1).
c. Marrie d, n ot filin g jo in tly, wit hou t t h e de cla ra ti on o f se parat e h ou seh olds set ou t i n Lin e 2 .b a bov e. Compl ete both Column A
("Debtor's Inc ome") and Colu mn B ("Spous e's Inc ome") for Lin es 3-11 .
d. Marrie d, fil in g joi nt ly. Compl ete both Column A (" Debtor's Incom e") an d Colu mn B (" Spouse's Inco me") for Lin es 3-11.
All fi gu re s m us t refl ec t ave rage mon th ly i nc om e rece ived from all s ou rces , d erived du ring th e s ix Colum n A Colum n B
cal en dar m on th s p ri or to filin g t he ba nkru pt cy c as e, en di ng on th e la st day of th e m on th befo re th e
filin g . If t he am oun t of mo nt hl y in com e va ri ed d uri ng th e si x mo nt hs , you m us t d ivid e t he s ix- Debtor's Spouse's
mon th t ota l by six, an d en te r t h e resu lt on th e ap prop riat e lin e. Income Income
3 Gross wages, s al ar y, tips, bon uses, overtime, commissi ons. $ 0.00 $ 0.00
Income from the op eration of a business , profession o r far m. Sub trac t Lin e b from Lin e a an d
en ter t he diffe re nc e in th e a pp ro priat e c olu mn (s) o f Li ne 4. D o not en te r a nu mb er les s th an zero.
Do not inc lude any part of the busin ess expenses entered on Lin e b as a deduction in Par t
V.
4 De bt or Spou s e
a. Gro ss re ce ipt s $ 0.00 $ 0.00
b. Ord in ary an d n ec es sary b us in es s ex pen se s $ 0.00 $ 0.00
c. Bus in es s in co me Sub trac t Lin e b from Lin e a $ 0.00 $ 0.00
Ren ts and other r eal proper ty in come. Sub trac t Lin e b from Li ne a an d en te r th e di fferen ce in
th e ap prop riat e co lu mn (s) of Lin e 5 . Do n ot en ter a n u mb er les s t ha n zero. Do not inc lude any
part of the operating exp enses entered on Line b as a deduction in Part V .
5 De bt or Spou s e
a. Gro ss re ce ipt s $ 0.00 $ 0.00
b. Ord in ary an d n ec es sary o perat in g ex pen se s $ 0.00 $ 0.00
c. Ren t an d o th er real prop erty in c ome Sub trac t Lin e b from Lin e a $ 0.00 $ 0.00
6 Interest, div idend s, and r oyalties. $ 0.00 $ 0.00
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15 The amount on Line 13 is less than or eq ual to the amount on Line 14. Ch eck t h e bo x for "Th e p resu mp ti on doe s n ot
aris e" at th e t op o f pag e 1 of t his s tat em ent , an d c om ple te Part VIII; d o n ot c om ple te P arts IV, V, VI or VII.
The amount on Line 13 is more than the amount on Line 14. Com ple te t h e rema in ing pa rt s o f th is st ate men t .
Complete Parts IV, V, VI, and VII of this statement only if required. (See Line 15.)
18 Current monthly income for § 707(b)(2). Sub trac t Lin e 1 7 fro m Lin e 1 6 a nd en ter t he re su lt. $
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Local Standards: housing and utilities; mortgage/rent expense. En te r, in Li ne a be low, the am oun t
of th e IRS H ou sin g and Ut ili tie s St an dards ; mo rt ga ge/ren t expe ns e for yo ur c oun t y an d fam ily size (t his in forma tio n i s
avai lab le a t www.u sd oj.g ov/u st / or from the cl erk of t he ban krup tc y co urt ); ent er on Lin e b t he to tal of th e Ave rage
Mon th ly P aym en ts for an y deb ts se cu red b y you r ho me, as st ate d in Lin e 4 2; s ub trac t Lin e b from Lin e a an d en te r t h e
20 B re su lt in Li ne 20 B. Do not enter an amount less than zero.
a. IRS H ou si ng an d U til iti es St an da rd s; m ortg age /re nt al e xpe ns e $
b. Averag e Mo nt hl y Paym en t fo r a ny d eb ts se cu re d b y you r ho me,
if an y, as s tat ed in Li ne 4 2 $
c. Net mo rt ga ge/ren t al ex pen se Sub trac t Lin e b from Lin e a . $
En te r t he am oun t fro m IRS Tran s porta ti on St an da rd s, Op erat in g Co st s & Pub lic Tran s port ati on C osts for th e ap pli ca ble
nu mb er of ve hic le s in th e a pp lic abl e Me trop olit an Sta tis ti ca l Area o r C ens u s Reg ion . (T his in forma tio n i s av aila ble at
www.u sd oj.g ov/u st / or from t he cl erk of t he ban krup tc y co urt .) $
En te r, in Li ne a be low, the am oun t of th e IRS Tra ns port ati on Stan da rd s, Owne rs h ip Co st s, Fi rst Car (avai lab le a t
23 www.u sd oj.g ov/u st / or from the cl erk of t he ban krup tc y co urt ); ent er in Lin e b t he tot al of th e Ave rage Mon th ly
Paym en ts for an y de bt s s ec ured by Ve hic le 1, a s s tat ed in Li ne 42 ; su bt ract Lin e b from Lin e a a nd en ter t he re su lt i n
Line 23 . Do not enter an amount less than zero.
a. IRS T ran spo rtat ion St and ards , Own ersh ip Costs , First Car $
Averag e Mo nt hl y Paym en t fo r a ny d eb ts se cu re d b y Veh ic le 1 ,
b. as st ate d in Lin e 4 2 $
c. Net own ers hip /lea se e xpe ns e for Ve hic le 1 Sub trac t Lin e b from Lin e a . $
Local Standards: transportation ownership/lease expense; Vehicle 2. Com ple te t hi s Lin e o nly if
you ch ec ked th e "2 or more " Box in Lin e 2 3.
En te r, in Li ne a be low, the am oun t of th e IRS Tra ns port ati on Stan da rd s, Owne rs h ip Co st s, S eco nd Car (ava ilab le a t
www.u sd oj.g ov/u st / or from the cl erk of t he ban krup tc y co urt ); ent er in Lin e b t he tot al of th e Ave rage Mon th ly
Paym en ts for an y de bt s s ec ured by Ve hic le 2, a s s tat ed in Li ne 42 ; su bt ract Lin e b from Lin e a a nd en ter t he re su lt i n
24
Line 24 . Do not enter an amount less than zero.
a. IRS T ran spo rtat ion St and ards , Own ersh ip Costs , Sec on d Ca r $
Averag e Mo nt hl y Paym en t fo r a ny d eb ts se cu re d b y Veh ic le 2 ,
b. as st ate d in Lin e 4 2 $
c. Net own ers hip /lea se e xpe ns e for Ve hic le 2 Sub trac t Lin e b from Lin e a . $
Other Necessary Expenses: life insurance. En te r a verag e mo nt hl y prem iu ms th at you act ua lly p ay fo r
27 term life ins u ra nc e for yo urs elf. Do not inc lude prem iums for ins urance on you r depend ents, for w hole life or
for any other form of insu rance.
$
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Other Necessary Expenses: health care. En te r t he ave ra ge m on th ly am ou nt th at you ac tu all y exp end on
31 he alt h c are ex pen se s t ha t are not reim bu rsed by i ns uran c e or pa id b y a h ea lth sa vin gs ac cou n t. Do not inc lude
payments for health ins urance or health savings accou nts listed in L ine 34 .
$
34 a. He alt h Ins u ra nc e $
b. Di sa bility In su ranc e $
c. He alt h Sa vin gs Accou nt $
Protection against family violence. En te r a ny a verag e mo nt hl y exp en ses th at you ac tu all y in cu rre d t o
36 mai nt ain th e s afet y of y our fa mil y un de r t h e Fam ily Vi olen c e Preve nt ion an d Se rv ice s Ac t o r o th er ap pli cab le fe deral
law. Th e na tu re of t he se e xpe ns es is re qu ired to b e kep t c on fide nt ial by t he cou rt. $
Home energ y costs. En te r t h e ave ra ge m on th ly a mou nt , in exc es s o f th e al lowa nc e in th e IRS Local St an dard s
37 for Ho us in g an d Uti lit ies , th at you ac tu all y exp end for h ome en ergy c osts . You m ust pr ovid e your case trus tee
with d ocumentation d em onstrating that the additional amou nt claimed is r eas onable and necess ar y. $
Education expenses for dependent children less than 18. En te r t he ave ra ge m on th ly ex pen se s t ha t
you ac tu ally inc u r, not to exc eed $ 13 7. 50 per c hi ld, in p rovid in g el eme nt ary an d s ec on dary e du cat ion for yo ur
38 dep en den t ch ild re n l ess th an 1 8 ye ars o f age . You m ust pr ovid e your case trus tee w ith doc umentation
demonstr ating that the amoun t c laimed is reason able and necessar y an d not already accoun ted for in the
IRS Standards .
$
Additional food and clothing expense. En te r t he ave ra ge m on th ly am ou nt by whi ch you r f ood and cl oth in g
exp ens es exc eed th e c omb in ed allo wan ces for foo d a nd app arel i n t he IRS N at ion al St an da rd s, n ot to exc eed five
39 perc en t of t h ose com bi ne d al lowa nc es. (Th is i nfo rm at ion is avai lab le at www.u sd oj.g ov/u st / or from t he cl erk of t he
ban kru ptc y c ou rt .) You m ust pr ovid e your case trus tee w ith doc umentation demon strating that the
additional amoun t claimed is r eas onable and necess ar y. $
40
Continued charitable contributions. En te r t he am oun t th at y ou w ill c on ti nu e t o co nt ribu te in t h e form o f
cas h or fin an cia l in st rum ent s to a ch arit abl e orga ni zat ion as de fine d i n 2 6 U .S.C. § 1 70 (c)(1 )-(2). $
41 Total Additional Exp ens e Deductions und er § 707(b). En te r t he to tal of Lin es 34 th roug h 40 $
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Other payments on secured claims. If a ny o f deb ts lis t ed in Lin e 4 2 a re se cu re d b y you r prim ary resi den c e,
a mo to r ve hi cle , or ot he r p rope rt y n ec ess ary for yo ur s up port or th e s up port of you r de pen de nt s, y ou m ay i nc lu de i n
43 you r d ed uc ti on 1 /6 0t h o f any amo un t (t he "cu re am ou nt ") th at you mu st pay th e c re dit or in add it ion to th e pa yme nt s
lis te d in Lin e 42 , in ord er to mai nt ain po ss ess io n of t h e prop erty. Th e c ure a mou nt wou ld in clu de an y su ms in de faul t
th at mu st be p aid in orde r t o av oid re posse ss ion or forec lo su re . Lis t an d t ot al a ny s uc h amo un ts in th e fol lowi ng ch art.
If n ec es sary, lis t ad di tio nal en tries on a s epa rate pag e.
Nam e o f Creditor Prope rty Se cu ri ng th e D eb t 1/6 0t h o f th e Cu re Am oun t
a. $
Tot al: Ad d Lin es $
44 Payments on priority claims. En te r t h e to tal amo un t o f all priorit y c laim s (i nc lu din g p riorit y ch il d s up port and
alim on y c laim s), d ivi ded by 6 0 . $
49 Enter the amount from Line 47 (Total of all deductions allowed under § 707(b)(2)) $
50 Monthly disposab le income under § 707(b)(2). Sub trac t Lin e 4 9 fro m Lin e 4 8 a nd en ter t he re su lt.
$
51
60-month disposable income under § 707(b)(2). Mu lti ply th e am ou nt in Li ne 50 by t he nu mb er 6 0 an d
en ter the re su lt. $
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The amount on Line 51 is at least $ 6,575, but not more than $10,950. Com ple te t h e rema in der of P art VI (Lin es 5 3
th roug h 5 5 ).
The amount on Line 51 is less than the amount on Line 54. Che ck t h e bo x for "Th e p re su mp ti on d oes n ot a rise " at t h e
top of p age 1 o f th is st ate men t, an d c omp let e t he v erific at ion in Part V III.
55
The amount on Line 51 is equal to or greater than the amount on Line 54. Che ck t h e bo x for "Th e p re su mp ti on
aris es" a t t he top of p age 1 o f th is st ate men t, an d c omp let e t he v erific at ion in Part VIII. You ma y als o com ple te P art VII.
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