Bankruptcy Cover Sheet Petition PDF Details

The Bankruptcy Cover Sheet Petition is a legal document that must be filed with the bankruptcy court. It provides information about your assets, liabilities and living expenses. The petition is also an opportunity to list any pending lawsuits or other matters which may affect your eligibility for bankruptcy relief. The Bankruptcy Cover Sheet Petition can be confusing and difficult to complete without guidance from a lawyer who specializes in this area of law. This article will provide you with helpful tips on filling out the form correctly so that it has the best chance of being accepted by the court.

Below is the data concerning the PDF you were in search of to fill out. It will tell you the amount of time you'll need to complete bankruptcy cover sheet petition, what fields you will need to fill in and some further specific facts.

QuestionAnswer
Form NameBankruptcy Cover Sheet Petition
Form Length63 pages
Fillable?Yes
Fillable fields1232
Avg. time to fill out37 min 27 sec
Other namess form chapter, bankruptcy forms colorado, denver county court forms, colorado bankruptcy forms chapter 7

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Local Bankruptcy Form 1002-1.1

COVER SHEET FOR PETITION

CHECK APPLICABLE BOXES TO SHOW ALL DOCUMENTS ATTACHED

Name of debtor(s):

[

] Attorney (firm name, address, telephone, and

 

registration number):

 

[

] No attorney (“pro se”)(home address, telephone):

 

 

 

Filing fee (revised 11/1/11 per directive of the Judicial Conference of the United States):

[ ] $306 for chapter 7

[ ] $1,213 for chapter 11 [ ] $246 for chapter 12 [ ] $281 for chapter 13

[ ] Other fee paid: $_________. Enter amount AND attach applicable application under FED.

R. BANKR. P. 1006 to pay in installments or pursuant to 28 U.S.C. § 1930(f) (if applicable).

Individual and business debtor(s) (except as otherwise noted):

[ ] Exhibit D Statement of Compliance with Credit Counseling Requirement for each individual debtor (a list of all authorized Credit Counselors for Colorado is found at http://www.usdoj.gov/ust or the court has a list that may be viewed in the Records/Public Information Room 114 of the court.)

[ ] Voluntary Petition – Official Form 1

[ ] Statement of Financial Affairs – Official Form 7

[ ] Summary of Schedules A–J – Official Form 6–Summary

[ ] Schedules A, B, C, D, E, F, G, H, I, and J – Official Forms 6A, 6B, 6C, 6D, 6E, 6F, 6Iand 6J

[ ] Declaration Concerning Debtor’s Schedules – Official Form 6–Declaration

[ ] Notice to Debtor by Non-Attorney Bankruptcy Petition Preparer – Official Form 19 (submitted only if debtor used the services of a bankruptcy petition preparer)

[ ] For each individual debtor, copies of all payment advices, paycheck stubs, or other evidence of all salary, commissions or income received within 60 days before the bankruptcy case was filed, copied on 8 ½ by 11 paper with the debtor’s first and last name printed on top of each page (and bankruptcy case number, if a number has been assigned); OR, as applicable, complete L.B. Form 1007-6.1 (“Statement Under Penalty of Perjury Concerning Payment Advices”) for each debtor.

[ ] A record of any interest in an education individual retirement account (“IRA”) (26 U.S.C. § 530(b)(1)) or qualified state tuition program (26 U.S.C. § 529(b)(1) plans).

[] Attorney Fee Disclosure Statement – Director’s Procedural Form B 203

[] Verification of Creditors’ Matrix – L.B. Form 1007-2.1

[] Creditors’ Matrix (see L.B.R. 1007-2 and L.B.R. 1007-2App. for instructions).

Additional items due from ALL individual debtors:

[] Statement of Social Security Number(s) – Official Form 21

Chapter 7 individual debtors also must file:

[] Statement of Current Monthly Income and Means Test Calculation – Official Form 22A*

[] Statement of Intention – Official Form 8 (due thirty days post-petition) (the failure to comply with this statement and file reaffirmation agreements or motions to redeem personal property that the debtor does not intend to surrender has ramifications 45 days after the first scheduled meeting of creditors under 11 U.S.C. § 362(h) of the Bankruptcy Code)

Chapter 11 individual debtors also must file:

[] Statement of Current Monthly Income – Official Form 22B Chapter 13 individual debtors also must file:

[] Statement of Current Monthly Income and Disposable Income Calculation – Official Form 22C*

[] Plan –L.B. Form 3015.1

*The links for the updated Internal Revenue Service and Census Bureau Information that may be needed to complete Statement of Current Monthly Income, Official Forms 22A and 22B, can be reached from the web site: http://www.usdoj.gov/ust/. (Not applicable in chapter 7 cases if debts are primarily business debts.)

Additional items due from chapter 11 debtors:

[] List of Twenty Largest Creditors – Official Form 4

[] Corporate Ownership Statement – Required by FED. R BANKR. P. 1007(a)(1) for corporations. L.B. Form 1007-4.1.

[] List of Equity Interest Holders – Required by FED. R. BANKR. P. 1007(a)(3) for

corporations. L.B. Form 1007-4.2.

[] Small business debtors must file the most recent 1) balance sheet, 2) statements of operations, 3) cash-flow statement and 4) federal income tax return; OR a verified statement that those documents do not exist and have not been prepared or filed.

[] Disclosure Regarding Receivers Bankruptcy Form 1007-7.1.

Date:

Printed name of party signing:

Signature of attorney (or debtor without counsel):

97

UNITED STATES BANKRUPTCY COURT

DISTRICT OF COLORADO

NOTICE REGARDING E-MAIL NOTIFICATION FOR DEBTORS WITHOUT AN

ATTORNEY AND PARTIES WITHOUT AN ATTORNEY

If you are not represented by an attorney and are a debtor or party in a bankruptcy case and you have an internet e-mail address, you can receive an electronic notice by e-mail whenever a filing is made in a case where you are a debtor or party. Benefits of receiving such notices are:

If your e-mail program supports viewing documents from hyper links and you have Adobe Acrobat Reader installed, you may be able to view the document filed through a hyperlink in the e-mail notice.

One look at the document is free (any additional opening(s) of the document will require a PACER account which may be obtained at the following web site: http://pacer.psc.uscourts.gov.)1

You will get immediate notification through e-mail when something is docketed in a case where you are a party.

To sign up for e-mail notification of filings made in a case where you are a debtor or party, provide the information requested below and return this form to the address stated.

By submitting this Notice, you are consenting to receive all notices required to be sent to you by the Bankruptcy Court by e-mail ONLY and you acknowledge and agree that such notices will NOT be sent to you by regular mail. You must keep the court notified of any changes in your e- mail address, which you may do by completing this form again and sending it to the court.

Please note: you are not allowed to file documents electronically with the Court or to communicate with the court through e-mail or fax transmission. (The only exceptions are our Court’s web based proof of claim program for qualified creditors and the creditor mailing matrix program for debtors.)

Your name: ____________________________________________________________________

(ONLY ONE NAME AND E-MAIL ADDRESS PER FORM)

Your case number or case number where you are a party: ________________________________

Your internet e-mail address: ______________________________________________________

Return Completed form to:

US Bankruptcy Court

721 19th St.

Denver, CO 80202

VISIT OUR WEBSITE FOR MORE INFORMATION: http://www.cob.uscourts.gov

1It is recommended that you download the document or print it out at that time.

B1 (Official Form 1) (04/13)

 

 

UNITED STATES BANKRUPTCY COURT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

__________ District of __________

 

 

 

 

 

VOLUNTARY PETITION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of Debtor (if individual, enter Last, First, Middle):

 

 

 

Name of Joint Debtor (Spouse) (Last, First, Middle):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

All Other Names used by the Debtor in the last 8 years

 

 

 

 

 

 

All Other Names used by the Joint Debtor in the last 8 years

 

 

 

(include married, maiden, and trade names):

 

 

 

 

 

 

(include married, maiden, and trade names):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Last four digits of Soc. Sec. or Individual-Taxpayer I.D. (ITIN)/Complete EIN

 

Last four digits of Soc. Sec. or Individual-Taxpayer I.D. (ITIN)/Complete EIN

(if more than one, state all):

 

 

 

 

 

 

 

(if more than one, state all):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Street Address of Debtor (No. and Street, City, and State):

 

 

 

Street Address of Joint Debtor (No. and Street, City, and State):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ZIP CODE

 

 

 

 

 

 

 

 

ZIP CODE

 

County of Residence or of the Principal Place of Business:

 

 

 

 

 

County of Residence or of the Principal Place of Business:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mailing Address of Debtor (if different from street address):

 

 

 

Mailing Address of Joint Debtor (if different from street address):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ZIP CODE

 

 

 

 

 

 

 

 

ZIP CODE

 

Location of Principal Assets of Business Debtor (if different from street address above):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ZIP CODE

 

 

Type of Debtor

 

 

 

 

Nature of Business

 

 

 

Chapter of Bankruptcy Code Under Which

 

(Form of Organization)

 

 

 

(Check one box.)

 

 

 

 

 

the Petition is Filed (Check one box.)

 

(Check one box.)

 

 

 

 

Health Care Business

 

 

 

Chapter 7

Chapter 15 Petition for

 

 

 

 

 

 

 

 

 

 

Individual (includes Joint Debtors)

 

 

 

 

Single Asset Real Estate as defined in

 

Chapter 9

Recognition of a Foreign

See Exhibit D on page 2 of this form.

 

 

 

 

11 U.S.C. § 101(51B)

 

 

 

Chapter 11

Main Proceeding

Corporation (includes LLC and LLP)

 

 

 

Railroad

 

 

 

 

 

Chapter 12

Chapter 15 Petition for

Partnership

 

 

 

 

 

Stockbroker

 

 

 

 

 

Chapter 13

Recognition of a Foreign

Other (If debtor is not one of the above entities, check

 

Commodity Broker

 

 

 

 

Nonmain Proceeding

this box and state type of entity below.)

 

 

 

Clearing Bank

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other

 

 

 

 

 

 

 

 

 

 

 

 

 

Chapter 15 Debtors

 

 

 

 

Tax-Exempt Entity

 

 

 

 

Nature of Debts

 

 

 

Country of debtor’s center of main interests:

 

 

 

(Check box, if applicable.)

 

 

 

 

(Check one box.)

 

 

 

 

 

 

 

 

 

 

 

 

 

Debts are primarily consumer

Debts are

 

 

 

 

 

 

 

Debtor is a tax-exempt organization

 

Each country in which a foreign proceeding by, regarding, or

 

 

debts, defined in 11 U.S.C.

primarily

 

under title 26 of the United States

 

§ 101(8) as “incurred by an

business debts.

against debtor is pending:

 

 

 

 

 

Code (the Internal Revenue Code).

 

individual primarily for a

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

personal, family, or

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

household purpose.”

 

 

 

 

 

Filing Fee (Check one box.)

 

 

 

 

 

 

 

 

Chapter 11 Debtors

 

 

 

 

 

 

 

 

 

 

 

 

 

Check one box:

 

 

 

 

 

 

 

Full Filing Fee attached.

 

 

 

 

 

 

 

Debtor is a small business debtor as defined in 11 U.S.C. § 101(51D).

Filing Fee to be paid in installments (applicable to individuals only). Must attach

Debtor is not a small business debtor as defined in 11 U.S.C. § 101(51D).

 

 

 

 

 

 

 

 

 

 

 

signed application for the court’s consideration certifying that the debtor is

 

Check if:

 

 

 

 

 

 

 

 

 

 

unable to pay fee except in installments. Rule 1006(b). See Official Form 3A.

 

Debtor’s aggregate noncontingent liquidated debts (excluding debts owed to

 

 

 

 

 

 

 

 

 

 

insiders or affiliates) are less than $2,490,925 (amount subject to adjustment

Filing Fee waiver requested (applicable to chapter 7 individuals only). Must

 

on 4/01/16 and every three years thereafter).

 

 

 

attach signed application for the court’s consideration. See Official Form 3B.

 

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Check all applicable boxes:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A plan is being filed with this petition.

 

 

 

 

 

 

 

 

 

 

 

 

 

Acceptances of the plan were solicited prepetition from one or more classes

 

 

 

 

 

 

 

 

 

 

of creditors, in accordance with 11 U.S.C. § 1126(b).

 

 

 

Statistical/Administrative Information

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

THIS SPACE IS FOR

 

Debtor estimates that funds will be available for distribution to unsecured creditors.

 

 

 

 

 

 

 

COURT USE ONLY

 

 

 

 

 

 

 

 

 

 

 

 

Debtor estimates that, after any exempt property is excluded and administrative expenses paid, there will be no funds available for

 

 

 

 

 

distribution to unsecured creditors.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Estimated Number of Creditors

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1-49

50-99

100-199

200-999

1,000-

 

 

5,001-

 

10,001-

25,001-

 

50,001-

Over

 

 

 

 

 

 

 

 

5,000

 

 

10,000

 

25,000

50,000

 

 

100,000

100,000

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Estimated Assets

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$0 to

$50,001 to

$100,001 to

$500,001

$1,000,001

$10,000,001

 

$50,000,001

$100,000,001

$500,000,001

More than

 

 

 

 

$50,000

$100,000

$500,000

to $1

to $10

to $50

to $100

to $500

to $1 billion

$1 billion

 

 

 

 

 

 

 

million

million

million

million

million

 

 

 

 

 

 

 

Estimated Liabilities

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$0 to

$50,001 to

$100,001 to

$500,001

$1,000,001

$10,000,001

 

$50,000,001

$100,000,001

$500,000,001

More than

 

 

 

 

$50,000

$100,000

$500,000

to $1

to $10

to $50

to $100

to $500

to $1 billion

$1 billion

 

 

 

 

 

 

 

million

million

million

million

million

 

 

 

 

 

 

 

B1 (Official Form 1) (04/13)

Page 2

Voluntary Petition

Name of Debtor(s):

(This page must be completed and filed in every case.)

 

All Prior Bankruptcy Cases Filed Within Last 8 Years (If more than two, attach additional sheet.)

Location

 

Case Number:

Date Filed:

Where Filed:

 

 

 

Location

 

Case Number:

Date Filed:

Where Filed:

 

 

 

 

Pending Bankruptcy Case Filed by any Spouse, Partner, or Affiliate of this Debtor (If more than one, attach additional sheet.)

Name of Debtor:

 

Case Number:

Date Filed:

 

 

 

 

District:

 

Relationship:

Judge:

 

 

 

 

Exhibit A

 

Exhibit B

(To be completed if debtor is required to file periodic reports (e.g., forms 10K and

 

(To be completed if debtor is an individual

10Q) with the Securities and Exchange Commission pursuant to Section 13 or 15(d)

 

whose debts are primarily consumer debts.)

of the Securities Exchange Act of 1934 and is requesting relief under chapter 11.)

I, the attorney for the petitioner named in the foregoing petition, declare that I have

 

 

informed the petitioner that [he or she] may proceed under chapter 7, 11, 12, or 13

 

of title 11, United States Code, and have explained the relief available under each

 

such chapter. I further certify that I have delivered to the debtor the notice required

Exhibit A is attached and made a part of this petition.

by 11 U.S.C. § 342(b).

 

 

 

 

 

 

 

X

 

 

 

 

Signature of Attorney for Debtor(s)

(Date)

 

Exhibit C

Does the debtor own or have possession of any property that poses or is alleged to pose a threat of imminent and identifiable harm to public health or safety?

Yes, and Exhibit C is attached and made a part of this petition.

No.

Exhibit D

(To be completed by every individual debtor. If a joint petition is filed, each spouse must complete and attach a separate Exhibit D.)

Exhibit D, completed and signed by the debtor, is attached and made a part of this petition.

If this is a joint petition:

Exhibit D, also completed and signed by the joint debtor, is attached and made a part of this petition.

Information Regarding the Debtor - Venue

(Check any applicable box.)

Debtor has been domiciled or has had a residence, principal place of business, or principal assets in this District for 180 days immediately preceding the date of this petition or for a longer part of such 180 days than in any other District.

There is a bankruptcy case concerning debtor’s affiliate, general partner, or partnership pending in this District.

Debtor is a debtor in a foreign proceeding and has its principal place of business or principal assets in the United States in this District, or has no principal place of business or assets in the United States but is a defendant in an action or proceeding [in a federal or state court] in this District, or the interests of the parties will be served in regard to the relief sought in this District.

Certification by a Debtor Who Resides as a Tenant of Residential Property

(Check all applicable boxes.)

Landlord has a judgment against the debtor for possession of debtor’s residence. (If box checked, complete the following.)

(Name of landlord that obtained judgment)

(Address of landlord)

Debtor claims that under applicable nonbankruptcy law, there are circumstances under which the debtor would be permitted to cure the entire monetary default that gave rise to the judgment for possession, after the judgment for possession was entered, and

Debtor has included with this petition the deposit with the court of any rent that would become due during the 30-day period after the filing of the petition.

Debtor certifies that he/she has served the Landlord with this certification. (11 U.S.C. § 362(l)).

B1 (Official Form 1) (04/13)

 

 

Page 3

Voluntary Petition

Name of Debtor(s):

 

 

 

 

(This page must be completed and filed in every case.)

 

 

 

 

 

 

 

 

 

Signatures

 

 

 

 

 

Signature(s) of Debtor(s) (Individual/Joint)

 

Signature of a Foreign Representative

I declare under penalty of perjury that the information provided in this petition is true

I declare under penalty of perjury that the information provided in this petition is true

and correct.

and correct, that I am the foreign representative of a debtor in a foreign proceeding,

[If petitioner is an individual whose debts are primarily consumer debts and has

and that I am authorized to file this petition.

chosen to file under chapter 7] I am aware that I may proceed under chapter 7, 11, 12

(Check only one box.)

 

 

 

 

or 13 of title 11, United States Code, understand the relief available under each such

 

 

 

 

 

 

 

 

 

 

chapter, and choose to proceed under chapter 7.

 

I request relief in accordance with chapter 15 of title 11, United States Code.

[If no attorney represents me and no bankruptcy petition preparer signs the petition] I

 

 

Certified copies of the documents required by 11 U.S.C. § 1515 are attached.

have obtained and read the notice required by 11 U.S.C. § 342(b).

 

 

 

 

 

 

 

I request relief in accordance with the chapter of title 11, United States Code,

 

Pursuant to 11 U.S.C. § 1511, I request relief in accordance with the

chapter of title 11 specified in this petition. A certified copy of the

specified in this petition.

 

order granting recognition of the foreign main proceeding is attached.

X

 

 

X

 

 

 

 

 

Signature of Debtor

 

(Signature of Foreign Representative)

 

 

 

X

 

 

 

 

 

 

 

 

 

Signature of Joint Debtor

 

(Printed Name of Foreign Representative)

 

 

 

 

 

 

 

 

 

 

 

 

Telephone Number (if not represented by attorney)

 

 

 

 

 

 

 

 

 

 

 

 

Date

 

 

 

 

 

Date

 

 

 

 

 

 

 

 

Signature of Attorney*

 

Signature of Non-Attorney Bankruptcy Petition Preparer

X

I declare under penalty of perjury that:

(1) I am a bankruptcy petition preparer as

 

Signature of Attorney for Debtor(s)

 

defined in 11 U.S.C. § 110; (2) I prepared this document for compensation and have

 

 

 

 

provided the debtor with a copy of this document and the notices and information

 

Printed Name of Attorney for Debtor(s)

required under 11 U.S.C. §§ 110(b), 110(h), and 342(b); and, (3) if rules or

 

 

 

 

guidelines have been promulgated pursuant to 11 U.S.C. § 110(h) setting a maximum

 

Firm Name

 

fee for services chargeable by bankruptcy petition preparers, I have given the debtor

 

 

 

 

notice of the maximum amount before preparing any document for filing for a debtor

 

 

 

 

or accepting any fee from the debtor, as required in that section. Official Form 19 is

 

 

 

 

attached.

 

 

 

 

 

Address

 

 

 

 

 

 

 

 

 

 

 

 

Telephone Number

 

 

Printed Name and title, if any, of Bankruptcy Petition Preparer

 

 

 

 

 

 

 

 

 

 

Date

 

 

 

 

 

 

 

*In a case in which § 707(b)(4)(D) applies, this signature also constitutes a

 

Social-Security number (If the bankruptcy petition preparer is not an individual,

 

state the Social-Security number of the officer, principal, responsible person or

certification that the attorney has no knowledge after an inquiry that the information

 

partner of the bankruptcy petition preparer.) (Required by 11 U.S.C. § 110.)

in the schedules is incorrect.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature of Debtor (Corporation/Partnership)

 

 

 

 

 

 

I declare under penalty of perjury that the information provided in this petition is true

 

 

 

 

 

 

 

Address

 

 

 

 

and correct, and that I have been authorized to file this petition on behalf of the

 

 

 

 

 

 

debtor.

X

 

 

 

 

The debtor requests the relief in accordance with the chapter of title 11, United States

 

 

 

 

 

Signature

 

 

 

 

Code, specified in this petition.

 

 

 

 

 

 

X

 

 

 

 

 

 

 

Date

 

 

 

 

 

Signature of Authorized Individual

 

 

 

 

 

 

 

 

 

 

 

Signature of bankruptcy petition preparer or officer, principal, responsible person, or

 

Printed Name of Authorized Individual

 

partner whose Social-Security number is provided above.

 

 

 

 

 

 

 

 

 

Title of Authorized Individual

 

Names and Social-Security numbers of all other individuals who prepared or assisted

 

 

 

 

 

 

 

 

in preparing this document unless the

bankruptcy petition preparer is not an

 

Date

 

individual.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If more than one person prepared this document, attach additional sheets conforming

 

 

 

 

to the appropriate official form for each person.

 

 

 

 

A bankruptcy petition preparer’s failure to comply with the provisions of title 11 and

 

 

 

 

the Federal Rules of Bankruptcy Procedure may result in fines or imprisonment or

 

 

 

 

both. 11 U.S.C. § 110; 18 U.S.C. § 156.

 

 

 

 

B 1D (Official Form 1, Exhibit D) (12/09)

UNITED STATES BANKRUPTCY COURT

__________ District of __________

In re__________________________

Case No._____________

Debtor

(if known)

EXHIBIT D - INDIVIDUAL DEBTOR’S STATEMENT OF COMPLIANCE WITH

CREDIT COUNSELING REQUIREMENT

Warning: You must be able to check truthfully one of the five statements regarding credit counseling listed below. If you cannot do so, you are not eligible to file a bankruptcy case, and the court can dismiss any case you do file. If that happens, you will lose whatever filing fee you paid, and your creditors will be able to resume collection activities against you. If your case is dismissed and you file another bankruptcy case later, you may be required to pay a second filing fee and you may have to take extra steps to stop creditors’ collection activities.

Every individual debtor must file this Exhibit D. If a joint petition is filed, each spouse must complete and file a separate Exhibit D. Check one of the five statements below and attach any documents as directed.

1. Within the 180 days before the filing of my bankruptcy case, I received a briefing from a credit counseling agency approved by the United States trustee or bankruptcy administrator that outlined the opportunities for available credit counseling and assisted me in performing a related budget analysis, and I have a certificate from the agency describing the services provided to me. Attach a copy of the certificate and a copy of any debt repayment plan developed through the agency.

2. Within the 180 days before the filing of my bankruptcy case, I received a briefing from a credit counseling agency approved by the United States trustee or bankruptcy administrator that outlined the opportunities for available credit counseling and assisted me in performing a related budget analysis, but I do not have a certificate from the agency describing the services provided to me. You must file a copy of a certificate from the agency describing the services provided to you and a copy of any debt repayment plan developed through the agency no later than 14 days after your bankruptcy case is filed.

B 1D (Official Form 1, Exh. D) (12/09) – Cont.

Page 2

 

3. I certify that I requested credit counseling services from an approved agency but was unable to obtain the services during the seven days from the time I made my request, and the following exigent circumstances merit a temporary waiver of the credit counseling requirement so I can file my bankruptcy case now. [Summarize exigent circumstances here.]

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

If your certification is satisfactory to the court, you must still obtain the credit counseling briefing within the first 30 days after you file your bankruptcy petition and promptly file a certificate from the agency that provided the counseling, together with a copy of any debt management plan developed through the agency. Failure to fulfill these requirements may result in dismissal of your case. Any extension of the 30-day deadline can be granted only for cause and is limited to a maximum of 15 days. Your case may also be dismissed if the court is not satisfied with your reasons for filing your bankruptcy case without first receiving a credit counseling briefing.

4. I am not required to receive a credit counseling briefing because of: [Check the applicable statement.] [Must be accompanied by a motion for determination by the court.]

Incapacity. (Defined in 11 U.S.C. § 109(h)(4) as impaired by reason of mental illness or mental deficiency so as to be incapable of realizing and making rational decisions with respect to financial responsibilities.);

Disability. (Defined in 11 U.S.C. § 109(h)(4) as physically impaired to the extent of being unable, after reasonable effort, to participate in a credit counseling briefing in person, by telephone, or through the Internet.);

Active military duty in a military combat zone.

5. The United States trustee or bankruptcy administrator has determined that the credit counseling requirement of 11 U.S.C. ' 109(h) does not apply in this district.

I certify under penalty of perjury that the information provided above is true and correct.

Signature of Debtor: ________________________

Date: _________________

B 1D (Official Form 1, Exhibit D) (12/09)

UNITED STATES BANKRUPTCY COURT

__________ District of __________

In re__________________________

Case No._____________

Debtor

(if known)

EXHIBIT D - INDIVIDUAL DEBTOR’S STATEMENT OF COMPLIANCE WITH

CREDIT COUNSELING REQUIREMENT

Warning: You must be able to check truthfully one of the five statements regarding credit counseling listed below. If you cannot do so, you are not eligible to file a bankruptcy case, and the court can dismiss any case you do file. If that happens, you will lose whatever filing fee you paid, and your creditors will be able to resume collection activities against you. If your case is dismissed and you file another bankruptcy case later, you may be required to pay a second filing fee and you may have to take extra steps to stop creditors’ collection activities.

Every individual debtor must file this Exhibit D. If a joint petition is filed, each spouse must complete and file a separate Exhibit D. Check one of the five statements below and attach any documents as directed.

1. Within the 180 days before the filing of my bankruptcy case, I received a briefing from a credit counseling agency approved by the United States trustee or bankruptcy administrator that outlined the opportunities for available credit counseling and assisted me in performing a related budget analysis, and I have a certificate from the agency describing the services provided to me. Attach a copy of the certificate and a copy of any debt repayment plan developed through the agency.

2. Within the 180 days before the filing of my bankruptcy case, I received a briefing from a credit counseling agency approved by the United States trustee or bankruptcy administrator that outlined the opportunities for available credit counseling and assisted me in performing a related budget analysis, but I do not have a certificate from the agency describing the services provided to me. You must file a copy of a certificate from the agency describing the services provided to you and a copy of any debt repayment plan developed through the agency no later than 14 days after your bankruptcy case is filed.

B 1D (Official Form 1, Exh. D) (12/09) – Cont.

Page 2

 

3. I certify that I requested credit counseling services from an approved agency but was unable to obtain the services during the seven days from the time I made my request, and the following exigent circumstances merit a temporary waiver of the credit counseling requirement so I can file my bankruptcy case now. [Summarize exigent circumstances here.]

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

If your certification is satisfactory to the court, you must still obtain the credit counseling briefing within the first 30 days after you file your bankruptcy petition and promptly file a certificate from the agency that provided the counseling, together with a copy of any debt management plan developed through the agency. Failure to fulfill these requirements may result in dismissal of your case. Any extension of the 30-day deadline can be granted only for cause and is limited to a maximum of 15 days. Your case may also be dismissed if the court is not satisfied with your reasons for filing your bankruptcy case without first receiving a credit counseling briefing.

4. I am not required to receive a credit counseling briefing because of: [Check the applicable statement.] [Must be accompanied by a motion for determination by the court.]

Incapacity. (Defined in 11 U.S.C. § 109(h)(4) as impaired by reason of mental illness or mental deficiency so as to be incapable of realizing and making rational decisions with respect to financial responsibilities.);

Disability. (Defined in 11 U.S.C. § 109(h)(4) as physically impaired to the extent of being unable, after reasonable effort, to participate in a credit counseling briefing in person, by telephone, or through the Internet.);

Active military duty in a military combat zone.

5. The United States trustee or bankruptcy administrator has determined that the credit counseling requirement of 11 U.S.C. ' 109(h) does not apply in this district.

I certify under penalty of perjury that the information provided above is true and correct.

Signature of Debtor: ________________________

Date: _________________

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special district form colorado spaces to complete

Type in the required data in the field Date:, Printed name of party signing:, and Signature of attorney (or debtor.

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Spell out the rights and obligations of the sides within the field Your case number or case number, Your internet e-mail address: , Return Completed form to:, US Bankruptcy Court 721 19 St, VISIT OUR WEBSITE FOR MORE, and It is recommended that you.

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End by checking these fields and writing the suitable details: the Petition is Filed (Check one, (Form of Organization), (Check one box, Individual (includes Joint Debtors), See Exhibit D on page 2 of this, this box and state type of entity, Chapter 15 Debtors, Country of debtor’s center of main, (Check one box, Health Care Business, Single Asset Real Estate as, Stockbroker, Railroad Commodity Broker Clearing, Tax-Exempt Entity, and (Check box.

special district form colorado the Petition is Filed (Check one, (Form of Organization), (Check one box, Individual (includes Joint Debtors), See Exhibit D on page 2 of this, this box and state type of entity, Chapter 15 Debtors, Country of debtor’s center of main, (Check one box, Health Care Business, Single Asset Real Estate as, Stockbroker, Railroad Commodity Broker Clearing, Tax-Exempt Entity, and (Check box blanks to fill

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