Form B6J - (Rev. 6/94) |
1998 USBC, District of New Hampshire |
SCHEDULE J - CURRENT EXPENDITURES OF INDIVIDUAL DEBTOR(S)
Complete this schedule by estimating the average monthly expenses of the debtor and the debtor's family. Prorate any payments made bi-weekly, quarterly, semi-annually, or annually to show monthly rate.
qCheck this box if a joint petition is filed and debtor's spouse maintains a separate household. Complete a separate schedule of expenditures labeled "Spouse."
Rent or home mortgage payment (include lot rented for mobile home) |
$_____________ |
Are real estate taxes included? |
Yes______ |
No______ |
|
Is property insurance included? |
Yes______ |
No______ |
|
Utilities: |
Electricity and heating fuel |
|
|
|
Water and sewer |
|
|
$_____________ |
|
Telephone |
|
|
$_____________ |
|
Other_____________________________________________________ |
$_____________ |
Home Maintenance (Repairs and Upkeep) |
|
$_____________ |
Food |
|
|
|
$_____________ |
Clothing |
|
|
|
$_____________ |
Laundry and dry cleaning |
|
|
$_____________ |
Medical and dental expenses |
|
|
$_____________ |
Transportation (not including car payments) |
|
$_____________ |
Recreation, clubs and entertainment, newspapers, magazines, etc. |
$_____________ |
Charitable contributions |
|
|
$_____________ |
Insurance (not deducted from wages or included in home mortgage payments): |
|
Homeowner’s or renter’s |
|
|
$_____________ |
Life |
|
|
|
$_____________ |
Health |
|
|
|
$_____________ |
Auto |
|
|
|
$_____________ |
Other____________________________________________________________________ |
$_____________ |
Taxes (not deducted from wages or included in home mortgage payments) |
$_____________ |
(Specify)_____________________________________________________________________ |
$_____________ |
Installment payments (In chapter 12 and 13 cases, do not list payments to be included in the |
|
Auto |
|
|
|
$_____________ |
Other____________________________________________________________________ |
$_____________ |
Other____________________________________________________________________ |
$_____________ |
Alimony, maintenance, and support paid to others |
|
$_____________ |
Payments for support of additional dependents not living at your home |
$_____________ |
Regular expenses from operation of business, profession, or farm (attach detailed statement) |
$_____________ |
Other_______________________________________________________________________ |
$_____________ |
|
|
|
|
|
TOTAL MONTHLY EXPENSES (Report also on Summary of Schedules) |
$_____________ |
|
[FOR CHAPTER 12 AND 13 DEBTORS ONLY]
Provide the information requested below, including whether plan payments are to be made bi-weekly, monthly, annually, or at some other regular interval.
A. |
Total projected monthly income |
$_____________ |
B. |
Total projected monthly expenses |
$_____________ |
C. Excess income (A minus B) |
$_____________ |
D. Total amount to be paid into plan each ___________________________________________ |
$_____________ |
|
(interval) |
|
__________________________________________________________
[Print or type name of individual signing on behalf of debtor]
[An individual signing on behalf of a partnership or corporation must indicate position or relationship to debtor.]
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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.
Signature _________________________________________________________
Date ________________________________________
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.
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DECLARATION UNDER PENALTY OF PERJURY ON BEHALF OF CORPORATION OR PARTNERSHIP
I, the ___________________________________ [the president or other officer or an authorized agent of the corporation or member or an authorized agent of
the partnership] of the ___________________________ [corporation or partnership] named as debtor in this case, declare under penalty of perjury that I have read
the foregoing summary and schedules, consisting of _______ sheets, and that they are true and correct to the best of my knowledge, information, and belief.
X __________________________________________________
Signature of Bankruptcy Petition Preparer
_______________________________________
Date
_____________________________________________________
_____________________________________________________
Address
Name and Social Security numbers of all other individuals who prepared or assisted in preparing this document:
If more than one person prepared this document, attach additional signed sheets conforming to the appropriate Official Form for each person.
_____________________________________________________
Printed or Typed Name of Bankruptcy Petition Preparer
________________________________________
Social Security Number
[If joint case, both spouses must sign
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CERTIFICATION AND SIGNATURE OF NON-ATTORNEY BANKRUPTCY PETITION PREPARER
(See 11 U.S.C. § 110)
I certify that I am a bankruptcy petition preparer as defined in 11 U.S.C. § 110, that I prepared this document for compensation, and that I have provided the debtor with a copy of this document.
Signature___________________________________________________________
(Joint Debtor, if any)
Date__________________________________________
Signature ___________________________________________________________
Debtor
Date__________________________________________
DECLARATION CONCERNING DEBTOR’S SCHEDULES
DECLARATION UNDER PENALTY OF PERJURY BY INDIVIDUAL DEBTOR
I declare under penalty of perjury that I have read the foregoing summary and schedules, consisting of _______________ sheets, and that they are correct to the
best of my knowledge, information, and belief.(Total shown on summary page plus 1)
Debtor.
(If known)
In re
Case No.:
Form B6J - Continued - (Rev. 6/94)
1998 USBC, District of New Hampshire