Official Form 122C-2

Chapter 13 Calculation of Your Disposable Income 04/19 

Part 1: Calculate Your Deductions from Your Income

Check if this is an amended filing

Fill in this information to identify your case:

Debtor 1

Debtor 2

(Spouse, if filing)

First Name Middle Name Last Name

First Name Middle Name Last Name

United States Bankruptcy Court for the:

Case number

(if known)

Ana Maria Restrepo

SOUTHERN DISTRICT OF FLORIDA

19-21842



To fill out this form, you will need your completed copy of Chapter 13 Statement of Your Current Monthly Income and 

Calculation of Commitment Period (Official Form 122C-1).

Be as complete and accurate as possible. If two married people are filing together, both are equally responsible for being 

accurate. If more space is needed, attach a separate sheet to this form. Include the line number to which the additional 

information applies. On the top of any additional pages, write your name and case number (if known).

5. The number of people used in determining your deductions from income

2

The Internal Revenue Service (IRS) issues National and Local Standards for certain expense amounts. Use these amounts 

to answer the questions in lines 6-15. To find the IRS standards, go online using the link specified in the separate 

instructions for this form. This information may also be available at the bankruptcy clerk's office.

Deduct the expense amounts set out in lines 6-15 regardless of your actual expense. In later parts of the form, you will use some of your 

actual expenses if they are higher than the standards. Do not include any operating expenses that you subtracted from income in lines 5 

and 6 of Form 122C-1, and do not deduct any amounts that you subtracted from your spouse's income in line 13 of Form 122C-1.

If your expenses differ from month to month, enter the average expense.

Note: Line numbers 1-4 are not used in this form. These numbers apply to information required by a similar form used in chapter 7 cases.

Fill in the number of people who could be claimed as exemptions on your federal income tax 

return, plus the number of any additional dependents whom you support. This number may 

be different from the number of people in your household.

National Standards You must use the IRS National Standards to answer the questions in lines 6-7.

6. Food, clothing and other items: Using the number of people you entered in line 5 and the IRS National Standards,

fill in the dollar amount for food, clothing, and other items.

$1,288.00 

7. Out-of-pocket health care allowance: Using the number of people you entered in line 5 and the IRS National Standards,

People who are under 65 years of age

7a. Out-of-pocket health care allowance per person

7b. Number of people who are under 65 X

7c. Subtotal. Multiply line 7a by line 7b. here

Copy



People who are 65 years of age or older

7d. Out-of-pocket health care allowance per person

7e. Number of people who are 65 or older X

7f. Subtotal. Multiply line 7d by line 7e. here

Copy



7g. Total. Add lines 7c and 7f..........................................................................................

+ Copy

here 

$55.00 

1 

$55.00 

$114.00 

1 

$114.00 

$169.00 

$55.00 

$114.00 

$169.00 

fill in the dollar amount for out-of-pocket health care. The number of people is split into two categories--people who are 

under 65 and people who are 65 or older--because older people have a higher IRS allowance for health care costs. If 

your actual expenses are higher than this IRS amount, you may deduct the additional amount on line 22.

Official Form 122C-2 Chapter 13 Calculation of Your Disposable Income page 1 

Case 19-21842-AJC Doc 16 Filed 10/14/19 Page 1 of 9
Debtor 1 Ana Maria Restrepo Case number (if known) 19-21842

Local Standards You must use the IRS Local Standards to answer the questions in lines 8-15.





Housing and utilities -- Insurance and operating expenses

Housing and utilities -- Mortgage or rent expenses

8. Housing and utilities -- Insurance and operating expenses: Using the number of people you entered in line 5,

fill in the dollar amount listed for your county for insurance and operating expenses.

$608.00 

Based on information from the IRS, the U.S. Trustee Program has divided the IRS Local Standard for housing 

for bankruptcy purposes into two parts:

To answer the questions in lines 8-9, use the U.S. Trustee Program chart. To find the chart, go online using 

the link specified in the separate instructions for this form. This chart may also be available at the 

bankruptcy clerk's office.

9. Housing and utilities -- Mortgage or rent expenses:

9a.

Name of the creditor

9b.

Average monthly

payment

+ 

9b. Total average monthly payment

Copy

here  –

9c.

Copy

here  $1,399.00 

$1,399.00 

$0.00 

$1,399.00 

$0.00 

Using the number of people you entered in line 5, fill in the dollar amount listed 

for your county for mortgage or rent expenses.

Total average monthly payment for all mortgages and other debts secured by 

your home.

To calculate the total average monthly payment, add all amounts that are 

contractually due to each secured creditor in the 60 months after you file for 

bankruptcy. Next divide by 60.

Repeat this 

amount on 

line 33a.

Net mortgage or rent expense.

Subtract line 9b (total average monthly payment) from line 9a (mortgage or 

rent expense). If this number is less than $0, enter $0.

10. If you claim that the U.S. Trustee Program's division of the IRS Local Standard for housing is incorrect 

and affects the calculation of your monthly expenses, fill in any additional amount you claim.

Explain

why:

11. Local transportation expenses: Check the number of vehicles for which you claim an ownership or operating expense.







0. Go to line 14.

1. Go to line 12.

2 or more. Go to line 12.

12. Vehicle operation expense: Using the IRS Local Standards and the number of vehicles for which you claim the

operating expenses, fill in the Operating Costs that apply for your Census region or metropolitan statistical area.

$316.00 

Official Form 122C-2 Chapter 13 Calculation of Your Disposable Income page 2 

Case 19-21842-AJC Doc 16 Filed 10/14/19 Page 2 of 9
Debtor 1 Ana Maria Restrepo Case number (if known) 19-21842

13. Vehicle ownership or lease expense: Using the IRS Local Standards, calculate the net ownership or lease

Vehicle 1 Describe Vehicle 1:

13a.

13b.

Ownership or leasing costs using IRS Local Standard. ................................................

Name of each creditor for Vehicle 1 Average monthly

payment

Copy

here  –

13c. expense

here 

Vehicle 1

Copy net

$508.00 

$184.00 $184.00 

$324.00 

Lincoln Financial Services $324.00 

+ 

Total average monthly payment $324.00 

....................

expense for each vehicle below. You may not claim the expense if you do not make any loan or lease payments on 

the vehicle. In addition, you may not claim the expense for more than two vehicles.

2019 Lincoln Nautilis

Average monthly payment for all debts secured by Vehicle 1.

Do not include costs for leased vehicles.

To calculate the average monthly payment here and on line 13e, add all 

amounts that are contractually due to each secured creditor in the 60 months 

after you file for bankruptcy. Then divide by 60.

Repeat this 

amount on 

line 33b.

Net Vehicle 1 ownership or lease expense.

Subtract line 13b from line 13a. If this number is less than $0, enter $0.

Vehicle 2 Describe Vehicle 2:

13d.

13e.

Ownership or leasing costs using IRS Local Standard. ................................................

Name of each creditor for Vehicle 2 Average monthly

payment

Copy

here  –

13f. expense

here 

Vehicle 2

Copy net

$0.00 

Total average monthly payment

........................

Average monthly payment for all debts secured by Vehicle 2. Do not include 

costs for leased vehicles.

Repeat this 

amount on 

line 33c.

Net Vehicle 2 ownership or lease expense.

Subtract line 13e from 13d. If this number is less than $0, enter $0.

14. Public transportation expense: If you claimed 0 vehicles in line 11, using the IRS Local Standards, fill in the Public

Transportation expense allowance regardless of whether you use public transportation.

$0.00 

15. Additional public transportation expense: If you claimed 1 or more vehicles in line 11 and if you claim that you may

also deduct a public transportation expense, you may fill in what you believe is the appropriate expense, but you may

$0.00 

not claim more than the IRS Local Standard for Public Transportation.

Official Form 122C-2 Chapter 13 Calculation of Your Disposable Income page 3 

Case 19-21842-AJC Doc 16 Filed 10/14/19 Page 3 of 9
Debtor 1 Ana Maria Restrepo Case number (if known) 19-21842

Other Necessary Expenses In addition to the expense deductions listed above, you are allowed your monthly expenses for the

following IRS categories.

16. Taxes: The total monthly amount that you actually pay for federal, state and local taxes, such as income taxes, self- $1,661.39 

employment taxes, social security taxes, and Medicare taxes. You may include the monthly amount withheld from 

your pay for these taxes. However, if you expect to receive a tax refund, you must divide the expected refund by 12 

and subtract that number from the total monthly amount that is withheld to pay for taxes.

Do not include real estate, sales, or use taxes.

17. Involuntary deductions: The total monthly payroll deductions that your job requires, such as retirement contributions, $0.00 

union dues, and uniform costs.

Do not include amounts that are not required by your job, such as voluntary 401(k) contributions or payroll savings.

18. Life insurance: The total monthly premiums that you pay for your own term life insurance. If two married people are $0.00 

filing together, include payments that you make for your spouse's term life insurance.

Do not include premiums for life insurance on your dependents, for a non-filing spouse's life insurance, or for any 

form of life insurance other than term.

19. Court-ordered payments: The total monthly amount that you pay as required by the order of a court or administrative $0.00 

agency, such as spousal or child support payments.

Do not include payments on past due obligations for spousal or child support. You will list these obligations in line 35.

20. Education: The total monthly amount that you pay for education that is either required: $0.00 





as a condition for your job, or

for your physically or mentally challenged dependent child if no public education is available for similar services.

21. Childcare: The total monthly amount that you pay for childcare, such as babysitting, daycare, nursery, and preschool.

Do not include payments for any elementary or secondary school education.

$0.00 

22. Additional health care expenses, excluding insurance costs: The monthly amount that you pay for health care that $0.00 

is required for the health and welfare of you or your dependents and that is not reimbursed by insurance or paid by a 

health savings account. Include only the amount that is more than the total entered in line 7.

Payments for health insurance or health savings accounts should be listed only in line 25.

23. Optional telephones and telephone services: The total monthly amount that you pay for telecommunication services + $0.00 

for you and your dependents, such as pagers, call waiting, caller identification, special long distance, or business cell 

phone service, to the extent necessary for your health and welfare or that of your dependents or for the production 

of income, if it is not reimbursed by your employer.

Do not include payments for basic home telephone, internet and cell phone service. Do not include self-employment 

expenses, such as those reported on line 5 of Official Form 122C-1, or any amount you previously deducted.

24. Add all of the expenses allowed under the IRS expense allowances.

Add lines 6 through 23. $5,625.39 

Additional Expense Deductions These are additional deductions allowed by the Means Test.

Note: Do not include any expense allowances listed in lines 6-24.

25. Health insurance, disability insurance, and health savings account expenses. The monthly expenses for health

Health insurance

Disability insurance

Health savings account

Total Copy total here 

+ 

...................................................

Do you actually spend this total amount?





No. How much do you actually spend?

Yes

$212.00 

$56.18 

$0.00 

$268.18 $268.18 

insurance, disability insurance, and health savings accounts that are reasonably necessary for yourself, your 

spouse, or your dependents.

26. Continued contributions to the care of household or family members. The actual monthly expenses that you $0.00 

will continue to pay for the reasonable and necessary care and support of an elderly, chronically ill, or disabled 

member of your household or member of your immediate family who is unable to pay for such expenses. These 

expenses may include contributions to an account of a qualified ABLE program. 26 U.S.C. § 529A(b).

27. Protection against family violence. The reasonably necessary monthly expenses that you incur to maintain the $0.00 

safety of you and your family under the Family Violence Prevention and Services Act or other federal laws that apply.

By law, the court must keep the nature of these expenses confidential.

Official Form 122C-2 Chapter 13 Calculation of Your Disposable Income page 4 

Case 19-21842-AJC Doc 16 Filed 10/14/19 Page 4 of 9
Debtor 1 Ana Maria Restrepo Case number (if known) 19-21842

28. Additional home energy costs. Your home energy costs are included in your insurance and operating expenses

on line 8.

If you believe that you have home energy costs that are more than the home energy costs included in expenses on 

line 8, then fill in the excess amount of home energy costs.

You must give your case trustee documentation of your actual expenses, and you must show that the additional 

amount claimed is reasonable and necessary.

29. Education expenses for dependent children who are younger than 18. The monthly expenses (not more than $0.00 

$170.83* per child) that you pay for your dependent children who are younger than 18 years old to attend a private or 

public elementary or secondary school.

You must give your case trustee documentation of your actual expenses, and you must explain why the amount 

claimed is reasonable and necessary and not already accounted for in lines 6-23.

* Subject to adjustment on 4/01/22, and every 3 years after that for cases begun on or after the date of adjustment.

30. Additional food and clothing expense. The monthly amount by which your actual food and clothing expenses are

higher than the combined food and clothing allowances in the IRS National Standards. That amount cannot be more 

than 5% of the food and clothing allowances in the IRS National Standards.

To find a chart showing the maximum additional allowance, go online using the link specified in the separate 

instructions for this form. This chart may also be available at the bankruptcy clerk's office.

You must show that the additional amount claimed is reasonable and necessary.

31. Continuing charitable contributions. The amount that you will continue to contribute in the form of cash or financial

instruments to a religious or charitable organization. 11 U.S.C. § 548(d)(3) and (4).

$208.33 

Do not include any amount more than 15% of your gross monthly income.

+ 

32. Add all of the additional expense deductions.

Add lines 25 though 31. $476.51 

Deductions for Debt Payment

33.

Mortgages on your home

33a. Copy line 9b here.................................................................................................. $0.00 

Loans on your first two vehicles

33b. Copy line 13b here................................................................................................ $324.00 

33c. Copy line 13e here................................................................................................ $0.00 

Copy total

here  $324.00 

Name of each creditor for

other secured debt

Identify property that

secures the debt





No

Yes

Does payment

include taxes or

insurance?





No

Yes





No

Yes

+ 

33e. Total average monthly payment. Add lines 33a through 33d.................................... $324.00 







33d. List other secured debts:

For debts that are secured by an interest in property that you own, including home mortgages, vehicle 

loans, and other secured debt, fill in lines 33a through 33e.

To calculate the total average monthly payment, add all amounts that are contractually due to each secured creditor in 

the 60 months after you file for bankruptcy. Then divide by 60.

Average monthly

payment

Official Form 122C-2 Chapter 13 Calculation of Your Disposable Income page 5 

Case 19-21842-AJC Doc 16 Filed 10/14/19 Page 5 of 9
Debtor 1 Ana Maria Restrepo Case number (if known) 19-21842

34.

 No.

 Yes.

Go to line 35.

Name of the creditor Identify property that

secures the debt

Total cure

amount

÷ 60 =

÷ 60 =

÷ 60 = + 

Copy total Total $0.00 here  $0.00 

Monthly cure

amount

Are any debts that you listed in line 33 secured by your primary residence, a vehicle, or other property 

necessary for your support or the support of your dependents?

State any amount that you must pay to a creditor, in addition to the payments listed in line 33, to keep 

possession of your property (called the cure amount). Next, divide by 60 and fill in the information below.

35.

 No.

 Yes.

Go to line 36.

Total amount of all past-due priority claims....................................................... $0.00 

Do you owe any priority claims--such as a priority tax, child support, or

11 U.S.C. § 507.

alimony--that are past due as of the filing date of your bankruptcy case?

÷ 60 =

Fill in the total amount of all of these priority claims. Do not include 

current or ongoing priority claims, such as those you listed in line 19.

36. Projected monthly Chapter 13 plan payment

Average monthly administrative expense

$200.00 

X 10 

Copy total $20.00 here  $20.00 

%

Current multiplier for your district as stated on the list issued by the Administrative 

Office of the United States Courts (for districts in Alabama and North Carolina) or 

by the Executive Office for United States Trustees (for all other districts).

To find a list of district multipliers that includes your district, go online using the link 

specified in the separate instructions for this form. This list may also be available 

at the bankruptcy clerk's office.

37. Add all of the deductions for debt payment.

Add lines 33g through 36. $344.00 

Total Deductions from Income

38. Add all of the allowed deductions.

Copy line 24, All of the expenses allowed under IRS expense allowances................... $5,625.39 

Copy line 32, All of the additional expense deductions.................................................. $476.51 

Copy line 37, All of the deductions for debt payment..................................................... + $344.00 

Total deductions $6,445.90 $6,445.90 

Copy total

here 

Part 2: Determine Your Disposable Income Under 11 U.S.C. § 1325(b)(2)

39. Copy your total current monthly income from line 14 of Form 122C-1, Chapter 13

Statement of Your Current Monthly Income and Calculation of Commitment Period. $7,655.65 .................................................

Official Form 122C-2 Chapter 13 Calculation of Your Disposable Income page 6 

Case 19-21842-AJC Doc 16 Filed 10/14/19 Page 6 of 9
Debtor 1 Ana Maria Restrepo Case number (if known) 19-21842

40. Fill in any reasonably necessary income you receive for support of dependent children.

The monthly average of any child support payments, foster care payments, or 

disability payments for a dependent child, reported in Part 1 of Form 122C-1, that 

you received in accordance with applicable nonbankruptcy law to the extent 

reasonably necessary to be expended for such child.

41. Fill in all qualified retirement deductions.

$1,217.28 

The monthly total of all amounts that

your employer withheld from wages as contributions for qualified retirement 

plans, as specified in 11 U.S.C. § 541(b)(7) plus all required repayments of loans 

from retirement plans, as specified in 11 U.S.C. § 362(b)(19).

42. Total of all deductions allowed under 11 U.S.C. § 707(b)(2)(A).

Copy line 38 here....................................................................................................... $6,445.90 

43. Deduction for special circumstances. If special circumstances justify additional

Describe the special circumstances Amount of expense

+ 

Total

Copy $0.00 here  + $0.00 

expenses and you have no reasonable alternative, describe the special 

circumstances and their expenses. You must give your case trustee a detailed 

explanation of the special circumstances and documentation for the expenses.

44. Total adjustments. Add lines 40 through 43................................................................ $7,663.18 $7,663.18 

Copy

here  –

45. Calculate your monthly disposable income under § 1325(b)(2). Subtract line 44 from line 39. ($7.53) 

Part 3: Change in Income or Expenses

46. Change in income or expenses. If the income in Form 122C-1 or the expenses you reported in this form have changed or are

Form Line Reason for change Date of change Increase or Amount of change

decrease?





122C-1

122C-2

 Increase

 Decrease





122C-1

122C-2

 Increase

 Decrease





122C-1

122C-2

 Increase

 Decrease





122C-1

122C-2

 Increase

 Decrease

virtually certain to change after the date you filed your bankruptcy petition and during the time your case will be open, fill in the 

information below. For example, if the wages reported increased after you filed your petition, check 122C-1 in the first column, enter 

line 2 in the second column, explain why the wages increased, fill in when the increase occurred, and fill in the amount of the 

increase.

Official Form 122C-2 Chapter 13 Calculation of Your Disposable Income page 7 

Case 19-21842-AJC Doc 16 Filed 10/14/19 Page 7 of 9
Debtor 1 Ana Maria Restrepo Case number (if known) 19-21842

By signing here, under penalty of perjury you declare that the information on this statement and in any attachments is true and correct.

Date Date

X X

Ana Maria Restrepo, Debtor 1 Signature of Debtor 2

10/8/2019

/s/ Ana Maria Restrepo

Part 4: Sign Below

MM / DD / YYYY MM / DD / YYYY

Official Form 122C-2 Chapter 13 Calculation of Your Disposable Income page 8 

Case 19-21842-AJC Doc 16 Filed 10/14/19 Page 8 of 9
Current Monthly Income Calculation Details

In re: Case Number: 19-21842

Chapter: 13

Ana Maria Restrepo

Gross wages, salary, tips, bonuses, overtime and commissions.

Debtor or Spouse's Income Description (if available)

2.

6

Months

Ago

5

Months

Ago

4

Months

Ago

3

Months

Ago

2

Months

Ago

Last

Month

Avg.

Per

Month

$8,115.12 

Debtor University of Miami

$8,115.12 $8,115.12 $8,115.12 $8,115.12 $8,115.12 $8,115.12 

Net income from operating a business, profession or farm.

Debtor or Spouse's Income Description (if available)

5.

6

Months

Ago

5

Months

Ago

4

Months

Ago

3

Months

Ago

2

Months

Ago

Last

Month

Avg.

Per

Month

$0.00 

Debtor Self-Employment-Miami Ostomy Aftercare

Gross receipts $0.00 $0.00 $0.00 $2,884.25 $0.00 $480.71 

Ordinary/necessary business expenses

Business income

$0.00 $117.66 $3,063.20 $2,185.70 $274.55 $0.00 $940.18 

$0.00 ($117.66) ($3,063.20) ($2,185.70) $2,609.70 $0.00 ($459.47) 

Computer software provided by LegalPRO Systems, Inc., San Antonio, Texas (210) 561-5300, Copyright 1996-2018

Case 19-21842-AJC Doc 16 Filed 10/14/19 Page 9 of 9