Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 1 

Official Form 101

Voluntary Petition for Individuals Filing for Bankruptcy /

The bankruptcy forms use you and Debtor 1 to refer to a debtor filing alone. A married couple may file a bankruptcy case together called a 

joint case and in joint cases, these forms use you to ask for information from both debtors. For example, if a form ask ,

the answer would be yes if either debtor owns a car. When information is needed about the spouses separately, the form uses Debtor 1 and 

Debtor 2 to distinguish between them. In joint cases, one of the spouses must report information as Debtor 1 and the other as Debtor 2. The 

same person must be Debtor 1 in all of the forms. 

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

information. If more space is needed, attach a separate sheet to this form. On the top of any additional pages, write your name and case number 

(if known). Answer every question. 

Part 1: Identify Yourself

About Debtor 1: About Debtor 2 (Spouse Only in a Joint Case):

1. Your full name

Write the name that is on your

government-issued picture

identification (for example,

passport).

Bring your picture

identification to your meeting

with the trustee.

__________________________________________________

First name

__________________________________________________

Middle name

__________________________________________________

Last name

___________________________

Suffix (Sr., Jr., II, III)

__________________________________________________

First name

__________________________________________________

Middle name

__________________________________________________

Last name

___________________________

Suffix (Sr., Jr., II, III)

2. All other names you

have used in the last 8

years

Include your married or

maiden names.

__________________________________________________

First name

__________________________________________________

Middle name

__________________________________________________

Last name

__________________________________________________

First name

__________________________________________________

Middle name

__________________________________________________

Last name

__________________________________________________

First name

__________________________________________________

Middle name

__________________________________________________

Last name

__________________________________________________

First name

__________________________________________________

Middle name

__________________________________________________

Last name

3. Only the last 4 digits of

your Social Security

number or federal

Individual Taxpayer

Identification number

(ITIN)

xxx xx ____ ____ ____ ____

OR

9 xx xx ____ ____ ____ ____

xxx xx ____ ____ ____ ____

OR

9 xx xx ____ ____ ____ ____

United States Bankruptcy Court for the: 

________________ District of ________

Case number (If known): _________________________ Chapter you are filing under: 

Chapter 7 

Chapter 11

Chapter 12

Chapter 13

Fill in this information to identify your case:

Check if this is an

amended filing

Case 21-19709-RAM Doc 1 Filed 10/08/21 Page 1 of 10
Debtor 1 _______________________________________________________ Case number (if known)_____________________________________ 

First Name Middle Name Last Name

Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 2 

About Debtor 1: About Debtor 2 (Spouse Only in a Joint Case): 

4. Any business names 

and Employer 

Identification Numbers 

(EIN) you have used in 

the last 8 years 

Include trade names and 

doing business as names 

I have not used any business names or EINs.

_________________________________________________ 

Business name

_________________________________________________ 

Business name 

___ ___ ___ ___ ___ ___ ___ ___ ___ 

EIN 

___ ___ ___ ___ ___ ___ ___ ___ ___ 

EIN 

I have not used any business names or EINs.

_________________________________________________ 

Business name

_________________________________________________ 

Business name 

___ ___ ___ ___ ___ ___ ___ ___ ___ 

EIN 

___ ___ ___ ___ ___ ___ ___ ___ ___ 

EIN 

5. Where you live 

_________________________________________________ 

Number Street 

_________________________________________________ 

_________________________________________________ 

City State ZIP Code 

_________________________________________________ 

County 

If your mailing address is different from the one 

above, fill it in here. Note that the court will send 

any notices to you at this mailing address.

_________________________________________________ 

Number Street 

_________________________________________________ 

P.O. Box 

_________________________________________________ 

City State ZIP Code 

If Debtor 2 lives at a different address: 

_________________________________________________ 

Number Street 

_________________________________________________ 

_________________________________________________ 

City State ZIP Code 

_________________________________________________ 

County 

If mailing address is different from 

yours, fill it in here. Note that the court will send 

any notices to this mailing address.

_________________________________________________ 

Number Street 

_________________________________________________ 

P.O. Box 

_________________________________________________ 

City State ZIP Code 

6. Why you are choosing 

this district to file for 

bankruptcy 

Check one: 

Over the last 180 days before filing this petition, 

I have lived in this district longer than in any 

other district. 

I have another reason. Explain. 

(See 28 U.S.C. § 1408.) 

________________________________________ 

________________________________________ 

________________________________________ 

________________________________________ 

Check one: 

Over the last 180 days before filing this petition, 

I have lived in this district longer than in any 

other district. 

I have another reason. Explain. 

(See 28 U.S.C. § 1408.) 

________________________________________ 

________________________________________ 

________________________________________ 

________________________________________

Case 21-19709-RAM Doc 1 Filed 10/08/21 Page 2 of 10
Debtor 1 _______________________________________________________ Case number (if known)_____________________________________ 

First Name Middle Name Last Name

Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 3 

Part 2: Tell the Court About Your Bankruptcy Case

7. The chapter of the 

Bankruptcy Code you 

are choosing to file 

under 

Check one. (For a brief description of each, see Notice Required by 11 U.S.C. § 342(b) for Individuals Filing 

for Bankruptcy (Form 2010)). Also, go to the top of page 1 and check the appropriate box. 

Chapter 7 

Chapter 11 

Chapter 12 

Chapter 13

8. How you will pay the fee I will pay the entire fee when I file my petition. 

local court for more details about how you may pay. Typically, if you are paying the fee 

yourself, you may attorney is 

submitting your payment on your behalf, your attorney may pay with a credit card or check 

with a pre-printed address. 

I need to pay the fee in installments. If you choose this option, sign and attach the 

Application for Individuals to Pay The Filing Fee in Installments (Official Form 103A).

I request that my fee be waived (You may request this option only if you are filing for Chapter 7. 

By law, a judge may, but is not required to, waive your fee, and may do so only if your income is 

less than 150% of the official poverty line that applies to your family size and you are unable to 

pay the fee in installments). If you choose this option, you must fill out the Application to Have the 

Chapter 7 Filing Fee Waived (Official Form 103B) and file it with your petition. 

9. Have you filed for 

bankruptcy within the 

last 8 years?

No 

Yes. District __________________________ When _______________ Case number ___________________________

 MM / DD / YYYY

District __________________________ When _______________ Case number ___________________________

 MM / DD / YYYY

 District __________________________ When _______________ Case number ___________________________ 

 MM / DD / YYYY

10. Are any bankruptcy 

cases pending or being 

filed by a spouse who is 

not filing this case with 

you, or by a business 

partner, or by an 

affiliate?

 No

Yes. Debtor _________________________________________________ Relationship to you _____________________

 District __________________________ When _______________ Case number, if known____________________ 

 MM / DD / YYYY

 Debtor _________________________________________________ Relationship to you _____________________ 

District __________________________ When _______________ Case number, if known____________________

 MM / DD / YYYY

11. Do you rent your 

residence?

No. Go to line 12.

Yes. Has your landlord obtained an eviction judgment against you?

No. Go to line 12.

Yes. Fill out Initial Statement About an Eviction Judgment Against You (Form 101A) and file it as 

part of this bankruptcy petition.

Case 21-19709-RAM Doc 1 Filed 10/08/21 Page 3 of 10
Debtor 1 _______________________________________________________ Case number (if known)_____________________________________ 

First Name Middle Name Last Name

Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 4 

Part 3: Report About Any Businesses You Own as a Sole Proprietor

12. Are you a sole proprietor

of any full- or part-time

business?

A sole proprietorship is a

business you operate as an

individual, and is not a

separate legal entity such as

a corporation, partnership, or

LLC.

If you have more than one

sole proprietorship, use a

separate sheet and attach it

to this petition.

No. Go to Part 4.

Yes. Name and location of business

_______________________________________________________________________________________

Name of business, if any

_______________________________________________________________________________________

Number Street

_______________________________________________________________________________________

_______________________________________________ _______ __________________________

City State ZIP Code

Check the appropriate box to describe your business:

Health Care Business (as defined in 11 U.S.C. § 101(27A))

Single Asset Real Estate (as defined in 11 U.S.C. § 101(51B))

Stockbroker (as defined in 11 U.S.C. § 101(53A))

Commodity Broker (as defined in 11 U.S.C. § 101(6))

None of the above

13. Are you filing under

Chapter 11 of the

Bankruptcy Code and

are you a small business

debtor

?

For a definition of small

business debtor, see

11 U.S.C. § 101(51D).

If you are filing under Chapter 11, the court must know whether you are a small business debtor

so that it can set appropriate deadlines. If you indicate that you

are a small business debtor , you must attach your

most recent balance sheet, statement of operations, cash-flow statement, and federal income tax return or 

if any of these documents do not exist, follow the procedure in 11 U.S.C. § 1116(1)(B).

No. I am not filing under Chapter 11.

No. I am filing under Chapter 11, but I am NOT a small business debtor according to the definition in

the Bankruptcy Code. 

Case 21-19709-RAM Doc 1 Filed 10/08/21 Page 4 of 10
Debtor 1 _______________________________________________________ Case number (if known)_____________________________________ 

First Name Middle Name Last Name

Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 5 

Part 4: Report if You Own or Have Any Hazardous Property or Any Property That Needs Immediate Attention

14. Do you own or have any

property that poses or is

alleged to pose a threat

of imminent and

identifiable hazard to

public health or safety?

Or do you own any

property that needs

immediate attention?

For example, do you own

perishable goods, or livestock

that must be fed, or a building

that needs urgent repairs?

No

Yes. What is the hazard? ________________________________________________________________________

________________________________________________________________________ 

If immediate attention is needed, why is it needed? _______________________________________________

________________________________________________________________________ 

Where is the property? ________________________________________________________________________ 

Number Street 

________________________________________________________________________ 

________________________________________ _______ ____________________ 

City State ZIP Code 

Case 21-19709-RAM Doc 1 Filed 10/08/21 Page 5 of 10
Debtor 1 _______________________________________________________ Case number (if known)_____________________________________ 

First Name Middle Name Last Name

Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page

Part 5: Explain Your Efforts to Receive a Briefing About Credit Counseling

15. Tell the court whether

you have received a

briefing about credit

counseling.

The law requires that you 

receive a briefing about credit 

counseling before you file for 

bankruptcy. You must 

truthfully check one of the 

following choices. If you 

cannot do so, you are not 

eligible to file.

If you file anyway, the court 

can dismiss your case, you 

will lose whatever filing fee 

you paid, and your creditors 

can begin collection activities 

again.

About Debtor 1: About Debtor 2 (Spouse Only in a Joint Case):

You must check one:

I received a briefing from an approved credit 

counseling agency within the 180 days before I

filed this bankruptcy petition, and I received a 

certificate of completion. 

Attach a copy of the certificate and the payment 

plan, if any, that you developed with the agency.

I received a briefing from an approved credit 

counseling agency within the 180 days before I

filed this bankruptcy petition, but I do not have a 

certificate of completion. 

Within 14 days after you file this bankruptcy petition,

you MUST file a copy of the certificate and payment 

plan, if any.

I certify that I asked for credit counseling 

services from an approved agency, but was

unable to obtain those services during the 7

days after I made my request, and exigent

circumstances merit a 30-day temporary waiver 

of the requirement.

To ask for a 30-day temporary waiver of the 

requirement, attach a separate sheet explaining

what efforts you made to obtain the briefing, why 

you were unable to obtain it before you filed for 

bankruptcy, and what exigent circumstances 

required you to file this case.

Your case may be dismissed if the court is 

dissatisfied with your reasons for not receiving a

briefing before you filed for bankruptcy.

If the court is satisfied with your reasons, you must 

still receive a briefing within 30 days after you file. 

You must file a certificate from the approved 

agency, along with a copy of the payment plan you 

developed, if any. If you do not do so, your case 

may be dismissed.

Any extension of the 30-day deadline is granted 

only for cause and is limited to a maximum of 15 

days. 

I am not required to receive a briefing about 

credit counseling because of:

Incapacity. I have a mental illness or a mental

deficiency that makes me

incapable of realizing or making 

rational decisions about finances. 

Disability. My physical disability causes me

to be unable to participate in a

briefing in person, by phone, or 

through the internet, even after I

reasonably tried to do so.

Active duty. I am currently on active military

duty in a military combat zone.

If you believe you are not required to receive a

briefing about credit counseling, you must file a 

motion for waiver of credit counseling with the court.

You must check one:

I received a briefing from an approved credit

counseling agency within the 180 days before I

filed this bankruptcy petition, and I received a 

certificate of completion. 

Attach a copy of the certificate and the payment 

plan, if any, that you developed with the agency.

I received a briefing from an approved credit

counseling agency within the 180 days before I

filed this bankruptcy petition, but I do not have a 

certificate of completion. 

Within 14 days after you file this bankruptcy petition, 

you MUST file a copy of the certificate and payment 

plan, if any.

I certify that I asked for credit counseling

services from an approved agency, but was

unable to obtain those services during the 7

days after I made my request, and exigent

circumstances merit a 30-day temporary waiver 

of the requirement.

To ask for a 30-day temporary waiver of the 

requirement, attach a separate sheet explaining 

what efforts you made to obtain the briefing, why 

you were unable to obtain it before you filed for 

bankruptcy, and what exigent circumstances 

required you to file this case.

Your case may be dismissed if the court is 

dissatisfied with your reasons for not receiving a

briefing before you filed for bankruptcy.

If the court is satisfied with your reasons, you must 

still receive a briefing within 30 days after you file. 

You must file a certificate from the approved 

agency, along with a copy of the payment plan you 

developed, if any. If you do not do so, your case 

may be dismissed.

Any extension of the 30-day deadline is granted 

only for cause and is limited to a maximum of 15 

days. 

I am not required to receive a briefing about

credit counseling because of:

Incapacity. I have a mental illness or a mental

deficiency that makes me

incapable of realizing or making 

rational decisions about finances. 

Disability. My physical disability causes me

to be unable to participate in a

briefing in person, by phone, or 

through the internet, even after I

reasonably tried to do so.

Active duty. I am currently on active military

duty in a military combat zone.

If you believe you are not required to receive a

briefing about credit counseling, you must file a

motion for waiver of credit counseling with the court.

Case 21-19709-RAM Doc 1 Filed 10/08/21 Page 6 of 10
Case 21-19709-RAM Doc 1 Filed 10/08/21 Page 7 of 10
Debtor 1 _______________________________________________________ Case number (if known)_____________________________________ 

First Name Middle Name Last Name

Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page

For your attorney, if you are 

represented by one

If you are not represented 

by an attorney, you do not 

need to file this page.

I, the attorney for the debtor(s) named in this petition, declare that I have informed the debtor(s) about eligibility 

to proceed under Chapter 7, 11, 12, or 13 of title 11, United States Code, and have explained the relief 

available under each chapter for which the person is eligible. I also certify that I have delivered to the debtor(s) 

the notice required by 11 U.S.C. § 342(b) and, in a case in which § 707(b)(4)(D) applies, certify that I have no 

knowledge after an inquiry that the information in the schedules filed with the petition is incorrect. 

_________________________________ Date _________________

Signature of Attorney for Debtor MM / DD / YYYY

_________________________________________________________________________________________________

Printed name

_________________________________________________________________________________________________

Firm name

_________________________________________________________________________________________________

Number Street

_________________________________________________________________________________________________

______________________________________________________ ____________ ______________________________

City State ZIP Code 

Contact phone _____________________________________ Email address ______________________________

______________________________________________________ ____________

Bar number State

Case 21-19709-RAM Doc 1 Filed 10/08/21 Page 8 of 10
Case 21-19709-RAM Doc 1 Filed 10/08/21 Page 9 of 10
Nationstar Mortgage

350 Highland Drive

Lewisville, TX 75067

c/o Robertson, Anschutz, Schneid, Crane

& Partners, PLLC

6409 Congress Avenue, Suite 100

Boca Raton, FL 33487

Case 21-19709-RAM Doc 1 Filed 10/08/21 Page 10 of 10