Official Form 122A-1Supp

Statement of Exemption from Presumption of Abuse Under § 707(b)(2) 12/15 

Part 1: Identify the Kind of Debts You Have

1.

 Check if this is an amended filing

Are your debts primarily consumer debts? Consumer debts are defined in 11 U.S.C. § 101(8) as "incurred by an individual primarily for a

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)

Clifford Ryan Morris

SOUTHERN DISTRICT OF FLORIDA

21-20416-MAM





No.

Yes.

personal, family or household purpose." Make sure that your answer is consistent with the answer you gave at line 16 of the Voluntary

Petition for Individuals Filing for Bankruptcy (Official Form 101).

Go to Form 122A-1; on the top of page 1 of that form, check box 1, There is no presumption of abuse, and sign Part 3. Then

submit this supplement with the signed Form 122A-1.

Go to Part 2.

File this supplement together with Chapter 7 Statement of Your Current Monthly Income (Official Form 122A-1), if you believe 

that you are exempted from a presumption of abuse. Be as complete and accurate as possible. If two married people are 

filing together, and any of the exclusions in this statement applies to only one of you, the other person should complete a 

separate Form 122A-1 if you believe that this is required by 11 U.S.C. § 707(b)(2)(C).

Part 2: Determine Whether Military Service Provisions Apply to You

2. Are you a disabled veteran (as defined in 38 U.S.C. § 3741(1))?

 No. Go to line 3.

 Yes. Did you incur debts mostly while you were on active duty or while you were performing a homeland defense activity?

10 U.S.C. § 101(d)(1); 32 U.S.C. § 901(1).





No.

Yes.

Go to line 3.

Go to Form 122A-1; on the top of page 1 of that form, check box 1, There is no presumption of abuse, and sign Part 3.

Then submit this supplement with the signed Form 122A-1.

3. Are you or have you been a Reservist or member of the National Guard?

 No. Complete Form 122A-1. Do not submit this supplement.

 Yes. Were you called to active duty or did you perform a homeland defense activity? 10 U.S.C. § 101(d)(1); 32 U.S.C. § 901(1)

 No. Complete Form 122A-1. Do not submit this supplement.

 Yes. Check any one of the following categories that applies:





If you checked one of the categories to the left, go to

Form 122A-1. On the top of page 1 of Form 122A-1, check

box 3, The Means Test does not apply now and sign

Part 3. Then submit this supplement with the signed Form

122A-1. You are not required to fill out the rest of Official

Form 122A-1 during the exclusion period. The exclusion

period means the time you are on active duty or are 

performing a homeland defense activity, and for 540 days

afterward. 11 U.S.C. § 707(b)(2)(D)(ii).

If your exclusion period ends before your case is closed,

you may have to file an amended form later.





I was called to active duty after September 11, 2001,

for at least 90 days and remain on active duty.

I was called to active duty after September 11, 2001,

for at least 90 days and was released from active duty on

which is fewer than 540 days before I

file this bankruptcy case.

I am performing a homeland defense activity for at

least 90 days.

I performed a homeland defense activity for at

least 90 days, ending on , which is

fewer than 540 days before I file this bankruptcy case.

Official Form 122A-1Supp Statement of Exemption from Presumption of Abuse Under § 707(b)(2) page 1 

Case 21-20416-MAM Doc 14 Filed 11/24/21 Page 1 of 4
Official Form 122A-1

Chapter 7 Statement of Your Current Monthly Income 04/20 

Part 1: Calculate Your Current Monthly Income

1.

 Check if this is an amended filing

What is your marital and filing status? Check one only.

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)

Clifford Ryan Morris

SOUTHERN DISTRICT OF FLORIDA

21-20416-MAM







Not married.

Married and your spouse is filing with you.

Married and your spouse is NOT filing with you. You and your spouse are:

Fill out Column A, lines 2-11.

Fill out both Columns A and B, lines 2-11.

Fill out Column A, lines 2-11; do not fill out Column B. By checking this box, you

Fill in the average monthly income that you received from all sources, derived during the 6 full months before you file this

bankruptcy case. 11 U.S.C. § 101(10A). For example, if you are filing on September 15, the 6-month period would be March 1 through

Check one box only as directed in this

form and in Form 122A-1Supp:







1.

2.

3.

 Living in the same household and are not legally separated. Fill out both Columns A and B, lines 2-11.

 Living separately or are legally separated.

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). If you believe that you

are exempted from a presumption of abuse because you do not have primarily consumer debts or because of qualifying 

military service, complete and file Statement of Exemption from Presumption of Abuse Under § 707(b)(2) (Official Form 

122A-1Supp) with this form.

August 31. If the amount of your monthly income varied during the 6 months, add the income for all 6 months and divide the total by 6. Fill 

in the result. Do not include any income amount more than once. For example, if both spouses own the same rental property, put the 

income from that property in one column only. If you have nothing to report for any line, write $0 in the space.

There is no presumption of abuse.

The calculation to determine if a presumption 

of abuse applies will be made under Chapter 7 

Means Test Calculation (Official Form 122A-2).

The Means Test does not apply now because 

of qualified military service but it could apply 

later.

declare under penalty of perjury that you and your spouse are legally separated under nonbankruptcy law that applies or that you 

and your spouse are living apart for reasons that do not include evading the Means Test requirements. 11 U.S.C. § 707(b)(7)(B).

Column B

Debtor 2 or

Column A

Debtor 1

non-filing spouse

2. Your gross wages, salary, tips, bonuses, overtime, and commissions

(before all payroll deductions).

3. Alimony and maintenance payments. Do not include payments from a spouse

if Column B is filled in.

4. All amounts from any source which are regularly paid for household

expenses of you or your dependents, including child support. Include

regular contributions from an unmarried partner, members of your household, 

your dependents, parents, and roommates. Include regular contributions from 

a spouse only if Column B is not filled in. Do not include payments you listed 

on line 3.

Official Form 122A-1 Chapter 7 Statement of Your Current Monthly Income page 1 

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Debtor 1 Clifford Ryan Morris Case number (if known) 21-20416-MAM

Column B

Debtor 2 or

Column A

Debtor 1

non-filing spouse

5. Net income from operating a business, profession, or farm

Gross receipts (before all

Ordinary and necessary operating

Net monthly income from a business,

Copy

here 

–

Debtor 1 Debtor 2

– expenses

profession, or farm

deductions)

6. Net income from rental and other real property

Gross receipts (before all

Ordinary and necessary operating

Net monthly income from rental or

Copy

here 

–

Debtor 1 Debtor 2

– expenses

other real property

deductions)

7. Interest, dividends, and royalties

8. Unemployment compensation

For you...............................................................................

For your spouse.................................................................

Do not enter the amount if you contend that the amount received was a

benefit under the Social Security Act. Instead, list it here: .................

9. Pension or retirement income. Do not include any amount received that

was a benefit under the Social Security Act. Also, except as stated in the 

next sentence, do not include any compensation, pension, pay, annuity, or 

allowance paid by the United States Government in connection with a 

disability, combat-related injury or disability, or death of a member of the 

uniformed services. If you received any retired pay paid under chapter 61 

of title 10, then include that pay only to extent that it does not exceed the 

amount of retired pay to which you would otherwise be entitled if retired 

under any provision of title 10 other than chapter 61 of that title.

10. Income from all other sources not listed above. Specify the source and

amount. Do not include any benefits received under the Social Security Act; 

payments made under the Federal law relating to the national emergency 

declared by the President under the National Emergencies Act 

(50 U.S.C. 1601 et seq.) with respect to the coronavirus disease 2019 

(COVID-19); payments received as a victim of a war crime, a crime against 

humanity, or international or domestic terrorism; or compensation, pension, 

pay, annuity, or allowance paid by the United States Government in 

connection with a disability, combat-related injury or disability, or death of a 

member of the uniformed services. If necessary, list other sources on a 

separate page and put the total below.

Total amounts from separate pages, if any. + + 

Official Form 122A-1 Chapter 7 Statement of Your Current Monthly Income page 2 

Case 21-20416-MAM Doc 14 Filed 11/24/21 Page 3 of 4
Debtor 1 Clifford Ryan Morris Case number (if known) 21-20416-MAM

Column B

Debtor 2 or

Column A

Debtor 1

non-filing spouse

11. Calculate your total current monthly income.

+ =

Total current

monthly income

Add lines 2 through 10 for each column.

Then add the total for Column A to the total for Column B.

Part 2: Determine Whether the Means Test Applies to You

12. Calculate your current monthly income for the year. Follow these steps:

12a. Copy your total current monthly income from line 11.........................................................Copy line 11 here  12a.

Multiply by 12 (the number of months in a year). X 12

12b. The result is your annual income for this part of the form. 12b.

13. Calculate the median family income that applies to you. Follow these steps:

Fill in the state in which you live.

Fill in the number of people in your household.

Fill in the median family income for your state and size of household............................................................................... 13.

To find a list of applicable median income amounts, 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.

14. How do the lines compare?

14a.  Line 12b is less than or equal to line 13. On the top of page 1, check box 1,

Go to Part 3. Do NOT fill out or file Official Form 122A-2.

There is no presumption of abuse.

14b.  Line 12b is more than line 13. On the top of page 1, check box 2,

Go to Part 3 and fill out Form 122A-2.

The presumption of abuse is determined by Form 122A-2.

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

Date Date

X X

Clifford Ryan Morris, Debtor 1 Signature of Debtor 2

11/23/2021

/s/ Clifford Ryan Morris

Part 3: Sign Below

MM / DD / YYYY MM / DD / YYYY

If you checked line 14a, do NOT fill out or file Form 122A-2.

If you checked line 14b, fill out Form 122A-2 and file it with this form.

Official Form 122A-1 Chapter 7 Statement of Your Current Monthly Income page 3 

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