3. Security deposits held by utility companies, landlord No Yes 4. Household goods, furniture, including audio, video, and computer equipment No Yes 5. pictures, art objects, records, compact discs, collectibles No Yes 6. Clothing No Yes 7. Furs and jewelry No Yes
8. Sports, photographic, hobby equipment, firearms No Yes 9. Interest in insurance policies-specify refund or cancellation value No Yes 10. Annuities No Yes 11. Interests in an education IRA, as defined in 26 USC § 530(b)(1) No Yes 12. Interests in pension or profit sharing plans No Yes 13. and interests in incorporated/ unincorporated business No Yes 14. Interests in partnerships/joint ventures No Yes 15. Bonds No Yes 16. Accounts receivable No Yes 17. Alimony/family support to you are entitled No Yes 18. Other liquidated debts owed to you, including tax refunds No Yes 19. Equitable or future interests or life estates No Yes
20. Interests in estate of decedent or life insurance plan or trust No Yes 21. Other contingent/ unliquidated claims, including tax refunds, counterclaims No Yes 22. Patents, copyrights, intellectual property No Yes 23. Licenses, franchises No Yes 24. Customer List or other compilation No Yes 25. Automobiles, trucks, trailers, and accessories No Yes 26. Boats, motors, and accessories No Yes 27. Aircraft and accessories No Yes 28. Office equipment, supplies No Yes 29. Machinery, fixtures etc. for business No Yes
Home loan and/or Mortgage 1. Amount Owed (amount of 2. Creditor Name and Address: 3. Account Number, if any: 4. Date/range of dates when debt was incurred: 5. Contact person's name and address if different: 1. Describe property: 2. Monthly payment amount: 3. Number of payments remaining: Is there a codebtor or cosigner on this loan? No Yes If yes, please provide name and address: No Yes Home loan and/or Mortgage 1. Amount Owed (amount of claim): 2. Creditor Name and Address: 3. Account Number, if any: 4. of dates when debt was incurred: 5. Contact person's name and address if different: 1. Describe property: 2. Monthly payment amount: 3. Number of payments remaining: Is there a codebtor or cosigner on this loan? No Yes If yes, please provide name and address: No Yes
Home loan and/or Mortgage 1. Amount Owed (amount of claim): 2. Creditor Name and Address: 3. Account Number, if any: 4. Date/range of dates when debt was incurred: 5. Contact person's name and address if different: 1. Describe property: 2. Monthly payment amount: 3. Number of payments remaining: Is there a codebtor or cosigner on this loan? No Yes If yes, please provide name and address: No Yes Home loan and/or Mortgage 1. Amount Owed (amount of 2. Creditor Name and Address: 3. Account Number, if any: 4. Date/range of dates when debt was incurred: 5. Contact person's name and address if different: 1. Describe property: 2. Monthly payment amount: 3. Number of payments remaining: Is there a codebtor or cosigner on this loan? No Yes If yes, please provide name and address: No Yes
Car 1. Amount Owed (amount of 2. Creditor Name and Address: 3. Account Number, if any: 4. Date/range of dates when debt was incurred: 5. Contact person's name and address if different: 1. Describe property: 2. Monthly payment amount: 3. Number of payments remaining: Is there a codebtor or cosigner on this loan? No Yes If yes, please provide name and address: No Yes Car loans 1. Amount Owed (amount of claim): 2. Creditor Name and Address: 3. Account Number, if any: 4. of dates when debt was incurred: 5. Contact person's name and address if different: 1. Describe property: 2. Monthly payment amount: 3. Number of payments remaining: Is there a codebtor or cosigner on this loan? No Yes If yes, please provide name and address: No Yes
Property loans 1. Amount Owed (amount of claim): 2. Creditor Name and Address: 3. Account Number, if any: 4. Date/range of dates when debt was incurred: 5. Contact person's name and address if different: 1. Describe property: 2. Monthly payment amount: 3. Number of payments remaining: Is there a codebtor or cosigner on this loan? No Yes If yes, please provide name and address: No Yes Other Property loans 1. Amount Owed (amount of claim): 2. Creditor Name and Address: 3. Account Number, if any: 4. of dates when debt was incurred: 5. Contact person's name and address if different: 1. Describe property: 2. Monthly payment amount: 3. Number of payments remaining: Is there a codebtor or cosigner on this loan? No Yes If yes, please provide name and address: No Yes
Major credit card debts (Visa, American Express, Master Card, Discover) 1. Amount Owed (amount of claim): 2. Creditor Name and Address: 3. Account Number, if any: 4. Date/range of dates when debt was incurred: 5. Contact person's name and address if different: Is there a codebtor or cosigner on this loan? No Yes If yes, please provide name and address: No Yes Major credit card debts (Visa, American Express, Master Card, Discover) 1. Amount Owed (amount of 2. Creditor Name and Address: 3. Account Number, if any: 4. Date/range of dates when debt was incurred: 5. Contact person's name and address if different: Is a codebtor or cosigner on this loan? No Yes If yes, please provide name and address: No Yes
credit card debts (Visa, American Express, Master Card, Discover) 1. Amount Owed (amount of 2. Creditor Name and Address: 3. Account Number, if any: 4. Date/range of dates when debt was incurred: 5. Contact person's name and address if different: Is a codebtor or cosigner on this loan? No Yes If yes, please provide name and address: No Yes Major credit card debts (Visa, American Express, Master Card, Discover) 1. Amount Owed (amount of claim): 2. Creditor Name and Address: 3. Account Number, if any: 4. Date/range of dates when debt was incurred: 5. Contact person's name and address if different: Is there a codebtor or cosigner on this loan? No Yes If yes, please provide name and address: No Yes
Unpaid Medical Bills 1. Amount Owed (amount of claim): 2. Creditor Name and Address: 3. Account Number, if any: 4. of dates when debt was incurred: 5. Contact person's name and address if different: 6. Any additional information about the debt: Is there a codebtor or cosigner on this loan? No Yes If yes, please provide name and address: No Yes Unpaid Medical Bills 1. Amount Owed (amount of claim): 2. Creditor Name and Address: 3. Account Number, if any: 4. Date/range of dates when debt was incurred: 5. Contact person's name and address if different: 6. Any additional information about the debt: Is there a codebtor or cosigner on this loan? No Yes If yes, please provide name and address: No Yes
Unpaid 1. Amount Owed (amount of 2. Creditor Name and Address: 3. Account Number, if any: 4. Date/range of dates when debt was incurred: 5. Contact person's name and address if different: 6. Any additional information the debt: Is there a codebtor or cosigner on this loan? No Yes If yes, please provide name and address: No Yes Unpaid taxes 1. Amount Owed (amount of claim): 2. Creditor Name and Address: 3. Account Number, if any: 4. Date/range of dates when debt was incurred: 5. Contact person's name and address if different: 6. Any additional information the debt: Is there a codebtor or cosigner on this loan? No Yes If yes, please provide name and address: No Yes