Official Form 107 "Statement of Financial Affairs for Individuals Filing for Bankruptcy"

What Is Official Form 107?

This is a legal form that was released by the United States Bankruptcy Court on April 1, 2019 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on April 1, 2019;
  • The latest available edition released by the United States Bankruptcy Court;
  • Easy to use and ready to print;
  • Yours to fill out and keep for your records;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Official Form 107 by clicking the link below or browse more documents and templates provided by the United States Bankruptcy Court.

ADVERTISEMENT
ADVERTISEMENT

Download Official Form 107 "Statement of Financial Affairs for Individuals Filing for Bankruptcy"

2096 times
Rate (4.6 / 5) 130 votes
Fill in this information to identify your case:
Debtor 1
__________________________________________________________________
First Name
Middle Name
Last Name
Debtor 2
________________________________________________________________
(Spouse, if filing)
First Name
Middle Name
Last Name
__________
__________ District of __________
United States Bankruptcy Court for the:
District of ______________
Case number
___________________________________________
Check if this is an
(If known)
amended filing
Official Form 107
Statement of Financial Affairs for Individuals Filing for Bankruptcy
04/19
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:
Give Details About Your Marital Status and Where You Lived Before
What is your current marital status?
1.
Married
Not married
During the last 3 years, have you lived anywhere other than where you live now?
2.
No
Yes. List all of the places you lived in the last 3 years. Do not include where you live now.
Debtor 1:
Dates Debtor 1
Debtor 2:
Dates Debtor 2
lived there
lived there
Same as Debtor 1
Same as Debtor 1
__________________________________________
From
___________________________________________
________
From
________
Number
Street
Number Street
To
To
_
________
_______
__________________________________________
___________________________________________
__________________________________________
___________________________________________
City
State ZIP Code
City
State ZIP Code
Same as Debtor 1
Same as Debtor 1
__________________________________________
From
___________________________________________
From
________
________
Number
Street
Number Street
To
________
To
_
_______
__________________________________________
___________________________________________
__________________________________________
___________________________________________
City
State ZIP Code
City
State
ZIP Code
Within the last 8 years, did you ever live with a spouse or legal equivalent in a community property state or territory? (Community property
3.
states and territories include Arizona, California, Idaho, Louisiana, Nevada, New Mexico, Puerto Rico, Texas, Washington, and Wisconsin.)
No
Yes. Make sure you fill out Schedule H: Your Codebtors (Official Form 106H).
Part 2:
Explain the Sources of Your Income
Official Form 107
Statement of Financial Affairs for Individuals Filing for Bankruptcy
page 1
Fill in this information to identify your case:
Debtor 1
__________________________________________________________________
First Name
Middle Name
Last Name
Debtor 2
________________________________________________________________
(Spouse, if filing)
First Name
Middle Name
Last Name
__________
__________ District of __________
United States Bankruptcy Court for the:
District of ______________
Case number
___________________________________________
Check if this is an
(If known)
amended filing
Official Form 107
Statement of Financial Affairs for Individuals Filing for Bankruptcy
04/19
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:
Give Details About Your Marital Status and Where You Lived Before
What is your current marital status?
1.
Married
Not married
During the last 3 years, have you lived anywhere other than where you live now?
2.
No
Yes. List all of the places you lived in the last 3 years. Do not include where you live now.
Debtor 1:
Dates Debtor 1
Debtor 2:
Dates Debtor 2
lived there
lived there
Same as Debtor 1
Same as Debtor 1
__________________________________________
From
___________________________________________
________
From
________
Number
Street
Number Street
To
To
_
________
_______
__________________________________________
___________________________________________
__________________________________________
___________________________________________
City
State ZIP Code
City
State ZIP Code
Same as Debtor 1
Same as Debtor 1
__________________________________________
From
___________________________________________
From
________
________
Number
Street
Number Street
To
________
To
_
_______
__________________________________________
___________________________________________
__________________________________________
___________________________________________
City
State ZIP Code
City
State
ZIP Code
Within the last 8 years, did you ever live with a spouse or legal equivalent in a community property state or territory? (Community property
3.
states and territories include Arizona, California, Idaho, Louisiana, Nevada, New Mexico, Puerto Rico, Texas, Washington, and Wisconsin.)
No
Yes. Make sure you fill out Schedule H: Your Codebtors (Official Form 106H).
Part 2:
Explain the Sources of Your Income
Official Form 107
Statement of Financial Affairs for Individuals Filing for Bankruptcy
page 1
Debtor 1
_______________________________________________________
Case number
_____________________________________
(if known)
First Name
Middle Name
Last Name
Did you have any income from employment or from operating a business during this year or the two previous calendar years?
4.
Fill in the total amount of income you received from all jobs and all businesses, including part-time activities.
If you are filing a joint case and you have income that you receive together, list it only once under Debtor 1.
No
Yes. Fill in the details.
Debtor 1
Debtor 2
Sources of income
Gross income
Sources of income
Gross income
Check all that apply.
(before deductions and
Check all that apply.
(before deductions and
exclusions)
exclusions)
Wages, commissions,
Wages, commissions,
From January 1 of current year until
$________________
$________________
bonuses, tips
bonuses, tips
the date you filed for bankruptcy:
Operating a business
Operating a business
Wages, commissions,
Wages, commissions,
For last calendar year:
bonuses, tips
bonuses, tips
$________________
$________________
(January 1 to December 31, _________)
Operating a business
Operating a business
YYYY
Wages, commissions,
Wages, commissions,
For the calendar year before that:
bonuses, tips
bonuses, tips
$________________
$________________
(January 1 to December 31, _________)
Operating a business
Operating a business
YYYY
Did you receive any other income during this year or the two previous calendar years?
5.
Include income regardless of whether that income is taxable. Examples of other income are alimony; child support; Social Security,
unemployment, and other public benefit payments; pensions; rental income; interest; dividends; money collected from lawsuits; royalties; and
gambling and lottery winnings. If you are filing a joint case and you have income that you received together, list it only once under Debtor 1.
List each source and the gross income from each source separately. Do not include income that you listed in line 4.
No
Yes. Fill in the details.
Debtor 1
Debtor 2
Sources of income
Gross income from
Sources of income
Gross income from
each source
each source
Describe below.
Describe below.
(before deductions and
(before deductions and
exclusions)
exclusions)
__________________
_____________________
$_________________
$_________________
From January 1 of current year until
the date you filed for bankruptcy:
__________________
_____________________
$_________________
$_________________
__________________
_____________________
$_________________
$_________________
__________________
_____________________
$_________________
For last calendar year:
$_________________
__________________
_____________________
$_________________
(January 1 to December 31, ______)
$_________________
YYYY
__________________
$_________________
_____________________
$_________________
For the calendar year before that:
$_________________
$_________________
__________________
_____________________
(January 1 to December 31, ______)
$_________________
$_________________
__________________
_____________________
YYYY
$_________________
$_________________
__________________
_____________________
Official Form 107
Statement of Financial Affairs for Individuals Filing for Bankruptcy
page 2
Debtor 1
_______________________________________________________
Case number
_____________________________________
(if known)
First Name
Middle Name
Last Name
Part 3:
List Certain Payments You Made Before You Filed for Bankruptcy
Are either Debtor 1’s or Debtor 2’s debts primarily consumer debts?
6.
No. Neither Debtor 1 nor Debtor 2 has primarily consumer debts. Consumer debts are defined in 11 U.S.C. § 101(8) as
“incurred by an individual primarily for a personal, family, or household purpose.”
During the 90 days before you filed for bankruptcy, did you pay any creditor a total of $6,825* or more?
No. Go to line 7.
Yes. List below each creditor to whom you paid a total of $6,825* or more in one or more payments and the
total amount you paid that creditor. Do not include payments for domestic support obligations, such as
child support and alimony. Also, do not include payments to an attorney for this bankruptcy case.
* Subject to adjustment on 4/01/22 and every 3 years after that for cases filed on or after the date of adjustment.

Yes. Debtor 1 or Debtor 2 or both have primarily consumer debts.
During the 90 days before you filed for bankruptcy, did you pay any creditor a total of $600 or more?
No. Go to line 7.
Yes. List below each creditor to whom you paid a total of $600 or more and the total amount you paid that
creditor. Do not include payments for domestic support obligations, such as child support and
alimony. Also, do not include payments to an attorney for this bankruptcy case.
Dates of
Total amount paid
Amount you still owe
Was this payment for…
payment
_________
$_________________ $__________________
____________________________________
Mortgage
Creditor’s Name
Car
_________
____________________________________
Credit card
Number
Street
Loan repayment
_________
____________________________________
Suppliers or vendors
____________________________________
Other ____________
City
State
ZIP Code
$_________________ $__________________
_________
____________________________________
Mortgage
Creditor’s Name
Car
_________
____________________________________
Credit card
Number
Street
Loan repayment
_________
____________________________________
Suppliers or vendors
____________________________________
Other ____________
City
State
ZIP Code
$_________________ $__________________
_________
____________________________________
Mortgage
Creditor’s Name
Car
_________
____________________________________
Credit card
Number
Street
Loan repayment
_________
____________________________________
Suppliers or vendors
____________________________________
Other ____________
City
State
ZIP Code
Official Form 107
Statement of Financial Affairs for Individuals Filing for Bankruptcy
page 3
Debtor 1
_______________________________________________________
Case number
_____________________________________
(if known)
First Name
Middle Name
Last Name
Within 1 year before you filed for bankruptcy, did you make a payment on a debt you owed anyone who was an insider?
7.
Insiders include your relatives; any general partners; relatives of any general partners; partnerships of which you are a general partner;
corporations of which you are an officer, director, person in control, or owner of 20% or more of their voting securities; and any managing
agent, including one for a business you operate as a sole proprietor. 11 U.S.C. § 101. Include payments for domestic support obligations,
such as child support and alimony.
No
Yes. List all payments to an insider.
Dates of
Total amount
Amount you still
Reason for this payment
payment
paid
owe
____________________________________________
_________
$____________ $____________
Insider’s Name
____________________________________________
_________
Number
Street
____________________________________________
_________
____________________________________________
City
State
ZIP Code
$____________ $____________
____________________________________________
_________
Insider’s Name
_________
____________________________________________
Number
Street
____________________________________________
_________
____________________________________________
City
State
ZIP Code
Within 1 year before you filed for bankruptcy, did you make any payments or transfer any property on account of a debt that benefited
8.
an insider?
Include payments on debts guaranteed or cosigned by an insider.
No
Yes. List all payments that benefited an insider.
Dates of
Total amount
Amount you still
Reason for this payment
payment
paid
owe
Include creditor’s name
____________________________________________
_________
$____________ $____________
Insider’s Name
_________
____________________________________________
Number
Street
_________
____________________________________________
____________________________________________
City
State
ZIP Code
$____________ $____________
____________________________________________
_________
Insider’s Name
____________________________________________
_________
Number
Street
_________
____________________________________________
____________________________________________
City
State
ZIP Code
Official Form 107
Statement of Financial Affairs for Individuals Filing for Bankruptcy
page 4
Debtor 1
_______________________________________________________
Case number
_____________________________________
(if known)
First Name
Middle Name
Last Name
Part 4:
Identify Legal Actions, Repossessions, and Foreclosures
Within 1 year before you filed for bankruptcy, were you a party in any lawsuit, court action, or administrative proceeding?
9.
List all such matters, including personal injury cases, small claims actions, divorces, collection suits, paternity actions, support or custody modifications,
and contract disputes.
No
Yes. Fill in the details.
Nature of the case
Court or agency
Status of the case
________________________________________
Pending
Case title_____________________________
Court Name
On appeal
____________________________________
________________________________________
Concluded
Number
Street
Case number ________________________
________________________________________
City
State
ZIP Code
________________________________________
Pending
Case title_____________________________
Court Name
On appeal
____________________________________
________________________________________
Concluded
Number
Street
Case number ________________________
________________________________________
City
State
ZIP Code
Within 1 year before you filed for bankruptcy, was any of your property repossessed, foreclosed, garnished, attached, seized, or levied?
10.
Check all that apply and fill in the details below.
No. Go to line 11.
Yes. Fill in the information below.
Describe the property
Date
Value of the property
_________________________________________
__________
$______________
Creditor’s Name
_________________________________________
Number
Street
Explain what happened
Property was repossessed.
_________________________________________
Property was foreclosed.
Property was garnished.
_________________________________________
Property was attached, seized, or levied.
City
State
ZIP Code
Describe the property
Date
Value of the property
__________
$______________
_________________________________________
Creditor’s Name
_________________________________________
Number
Street
Explain what happened
_________________________________________
Property was repossessed.
Property was foreclosed.
_________________________________________
Property was garnished.
City
State
ZIP Code
Property was attached, seized, or levied.
Official Form 107
Statement of Financial Affairs for Individuals Filing for Bankruptcy
page 5
Page of 12