Official Form 207 "Statement of Financial Affairs for Non-individuals Filing for Bankruptcy"

What Is Official Form 207?

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 printable version of Official Form 207 by clicking the link below or browse more documents and templates provided by the United States Bankruptcy Court.

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Download Official Form 207 "Statement of Financial Affairs for Non-individuals Filing for Bankruptcy"

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Fill in this information to identify the case:
Debtor name __________________________________________________________________
______________________
_________
United States Bankruptcy Court for the:
District of
(State)
Case number (If known):
_________________________
___________________________________________
Check if this is an
amended filing
Official Form 207
Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy
04/19
The debtor must answer every question. If more space is needed, attach a separate sheet to this form. On the top of any additional pages,
write the debtor’s name and case number (if known).
Part 1:
Income
Gross revenue from business
1.
None
Identify the beginning and ending dates of the debtor’s fiscal year, which
Sources of revenue
Gross revenue
may be a calendar year
Check all that apply
(before deductions and
exclusions)
From the beginning of the
Operating a business
$
fiscal year to filing date:
From ___________
to
Filing date
________________
Other _______________________
MM / DD / YYYY
For prior year:
From ___________
to
___________
Operating a business
$
________________
MM / DD / YYYY
MM / DD / YYYY
Other _______________________
For the year before that:
From ___________
to
___________
Operating a business
$
________________
MM / DD / YYYY
MM / DD / YYYY
Other _______________________
Non-business revenue
2.
Include revenue regardless of whether that revenue is taxable. Non-business income may include interest, dividends, money collected
from lawsuits, and royalties. List each source and the gross revenue for each separately. Do not include revenue listed in line 1.
None
Description of sources of revenue
Gross revenue from each
source
(before deductions and
exclusions)
From the beginning of the
___________________________
$________________
fiscal year to filing date:
From ___________
to
Filing date
MM / DD / YYYY
For prior year:
From ___________
to
___________
___________________________
MM / DD / YYYY
MM / DD / YYYY
$________________
For the year before that:
From ___________
to
___________
MM / DD / YYYY
MM / DD / YYYY
___________________________
$________________
Official Form 207
Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy
page 1
Fill in this information to identify the case:
Debtor name __________________________________________________________________
______________________
_________
United States Bankruptcy Court for the:
District of
(State)
Case number (If known):
_________________________
___________________________________________
Check if this is an
amended filing
Official Form 207
Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy
04/19
The debtor must answer every question. If more space is needed, attach a separate sheet to this form. On the top of any additional pages,
write the debtor’s name and case number (if known).
Part 1:
Income
Gross revenue from business
1.
None
Identify the beginning and ending dates of the debtor’s fiscal year, which
Sources of revenue
Gross revenue
may be a calendar year
Check all that apply
(before deductions and
exclusions)
From the beginning of the
Operating a business
$
fiscal year to filing date:
From ___________
to
Filing date
________________
Other _______________________
MM / DD / YYYY
For prior year:
From ___________
to
___________
Operating a business
$
________________
MM / DD / YYYY
MM / DD / YYYY
Other _______________________
For the year before that:
From ___________
to
___________
Operating a business
$
________________
MM / DD / YYYY
MM / DD / YYYY
Other _______________________
Non-business revenue
2.
Include revenue regardless of whether that revenue is taxable. Non-business income may include interest, dividends, money collected
from lawsuits, and royalties. List each source and the gross revenue for each separately. Do not include revenue listed in line 1.
None
Description of sources of revenue
Gross revenue from each
source
(before deductions and
exclusions)
From the beginning of the
___________________________
$________________
fiscal year to filing date:
From ___________
to
Filing date
MM / DD / YYYY
For prior year:
From ___________
to
___________
___________________________
MM / DD / YYYY
MM / DD / YYYY
$________________
For the year before that:
From ___________
to
___________
MM / DD / YYYY
MM / DD / YYYY
___________________________
$________________
Official Form 207
Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy
page 1
Debtor
_______________________________________________________
Case number
_____________________________________
(if known)
Name
Part 2:
List Certain Transfers Made Before Filing for Bankruptcy
Certain payments or transfers to creditors within 90 days before filing this case
3.
List payments or transfers⎯including expense reimbursements⎯to any creditor, other than regular employee compensation, within 90
days before filing this case unless the aggregate value of all property transferred to that creditor is less than $6,825. (This amount may be
adjusted on 4/01/22 and every 3 years after that with respect to cases filed on or after the date of adjustment.)
None
Creditor’s name and address
Dates
Total amount or value
Reasons for payment or transfer
Check all that apply
3.1.
Secured debt
__________________________________________
________
$
_________________
Creditor’s name
Unsecured loan repayments
__________________________________________
Suppliers or vendors
________
Street
__________________________________________
Services
__________________________________________
________
Other _______________________________
City
State
ZIP Code
3.2.
Secured debt
__________________________________________
________
$
_________________
Creditor’s name
Unsecured loan repayments
__________________________________________
________
Suppliers or vendors
Street
__________________________________________
Services
__________________________________________
________
Other _______________________________
City
State
ZIP Code
Payments or other transfers of property made within 1 year before filing this case that benefited any insider
4.
List payments or transfers, including expense reimbursements, made within 1 year before filing this case on debts owed to an insider or
guaranteed or cosigned by an insider unless the aggregate value of all property transferred to or for the benefit of the insider is less than
$6,825. (This amount may be adjusted on 4/01/22 and every 3 years after that with respect to cases filed on or after the date of adjustment.)
Do not include any payments listed in line 3. Insiders include officers, directors, and anyone in control of a corporate debtor and their relatives;
general partners of a partnership debtor and their relatives; affiliates of the debtor and insiders of such affiliates; and any managing agent of
the debtor. 11 U.S.C. § 101(31).
None
Insider’s name and address
Dates
Total amount or value
Reasons for payment or transfer
4.1.
__________________________________________
_________
___________________________________________
$
__________________
Insider’s name
__________________________________________
_________
___________________________________________
Street
__________________________________________
_________
___________________________________________
__________________________________________
City
State
ZIP Code
Relationship to debtor
__________________________________________
4.2.
__________________________________________
_________
$
___________________________________________
__________________
Insider’s name
__________________________________________
_________
___________________________________________
Street
__________________________________________
_________
___________________________________________
__________________________________________
City
State
ZIP Code
Relationship to debtor
__________________________________________
Official Form 207
Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy
page 2
Debtor
_______________________________________________________
Case number
_____________________________________
(if known)
Name
Repossessions, foreclosures, and returns
5.
List all property of the debtor that was obtained by a creditor within 1 year before filing this case, including property repossessed by a creditor,
sold at a foreclosure sale, transferred by a deed in lieu of foreclosure, or returned to the seller. Do not include property listed in line 6.
None
Creditor’s name and address
Description of the property
Date
Value of property
5.1.
__________________________________________
___________________________________________
______________
$
___________
Creditor’s name
__________________________________________
___________________________________________
Street
__________________________________________
___________________________________________
__________________________________________
City
State
ZIP Code
5.2.
__________________________________________
___________________________________________
_______________
$
___________
Creditor’s name
__________________________________________
___________________________________________
Street
__________________________________________
___________________________________________
__________________________________________
City
State
ZIP Code
Setoffs
6.
List any creditor, including a bank or financial institution, that within 90 days before filing this case set off or otherwise took anything from an account of
the debtor without permission or refused to make a payment at the debtor’s direction from an account of the debtor because the debtor owed a debt.
None
Creditor’s name and address
Description of the action creditor took
Date action was
Amount
taken
__________________________________________
___________________________________________
_______________
$
___________
Creditor’s name
__________________________________________
___________________________________________
Street
__________________________________________
Last 4 digits of account number: XXXX– __ __ __ __
__________________________________________
City
State
ZIP Code
Part 3:
Legal Actions or Assignments
Legal actions, administrative proceedings, court actions, executions, attachments, or governmental audits
7.
List the legal actions, proceedings, investigations, arbitrations, mediations, and audits by federal or state agencies in which the debtor
was involved in any capacity—within 1 year before filing this case.
None
Court or agency’s name and address
Case title
Nature of case
Status of case
7.1.
Pending
______________________________
__________________________________________
_________________________________
Name
On appeal
__________________________________________
Case number
Concluded
Street
__________________________________________
__________________________________________
_________________________________
City
State
ZIP Code
Court or agency’s name and address
Case title
Pending
7.2.
_________________________________
______________________________
__________________________________________
On appeal
Name
Concluded
__________________________________________
Case number
Street
__________________________________________
_________________________________
__________________________________________
City
State
ZIP Code
Official Form 207
Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy
page 3
Debtor
_______________________________________________________
Case number
_____________________________________
(if known)
Name
Assignments and receivership
8.
List any property in the hands of an assignee for the benefit of creditors during the 120 days before filing this case and any property in the
hands of a receiver, custodian, or other court-appointed officer within 1 year before filing this case.
None
Custodian’s name and address
Description of the property
Value
______________________________________
$_____________
__________________________________________
Custodian’s name
Case title
Court name and address
__________________________________________
Street
______________________________________
__________________________________________
__________________________________________
Name
__________________________________________
Case number
__________________________________________
City
State
ZIP Code
Street
______________________________________
__________________________________________
__________________________________________
Date of order or assignment
City
State
ZIP Code
______________________________________
Part 4:
Certain Gifts and Charitable Contributions
List all gifts or charitable contributions the debtor gave to a recipient within 2 years before filing this case unless the aggregate value
9.
of the gifts to that recipient is less than $1,000
None
Recipient’s name and address
Description of the gifts or contributions
Dates given
Value
__________________________________________
___________________________________________
_________________
$__________
9.1.
Recipient’s name
__________________________________________
___________________________________________
Street
__________________________________________
__________________________________________
City
State
ZIP Code
Recipient’s relationship to debtor
__________________________________________
_________________
__________________________________________
___________________________________________
$__________
9.2.
Recipient’s name
__________________________________________
___________________________________________
Street
__________________________________________
__________________________________________
City
State
ZIP Code
Recipient’s relationship to debtor
__________________________________________
Part 5:
Certain Losses
All losses from fire, theft, or other casualty within 1 year before filing this case.
10.
None
Description of the property lost and how the loss
Amount of payments received for the loss
Date of loss
Value of property
occurred
lost
If you have received payments to cover the loss, for
example, from insurance, government compensation, or
tort liability, list the total received.
List unpaid claims on Official Form 106A/B (Schedule A/B:
Assets – Real and Personal Property).
___________________________________________
___________________________________________
_________________
$__________
___________________________________________
Official Form 207
Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy
page 4
Debtor
_______________________________________________________
Case number
_____________________________________
(if known)
Name
Part 6:
Certain Payments or Transfers
Payments related to bankruptcy
11.
List any payments of money or other transfers of property made by the debtor or person acting on behalf of the debtor within 1 year before
the filing of this case to another person or entity, including attorneys, that the debtor consulted about debt consolidation or restructuring,
seeking bankruptcy relief, or filing a bankruptcy case.
None
Who was paid or who received the transfer?
If not money, describe any property transferred
Dates
Total amount or
value
__________________________________________
11.1.
___________________________________________
______________
$
_________
Address
___________________________________________
__________________________________________
Street
__________________________________________
__________________________________________
City
State
ZIP Code
Email or website address
_________________________________
Who made the payment, if not debtor?
__________________________________________
Who was paid or who received the transfer?
If not money, describe any property transferred
Dates
Total amount or
value
__________________________________________
11.2.
___________________________________________
$
______________
_________
Address
___________________________________________
__________________________________________
Street
__________________________________________
__________________________________________
City
State
ZIP Code
Email or website address
__________________________________________
Who made the payment, if not debtor?
__________________________________________
Self-settled trusts of which the debtor is a beneficiary
12.
List any payments or transfers of property made by the debtor or a person acting on behalf of the debtor within 10 years before the filing of this case to
a self-settled trust or similar device.
Do not include transfers already listed on this statement.
None
Name of trust or device
Describe any property transferred
Dates transfers
Total amount or
were made
value
______________
$
_________
__________________________________________
___________________________________________
Trustee
___________________________________________
__________________________________________
Official Form 207
Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy
page 5
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