Official Form 105 "Involuntary Petition Against an Individual"

What Is Official Form 105?

This is a legal form that was released by the United States Bankruptcy Court on December 1, 2015 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on December 1, 2015;
  • 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 105 by clicking the link below or browse more documents and templates provided by the United States Bankruptcy Court.

ADVERTISEMENT
ADVERTISEMENT

Download Official Form 105 "Involuntary Petition Against an Individual"

1092 times
Rate (4.5 / 5) 76 votes
Fill in this information to identify the case:
United States Bankruptcy Court for the:
__________ District of __________
__________ District of __________
Case number
_________________________ Chapter _____
(If known):
Check if this is an
amended filing
Official Form 105
Involuntary Petition Against an Individual
12/15
Use this form to begin a bankruptcy case against an individual you allege to be a debtor subject to an involuntary case. If you want to begin a
case against a non-individual, use the Involuntary Petition Against a Non-individual (Official Form 205). Be as complete and accurate as
possible. If more space is needed, attach a separate sheet to this form. On the top of any additional pages, write name and case number (if
known).
Part 1:
Identify the Chapter of the Bankruptcy Code Under Which Petition Is Filed
Chapter of the
Check one:
1.
Bankruptcy Code
Chapter 7
Chapter 11
Part 2:
Identify the Debtor
Debtor’s full name
2.
__________________________________________________
First name
__________________________________________________
Middle name
__________________________________________________
Last name
___________________________
Suffix (Sr., Jr., II, III)
Other names you know
3.
__________________________________________________
the debtor has used in
__________________________________________________
the last 8 years
__________________________________________________
Include any assumed,
married, maiden, or trade
names, or doing business as
names.
Only the last 4 digits of
4.
Unknown
debtor’s Social Security
Number or federal
9
xxx
– xx – ____ ____ ____ ____
xx – xx – ____ ____ ____ ____
OR
Individual Taxpayer
Identification Number
(ITIN)
Any Employer
5.
Unknown
Identification Numbers
(EINs) used in the last 8
___ ___ – ___ ___ ___ ___ ___ ___ ___
years
EIN
___ ___ – ___ ___ ___ ___ ___ ___ ___
EIN
page 1
Official Form 105
Involuntary Petition Against an Individual
Fill in this information to identify the case:
United States Bankruptcy Court for the:
__________ District of __________
__________ District of __________
Case number
_________________________ Chapter _____
(If known):
Check if this is an
amended filing
Official Form 105
Involuntary Petition Against an Individual
12/15
Use this form to begin a bankruptcy case against an individual you allege to be a debtor subject to an involuntary case. If you want to begin a
case against a non-individual, use the Involuntary Petition Against a Non-individual (Official Form 205). Be as complete and accurate as
possible. If more space is needed, attach a separate sheet to this form. On the top of any additional pages, write name and case number (if
known).
Part 1:
Identify the Chapter of the Bankruptcy Code Under Which Petition Is Filed
Chapter of the
Check one:
1.
Bankruptcy Code
Chapter 7
Chapter 11
Part 2:
Identify the Debtor
Debtor’s full name
2.
__________________________________________________
First name
__________________________________________________
Middle name
__________________________________________________
Last name
___________________________
Suffix (Sr., Jr., II, III)
Other names you know
3.
__________________________________________________
the debtor has used in
__________________________________________________
the last 8 years
__________________________________________________
Include any assumed,
married, maiden, or trade
names, or doing business as
names.
Only the last 4 digits of
4.
Unknown
debtor’s Social Security
Number or federal
9
xxx
– xx – ____ ____ ____ ____
xx – xx – ____ ____ ____ ____
OR
Individual Taxpayer
Identification Number
(ITIN)
Any Employer
5.
Unknown
Identification Numbers
(EINs) used in the last 8
___ ___ – ___ ___ ___ ___ ___ ___ ___
years
EIN
___ ___ – ___ ___ ___ ___ ___ ___ ___
EIN
page 1
Official Form 105
Involuntary Petition Against an Individual
Debtor
_______________________________________________________
Case number
_____________________________________
(if known)
Principal residence
Mailing address, if different from residence
Debtor’s address
6.
_________________________________________________
_________________________________________________
Number
Street
Number
Street
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
City
State
ZIP Code
City
State
ZIP Code
_________________________________________________
County
Principal place of business
_________________________________________________
Number
Street
_________________________________________________
_________________________________________________
City
State
ZIP Code
_________________________________________________
County
Debtor does not operate a business
Type of business
7.
Check one if the debtor operates a 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
Type of debt
8.
Each petitioner believes:
Debts are 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.”
Debts
primarily business debts.
are
Business debts are debts that were incurred to obtain money
for a business or investment or through the operation of the business or investment.
Do you know of any
9.
No
bankruptcy cases
Yes.
Debtor _________________________________________________ Relationship __________________________
pending by or against
any partner, spouse, or
District __________________________Date filed _______________ Case number, if known___________________
affiliate of this debtor?
MM / DD / YYYY
Debtor _________________________________________________
Relationship ___________________________
District __________________________ Date filed _______________ Case number, if known___________________
MM / DD / YYYY
page 2
Official Form 105
Involuntary Petition Against an Individual
Debtor
_______________________________________________________
Case number
_____________________________________
(if known)
Part 3:
Report About the Case
Venue
10.
Check one:
Reason for filing in this court.
Over the last 180 days before the filing of this bankruptcy, the debtor has resided, had the principal place of
business, or had principal assets in this district longer than in any other district.
A bankruptcy case concerning debtor’s affiliates, general partner, or partnership is pending in this district.
Other reason. Explain. (See 28 U.S.C. § 1408.) ___________________________________________________
Allegations
Each petitioner is eligible to file this petition under 11 U.S.C. § 303(b).
11.
The debtor may be the subject of an involuntary case under 11 U.S.C. § 303(a).
At least one box must be checked:
The debtor is generally not paying such debtor’s debts as they become due, unless they are the subject of a
bona fide dispute as to liability or amount.
Within 120 days before the filing of this petition, a custodian, other than a trustee, receiver, or agent appointed or
authorized to take charge of less than substantially all of the property of the debtor for the purpose of enforcing a
lien against such property, was appointed or took possession.
Has there been a
12.
No
transfer of any claim
Yes. Attach all documents that evidence the transfer and any statements required under Bankruptcy Rule
against the debtor by or
to any petitioner?
1003(a).
Amount of the
Each petitioner’s claim
13.
Nature of petitioner’s claim
claim above the
Name of petitioner
value of any lien
$
________________
$
________________
$
________________
$
Total
________________
If more than 3 petitioners, attach additional sheets with the statement under penalty
of perjury, each petitioner’s (or representative’s) signature under the statement,
along with the signature of the petitioner’s attorney, and the information on the
petitioning creditor, the petitioner’s claim, the petitioner’s representative, and the
attorney following the format on this form.
page 3
Official Form 105
Involuntary Petition Against an Individual
Debtor
_______________________________________________________
Case number
_____________________________________
(if known)
Part 4:
Request for Relief
Petitioners request that an order for relief be entered against the debtor under the chapter specified in Part 1 of this petition. If a petitioning
creditor is a corporation, attach the corporate ownership statement required by Bankruptcy Rule 1010(b). If any petitioner is a foreign
representative appointed in a foreign proceeding, a certified copy of the order of the court granting recognition is attached.
Petitioners declare under penalty of perjury that the information provided in this petition is true and correct. Petitioners understand that if they make a
false statement, they could be fined up to $250,000 or imprisoned for up to 5 years, or both.
18 U.S.C. §§ 152 and 3571. If relief is not ordered, the court may award attorneys’ fees, costs, damages, and punitive damages. 11 U.S.C. § 303(i).
Petitioners or Petitioners’ Representative
Attorneys
________________________________________
________________________________________
Signature of petitioner or representative, including representative’s title
Signature of attorney
______________________________________________________________
________________________________________________________________
Printed name of petitioner
Printed name
________________________________________________________________
Date signed
_________________
Firm name, if any
MM / DD / YYYY
________________________________________________________________
Number
Street
Mailing address of petitioner
________________________________________________________________
City
State
ZIP Code
______________________________________________________________
Number
Street
Date signed
_________________
______________________________________________________________
MM / DD / YYYY
City
State
ZIP Code
Contact phone
_________________ Email ____________________________
If petitioner is an individual and is not represented by an
attorney:
Contact phone
____________________________
Email
____________________________
Name and mailing address of petitioner’s representative, if any
______________________________________________________________
Name
______________________________________________________________
Number
Street
______________________________________________________________
City
State
ZIP Code
page 4
Official Form 105
Involuntary Petition Against an Individual
Debtor
_______________________________________________________
Case number
_____________________________________
(if known)
________________________________________
________________________________________
Signature of petitioner or representative, including representative’s title
Signature of Attorney
______________________________________________________________
________________________________________________________________
Printed name of petitioner
Printed name
________________________________________________________________
Date signed
_________________
Firm name, if any
MM / DD / YYYY
________________________________________________________________
Number
Street
Mailing address of petitioner
________________________________________________________________
City
State
ZIP Code
______________________________________________________________
Number
Street
Date signed
_________________
______________________________________________________________
MM / DD / YYYY
City
State
ZIP Code
Contact phone
_________________ Email ____________________________
Name and mailing address of petitioner’s representative, if any
______________________________________________________________
Name
______________________________________________________________
Number
Street
______________________________________________________________
City
State ZIP Code
________________________________________
________________________________________
Signature of petitioner or representative, including representative’s title
Signature of Attorney
______________________________________________________________
________________________________________________________________
Printed name of petitioner
Printed name
________________________________________________________________
Date signed
_________________
Firm name, if any
MM / DD / YYYY
________________________________________________________________
Number
Street
Mailing address of petitioner
________________________________________________________________
City
State
ZIP Code
______________________________________________________________
Number
Street
Date signed
_________________
______________________________________________________________
MM / DD / YYYY
City
State
ZIP Code
Contact phone
_________________ Email ____________________________
Name and mailing address of petitioner’s representative, if any
______________________________________________________________
Name
______________________________________________________________
Number
Street
_____________________________________________________________
City
State
ZIP Code
page 5
Official Form 105
Involuntary Petition Against an Individual
Print
Save As...
Add Attachment
Reset
Page of 5