form_b106sum, Summary of Your Assets and Liabilities and Certain Statistical Information

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Official Form 106SumSummary of Your Assets and Liabilities and Certain Statistical Information
 page 1 of 2  Official Form 106Sum 	
Summary of Your Assets and Liabilitie
s and Certain Statistical Information 	12/15	
Be as complete and accurate as possible. If two married people are filing together, both are equally responsible for supplying  correct 
information. Fill out all of your schedules firs t; then complete the information on this form.	
 If you are filing amended schedules after you file 
your original forms, you must fill out a new  Summary and check the box at the top of this page.  	
Part 1:   Summarize Your Assets 	
Your assets  
Value of what you own 	
1. 	Schedule A/B: Property  (Official Form 106A/B)
1a. 	Copy line 55, Total real estate, from  Schedule A/B .......................................................................\
................................... 	  $ ________________	
 1b. 	Copy line 62, Total personal property, from 
Schedule A/B .......................................................................\
........................ 	 
$ ________________	
 1c. 	Copy line 63, Total of all property on Schedule A/B  .......................................................................\
.................................. 	  $ ________________	
Part 2:  Summarize Your Liabilities 	
Your liabilities 
Amount you owe  	
2. 	Schedule D: Creditors Who Have Claims Secured by Property  (Official Form 106D)
2a. 	Copy the total you listed in Column A, Amount of claim, at the bottom of the last page of Part 1 of  Schedule D ............ 	 	$ ________________	
3. 	Schedule E/F: Creditors Who Have Unsecured Claims (Official Form 106E/F)
3a. 	Copy the total claims from Part 1 (priority unsecured claims) from line 6e of  Schedule E/F ............................................ 	 	$ ________________	
 3b. 	Copy the total claims from Part 2 (nonpri ority unsecured claims) from line 6j of Schedule E/F ....................................... 	 + $ ________________	
Your total liabilities 	 $ ________________	
Part 3:   Summarize Your Income and Expenses 
4. 	Schedule I: Your Income  (Official Form 106I)
Copy your combined monthly income from line 12 of  Schedule I .......................................................................\
................... 	
  $ ________________	
5. 	Schedule J: Your Expenses (Official Form 106J)
Copy your monthly expenses from line 22c of  Schedule J .......................................................................\
............................. 	
  $ ________________	
Debtor 1  __________________________________________________________________   	First Name  Middle Name Last Name	 	
Debtor 2  ________________________________________________________________ (Spouse, if filing)	 First Name  Middle Name Last Name	 	
United States Bankruptcy Court for the:	 __________	 District of 	__________ 	
Case number  ___________________________________________ 	(If known	) 	
  Fill in this information to identify your case: 	
	Check if this is an
amended filing

Debtor 1  _______________________________________________________ Case number 	(if known )	_____________________________________  	First Name  Middle Name  Last Name	       Official Form 106Sum Summary of Your Assets and Liabilities and Certain Statistical Information 	
page 2 of 2 	
Part 4:	  	Answer These Questions for Admini
strative and Statistical Records	 
6. 	
Are you filing for bankruptcy under Chapters 7, 11, or 13?
	 No. You have nothing to report on this part of the form. Check this box and submit this form to the court with your other sched ules.	
	 Yes	
7. 	What kind of debt do you have?	 	
	Your debts are primarily consumer debts. Cons umer debts are those “incurred by an indi vidual primarily for a personal,
family , or household purpose.” 11 U.S.C. § 101(8).	 Fill out lines 8-9g for statistical purposes. 28 U.S.C. § 159.	
	Your debts are not primarily consumer debts .  You have nothing to report on this part of the form. Check this box and submit
this form to the c ourt with your othe r schedules.	
8. 	From the Statement of Your Current Monthly Income :	 Copy your total current monthly income from Official
Form 12 2A-1 Line 11;  OR, Form 122B Line 11;  OR, Form 122C-1 Line  14.	
 $ _________________ 	
9. 	Copy the following special categories of claims from Part 4, line 6 of  Schedule E/F:	
Total claim	
From Part 4 on  Schedule E/F, copy the following: 
9a. Domestic support obligations (Copy line 6a.)	   $_____________________	
9b. Taxes and certain other debts you owe the government. (Copy line 6b.)	  $_____________________	
9c. Claims for death or personal injury wh
ile you were intoxicated. (Copy line 6c.)	  $_____________________	
9d. Student loans. (Copy line 6f.) 	 $_____________________ 	
9e. Obligations arising out of 
a separation agreement or divorce that you did not report as 
priority claims. (Copy line 6g.) 	 $_____________________ 	
9f.  Debts to pension or profit-sharing pl ans, and other similar debts. (Copy line 6h.) 	+ $_____________________	
9g. Total. Add lines 9a through 9f.  	 $_____________________