Total Assets

Total Debt

Total Exempt

Quick Definitions

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Okay -- Now Onto Household Expenses

First question - Do you or your Co-Debtor live in separate households?

Food and housekeeping supplies

Childcare and children's education costs

Clothing, laundry, and dry cleaning

Personal care products and services

Medical and dental expenses

Entertainment, clubs, recreation, newspapers, magazines, and books

Charitable contributions and religious donations

Life insurance

Health insurance

Vehicle insurance

Taxes

Specify
Amount

Out-of-pocket healthcare expenses per person under 65

Out-of-pocket healthcare expenses per person 65 and older

Non-Vehicle Installment or Lease Payments

Your payments of alimony, maintenance, and support that you did not report as deducted from other payments you make to support others who do not live with you.

Childcare Payments

Education: The total monthly amount that you pay for education that is either required:

Additional health care expenses, excluding insurance costs:

Protection against family violence. The reasonably necessary monthly expenses that you incur to maintain the safety

Do you expect an increase or decrease of your income or your co-debtors income in the year after you file the bankruptcy petition?

If yes, please explain