Chapter 7 Bankruptcy Form

CHAPTER 7 BANKRUPTCY PETITION

This voluntary petition under Chapter 7 of the United States Bankruptcy Code is submitted on behalf of the Debtor Name: and Attorney/Preparer Name: . The Debtor requests relief under Chapter 7 and certifies the information contained herein is true and correct to the best of the Debtor's knowledge.

RECITALS

WHEREAS, the Debtor is an individual residing at Address: , and is the legal owner of the property and assets listed in the accompanying schedules;

WHEREAS, the Debtor isUnable to maintain payments on certain unsecured obligations and seeks the protections afforded by the automatic stay and discharge provisions of the Bankruptcy Code;

WHEREAS, the Attorney/Preparer will represent the Debtor in matters relating to this Chapter 7 case, prepare required schedules and statements, and will comply with the requirements of the Bankruptcy Rules and local court requirements.

NOW, THEREFORE

The Debtor hereby petitions this court for an order for relief under Chapter 7 of the Bankruptcy Code and respectfully represents and requests as follows:

1. PETITION INFORMATION

Debtor Full Name: Social Security Number (last 4):

Date of Birth: Employer Name:

2. CHAPTER SELECTION AND RELIEF REQUESTED

The Debtor elects relief under: Chapter 7 Chapter 11 (if applicable) Chapter 13 (if applicable)

Relief requested: The Debtor requests entry of an order granting relief under Chapter 7, including the appointment of a trustee, the imposition of the automatic stay as provided in 11 U.S.C. § 362, and the discharge of eligible debts upon completion of this case consistent with the Bankruptcy Code.

3. SCHEDULES, STATEMENTS AND MEANS TEST

The Debtor shall file the following with this petition as required by the Bankruptcy Rules: Schedules A through J, Schedule of Current Income and Expenditures, Statement of Financial Affairs, and Statement of Intention for secured debts. The Debtor further acknowledges the requirement to file the Means Test (Official Form) when applicable.

4. AUTOMATIC STAY AND PROTECTIONS

Upon the filing of this petition, the automatic stay as set forth in 11 U.S.C. § 362 shall take effect as to all creditors. The Debtor represents that no creditor has grounds known to the Debtor for relief from the automatic stay other than those listed in the schedules and statements filed herewith.

5. EXEMPTIONS AND REDEMPTIONS

The Debtor asserts all exemptions claimed on Schedule C. If the Debtor intends to file claims of exemption under state law or the federal exemptions, those exemptions will be set forth in the schedules and will be asserted and defended in this case. The Debtor reserves the right to redeem or reaffirm secured debts where permitted by law and where warranted by the facts.

6. VERIFICATION AND CERTIFICATION

The Debtor certifies under penalty of perjury under the laws of the United States that the information contained in this petition, schedules, and statements is true and correct. The Debtor further acknowledges that willful false statements or concealment of property may result in fines or imprisonment or both.

7. NOTICES

All notices, correspondence, and pleadings to the Debtor shall be provided to the Debtor's mailing address or to the Attorney/Preparer address indicated below. Notice to the Attorney/Preparer shall be deemed notice to the Debtor for purposes of this proceeding.

8. GOVERNING LAW; ENTIRE AGREEMENT; SEVERABILITY

This petition and all matters arising from or related to this case shall be governed by the Bankruptcy Code, federal law, and applicable local rules of the bankruptcy court. This petition, together with the schedules and statements filed herewith, constitutes the entire filing of the Debtor and supersedes any prior inconsistent representations made to creditors concerning the matters set forth herein. If any provision of this petition or any schedule is held invalid, the remaining provisions shall remain in full force and effect.

9. AMENDMENTS, WAIVER AND COUNTERPARTS

The Debtor may amend this petition, schedules, or statements as necessary to correct or supplement information. No waiver of any provision or right under this petition shall be effective unless in writing and signed by the party granting the waiver. This petition may be executed in counterparts and delivered by facsimile, electronic image, or other reproduction, each of which shall be deemed an original.

10. DECLARATION

I, the undersigned Debtor, declare under penalty of perjury that the foregoing statements are true and correct to the best of my knowledge, information and belief, and that I have provided all required schedules and statements to the best of my ability.

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