Fill and Sign the Nv Division of Mineralsaffidavit of Annual Assessment Work Form

Official Form 6 - Summary (10/06) United States Bankruptcy Court _______________ District Of ______________ In re ___________________________________, Debtor Case No. ___________________ Chapter ____________ SUMMARY OF SCHEDULES Indicate as to each schedule whether that schedule is attached and state the number of pages in each. Report the totals from Schedules A, B, D, E, F, I, and J in the boxes provided. Add the amounts from Schedules A and B to determine the total amount of the debtor’s assets. Add the amounts of all claims from Schedules D, E, and F to determine the total amount of the debtor’s liabilities. Individual debtors also must complete the “Statistical Summary of Certain Liabilities and Related Data” if they file a case under chapter 7, 11, or 13. ATTACHED (YES/NO) NAME OF SCHEDULE NO. OF SHEETS ASSETS A - Real Property OTHER $ B - Personal Property LIABILITIES $ C - Property Claimed as Exempt D - Creditors Holding Secured Claims $ E - Creditors Holding Unsecured Priority Claims (Total of Claims on Schedule E) $ F - Creditors Holding Unsecured Nonpriority Claims $ G - Executory Contracts and Unexpired Leases H - Codebtors I - Current Income of Individual Debtor(s) $ J - Current Expenditures of Individual Debtors(s) $ TOTAL $ $ Official Form 6 - Statistical Summary (10/06) United States Bankruptcy Court _______________ District Of ______________ In re ___________________________________, Debtor Case No. ___________________ Chapter ____________ STATISTICAL SUMMARY OF CERTAIN LIABILITIES AND RELATED DATA (28 U.S.C. § 159) If you are an individual debtor whose debts are primarily consumer debts, as defined in § 101(8) of the Bankruptcy Code (11 U.S.C. § 101(8)), filing a case under chapter 7, 11 or 13, you must report all information requested below. Q Check this box if you are an individual debtor whose debts are NOT primarily consumer debts. You are not required to report any information here. This information is for statistical purposes only under 28 U.S.C. § 159. Summarize the following types of liabilities, as reported in the Schedules, and total them. Type of Liability Amount Domestic Support Obligations (from Schedule E) $ Taxes and Certain Other Debts Owed to Governmental Units (from Schedule E) (whether disputed or undisputed) $ Claims for Death or Personal Injury While Debtor Was Intoxicated (from Schedule E) $ Student Loan Obligations (from Schedule F) $ Domestic Support, Separation Agreement, and Divorce Decree Obligations Not Reported on Schedule E $ Obligations to Pension or Profit-Sharing, and Other Similar Obligations (from Schedule F) $ TOTAL $ State the following: Average Income (from Schedule I, Line 16) $ Average Expenses (from Schedule J, Line 18) $ Current Monthly Income (from Form 22A Line 12; OR, Form 22B Line 11; OR, Form 22C Line 20 ) $ State the following: 1. Total from Schedule D, “UNSECURED PORTION, IF ANY” column 2. Total from Schedule E, “AMOUNT ENTITLED TO PRIORITY” column. $ $ 3. Total from Schedule E, “AMOUNT NOT ENTITLED TO PRIORITY, IF ANY” column $ 4. Total from Schedule F $ 5. Total of non-priority unsecured debt (sum of 1, 3, and 4) $