Fill in this information to identify your case: Debtor 1 Debtor 2 __________________________________________________________________ First Name Middle Name Last Name (Spouse, if filing) First Name ________________________________________________________________ Middle Name Last Name United States Bankruptcy Court for the: ______________________ District of __________ (State) Case number (If known) ___________________________________________ Check if this is an amended filing Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims 12/15 Be as complete and accurate as possible. Use Part 1 for creditors with PRIORITY claims and Part 2 for creditors with NONPRIORITY claims. List the other party to any executory contracts or unexpired leases that could result in a claim. Also list executory contracts on Schedule A/B: Property (Official Form 106A/B) and on Schedule G: Executory Contracts and Unexpired Leases (Official Form 106G). Do not include any creditors with partially secured claims that are listed in Schedule D: Creditors Who Have Claims Secured by Property. If more space is needed, copy the Part you need, fill it out, number the entries in the boxes on the left. Attach the Continuation Page to this page. On the top of any additional pages, write your name and case number (if known). Part 1: List All of Your PRIORITY Unsecured Claims 1. Do any creditors have priority unsecured claims against you? No. Go to Part 2. Yes. 2. List all of your priority unsecured claims. If a creditor has more than one priority unsecured claim, list the creditor separately for each claim. For each claim listed, identify what type of claim it is. If a claim has both priority and nonpriority amounts, list that claim here and show both priority and nonpriority amounts. As much as possible, list the claims in alphabetical order according to the creditor's name. If you have more than two priority unsecured claims, fill out the Continuation Page of Part 1. If more than one creditor holds a particular claim, list the other creditors in Part 3. (For an explanation of each type of claim, see the instructions for this form in the instruction booklet.) Total claim Priority amount Nonpriority amount 2.1 ____________________________________________ Priority Creditor's Name Number Street Last 4 digits of account number ___ ___ ___ ___ When was the debt incurred? ____________ $_____________ $___________ $____________ ____________________________________________ ____________________________________________ ____________________________________________ City State ZIP Code As of the date you file, the claim is: Check all that apply. Who incurred the debt? Check one. 2.2 Debtor 1 only Debtor 2 only Debtor 1 and Debtor 2 only At least one of the debtors and another Contingent Unliquidated Disputed Type of PRIORITY unsecured claim: Domestic support obligations Taxes and certain other debts you owe the government Claims for death or personal injury while you were intoxicated Other. Specify _________________________________ Check if this claim is for a community debt No Yes Is the claim subject to offset? ____________________________________________ Priority Creditor's Name Number Street Last 4 digits of account number ___ ___ ___ ___ When was the debt incurred? ____________ $_____________ $___________ $____________ ____________________________________________ ____________________________________________ ____________________________________________ City State ZIP Code As of the date you file, the claim is: Check all that apply. Who incurred the debt? Check one. Contingent Unliquidated Disputed Debtor 1 only Debtor 2 only Debtor 1 and Debtor 2 only At least one of the debtors and another Type of PRIORITY unsecured claim: Domestic support obligations Taxes and certain other debts you owe the government Claims for death or personal injury while you were intoxicated Other. Specify _________________________________ Check if this claim is for a community debt No Yes Is the claim subject to offset? Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims American LegalNet, Inc. www.FormsWorkFlow.com page 1 of ___ Debtor 1 First Name _______________________________________________________ Middle Name Last Name Case number (if known)_____________________________________ Part 1: Your PRIORITY Unsecured Claims Continuation Page Total claim Priority amount Nonpriority amount After listing any entries on this page, number them beginning with 2.3, followed by 2.4, and so forth. ____________________________________________ Priority Creditor's Name Number Street Last 4 digits of account number ___ ___ ___ ___ When was the debt incurred? ____________ $____________ $__________ $____________ ____________________________________________ ____________________________________________ ____________________________________________ City State ZIP Code As of the date you file, the claim is: Check all that apply. Who incurred the debt? Check one. Contingent Unliquidated Disputed Debtor 1 only Debtor 2 only Debtor 1 and Debtor 2 only At least one of the debtors and another Type of PRIORITY unsecured claim: Domestic support obligations Taxes and certain other debts you owe the government Claims for death or personal injury while you were intoxicated Other. Specify _________________________________ Check if this claim is for a community debt Is the claim subject to offset? No Yes ____________________________________________ Priority Creditor's Name Number Street Last 4 digits of account number ___ ___ ___ ___ When was the debt incurred? ____________ $____________ $__________ $____________ ____________________________________________ ____________________________________________ ____________________________________________ City State ZIP Code As of the date you file, the claim is: Check all that apply. Who incurred the debt? Check one. Contingent Unliquidated Disputed Debtor 1 only Debtor 2 only Debtor 1 and Debtor 2 only At least one of the debtors and another Type of PRIORITY unsecured claim: Domestic support obligations Taxes and certain other debts you owe the government Claims for death or personal injury while you were intoxicated Other. Specify _________________________________ Check if this claim is for a community debt Is the claim subject to offset? No Yes ____________________________________________ Priority Creditor's Name Number Street Last 4 digits of account number ___ ___ ___ ___ When was the debt incurred? ____