B 22B (Official Form 22B) (Chapter 11) (12/10) In re ______________________________ Debtor(s) Case Number: __________________ (If known) CHAPTER 11 STATEMENT OF CURRENT MONTHLY INCOME In addition to Schedules I and J, this statement must be completed by every individual chapter 11 debtor, whether or not filing jointly. Joint debtors may complete one statement only. Part I. CALCULATION OF CURRENT MONTHLY INCOME 1 2 Marital/filing status. Check the box that applies and complete the balance of this part of this statement as directed. Unmarried. Complete only Column A (“Debtor’s Income”) for Lines 2-10. a. b. Married, not filing jointly. Complete only Column A (“Debtor’s Income”) for Lines 2-10. c. Married, filing jointly. Complete both Column A (“Debtor’s Income”) and Column B (“Spouse’s Income”) for Lines 2-10. All figures must reflect average monthly income received from all sources, derived during the Column A Column B six calendar months prior to filing the bankruptcy case, ending on the last day of the month Debtor’s Spouse’s before the filing. If the amount of monthly income varied during the six months, you must Income Income divide the six-month total by six, and enter the result on the appropriate line. Gross wages, salary, tips, bonuses, overtime, commissions. $ $ $ $ $ $ Net income from the operation of a business, profession, or farm. Subtract Line b from Line a and enter the difference in the appropriate column(s) of Line 3. If more than one business, profession or farm, enter aggregate numbers and provide details on an attachment. Do not enter a number less than zero. 3 a. Gross receipts $ b. Ordinary and necessary business expenses $ c. Business income Subtract Line b from Line a. Net rental and other real property income. Subtract Line b from Line a and enter the difference in the appropriate column(s) of Line 4. Do not enter a number less than zero. a. Gross receipts $ b. Ordinary and necessary operating expenses $ c. 4 Rent and other real property income Subtract Line b from Line a. 5 Interest, dividends, and royalties. $ $ 6 Pension and retirement income. $ $ 7 Any amounts paid by another person or entity, on a regular basis, for the household expenses of the debtor or the debtor’s dependents, including child support paid for that purpose. Do not include alimony or separate maintenance payments or amounts paid by the debtor’s spouse if Column B is completed. Each regular payment should be reported in only one column; if a payment is listed in Column A, do not report that payment in Column B. $ $ $ $ 8 Unemployment compensation. Enter the amount in the appropriate column(s) of Line 8. However, if you contend that unemployment compensation received by you or your spouse was a benefit under the Social Security Act, do not list the amount of such compensation in Column A or B, but instead state the amount in the space below: Unemployment compensation claimed to be a benefit under the Social Security Act Debtor $ ________ Spouse $ _________ American LegalNet, Inc. www.FormsWorkFlow.com B 22B (Official Form 22B) (Chapter 11) (12/10) 9 2 Income from all other sources. Specify source and amount. If necessary, list additional sources on a separate page. Total and enter on Line 9. Do not include alimony or separate maintenance payments paid by your spouse if Column B is completed, but include all other payments of alimony or separate maintenance. Do not include any benefits received under the Social Security Act or payments received as a victim of a war crime, crime against humanity, or as a victim of international or domestic terrorism. a. b. $ $ $ $ 10 Subtotal of current monthly income. Add Lines 2 thru 9 in Column A, and, if Column B is completed, add Lines 2 through 9 in Column B. Enter the total(s). $ $ 11 Total current monthly income. If Column B has been completed, add Line 10, Column A to Line 10, Column B, and enter the total. If Column B has not been completed, enter the amount from Line 10, Column A. $ Part II: VERIFICATION I declare under penalty of perjury that the information provided in this statement is true and correct. (If this a joint case, both debtors must sign.) 12 Date: ________________________ Signature: ________________________ (Debtor) Date: ________________________ Signature: ________________________ (Joint Debtor, if any) American LegalNet, Inc. www.FormsWorkFlow.com