Fill in this information to identify your case: United States Bankruptcy Court for the: ____________________ District of _________________ (State) Case number (If known): _________________________ Chapter you are filing under: Chapter 7 Chapter 11 Chapter 12 Chapter 13 Check if this is an amended filing Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy 12/15 The bankruptcy forms use you and Debtor 1 to refer to a debtor filing alone. A married couple may file a bankruptcy case together--called a joint case--and in joint cases, these forms use you to ask for information from both debtors. For example, if a form asks, "Do you own a car," the answer would be yes if either debtor owns a car. When information is needed about the spouses separately, the form uses Debtor 1 and Debtor 2 to distinguish between them. In joint cases, one of the spouses must report information as Debtor 1 and the other as Debtor 2. The same person must be Debtor 1 in all of the forms. Be as complete and accurate as possible. If two married people are filing together, both are equally responsible for supplying correct information. If more space is needed, attach a separate sheet to this form. On the top of any additional pages, write your name and case number (if known). Answer every question. Part 1: Identify Yourself About Debtor 1: 1. About Debtor 2 (Spouse Only in a Joint Case): Your full name Write the name that is on your government-issued picture identification (for example, your driver's license or passport). Bring your picture identification to your meeting with the trustee. __________________________________________________ First name __________________________________________________ Middle name __________________________________________________ Last name ___________________________ Suffix (Sr., Jr., II, III) __________________________________________________ First name __________________________________________________ Middle name __________________________________________________ Last name ___________________________ Suffix (Sr., Jr., II, III) 2. All other names you have used in the last 8 years Include your married or maiden names. __________________________________________________ First name __________________________________________________ Middle name __________________________________________________ Last name __________________________________________________ First name __________________________________________________ Middle name __________________________________________________ Last name __________________________________________________ First name __________________________________________________ Middle name __________________________________________________ Last name __________________________________________________ First name __________________________________________________ Middle name __________________________________________________ Last name 3. Only the last 4 digits of your Social Security number or federal Individual Taxpayer Identification number (ITIN) xxx OR ­ xx ­ ____ ____ ____ ____ xxx OR ­ xx ­ ____ ____ ____ ____ 9 xx ­ xx ­ ____ ____ ____ ____ 9 xx ­ xx ­ ____ ____ ____ ____ page 1 American LegalNet, Inc. www.FormsWorkFlow.com Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy Debtor 1 First Name _______________________________________________________ Middle Name Last Name Case number (if known)_____________________________________ About Debtor 1: 4. About Debtor 2 (Spouse Only in a Joint Case): Any business names and Employer Identification Numbers (EIN) you have used in the last 8 years Include trade names and doing business as names I have not used any business names or EINs. _________________________________________________ Business name _________________________________________________ Business name ___ ___ ­ ___ ___ ___ ___ ___ ___ ___ EIN ___ ___ ­ ___ ___ ___ ___ ___ ___ ___ EIN I have not used any business names or EINs. _________________________________________________ Business name _________________________________________________ Business name ___ ___ ­ ___ ___ ___ ___ ___ ___ ___ EIN ___ ___ ­ ___ ___ ___ ___ ___ ___ ___ EIN 5. Where you live _________________________________________________ Number Street _________________________________________________ _________________________________________________ City State ZIP Code _________________________________________________ County If Debtor 2 lives at a different address: _________________________________________________ Number Street _________________________________________________ _________________________________________________ City State ZIP Code _________________________________________________ County If your mailing address is different from the one above, fill it in here. Note that the court will send any notices to you at this mailing address. _________________________________________________ Number Street _________________________________________________ P.O. Box _________________________________________________ City State ZIP Code If Debtor 2's mailing address is different from yours, fill it in here. Note that the court will send any notices to this mailing address. _________________________________________________ Number Street _________________________________________________ P.O. Box _________________________________________________ City State ZIP Code 6. Why you are choosing this district to file for bankruptcy Check one: Check one: Over the last 180 days before filing this petition, I have lived in this district longer than in any other district. (See 28 U.S.C. § 1408.) Over the last 180 days before filing this petition, I have lived in this district longer than in any other district. (See 28 U.S.C. § 1408.) I have another reason. Explain. ________________________________________ ________________________________________ ________________________________________ ________________________________________ I have another reason. Explain. ________________________________________ ________________________________________ ________________________________________ ________________________________________ Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy American LegalNet, Inc. www.FormsWorkFlow.com page 2 Debtor 1 First Name _______________________________________________________ Middle Name Last Name Case number (if known)_____________________________________ Part 2: 7. Tell the Court About Your Bankruptcy Case Check one