Expression, Schedule A/B: Property (individuals)

• Legal Form Number: B 106A
• Court: United States Federal Court
• Section: United States Federal Court

Official Form 106A/BSchedule A/B: Propertypage 1

Official Form 106A/B

Schedule A/B: Property 12/15

In each category, separately list and describe items. List an asset only once. If an asset fits in more than one categ ory, list the asset in the

category where you think it fits best. Be as complete and accurate as possible. If two married people are filing together, b oth are equally

responsible for supplying correct information. If more space is needed, attach a separate sheet to this form. On the to p of any additional pages,

write your name and case number (if known). Answer every question.

Part 1: Describe Each Residence, Building, Land, or Other Real Estate You Own or Have an Interest In

1. Do you ow n or have any legal or equitable interest in any residence, building, land, or similar property?

No. Go to Part 2.

Yes. Where is the property?

1.1._________________________________________

Street address, if available, or other description

_________________________________________

_________________________________________

City State ZIP Code

_________________________________________

County

What is the property? Check all that apply.

Single-family home

Duplex or multi-unit building

Condominium or cooperative

Manufactured or mobile home

Land

Investment property

Timeshare

Other __________________________________

Do not deduct secured claims or exemptions. Put

the amount of any secured claims onSchedule D:

Creditors Who Have Claims Secured by Property.

Current value of the

entire property?

$________________

Current value of the

portion you own?

$_______________

Describe the nature of your ownership

interest (such as fee simple, tenancy by

the entireties, or a life estate), if known.

Who has an interest in the property? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

__________________________________________

Check if this is community property

(see instructions)

Other information you wish to add about this item, such as local

property identification number: _______________________________

If you own or have more than one, list here:

1.2.________________________________________

Street address, if available, or other description

________________________________________

________________________________________

City State

ZIP Code

________________________________________

County

What is the property? Check all that apply.

Single-family home

Duplex or multi-unit building

Condominium or cooperative

Manufactured or mobile home

Land

Investment property

Timeshare

Other __________________________________

Do not deduct secured claims or exemptions. Put

the amount of any secured claims onSchedule D:

Creditors Who Have Claims Secured by Property.

Current value of the

entire property?

$________________

Current value of the

portion you own?

$_________________

Describe the nature of your ownership

interest (such as fee simple, tenancy by

the entireties, or a life estate), if known.

Who has an interest in the property? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

__________________________________________

Check if this is community property

(see instructions)

Other information you wish to add about this item, such as local

property identification number: _______________________________

Debtor 1 __________________________________________________________________

First Name Middle Name Last Name

Debtor 2 ________________________________________________________________

(Spouse, if filing)First Name Middle Name Last Name

United States Bankruptcy Court for the: __________ District of ___________

Case number ___________________________________________

Fill in this information to identify your case and this filing:

Check if this is an

amended filing

__________ District of __________