Schedule I, Current Income of Individual Debtor(s) (United States)
This is Schedule I, current income of individual debtor(s). The form provided here is simply a sample of what the actual Form B6I looks like.
FORM B6I
In re ___________________________ Debtor
Case No. __________________________ (if known)
SCHEDULE I - CURRENT INCOME OF INDIVIDUAL DEBTOR(S)
The column labeled "Spouse" must be completed in all cases filed by joint debtors and by a married debtor in a chapter 12 or 13 case whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.
Debtor's Marital Status:
DEPENDENTS OF DEBTOR AND SPOUSE
NAMES __________________________
AGE __________________________
RELATIONSHIP __________________________
Employment:
DEBTOR
Occupation __________________________
Name of Employer __________________________
How long employed __________________________
Address of Employer __________________________
SPOUSE
Occupation __________________________
Name of Employer __________________________
How long employed __________________________
Address of Employer __________________________
DEBTOR
Income: (Estimate of average monthly income)
Current monthly gross wages, salary, and commissions (pro rate if not paid monthly.)
$____________
Estimated monthly overtime $____________
SUBTOTAL $____________
LESS PAYROLL DEDUCTIONS
a. Payroll taxes and social security $____________
b. Insurance $____________
c. Union dues $____________
d. Other (Specify: ______________________________________) $____________
SUBTOTAL OF PAYROLL DEDUCTIONS $____________
TOTAL NET MONTHLY TAKE HOME PAY $____________
Regular income from operation of business or profession or farm
$____________
(attach detailed statement)
Income from real property ____________
Interest and dividends $____________
Alimony, maintenance or support payments payable to the debtor for the debtor's use or that of dependents listed above.
$____________
Social security or other government assistance (Specify) __________________________________________________
$____________
Pension or retirement income $____________
Other monthly income (Specify)
____________________________________________ $____________
TOTAL MONTHLY INCOME $_________________
TOTAL COMBINED MONTHLY INCOME $_________________ (Report also on Summary of Schedules)
Describe any increase or decrease of more than 10% in any of the above categories anticipated to occur within the year following the filing of this document:
_________________
SPOUSE
Income: (Estimate of average monthly income)
Current monthly gross wages, salary, and commissions (pro rate if not paid monthly.)
$____________
Estimated monthly overtime $____________
SUBTOTAL $____________
LESS PAYROLL DEDUCTIONS
a. Payroll taxes and social security $____________
b. Insurance $____________
c. Union dues $____________
d. Other (Specify: ______________________________) $____________
SUBTOTAL OF PAYROLL DEDUCTIONS $____________
TOTAL NET MONTHLY TAKE HOME PAY $____________
Regular income from operation of business or profession or farm $____________
(attach detailed statement)
Income from real property ____________
Interest and dividends $____________
Alimony, maintenance or support payments payable to the debtor for the debtor's use or that of dependents listed above.
$____________
Social security or other government assistance (Specify)
__________________________________________________
$____________
Pension or retirement income $____________
Other monthly income (Specify)
____________________________________________ $____________
TOTAL MONTHLY INCOME $_________________
TOTAL COMBINED MONTHLY INCOME $_________________
(Report also on Summary of Schedules)
Describe any increase or decrease of more than 10% in any of the above categories anticipated to occur within the year following the filing of this document:
_________________