Official Form B6I (10/53)
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 7, 11, 12, or 13 case whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed. Do not state the name of any minor child. Debtor’s Marital Status: RELATIONSHIP Employment: Occupation Name of Employer How long employed Address of Employer DEBTOR SPOUSE DEPENDENTS OF DEBTOR AND SPOUSE AGE
Income: (Estimate of monthly income as of the filing of the petition) 1. Current monthly gross wages, salary, and commissions (pro rate if not paid monthly.) 2. Estimated monthly overtime SUBTOTAL LESS PAYROLL DEDUCTIONS a. Payroll taxes and social security b. Insurance c. Union dues d. Other (Specify: ______________________________________)
DEBTOR $ ____________ $ ____________
SPOUSE $ ____________ $ ____________
$__________
$ ____________ $ ____________ $ ____________ $ ____________
$ _________
$ ____________ $ ____________ $ ____________ $ ____________
SUBTOTAL OF PAYROLL DEDUCTIONS 3. TOTAL NET MONTHLY TAKE HOME PAY
$__________ $__________
$ ____________ $ ____________ $ ____________ $ ____________ $ ____________ $ ____________ $ ____________ $ ____________ $ ____________
$ __________ $ __________
$ ____________ $ ____________ $ ____________ $ ____________ $ ____________ $ ____________ $ ____________ $ ____________ $ ____________
4. Regular income from operation of business or profession or farm (Attach detailed statement.) 5. Income from real property 6. Interest and dividends 7. Alimony, maintenance or support payments payable to the debtor for the debtor’s use or that of dependents listed above. 8. Social security or other government assistance (Specify: )______________________ 9. Pension or retirement income 10. Other monthly income (Specify)_________________________________________________ _________________________________________________ 11. SUBTOTAL OF INCOME REPORTED ON LINES 4 THROUGH 10 12. TOTAL MONTHLY INCOME (Add amounts shown on Lines 3 through 11.) TOTAL COMBINED MONTHLY INCOME $_________________
$__________
$ __________
(Report also on Summary of Schedules)
Describe any increase [or decrease] in income anticipated to occur within the year following the filing of this document: