CHAPTER 7 BANKRUPTCY PETITION

United States Bankruptcy Court – [Northern / Southern] District of Ohio

[// GUIDANCE: This template tracks the structure of the Official Bankruptcy Forms (primarily Forms 101, 106A–J, 107, 108, 122A-1/2) and incorporates all Ohio-specific requirements, local rule references, and trustee practice points. It is formatted so counsel may copy each section into the corresponding Official Form or use it as an annotated master checklist. Bracketed items require case-specific data or district selection. Delete all guidance comments before filing.]

TABLE OF CONTENTS

1. Document Header
2. Definitions
3. Voluntary Petition—Official Form 101 (Core Data Set)
4. Property & Exemptions (Schedules A/B & C)
5. Creditor & Contract Schedules (Schedules D–H)
6. Current Income & Expenses (Schedules I & J)
7. Statement of Financial Affairs—Official Form 107
8. Statement of Intention—Official Form 108
9. Means Test—Official Forms 122A-1 & 122A-2
10. Verification, Declarations & Signature Blocks
11. Local District Addenda & Trustee Compliance
12. Exhibit Index / Attachments

1. DOCUMENT HEADER

UNITED STATES BANKRUPTCY COURT
[NORTHERN / SOUTHERN] DISTRICT OF OHIO

In re: )
)
[Debtor Full Legal Name] ) Case No. ______
[Joint Debtor Full Legal Name, if any] )
) Chapter 7
Debtor(s). )

VOLUNTARY PETITION FOR INDIVIDUALS FILING FOR BANKRUPTCY
(Official Form 101 with Ohio Local Addenda)

Date Filed: [MM / DD / YYYY]
[// GUIDANCE: Insert the district name exactly as shown in the clerk’s style guide. The case number is assigned by the clerk upon filing.]

2. DEFINITIONS

For purposes of this Petition and all accompanying schedules, the following terms have the meanings indicated. Capitalized terms appear throughout the template.

1. “Bankruptcy Code” means title 11 of the United States Code.
2. “Bankruptcy Rules” means the Federal Rules of Bankruptcy Procedure.
3. “District” means either the Northern District of Ohio (“N.D. Ohio”) or the Southern District of Ohio (“S.D. Ohio”), as selected above.
4. “Exempt Property” means property claimed exempt under Ohio Revised Code § 2329.66 and 11 U.S.C. § 522(b)(3).
5. “Petition Date” means the date this Voluntary Petition is filed with the clerk.
6. “Trustee” means the Chapter 7 panel trustee appointed pursuant to 11 U.S.C. § 701.

3. VOLUNTARY PETITION—OFFICIAL FORM 101 (CORE DATA SET)

Complete each numbered item on Official Form 101. Insert the following information in the stated order; fields match Form 101 boxes.

A. Debtor Information
• Full Legal Name: [DEBTOR NAME]
• All Other Names in past 8 years: [a/k/a, d/b/a]
• Last four digits of SSN/ITIN: [_]
• Residential Address: [STREET, CITY, STATE OH, ZIP]
• County: [_]
• Mailing Address (if different): [____]

B. Joint Debtor Information (if filing jointly)
[Same data set as A.]

C. Statistical / Administrative Information
• Type of Debtor: Individual / Consumer (check box)
• Chapter: 7 ✔
• Nature of Debts: Primarily Consumer ✔ / Primarily Business ☐
• Filing Fee: Paid in Full ✔ / Installment Request ☐ / Waiver Request ☐
• Prior Bankruptcy Cases within 8 Years: [Case Nos., Districts, Dates]
• Pending Bankruptcy Cases Concerning Debtor’s Affiliate: [List or “None”]

D. District Selection Statement
“Venue is proper in this District under 28 U.S.C. § 1408 because the Debtor has had domicile, residence, principal assets, or principal place of business in the District for over 180 days preceding the Petition Date.”

E. Certification of Credit Counseling
• Provider: [Agency Name]
• Certificate No.: [____]
• Date Completed: [MM / DD / YYYY] (must be within 180 days pre-petition or qualify for exemption)

F. Signature / Declaration—see Section 10.

[// GUIDANCE: While the Official Form already contains declarations, most Ohio judges require separate signature blocks for each schedule; use Section 10 for uniformity.]

4. PROPERTY & EXEMPTIONS (Schedules A/B & C)

4.1 Schedule A/B – Property

List all property in the categories mandated by Official Form 106A/B. Insert “NONE” where applicable.

1. Real Property
   a. [Street Address, City, OH ZIP] – Fee simple, current value $[_], secured claim $[_].
2. Motor Vehicles
   a. [Year/Make/Model] – Value $[_], lien $[_].
3. Financial Assets
   a. Checking Account – Bank [_], balance $[_].
4. Personal & Household Items
   a. Clothing – estimated resale value $[____].
5. Miscellaneous
   a. 2023 Tax Refund (anticipated) – $[____].

4.2 Schedule C – Exemptions (Ohio Opt-Out Regime)

Claim each exemption in the chart below by statute and amount.

[// GUIDANCE: Update dollar amounts annually—Ohio exemption values adjust every three years. Verify the current limits using the Ohio Judicial Conference chart effective on the Petition Date.]

5. CREDITOR & CONTRACT SCHEDULES (Schedules D–H)

1. Schedule D – Secured Claims
   • Creditor: [Lender], Collateral: [Real Property], Amount: $[____], Claim Type: [Mortgage / Judgment Lien]
2. Schedule E/F – Unsecured Claims
   • Priority – IRS 2021 tax, $[_]
   • Non-Priority – Credit Card (Bank X), $[_]
3. Schedule G – Executory Contracts & Unexpired Leases
   • Residential Lease with [Landlord]. Term ends [Date].
4. Schedule H – Codebtors
   • [Spouse / Cosigner], Address: [____]

6. CURRENT INCOME & EXPENSES (Schedules I & J)

6.1 Schedule I – Income

6.2 Schedule J – Expenses

Disposable Monthly Income (Schedule I minus Schedule J): $[____]

[// GUIDANCE: Chapter 7 presumption of abuse under 11 U.S.C. § 707(b) is determined by the Means Test, not Schedule I/J. Nevertheless, internal consistency is critical—ensure the numbers reconcile.]

7. STATEMENT OF FINANCIAL AFFAIRS — Official Form 107

Answer each Part precisely; common Ohio practice issues are highlighted.

1. Income – Past 3 Years
   • 2023 Gross W-2 Wages: $[____]
2. Payments to Creditors – 90-day preference window
   • Credit Card payoff to [Bank] $[4,500] on [Date]
3. Lawsuits, Garnishments, & Seizures
   • Case: [Smith v. Debtor], Common Pleas Cuyahoga No. [____], Judgment entered [Date]
4. Repossessions & Foreclosures
   • None ✔
5. Gifts & Charitable Contributions
   • Church donations $[____] in 2023
6. Losses
   • Car accident (total loss) 02/14/2024, Insurance claim pending
7. Financial Accounts Closed within 1 year
   • KeyBank checking, closed 08/2023
8. Safe-Deposit Boxes
   • None ✔
9. Property Held for Another
   • None ✔
10. Prior Addresses within 3 Years
    • 123 Elm St., Akron, OH 44308 (01/2021–06/2023)

[// GUIDANCE: Be meticulous. Omissions are the leading cause of 11 U.S.C. § 727 objections.]

8. STATEMENT OF INTENTION — Official Form 108

Debtor intends to:

Deadline: File and serve on creditor within 30 days of Petition Date or on/ before § 341 meeting, whichever is earlier.

[// GUIDANCE: Northern District of Ohio Standing Order 17-4 requires the Debtor to perform the stated intention within 45 days of filing Form 108.]

9. MEANS TEST — Official Forms 122A-1 & 122A-2

A. Current Monthly Income (CMI) Calculation
• Household Size: [_]
• Ohio Median Income for Size: $[_] (effective [Date])
• Debtor’s Six-Month Average: $[____]
• Presumption of Abuse: ☐ Yes / ✔ No

B. Deductions & Additional Expense Adjustments
• National/Local Standards auto-populated via software; insert manual overrides only with documentation.

C. Signature & Certification – see Section 10.

[// GUIDANCE: If presumption arises, attach Statement of Exemption from Presumption or Notice of Special Circumstances. Use LBR 1017-5 procedures.]

10. VERIFICATION, DECLARATIONS & SIGNATURE BLOCKS

I declare under penalty of perjury that the information provided in this Petition and all accompanying schedules and statements is true and correct to the best of my knowledge, information, and belief.
Date: [MM / DD / YYYY]

/s/ [Typed Debtor Name]
Debtor

/s/ [Typed Joint Debtor Name] (if applicable)
Joint Debtor

Prepared By:
/s/ [Attorney Name] (Ohio Bar No. [_])
[Law Firm Name]
[Street Address]
[City], Ohio [ZIP]
Telephone: () -
Email: [_]
[// GUIDANCE: Insert the attorney’s “best practices” certification for the petition preparer, if any, and complete Official Form 121 (SSN statement) as a separate, non-public document.]

11. LOCAL DISTRICT ADDENDA & TRUSTEE COMPLIANCE

11.1 Local Bankruptcy Rules (“LBR”) Requirements
• N.D. Ohio LBR 1007-1 / S.D. Ohio LBR 1007-1: Debtor must file pay advices (60 days pre-petition) or certification of non-existence.
• N.D. Ohio LBR 5080-1: Filing fee installment application must accompany petition if not paid in full.
• S.D. Ohio LBR 4002-1(b): Provide tax returns to trustee no later than 7 days before § 341 meeting.

11.2 Trustee Document Production
Within 7 days of the petition, deliver to the assigned trustee:
• Bank statements covering the Petition Date.
• Most recent federal and state tax returns.
• Vehicle titles; real estate deeds.
• Valuation appraisals (if real property claimed exempt exceeds $100k equity).

[// GUIDANCE: Use the trustee’s preferred secure portal where available; otherwise mail hard-copy with exhibit index.]

12. EXHIBIT INDEX / ATTACHMENTS

A. Creditor Matrix (ASCII .txt file).
B. Certificate of Credit Counseling.
C. Means Test Forms 122A-1 & 122A-2.
D. Pay Advice Cover Sheet & Redacted Documents.
E. Proposed Order for Joint Administration (if spouses maintain separate estates).
F. Proof of Eligibility for Ohio Exemptions (domicile statement per 11 U.S.C. § 522(b)(3)(A)).

AUTOMATIC STAY NOTICE

Upon filing, the automatic stay described in 11 U.S.C. § 362 is in effect. Creditors are advised to cease all collection activity unless and until relief from stay is granted.

GOVERNING LAW & VENUE

This Petition and accompanying schedules are submitted pursuant to the Bankruptcy Code and are subject to the exclusive jurisdiction of the United States Bankruptcy Court for the [Northern / Southern] District of Ohio.

NO ARBITRATION OR JURY TRIAL

Bankruptcy proceedings are non-arbitrable, and jury trials are available only upon proper motion and district court withdrawal of the reference. See 28 U.S.C. § 157(e).

END OF TEMPLATE

[// GUIDANCE: Review all numbers against current IRS/National standards and Ohio exemption adjustments. Confirm LBR citations with the chosen District’s most recent revision. Delete unused sections (e.g., joint debtor provisions) before filing. This template does not itself create attorney-client relationship and must be tailored to client facts.]