Bankruptcy Schedule I – Current Income of Individual Debtor(s) Template - Free Editor
Bankruptcy Schedule I – Current Income of Individual Debtor(s) Template
United States Bankruptcy Court
District of [District]
In re: [Debtor Name(s)]
Case No.: [if known]
Chapter: [7/13]
Schedule I: Debtor’s Income
Provide monthly income information for each debtor as of filing date.
Part 1: Employment Information
| Debtor | Employer | Address | Occupation | Employment Duration |
|---|---|---|---|---|
| Debtor 1 | [Employer Name] | [Address] | [Job Title] | [Years/Months] |
| Debtor 2 (if any) |
Part 2: Monthly Income (Gross)
- Debtor 1 gross wages/salary/commissions: $[Amount]
- Debtor 2 gross wages/salary/commissions: $[Amount]
- Monthly overtime, tips, bonuses: $[Amount]
Part 3: Payroll Deductions
| Description | Debtor 1 | Debtor 2 |
|---|---|---|
| Payroll taxes and Social Security | $[Amount] | $[Amount] |
| Insurance (medical, dental, life) | $[Amount] | $[Amount] |
| Union dues | $[Amount] | $[Amount] |
| Retirement contributions | $[Amount] | $[Amount] |
| Other deductions | $[Amount] | $[Amount] |
Part 4: Other Monthly Income
- Net income from business or self-employment (attach Form 122A/B): $[Amount]
- Rental and real property income: $[Amount]
- Interest and dividends: $[Amount]
- Family support payments received: $[Amount]
- Unemployment, disability, Social Security, pension: $[Amount]
- Other income (describe): $[Amount]
Part 5: Net Monthly Income
- Total combined monthly income: $[Total Gross]
- Total payroll deductions: $[Total Deductions]
- Net employment income: $[Gross – Deductions]
- Add other income sources: $[Amount]
- Combined monthly income: $[Total]
Declaration
I declare under penalty of perjury that the information provided is true and correct.
Debtor 1 Signature: ____ Date: __
Debtor 2 Signature (if joint case): ____ Date: __
Align with Official Form 106I; attach continuation sheets for additional detail if necessary.
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