Official Form 106E/F - Schedule of Unsecured Claims (Priority and Nonpriority)
United States Bankruptcy Court
District of [District]
In re: [Debtor Name(s)]
Case No.: [if known]
Chapter: [7/11/13]
Instructions
Data-collection worksheet to gather everything needed for the U.S. Official Form 106E/F. Not a filing-ready substitute for the official court form. Split into priority and nonpriority. Use continuation sheets as needed. Capture creditor name/address, basis, dates, setoff, and whether contingent, unliquidated, or disputed (C/U/D).
Part 1: List of Priority Unsecured Claims
| Creditor Name | Mailing Address | Basis / Priority Category (11 U.S.C. §507) | Date Incurred | Amount of Claim | Setoff? | C/U/D? |
|---|---|---|---|---|---|---|
| [IRS / State DOR] | [Address] | Taxes (§507(a)(8)) | [mm/dd/yyyy] | $[ ] | [Yes/No] | [C/U/D] |
| [Domestic Support Obligee] | [Address] | Support (§507(a)(1)) | [mm/dd/yyyy] | $[ ] | [Yes/No] | [C/U/D] |
| [Other priority creditor] | [Address] | [Basis / §507 type] | [mm/dd/yyyy] | $[ ] | [Yes/No] | [C/U/D] |
Subtotal priority claims: $[Total Priority]
Priority by category (optional cross-check): Support $[ ], Wages $[ ], Taxes $[ ], Other $[ ].
Part 2: List of Nonpriority Unsecured Claims
| Creditor Name | Mailing Address | Basis of Claim | Last 4 of Account | Date Incurred | Amount of Claim | Setoff? | C/U/D? |
|---|---|---|---|---|---|---|---|
| [Credit Card Lender] | [Address] | Credit card | [####] | [mm/dd/yyyy] | $[ ] | [Yes/No] | [C/U/D] |
| [Medical Provider] | [Address] | Medical services | [####] | [mm/dd/yyyy] | $[ ] | [Yes/No] | [C/U/D] |
| [Other creditor] | [Address] | [Basis] | [####] | [mm/dd/yyyy] | $[ ] | [Yes/No] | [C/U/D] |
Subtotal nonpriority claims: $[Total Nonpriority]
Total unsecured claims (priority + nonpriority): $[Total]
Part 3: Sign Below
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: __________
Complete Official Form 106Sum after finishing all schedules, and transfer this data into the court-approved Official Form 106E/F (or e-filing software) before filing.