Form 106J-2 Worksheet - Schedule J-2: Expenses for Separate Household of Debtor 2
Worksheet only. Not the official form. Use only if Debtor 2 maintains a separate household. Transfer to Official Form 106J-2 or e-filing software. Do not duplicate expenses already reported on Schedule J.
United States Bankruptcy Court
District of [District]
In re: [Debtor Name(s)]
Case No.: [if known]
Chapter: [7/11/13]
Check if amended filing: [ ]
Check if supplement showing postpetition Chapter 13 expenses as of (date): [ ]
Part 1: Describe Your Household
- Do Debtor 1 and Debtor 2 maintain separate households? [No / Yes]
- Do you have dependents? [No / Yes]
Dependents of Debtor 2 (do not state names; list relationship/age and whether they live with Debtor 2; if Debtor 1 and Debtor 2 have dependents in common, list them on both Schedule J and J-2):
| Relationship | Age | Does dependent live with Debtor 2? |
| --- | --- | --- |
| [ ] | [ ] | [Yes/No] |
| [ ] | [ ] | [Yes/No] |
| [ ] | [ ] | [Yes/No] | - Do your expenses include expenses of people other than yourself, your dependents, and Debtor 1? [No / Yes] If yes, describe: [ ]
- Debtor 2 separate household address: [Number/Street/City/State/ZIP]
- Reason for separate household: [ ]
Part 2: Debtor 2 Separate Household Expenses (average monthly)
Enter only expenses for Debtor 2’s separate household. Match the official line structure.
| Line | Category | Amount |
|---|---|---|
| 4 | Rent or home mortgage payment (including lot rent) | $[ ] |
| 4a | If not included in Line 4: real estate taxes | $[ ] |
| 4b | If not included in Line 4: property/homeowner’s/renter’s insurance | $[ ] |
| 4c | If not included in Line 4: home maintenance, repair, and upkeep | $[ ] |
| 4d | If not included in Line 4: homeowner association/condo dues | $[ ] |
| 5 | Additional mortgage payments (e.g., home equity loans) | $[ ] |
| 6a | Utilities: electricity, heat, natural gas | $[ ] |
| 6b | Water, sewer, garbage collection | $[ ] |
| 6c | Telephone, cell phone, internet, satellite, cable | $[ ] |
| 6d | Other home utilities (specify) | $[ ] |
| 7 | Food and housekeeping supplies | $[ ] |
| 8 | Childcare and children’s education costs | $[ ] |
| 9 | Clothing, laundry, dry cleaning | $[ ] |
| 10 | Personal care products and services | $[ ] |
| 11 | Medical and dental expenses (out-of-pocket) | $[ ] |
| 12 | Transportation (gas, maintenance, public transit) | $[ ] |
| 13 | Entertainment, clubs, recreation, newspapers, magazines | $[ ] |
| 14 | Charitable contributions and religious donations | $[ ] |
| 15a | Insurance: life | $[ ] |
| 15b | Insurance: health | $[ ] |
| 15c | Insurance: vehicle | $[ ] |
| 15d | Insurance: other | $[ ] |
| 16 | Taxes (specify type) | $[ ] |
| 17a | Installment or lease payments: vehicle 1 | $[ ] |
| 17b | Installment or lease payments: vehicle 2 | $[ ] |
| 17c | Other installment or lease payments | $[ ] |
| 17d | Other installment or lease payments | $[ ] |
| 18 | Alimony, maintenance, support paid | $[ ] |
| 19 | Support paid for others not living with you | $[ ] |
| 20a | Other real property expenses: mortgages on other property | $[ ] |
| 20b | Other real property expenses: real estate taxes | $[ ] |
| 20c | Other real property expenses: property/homeowner’s/renter’s insurance | $[ ] |
| 20d | Other real property expenses: maintenance, repair, upkeep | $[ ] |
| 20e | Other real property expenses: homeowner association/condo dues | $[ ] |
| 21 | Other expenses (specify) | $[ ] |
Total separate household expenses (line 22): $[ ]
Copy this total to Schedule J, line 22b: $[ ]
Part 3: Changes in Expenses
- Do you expect your separate household expenses to increase or decrease within a year after filing? [No / Yes] If yes, explain: [ ]
Signature
Under penalty of perjury, I declare that the information provided is true and correct.
Debtor 2 Signature: __________________________ Date: __________
File Official Form 106J-2 with Schedule J when required; do not file this worksheet.