Form 108 Worksheet - Statement of Intention for Individuals Filing Under Chapter 7
Worksheet only. Not the official form. You must file Form 108 within 30 days after filing or by the meeting of creditors date (whichever is earlier), and send copies to creditors/lessors. Deadlines may be extended by court order.
United States Bankruptcy Court
District of [District]
In re: [Debtor Name(s)]
Case No.: [if known]
Chapter: 7
Part 1: List Your Creditors Who Have Secured Claims
For any creditor listed in Schedule D, identify the creditor, describe the collateral, and state your intention.
| Creditor name | Description of property securing debt | Intention (check one) | Claimed exempt on Schedule C? | If retain and explain |
|---|---|---|---|---|
| [Creditor] | [Property] | [Surrender / Redeem / Reaffirm / Retain and explain] | [Yes/No] | [ ] |
| [Creditor] | [Property] | [Surrender / Redeem / Reaffirm / Retain and explain] | [Yes/No] | [ ] |
| [Creditor] | [Property] | [Surrender / Redeem / Reaffirm / Retain and explain] | [Yes/No] | [ ] |
Part 2: List Your Unexpired Personal Property Leases
List unexpired personal property leases from Schedule G. Do not list real estate leases.
| Lessor name | Description of leased property | Will the lease be assumed? |
|---|---|---|
| [Lessor] | [Property] | [Yes/No] |
| [Lessor] | [Property] | [Yes/No] |
| [Lessor] | [Property] | [Yes/No] |
Part 3: Sign Below
Under penalty of perjury, I declare that I have indicated my intention about any property of my estate that secures a debt and any personal property that is subject to an unexpired lease.
Debtor 1 Signature: __________________________ Date: __________
Debtor 2 Signature (if joint): __________________________ Date: __________
If you choose reaffirmation, file the reaffirmation agreement on the required form within applicable deadlines.