Section 11.19 Statement of Current Monthly Income and Calculation of Commitment Period and Disposable Income

• Library: Bankruptcy 2015 Cum - Forms

This form was replaced with forms B22C-1 and B22C-2 (effective December 1, 2014).

These forms are available at:

www.uscourts.gov/services-forms/forms

Fill in this information to identify your case:
Debtor 1	__________ First Name	__________ Middle Name	__________ Last Name
Debtor 2 (Spouse, if filing)	__________ First Name	__________ Middle Name	__________ Last Name
United States Bankruptcy Court for the:		__________	District of __________
Case number (If known)	__________

Check as directed in lines 17 and 21:

According to the calculations required by this Statement:

[ ] 1. Disposable income is not determined under 11 U.S.C. § 1325(b)(3).

[ ] 2. Disposable income is determined under 11 U.S.C. § 1325(b)(3).

[ ] 3. The commitment period is 3 years.

[ ] 4. The commitment period is 5 years.

[ ] Check if this is an amended filing

Official Form B 22C1

Chapter 13 Statement of Your Current Monthly Income and Calculation of Commitment Period 12/14

Be as complete and accurate as possible. If two married people are filing together, both are equally responsible for being accurate. If more space is needed, attach a separate sheet to this form. Include the line number to which the additional information applies. On the top of any additional pages, write your name and case number (if known).

Part 1: Calculate Your Average Monthly Income

1. What is your marital and filing status? Check one only.
[ ] Not married. Fill out Column A, lines 2-11.
[ ] Married. Fill out both Columns A and B, lines 2-11.
Fill in the average monthly income that you received from all sources, derived during the 6 full months before you file this bankruptcy case. 11 U.S.C. § 101(10A). For example, if you are filing on September 15, the 6-month period would be March 1 through August 31. If the amount of your monthly income varied during the 6 months, add the income for all 6 months and divide the total by 6. Fill in the result. Do not include any income amount more than once. For example, if both spouses own the same rental property, put the income from that property in one column only. If you have nothing to report for any line, write $0 in the space.
			Column A	Column B
			Debtor 1	Debtor 2 or non-filing spouse
2. Your gross wages, salary, tips, bonuses, overtime, and commissions (before all payroll deductions).			$__________	$__________
3. Alimony and maintenance payments. Do not include payments from a spouse if Column B is filled in.			$__________	$__________
4. All amounts from any source which are regularly paid for household expenses of you or your dependents, including child support. Include regular contributions from an unmarried partner, members of your household, your dependents, parents, and roommates. Include regular contributions from a spouse only if Column B is not filled in. Do not include payments you listed on line 3.			$__________	$__________
5. Net income from operating a business, profession, or farm
Gross receipts (before all deductions)	$__________
Ordinary and necessary operating expenses	- $__________
Net monthly income from a business, profession, or farm	$	Copy here?	$__________	$__________
6. Net income from rental and other real property
Gross receipts (before all deductions)	$__________
Ordinary and necessary operating expenses	- $__________
Net monthly income from rental or other real property	$__________	Copy here?	$__________	$__________

	Column A	Column B
	Debtor 1	Debtor 2 or non-filing spouse
7. Interest, dividends, and royalties	$__________	$__________
8. Unemployment compensation	$__________	$__________
Do not enter the amount if you contend that the amount received was a benefit under the Social Security Act. Instead, list it here:?
For you $__________
For your spouse $__________
9. Pension or retirement income. Do not include any amount received that was a benefit under the Social Security Act.	$__________	$__________
10. Income from all other sources not listed above. Specify the source and amount. Do not include any benefits received under the Social Security Act or payments received as a victim of a war crime, a crime against humanity, or international or domestic terrorism. If necessary, list other sources on a separate page and put the total on line 10c.
10a. __________	$__________	$__________
10b. __________	$__________	$__________
10c. Total amounts from separate pages, if any.	+ $ __________	+ $__________
11. Calculate your total average monthly income. Add lines 2 through 10 for each column. Then add the total for Column A to the total for Column B.	$ __________+	$__________	= $__________ Total average monthly income

Part 2: Determine How to Measure Your Deductions from Income

12. Copy your total average monthly income from line 11.			$__________
13. Calculate the marital adjustment. Check one:
[ ] You are not married. Fill in 0 in line 13d.
[ ] You are married and your spouse is filing with you. Fill in 0 in line 13d.
[ ] You are married and your spouse is not filing with you.
Fill in the amount of the income listed in line 11, Column B, that was NOT regularly paid for the household expenses of you or your dependents, such as payment of the spouse's tax liability or the spouse's support of someone other than you or your dependents.
In lines 13a-c, specify the basis for excluding this income and the amount of income devoted to each purpose. If necessary, list additional adjustments on a separate page.
If this adjustment does not apply, enter 0 on line 13d.
13a. __________	$__________
13b. __________	$__________
13c. __________	+ $__________
13d. Total	$__________	Copy here. ?13d.	—__________
14. Your current monthly income. Subtract line 13d from line 12.		14.	$__________
15. Calculate your current monthly income for the year. Follow these steps:
15a. Copy line 14 here ?		15a.	$__________
Multiply line 15a by 12 (the number of months in a year).			x 12
15b. The result is your current monthly income for the year for this part of the form.		15b.	$__________

16. Calculate the median family income that applies to you. Follow these steps:
16a. Fill in the state in which you live. __________
16b. Fill in the number of people in your household. __________
16c. Fill in the median family income for your state and size of household	16c.	$__________
To find a list of applicable median income amounts, go online using the link specified in the separate instructions for this form. This list may also be available at the bankruptcy clerk's office.
17. How do the lines compare?
17a. [ ] Line 15b is less than or equal to line 16c. On the top of page 1 of this form, check box 1, Disposable income is not determined under 11 U.S.C. § 1325(b)(3). Go to Part 3. Do NOT fill out Calculation of Disposable Income (Official Form 22C-2).
17b. [ ] Line 15b is more than line 16c. On the top of page 1 of this form, check box 2, Disposable income is determined under 11 U.S.C. § 1325(b)(3). Go to Part 3 and fill out Calculation of Disposable Income (Official Form 22C-2). On line 39 of that form, copy your current monthly income from line 14 above.

Part 3: Calculate Your Commitment Period Under 11 U.S.C. §1325(b)(4)

18. Copy your total average monthly income from line 11.	18.	$__________
19. Deduct the marital adjustment if it applies. If you are married, your spouse is not filing with you, and you contend that calculating the commitment period under 11 U.S.C. § 1325(b)(4) allows you to deduct part of your spouse's income, copy the amount from line 13d.
If the marital adjustment does not apply, fill in 0 on line 19a.	19a.	— $__________
Subtract line 19a from line 18.	19b.	$__________
20. Calculate your current monthly income for the year. Follow these steps:
20a. Copy line 19b	20a.	$__________
Multiply by 12 (the number of months in a year).		x 12
20b. The result is your current monthly income for the year for this part of the form.	20b.	$__________
20c. Copy the median family income for your state and size of household from line 16c		$
21. How do the lines compare?
[ ] Line 20b is less than line 20c. Unless otherwise ordered by the court, on the top of page 1 of this form, check box 3, The commitment period is 3 years. Go to Part 4.
[ ] Line 20b is more than or equal to line 20c. Unless otherwise ordered by the court, on the top of page 1 of this form, check box 4, The commitment period is 5 years. Go to Part 4.

Part 4: Sign Below

By signing here, under penalty of perjury I declare that the information on this statement and in any attachments is true and correct.
X__________ Signature of Debtor 1	X__________ Signature of Debtor 2
Date __________ MM / DD / YYYY	Date __________ MM / DD / YYYY
If you checked 17a, do NOT fill out or file Form 22C-2.
If you checked 17b, fill out Form 22C-2 and file it with this form. On line 39 of that form, copy your current monthly income from line 14 above.

Fill in this information to identify your case:
Debtor 1	__________ First Name	__________ Middle Name	__________ Last Name
Debtor 2 (Spouse, if filing	__________ First Name	__________ Middle Name	__________ Last Name
United States Bankruptcy Court for the:		__________	District of __________
Case number (If known)	__________

[ ] Check if this is an amended filing

Official Form B 22C2

Chapter 13 Calculation of Your Disposable Income 12/14

To fill out this form, you will need your completed copy of Chapter 13 Statement of Your Current Monthly...