Bankruptcy Chapter 7 & 13

Doney &
Associates
PLC
L A W Y E R S

Copyright Notice

     
Schedule I - Income
  After data is entered:
Marital Status:
Not married. Complete only the blue column
Married and filing jointly. Complete blue column for husband and pink column for wife.
Married, living together, but spouse is not filing. Complete the blue column for the spouse filing, and the pink column for the non-filing spouse.
Married but separated, and spouse is not filing. Complete the blue column for the filing spouse
Dependents of Debtor and Spouse
Name:   Relationship:
Date of Birth:
mm dd yyyy  
Age:
Primary employment of debtor
(husband if joint case)
Employer Name:
Employer Address, City:
Employed since [date]:
Occupation:
Pay period: Weekly (i.e., every Friday)
Biweekly (i.e., every other Friday)
Semimonthly (i.e., 1st and 15th)
Monthly (i.e., once a month)
Year to Date (give dates below)
If Year to Date give starting date:
mm dd yyyy
If Year to Date give ending date:
mm dd yyyy
Days in Period Multiplier
Income Per Pay Period Per Month
Gross pay before tax & deductions:
Estimated average overtime:
Other:
Other:
Total Income:
Deductions Per Pay Period Per Month
Federal withholding tax:
Social Security (FICA):
Medicare:
State withholding tax:
Insurance:
Mandatory retirement, profit sharing, 401K, etc.:
Maintenance & support deducted from pay:
Payment loans from profit sharing, 401K, etc.:
Other:
Other:
Other:
Take Home Pay from Primary Employment:
Additional employment of debtor
(husband if joint case)
Employer Name:
Employer Address, City:
Employed since [date]:
Occupation:
Pay period: Weekly (i.e., every Friday)
Biweekly (i.e., every other Friday)
Semimonthly (i.e., 1st and 15th)
Monthly (i.e., once a month)
Year to Date (give dates below)
If Year to Date give starting date:
mm dd yyyy
If Year to Date give ending date:
mm dd yyyy
Days in Period Multiplier
Income Per Pay Period Per Month
Gross pay before tax & deductions:
Estimated average overtime:
Other:
Other:
Total Income:
Deductions Per Pay Period Per Month
Federal withholding tax:
Social Security (FICA):
Medicare:
State withholding tax:
Insurance:
Mandatory retirement, profit sharing, 401K, etc.:
Maintenance & support deducted from pay:
Payment loans from profit sharing, 401K, etc.:
Other:
Other:
Other:
Take Home Pay from Additional Employment:
Other Income of debtor
(husband if joint case)		 Per Month
Self-employment/business/profession:
Income from real property:
Interest and dividends:
Maintenance & support actually received:
Social Security:
Government assistance:
Pension/retirement:
Other:
Other:
Other:
Total Other Income:
Total Take Home Pay and Other Income:
Primary employment of spouse
(wife if joint case)
Employer Name:
Employer Address, City:
Employed since [date]:
Occupation:
Pay period: Weekly (i.e., every Friday)
Biweekly (i.e., every other Friday)
Semimonthly (i.e., 1st and 15th)
Monthly (i.e., once a month)
Year to Date (give dates below)
If Year to Date give starting date:
mm dd yyyy
If Year to Date give ending date:
mm dd yyyy
Days in Period Multiplier
Income Per Pay Period Per Month
Gross pay before tax & deductions:
Estimated average overtime:
Other:
Other:
Total Income:
Deductions Per Pay Period Per Month
Federal withholding tax:
Social Security (FICA):
Medicare:
State withholding tax:
Insurance:
Mandatory retirement, profit sharing, 401K, etc.:
Maintenance & support deducted from pay:
Payment loans from profit sharing, 401K, etc.:
Other:
Other:
Other:
Take Home Pay from Primary Employment:
Additional employment of spouse
(wife if joint case)
Employer Name:
Employer Address, City:
Employed since [date]:
Occupation:
Pay period: Weekly (i.e., every Friday)
Biweekly (i.e., every other Friday)
Semimonthly (i.e., 1st and 15th)
Monthly (i.e., once a month)
Year to Date (give dates below)
If Year to Date give starting date:
mm dd yyyy
If Year to Date give ending date:
mm dd yyyy
Days in Period Multiplier
Income Per Pay Period Per Month
Gross pay before tax & deductions:
Estimated average overtime:
Other:
Other:
Total Income:
Deductions Per Pay Period Per Month
Federal withholding tax:
Social Security (FICA):
Medicare:
State withholding tax:
Insurance:
Mandatory retirement, profit sharing, 401K, etc.:
Maintenance & support deducted from pay:
Payment loans from profit sharing, 401K, etc.:
Other:
Other:
Other:
Take Home Pay from Additional Employment:
Other Income of spouse
(wife if joint case)		 Per Month
Self-employment/business/profession:
Income from real property:
Interest and dividends:
Maintenance & support actually received:
Social Security:
Government assistance:
Pension/retirement:
Other:
Other:
Other:
Total Other Income:
Total Take Home Pay and Other Income:
Total Take Home Pay and Other Income: