CACB — Schedule D: Creditors Who Have Claims Secured by Property (206D)

Source: https://www.cacb.uscourts.gov/sites/cacb/files/documents/forms/206D.pdf

Fill in this information to identify the case:

Debtor name __________________________________________________________________ United States Bankruptcy Court for the: ______________________ District of _________ (State) Case number (If known): _________________________ Check if this is an amended filing Official Form 206D Schedule D: Creditors Who Have Claims Secured by Property 12/15 Be as complete and accurate as possible.

1. Do any creditors have claims secured by debtor’s property? No. Check this box and submit page 1 of this form to the court with debtor’s other schedules. Debtor has nothing else to report on this form. Yes. Fill in all of the information below. Part 1: List Creditors Who Have Secured Claims Column A Column B 2. List in alphabetical order all creditors who have secured claims. If a creditor has more than one Amount of claim Value of collateral secured claim, list the creditor separately for each claim. Do not deduct the value that supports this of collateral. claim

2.1 Creditor’s name Describe debtor’s property that is subject to a lien __________________________________________ ___________________________________________________ $__________________ $_________________ Creditor’s mailing address ___________________________________________________

________________________________________________________ ___________________________________________________
________________________________________________________ Describe the lien
__________________________________________________
Creditor’s email address, if known Is the creditor an insider or related party?
No
_________________________________________ Yes
Date debt was incurred __________________ Is anyone else liable on this claim?
No
Last 4 digits of account Yes. Fill out Schedule H: Codebtors (Official Form 206H).
number ___ ___ ___ ___

Do multiple creditors have an interest in the As of the petition filing date, the claim is: same property? Check all that apply. No Contingent Yes. Specify each creditor, including this creditor, Unliquidated and its relative priority. Disputed ___________________________________ ___________________________________ 2.2 Creditor’s name Describe debtor’s property that is subject to a lien __________________________________________ ___________________________________________________ $__________________ $_________________ Creditor’s mailing address ___________________________________________________ ________________________________________________________ ___________________________________________________ ________________________________________________________ Describe the lien __________________________________________________ Creditor’s email address, if known Is the creditor an insider or related party? No _________________________________________ Yes Date debt was incurred __________________ Is anyone else liable on this claim? No Last 4 digits of account Yes. Fill out Schedule H: Codebtors (Official Form 206H). number ___ ___ ___ ___ Do multiple creditors have an interest in the As of the petition filing date, the claim is: same property? Check all that apply. No Contingent Yes. Have you already specified the relative Unliquidated priority? Disputed No. Specify each creditor, including this creditor, and its relative priority. _________________________________ _________________________________ Yes. The relative priority of creditors is specified on lines _____ 3. Total of the dollar amounts from Part 1, Column A, including the amounts from the Additional $________________ Page, if any.

Official Form 206D Schedule D: Creditors Who Have Claims Secured by Property page 1 of ___

Debtor _______________________________________________________ Case number (if known)_____________________________________ Name

Column A Column B

Part 1: Additional Page Amount of claim Value of collateral Do not deduct the value that supports this of collateral. claim Copy this page only if more space is needed. Continue numbering the lines sequentially from the previous page.

2._ Creditor’s name Describe debtor’s property that is subject to a lien

__________________________________________ ___________________________________________________
$__________________ $_________________
___________________________________________________
Creditor’s mailing address

___________________________________________________
________________________________________________________
________________________________________________________ Describe the lien
__________________________________________________

Creditor’s email address, if known Is the creditor an insider or related party?
No
_________________________________________ Yes

Date debt was incurred __________________ Is anyone else liable on this claim?
No
Last 4 digits of account Yes. Fill out Schedule H: Codebtors (Official Form 206H).
number ___ ___ ___ ___

Do multiple creditors have an interest in the As of the petition filing date, the claim is:
same property? Check all that apply.

No Contingent Unliquidated Yes. Have you already specified the relative Disputed priority? No. Specify each creditor, including this creditor, and its relative priority. _______________________________ _______________________________ _______________________________

Yes. The relative priority of creditors is specified on lines _____

2._ Creditor’s name Describe debtor’s property that is subject to a lien

---

___________________________________________________
$__________________ $_________________
Creditor’s mailing address ___________________________________________________

___________________________________________________
________________________________________________________
________________________________________________________ Describe the lien
__________________________________________________

Creditor’s email address, if known Is the creditor an insider or related party?
No
_________________________________________ Yes
Date debt was incurred __________________ Is anyone else liable on this claim?
No
Last 4 digits of account Yes. Fill out Schedule H: Codebtors (Official Form 206H).
number ___ ___ ___ ___

Do multiple creditors have an interest in the As of the petition filing date, the claim is:
same property? Check all that apply.

No Contingent Unliquidated Yes. Have you already specified the relative Disputed priority? No. Specify each creditor, including this creditor, and its relative priority. _______________________________ _______________________________ _______________________________ Yes. The relative priority of creditors is specified on lines _____

Official Form 206D Additional Page of Schedule D: Creditors Who Have Claims Secured by Property page ___ of ___

Debtor _______________________________________________________ Case number (if known)_____________________________________ Name

Part 2: List Others to Be Notified for a Debt Already Listed in Part 1

List in alphabetical order any others who must be notified for a debt already listed in Part 1. Examples of entities that may be listed are collection agencies, assignees of claims listed above, and attorneys for secured creditors. If no others need to be notified for the debts listed in Part 1, do not fill out or submit this page. If additional pages are needed, copy this page.

On which line in Part 1 Last 4 digits of Name and address did you enter the account number
related creditor? for this entity

__________________________________________________________________________________________________________________

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Form 206D Official Part 2 of Schedule D: Creditors Who Have Claims Secured by Property page ___ of ___