CACB — Schedule A/B: Property (106AB)

Source: https://www.cacb.uscourts.gov/sites/cacb/files/documents/forms/106AB.pdf

Fill in this information to identify your case and this filing:

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: ____________________ DistrictDistrictof ___________of __________

Case number ___________________________________________ Check if this is an amended filing Official Form 106A/B

12/15Schedule A/B: Property

In each category, separately list and describe items. List an asset only once. If an asset fits in more than one category, list the asset in the category where you think it fits best. Be as complete and accurate as possible. If two married people are filing together, both are equally responsible for supplying correct information. If more space is needed, attach a separate sheet to this form. On the top of any additional pages, write your name and case number (if known). Answer every question.

Part 1: Describe Each Residence, Building, Land, or Other Real Estate You Own or Have an Interest In

1. Do you own or have any legal or equitable interest in any residence, building, land, or similar property? No. Go to Part 2. Yes. Where is the property? What is the property? Check all that apply. Do not deduct secured claims or exemptions. Put Single-family home the amount of any secured claims on Schedule D: 1.1. _________________________________________ Duplex or multi-unit building Creditors Who Have Claims Secured by Property. Street address, if available, or other description Condominium or cooperative Current value of the Current value of the Manufactured or mobile home entire property? portion you own? _________________________________________ Land $________________ $_______________ Investment property _________________________________________ Timeshare Describe the nature of your ownership City State ZIP Code interest (such as fee simple, tenancy by Other __________________________________ the entireties, or a life estate), if known. Who has an interest in the property? Check one. __________________________________________ Debtor 1 only _________________________________________ County Debtor 2 only Check if this is community property Debtor 1 and Debtor 2 only At least one of the debtors and another (see instructions) Other information you wish to add about this item, such as local property identification number: _______________________________

   If you own or have more than one, list here: What is the property? Check all that apply. Do not deduct secured claims or exemptions. Put Single-family home the amount of any secured claims on Schedule D: 1.2. ________________________________________ Duplex or multi-unit building Creditors Who Have Claims Secured by Property. Street address, if available, or other description Condominium or cooperative Current value of the Current value of the Manufactured or mobile home entire property? portion you own? ________________________________________ Land $________________ $_________________ Investment property ________________________________________ Timeshare Describe the nature of your ownership City State ZIP Code interest (such as fee simple, tenancy by Other __________________________________ the entireties, or a life estate), if known. Who has an interest in the property? Check one. __________________________________________ Debtor 1 only ________________________________________ County Debtor 2 only Debtor 1 and Debtor 2 only Check if this is community property At least one of the debtors and another (see instructions) Other information you wish to add about this item, such as local property identification number: _______________________________

Official Form 106A/B Schedule A/B: Property page 1

Debtor 1 _______________________________________________________ Case number (if known)_____________________________________ First Name Middle Name Last Name

What is the property? Check all that apply. Do not deduct secured claims or exemptions. Put
Single-family home the amount of any secured claims on Schedule D:
1.3. ________________________________________ Creditors Who Have Claims Secured by Property.
Street address, if available, or other description Duplex or multi-unit building
Condominium or cooperative Current value of the Current value of the
entire property? portion you own?
________________________________________ Manufactured or mobile home
Land $________________ $_________________
Investment property ________________________________________
City State ZIP Code Timeshare Describe the nature of your ownership
interest (such as fee simple, tenancy by
Other __________________________________ the entireties, or a life estate), if known.
__________________________________________ Who has an interest in the property? Check one.
________________________________________ Debtor 1 only
County Debtor 2 only
Debtor 1 and Debtor 2 only Check if this is community property
At least one of the debtors and another (see instructions)

Other information you wish to add about this item, such as local
property identification number: _______________________________

2. Add the dollar value of the portion you own for all of your entries from Part 1, including any entries for pages $_________________ you have attached for Part 1. Write that number here. ......................................................................................

Part 2: Describe Your Vehicles

Do you own, lease, or have legal or equitable interest in any vehicles, whether they are registered or not? Include any vehicles you own that someone else drives. If you lease a vehicle, also report it on Schedule G: Executory Contracts and Unexpired Leases.

3. Cars, vans, trucks, tractors, sport utility vehicles, motorcycles No Yes

   3.1. Make: ______________ Who has an interest in the property? Check one. Do not deduct secured claims or exemptions. Put the amount of any secured claims on Schedule D: Debtor 1 only Creditors Who Have Claims Secured by Property. Model: ______________
   Debtor 2 only Year: ____________ Current value of the Current value of the Debtor 1 and Debtor 2 only entire property? portion you own? Approximate mileage: ____________ At least one of the debtors and another Other information: Check if this is community property (see $________________ $________________ instructions)

   If you own or have more than one, describe here:

   3.2. Make: ______________ Who has an interest in the property? Check one. Do not deduct secured claims or exemptions. Put the amount of any secured claims on Schedule D: Debtor 1 only Creditors Who Have Claims Secured by Property. Model: ______________
   Debtor 2 only Year: ____________ Current value of the Current value of the Debtor 1 and Debtor 2 only entire property? portion you own? Approximate mileage: ____________ At least one of the debtors and another Other information: Check if this is community property (see $________________ $________________ instructions)

Official Form 106A/B Schedule A/B: Property page 2

Debtor 1 _______________________________________________________ Case number (if known)_____________________________________ First Name Middle Name Last Name

3.3. Make: ______________ Who has an interest in the property? Check one. Do not deduct secured claims or exemptions. Put
the amount of any secured claims on Schedule D:
Debtor 1 only Creditors Who Have Claims Secured by Property. Model: ______________
Debtor 2 only
Year: ____________ Current value of the Current value of the Debtor 1 and Debtor 2 only
entire property? portion you own?
Approximate mileage: ____________ At least one of the debtors and another
Other information:
Check if this is community property (see $________________ $________________
instructions)

3.4. Make: ______________ Who has an interest in the property? Check one. Do not deduct secured claims or exemptions. Put
the amount of any secured claims on Schedule D:
Debtor 1 only Creditors Who Have Claims Secured by Property. Model: ______________
Debtor 2 only
Year: ____________ Current value of the Current value of the Debtor 1 and Debtor 2 only
entire property? portion you own?
Approximate mileage: ____________ At least one of the debtors and another
Other information:
Check if this is community property (see $________________ $________________
instructions)

4. Watercraft, aircraft, motor homes, ATVs and other recreational vehicles, other vehicles, and accessories Examples: Boats, trailers, motors, personal watercraft, fishing vessels, snowmobiles, motorcycle accessories No Yes

4.1. Make: ____________________ Who has an interest in the property? Check one. Do not deduct secured claims or exemptions. Put the amount of any secured claims on Schedule D: Debtor 1 only Creditors Who Have Claims Secured by Property. Model: ____________________
Debtor 2 only Year: ____________ Debtor 1 and Debtor 2 only Current value of the Current value of the Other information: At least one of the debtors and another entire property? portion you own?

Check if this is community property (see $________________ $________________
instructions)

If you own or have more than one, list here:
4.2. Make: ____________________ Who has an interest in the property? Check one. Do not deduct secured claims or exemptions. Put
the amount of any secured claims on Schedule D:
Debtor 1 only Creditors Who Have Claims Secured by Property. Model: ____________________
Debtor 2 only
Year: ____________ Current value of the Current value of the Debtor 1 and Debtor 2 only entire property? portion you own?
Other information: At least one of the debtors and another

Check if this is community property (see $________________ $________________
instructions)

5. Add the dollar value of the portion you own for all of your entries from Part 2, including any entries for pages $_________________ you have attached for Part 2. Write that number here ........................................................................................................................

Official Form 106A/B Schedule A/B: Property page 3

Debtor 1 _______________________________________________________ Case number (if known)_____________________________________ First Name Middle Name Last Name

Part 3: Describe Your Personal and Household Items

Current value of the

Do you own or have any legal or equitable interest in any of the following items? portion you own? Do not deduct secured claims or exemptions.

6. Household goods and furnishings Examples: Major appliances, furniture, linens, china, kitchenware No Yes. Describe. ........ $___________________

7. Electronics Examples: Televisions and radios; audio, video, stereo, and digital equipment; computers, printers, scanners; music collections; electronic devices including cell phones, cameras, media players, games

No Yes. Describe. ......... $___________________

8. Collectibles of value Examples: Antiques and figurines; paintings, prints, or other artwork; books, pictures, or other art objects; stamp, coin, or baseball card collections; other collections, memorabilia, collectibles

No Yes. Describe. ......... $___________________

9. Equipment for sports and hobbies Examples: Sports, photographic, exercise, and other hobby equipment; bicycles, pool tables, golf clubs, skis; canoes and kayaks; carpentry tools; musical instruments

No Yes. Describe. ......... $___________________

10. Firearms Examples: Pistols, rifles, shotguns, ammunition, and related equipment No Yes. Describe. .......... $___________________

11. Clothes Examples: Everyday clothes, furs, leather coats, designer wear, shoes, accessories No Yes. Describe. .......... $___________________

12. Jewelry Examples: Everyday jewelry, costume jewelry, engagement rings, wedding rings, heirloom jewelry, watches, gems, gold, silver

No Yes. Describe. .......... $___________________

13. Non-farm animals Examples: Dogs, cats, birds, horses No Yes. Describe. .......... $___________________

14. Any other personal and household items you did not already list, including any health aids you did not list

No Yes. Give specific $___________________ information. ..............

15. Add the dollar value of all of your entries from Part 3, including any entries for pages you have attached $______________________ for Part 3. Write that number here ....................................................................................................................................................

Official Form 106A/B Schedule A/B: Property page 4

Debtor 1 _______________________________________________________ Case number (if known)_____________________________________ First Name Middle Name Last Name

Part 4: Describe Your Financial Assets

Do you own or have any legal or equitable interest in any of the following? Current value of the portion you own? Do not deduct secured claims or exemptions.

16. Cash Examples: Money you have in your wallet, in your home, in a safe deposit box, and on hand when you file your petition

No Yes ................................................................................................................................................................ Cash: ....................... $__________________

17. Deposits of money Examples: Checking, savings, or other financial accounts; certificates of deposit; shares in credit unions, brokerage houses, and other similar institutions. If you have multiple accounts with the same institution, list each.

No Yes ..................... Institution name:

17.1. Checking account: _________________________________________________________ $__________________

17.2. Checking account: _________________________________________________________ $__________________

17.3. Savings account: _________________________________________________________ $__________________

17.4. Savings account: _________________________________________________________ $__________________

17.5. Certificates of deposit: _________________________________________________________ $__________________

17.6. Other financial account: _________________________________________________________ $__________________

17.7. Other financial account: _________________________________________________________ $__________________

17.8. Other financial account: _________________________________________________________ $__________________

17.9. Other financial account: _________________________________________________________ $__________________

18. Bonds, mutual funds, or publicly traded stocks Examples: Bond funds, investment accounts with brokerage firms, money market accounts No Yes ................. Institution or issuer name:

_________________________________________________________________________________________ $__________________

_________________________________________________________________________________________ $__________________
_________________________________________________________________________________________ $__________________

19. Non-publicly traded stock and interests in incorporated and unincorporated businesses, including an interest in an LLC, partnership, and joint venture No Name of entity: % of ownership:

Yes. Give specific _____________________________________________________________________ % $_______ information about them......................... _____________________________________________________________________ % $_______

_____________________________________________________________________ % $_______

Official Form 106A/B Schedule A/B: Property page 5

Debtor 1 _______________________________________________________ Case number (if known)_____________________________________ First Name Middle Name Last Name

20. Government and corporate bonds and other negotiable and non-negotiable instruments Negotiable instruments include personal checks, cashiers’ checks, promissory notes, and money orders. Non-negotiable instruments are those you cannot transfer to someone by signing or delivering them.

No Yes. Give specific Issuer name: information about them....................... ______________________________________________________________________________________ $__________________ ______________________________________________________________________________________ $__________________ ______________________________________________________________________________________ $__________________

21. Retirement or pension accounts Examples: Interests in IRA, ERISA, Keogh, 401(k), 403(b), thrift savings accounts, or other pension or profit-sharing plans No Yes. List each account separately. Type of account: Institution name:

    401(k) or similar plan: ___________________________________________________________________ $__________________

    Pension plan: ___________________________________________________________________ $__________________

    IRA: ___________________________________________________________________ $__________________

    Retirement account: ___________________________________________________________________ $__________________

    Keogh: ___________________________________________________________________ $__________________

    Additional account: ___________________________________________________________________ $__________________

    Additional account: ___________________________________________________________________ $__________________

22. Security deposits and prepayments Your share of all unused deposits you have made so that you may continue service or use from a company Examples: Agreements with landlords, prepaid rent, public utilities (electric, gas, water), telecommunications companies, or others

No Yes .......................... Institution name or individual:

Electric: ______________________________________________________________________ $___________________ Gas: ______________________________________________________________________ $___________________ Heating oil: ______________________________________________________________________ $___________________ Security deposit on rental unit: _____________________________________________________________ $___________________ Prepaid rent: ______________________________________________________________________ $___________________

Telephone: ______________________________________________________________________ $___________________

Water: ______________________________________________________________________ $___________________
Rented furniture: ______________________________________________________________________ $___________________
Other: ______________________________________________________________________
$___________________

23. Annuities (A contract for a periodic payment of money to you, either for life or for a number of years) No Yes .......................... Issuer name and description:

    _______________________________________________________________________________________ $__________________
    _______________________________________________________________________________________ $__________________
    _______________________________________________________________________________________ $__________________

Official Form 106A/B Schedule A/B: Property page 6

Debtor 1 _______________________________________________________ Case number (if known)_____________________________________ First Name Middle Name Last Name

24. Interests in an education IRA, in an account in a qualified ABLE program, or under a qualified state tuition program. 26 U.S.C. §§ 530(b)(1), 529A(b), and 529(b)(1). No Yes .................................... Institution name and description. Separately file the records of any interests.11 U.S.C. § 521(c):

    ____________________________________________________________________________________ $_________________

    ____________________________________________________________________________________ $_________________
    ____________________________________________________________________________________ $_________________

25. Trusts, equitable or future interests in property (other than anything listed in line 1), and rights or powers exercisable for your benefit No Yes. Give specific information about them. ... $__________________

26. Patents, copyrights, trademarks, trade secrets, and other intellectual property Examples: Internet domain names, websites, proceeds from royalties and licensing agreements No Yes. Give specific information about them. ... $__________________

27. Licenses, franchises, and other general intangibles Examples: Building permits, exclusive licenses, cooperative association holdings, liquor licenses, professional licenses No Yes. Give specific information about them. ... $__________________

Money or property owed to you? Current value of the portion you own? Do not deduct secured claims or exemptions.

28. Tax refunds owed to you No Yes. Give specific information Federal: $_________________ about them, including whether you already filed the returns State: $_________________ and the tax years. ....................... Local: $_________________

29. Family support Examples: Past due or lump sum alimony, spousal support, child support, maintenance, divorce settlement, property settlement No Yes. Give specific information. ............. Alimony: $________________ Maintenance: $________________ Support: $________________ Divorce settlement: $________________ Property settlement: $________________

30. Other amounts someone owes you Examples: Unpaid wages, disability insurance payments, disability benefits, sick pay, vacation pay, workers’ compensation, Social Security benefits; unpaid loans you made to someone else

No Yes. Give specific information. .............. $______________________

Official Form 106A/B Schedule A/B: Property page 7

Debtor 1 _______________________________________________________ Case number (if known)_____________________________________ First Name Middle Name Last Name

31. Interests in insurance policies Examples: Health, disability, or life insurance; health savings account (HSA); credit, homeowner’s, or renter’s insurance No Yes. Name the insurance company Company name: Beneficiary: Surrender or refund value: of each policy and list its value. ... ___________________________________________ ____________________________ $__________________ ___________________________________________ ____________________________ $__________________ ___________________________________________ ____________________________ $__________________

32. Any interest in property that is due you from someone who has died If you are the beneficiary of a living trust, expect proceeds from a life insurance policy, or are currently entitled to receive property because someone has died. No Yes. Give specific information. ............. $_____________________

33. Claims against third parties, whether or not you have filed a lawsuit or made a demand for payment Examples: Accidents, employment disputes, insurance claims, or rights to sue No Yes. Describe each claim. .................... $______________________

34. Other contingent and unliquidated claims of every nature, including counterclaims of the debtor and rights to set off claims No Yes. Describe each claim. .................... $_____________________

35. Any financial assets you did not already list No Yes. Give specific information. ........... $_____________________

36. Add the dollar value of all of your entries from Part 4, including any entries for pages you have attached for Part 4. Write that number here .................................................................................................................................................... $_____________________

Part 5: Describe Any Business-Related Property You Own or Have an Interest In. List any real estate in Part 1.

37. Do you own or have any legal or equitable interest in any business-related property? No. Go to Part 6. Yes. Go to line 38.

Current value of the portion you own? Do not deduct secured claims or exemptions.

38. Accounts receivable or commissions you already earned No Yes. Describe ....... $_____________________

39. Office equipment, furnishings, and supplies Examples: Business-related computers, software, modems, printers, copiers, fax machines, rugs, telephones, desks, chairs, electronic devices No Yes. Describe ....... $_____________________

Official Form 106A/B Schedule A/B: Property page 8

Debtor 1 _______________________________________________________ Case number (if known)_____________________________________ First Name Middle Name Last Name

40. Machinery, fixtures, equipment, supplies you use in business, and tools of your trade No Yes. Describe ....... $_____________________

41. Inventory No Yes. Describe ....... $_____________________

42. Interests in partnerships or joint ventures No Yes. Describe ....... Name of entity: % of ownership:

    ______________________________________________________________________ % $_____________
    ______________________________________________________________________ % $_____________
    ______________________________________________________________________ % $_____________

43. Customer lists, mailing lists, or other compilations No Yes. Do your lists include personally identifiable information (as defined in 11 U.S.C. § 101(41A))? No Yes. Describe. ....... $____________________

44. Any business-related property you did not already list No Yes. Give specific ______________________________________________________________________________________ $____________________ information ......... ______________________________________________________________________________________ $____________________ ______________________________________________________________________________________ $____________________ ______________________________________________________________________________________ $____________________ ______________________________________________________________________________________ $____________________ ______________________________________________________________________________________ $____________________

45. Add the dollar value of all of your entries from Part 5, including any entries for pages you have attached $____________________

for Part 5. Write that number here ....................................................................................................................................................

Part 6: Describe Any Farm- and Commercial Fishing-Related Property You Own or Have an Interest In. If you own or have an interest in farmland, list it in Part 1.

46. Do you own or have any legal or equitable interest in any farm- or commercial fishing-related property? No. Go to Part 7. Yes. Go to line 47. Current value of the portion you own? Do not deduct secured claims or exemptions.

47. Farm animals Examples: Livestock, poultry, farm-raised fish No Yes ..........................

    $___________________

Official Form 106A/B Schedule A/B: Property page 9

Debtor 1 _______________________________________________________ Case number (if known)_____________________________________ First Name Middle Name Last Name

48. Crops—either growing or harvested No Yes. Give specific information. ............ $___________________

49. Farm and fishing equipment, implements, machinery, fixtures, and tools of trade No Yes ..........................

    $___________________

50. Farm and fishing supplies, chemicals, and feed No Yes ..........................

    $___________________

51. Any farm- and commercial fishing-related property you did not already list No Yes. Give specific information. ............ $___________________

52. Add the dollar value of all of your entries from Part 6, including any entries for pages you have attached $___________________

for Part 6. Write that number here ....................................................................................................................................................

Part 7: Describe All Property You Own or Have an Interest in That You Did Not List Above

53. Do you have other property of any kind you did not already list? Examples: Season tickets, country club membership No Yes. Give specific $________________ information. ............ $________________

    $________________

54. Add the dollar value of all of your entries from Part 7. Write that number here ................................................................. $________________

Part 8: List the Totals of Each Part of this Form

55. Part 1: Total real estate, line 2 .............................................................................................................................................................. $________________

56. Part 2: Total vehicles, line 5 $________________

57. Part 3: Total personal and household items, line 15 $________________

58. Part 4: Total financial assets, line 36 $________________

59. Part 5: Total business-related property, line 45 $________________

60. Part 6: Total farm- and fishing-related property, line 52 $________________

61. Part 7: Total other property not listed, line 54 + $________________

62. Total personal property. Add lines 56 through 61. .................... $________________ Copy personal property total + $_________________

63. Total of all property on Schedule A/B. Add line 55 + line 62. ......................................................................................... $_________________

Official Form 106A/B Schedule A/B: Property page 10 Print Save As... Add Attachment Reset