CACB — Schedule C: The Property You Claim as Exempt (106C)

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

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: Central__________DistrictDistrictof Californiaof __________ Case number ___________________________________________ Check if this is an (If known) amended filing

Official Form 106C Schedule C: The Property You Claim as Exempt 04/25

Be as complete and accurate as possible. If two married people are filing together, both are equally responsible for supplying correct information. Using the property you listed on Schedule A/B: Property (Official Form 106A/B) as your source, list the property that you claim as exempt. If more space is needed, fill out and attach to this page as many copies of Part 2: Additional Page as necessary. On the top of any additional pages, write your name and case number (if known).

For each item of property you claim as exempt, you must specify the amount of the exemption you claim. One way of doing so is to state a specific dollar amount as exempt. Alternatively, you may claim the full fair market value of the property being exempted up to the amount of any applicable statutory limit. Some exemptions—such as those for health aids, rights to receive certain benefits, and tax-exempt retirement funds—may be unlimited in dollar amount. However, if you claim an exemption of 100% of fair market value under a law that limits the exemption to a particular dollar amount and the value of the property is determined to exceed that amount, your exemption would be limited to the applicable statutory amount.

Part 1: Identify the Property You Claim as Exempt

1. Which set of exemptions are you claiming? Check one only, even if your spouse is filing with you. You are claiming state and federal nonbankruptcy exemptions. 11 U.S.C. § 522(b)(3) You are claiming federal exemptions. 11 U.S.C. § 522(b)(2)

2. For any property you list on Schedule A/B that you claim as exempt, fill in the information below.

   Brief description of the property and line on Current value of the Amount of the exemption you claim Specific laws that allow exemption Schedule A/B that lists this property portion you own

   Copy the value from Check only one box for each exemption.
   Schedule A/B

Brief ____________________________ description: _________________________ $________________ $ ____________ ____________________________ 100% of fair market value, up to ____________________________ Line from Schedule A/B: ______ any applicable statutory limit ____________________________

Brief ____________________________
description: _________________________ $________________ $ ____________ ____________________________
100% of fair market value, up to ____________________________ Line from ______ any applicable statutory limit ____________________________ Schedule A/B:

Brief ____________________________
description: _________________________ $________________ $ ____________ ____________________________
Line from 100% of fair market value, up to ____________________________
Schedule A/B: ______ any applicable statutory limit ____________________________

3. Are you claiming a homestead exemption of more than $214,000? (Subject to adjustment on 4/01/28 and every 3 years after that for cases filed on or after the date of adjustment.) No Yes. Did you acquire the property covered by the exemption within 1,215 days before you filed this case? No Yes

Official Form 106C Schedule C: The Property You Claim as Exempt page 1 of __

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

Part 2: Additional Page

Brief description of the property and line Current value of the Amount of the exemption you claim Specific laws that allow exemption
on Schedule A/B that lists this property portion you own

Copy the value from Check only one box for each exemption
Schedule A/B

Brief ____________________________
description: _________________________ $________________ $ ____________ ____________________________
100% of fair market value, up to ____________________________ Line from ______
any applicable statutory limit ____________________________ Schedule A/B:

Brief ____________________________
description: _________________________ $________________ $ ____________ ____________________________
100% of fair market value, up to ____________________________ Line from
______ any applicable statutory limit ____________________________ Schedule A/B:

Brief ____________________________
description: _________________________ $________________ $ ____________ ____________________________
100% of fair market value, up to ____________________________
Line from ______ any applicable statutory limit ____________________________ Schedule A/B:

Brief ____________________________
description: _________________________ $________________ $ ____________ ____________________________
100% of fair market value, up to ____________________________ Line from ______
any applicable statutory limit ____________________________ Schedule A/B:

Brief ____________________________
description: _________________________ $________________ $ ____________ ____________________________
100% of fair market value, up to ____________________________ Line from
______ any applicable statutory limit ____________________________ Schedule A/B:

Brief ____________________________
description: _________________________ $________________ $ ____________ ____________________________
100% of fair market value, up to ____________________________
Line from ______ any applicable statutory limit ____________________________ Schedule A/B:

Brief ____________________________
description: _________________________ $________________ $ ____________ ____________________________
100% of fair market value, up to ____________________________ Line from ______
any applicable statutory limit ____________________________ Schedule A/B:

Brief ____________________________
description: _________________________ $________________ $ ____________ ____________________________
100% of fair market value, up to ____________________________ Line from
______ any applicable statutory limit ____________________________ Schedule A/B:

Brief ____________________________
description: _________________________ $________________ $ ____________ ____________________________
100% of fair market value, up to ____________________________
Line from ______ any applicable statutory limit ____________________________ Schedule A/B:

Brief ____________________________
description: _________________________ $________________ $ ____________ ____________________________
100% of fair market value, up to ____________________________ Line from ______
any applicable statutory limit ____________________________ Schedule A/B:

Brief ____________________________
description: _________________________ $________________ $ ____________ ____________________________
100% of fair market value, up to ____________________________ Line from
______ any applicable statutory limit ____________________________ Schedule A/B:

Brief ____________________________
description: _________________________ $________________ $ ____________ ____________________________
100% of fair market value, up to ____________________________ Line from ______ any applicable statutory limit ____________________________ Schedule A/B:

Official Form 106C Schedule C: The Property You Claim as Exempt page ___2 of __ Print Save As... Add Attachment Reset