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Form B22B (Chapter 11) (10/05) In re ______________________________
Debtor(s)

Case Number: __________________
(If known)

STATEMENT OF CURRENT MONTHLY INCOME
FOR USE IN CHAPTER 11
In addition to Schedules I and J, this statement must be completed by every individual Chapter 11 debtor, whether or not filing jointly. Joint debtors may complete one statement only.

Part I. CALCULATION OF CURRENT MONTHLY INCOME
Marital/filing status. Check the box that applies and complete the balance of this part of this statement as directed. a. 1 b. c. Unmarried. Complete only Column A ("Debtor's Income") for Lines 2-10. Married, not filing jointly. Complete only Column A ("Debtor's Income") for Lines 2-10. Married, filing jointly. Complete both Column A ("Debtor's Income") and Column B ("Spouse's Income") for Lines 2-10. Column A Debtor's Income $ $ Column B Spouse's Income

All figures must reflect average monthly income for the six calendar months prior to filing the bankruptcy case, ending on the last day of the month before the filing. If you received different amounts of income during these six months, you must total the amounts received during the six months, divide this total by six, and enter the result on the appropriate line. 2 Gross wages, salary, tips, bonuses, overtime, commissions. Net income from the operation of a business, profession, or farm. Subtract Line b from Line a and enter the difference on Line 3. Do not enter a number less than zero. 3 a. b. c. Gross receipts Ordinary and necessary business expenses Business income $ $ Subtract Line b from Line a $

$

Net rental and other real property income. Subtract Line b from Line a and enter the difference on Line 4. Do not enter a number less than zero. 4 a. b. c. 5 6 7 Gross receipts Ordinary and necessary operating expenses Rental income $ $ Subtract Line b from Line a $ $ $ $ $ $

Interest, dividends, and royalties. Pension and retirement income. Regular contributions to the household expenses of the debtor or the debtor's dependents, including child or spousal support. Do not include contributions from the debtor's spouse if Column B is completed. Unemployment compensation. Enter the amount in Column A and, if applicable, Column B. However, if you contend that unemployment compensation received by you or your spouse was a benefit under the Social Security Act, do not list the amount of such compensation in Column A or B, but instead state the amount in the space below: Unemployment compensation claimed to be a benefit under the Social Security Act Debtor $ ________ Spouse $ _________

$

$

8

$

$

9

Income from all other sources. If necessary, list additional sources on a separate page. Do not include any benefits received under the Social Security Act or payments received as a victim of a war crime, crime against humanity, or as a victim of international or domestic terrorism. Specify source and amount. a. b. Total and enter on Line 9 $ $ $ $ $ $

10 11

Subtotal of current monthly income. Add Lines 2 thru 9 in Column A, and, if Column
B is completed, add Lines 2 through 9 in Column B. Enter the total(s).

Total current monthly income. If Column B has been completed, add Line 10, Column
A to Line 10, Column B, and enter the total. If Column B has not been completed, enter the

amount from Line 10, Column A.

$

Part II: VERIFICATION
I declare under penalty of perjury that the information provided in this statement is true and correct. (If this a joint case, both debtors must sign.) 12 Date: ________________________ Date: ________________________ Signature: ________________________
(Debtor)

Signature: ________________________
(Joint Debtor, if any)