Free Debtor’s Statement of Intent re Secured Prop. (12/1/08) [NOTE: Only for Use w/ Case Filed On/After 10/17/05][3 Pages] - Oregon

UNITED STATES BANKRUPTCY COURT DISTRICT OF OREGON In re ) ) ) ) ) Case No. ________________ (If Known) CHAPTER 7 INDIVIDUAL DEBTOR'S* STATEMENT OF INTENTION PER 11 U.S.C. §521(a)

Debtor(s)

*IMPORTANT NOTICES TO DEBTOR(S): (1) SIGN AND FILE this form even if you show "NONE," AND, if creditors are listed, have the service certificate COMPLETED; AND (2) Failure to perform the intentions as to property stated below within 30 days after the first date set for the Meeting of Creditors under 11 USC §341(a) may result in relief for the creditor from the Automatic Stay protecting such property. PART A - Debts secured by property of the estate. (Part A must be FULLY COMPLETED for EACH debt which is secured by property of the estate. Attach additional pages is necessary.) Property No. 1 Creditor's Name: Describe Property Securing Debt:

Property will be (check one):

SURRENDERED

RETAINED

If retaining the property, I intend to (check at least one): Redeem the property Reaffirm the debt Other. Explain (for example, avoid lien using 11 USC §522(f))_______________________________________________________ Property is (check one): Property No. 2 (if necessary) Creditor's Name: Describe Property Securing Debt: CLAIMED AS EXEMPT NOT CLAIMED AS EXEMPT

Property will be (check one):

SURRENDERED

RETAINED

If retaining the property, I intend to (check at least one): Redeem the property Reaffirm the debt Other. Explain (for example, avoid lien using 11 USC §522(f))_______________________________________________________ Property is (check one): Property No. 3 (if necessary) Creditor's Name: Describe Property Securing Debt: CLAIMED AS EXEMPT NOT CLAIMED AS EXEMPT

Property will be (check one):

SURRENDERED

RETAINED

If retaining the property, I intend to (check at least one): Redeem the property Reaffirm the debt Other. Explain (for example, avoid lien using 11 USC §522(f))_______________________________________________________ Property is (check one): CLAIMED AS EXEMPT NOT CLAIMED AS EXEMPT

521.05 (12/1/08) Page 1 of 2

PART B - Personal property subject to unexpired leases. (All three columns of Part B must be completed for each unexpired lease. Attach additional pages if necessary.) Property No. 1 Lessor's Name: Describe Leased Property: Lease will be assumed pursuant to 11 USC §365(p)(2): YES NO

Property No. 2 (if necessary) Lessor's Name: Describe Leased Property: Lease will be assumed pursuant to 11 USC §365(p)(2): YES NO

Property No. 3 (if necessary) Lessor's Name: Describe Leased Property: Lease will be assumed pursuant to 11 USC §365(p)(2): YES NO

Continuation sheets attached (if any). I DECLARE UNDER PENALTY OF PERJURY THAT THE ABOVE INDICATES INTENTION AS TO ANY PROPERTY OF MY ESTATE SECURING A DEBT AND/OR PERSONAL PROPERTY SUBJECT TO AN UNEXPIRED LEASE.
DATE: __________ ____________________________________________________________ DEBTOR OR ATTORNEY'S SIGNATURE OSB# (if attorney) _____________________________________________________________ JOINT DEBTOR'S SIGNATURE (If applicable and no attorney) ____________________________________________________________ PRINT OR TYPE SIGNER'S NAME & PHONE NO. ____________________________________________________________ SIGNER'S ADDRESS (if attorney) ____________________________________________________________

I/WE THE UNDERSIGNED, CERTIFY THAT COPIES OF BOTH THIS DOCUMENT AND LOCAL FORM #715 WERE SERVED ON ANY CREDITOR NAMED ABOVE.
DATE: __________

____________________________________________________________ DEBTOR'S SIGNATURE ____________________________________________________________ JOINT DEBTOR'S SIGNATURE (If applicable)

NON-JUDICIAL REMEDY WHEN CONSUMER DEBTOR FAILS TO TIMELY PERFORM STATED INTENTIONS Creditors, see Local Form #715 [attached if this document was served on paper] if you wish information on how to obtain NON-JUDICIAL relief from the automatic stay of 11 U.S.C. §362(a) as to your collateral. QUESTIONS???? Call an attorney with questions about these procedures or the law. However, only call the debtor's attorney if you have questions about the debtor's intent as to your collateral.

521.05 (12/1/08) Page 2 of 2

PART A - Continuation Property No. 4 Creditor's Name:

CHAPTER 7 INDIVIDUAL DEBTOR'S STATEMENT OF INTENTION (Continuation Sheet)

Describe Property Securing Debt:

Property will be (check one):

SURRENDERED

RETAINED

If retaining the property, I intend to (check at least one): Redeem the property Reaffirm the debt Other. Explain (for example, avoid lien using 11 USC §522(f))_______________________________________________________ Property is (check one): Property No. 5 (if necessary) Creditor's Name: Describe Property Securing Debt: CLAIMED AS EXEMPT NOT CLAIMED AS EXEMPT

Property will be (check one):

SURRENDERED

RETAINED

If retaining the property, I intend to (check at least one): Redeem the property Reaffirm the debt Other. Explain (for example, avoid lien using 11 USC §522(f))_______________________________________________________ Property is (check one): Property No. 6 (if necessary) Creditor's Name: Describe Property Securing Debt: CLAIMED AS EXEMPT NOT CLAIMED AS EXEMPT

Property will be (check one):

SURRENDERED

RETAINED

If retaining the property, I intend to (check at least one): Redeem the property Reaffirm the debt Other. Explain (for example, avoid lien using 11 USC §522(f))_______________________________________________________ Property is (check one): PART B - Continuation Property No. 4 Lessor's Name: Describe Leased Property: Lease will be assumed pursuant to 11 USC §365(p)(2): YES NO CLAIMED AS EXEMPT NOT CLAIMED AS EXEMPT

Property No. 5 (if necessary) Lessor's Name: Describe Leased Property: Lease will be assumed pursuant to 11 USC §365(p)(2): YES NO

Property No. 6 (if necessary) Lessor's Name: Describe Leased Property: Lease will be assumed pursuant to 11 USC §365(p)(2): YES NO

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