Free Chapter 7 Individual Debtor's Statement of Intention - Pennsylvania

B 8 (Official Form 8) (12/08)

UNITED STATES BANKRUPTCY COURT
__________ District of __________
In re ____________________________,
Debtor

Case No. ___________________
Chapter 7

CHAPTER 7 INDIVIDUAL DEBTOR'S STATEMENT OF INTENTION
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 if 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 U.S.C. § 522(f)). Property is (check one): ' Claimed as exempt
Property No. 2 (if necessary)

' Not claimed as exempt

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 U.S.C. § 522(f)). Property is (check one): ' Claimed as exempt

' Not claimed as exempt

B 8 (Official Form 8) (12/08)

Page 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 U.S.C. § 365(p)(2): ' YES ' NO

Property No. 2 (if necessary)

Lessor's Name:

Describe Leased Property:

Lease will be Assumed pursuant to 11 U.S.C. § 365(p)(2): ' YES ' NO

Property No. 3 (if necessary)

Lessor's Name:

Describe Leased Property:

Lease will be Assumed pursuant to 11 U.S.C. § 365(p)(2): ' YES ' NO

_____ continuation sheets attached (if any)

I declare under penalty of perjury that the above indicates my intention as to any property of my
estate securing a debt and/or personal property subject to an unexpired lease.

Date: ____________________

___________________________________________ Signature of Debtor

___________________________________________ Signature of Joint Debtor

B 8 (Official Form 8) (12/08)

Page 3

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

PART A - Continuation
Property No.

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 U.S.C. § 522(f)). Property is (check one): ' Claimed as exempt

' Not claimed as exempt

PART B - Continuation
Property No.

Lessor's Name:

Describe Leased Property:

Lease will be Assumed pursuant to 11 U.S.C. § 365(p)(2): ' YES ' NO

Property No.

Lessor's Name:

Describe Leased Property:

Lease will be Assumed pursuant to 11 U.S.C. § 365(p)(2): ' YES ' NO

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