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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