Fillable Official Form 106D Schedule D: Creditors Who Have (US Courts)

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Official Form 106D Schedule D: Creditors Who Have (US Courts)

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Official Form 106D Schedule D: Creditors Who Have Claims Secured by Property page 1 of ___
Official Form 106D
Schedule D: Creditors Who Have Claims Secured by Property 12/15
Be as complete and accurate as possible. If two married people are filing together, both are equally responsible for supplying correct
information. If more space is needed, copy the Additional Page, fill it out, number the entries, and attach it to this form. On the top of any
additional pages, write your name and case number (if known).
1. Do any creditors have claims secured by your property?
No. Check this box and submit this form to the court with your other schedules. You have nothing else to report on this form.
Yes. Fill in all of the information below.
Part 1: List All Secured Claims
2. List all secured claims. If a creditor has more than one secured claim, list the creditor separately
for each claim. If more than one creditor has a particular claim, list the other creditors in Part 2.
As much as possible, list the claims in alphabetical order according to the creditor’s name.
Column A
Amount of claim
Do not deduct the
value of collateral.
Column B
Value of collateral
that supports this
claim
Column C
Unsecured
portion
If any
2.1
______________________________________
Creditor’s Name
______________________________________
Number Street
______________________________________
______________________________________
City State ZIP Code
Describe the property that secures the claim:
$_________________ $________________$____________
As of the date you file, the claim is: Check all that apply.
Contingent
Unliquidated
Disputed
Nature of lien. Check all that apply.
An agreement you made (such as mortgage or secured
car loan)
Statutory lien (such as tax lien, mechanic’s lien)
Judgment lien from a lawsuit
Other (including a right to offset) ____________________
Who owes the debt? Check one.
Debtor 1 only
Debtor 2 only
Debtor 1 and Debtor 2 only
At least one of the debtors and another
Check if this claim relates to a
community debt
Date debt was incurred ____________ Last 4 digits of account number ___ ___ ___ ___
2.2
______________________________________
Creditor’s Name
______________________________________
Number Street
______________________________________
______________________________________
City State ZIP Code
Describe the property that secures the claim:
$_________________ $________________$____________
As of the date you file, the claim is: Check all that apply.
Contingent
Unliquidated
Disputed
Nature of lien
. Check all that apply.
An agreement you made (such as mortgage or secured
car loan)
Statutory lien (such as tax lien, mechanic’s lien)
Judgment lien from a lawsuit
Other (including a right to offset) ____________________
Who owes the debt? Check one.
Debtor 1 only
Debtor 2 only
Debtor 1 and Debtor 2 only
At least one of the debtors and another
Check if this claim relates to a
community debt
Date debt was incurred ____________ Last 4 digits of account number ___ ___ ___ ___
Add the dollar value of your entries in Column A on this page. Write that number here:
$________________
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: __________ District of __________
Case number ___________________________________________
(
If known
)
Fill in this information to identify your case:
Check if this is an
amended filing
__________ District of __________
Debtor 1 _______________________________________________________ Case number (if known)_____________________________________
First Name Middle Name Last Name
Official Form 106D Additional Page of Schedule D: Creditors Who Have Claims Secured by Property page ___ of ___
Part 1:
Additional Page
After listing any entries on this page, number them beginning with 2.3, followed
by 2.4, and so forth.
Column A
Amount of claim
Do not deduct the
value of collateral.
Column B
Value of collateral
that supports this
claim
Column C
Unsecured
portion
If any
______________________________________
Creditor’s Name
______________________________________
Number Street
______________________________________
______________________________________
City State ZIP Code
Describe the property that secures the claim:
$_________________ $________________$____________
As of the date you file, the claim is: Check all that apply.
Contingent
Unliquidated
Disputed
Nature of lien. Check all that apply.
An agreement you made (such as mortgage or secured
car loan)
Statutory lien (such as tax lien, mechanic’s lien)
Judgment lien from a lawsuit
Other (including a right to offset) ____________________
Who owes the debt? Check one.
Debtor 1 only
Debtor 2 only
Debtor 1 and Debtor 2 only
At least one of the debtors and another
Check if this claim relates to a
community debt
Date debt was incurred ____________ Last 4 digits of account number ___ ___ ___ ___
______________________________________
Creditor’s Name
______________________________________
Number Street
______________________________________
______________________________________
City State ZIP Code
Describe the property that secures the claim: $_________________ $________________$____________
As of the date you file, the claim is: Check all that apply.
Contingent
Unliquidated
Disputed
Nature of lien. Check all that apply.
An agreement you made (such as mortgage or secured
car loan)
Statutory lien (such as tax lien, mechanic’s lien)
Judgment lien from a lawsuit
Other (including a right to offset) ____________________
Who owes the debt? Check one.
Debtor 1 only
Debtor 2 only
Debtor 1 and Debtor 2 only
At least one of the debtors and another
Check if this claim relates to a
community debt
Date debt was incurred ____________ Last 4 digits of account number ___ ___ ___ ___
______________________________________
Creditor’s Name
______________________________________
Number Street
______________________________________
______________________________________
City State ZIP Code
Describe the property that secures the claim:
$_________________ $________________$____________
As of the date you file, the claim is: Check all that apply.
Contingent
Unliquidated
Disputed
Nature of lien. Check all that apply.
An agreement you made (such as mortgage or secured
car loan)
Statutory lien (such as tax lien, mechanic’s lien)
Judgment lien from a lawsuit
Other (including a right to offset) ____________________
Who owes the debt? Check one.
Debtor 1 only
Debtor 2 only
Debtor 1 and Debtor 2 only
At least one of the debtors and another
Check if this claim relates to a
community debt
Date debt was incurred ____________ Last 4 digits of account number ___ ___ ___ ___
Add the dollar value of your entries in Column A on this page. Write that number here:
$_________________
If this is the last page of your form, add the dollar value totals from all pages.
Write that number here:
$_________________
Debtor 1 _______________________________________________________ Case number (if known)_____________________________________
First Name Middle Name Last Name
Official Form 106D Part 2 of Schedule D: Creditors Who Have Claims Secured by Property page ___ of ___
Part 2: List Others to Be Notified for a Debt That You Already Listed
Use this page only if you have others to be notified about your bankruptcy for a debt that you already listed in Part 1. For example, if a collection
agency is trying to collect from you for a debt you owe to someone else, list the creditor in Part 1, and then list the collection agency here. Similarly, if
you have more than one creditor for any of the debts that you listed in Part 1, list the additional creditors here. If you do not have additional persons to
be notified for any debts in Part 1, do not fill out or submit this page.
_____________________________________________________________________
Name
_____________________________________________________________________
Number Street
_____________________________________________________________________
_____________________________________________________________________
City State ZIP Code
On which line in Part 1 did you enter the creditor? _____
Last 4 digits of account number ___ ___ ___ ___
_____________________________________________________________________
Name
_____________________________________________________________________
Number Street
_____________________________________________________________________
_____________________________________________________________________
City State ZIP Code
On which line in Part 1 did you enter the creditor? _____
Last 4 digits of account number ___ ___ ___ ___
_____________________________________________________________________
Name
_____________________________________________________________________
Number Street
_____________________________________________________________________
_____________________________________________________________________
City State ZIP Code
On which line in Part 1 did you enter the creditor? _____
Last 4 digits of account number ___ ___ ___ ___
_____________________________________________________________________
Name
_____________________________________________________________________
Number Street
_____________________________________________________________________
_____________________________________________________________________
City State ZIP Code
On which line in Part 1 did you enter the creditor? _____
Last 4 digits of account number ___ ___ ___ ___
____________
_________________________________________________________
Name
_____________________________________________________________________
Number Street
_____________________________________________________________________
_____________________________________________________________________
City State
ZIP
Code
On which line in Part 1 did you enter the creditor? _____
Last 4 digits of account number ___ ___ ___ ___
____________
_________________________________________________________
Name
_____________________________________________________________________
Number Street
_____________________________________________________________________
_____________________________________________________________________
City State
ZIP
Code
On which line in Part 1 did you enter the creditor? _____
Last 4 digits of account number ___ ___ ___ ___
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Official Form 106D Schedule D: Creditors Who Have (US Courts)

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Completed 13 October 2020

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