Your Current Monthly Statement Income Form
Official Form B 22B Chapter 11 Statement of Your Current Monthly Income page 1
Official Form B 22B
Chapter 11 Statement of Your Current Monthl y Income 12/14
You must file this form if you are an individual and are filing for bankruptcy under Chapter 11. If more space is needed, attach a separate sheet to
this form. Include the line number to which the additional information applies. On the top of any additional pages, write your name and case
number (if known).
Part 1: Calculate Your Average Monthly Income
1. What is your marital and filing status? Check one only.
Not married. Fill out Column A, lines 2-11.
Married and your spouse is filing with you. Fill out both Columns A and B, lines 2-11.
Married and your spouse is NOT filing with you. Fill out Column A, lines 2-11.
Fill in the average monthly income that you received from all sources, derived during the 6 full months before you file this bankruptcy
case. 11 U.S.C. § 101(10A). For example, if you are filing on September 15, the 6-month period would be March 1 through August 31. If the
amount of your monthly income varied during the 6 months, add the income for all 6 months and divide the total by 6. Fill in the result.
Do not include any income amount more than once. For example, if both spouses own the same rental property, put the income from that
property in one column only. If you have nothing to report for any line, write $0 in the space.
Column A
Debtor 1
Column B
Debtor 2
2. Your gross wages, salary, tips, bonuses, overtime, and commissions (before all
payroll deductions). $____________ $__________
3. Alimony and maintenance payments. Do not include payments from a spouse if
Column B is filled in. $____________ $__________
4. All amounts from any source which are regularly paid for household expenses of
you or your dependents, including child support. Include regular contributions from
an unmarried partner, members of your household, your dependents, parents, and
roommates. Include regular contributions from a spouse only if Column B is not filled in.
Do not include payments you listed on line 3.
$____________ $__________
5. Net income from operating a business, profession, or farm
Gross receipts (before all deductions) $_________
Ordinary and necessary operating expenses
– $_________
Net monthly income from a business, profession, or farm $_________
Copy
here
$___________
$__________
6. Net income from rental and other real property
Gross receipts (before all deductions) $_________
Ordinary and necessary operating expenses
– $_________
Net monthly income from rental or other real proper ty $_________
Copy
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: ______________________ Dis t rict of __________
Case number ___________________________________________
(If known)
Fill in this information to identify your case:
Check if this is an amended filing
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