Voluntary Petition For Individuals Filing For Bankruptcy: Official Form 101
Voluntary Petition For Individuals Filing For Bankruptcy: Official Form 101
Voluntary Petition For Individuals Filing For Bankruptcy: Official Form 101
22-50073
Case number (If known): _________________________ Chapter you are filing under:
Chapter 7
✔
Chapter 11
Chapter 12
Chapter 13
✔ Check if this is an
amended filing
The bankruptcy forms use you and Debtor 1 to refer to a debtor filing alone. A married couple may file a bankruptcy case together—called a
joint case—and in joint cases, these forms use you to ask for information from both debtors. For example, if a form asks, “Do you own a car,”
the answer would be yes if either debtor owns a car. When information is needed about the spouses separately, the form uses Debtor 1 and
Debtor 2 to distinguish between them. In joint cases, one of the spouses must report information as Debtor 1 and the other as Debtor 2. The
same person must be Debtor 1 in all of the forms.
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, attach a separate sheet to this form. On the top of any additional pages, write your name and case number
(if known). Answer every question.
Wengui
__________________________________________________ __________________________________________________
First name First name
__________________________________________________ __________________________________________________
Middle name Middle name
Guo
__________________________________________________ __________________________________________________
Last name Last name
Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 1
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___ ___ – ___ ___ ___ ___ ___ ___ ___ ___ ___ – ___ ___ ___ ___ ___ ___ ___
EIN EIN
___ ___ – ___ ___ ___ ___ ___ ___ ___ ___ ___ – ___ ___ ___ ___ ___ ___ ___
EIN EIN
New York
_________________________________________________ _________________________________________________
County County
If your mailing address is different from the one If Debtor 2’s mailing address is different from
above, fill it in here. Note that the court will send yours, fill it in here. Note that the court will send
any notices to you at this mailing address. any notices to this mailing address.
_________________________________________________ _________________________________________________
Number Street Number Street
_________________________________________________ _________________________________________________
P.O. Box P.O. Box
_________________________________________________ _________________________________________________
City State ZIP Code City State ZIP Code
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7. The chapter of the Check one. (For a brief description of each, see Notice Required by 11 U.S.C. § 342(b) for Individuals Filing
Bankruptcy Code you for Bankruptcy (Form 2010)). Also, go to the top of page 1 and check the appropriate box.
are choosing to file
under
Chapter 7
✔ Chapter 11
Chapter 12
Chapter 13
8. How you will pay the fee ✔ I will pay the entire fee when I file my petition. Please check with the clerk’s office in your
local court for more details about how you may pay. Typically, if you are paying the fee
yourself, you may pay with cash, cashier’s check, or money order. If your attorney is
submitting your payment on your behalf, your attorney may pay with a credit card or check
with a pre-printed address.
I need to pay the fee in installments. If you choose this option, sign and attach the
Application for Individuals to Pay The Filing Fee in Installments (Official Form 103A).
I request that my fee be waived (You may request this option only if you are filing for Chapter 7.
By law, a judge may, but is not required to, waive your fee, and may do so only if your income is
less than 150% of the official poverty line that applies to your family size and you are unable to
pay the fee in installments). If you choose this option, you must fill out the Application to Have the
Chapter 7 Filing Fee Waived (Official Form 103B) and file it with your petition.
Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 3
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13. Are you filing under If you are filing under Chapter 11, the court must know whether you are a small business debtorRUDGHEWRU
Chapter 11 of the FKRRVLQJWRSURFHHGXQGHU6XEFKDSWHU9 so that it can set appropriate deadlines. If you indicate that you
Bankruptcy Code and are a small business debtorRU\RXDUHFKRRVLQJWRSURFHHGXQGHU6XEFKDSWHU9, you must attach your
most recent balance sheet, statement of operations, cash-flow statement, and federal income tax return or
are you a small business
if any of these documents do not exist, follow the procedure in 11 U.S.C. § 1116(1)(B).
debtorRUDGHEWRUDV
GHILQHGE\86& No. I am not filing under Chapter 11.
? ✔ No.
I am filing under Chapter 11, but I am NOT a small business debtor according to the definition in
For a definition of small the Bankruptcy Code.
business debtor, see
11 U.S.C. § 101(51D).
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&RGHDQG,GRQRWFKRRVHWRSURFHHGXQGHU6XEFKDSWHU9RI&KDSWHU
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Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 4
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Part 4: Report if You Own or Have Any Hazardous Property or Any Property That Needs Immediate Attention
________________________________________________________________________
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I am not required to receive a briefing about I am not required to receive a briefing about
credit counseling because of: credit counseling because of:
Incapacity. I have a mental illness or a mental Incapacity. I have a mental illness or a mental
deficiency that makes me deficiency that makes me
incapable of realizing or making incapable of realizing or making
rational decisions about finances. rational decisions about finances.
Disability. My physical disability causes me Disability. My physical disability causes me
to be unable to participate in a to be unable to participate in a
briefing in person, by phone, or briefing in person, by phone, or
through the internet, even after I through the internet, even after I
reasonably tried to do so. reasonably tried to do so.
Active duty. I am currently on active military Active duty. I am currently on active military
duty in a military combat zone. duty in a military combat zone.
If you believe you are not required to receive a If you believe you are not required to receive a
briefing about credit counseling, you must file a briefing about credit counseling, you must file a
motion for waiver of credit counseling with the court. motion for waiver of credit counseling with the court.
Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page
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16a. Are your debts primarily consumer debts? Consumer debts are defined in 11 U.S.C. § 101(8)
16. What kind of debts do as “incurred by an individual primarily for a personal, family, or household purpose.”
you have?
✔
No. Go to line 16b.
Yes. Go to line 17.
16b. Are your debts primarily business debts? Business debts are debts that you incurred to obtain
money for a business or investment or through the operation of the business or investment.
✔
No. Go to line 16c.
Yes. Go to line 17.
16c. State the type of debts you owe that are not consumer debts or business debts.
Litigation expenses, claims, and judgments
_______________________________________________________________
Do you estimate that after Yes. I am filing under Chapter 7. Do you estimate that after any exempt property is excluded and
any exempt property is administrative expenses are paid that funds will be available to distribute to unsecured creditors?
excluded and No
administrative expenses
are paid that funds will be Yes
available for distribution
to unsecured creditors?
I have examined this petition, and I declare under penalty of perjury that the information provided is true and
For you correct.
If I have chosen to file under Chapter 7, I am aware that I may proceed, if eligible, under Chapter 7, 11,12, or 13
of title 11, United States Code. I understand the relief available under each chapter, and I choose to proceed
under Chapter 7.
If no attorney represents me and I did not pay or agree to pay someone who is not an attorney to help me fill out
this document, I have obtained and read the notice required by 11 U.S.C. § 342(b).
I request relief in accordance with the chapter of title 11, United States Code, specified in this petition.
I understand making a false statement, concealing property, or obtaining money or property by fraud in connection
with a bankruptcy case can result in fines up to $250,000, or imprisonment for up to 20 years, or both.
18 U.S.C. §§ 152, 1341, 1519, and 3571.
02/23/2022
Executed on _________________ Executed on __________________
MM / DD / YYYY MM / DD / YYYY
Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page
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I, the attorney for the debtor(s) named in this petition, declare that I have informed the debtor(s) about eligibility
For your attorney, if you are to proceed under Chapter 7, 11, 12, or 13 of title 11, United States Code, and have explained the relief
represented by one available under each chapter for which the person is eligible. I also certify that I have delivered to the debtor(s)
the notice required by 11 U.S.C. § 342(b) and, in a case in which § 707(b)(4)(D) applies, certify that I have no
If you are not represented knowledge after an inquiry that the information in the schedules filed with the petition is incorrect.
by an attorney, you do not
need to file this page.
8_________________________________
/s/ Dylan Kletter Date _________________
02/23/2022
Signature of Attorney for Debtor MM / DD / YYYY
Dylan Kletter
_________________________________________________________________________________________________
Printed name
_________________________________________________________________________________________________
Hartford
______________________________________________________ CT
____________ 06103
______________________________
City State ZIP Code
(860) 509-6557
Contact phone _____________________________________ Email address dkletter@brownrudnick.com
______________________________
429244
______________________________________________________ CT
____________
Bar number State
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For you if you are filing this The law allows you, as an individual, to represent yourself in bankruptcy court, but you
bankruptcy without an should understand that many people find it extremely difficult to represent
attorney themselves successfully. Because bankruptcy has long-term financial and legal
consequences, you are strongly urged to hire a qualified attorney.
If you are represented by
an attorney, you do not To be successful, you must correctly file and handle your bankruptcy case. The rules are very
need to file this page. technical, and a mistake or inaction may affect your rights. For example, your case may be
dismissed because you did not file a required document, pay a fee on time, attend a meeting or
hearing, or cooperate with the court, case trustee, U.S. trustee, bankruptcy administrator, or audit
firm if your case is selected for audit. If that happens, you could lose your right to file another
case, or you may lose protections, including the benefit of the automatic stay.
You must list all your property and debts in the schedules that you are required to file with the
court. Even if you plan to pay a particular debt outside of your bankruptcy, you must list that debt
in your schedules. If you do not list a debt, the debt may not be discharged. If you do not list
property or properly claim it as exempt, you may not be able to keep the property. The judge can
also deny you a discharge of all your debts if you do something dishonest in your bankruptcy
case, such as destroying or hiding property, falsifying records, or lying. Individual bankruptcy
cases are randomly audited to determine if debtors have been accurate, truthful, and complete.
Bankruptcy fraud is a serious crime; you could be fined and imprisoned.
If you decide to file without an attorney, the court expects you to follow the rules as if you had
hired an attorney. The court will not treat you differently because you are filing for yourself. To be
successful, you must be familiar with the United States Bankruptcy Code, the Federal Rules of
Bankruptcy Procedure, and the local rules of the court in which your case is filed. You must also
be familiar with any state exemption laws that apply.
Are you aware that filing for bankruptcy is a serious action with long-term financial and legal
consequences?
No
Yes
Are you aware that bankruptcy fraud is a serious crime and that if your bankruptcy forms are
inaccurate or incomplete, you could be fined or imprisoned?
No
Yes
Did you pay or agree to pay someone who is not an attorney to help you fill out your bankruptcy forms?
No
Yes. Name of Person_____________________________________________________________________.
Attach Bankruptcy Petition Preparer’s Notice, Declaration, and Signature (Official Form 119).
By signing here, I acknowledge that I understand the risks involved in filing without an attorney. I
have read and understood this notice, and I am aware that filing a bankruptcy case without an
attorney may cause me to lose my rights or property if I do not properly handle the case.
8_______________________________________________ 8______________________________
Signature of Debtor 1 Signature of Debtor 2
Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page