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General Information
Petition — Form 101
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Debtor Identity
First Name *
Middle Name
Last Name *
Suffix
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Jr.
Sr.
II
III
IV
SSN
Date of Birth
Phone
Email
Marital Status
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Single
Married
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Filing Type
Individual
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Case Information
Chapter
Chapter 7
Chapter 13
Chapter 12
District
Northern District of Illinois
Central District of Illinois
Southern District of Illinois
Division
Western Division
Eastern Division
Credit Counseling
Status
Completed credit counseling
Requesting exemption from requirement
Requesting extension to complete
Not applicable (business case)
Provider
Date Completed
Certificate Number
Fee Disclosure
Matter Rate
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Hourly
Pro Bono Case
Attorney Base Fee
Add'l Fees & Costs
Total Paid
Source of Compensation
Debtor
Other
Filing Fees
Filing Fee Amount
Filing Fee Paid to Court
Payment Method
Attached
Installments
Waiver Requested
Residence
Debtor rents residence
Hazardous Property
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Location
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Prior Addresses
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Debtor 2 (Joint Filer)
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Middle Name
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Chapter
7
13
12
11
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Disposition
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Location
Description
Reason for Immediate Attention