Debtor 1 _______________________________________________________ Case number (if known)_____________________________________
First Name Middle Name Last Name
Official Form 107 Statement of Financial Affairs for Individuals Filing for Bankruptcy page 10
22. Have you stored property in a storage unit or place other than your home within 1 year before you filed for bankruptcy?
No
Yes. Fill in the details.
___________________________________
Name of Storage Facility
___________________________________
Number Street
___________________________________
___________________________________
City State ZIP Code
Who else has or had access to it? Describe the contents Do you still
have it?
_______________________________________
Name
_______________________________________
Number Street
_______________________________________
City State ZIP Code
No
Yes
Part 9: Identify Property You Hold or Control for Someone Else
23. Do you hold or control any property that someone else owns? Include any property you borrowed from, are storing for,
or hold in trust for someone.
No
Yes. Fill in the details.
___________________________________
Owner’s Name
___________________________________
Number Street
___________________________________
___________________________________
City State ZIP Code
Where is the property? Describe the property Value
________________________________________
Number Street
________________________________________
________________________________________
City State ZIP Code
$__________
Part 10: Give Details About Environmental Information
For the purpose of Part 10, the following definitions apply:
Environmental law means any federal, state, or local statute or regulation concerning pollution, contamination, releases of
hazardous or toxic substances, wastes, or material into the air, land, soil, surface water, groundw
ater, or other medium,
including statutes or regulations controlling the cleanup of these substances, wastes, or material.
Site means any location, facility, or property as defined under any environmental law, whether you now own, operate, or
utilize it or used to own, operate, or utilize it, including disposal sites.
Hazardous material means anything an environmental law defines as a hazardous waste, hazardous substance, toxic
substance, hazardous material, pollutant, contaminant, or similar term.
Report all notices, releases, and proceedings that you know about, regardless of when they occurred.
24. Has any governmental unit notified you that you may be liable or potentially liable under or in violation of an environmental law?
No
Yes. Fill in the details.
____________________________________
Name of site
____________________________________
Number Street
____________________________________
____________________________________
City State ZIP Code
Governmental unit Environmental law, if you know it Date of notice
_______________________________
Governmental unit
_______________________________
Number Street
_______________________________
City State ZIP Code
_________