United States Bankruptcy Court Southern District of Indiana

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Family size Include yourself, spouse and anyone you could claim as a dependent for tax purposes. Use numbers only.
 
How are you paid? Weekly Bi-weekly (every two weeks) Semi-monthly (twice a month) Monthly
 
Gross income per pay
period listed above
$ Include yourself and spouse. Gross income is before taxes and other deductions, not "take-home pay."
 
Do you have a pending case
with the Bankruptcy Court?
Yes No
 
Do you have any extraordinary monthly expenses, ongoing medical conditions or other special circumstances?

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