EXEMPT PROPERTY REPORT
UNITED STATES BANKRUPTCY COURT
FOR THE __________ DISTRICT OF __________
To the Honorable _________________________,
United States Bankruptcy Judge:
Your trustee, for the purpose of this report,
only adopts as the estimated value of each item of property, or the amount of
money claimed, if any, the value or amount shown on the schedules.
The property listed in Schedule
“________________” is set apart as provided under the Bankruptcy Code as
exemptions allowed by law, except that the following property claimed as exempt
is not set apart for the reasons indicated:
Item Reason not allowable
1.
____________________
____________________________________________
2.
____________________
____________________________________________
3.
____________________
____________________________________________
___________________________ ___________________
Signature Date
__________________________________
Address
___________________________________
Title