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

 

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Title