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Your Statement About Your Social Security Numbers

Produced by Attorney Mariah Jennings-Rampsi for MassLegalHelp
Created October 2016

Get the Your Statement About Your Social Security Numbers form from the US Bankruptcy Court website.

Save the form on your computer.

In the top box put your name and your spouse’s if you are both filing.

Skip the box that asks for the District

Put “Mass.” in the box that asks for your state.

The clerk will give you the Case No. when you file your Statement.

The top box of most Bankruptcy forms.

Most of the form is easy to fill out. Some parts are not so easy to understand. It is important to understand the question before you answer it.

List your full name and full Social Security Number.

If you are filing jointly with your spouse, list your spouse’s full name and full Social Security Number too.

Sign and date the form at the bottom.

If you are filing jointly with your spouse, your spouse must sign and date the form also.

Use today’s date. It does not need to be the date you actually file your bankruptcy. 

Filing without a lawyer

  • Bankruptcy is complicated. Filing without a lawyer is risky.
  • You can lose property and money. You can go to jail if you do not tell the truth.

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