Practitioner-Use Draft – Not Legal Advice
This template is provided for informational purposes only. It is not a substitute for the Judicial Conference “Official Bankruptcy Forms,” the Federal Rules of Bankruptcy Procedure, or the Local Rules of the United States Bankruptcy Court for the Eastern, Middle, or Western District of Pennsylvania (collectively, “PA Bankruptcy Courts”). Counsel must (i) file the Official Forms exactly as promulgated, (ii) consult the applicable Chapter 13 Standing Trustee website for district-specific procedures, and (iii) review all local form requirements before use. No attorney–client relationship is created by this template. Confirm all facts, citations, and rule references prior to filing.

MASTER CHAPTER 13 BANKRUPTCY PETITION & PLAN PACKAGE

United States Bankruptcy Court – Pennsylvania Districts
(11 U.S.C. §§ 101–1532; Fed. R. Bankr. P. 1007, 3015; Local Rules)

[// GUIDANCE: This single consolidated file is designed as an internal working draft from which counsel can cut-and-paste data into the Official Forms inside your petition software/ECF interface. Square-bracketed fields are user-editable. Do not file this document itself.]

TABLE OF CONTENTS

1. Document Header
2. Definitions
3. Voluntary Petition Data Sheet (Official Form 101)
4. Schedules & Statements Checklist
5. Pennsylvania Chapter 13 Plan (Local Form 3015-1)
6. Representations & Warranties / Debtor Certifications
7. Covenants & Debtor Duties During the Case
8. Default & Remedies (Plan-Related)
9. Risk Allocation (Automatic Stay; Plan Payments)
10. Dispute Resolution, Governing Law & Venue
11. General Provisions
12. Execution Blocks & Verifications

1. DOCUMENT HEADER

UNITED STATES BANKRUPTCY COURT
FOR THE [EASTERN | MIDDLE | WESTERN] DISTRICT OF PENNSYLVANIA

In re: : Chapter 13
[Debtor 1 Name], :
[Debtor 2 Name] (if joint), : Case No. _____
Debtor(s). :

VOLUNTARY PETITION – CHAPTER 13
Filing Date: [MM / DD / YYYY]
Effective upon electronic docketing pursuant to Fed. R. Bankr. P. 5005.

Jurisdiction & Venue: 28 U.S.C. §§ 1334(a), 157(b), 1408.

2. DEFINITIONS (Alphabetical)

Automatic Stay – 11 U.S.C. § 362(a); injunction protecting the Debtor from collection activity.
Bankruptcy Code – Title 11 of the United States Code.
Confirmation Order – Order entered under 11 U.S.C. § 1325 approving the Plan.
Debtor – The individual(s) identified in the caption.
Domestic Support Obligation (“DSO”) – Defined at 11 U.S.C. § 101(14A).
Petition Date – The date the Voluntary Petition is filed.
Plan – The Chapter 13 repayment plan attached hereto at Section 5.
Plan Payment – Amount stated in § 5.01 to be remitted to the Trustee.
Priority Claim – Claim entitled to priority under 11 U.S.C. § 507.
Secured Claim – Claim secured by a lien in property of the estate.
Trustee – The Chapter 13 Standing Trustee appointed for this District.

[// GUIDANCE: Maintain consistency of defined terms across all schedules, the plan, and any subsequent amendments.]

3. VOLUNTARY PETITION DATA SHEET

(Official Form 101 – populate electronically)

A. Debtor Information
• Full Legal Name: [_]
• All Prior Names used in last 8 years: [_]
• SSN/ITIN (last 4 digits): [_]
• Residential Address: [_]
• County of Residence: [______]

B. Chapter Selection
☒ Chapter 13 (11 U.S.C. §§ 1301–1330) – Wage Earner Repayment Plan

C. Statistical/Admin Data
• Estimated Number of Creditors: [☐ 1-49 ☐ 50-99 ☐ 100-199 ☐ 200-999]
• Estimated Assets: [☐ $0-$50k ☐ $50k-$100k ☐ $100k-$500k ☐ $500k-$1M]
• Nature of Debts (Consumer/Business): [__]
• Filing Fee Paid: ☐ Yes ☐ No – Application to Pay in Installments attached.

[// GUIDANCE: Mirror each line item from Official Form 101 §§ 1-19; attach Exhibit D (credit counseling) or local certificate as required.]

4. SCHEDULES & STATEMENTS CHECKLIST

1. Summary of Assets & Liabilities (Form 106Sum)
2. Schedules A/B–J (Forms 106A/B through 106J-2)
3. Declaration About an Individual Debtor’s Schedules (Form 106Dec)
4. Statement of Financial Affairs (Form 107)
5. Statement of Current Monthly Income (Forms 122C-1 & 122C-2)
6. Verification of Creditor Matrix (PA local form)
7. Disclosure of Compensation of Attorney for Debtor (Form 2030)
8. Means-Test Exemption/Certificate (if applicable)

[// GUIDANCE: PA districts generally require all schedules to be filed with the petition (“full filing”) unless a request for extension under Rule 1007(c) is granted.]

5. PENNSYLVANIA CHAPTER 13 PLAN

(Local Form 3015-1 – editable model below)

Article I. Plan Payments & Length

5.01 Regular Plan Payment. Debtor shall pay $[monthly amount] to the Trustee by payroll deduction/ACH beginning [first due date] and continuing for [36–60] months.
5.02 Additional Lump-Sum Payments. [If any]

Article II. Treatment of Secured Claims

2.01 Real Property – Cure & Maintain
• Creditor: [__] – Collateral: [Address] – Arrearage: $[_] – Interest [%] – Cure through Trustee in [__] months; ongoing mortgage payments paid [inside/outside] plan.
2.02 Secured Claims Valued Under 11 U.S.C. § 506
• Creditor: [_] – Collateral: [__] – Value: $[__] – Interest [__]% – Monthly Adequate Protection: $[____].

Article III. Priority Claims

3.01 Domestic Support Obligations – Pay 100 % of allowed DSO claims.
3.02 Tax Claims – IRS/PA Department of Revenue to be paid [___] % / in full with [__]% interest.

Article IV. Nonpriority Unsecured Claims

4.01 Dividend. Holders of allowed nonpriority unsecured claims will receive a pro rata distribution of [___]% or $[base amount], whichever is greater, from funds remaining after payment of all other classes.

Article V. Executory Contracts & Unexpired Leases

5.01 Assumed: [Name, monthly payment]
5.02 Rejected: [Name] – Rejection damage claim treated in § IV.

Article VI. Vesting of Property of the Estate

Property of the estate shall revest in Debtor [upon confirmation | upon discharge].

Article VII. Plan Confirmation Requirements (PA Specific)

7.01 Feasibility. Debtor’s Schedule J shows monthly net income ≥ Plan Payment.
7.02 Best-Interest Test. Liquidation analysis in Form 106A/B & 106C demonstrates unsecured creditors will receive not less than the amount distributable under Chapter 7 per 11 U.S.C. § 1325(a)(4).
7.03 Disposable Income Test. Form 122C-2 evidences compliance with 11 U.S.C. § 1325(b).

Article VIII. Miscellaneous Provisions

8.01 Non-Standard Plan Language (Rule 3015-2(b)). [Insert any]
8.02 Trustee’s Percentage Fee. Allowed pursuant to 28 U.S.C. § 586(e).
8.03 Duties in Event of Income Change. Debtor will notify Trustee and amend Schedules I/J within 14 days of any income change > 10 %.

[// GUIDANCE: Each PA district has its own Chapter 13 plan form. Replace this model with the correct local form before filing.]

6. REPRESENTATIONS & WARRANTIES

1. Accuracy of Information. Debtor certifies, under penalty of perjury (28 U.S.C. § 1746), that all information provided in the Official Forms, this Plan, and any attachments is true, correct, and complete.
2. Eligibility. Debtor’s noncontingent, liquidated secured and unsecured debts are within the limits of 11 U.S.C. § 109(e) on the Petition Date.
3. Pre-Petition Credit Counseling. Debtor received the required briefing within 180 days prior to filing as evidenced by the Certificate filed contemporaneously herewith.
4. No Prior Dismissal with Prejudice. No bankruptcy case of the Debtor was dismissed within the past 180 days for willful failure to abide by court orders.

All representations survive confirmation and the entry of discharge.

7. COVENANTS & DEBTOR DUTIES DURING THE CASE

a. Timely Plan Payments. Debtor shall make all payments set forth in § 5.01.
b. Tax Filings. Debtor will file all federal, state, and local tax returns as they come due.
c. Insurance. Debtor shall maintain insurance on all property subject to a lien.
d. Post-Petition Domestic Support. Debtor shall remain current on all DSOs per § 1325(a)(8).
e. Periodic Financial Updates. Upon Trustee request, Debtor will provide updated pay stubs, tax returns, and bank statements within 14 days.

8. DEFAULT & REMEDIES

8.01 Plan Payment Default. Upon written notice of default by the Trustee and failure to cure within 30 days, the Trustee may file a motion to dismiss.
8.02 Stay Relief. If Debtor defaults on post-petition payments to a secured creditor provided for in § 2.01, that creditor may, after 14-day notice and opportunity to cure, file a certification of default and proposed order for stay relief.
8.03 Conversion. Debtor may convert to Chapter 7 at any time (11 U.S.C. § 1307(a)).
8.04 Dismissal for Cause. Court may dismiss or convert under § 1307(c) for material default, failure to file documents, unreasonable delay, or failure to make plan payments.

9. RISK ALLOCATION

9.01 Automatic Stay. The stay under 11 U.S.C. § 362(a) remains in effect until lifted, modified, or terminated by operation of law (e.g., § 362(c)(2)).
9.02 Liability Caps. Debtor’s aggregate distribution to unsecured creditors is capped at the amounts specified in Plan §§ IV & 5.01, subject to modification under § 1329.
9.03 Force Majeure. If Debtor suffers a verified involuntary job loss, medical emergency, or other substantial hardship, Debtor may seek plan modification under § 1329 or a temporary suspension of payments.

10. DISPUTE RESOLUTION, GOVERNING LAW & VENUE

10.01 Governing Law. All questions arising under the Bankruptcy Code are governed exclusively by federal law (Title 11, United States Code).
10.02 Forum Selection. Any contested matter or adversary proceeding shall be brought in the PA Bankruptcy Court where this case is pending.
10.03 Arbitration. Not applicable; bankruptcy jurisdiction is exclusive and non-arbitrable.
10.04 Jury Trial Waiver. To the extent a jury trial right exists, Debtor knowingly waives such right as to all matters arising in or related to the Chapter 13 case, subject to court approval.
10.05 Injunctive Relief. The automatic stay and discharge injunction constitute the sole injunctive relief mechanisms contemplated herein.

11. GENERAL PROVISIONS

11.01 Amendments. Debtor may amend the Plan or schedules in accordance with Fed. R. Bankr. P. 1009 & 3015(c) upon notice to all parties.
11.02 Severability. Any provision found unenforceable shall be severed, and the remainder enforced.
11.03 Entire Agreement. The confirmed Plan, together with the Confirmation Order, constitutes the entire agreement among the Debtor, Trustee, and creditors regarding treatment of claims.
11.04 Successors & Assigns. The rights and obligations of the parties are binding on their successors, assigns, personal representatives, and heirs.
11.05 Electronic Signatures. Allowed in the PA Bankruptcy Courts per Local Rule 5005-2 and Standing Orders regarding CM/ECF.

12. EXECUTION BLOCKS & VERIFICATIONS

/s/ [Debtor 1 Name] Date: [__]

Debtor 1

/s/ [Debtor 2 Name] Date: [__]

Debtor 2

/s/ [Attorney Name] Date: [_]
[Law Firm Name]
PA Bar ID No. [_]
Counsel for Debtor(s)
Notary Acknowledgment (only if required for specific local form):
Commonwealth of Pennsylvania, County of [] — subscribed and sworn before me on [date] by [Debtor Name].

Notary Public

[// GUIDANCE: The Official Forms require electronic “/s/” signatures; retain wet signatures in your file per Fed. R. Bankr. P. 5005 & PA Local Rules.]

APPENDIX – CHECKLIST OF PENNSYLVANIA-SPECIFIC FILINGS

• Chapter 13 Plan (Local Form 3015-1 – E.D.Pa.; L.B.F. 3015-1 – M.D.Pa.; W.Pa. Form 10)
• Certificate of Credit Counseling (Local Rule 1007-1)
• Pay Advices Cover Sheet (L.B.R. 1007-1F)
• Proof of Income (last 60 days) – attach separately, docket event “Pay Statements.”
• Domestic Support Obligation Checklist (if applicable)
• Notice of Filing of Plan and Transmittal to Creditors (Clerk typically issues; verify)

[// GUIDANCE: Review each district’s Standing Orders for trustee conduit mortgage procedures, wage attachment orders, and tax refund turnover requirements.]

END OF TEMPLATE