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Federal Registration of Money Services Business
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Extracted from PDF file 2020-federal-form-fincen107.pdf, last modified November 2015Registration of Money Services Business
Fill in this information to identify your case: Debtor 1 __________________________________________________________________ First Name Debtor 2 Middle Name Last Name ________________________________________________________________ (Spouse, if filing) First Name Middle Name Last Name United States Bankruptcy Court for the: __________ District Districtofof______________ __________ Case number ___________________________________________ Check if this is an (If known) amended filing Official Form 107 Statement of Financial Affairs for Individuals Filing for Bankruptcy 04/19 Be as complete and accurate as possible. If two married people are filing together, both are equally responsible for supplying correct information. If more space is needed, attach a separate sheet to this form. On the top of any additional pages, write your name and case number (if known). Answer every question. Part 1: Give Details About Your Marital Status and Where You Lived Before 1. What is your current marital status? Married Not married 2. During the last 3 years, have you lived anywhere other than where you live now? No Yes. List all of the places you lived in the last 3 years. Do not include where you live now. Debtor 1: Dates Debtor 1 lived there Debtor 2: Same as Debtor 1 __________________________________________ Number Street From ________ To ________ __________________________________________ City State ZIP Code ___________________________________________ City State ZIP Code Same as Debtor 1 ________ To ________ Same as Debtor 1 From ________ To ___________________________________________ From ___________________________________________ Number Street __________________________________________ __________________________________________ Number Street Dates Debtor 2 lived there ___________________________________________ Number Street Same as Debtor 1 From ________ To __________________________________________ ___________________________________________ __________________________________________ City State ZIP Code ___________________________________________ City State ZIP Code ________ ________ 3. Within the last 8 years, did you ever live with a spouse or legal equivalent in a community property state or territory? (Community property states and territories include Arizona, California, Idaho, Louisiana, Nevada, New Mexico, Puerto Rico, Texas, Washington, and Wisconsin.) No Yes. Make sure you fill out Schedule H: Your Codebtors (Official Form 106H). Part 2: Explain the Sources of Your Income Official Form 107 Statement of Financial Affairs for Individuals Filing for Bankruptcy page 1 Debtor 1 _______________________________________________________ First Name Middle Name Case number (if known)_____________________________________ Last Name 4. Did you have any income from employment or from operating a business during this year or the two previous calendar years? Fill in the total amount of income you received from all jobs and all businesses, including part-time activities. If you are filing a joint case and you have income that you receive together, list it only once under Debtor 1. No Yes. Fill in the details. Debtor 1 Sources of income Check all that apply. From January 1 of current year until the date you filed for bankruptcy: For last calendar year: (January 1 to December 31, _________) YYYY For the calendar year before that: (January 1 to December 31, _________) YYYY Wages, commissions, bonuses, tips Debtor 2 Gross income (before deductions and exclusions) $________________ $________________ Operating a business Wages, commissions, bonuses, tips Operating a business Operating a business Wages, commissions, bonuses, tips Sources of income Check all that apply. $________________ Wages, commissions, bonuses, tips Gross income (before deductions and exclusions) $________________ Operating a business Wages, commissions, bonuses, tips $________________ Operating a business Wages, commissions, bonuses, tips Operating a business $________________ 5. Did you receive any other income during this year or the two previous calendar years? Include income regardless of whether that income is taxable. Examples of other income are alimony; child support; Social Security, unemployment, and other public benefit payments; pensions; rental income; interest; dividends; money collected from lawsuits; royalties; and gambling and lottery winnings. If you are filing a joint case and you have income that you received together, list it only once under Debtor 1. List each source and the gross income from each source separately. Do not include income that you listed in line 4. No Yes. Fill in the details. Debtor 1 Sources of income Describe below. __________________ From January 1 of current year until the date you filed for bankruptcy: __________________ __________________ Debtor 2 Gross income from each source (before deductions and exclusions) Sources of income Describe below. Gross income from each source (before deductions and exclusions) $_________________ _____________________ $_________________ $_________________ _____________________ $_________________ $_________________ _____________________ $_________________ __________________ $_________________ _____________________ $_________________ __________________ $_________________ _____________________ $_________________ __________________ $_________________ _____________________ $_________________ For the calendar year before that: __________________ $_________________ _____________________ $_________________ (January 1 to December 31, ______) __________________ $_________________ _____________________ $_________________ __________________ $_________________ _____________________ $_________________ For last calendar year: (January 1 to December 31, ______) YYYY YYYY Official Form 107 Statement of Financial Affairs for Individuals Filing for Bankruptcy page 2 Debtor 1 _______________________________________________________ First Name Part 3: Middle Name Case number (if known)_____________________________________ Last Name List Certain Payments You Made Before You Filed for Bankruptcy 6. Are either Debtor 1’s or Debtor 2’s debts primarily consumer debts? No. Neither Debtor 1 nor Debtor 2 has primarily consumer debts. Consumer debts are defined in 11 U.S.C. § 101(8) as “incurred by an individual primarily for a personal, family, or household purpose.” During the 90 days before you filed for bankruptcy, did you pay any creditor a total of $6,825* or more? No. Go to line 7. Yes. List below each creditor to whom you paid a total of $6,825* or more in one or more payments and the total amount you paid that creditor. Do not include payments for domestic support obligations, such as child support and alimony. Also, do not include payments to an attorney for this bankruptcy case. * Subject to adjustment on 4/01/22 and every 3 years after that for cases filed on or after the date of adjustment. Yes. Debtor 1 or Debtor 2 or both have primarily consumer debts. During the 90 days before you filed for bankruptcy, did you pay any creditor a total of $600 or more? No. Go to line 7. Yes. List below each creditor to whom you paid a total of $600 or more and the total amount you paid that creditor. Do not include payments for domestic support obligations, such as child support and alimony. Also, do not include payments to an attorney for this bankruptcy case. Dates of payment ____________________________________ _________ Total amount paid Amount you still owe $_________________ $__________________ Mortgage Car Credit card Loan repayment Suppliers or vendors Other ____________ $_________________ $__________________ Mortgage Car Credit card Loan repayment Suppliers or vendors Other ____________ $_________________ $__________________ Mortgage Car Credit card Loan repayment Suppliers or vendors Other ____________ Creditor’s Name ____________________________________ Number _________ Street ____________________________________ _________ ____________________________________ City State ZIP Code ____________________________________ _________ Creditor’s Name ____________________________________ Number _________ Street ____________________________________ _________ ____________________________________ City State ZIP Code ____________________________________ _________ Creditor’s Name ____________________________________ Number _________ Street ____________________________________ _________ ____________________________________ City Official Form 107 State Was this payment for… ZIP Code Statement of Financial Affairs for Individuals Filing for Bankruptcy page 3 Debtor 1 _______________________________________________________ First Name Middle Name Case number (if known)_____________________________________ Last Name 7. Within 1 year before you filed for bankruptcy, did you make a payment on a debt you owed anyone who was an insider? Insiders include your relatives; any general partners; relatives of any general partners; partnerships of which you are a general partner; corporations of which you are an officer, director, person in control, or owner of 20% or more of their voting securities; and any managing agent, including one for a business you operate as a sole proprietor. 11 U.S.C. § 101. Include payments for domestic support obligations, such as child support and alimony. No Yes. List all payments to an insider. Dates of payment ____________________________________________ _________ Total amount paid Amount you still owe Reason for this payment $____________ $____________ Insider’s Name ____________________________________________ Number _________ Street ____________________________________________ _________ ____________________________________________ City State ZIP Code ____________________________________________ _________ $____________ $____________ Insider’s Name ____________________________________________ Number _________ Street ____________________________________________ _________ ____________________________________________ City State ZIP Code 8. Within 1 year before you filed for bankruptcy, did you make any payments or transfer any property on account of a debt that benefited an insider? Include payments on debts guaranteed or cosigned by an insider. No Yes. List all payments that benefited an insider. Dates of payment ____________________________________________ Insider’s Name ____________________________________________ Number _________ Total amount paid Amount you still owe Reason for this payment Include creditor’s name $____________ $____________ _________ Street ____________________________________________ _________ ____________________________________________ City State ZIP Code ____________________________________________ _________ $____________ $____________ Insider’s Name ____________________________________________ Number _________ Street ____________________________________________ _________ ____________________________________________ City Official Form 107 State ZIP Code Statement of Financial Affairs for Individuals Filing for Bankruptcy page 4 Debtor 1 _______________________________________________________ First Name Part 4: Middle Name Case number (if known)_____________________________________ Last Name Identify Legal Actions, Repossessions, and Foreclosures 9. Within 1 year before you filed for bankruptcy, were you a party in any lawsuit, court action, or administrative proceeding? List all such matters, including personal injury cases, small claims actions, divorces, collection suits, paternity actions, support or custody modifications, and contract disputes. No Yes. Fill in the details. Nature of the case Court or agency Status of the case ________________________________________ Case title_____________________________ Court Name ____________________________________ ________________________________________ Number Case number ________________________ Street Pending On appeal Concluded ________________________________________ City State ZIP Code ________________________________________ Case title_____________________________ Court Name ____________________________________ ________________________________________ Number Case number ________________________ Street Pending On appeal Concluded ________________________________________ City State ZIP Code 10. Within 1 year before you filed for bankruptcy, was any of your property repossessed, foreclosed, garnished, attached, seized, or levied? Check all that apply and fill in the details below. No. Go to line 11. Yes. Fill in the information below. Describe the property _________________________________________ Date __________ Creditor’s Name Value of the property $______________ _________________________________________ Number Explain what happened Street _________________________________________ _________________________________________ City State ZIP Code Property was repossessed. Property was foreclosed. Property was garnished. Property was attached, seized, or levied. Describe the property Date __________ _________________________________________ Value of the property $______________ Creditor’s Name _________________________________________ Number Street Explain what happened _________________________________________ _________________________________________ City Official Form 107 State ZIP Code Property was repossessed. Property was foreclosed. Property was garnished. Property was attached, seized, or levied. Statement of Financial Affairs for Individuals Filing for Bankruptcy page 5 Debtor 1 _______________________________________________________ First Name Middle Name Case number (if known)_____________________________________ Last Name 11. Within 90 days before you filed for bankruptcy, did any creditor, including a bank or financial institution, set off any amounts from your accounts or refuse to make a payment because you owed a debt? No Yes. Fill in the details. Describe the action the creditor took ______________________________________ Date action was taken Amount Creditor’s Name ______________________________________ Number ____________ $________________ Street ______________________________________ ______________________________________ City State ZIP Code Last 4 digits of account number: XXXX–___ ___ ___ ___ 12. Within 1 year before you filed for bankruptcy, was any of your property in the possession of an assignee for the benefit of creditors, a court-appointed receiver, a custodian, or another official? No Yes Part 5: List Certain Gifts and Contributions 13. Within 2 years before you filed for bankruptcy, did you give any gifts with a total value of more than $600 per person? No Yes. Fill in the details for each gift. Gifts with a total value of more than $600 per person Describe the gifts ______________________________________ Dates you gave the gifts Value _________ $_____________ _________ $_____________ Person to Whom You Gave the Gift ______________________________________ ______________________________________ Number Street ______________________________________ City State Person’s relationship to you ZIP Code ______________ Gifts with a total value of more than $600 per person Describe the gifts ______________________________________ Dates you gave the gifts Value _________ $_____________ _________ $_____________ Person to Whom You Gave the Gift ______________________________________ ______________________________________ Number Street ______________________________________ City State ZIP Code Person’s relationship to you ______________ Official Form 107 Statement of Financial Affairs for Individuals Filing for Bankruptcy page 6 Debtor 1 _______________________________________________________ First Name Middle Name Case number (if known)_____________________________________ Last Name 14. Within 2 years before you filed for bankruptcy, did you give any gifts or contributions with a total value of more than $600 to any charity? No Yes. Fill in the details for each gift or contribution. Gifts or contributions to charities that total more than $600 Describe what you contributed _____________________________________ Date you contributed Value _________ $_____________ _________ $_____________ Charity’s Name _____________________________________ _____________________________________ Number Street _____________________________________ City State Part 6: ZIP Code List Certain Losses 15. Within 1 year before you filed for bankruptcy or since you filed for bankruptcy, did you lose anything because of theft, fire, other disaster, or gambling? No Yes. Fill in the details. Describe the property you lost and how the loss occurred Describe any insurance coverage for the loss Include the amount that insurance has paid. List pending insurance claims on line 33 of Schedule A/B: Property. Date of your loss _________ Part 7: Value of property lost $_____________ List Certain Payments or Transfers 16. Within 1 year before you filed for bankruptcy, did you or anyone else acting on your behalf pay or transfer any property to anyone you consulted about seeking bankruptcy or preparing a bankruptcy petition? Include any attorneys, bankruptcy petition preparers, or credit counseling agencies for services required in your bankruptcy. No Yes. Fill in the details. Description and value of any property transferred ___________________________________ Person Who Was Paid Date payment or transfer was made Amount of payment _________ $_____________ _________ $_____________ ___________________________________ Number Street ___________________________________ ___________________________________ City State ZIP Code ____________________________________________ Email or website address ___________________________________ Person Who Made the Payment, if Not You Official Form 107 Statement of Financial Affairs for Individuals Filing for Bankruptcy page 7 Debtor 1 _______________________________________________________ First Name Middle Name Case number (if known)_____________________________________ Last Name Description and value of any property transferred Date payment or transfer was made Amount of payment ____________________________________ Person Who Was Paid _________ $_____________ _________ $_____________ ____________________________________ Number Street ____________________________________ ____________________________________ City State ZIP Code ________________________________________________ Email or website address ___________________________________ Person Who Made the Payment, if Not You 17. Within 1 year before you filed for bankruptcy, did you or anyone else acting on your behalf pay or transfer any property to anyone who promised to help you deal with your creditors or to make payments to your creditors? Do not include any payment or transfer that you listed on line 16. No Yes. Fill in the details. Description and value of any property transferred ____________________________________ Date payment or transfer was made Amount of payment _________ $____________ _________ $____________ Person Who Was Paid ____________________________________ Number Street ____________________________________ ____________________________________ City State ZIP Code 18. Within 2 years before you filed for bankruptcy, did you sell, trade, or otherwise transfer any property to anyone, other than property transferred in the ordinary course of your business or financial affairs? Include both outright transfers and transfers made as security (such as the granting of a security interest or mortgage on your property). Do not include gifts and transfers that you have already listed on this statement. No Yes. Fill in the details. Description and value of property transferred Describe any property or payments received or debts paid in exchange Date transfer was made ___________________________________ Person Who Received Transfer ___________________________________ Number _________ Street ___________________________________ ___________________________________ City State ZIP Code Person’s relationship to you _____________ ___________________________________ Person Who Received Transfer _________ ___________________________________ Number Street ___________________________________ ___________________________________ City State ZIP Code Person’s relationship to you _____________ Official Form 107 Statement of Financial Affairs for Individuals Filing for Bankruptcy page 8 Debtor 1 _______________________________________________________ First Name Middle Name Case number (if known)_____________________________________ Last Name 19. Within 10 years before you filed for bankruptcy, did you transfer any property to a self-settled trust or similar device of which you are a beneficiary? (These are often called asset-protection devices.) No Yes. Fill in the details. Description and value of the property transferred Date transfer was made _________ Name of trust __________________________ ______________________________________ Part 8: List Certain Financial Accounts, Instruments, Safe Deposit Boxes, and Storage Units 20. Within 1 year before you filed for bankruptcy, were any financial accounts or instruments held in your name, or for your benefit, closed, sold, moved, or transferred? Include checking, savings, money market, or other financial accounts; certificates of deposit; shares in banks, credit unions, brokerage houses, pension funds, cooperatives, associations, and other financial institutions. No Yes. Fill in the details. Last 4 digits of account number Type of account or instrument Date account was closed, sold, moved, or transferred Last balance before closing or transfer _________ $___________ _________ $___________ ____________________________________ Name of Financial Institution XXXX–___ ___ ___ ___ ____________________________________ Number Street ____________________________________ ____________________________________ City State ZIP Code ____________________________________ XXXX–___ ___ ___ ___ Name of Financial Institution ____________________________________ Number Street ____________________________________ ____________________________________ City State Checking Savings Money market Brokerage Other__________ Checking Savings Money market Brokerage Other__________ ZIP Code 21. Do you now have, or did you have within 1 year before you filed for bankruptcy, any safe deposit box or other depository for securities, cash, or other valuables? No Yes. Fill in the details. Who else had access to it? ____________________________________ Name of Financial Institution Street ____________________________________ Official Form 107 _______________________________________ Number ____________________________________ City _______________________________________ Name ____________________________________ Number State Describe the contents Do you still have it? No Yes Street _______________________________________ City State ZIP Code ZIP Code Statement of Financial Affairs for Individuals Filing for Bankruptcy page 9 Debtor 1 _______________________________________________________ First Name Middle Name Case number (if known)_____________________________________ Last Name 22. Have you stored property in a storage unit or place other than your home within 1 year before you filed for bankruptcy? No Yes. Fill in the details. Who else has or had access to it? Describe the contents ___________________________________ _______________________________________ Name of Storage Facility Name ___________________________________ _______________________________________ Number Number Street ___________________________________ Do you still have it? No Yes Street _______________________________________ City State ZIP Code ___________________________________ City Part 9: State ZIP Code Identify Property You Hold or Control for Someone Else 23. Do you hold or control any property that someone else owns? Include any property you borrowed from, are storing for, or hold in trust for someone. No Yes. Fill in the details. Where is the property? Describe the property Value ___________________________________ $__________ Owner’s Name ___________________________________ Number Street ___________________________________ ___________________________________ City Part 10: State ZIP Code _________________________________________ Number Street _________________________________________ _________________________________________ City State ZIP Code Give Details About Environmental Information For the purpose of Part 10, the following definitions apply: Environmental law means any federal, state, or local statute or regulation concerning pollution, contamination, releases of hazardous or toxic substances, wastes, or material into the air, land, soil, surface water, groundwater, or other medium, including statutes or regulations controlling the cleanup of these substances, wastes, or material. Site means any location, facility, or property as defined under any environmental law, whether you now own, operate, or utilize it or used to own, operate, or utilize it, including disposal sites. Hazardous material means anything an environmental law defines as a hazardous waste, hazardous substance, toxic substance, hazardous material, pollutant, contaminant, or similar term. Report all notices, releases, and proceedings that you know about, regardless of when they occurred. 24. Has any governmental unit notified you that you may be liable or potentially liable under or in violation of an environmental law? No Yes. Fill in the details. Governmental unit Environmental law, if you know it ____________________________________ _______________________________ Name of site Governmental unit ____________________________________ _______________________________ Number Number Street ____________________________________ Date of notice _________ Street _______________________________ City State ZIP Code ____________________________________ City Official Form 107 State ZIP Code Statement of Financial Affairs for Individuals Filing for Bankruptcy page 10 Debtor 1 _______________________________________________________ First Name Middle Name Case number (if known)_____________________________________ Last Name 25. Have you notified any governmental unit of any release of hazardous material? No Yes. Fill in the details. Governmental unit Environmental law, if you know it Date of notice ____________________________________ _______________________________ Name of site _________ Governmental unit ____________________________________ _______________________________ Number Street Number Street ____________________________________ _______________________________ City State ZIP Code ____________________________________ City State ZIP Code 26. Have you been a party in any judicial or administrative proceeding under any environmental law? Include settlements and orders. No Yes. Fill in the details. Court or agency Case title______________________________ Status of the case Nature of the case Pending On appeal Concluded ________________________________ Court Name ______________________________________ ________________________________ Number ______________________________________ Case number Part 11: Street ________________________________ City State ZIP Code Give Details About Your Business or Connections to Any Business 27. Within 4 years before you filed for bankruptcy, did you own a business or have any of the following connections to any business? A sole proprietor or self-employed in a trade, profession, or other activity, either full-time or part-time A member of a limited liability company (LLC) or limited liability partnership (LLP) A partner in a partnership An officer, director, or managing executive of a corporation An owner of at least 5% of the voting or equity securities of a corporation No. None of the above applies. Go to Part 12. Yes. Check all that apply above and fill in the details below for each business. Describe the nature of the business ____________________________________ Do not include Social Security number or ITIN. Business Name EIN: ___ ___ – ___ ___ ___ ___ ___ ___ ___ ____________________________________ Number Employer Identification number Street Name of accountant or bookkeeper Dates business existed ____________________________________ From ____________________________________ City State Describe the nature of the business ____________________________________ Employer Identification number Do not include Social Security number or ITIN. Business Name EIN: ___ ___ – ___ ___ ___ ___ ___ ___ ___ ____________________________________ Number _______ To _______ ZIP Code Street Name of accountant or bookkeeper Dates business existed ____________________________________ ____________________________________ City Official Form 107 State From _______ To _______ ZIP Code Statement of Financial Affairs for Individuals Filing for Bankruptcy page 11 Debtor 1 _______________________________________________________ First Name Middle Name Case number (if known)_____________________________________ Last Name Describe the nature of the business Employer Identification number Do not include Social Security number or ITIN. ____________________________________ Business Name EIN: ___ ___ – ___ ___ ___ ___ ___ ___ ___ ____________________________________ Number Street Name of accountant or bookkeeper Dates business existed ____________________________________ From ____________________________________ City State _______ To _______ ZIP Code 28. Within 2 years before you filed for bankruptcy, did you give a financial statement to anyone about your business? Include all financial institutions, creditors, or other parties. No Yes. Fill in the details below. Date issued ____________________________________ Name ____________ MM / DD / YYYY ____________________________________ Number Street ____________________________________ ____________________________________ City Part 12: State ZIP Code Sign Below I have read the answers on this Statement of Financial Affairs and any attachments, and I declare under penalty of perjury that the answers are true and correct. I understand that making a false statement, concealing property, or obtaining money or property by fraud in connection with a bankruptcy case can result in fines up to $250,000, or imprisonment for up to 20 years, or both. 18 U.S.C. §§ 152, 1341, 1519, and 3571. ______________________________________________ _____________________________ Signature of Debtor 1 Signature of Debtor 2 Date ________________ Date _________________ Did you attach additional pages to Your Statement of Financial Affairs for Individuals Filing for Bankruptcy (Official Form 107)? No Yes Did you pay or agree to pay someone who is not an attorney to help you fill out bankruptcy forms? No Yes. Name of person_____________________________________________________________. Attach the Bankruptcy Petition Preparer’s Notice, Declaration, and Signature (Official Form 119). Official Form 107 Print Statement of Financial Affairs for Individuals Filing for Bankruptcy Save As... Add Attachment page 12 Reset
Statement of Financial Affairs for Individuals Filing for Bankruptcy
More about the Federal Form FinCEN107 Corporate Income Tax
We last updated the Registration of Money Services Business in July 2021, and the latest form we have available is for tax year 2020. This means that we don't yet have the updated form for the current tax year. Please check this page regularly, as we will post the updated form as soon as it is released by the Federal Internal Revenue Service. You can print other Federal tax forms here.
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TaxFormFinder has an additional 774 Federal income tax forms that you may need, plus all federal income tax forms.
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View all 775 Federal Income Tax Forms
Form Sources:
The Internal Revenue Service usually releases income tax forms for the current tax year between October and January, although changes to some forms can come even later. We last updated Federal Form FinCEN107 from the Internal Revenue Service in July 2021.
About the Corporate Income Tax
The IRS and most states require corporations to file an income tax return, with the exact filing requirements depending on the type of company.
Sole proprietorships or disregarded entities like LLCs are filed on Schedule C (or the state equivalent) of the owner's personal income tax return, flow-through entities like S Corporations or Partnerships are generally required to file an informational return equivilent to the IRS Form 1120S or Form 1065, and full corporations must file the equivalent of federal Form 1120 (and, unlike flow-through corporations, are often subject to a corporate tax liability).
Additional forms are available for a wide variety of specific entities and transactions including fiduciaries, nonprofits, and companies involved in other specific types of business.
Historical Past-Year Versions of Federal Form FinCEN107
We have a total of eight past-year versions of Form FinCEN107 in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:
2020 Form FinCEN107
Statement of Financial Affairs for Individuals Filing for Bankruptcy
2019 Form FinCEN107
Form FinCEN 107 (Rev. 8-2008)
2018 Form FinCEN107
Form FinCEN 107 (Rev. 8-2008)
2017 Form FinCEN107
Form FinCEN 107 (Rev. 8-2008)
2016 Form FinCEN107
Form FinCEN 107 (Rev. 8-2008)
2015 Form FinCEN107
Form FinCEN 107 (Rev. 8-2008)
2012 Form FinCEN107
Form FinCEN 107 (Rev. 8-2008)
2011 Form FinCEN107
FinCEN FORM 107 (Rev. 8-2008)
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