Bankruptcy Questionnaire

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This Bankruptcy Questionnaire will help you organize and record your financial information before beginning the bankruptcy process.

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This Bankruptcy Questionnaire is a valuable resource for those who are considering filing bankruptcy. This questionnaire sets out the necessary paperwork you will need before meeting with an attorney. It includes questions regarding your assets (both real and personal property), bank account information and information about your household property. It also includes questions about investments, alimony or property settlements, as well as your monthly income and debts. When filing for bankruptcy it is important to have your paperwork organized and up-to-date. This Bankruptcy Questionnaire will be instrumental in ensuring that you have all the information your bankruptcy attorney requires.

This Bankruptcy Questionnaire includes the following:
  • Assets: Information regarding real estate, bank accounts and household and personal property;
  • Debts: Information about mortgages owed on your home or business, loans and credit card debt;
  • Monthly Income: Information about your income including wages and non-wage income;
  • Monthly Expenses: Information about your expenses including rent, food and medical and dental expenses.

Protect yourself and your rights by using our attorney-prepared forms.

This attorney-prepared packet contains:
  1. Information
  2. Bankruptcy Questionnaire
State Law Compliance: This form complies with the laws of all states
This is the content of the form and is provided for your convenience. It is not necessarily what the actual form looks like and does not include the information, instructions and other materials that come with the form you would purchase. An actual sample can also be viewed by clicking on the "Sample Form" near the top left of this page.











Bankruptcy Questionnaire







This Packet Includes:
1. Information; and
2. Bankruptcy Questionnaire





Information
Bankruptcy Questionnaire




Before you begin to actually prepare your bankruptcy papers, you must have a clear record of what your assets, debts, income and expenses are. Having this information in front of you will help you understand your overall financial position and will eventually be used by you to complete the various bankruptcy forms required by the court.  



The following Bankruptcy Questionnaire will assist you in this endeavor and should provide you with all of the necessary information to make the actual preparation of your bankruptcy papers a relatively easy task.

You must complete this questionnaire and the related bankruptcy papers with absolute honesty. Any attempts, however minor, to hide your property or trick creditors in any manner may result in the denial of your bankruptcy by the court.

To prepare this questionnaire, you will need before you all of the paperwork that you have regarding your finances. It will be necessary to consult your bills, payment records, paycheck stubs, mortgages, loan applications, checkbooks, tax returns and all other financial information in order to complete this questionnaire. If you are filing jointly, include totals for both spouses.





DISCLAIMER:

FindLegalForms, Inc. (“FLF”) is not a law firm and does not provide legal advice.  The use of these materials is not a substitute for legal advice. Only an attorney can provide legal advice.  An attorney should be consulted for all serious legal matters.  No Attorney-Client relationship is created by use of these materials.  

THESE MATERIALS ARE PROVIDED “AS-IS.  FLF DOES NOT GIVE ANY EXPRESS OR IMPLIED WARRANTIES OF MERCHANTABILITY, SUITABILITY OR COMPLETENESS FOR ANY OF THE MATERIALS FOR YOUR PARTICULAR NEEDS.  THE MATERIALS ARE USED AT YOUR OWN RISK.  IN NO EVENT WILL:  I) FLF, ITS AGENTS, PARTNERS, OR AFFILIATES; OR II) THE PROVIDERS, AUTHORS OR PUBLISHERS OF ITS MATERIALS, BE RESPONSIBLE OR LIABLE FOR ANY DIRECT, INDIRECT, INCIDENTAL, SPECIAL, EXEMPLARY, OR CONSEQUENTIAL DAMAGES (INCLUDING, BUT NOT LIMITED TO, PROCUREMENT OF SUBSTITUTE GOODS OR SERVICES; LOSS OF USE, DATE OR PROFITS; OR BUSINESS INTERRUPTION) HOWEVER USED AND ON ANY THEORY OF LIABILITY, WHETHER IN CONTRACT, STRICT LIABILITY, OR TORT (INCLUDING NEGLIGENCE OR OTHERWISE) ARISING IN ANY WAY OUT OF THE USE OF THESE MATERIALS. 



Bankruptcy Questionnaire

What Are Your Assets?

Real Estate

Personal Residence
Description ____________________________________________________________
Location ________________________________________________________________
Market Value: $ _______________
How held and percent held? (Joint tenants, tenancy-in-common, etc?)
___________________/______ %
Value of your share ............................................................................... $_____________
Amount of mortgage or other debt ........................................................ $_____________

Vacation Home
Description ____________________________________________________________
Location ______________________________________________________________
Market Value: $ _______________
How held and percent held? (Joint tenants, tenancy-in-common, etc?)
___________________/______ %
Value of your share ................................................................................$_____________
Amount of mortgage or other debt .........................................................$_____________

Vacant Land
Description ____________________________________________________________
Location ______________________________________________________________
Market Value: $ _______________
How held and percent held? (Joint tenants, tenancy-in-common, etc?)
___________________/______ %
Value of your share ............................................................................... $_____________
Amount of mortgage or other debt ........................................................ $_____________

Other Property
Description ____________________________________________________________
Location_______________________________________________________________
Market Value: $ _______________
How held and percent held? (Joint tenants, tenancy-in-common, etc?)
___________________/______ %
Value of your share ............................................................................... $_____________
Amount of mortgage or other debt ........................................................ $_____________

Other Property
Description ____________________________________________________________
Location ______________________________________________________________
Market Value: $ _______________
How held and percent held? (Joint tenants, tenancy-in-common, etc?)
___________________/______ %
Value of your share ............................................................................... $_____________
Amount of mortgage or other debt ........................................................ $_____________

Total Real Estate .................................................................................. $_____________


Personal Property

Cash and Bank Accounts
Cash ..................................................................................................... $_____________

Checking account ................................................................................. $_____________
Bank _________________________________________________________________
Address _______________________________________________________________
Account # _____________________________________________________________
Name(s) on account _____________________________________________________

Savings account ................................................................................... $_____________
Bank _________________________________________________________________
Address _______________________________________________________________
Account # _____________________________________________________________
Name(s) on account _____________________________________________________

Certificate of deposit ............................................................................. $_____________
Held by _______________________________________________________________
Address _______________________________________________________________
Expiration date _________________________________________________________
Name(s) on account _____________________________________________________

Other account ....................................................................................... $_____________
Bank _________________________________________________________________
Address _______________________________________________________________
Account # _____________________________________________________________
Name(s) on account _____________________________________________________

Total Cash and Bank Accounts ............................................................ $_____________


Security Deposits (Held by Utilities, Landlords, etc.)

Security deposit .................................................................................... $_____________
Held by _______________________________________________________________
Address _______________________________________________________________
Reason for deposit ______________________________________________________
Name(s) on account _____________________________________________________

Security deposit .................................................................................... $_____________
Held by _______________________________________________________________
Address _______________________________________________________________
Reason for deposit ______________________________________________________
Name(s) on account _____________________________________________________

Total Security Deposits ......................................................................... $_____________


Miscellaneous Household and Personal Property

Household furnishings .......................................................................... $_____________
Description ____________________________________________________________
Location ______________________________________________________________

Audio or video equipment ..................................................................... $_____________
Description ____________________________________________________________
Location ______________________________________________________________

Computer equipment..............................................................................$_____________
Description ____________________________________________________________
Location ______________________________________________________________

Books, pictures, or artwork.....................................................................$_____________
Description ____________________________________________________________
Location _____________________________________________________________

Stamp, coin, or other collections ........................................................... $_____________
Description ____________________________________________________________
Location ______________________________________________________________

Clothing ................................................................................................. $_____________
Description ____________________________________________________________
Location ______________________________________________________________

Jewelry and furs .................................................................................... $_____________
Description ____________________________________________________________
Location ______________________________________________________________

Firearms and sporting equipment ..........................................................$_____________
Description ____________________________________________________________
Location ______________________________________________________________

Camera and hobby equipment ..............................................................$_____________
Description ____________________________________________________________
Location ______________________________________________________________

Any other miscellaneous household and personal property ..................$_____________
Description ____________________________________________________________
Location ______________________________________________________________

Total Miscellaneous Household and Personal Property ........................$_____________


Insurance and Annuity Contracts

Life insurance (face value) .............................................Policy Amount $_____________
Policy # _______________________________________________________________
Company _____________________________________________________________
Address_______________________________________________________________
Cash surrender value.............................................................................$_____________

Annuity contract (face value) .........................................Policy Amount $_____________
Policy # _______________________________________________________________
Company______________________________________________________________
Address_______________________________________________________________
Cash surrender value ............................................................................$_____________

Total Insurance and Annuity Contracts …..............................................$_____________


IRA, Keogh, and/or Pension/Profit-Sharing Plans

Company or administrator_________________________________________________
Address _______________________________________________________________
Plan type ______________________________________________________________
Net value ................................................................................................$_____________

Company or administrator ________________________________________________
Address _______________________________________________________________
Plan type ______________________________________________________________
Net value ................................................................................................$_____________

Total IRA, Keogh, and/or Pension/Profit-Sharing Plans ........................$_____________
Stocks and Mutual Funds

Company _____________________________________________________________
CUSIP or Certificate # ___________________________________________________
Number and type of shares _______________________________________________
Value ..................................................................................................... $_____________

Company _____________________________________________________________
CUSIP or Certificate # ___________________________________________________
Number and type of shares _______________________________________________
Value ..................................................................................................... $_____________

Total Stocks and Mutual Funds .............................................................$_____________

Business Interests

Sole Proprietorship
Name ________________________________________________________________
Location ______________________________________________________________
Type of business ________________________________________________________
Your net value ....................................................................................... $_____________

Interest in Partnership
Name ________________________________________________________________
Location ______________________________________________________________
Type of business ________________________________________________________
Gross value $ _______________
Percentage share held _______________
Your net value ....................................................................................... $_____________

Corporation Interest
Name ________________________________________________________________
Location ______________________________________________________________
Type of business ________________________________________________________
Gross value $ _______________
Percentage shares held _______________
Your net value ....................................................................................... $_____________

Joint Venture Interest
Name ________________________________________________________________
Location ______________________________________________________________
Type of business ________________________________________________________
Gross value $ _______________
Percentage share held _______________
Your net value ....................................................................................... $_____________

Total Business Interests ........................................................................ $____________


Bonds and Mutual Bond Funds

Company _____________________________________________________________
CUSIP or Certificate # ___________________________________________________
Number and type of shares _______________________________________________
Value ..................................................................................................... $_____________

Company _____________________________________________________________
CUSIP or Certificate # ___________________________________________________
Number and type of shares _______________________________________________
Value ..................................................................................................... $_____________

Total Bonds and Mutual Bond Funds ................................................... $_____________

Accounts Receivable

Accounts owed to you ............................................................................$_____________
Due from______________________________________________________________ Address _______________________________________________________________
Accounts owed to you ........................................................................... $_____________
Due from ______________________________________________________________
Address _______________________________________________________________

Total Accounts Receivable ................................................................... $_____________


Alimony, Support, or Property Settlements Owed to You

Alimony ................................................................................................. $_____________
Due from ______________________________________________________________
Address _______________________________________________________________
Property settlement ............................................................................... $_____________
Due from ______________________________________________________________
Address _______________________________________________________________
Total Alimony, Support, or Property Settlements Owed to You .............$_____________


Other Debts Owed to You

Other debt owed to you ........................................................................ $_____________
Due from______________________________________________________________
Address_______________________________________________________________

Other debt owed to you ........................................................................ $_____________
Due from______________________________________________________________
Address_______________________________________________________________

Total Other Debts Owed to You ............................................................ $_____________


Tax Refunds Due to You

Federal income tax ............................................................................... $_____________
Address of IRS office ____________________________________________________

State income tax ................................................................................... $_____________
Name of state __________________________________________________________
Address of tax authority __________________________________________________

Other tax ............................................................................................... $_____________
Name of tax authority ____________________________________________________
Address of tax authority __________________________________________________

Total Tax Refunds Due to You ..............................................................$_____________


Miscellaneous Property Interests

Future interest and/or life estates ......................................................... $_____________
Description ____________________________________________________________
Location ______________________________________________________________

Interests in estates of decedents, etc. .................................................. $_____________
Description ____________________________________________________________
Location ______________________________________________________________

Interests in another persons life insurance policy .................................$_____________
Description ____________________________________________________________
Location ______________________________________________________________

Other contingent or unliquidated claims ............................................... $_____________
Description ____________________________________________________________
Location ______________________________________________________________
Royalties, patents, copyrights, etc. ........................................................$_____________
Description ____________________________________________________________
Location ______________________________________________________________

Licenses, franchises, etc .......................................................................$_____________
Description ____________________________________________________________
Location ______________________________________________________________

Auto, truck, or other vehicles ................................................................ $_____________
Description ____________________________________________________________
Location ______________________________________________________________

Boat, marine motor, etc. ....................................................................... $_____________
Description ____________________________________________________________
Location ______________________________________________________________

Airplane and accessories ...................................................................... $_____________
Description ____________________________________________________________
Location ______________________________________________________________

Office equipment, supplies, and furnishings ......................................... $_____________
Description ____________________________________________________________
Location ______________________________________________________________

Machinery, business equipment, etc. ....................................................$_____________
Description ____________________________________________________________
Location ______________________________________________________________

Business inventory ................................................................................ $_____________
Description ____________________________________________________________
Location ______________________________________________________________

Animals ................................................................................................. $_____________
Description ____________________________________________________________
Location ______________________________________________________________

Crops (growing or harvested) ............................................................... $_____________
Description ____________________________________________________________
Location ______________________________________________________________

Farm equipment .................................................................................... $_____________
Description ____________________________________________________________
Location ______________________________________________________________

Farm supplies and seed ....................................................................... $_____________
Description ____________________________________________________________
Location  ______________________________________________________________

Tools ..................................................................................................... $_____________
Description ____________________________________________________________
Location ______________________________________________________________

Season tickets ...................................................................................... $_____________
Description ____________________________________________________________
Location ______________________________________________________________

Any other personal property not listed .................................................. $_____________
Description ____________________________________________________________
Location ______________________________________________________________

Any other personal property not listed .................................................. $_____________
Description ____________________________________________________________
Location ______________________________________________________________

Any other personal property not listed .................................................. $_____________
Description ____________________________________________________________
Location ______________________________________________________________

Any other personal property not listed .................................................. $_____________
Description ____________________________________________________________
Location ______________________________________________________________

Total Miscellaneous Property Interests ................................................. $_____________


Summary of Assets
(Insert totals from previous pages)

Real Estate Total .................................................................................. $_____________
Cash and Bank Accounts Total............................................................. $_____________
Security Deposits Total ......................................................................... $_____________
Miscellaneous Household and Personal Property Total ....................... $_____________
Insurance and Annuity Contracts Total ................................................. $_____________
Ira, Keogh, and/or Pension/Profit-Sharing Plans Total ......................... $_____________
Stocks and Mutual Funds Total ............................................................ $_____________
Business Interests Total ....................................................................... $_____________
Bonds and Mutual Bond Funds Total ................................................... $_____________
Accounts Receivable Total ................................................................... $_____________
Alimony, Support, or Property Settlements Owed to You Total ............ $_____________
Other Debts Owed to You Total ............................................................ $_____________
Tax Refunds Due to You Total ............................................................. $_____________
Miscellaneous Property Interests Total ................................................. $_____________

Total Assets ......................................................................................... $____________


What Are Your Debts?

Mortgages You Owe (Home or Business)

Payable to ___________________________________ Mortgage # ________________
Address _______________________________________________________________
Property location ________________________________________________________
Reason for debt ________________________________________________________
Place debt originated ________________________ Date incurred ________________
Do you dispute debt? _________________ Did you sign contract? ________________
Any legal action on this debt? ______ Name of co-signer (if any)? _________________
Length of term _____________________________ Interest rate __________________
Total amount now due........................................................................... $_____________

Payable to ___________________________________ Mortgage # ________________
Address _______________________________________________________________
Property location ________________________________________________________
Reason for debt ________________________________________________________
Has there been any legal action regarding this debt? ___________________________
Place debt originated ________________________ Date incurred ________________
Do you dispute debt? _________________ Did you sign contract? ________________
Any legal action on this debt? ______ Name of co-signer (if any)? _________________
Length of term _____________________________ Interest rate __________________
Total amount now due........................................................................... $_____________

Total Mortgages You Owe .................................................................... $_____________


Loans You Owe (Finance Company, Bank, Auto, or Personal)

Payable to ______________________________________ Loan # ________________
Address _______________________________________________________________
Collateral _______________________________ Reason for debt _________________
Place debt originated ________________________ Date incurred ________________
Do you dispute debt? _____________ Did you sign loan contract? ________________
Any legal action on this debt? ______ Name of co-signer (if any)? _________________
Length of term _____________________________ Interest rate __________________
Total amount now due........................................................................... $_____________
Payable to ______________________________________ Loan # ________________
Address _______________________________________________________________
Collateral _______________________________ Reason for debt _________________
Place debt originated ________________________ Date incurred ________________
Do you dispute debt? _____________ Did you sign loan contract? ________________
Any legal action on this debt? ______ Name of co-signer (if any)? _________________
Length of term _____________________________ Interest rate __________________
Total amount now due........................................................................... $_____________
Total Loans You Owe ........................................................................... $____________

Accounts Payable You Owe (Medical, Dental, Stores, etc.)

Payable to ____________________________________ Account # ________________
Address _______________________________________________________________
Reason for debt ________________________________________________________
Place debt originated ________________________ Date incurred ________________
Do you dispute debt? _________________ Did you sign contract? ________________
Is account past due? _________________________ Interest rate _________________
Total amount now due........................................................................... $_____________

Payable to ____________________________________ Account # ________________
Address _______________________________________________________________
Reason for debt ________________________________________________________
Place debt originated ________________________ Date incurred ________________
Do you dispute debt? _________________ Did you sign contract? ________________
Is account past due? _________________________ Interest rate _________________
Total amount now due........................................................................... $_____________

Payable to ____________________________________ Account # ________________
Address _______________________________________________________________
Reason for debt ________________________________________________________
Place debt originated ________________________ Date incurred ________________
Do you dispute debt? _________________ Did you sign contract? ________________
Is account past due? _________________________ Interest rate _________________
Total amount now due........................................................................... $_____________

Total Accounts Payable You Owe..........................................................$_____________

Rent You Owe

Payable to _____________________________________________________________
Address _______________________________________________________________
Address of rental property ____________________ Date incurred _________________
Do you dispute debt? ___________________ Did you sign lease? ________________
Is rent past due? _____________________________ Late charge ________________
Total amount now due........................................................................... $_____________

Payable to _____________________________________________________________
Address _______________________________________________________________
Address of rental property ____________________ Date incurred ________________
Do you dispute debt? ___________________ Did you sign lease? ________________
Is rent past due? _____________________________ Late charge_________________
Total amount now due........................................................................... $_____________

Total Rent You Owe ............................................................................. $ ____________


Taxes Due

Federal income (name of tax authority _____________________ ) .... $_____________
State income (name of tax authority _____________________ ) ........ $_____________
Personal property (name of tax authority _____________________ ). $_____________
Real estate (name of tax authority _____________________ ) .......... $_____________
Other (name of tax authority _____________________ ) .................... $_____________

Total Taxes Due ....................................................................................$_____________


Credit Card Debts

Credit card company __________________ Credit card account # ________________
Address _______________________________________________________________
Reason for debt ________________________________________________________
Place debt originated ________________________ Date incurred ________________
Do you dispute debt? _________________ Did you sign contract? ________________
Amount due........................................................................................... $_____________

Credit card company __________________ Credit card account # ________________
Address _______________________________________________________________
Reason for debt ________________________________________________________
Place debt originated ________________________ Date incurred ________________
Do you dispute debt? _________________ Did you sign contract? ________________
Amount due........................................................................................... $_____________

Credit card company __________________ Credit card account # ________________
Address _______________________________________________________________
Reason for debt ________________________________________________________
Place debt originated ________________________ Date incurred ________________
Do you dispute debt? _________________ Did you sign contract? ________________
Amount due........................................................................................... $_____________

Total Credit Card Debts ........................................................................ $_____________


Miscellaneous Debts

To whom due __________________________________________________________
Address _______________________________________________________________
Collateral _______________________________ Reason for debt _________________
Place debt originated ________________________ Date incurred ________________
Do you dispute debt? _________________ Did you sign contract? ________________
Any legal action on this debt? ______ Name of co-signer (if any)? _________________
Term ______________________________________ Interest rate ________________
Amount due.......................................................................................... $ _____________

To whom due __________________________________________________________
Address _______________________________________________________________
Collateral _______________________________ Reason for debt _________________
Place debt originated ________________________ Date incurred ________________
Do you dispute debt? _________________ Did you sign contract? ________________
Any legal action on this debt? ______ Name of co-signer (if any)? _________________
Term ______________________________________ Interest rate ________________
Amount due .......................................................................................... $_____________

Total Miscellaneous Debts .................................................................... $_____________


Summary of Debts
(Insert totals from previous pages)

Mortgages You Owe Total .................................................................... $_____________
Loans You Owe Total ........................................................................... $_____________
Accounts Payable You Owe Total ........................................................ $_____________
Rent You Owe Total ............................................................................. $_____________
Taxes Due Total ................................................................................... $_____________
Credit Card Debts Total ........................................................................ $_____________
Miscellaneous Debts Total .................................................................... $_____________

Total Debts .......................................................................................... $_____________


What Is Your Monthly Income?

Occupation ____________________________________________________________
How long employed? _______________
Name of employer ______________________________________________________
Address of employer _____________________________________________________

Monthly Wage Income                You             Spouse
Gross wages, salary, and commissions
(pro-rate if not paid monthly): ................................ $_____________ $_____________
Estimated monthly overtime: ................................. $_____________ $_____________
Total Monthly Wages ............................................. $_____________ $_____________
Less payroll deductions:
Taxes .................................................................... $_____________ $_____________
Social Security ...................................................... $_____________ $_____________
Insurance .............................................................. $_____________ $_____________
Union dues ............................................................ $_____________ $____________
Other (Specify: _________________ ) …... $_____________ $_____________
Other (Specify: _________________ ) ................. $_____________ $_____________
Subtotal Of Payroll Deductions ............................. $_____________ $_____________

Total Net Monthly Wage Income (take-home pay:
total monthly wages minus payroll deductions) ...... $_____________ $_____________

Do you anticipate any change of more than 10% in any of the above categories within the next year? Explain: ___________________________________________________

Monthly Non-Wage Income             You             Spouse
Income from business, profession, or farm: ............ $_____________ $_____________
Income from real property: ...................................... $_____________ $_____________
Interest and dividends: ............................................ $_____________ $_____________
Alimony or child support payments: ........................ $_____________ $_____________
Social Security or other government assistance: .... $_____________ $_____________
Pension or retirement income: ................................ $_____________ $_____________
Other monthly income: ............................................ $_____________ $_____________

Total Monthly Non-Wage Income ............................ $_____________ $_____________

Do you anticipate any change of more than 10% in any of the above categories within the next year? Explain: ___________________________________________________


Summary of Monthly Income
(Insert totals from previous pages)

You             Spouse
Total Net Monthly Wage Income ............................. $_____________ $_____________
Total Monthly Non-Wage Income ............................ $_____________ $_____________

Total Monthly Income ............................................ $_____________ $_____________


What Are Your Monthly Expenses?

Rent or home mortgage payment (include lot rent for mobile home):... $_____________
Real estate taxes .................................................................................. $_____________
Property insurance ................................................................................ $_____________
Utilities:
Electricity and heating fuel ......................................................... $_____________
Water and sewer …......................................................... $_____________
Telephone .................................................................................. $_____________
Other .......................................................................................... $_____________
Subtotal of Utilities ..................................................................... $_____________

Home maintenance (repairs and upkeep):............................................ $_____________
Food:...................................................................................................... $_____________
Clothing:................................................................................................. $_____________
Laundry and dry cleaning:..................................................................... $_____________
Medical and dental expenses:............................................................... $_____________
Transportation (not including car payments):........................................ $_____________
Recreation, clubs and entertainment, newspapers, magazines, etc.: .. $_____________
Charitable contributions:........................................................................ $_____________
Insurance (not deducted from wages or included in mortgage payments):
Homeowners or renters............................................................. $_____________
Life.............................................................................................. $_____________
Health.......................................................................................... $_____________
Auto…......................................................................................... $_____________
Other........................................................................................... $_____________
Subtotal of Insurance ................................................................. $_____________
Taxes (not deducted from wages or included in mortgage payments):. $_____________
Installment payments:
Auto............................................................................................. $_____________
Other........................................................................................... $_____________
Other........................................................................................... $_____________
Subtotal of Installment Payments .............................................. $_____________
Alimony, maintenance, and support paid to others: .............................. $_____________
Support of dependents not living at your home: ................................... $_____________
Regular expenses from operation of business, profession, or farm: .... $_____________
Other: .................................................................................................... $_____________
Other: .................................................................................................... $_____________
Other: .................................................................................................... $_____________

Total Monthly Expenses ..................................................................... $_____________

Do you anticipate any change of more than 10% in any of the above categories within the next year? Explain: ___________________________________________________


Financial Summary
(Insert totals from previous pages)

Total Assets ...........................................................................................$_____________
Total Debts ........................................................................................... $_____________
You             Spouse
Total Monthly Income .............................................. $_____________ $_____________
Total Monthly Expenses ....................................................................... $_____________


Number of Pages17
DimensionsDesigned for Letter Size (8.5" x 11")
EditableYes (.doc, .wpd and .rtf)
UsageUnlimited number of prints
Product number#27193
This is the content of the form and is provided for your convenience. It is not necessarily what the actual form looks like and does not include the information, instructions and other materials that come with the form you would purchase. An actual sample can also be viewed by clicking on the "Sample Form" near the top left of this page.











Bankruptcy Questionnaire







This Packet Includes:
1. Information; and
2. Bankruptcy Questionnaire





Information
Bankruptcy Questionnaire




Before you begin to actually prepare your bankruptcy papers, you must have a clear record of what your assets, debts, income and expenses are. Having this information in front of you will help you understand your overall financial position and will eventually be used by you to complete the various bankruptcy forms required by the court.  



The following Bankruptcy Questionnaire will assist you in this endeavor and should provide you with all of the necessary information to make the actual preparation of your bankruptcy papers a relatively easy task.

You must complete this questionnaire and the related bankruptcy papers with absolute honesty. Any attempts, however minor, to hide your property or trick creditors in any manner may result in the denial of your bankruptcy by the court.

To prepare this questionnaire, you will need before you all of the paperwork that you have regarding your finances. It will be necessary to consult your bills, payment records, paycheck stubs, mortgages, loan applications, checkbooks, tax returns and all other financial information in order to complete this questionnaire. If you are filing jointly, include totals for both spouses.





DISCLAIMER:

FindLegalForms, Inc. (“FLF”) is not a law firm and does not provide legal advice.  The use of these materials is not a substitute for legal advice. Only an attorney can provide legal advice.  An attorney should be consulted for all serious legal matters.  No Attorney-Client relationship is created by use of these materials.  

THESE MATERIALS ARE PROVIDED “AS-IS.  FLF DOES NOT GIVE ANY EXPRESS OR IMPLIED WARRANTIES OF MERCHANTABILITY, SUITABILITY OR COMPLETENESS FOR ANY OF THE MATERIALS FOR YOUR PARTICULAR NEEDS.  THE MATERIALS ARE USED AT YOUR OWN RISK.  IN NO EVENT WILL:  I) FLF, ITS AGENTS, PARTNERS, OR AFFILIATES; OR II) THE PROVIDERS, AUTHORS OR PUBLISHERS OF ITS MATERIALS, BE RESPONSIBLE OR LIABLE FOR ANY DIRECT, INDIRECT, INCIDENTAL, SPECIAL, EXEMPLARY, OR CONSEQUENTIAL DAMAGES (INCLUDING, BUT NOT LIMITED TO, PROCUREMENT OF SUBSTITUTE GOODS OR SERVICES; LOSS OF USE, DATE OR PROFITS; OR BUSINESS INTERRUPTION) HOWEVER USED AND ON ANY THEORY OF LIABILITY, WHETHER IN CONTRACT, STRICT LIABILITY, OR TORT (INCLUDING NEGLIGENCE OR OTHERWISE) ARISING IN ANY WAY OUT OF THE USE OF THESE MATERIALS. 



Bankruptcy Questionnaire

What Are Your Assets?

Real Estate

Personal Residence
Description ____________________________________________________________
Location ________________________________________________________________
Market Value: $ _______________
How held and percent held? (Joint tenants, tenancy-in-common, etc?)
___________________/______ %
Value of your share ............................................................................... $_____________
Amount of mortgage or other debt ........................................................ $_____________

Vacation Home
Description ____________________________________________________________
Location ______________________________________________________________
Market Value: $ _______________
How held and percent held? (Joint tenants, tenancy-in-common, etc?)
___________________/______ %
Value of your share ................................................................................$_____________
Amount of mortgage or other debt .........................................................$_____________

Vacant Land
Description ____________________________________________________________
Location ______________________________________________________________
Market Value: $ _______________
How held and percent held? (Joint tenants, tenancy-in-common, etc?)
___________________/______ %
Value of your share ............................................................................... $_____________
Amount of mortgage or other debt ........................................................ $_____________

Other Property
Description ____________________________________________________________
Location_______________________________________________________________
Market Value: $ _______________
How held and percent held? (Joint tenants, tenancy-in-common, etc?)
___________________/______ %
Value of your share ............................................................................... $_____________
Amount of mortgage or other debt ........................................................ $_____________

Other Property
Description ____________________________________________________________
Location ______________________________________________________________
Market Value: $ _______________
How held and percent held? (Joint tenants, tenancy-in-common, etc?)
___________________/______ %
Value of your share ............................................................................... $_____________
Amount of mortgage or other debt ........................................................ $_____________

Total Real Estate .................................................................................. $_____________


Personal Property

Cash and Bank Accounts
Cash ..................................................................................................... $_____________

Checking account ................................................................................. $_____________
Bank _________________________________________________________________
Address _______________________________________________________________
Account # _____________________________________________________________
Name(s) on account _____________________________________________________

Savings account ................................................................................... $_____________
Bank _________________________________________________________________
Address _______________________________________________________________
Account # _____________________________________________________________
Name(s) on account _____________________________________________________

Certificate of deposit ............................................................................. $_____________
Held by _______________________________________________________________
Address _______________________________________________________________
Expiration date _________________________________________________________
Name(s) on account _____________________________________________________

Other account ....................................................................................... $_____________
Bank _________________________________________________________________
Address _______________________________________________________________
Account # _____________________________________________________________
Name(s) on account _____________________________________________________

Total Cash and Bank Accounts ............................................................ $_____________


Security Deposits (Held by Utilities, Landlords, etc.)

Security deposit .................................................................................... $_____________
Held by _______________________________________________________________
Address _______________________________________________________________
Reason for deposit ______________________________________________________
Name(s) on account _____________________________________________________

Security deposit .................................................................................... $_____________
Held by _______________________________________________________________
Address _______________________________________________________________
Reason for deposit ______________________________________________________
Name(s) on account _____________________________________________________

Total Security Deposits ......................................................................... $_____________


Miscellaneous Household and Personal Property

Household furnishings .......................................................................... $_____________
Description ____________________________________________________________
Location ______________________________________________________________

Audio or video equipment ..................................................................... $_____________
Description ____________________________________________________________
Location ______________________________________________________________

Computer equipment..............................................................................$_____________
Description ____________________________________________________________
Location ______________________________________________________________

Books, pictures, or artwork.....................................................................$_____________
Description ____________________________________________________________
Location _____________________________________________________________

Stamp, coin, or other collections ........................................................... $_____________
Description ____________________________________________________________
Location ______________________________________________________________

Clothing ................................................................................................. $_____________
Description ____________________________________________________________
Location ______________________________________________________________

Jewelry and furs .................................................................................... $_____________
Description ____________________________________________________________
Location ______________________________________________________________

Firearms and sporting equipment ..........................................................$_____________
Description ____________________________________________________________
Location ______________________________________________________________

Camera and hobby equipment ..............................................................$_____________
Description ____________________________________________________________
Location ______________________________________________________________

Any other miscellaneous household and personal property ..................$_____________
Description ____________________________________________________________
Location ______________________________________________________________

Total Miscellaneous Household and Personal Property ........................$_____________


Insurance and Annuity Contracts

Life insurance (face value) .............................................Policy Amount $_____________
Policy # _______________________________________________________________
Company _____________________________________________________________
Address_______________________________________________________________
Cash surrender value.............................................................................$_____________

Annuity contract (face value) .........................................Policy Amount $_____________
Policy # _______________________________________________________________
Company______________________________________________________________
Address_______________________________________________________________
Cash surrender value ............................................................................$_____________

Total Insurance and Annuity Contracts …..............................................$_____________


IRA, Keogh, and/or Pension/Profit-Sharing Plans

Company or administrator_________________________________________________
Address _______________________________________________________________
Plan type ______________________________________________________________
Net value ................................................................................................$_____________

Company or administrator ________________________________________________
Address _______________________________________________________________
Plan type ______________________________________________________________
Net value ................................................................................................$_____________

Total IRA, Keogh, and/or Pension/Profit-Sharing Plans ........................$_____________
Stocks and Mutual Funds

Company _____________________________________________________________
CUSIP or Certificate # ___________________________________________________
Number and type of shares _______________________________________________
Value ..................................................................................................... $_____________

Company _____________________________________________________________
CUSIP or Certificate # ___________________________________________________
Number and type of shares _______________________________________________
Value ..................................................................................................... $_____________

Total Stocks and Mutual Funds .............................................................$_____________

Business Interests

Sole Proprietorship
Name ________________________________________________________________
Location ______________________________________________________________
Type of business ________________________________________________________
Your net value ....................................................................................... $_____________

Interest in Partnership
Name ________________________________________________________________
Location ______________________________________________________________
Type of business ________________________________________________________
Gross value $ _______________
Percentage share held _______________
Your net value ....................................................................................... $_____________

Corporation Interest
Name ________________________________________________________________
Location ______________________________________________________________
Type of business ________________________________________________________
Gross value $ _______________
Percentage shares held _______________
Your net value ....................................................................................... $_____________

Joint Venture Interest
Name ________________________________________________________________
Location ______________________________________________________________
Type of business ________________________________________________________
Gross value $ _______________
Percentage share held _______________
Your net value ....................................................................................... $_____________

Total Business Interests ........................................................................ $____________


Bonds and Mutual Bond Funds

Company _____________________________________________________________
CUSIP or Certificate # ___________________________________________________
Number and type of shares _______________________________________________
Value ..................................................................................................... $_____________

Company _____________________________________________________________
CUSIP or Certificate # ___________________________________________________
Number and type of shares _______________________________________________
Value ..................................................................................................... $_____________

Total Bonds and Mutual Bond Funds ................................................... $_____________

Accounts Receivable

Accounts owed to you ............................................................................$_____________
Due from______________________________________________________________ Address _______________________________________________________________
Accounts owed to you ........................................................................... $_____________
Due from ______________________________________________________________
Address _______________________________________________________________

Total Accounts Receivable ................................................................... $_____________


Alimony, Support, or Property Settlements Owed to You

Alimony ................................................................................................. $_____________
Due from ______________________________________________________________
Address _______________________________________________________________
Property settlement ............................................................................... $_____________
Due from ______________________________________________________________
Address _______________________________________________________________
Total Alimony, Support, or Property Settlements Owed to You .............$_____________


Other Debts Owed to You

Other debt owed to you ........................................................................ $_____________
Due from______________________________________________________________
Address_______________________________________________________________

Other debt owed to you ........................................................................ $_____________
Due from______________________________________________________________
Address_______________________________________________________________

Total Other Debts Owed to You ............................................................ $_____________


Tax Refunds Due to You

Federal income tax ............................................................................... $_____________
Address of IRS office ____________________________________________________

State income tax ................................................................................... $_____________
Name of state __________________________________________________________
Address of tax authority __________________________________________________

Other tax ............................................................................................... $_____________
Name of tax authority ____________________________________________________
Address of tax authority __________________________________________________

Total Tax Refunds Due to You ..............................................................$_____________


Miscellaneous Property Interests

Future interest and/or life estates ......................................................... $_____________
Description ____________________________________________________________
Location ______________________________________________________________

Interests in estates of decedents, etc. .................................................. $_____________
Description ____________________________________________________________
Location ______________________________________________________________

Interests in another persons life insurance policy .................................$_____________
Description ____________________________________________________________
Location ______________________________________________________________

Other contingent or unliquidated claims ............................................... $_____________
Description ____________________________________________________________
Location ______________________________________________________________
Royalties, patents, copyrights, etc. ........................................................$_____________
Description ____________________________________________________________
Location ______________________________________________________________

Licenses, franchises, etc .......................................................................$_____________
Description ____________________________________________________________
Location ______________________________________________________________

Auto, truck, or other vehicles ................................................................ $_____________
Description ____________________________________________________________
Location ______________________________________________________________

Boat, marine motor, etc. ....................................................................... $_____________
Description ____________________________________________________________
Location ______________________________________________________________

Airplane and accessories ...................................................................... $_____________
Description ____________________________________________________________
Location ______________________________________________________________

Office equipment, supplies, and furnishings ......................................... $_____________
Description ____________________________________________________________
Location ______________________________________________________________

Machinery, business equipment, etc. ....................................................$_____________
Description ____________________________________________________________
Location ______________________________________________________________

Business inventory ................................................................................ $_____________
Description ____________________________________________________________
Location ______________________________________________________________

Animals ................................................................................................. $_____________
Description ____________________________________________________________
Location ______________________________________________________________

Crops (growing or harvested) ............................................................... $_____________
Description ____________________________________________________________
Location ______________________________________________________________

Farm equipment .................................................................................... $_____________
Description ____________________________________________________________
Location ______________________________________________________________

Farm supplies and seed ....................................................................... $_____________
Description ____________________________________________________________
Location  ______________________________________________________________

Tools ..................................................................................................... $_____________
Description ____________________________________________________________
Location ______________________________________________________________

Season tickets ...................................................................................... $_____________
Description ____________________________________________________________
Location ______________________________________________________________

Any other personal property not listed .................................................. $_____________
Description ____________________________________________________________
Location ______________________________________________________________

Any other personal property not listed .................................................. $_____________
Description ____________________________________________________________
Location ______________________________________________________________

Any other personal property not listed .................................................. $_____________
Description ____________________________________________________________
Location ______________________________________________________________

Any other personal property not listed .................................................. $_____________
Description ____________________________________________________________
Location ______________________________________________________________

Total Miscellaneous Property Interests ................................................. $_____________


Summary of Assets
(Insert totals from previous pages)

Real Estate Total .................................................................................. $_____________
Cash and Bank Accounts Total............................................................. $_____________
Security Deposits Total ......................................................................... $_____________
Miscellaneous Household and Personal Property Total ....................... $_____________
Insurance and Annuity Contracts Total ................................................. $_____________
Ira, Keogh, and/or Pension/Profit-Sharing Plans Total ......................... $_____________
Stocks and Mutual Funds Total ............................................................ $_____________
Business Interests Total ....................................................................... $_____________
Bonds and Mutual Bond Funds Total ................................................... $_____________
Accounts Receivable Total ................................................................... $_____________
Alimony, Support, or Property Settlements Owed to You Total ............ $_____________
Other Debts Owed to You Total ............................................................ $_____________
Tax Refunds Due to You Total ............................................................. $_____________
Miscellaneous Property Interests Total ................................................. $_____________

Total Assets ......................................................................................... $____________


What Are Your Debts?

Mortgages You Owe (Home or Business)

Payable to ___________________________________ Mortgage # ________________
Address _______________________________________________________________
Property location ________________________________________________________
Reason for debt ________________________________________________________
Place debt originated ________________________ Date incurred ________________
Do you dispute debt? _________________ Did you sign contract? ________________
Any legal action on this debt? ______ Name of co-signer (if any)? _________________
Length of term _____________________________ Interest rate __________________
Total amount now due........................................................................... $_____________

Payable to ___________________________________ Mortgage # ________________
Address _______________________________________________________________
Property location ________________________________________________________
Reason for debt ________________________________________________________
Has there been any legal action regarding this debt? ___________________________
Place debt originated ________________________ Date incurred ________________
Do you dispute debt? _________________ Did you sign contract? ________________
Any legal action on this debt? ______ Name of co-signer (if any)? _________________
Length of term _____________________________ Interest rate __________________
Total amount now due........................................................................... $_____________

Total Mortgages You Owe .................................................................... $_____________


Loans You Owe (Finance Company, Bank, Auto, or Personal)

Payable to ______________________________________ Loan # ________________
Address _______________________________________________________________
Collateral _______________________________ Reason for debt _________________
Place debt originated ________________________ Date incurred ________________
Do you dispute debt? _____________ Did you sign loan contract? ________________
Any legal action on this debt? ______ Name of co-signer (if any)? _________________
Length of term _____________________________ Interest rate __________________
Total amount now due........................................................................... $_____________
Payable to ______________________________________ Loan # ________________
Address _______________________________________________________________
Collateral _______________________________ Reason for debt _________________
Place debt originated ________________________ Date incurred ________________
Do you dispute debt? _____________ Did you sign loan contract? ________________
Any legal action on this debt? ______ Name of co-signer (if any)? _________________
Length of term _____________________________ Interest rate __________________
Total amount now due........................................................................... $_____________
Total Loans You Owe ........................................................................... $____________

Accounts Payable You Owe (Medical, Dental, Stores, etc.)

Payable to ____________________________________ Account # ________________
Address _______________________________________________________________
Reason for debt ________________________________________________________
Place debt originated ________________________ Date incurred ________________
Do you dispute debt? _________________ Did you sign contract? ________________
Is account past due? _________________________ Interest rate _________________
Total amount now due........................................................................... $_____________

Payable to ____________________________________ Account # ________________
Address _______________________________________________________________
Reason for debt ________________________________________________________
Place debt originated ________________________ Date incurred ________________
Do you dispute debt? _________________ Did you sign contract? ________________
Is account past due? _________________________ Interest rate _________________
Total amount now due........................................................................... $_____________

Payable to ____________________________________ Account # ________________
Address _______________________________________________________________
Reason for debt ________________________________________________________
Place debt originated ________________________ Date incurred ________________
Do you dispute debt? _________________ Did you sign contract? ________________
Is account past due? _________________________ Interest rate _________________
Total amount now due........................................................................... $_____________

Total Accounts Payable You Owe..........................................................$_____________

Rent You Owe

Payable to _____________________________________________________________
Address _______________________________________________________________
Address of rental property ____________________ Date incurred _________________
Do you dispute debt? ___________________ Did you sign lease? ________________
Is rent past due? _____________________________ Late charge ________________
Total amount now due........................................................................... $_____________

Payable to _____________________________________________________________
Address _______________________________________________________________
Address of rental property ____________________ Date incurred ________________
Do you dispute debt? ___________________ Did you sign lease? ________________
Is rent past due? _____________________________ Late charge_________________
Total amount now due........................................................................... $_____________

Total Rent You Owe ............................................................................. $ ____________


Taxes Due

Federal income (name of tax authority _____________________ ) .... $_____________
State income (name of tax authority _____________________ ) ........ $_____________
Personal property (name of tax authority _____________________ ). $_____________
Real estate (name of tax authority _____________________ ) .......... $_____________
Other (name of tax authority _____________________ ) .................... $_____________

Total Taxes Due ....................................................................................$_____________


Credit Card Debts

Credit card company __________________ Credit card account # ________________
Address _______________________________________________________________
Reason for debt ________________________________________________________
Place debt originated ________________________ Date incurred ________________
Do you dispute debt? _________________ Did you sign contract? ________________
Amount due........................................................................................... $_____________

Credit card company __________________ Credit card account # ________________
Address _______________________________________________________________
Reason for debt ________________________________________________________
Place debt originated ________________________ Date incurred ________________
Do you dispute debt? _________________ Did you sign contract? ________________
Amount due........................................................................................... $_____________

Credit card company __________________ Credit card account # ________________
Address _______________________________________________________________
Reason for debt ________________________________________________________
Place debt originated ________________________ Date incurred ________________
Do you dispute debt? _________________ Did you sign contract? ________________
Amount due........................................................................................... $_____________

Total Credit Card Debts ........................................................................ $_____________


Miscellaneous Debts

To whom due __________________________________________________________
Address _______________________________________________________________
Collateral _______________________________ Reason for debt _________________
Place debt originated ________________________ Date incurred ________________
Do you dispute debt? _________________ Did you sign contract? ________________
Any legal action on this debt? ______ Name of co-signer (if any)? _________________
Term ______________________________________ Interest rate ________________
Amount due.......................................................................................... $ _____________

To whom due __________________________________________________________
Address _______________________________________________________________
Collateral _______________________________ Reason for debt _________________
Place debt originated ________________________ Date incurred ________________
Do you dispute debt? _________________ Did you sign contract? ________________
Any legal action on this debt? ______ Name of co-signer (if any)? _________________
Term ______________________________________ Interest rate ________________
Amount due .......................................................................................... $_____________

Total Miscellaneous Debts .................................................................... $_____________


Summary of Debts
(Insert totals from previous pages)

Mortgages You Owe Total .................................................................... $_____________
Loans You Owe Total ........................................................................... $_____________
Accounts Payable You Owe Total ........................................................ $_____________
Rent You Owe Total ............................................................................. $_____________
Taxes Due Total ................................................................................... $_____________
Credit Card Debts Total ........................................................................ $_____________
Miscellaneous Debts Total .................................................................... $_____________

Total Debts .......................................................................................... $_____________


What Is Your Monthly Income?

Occupation ____________________________________________________________
How long employed? _______________
Name of employer ______________________________________________________
Address of employer _____________________________________________________

Monthly Wage Income                You             Spouse
Gross wages, salary, and commissions
(pro-rate if not paid monthly): ................................ $_____________ $_____________
Estimated monthly overtime: ................................. $_____________ $_____________
Total Monthly Wages ............................................. $_____________ $_____________
Less payroll deductions:
Taxes .................................................................... $_____________ $_____________
Social Security ...................................................... $_____________ $_____________
Insurance .............................................................. $_____________ $_____________
Union dues ............................................................ $_____________ $____________
Other (Specify: _________________ ) …... $_____________ $_____________
Other (Specify: _________________ ) ................. $_____________ $_____________
Subtotal Of Payroll Deductions ............................. $_____________ $_____________

Total Net Monthly Wage Income (take-home pay:
total monthly wages minus payroll deductions) ...... $_____________ $_____________

Do you anticipate any change of more than 10% in any of the above categories within the next year? Explain: ___________________________________________________

Monthly Non-Wage Income             You             Spouse
Income from business, profession, or farm: ............ $_____________ $_____________
Income from real property: ...................................... $_____________ $_____________
Interest and dividends: ............................................ $_____________ $_____________
Alimony or child support payments: ........................ $_____________ $_____________
Social Security or other government assistance: .... $_____________ $_____________
Pension or retirement income: ................................ $_____________ $_____________
Other monthly income: ............................................ $_____________ $_____________

Total Monthly Non-Wage Income ............................ $_____________ $_____________

Do you anticipate any change of more than 10% in any of the above categories within the next year? Explain: ___________________________________________________


Summary of Monthly Income
(Insert totals from previous pages)

You             Spouse
Total Net Monthly Wage Income ............................. $_____________ $_____________
Total Monthly Non-Wage Income ............................ $_____________ $_____________

Total Monthly Income ............................................ $_____________ $_____________


What Are Your Monthly Expenses?

Rent or home mortgage payment (include lot rent for mobile home):... $_____________
Real estate taxes .................................................................................. $_____________
Property insurance ................................................................................ $_____________
Utilities:
Electricity and heating fuel ......................................................... $_____________
Water and sewer …......................................................... $_____________
Telephone .................................................................................. $_____________
Other .......................................................................................... $_____________
Subtotal of Utilities ..................................................................... $_____________

Home maintenance (repairs and upkeep):............................................ $_____________
Food:...................................................................................................... $_____________
Clothing:................................................................................................. $_____________
Laundry and dry cleaning:..................................................................... $_____________
Medical and dental expenses:............................................................... $_____________
Transportation (not including car payments):........................................ $_____________
Recreation, clubs and entertainment, newspapers, magazines, etc.: .. $_____________
Charitable contributions:........................................................................ $_____________
Insurance (not deducted from wages or included in mortgage payments):
Homeowners or renters............................................................. $_____________
Life.............................................................................................. $_____________
Health.......................................................................................... $_____________
Auto…......................................................................................... $_____________
Other........................................................................................... $_____________
Subtotal of Insurance ................................................................. $_____________
Taxes (not deducted from wages or included in mortgage payments):. $_____________
Installment payments:
Auto............................................................................................. $_____________
Other........................................................................................... $_____________
Other........................................................................................... $_____________
Subtotal of Installment Payments .............................................. $_____________
Alimony, maintenance, and support paid to others: .............................. $_____________
Support of dependents not living at your home: ................................... $_____________
Regular expenses from operation of business, profession, or farm: .... $_____________
Other: .................................................................................................... $_____________
Other: .................................................................................................... $_____________
Other: .................................................................................................... $_____________

Total Monthly Expenses ..................................................................... $_____________

Do you anticipate any change of more than 10% in any of the above categories within the next year? Explain: ___________________________________________________


Financial Summary
(Insert totals from previous pages)

Total Assets ...........................................................................................$_____________
Total Debts ........................................................................................... $_____________
You             Spouse
Total Monthly Income .............................................. $_____________ $_____________
Total Monthly Expenses ....................................................................... $_____________


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