Riverside Bankruptcy Lawyers | San Bernardino Foreclosures Attorneys

Bankruptcy Questionnaire

All information provided is confidential and shall not be used for any purpose other than to render legal advise regarding bankruptcy and non-bankruptcy options. To properly advise you of your rights it is essential that you accurately complete this questionnaire.

Full Name:

Street Address:

City, Zip:

Home Phone:

Cell Phone:

Email Address:

What other names have you used in the last (6) years?

Marital Status:

PRIOR BANKRUPTCIES: If you have previously filed a bankruptcy petition, please list the case number, date, outcome and the location where you filed on the following lines:

Case Number:

Date:

Outcome:

Location:

POTENTIAL INHERITANCE: Are you the beneficiary of a will where you will inherit property in the near future? Yes No

TRANSFERS: Have you sold, transferred or given away any property that you owned outright or that you were paying for on time in the last year? Yes No

LOAN APPLICATIONS: Have you ever given a false financial statement to obtain a loan? Yes No

LAW SUITS: Do you have the right to file a personal injury case, workers compensation or other law suit against anyone? Yes No

Have you lived in this jurisdiction the last 90 days? Yes No

Have you paid any debts to any relatives in the last year? Yes No

Do you have any debts resulting from a D.U.I.? Yes No

Do you have any debts resulting from a Criminal Fine? Yes No

Do you have any debts resulting from Student Loans or Tuition? Yes No

Do you owe any taxes? Yes No

Have you taken credit card cash advances to pay taxes? Yes No

Are you on title to anyone else's property? Yes No

Have you co-signed for another's debt? Yes No

Has anyone co-signed for any of your obligations? Yes No

Have you ever had a HUD, VA or Cal Vet loan? Yes No

REAL PROPERTY: Is land and things permanently attached to land including unimproved land, vacation cabins, condominiums, duplexes, rental properties, business properties, mobile home park spaces, agricultural land, airplane hangers, and other buildings permanently attached to land. Also include property you are entitled to by a trust and all property in which you have any legal, equitable, or future interest, include property owned by either spouse.

1. Address:

Market Value:

Amount Owed:

1st Trust Deed Holder:

Monthly Mortgage Payment:

Due Date:

Number of Payments Behind:

2nd Trust Deed Holder:

Monthly Mortgage Payment:

Due Date:

Number of Payments Behind:

Do you own any other real property, raw land or timeshares? Yes No

PERSONAL PROPERTY: List all property you own. If you do not own property in a specific category, please place an 'X' in the description column. When the value of the property is requested, please use a liquidation or yard sale value.

Property Description

Value

1. Cash on Hand

2. Bank Accounts Credit Union Accts

3. Security Deposits

4. Household Goods

5. Books, Art and Collectibles

6. Wearing Apparel

7. Furs and Jewelry

8. Guns, Hobby and Sports Equipment

9. Interests in Insurance Accounts

10. Annuities

11. IRA, KEOGH or Pension Plans

12. Stocks or Business Interests

13. Interests in Partnerships/Joint Ventures

14. Govt & Corporate Bonds/Notes

15. Accounts Receivables

16. Alimony, Support, Maintenance and Property Settlements

17. Other Liquidated Debts/Tax Refunds

18. Equitable or Future Interests/Life Estates

19. Contingent/Non-Contingent Interests in a Will

20. Other Contingent/Unliquidated Debts

21. Patents, Copyrights/Intellectual Property

22. Licenses/Franchises

23. Automobiles, Trucks, Trailers and other Vehicles

24. Boats, Motors & Accessories

25. Aircraft & Accessories

26. Office Equipment, Furniture & Supplies

27. Machinery, Fixtures, Equipment & Supplies used in Business

28. Inventory

29. Animals

30. Crops Growing or Harvested

31. Farming Equipment & Implements

32. Farm Supplies, Chemicals & Feed

33. All other Property not listed

LEASES OR CONTRACTS: Are you a party to any leases or contracts? If yes, list the parties involved and their addresses:

INCOME AND EXPENSE:

OCCUPATION:

LENGTH OF EMPLOYMENT:

EMPLOYERS NAME:

EMPLOYERS ADDRESS:

DEPENDENTS:

NAME and AGE:

MONTHLY INCOME

	DEBTOR	SPOUSE
Monthly Gross Wages, Salary, Commissions
Estimated Monthly Overtime
Subtract Payroll Taxes and Social Security
Subtract Insurance
Subtract Union Dues
Other Payroll Deductions-Specify
Regular Monthly Income from Business or Profession
Monthly Income from Real Property
Monthly Interest and Dividends
Alimony, Maintenance or Support Payments (For your or your dependents use)
Social Security or Government Assistance
Pension or Retirement
NAME:

MONTHLY EXPENSES

Debtor(s)

Rent/Mortgage (Add property tax if paid separately)

Electricity and Heating

Water and Sewer

Telephone

Other Utilities

Home Maintenance/Repairs

Food

Clothing

Laundry and Dry Cleaning

Medical and Dental Expenses

Transportation (not including car payments)

Recreation, Clubs and Entertainment

Charitable Contributions

Homeowners/Renters Insurance

Life Insurance

Health Insurance

Auto Insurance

Other Insurance - Specify

Taxes (not deducted from wages or in home mortgage payments)

Installment Auto Payments

Other Installment Payments

Alimony, Maintenance and Support paid to Others

Payments for Dependents not Living at Home

Operation Expenses of Business, Profession or Farm

Total Credit Card Debt

PLEASE ANSWER THE FOLLOWING QUESTIONS: DO NOT LEAVE ANY QUESTION BLANK. IF THE QUESTION IS NOT APPLICABLE TO YOUR SITUATION - WRITE "N/A"

1. List amount of income from employment, or operation of business, for each of the last two years:

Amount:

Source:

Fiscal Period:

2. Income other than from employment or operation of business for the last two years:

Amount:

Source:

Fiscal Period:

3. A. List all payments to creditors, within the last 90 days, totaling $600.00 or more:
Name and Address of Creditor / Amount paid and Amount still owed

B. List all payments made within the last year to creditors who were family members:

4. A. List all lawsuits or garnishments you are involved in as a plaintiff or defendant:
Caption of Suit/Case Number Action Court Location Status

B. List all property attached or seized within last year:
Name and Address of Creditor Date of Seizure Value of Property

5. List all completed Repossessions, Foreclosures and Returns:
Name and Address of Creditor Date Description of Property

6. List all properties assigned, or placed in the hands of a receiver, within the last year:
Name and Address of Assignee Date of Assignment Terms

7. List all large gifts made within the last year:
Name of Person Relation Description of Gift

8. List all losses from theft, fire, or gambling within the last year:
Description and Value of Property Date of Loss

9. List all payments to attorneys or others regarding bankruptcy within the last year:
Name of Payee Date of Payment Amount

10. List all valuable properties sold, transferred, given away, or put into someone else's hands, within the last 12 months:
Name of Transferee/Relation Describe Property Value

11. List all closed financial accounts:
Name and Address of Institution Type of Account Amount/Date

12. List all safe deposit boxes held within the last year:
Name and Address of Bank Description of Contents

13. List all creditors to whom property was given in exchange for forgiving a debt:
Name and Address of Creditor Date Amount of Set-off

14. List all your properties held by another:
Holder's Name Description of Property Location of Property

15. If you have moved within the last two years, list all past addresses:
Address Date of Occupancy

PLEASE COMPLETE QUESTIONS 16 - 21 IF YOU WERE MEMBER OF A CORPORATION OR PARTNERSHIP WITHIN THE LAST 2 YEARS

16. List the Name, Location and Nature of the Business:

17. List all bookkeepers and accountants who, within the last 6 years, have kept business records: Name and Address Date Services were Rendered

18. List the dates of last 2 inventories taken and the dollar amount of each inventory:
Date of Inventory Name of Person Taking Inventory Value

19. If in a current partnership, list the nature and percentage of interest in the partnership:

20. List all former partners who withdrew from the partnership within the last year:

21. List all withdrawals by or distributions to insiders within the last year: