Collins & Arnove 555 Republic Dr., Ste 200 Plano, TX Office Fax

Transcription

1 Collins & Arnove 555 Republic Dr., Ste 200 Plano, TX Office Fax Bankruptcy is an honest disclosure of a person(s) assets, liabilities, income, and expenses. This paperwork, as well as the documents we ask for, are designed for our office to present your case to the Court and the trustee in the proper format so that your case goes through correctly. There is no way our office can know this information unless we get it from you. So please help us help you. Don t be overwhelmed by the size of this packet. Many of the questions will be inapplicable to you. Nonetheless, you should thoroughly review each question and be certain that you do not have information that is non-responsive. If you can, answer the questions on this questionnaire. If you can t, add extra sheets of paper. If you have the information in another format (spread sheet, Quicken printout), you may attach that. Just remember, this is your financial future, please take the time to do this correctly. It will save both of us time in the end. Initial Here: Page 1

2 Items Needed: Tax Return and W2s (if married) Tax Return and W2s (if married) 3. Any paycheck stubs from either spouse (where or not filing jointly) for the previous six months. 4. Any other evidence of income such as Social Security, Pension, Unemployment, etc Attorney Notes Initial Here: Page 2

3 Client Questionnaire Section 1 - Basic Information Part A. Name and Address 1. Name: Have you used any other names in the past eight years? No Yes If yes, please list other names used: 2. Telephone Numbers\ address: Home: Work: Cell: 3. Social Security Number: Driver's License Number: Expiration Date: State: 5. Date of Birth: 6. Address: City: State: Zip: County: 7. Have you lived at this address for at least 180 days? No Yes If you have a different mailing address, please list: Mailing Address: City: State: Zip: County: Part B. Name and Address of Spouse 1. If you are filing jointly with your spouse, fill in the following information about your spouse: Name: Has your spouse used any other names in the past eight years? No Yes If yes, please list other names used: 2. Telephone Numbers\ address: Home: Work: Cell: 3. Social Security Number: Driver's License Number: Expiration Date: State: 5. Date of Birth: 6. Address:(enter only if different address) City: State: Zip: County: Initial Here: Page 3

4 Part C. Prior/Pending Bankruptcy Cases 1. Has a bankruptcy case been filed by you or against you in the last 8 years? No Yes If yes, in which district of which state was the case filed? Case Number: Date filed: 2. Are there currently any bankruptcy cases pending against you, your business, your spouse, or your spouse s business? No Yes If yes, name of debtor: Relationship to you: Case Number: Date filed: Judge: In which district of which state was the case filed? Initial Here: Page 4

5 READ CAREFULLY: Bankruptcy requires that you report ali of your assets. The questions below are designed to help us report your assets to the court in the format that they require. Please take this seriously and go through the all the types of assets. Remember to list household items at a replacement value (garage sale or craigslist value). I have no way of knowing what you own unless you tell me. Some commonly left off assets are: 401K balances, IRA balances, Insurance policies, and other "soft" assets. Many items will not apply to you, but I am still required by law to ask. So please check the "no" box if you do not own this type of asset. Section 2 Property Part A. Real Estate (Schedule A) A. Do you rent? No Yes If yes, please provide the name and address of the landlord: Name: Date you moved in?: Security deposit Amount: $ City: State: Zip: B. Do you own your house? No Yes Is this your homestead? (where you permanently live: No Yes What is the value of your house? (we generally use the tax appraised value) $ Are you current with all mortgage payments? No Yes C. Do you own any other properties? (Such as land, rental properties, time shares) No Yes Part B. Personal Property (Schedule B) 1. List ALL Checking/Savings Account, Certificates of deposit, other bank accounts: Initial Here: Page 5

6 Name of bank: Type of account: Last 4 digits of account number: Name of bank: Type of account: Last 4 digits of account number: Name of bank: Type of account: Last 4 digits of account number: Name of bank: Type of account: Last 4 digits of account number: 2. Do you have any security deposits held by utility companies, landlord? No Yes Name security held by: Amount of deposit: $ Name security held by: Amount of deposit: $ Initial Here: Page 6

7 LIVING ROOM FAMILY ROOM KITCHEN Sofa $ Sofa Bed $ Dinette Table/Chairs $ Armchair $ Sofa $ Kitchen clock $ Loveseat $ Chair $ Microwave $ Cocktail Table $ Loveseat $ Toaster Oven $ End Table $ Coffee Table $ Dishwasher $ Picture $ Cocktail Table $ Dishes/silverware $ Lamp $ Desk $ Pots/Pans $ Credenza $ Lamp $ Refrigerator $ Bookcase $ Bookcase $ Stove $ Desk $ Ent. Center $ TV (Size ) $ Wall Unit $ Stereo $ DINING ROOM Bar $ TV (Size ) $ Dining Table $ Piano $ Bridge Table/Chairs $ Dining Chairs $ Drapes $ Recliner $ Étagère $ Recliner $ CD Player $ Buffet $ Painting $ Telephone $ China Cabinet $ Plant $ Answering Mach. $ Picture $ $ $ Plant $ $ $ Armoire $ Total $ Total $ Total $ MASTER BEDROOM BEDROOM #2 BEDROOM #3 Mattress (size ) $ Mattress (size ) $ Mattress (size ) $ Box Spring (size ) $ Box Spring (size ) $ Box Spring (size ) $ Frame (size ) $ Frame (size ) $ Frame (size ) $ Water Bed $ Water Bed $ Water Bed $ Headboard (size ) $ Headboard (size ) $ Headboard (size ) $ Dresser $ Dresser $ Dresser $ Night Tables $ Night Tables $ Night Tables $ Lamp $ Lamp $ Lamp $ Vanity $ Vanity $ Vanity $ Chair $ Chair $ Chair $ Picture $ Picture $ Picture $ Footstool/ Chest $ Footstool/ Chest $ Footstool/ Chest $ TV (size ) $ TV (size ) $ TV (size ) $ VCR/ DVD $ VCR/ DVD $ VCR/ DVD $ Bedding $ Bedding $ Bedding $ Painting $ Painting $ Painting $ Plant $ Plant $ Plant $ Total $ Total $ Total $ Initial Here: Page 7 craigslistvalue)

8 BEDROOM #4 OFFICE PATIO Mattress (size ) $ Copy Machine $ Patio Table $ Box Spring (size ) $ Typewriter $ Patio Chairs $ Frame (size ) $ Telephone $ Umbrella $ Water Bed $ Cell Phones $ Lounge $ Headboard (size ) $ Car Phone $ Grill $ Dresser $ Fax Machine $ $ Night Tables $ Computers/ Laptops $ $ Lamp $ Comp. Printer $ $ Vanity $ Comp. Scanner $ $ Chair $ File Cabinet $ $ Picture $ Books $ POOL AREA Footstool/ Chest $ CD's/ DVD's/Records $ Lounge $ TV (size ) $ TV (size ) $ Chairs $ VCR/ DVD $ VCR/ DVD $ Table $ Bedding $ Camera/ Recorders $ Umbrella $ Painting $ MP3 Players $ Pool equip. $ Plant $ Desk $ Pool Supplies $ $ Chair $ $ $ Computer Equip. $ $ Total $ Total $ Total $ OTHER (if not already listed) FAMILY BELONGINGS OTHER Description Washer $ Adults Clothing $ Collectables $ Dryer $ Children's Clothing $ Art Objects $ Freezer $ Baby Clothing $ Art $ Compactor $ Jackets/Coats $ Hobby equip. $ Microwave $ $ Fire Arms $ TV (size ) $ $ Fire Arms Equip $ Window A/C $ $ Fire Arms Supplies $ A/C Compress $ $ Sports Equipment $ VCR/ DVD $ $ Furs & Jewelry $ Video Games/System $ $ Antiques $ Vacuum Cleaners $ $ Musical Instruments $ Baby Furniture $ $ Public Storage $ Baby Equipment $ $ Bicycles $ Children's Toys Sewing Machine Lawn Mower Garden Equip. Total $ Total $ Total $ Initial Here: Page 8

9 3. Interest in a universal or whole insurance policies (You only have this if it has a cash value -- not term life)? No Yes Name: Amount of value: $ Name: Amount of value: $ 4. Annuities? No Yes Name of Institution: Amount: $ Name of Institution: Amount: $ 5. Interests in an education IRA, as defined in 26 USC 530(b)(1)? No Yes Name of Institution: Amount: $ Name of Institution: Amount: $ 6. Interests in pension or profit sharing plans (This is a 401K, IRA, 403B, etc).? No Yes (YOU HAVE THIS IF A DEDUCTION IS COMING OUT OF YOUR CHECK. Name of Institution: Amount: $ Name of Institution: Amount: $ 7. Stock and interests in incorporated/unincorporated business? No Yes Value: $ Description: Initial Here: Page 9

10 8. Bonds? No Yes Value: $ Description: 9. Alimony/family support to which you are entitled? No Yes Value: $ Description: 10. Other liquidated debts owed to you, including tax refunds? No Yes Value: $ Description: 11. Can you sue anyone or any business for any reason OR does anybody owe you any money for any reason? No Yes Value: $ Description: 12. Patents, copyrights, other intellectual property? No Yes Value: $ Description: Initial Here: Page 10

11 13. Automobiles, trucks, trailers, and accessories? No Yes Year/Make/Model: Value: $ Name of owner: Year/Make/Model: Value: $ Name of owner: Year/Make/Model: Value: $ Name of owner: Year/Make/Model: Value: $ Name of owner: Year/Make/Model: Value: $ Name of owner: Year/Make/Model: Value: $ Name of owner: 14. Boats, motors, and accessories? No Yes Description: Year/Make/Model: Value: $ Name of owner: Description: Year/Make/Model: Value: $ Name of owner: 15. Animals or pets? No Yes Value: $ Description: Initial Here: Page 11

12 READ CAREFULLY: I will pull your credit report to find out a good portion of your debts. In some cases, the credit report will be an exclusive list of your debts. If that is the case, then it is unnecessary to fill this section out. However, some debts do not appear on credit reports. Examples include: payday loans, medical bills, old unpaid bills (phone, electricity, etc), broken apartment leases, and loans from family or friends. The best thing to do is to attach a copy of these statements. I will be able to gather the appropriate information from these statements. IF YOU CHOOSE TO NOT ATTACH STATEMENTS THEN I WILL NEED YOU TO FILL OUT ANY OTHER CREDITORS THAT YOU WANT LISTED. IT IS IMPOSSIBLE FOR TO KNOW ANY CREDITORS THAT ARE NOT LISTED ON THE CREDIT REPORT OR GIVEN TO ME (FROM A STATEMENT OR THIS PAPERWORK). Section 3 Debts List below all debts that you owe, or that creditor s claim that you owe which is not listed on your credit report or for which you have not provided documentation Initial Here: Page 12

13 Initial Here: Page 13

14 Section 4 Unexpired Leases and Contracts (Schedule G) 1. Do you have any unexpired leases and or contracts? No Yes Initial Here: Page 14

15 If yes, list below any leases or contracts that are still current that you are a party to. Include residential, car and business leases, and service or business contracts. Nature and Description of Contract: Name & address of other parties: Date contract expires: Nature and Description of Contract: Name & address of other parties: Date contract expires: Nature and Description of Contract: Name & address of other parties: Date contract expires: Initial Here: Page 15

16 READ CAREFULLY: Bankruptcy requires that you report ali of your income from all sources. Section 5 Current Income 1. What is your marital status? Married Single Divorced Separated Widowed 2. Do you have dependents? No Yes Name: Name: Age: Relationship: Age: Relationship: Name: Age: Relationship: Name: Age: Relationship: Part A. Debtor s Income 1. What is your official occupation title? 2. Name and address of your employer: 3. How long employed there? (MONTH/YEAR) 4. Do you receive: a. A b. S i. If so, how much per month? $ i. If so, how much per month? $ c. R Yes i. If so, how much per month? $ 5. Do you have any other income not listed? Yes a. If yes, for what? How much: $ Part B. Joint Debtor s Income 1. What is their official occupation title? 2. Name and address of your employer: 3. How long employed there? MONTH/YEAR 4. Do they receive: a. A i. If so, how much per month? $ b. S i. If so, how much per month? $ c. R Yes i. If so, how much per month? $ 5. Do they have any other income not listed? Yes a. If yes, for what? How much: $ Initial Here: Page 16

17 READ CAREFULLY: Bankruptcy requires that you report the expenses for your household. This budget does not include payments on unsecured debts such as credit cards, medical bills, payday loans, etc. This is the point of the Bankruptcy, to see what kind of budget your household has without payments for these types of items. Please provide an exact number for items that have an exact number. EX: cell phone, cable, internet, car insurance. The trustee looks at cases very SKEPTICALLY if every expense item is $100. For other items, try to use a rolling average. EX: food, clothing, medical expenses. Do not include any expenses that are itemized in your paycheck stubs. Section 6 Current Expenses 1. Do you and your spouse maintain separate households? No Yes. If so, fill one page out for your household and another for your spouse s. Indicate how much you pay for each item each month 1. your rent or your home mortgage $ Does that amount include real estate taxes? No Yes Does it include property insurance? No Yes 2. electricity and heating $ 3. water and sewage $ 4. Cell phone $ 5. Internet $ 6. Cable $ 7. home maintenance, including repairs and general upkeep $ 8. food $ 9. clothing $ 10. laundry and dry cleaning $ 11. Out of pocket medical and dental co-pays $ 12. transportation (gas, maintenance, tolls, etc) $ 13. entertainment, recreation, newspapers, magazines $ 14. charitable contributions $ 15. insurance not deducted from paycheck a) homeowner s (if not escrowed) or renter s insurance $ b) life insurance $ c) health insurance $ d) auto insurance $ e) other insurance $ 16. taxes not deducted from paycheck $ 17. installment payments for car, furniture, etc. (Specify) $ $ $ 18. alimony, maintenance, support paid to others $ 19. payments for support of dependents not living at home $ Initial Here: Page 17

18 20. childcare $ 21. Student Loan Payments (not on deferment) $ $ 22. ANY other expenses not listed above $ $ $ $ Initial Here: Page 18

19 READ CAREFULLY: Below is a list of questions that I am required to ask you by law. Many of these will questions will not apply to you. However, I still need you to check the box NO for those items. Section 7 Statement of Financial Affairs If you are filing jointly with your spouse, include information about both you and your spouse. If you are filing under chapter 12 or 13, and you are married and not separated, you must provide information about your spouse even if you are not filing jointly. 1. Payments to creditors a. Have you made your mortgage payment(s) in the last 90 days? b. Have you made your car payment(s) in the last 90 days? c. Have you paid ANY OTHER creditors OVER $600 in the last 90 days? (PLEASE ITEMIZE THESE PAYMENTS BELOW) NAME DATES OF PAYMENTS TOTAL AMOUNT PAID 2. Have you given or transferred any money/ property to any family members, relatives, friends, business partners and their relatives, your corporations, or your affiliates, in the past year? If you have answered yes to the above questions please list below the payments you have made: NAME & ADDRESS DATES OF PAYMENTS TOTAL AMOUNT PAID Initial Here: Page 19

20 3. Have you any lawsuits, executions, garnishments and attachments in the last year? List all suits and administrative proceedings to which you are or were a party within one year preceding the filing of this case. CAPTION OF SUIT & CASE # NATURE OF PROCEEDING COURT/AGENCY STATUS 4. Have you had any property that has been garnished, seized, or attached under any legal or equitable process within one year immediately preceding the commencement of this case? NAME & ADDRESS OF PERSON/COMPANY DATE OF SEIZURE DESCRIPTION & VALUE OF PROPERTY 5. Have you had any repossessions, foreclosures? List all property that has been repossessed by a creditor, sold at a foreclosure sale, transferred through a deed in lieu of foreclosure, or returned to the seller, within one year immediately preceding the commencement of this case. NAME & ADDRESS OF PERSON/ CREDITOR DATE OF REPOSSESSION/ FORECLOSURE/ TRANSFER DESCRIPTION & VALUE OF PROPERTY 6. Have you had any assignments and receiverships in the past 120 days? (If you don t know what this is then the answer is probably no) Initial Here: Page 20

21 NAME & ADDRESS OF ASSIGNEE DATE OF ASSIGNMENT TERMS OF ASSIGNMENT 7. Have you had any property which has been in the hands of a custodian, receiver, or court-appointed official within one year immediately preceding the commencement of this case? NAME & ADDRESS OF CUSTODIAN NAME & LOCATION OF COURT, CASE TITLE & # DESCRIPTION & VALUE OF PROPERTY 8. Have you given any gifts or charitable contributions within one year immediately preceding the commencement of this case except ordinary and usual gifts to family members aggregating less than $200 in value per individual family member and charitable contributions aggregating less than $100 per recipient? NAME & ADDRESS OF RECIPIENT RELATIONSHIP TO YOU IF ANY DATE OF GIFT DESCRIPTION & VALUE OF GIFT 9. Have you had any losses from fire, theft, gambling or other casualty within one year immediately preceding the commencement of this case or since the commencement of this case? DESCRIPTION & VALUE OF PROPERTY CIRCUMSTANCES & AMOUNT COVERED BY INSURANCE DATE OF LOSS 10. Have you had other property transferred in your ordinary course of business or financial affairs, transferred either absolutely or as a security within two years immediately preceding the commencement of this case (including sale of your property)? Initial Here: Page 21

22 NAME & ADDRESS OF TRANSFEREE & RELATIONSHIP DATE OF TRANSFER DESCRIPTION OF PROPERTY & VALUE RECEIVED 11.In the past 10 years have you had any property transferred to a self-settled trust, or a similar device of which you are the beneficiary? NAME OF TRUST OR SIMILAR DEVICE DATE OF TRANSFER AMOUNT OF MONEY OR VALUE OF PROPERTY OF INTEREST 12. Have you had any financial accounts and instruments held in your name or for your benefit which were closed, sold, or otherwise transferred within one year immediately preceding the commencement of this case? NAME & ADDRESS OF INSTITUTION TYPE/ ACCOUNT # & FINAL BALANCE AMOUNT & DATE OF SALE OR CLOSING 13. Have you have or have had a safe deposit or other box or depository in which you have or have had securities, cash, or other valuables within one year immediately preceding commencement of this case? NAME & ADDRESS OF BANK OR DEPOSITORY NAME/ ADDRESS WITH ACCESS DESCRIPTION OF CONTENTS DATE IF TRANSFER Initial Here: Page 22

23 14. Have you had any setoffs made by any creditor, including a bank, against a debt or deposit of yours within 90 days preceding the commencement of this case? NAME & ADDRESS OF CREDITOR DATE OF SETOFF AMOUNT OF SETOFF 15. Do you have any property that you hold or control that is owned by another person? NAME & ADDRESS OF OWNER DESCRIPTION & VALUE OF PROPERTY LOCATION OF PROPERTY 16. LIST ALL ADDRESS where you have resided in the last three years immediately preceding the commencement of this case. ADDRESS TO (MONTH & YEAR) FROM (MONTH & YEAR) 17. Do you have spouses or former spouses? (The last eight years) NAMES Initial Here: Page 23