Your Name
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First Name
Last Name
What state have you lived last 2 years?
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Do you own, rent or stay with family?
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Email Address
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example@example.com
Phone Number
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Full Street Address, City, State, Zip
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SS Number (to search bankruptcy and court cases)
DOB (to search bankruptcy and court cases)
Spouse/ Partner (even if not filing)
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First Name
Last Name
Spouse/ Partner Email
example@example.com
Spouse/ Partner Phone
Spouse/ Partner DOB
Spouse/ Partner SS
List all bankruptcy cases in last 10 yrs
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Are you single, married/partnered, separated?
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Identify all people who live in household, their relation to you and their ages. Include spouse, partner, roommate, children
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Employer, Job Title, annual salary. If retired state so.
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Spouse or Partner Employer and annual salary.
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Name of home HOA.
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houses/condos/land
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Rows
Address
1st mtg total balance
2nd mtg total balance
Mtg company
Property 1
Property 2
Property 3
Vehicles, motorcycles, RV etc
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Rows
Year
Brand
Model
Mileage
Creditor
Vehicle 1
Vehicle 2
Vehicle 3
Are behind on your mortgage? If you are current, state "current."
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Have you removed your name from a house deed or bank account in the last 5 years?
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Have you sold, transferred house, land, car in the last 5 yrs (to anyone)?
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Do you or spouse/partner get child support, veterans, ss, pension or other income? How much monthly?
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In last 5 years insurance payout, inheritance, retirement loan, car settlement payout? Expect those?
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Any lawsuits you could file or you could be sued like car accident, workers comp, personal injury or any other?
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Did you charge more than 10k in the last 3 months on your credit cards?
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List all Checking, Savings/ cashapp / venmo /paypal etc and current balance
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List all brokerage, investments/ crypto/ retirement accounts and current balance
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List electronics, furniture, gold or diamond jewelry, other expensive items.
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Creditors you owe
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Rows
Approx Total Combined
Balances
mortgage arrears
hoa arrears
federal taxes
state taxes
credit cards/ personal loans
repossessions
back child support arrears
student loans
md mva or tickets
condo fees arrears
other describe
other describe
other describe
other describe
other describe
Monthly Expenses(include total for everyone in household, not just your half)
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Rows
monthly
Rent or mortgage
home owners assocation/ condo fees
2nd mortgage/ equity line
gas electric combined
water sewer garbage
cell phone
cable internet
home repairs maintenance
food groceries
clothing
medical dental out of pocket
charitable contributions
pet care
personal care grooming
child support you pay monthly
car insurance
car gasoline maintenance
metro / uber
daycare childcare
vehicle payment 1
vehicle payment 2
other describe
other describe
other describe
I certify that I have answered all questions truthfully. Omitting or mispresenting info could lead to serious consequences in bankruptcy court. Please type name to sign.
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