Chapter 7 Bankruptcy Questionnaire (Individual or Joint)

Chapter 7 Bankruptcy Questionnaire (Individual or Joint)

Complete this questionnaire for your Chapter 7 filing, and answer spouse questions only if you’re filing jointly.

Nevada Exemptions (Your Choice)
Nevada residents use Nevada's exemption list in NRS 21.090(1), not the federal list (NRS 21.090(3)). Exemptions protect property from being taken in your bankruptcy. I cannot tell you which exemptions to claim; this is your decision. If you are unsure, please talk to a licensed Nevada attorney. If you are filing jointly, each spouse may claim exemptions separately for property he or she has an interest in (11 U.S.C. § 522(m)), so most limits double for a couple. The homestead is NOT doubled, and personal injury money may only be claimed by the injured spouse.
Example of how to answer (not your property): (a) Jewelry — Wedding ring, $800, Debtor 2; guitar, $300, Debtor 1; family photos, $0, both.
Check ONLY the exemptions you plan to claim:
(a) — which property, the amount, and whose it is (Debtor 1, Debtor 2, or both)
(b) — which property, the amount, and whose it is (Debtor 1, Debtor 2, or both)
(c) — which property, the amount, and whose it is (Debtor 1, Debtor 2, or both)
(d) — which property, the amount, and whose it is (Debtor 1, Debtor 2, or both)
(e) — which property, the amount, and whose it is (Debtor 1, Debtor 2, or both)
(f) — which property, the amount, and whose it is (Debtor 1, Debtor 2, or both)
(g) — which property, the amount, and whose it is (Debtor 1, Debtor 2, or both)
You do not need to do any math. Just tell me your gross pay and your take-home pay for any paycheck you have earned but not received on the day you file, and I will figure it out.
(i) — which property, the amount, and whose it is (Debtor 1, Debtor 2, or both)
(k) — which property, the amount, and whose it is (Debtor 1, Debtor 2, or both)
(l)/(m) — which property, the amount, and whose it is (Debtor 1, Debtor 2, or both)
(n) — which property, the amount, and whose it is (Debtor 1, Debtor 2, or both)
(p) — which property, the amount, and whose it is (Debtor 1, Debtor 2, or both)
(q) — which property, the amount, and whose it is (Debtor 1, Debtor 2, or both)
(r) — which property, the amount, and whose it is (Debtor 1, Debtor 2, or both)
(s)/(t) — which property, the amount, and whose it is (Debtor 1, Debtor 2, or both)
(u) — which property, the amount, and whose it is (Debtor 1, Debtor 2, or both)
(v)/(w) — which property, the amount, and whose it is (Debtor 1, Debtor 2, or both)
(x) — which property, the amount, and whose it is (Debtor 1, Debtor 2, or both)
(y) — which property, the amount, and whose it is (Debtor 1, Debtor 2, or both)
(z) — which property, the amount, and whose it is (Debtor 1, Debtor 2, or both)
Each of you has up to $10,000 of wildcard in total to split across as many items as you choose. For example, if you use $2,000 for a bank account, you still have $8,000 left for other items.
(aa) — which property, the amount, and whose it is (Debtor 1, Debtor 2, or both)
(ee) — which property, the amount, and whose it is (Debtor 1, Debtor 2, or both)
(ff) — which property, the amount, and whose it is (Debtor 1, Debtor 2, or both)
(gg)–(ll) — which property, the amount, and whose it is (Debtor 1, Debtor 2, or both)
Page 1 - Disclosure and Contact
NRS 240A Disclosure — Please Read Carefully
I have read and understand that Deborah Barnhart is not an attorney and cannot give me legal advice.
Page 2 - Filing Type and Eligibility
Your Full Name

First NameMiddle NameLast Name
Your Email Address
example@example.com
Your Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Your Role in This Matter
If Other, Please Explain Your Role
Best Way to Reach You
Who is filing this bankruptcy?
Marital status
Have you lived in Nevada for at least the last 2 years (730 days)?
If no, list every state you lived in during the last 3 years and the dates you lived there
County of residence
Have you filed bankruptcy in the last 8 years?
If yes, provide the district, case number, chapter, and date filed
Have you completed credit counseling within the last 180 days?
You must complete an approved credit counseling course BEFORE your case can be filed, and each spouse needs his or her own certificate. You can take it online. Two approved providers for Nevada: Summit Financial Education — www.summitfe.org or 1-800-780-5965; Springboard Nonprofit (credit.org) — www.bkhelp.org or 1-888-425-3452. Full list: www.justice.gov/ust/credit-counseling-by-district/District-of-Nevada. Save the website and your login: after your case is filed, each of you must also take a second course (debtor education) before you can receive your discharge. Both providers above offer it. Email your certificates to dbarnhart@dpsnnv.com.
Page 3 - Debtor 1 Information
Debtor 1 full legal name

First NameMiddle NameLast Name
Other names used in the last 8 years
Date of birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Social Security Number
Street address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Mailing address different?
Mailing address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Email
example@example.com
Phone number
Please enter a valid phone number.Format: (000) 000-0000.
Driver’s license number and state
Page 4 - Debtor 2 / Spouse Information
Debtor 2 / Spouse Full Legal Name

First NameMiddle NameLast Name
Other Names Used in the Last 8 Years (including maiden names)
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Identification Number
Street Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Mailing Address Different?
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Driver’s License Number
Driver’s License State
Page 5 - Household and Income
Household size
Dependents
Debtor 1 employment status
Employer name
Employer address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Job title
How long employed
Gross pay per paycheck
Pay frequency
Debtor 2 employment status
Debtor 2 employer name
Debtor 2 employer address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Debtor 2 job title
Debtor 2 how long employed
Debtor 2 gross pay per paycheck
Debtor 2 pay frequency
Non-filing spouse monthly gross income
Other monthly income
Total household gross income for the last 6 months
Gross income from tax return, last year
Debtor 1 gross income this year so far (January 1 to today)
Debtor 2 gross income this year so far (January 1 to today)
Debtor 1 gross income last year
Debtor 2 gross income last year
Debtor 1 gross income the year before last
Debtor 2 gross income the year before last
Debtor 1 accrued vacation/PTO your employer would pay out (hours and hourly rate)
Debtor 2 accrued vacation/PTO your employer would pay out (hours and hourly rate)
Any overtime, bonuses, commissions, or back pay owed to you but not yet paid? Who owes it and how much?
Gross income from tax return, year before last
Page 6 - Monthly Expenses
Rent or mortgage (average monthly amount)
Property taxes / HOA (average monthly amount)
Homeowners or renters insurance (average monthly amount)
Electricity and gas (average monthly amount)
Health insurance (average monthly amount)
Life insurance (average monthly amount)
Water, sewer, and trash (average monthly amount)
Phone, internet, and cable (average monthly amount)
Food and groceries (average monthly amount)
Clothing and laundry (average monthly amount)
Medical and dental not covered by insurance (average monthly amount)
Transportation: gas and maintenance (average monthly amount)
Car payments — TOTAL for all vehicles (average monthly amount). You will list each vehicle's payment separately on the property page.
Car insurance (average monthly amount)
Health or life insurance (average monthly amount)
Child care (average monthly amount)
Child support or alimony paid (average monthly amount)
Other monthly expense(s) and description
Page 7 - Property You Own (Assets)
Do you own or are you buying any real estate?
Real estate details (address, estimated value, title holders, amount owed, lender, keep property?)
Do you own any vehicles?
Vehicle details (year, make, model, mileage, estimated value, amount owed, lender, keep vehicle?)
Each Vehicle — answer for every vehicle you own or are paying on
Vehicle 1: year, make, model
Vehicle 1: mileage
Vehicle 1: ONE estimated value in dollars (not a range)
Vehicle 1: whose name is it titled in?
Vehicle 1: lender name and amount owed
Vehicle 1: monthly payment
Vehicle 1: what do you intend to do with it? (your choice — I cannot advise you)
Do you have another vehicle?
Vehicle 2: year, make, model
Vehicle 2: mileage
Vehicle 2: ONE estimated value in dollars (not a range)
Vehicle 2: whose name is it titled in?
Vehicle 2: lender name and amount owed
Vehicle 2: monthly payment
Vehicle 2: what do you intend to do with it? (your choice — I cannot advise you)
Do you have another vehicle?
Vehicle 3: year, make, model
Vehicle 3: mileage
Vehicle 3: ONE estimated value in dollars (not a range)
Vehicle 3: whose name is it titled in?
Vehicle 3: lender name and amount owed
Vehicle 3: monthly payment
Vehicle 3: what do you intend to do with it? (your choice — I cannot advise you)
Rent-to-Own and Financed Items
Do you have any rent-to-own or financed furniture, appliances, or electronics?
For each item: company, item, amount owed, monthly payment, and whether it is a LEASE (you rent it and can return it) or a PAYMENT PLAN (you are buying it), and whether you want to keep it.
Property People Often Forget
Clothing — estimated total value
Your last year's federal tax refund: amount, date received, and how much is still unspent
Your ESTIMATED federal tax refund for this year
Balances in Venmo, Cash App, PayPal, Chime or other apps, gift cards, store credit, or cryptocurrency (name and balance of each)
Money anyone owes you (loans to friends or family, refunds, utility or storage deposits, money owed back from a repossessed vehicle sale)
Any claim you could bring against someone else (car accident damage, unpaid wages, insurance claim, small claims)
Firearms: for each gun, whose name is it in? (Debtor 1, Debtor 2, or Both)
Do you have a safe deposit box or storage unit?
Where?
Do you own any property that is hazardous or needs immediate attention?
Explain
Do you expect to inherit property, or receive life insurance or a settlement, in the next 6 months?
Explain
Equipment or property left over from a closed business (describe and give a value)
Bank accounts details (bank name, account type, current balance; do not include account numbers)
Cash on hand amount
Household goods and furniture estimated value
Electronics estimated value
Jewelry estimated value
Firearms details and estimated value
Collectibles, tools, or sports/hobby equipment details and estimated value
Pets or animals of value details and estimated value
Retirement accounts details (401k, IRA, pension) and balance
Life insurance cash value, stocks/bonds/crypto, expected tax refund, money owed to you, pending claims, inheritance, and business interests
Page 8 - Debts
Important: when providing account details, include only the last 4 digits of any account number.
Secured debts (mortgage, car loans, furniture financing): creditor name, mailing address, amount owed, and property securing the debt
Do you have any priority debts such as back taxes or past-due child support/alimony?
Priority debt details (include creditor name, amount owed, and any relevant account details)
Has Anyone Co-Signed a Debt With You?
If yes, list the co-signer's name, address, and which debt
Do You Have Any Leases or Contracts (apartment lease, car lease, cell phone contract, timeshare)?
If yes, list the company, what it is for, and whether you want to keep it
Unsecured debts (credit cards, medical bills, personal loans, payday loans, collection accounts, judgments, student loans): for EACH debt list creditor name, full mailing address (with street number), last 4 digits of the account, the year the debt started, ONE exact amount owed (not a range — give your best single estimate), and whose debt it is (Debtor 1, Debtor 2, or both)
Any lawsuits, wage garnishments, repossessions, or foreclosures in the last year? If yes, provide details.
Lawsuits against you: for each, the name of the court and the case number (from your papers)
Repossessions: for each, which vehicle or property, the lender, the date, and its value at the time
Has any creditor taken money out of your bank account (setoff) in the last 90 days?
Explain
Page 9 - Financial History
Paid any single creditor more than $600 in the last 90 days?
If yes, provide details
For each item: what it was, who received it, the date, and the amount you received
Repaid or paid money to family members or friends in the last year?
If yes, provide details
Sold, gave away, or transferred property worth more than $600 in the last 2 years?
If yes, provide details
Made gifts or charitable donations over $600 in the last 2 years?
If yes, provide details
Business name
Business address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Date the business started

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Date the business ended (if closed)

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Type of business
EIN, if any (do not enter a Social Security number)
Name of any accountant or bookkeeper
Within the last 10 years, did you transfer any property into a trust that you benefit from?
Explain
Lost property to theft, fire, disaster, or gambling in the last year?
If yes, provide details
Closed any bank accounts in the last year?
If yes, provide details
Owned or operated a business in the last 4 years?
If yes, provide details
Paid anyone to help with debt relief or bankruptcy in the last year?
If yes, provide details
Are you holding property that belongs to someone else?