Bankruptcy Information Form

Bankruptcy Information
Your Basic Information:

All information is STRICTLY confidential
Your Name:*

First NameMiddle NameLast Name
Spouse's Name:

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Spouse's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Your Phone Number*
Spouse's Phone Number
Your Email*
Spouses E-mail
Your Social Security #*
Spouse's SSN
Past addresses for the last three years:
Children Living With You
Do you pay child support for any children who do NOT live with you?
How much child support do you pay every month?

HOUSEHOLD ITEMS

Please list
Living Room
Appliances
Tools
Dining Room
Office
Collector's Items and Hobbies
Kitchen/Laundry Room
Electronics
Bathrooms
Jewelry
Furs/Designer Clothing
Halls, Entryway and Passages
Sports/exercise equip and Miscellaneous
Master Bedroom
Bedroom #2
Bedroom #3
Bedroom #4
Attic
Basement
Garage

Avg Monthly Expenses
Home:

RentMortage
If Mortgage:
Average Principal: $
Average Interest: $
Homeowner's or renter's insurance(if not included above):$
Real Property Taxes: $
Maintenance and repair: $
Health-care costs not paid by insurance: $
Child Care: $
Groceries and household supplies: $
Eating Out: $
Utilities(gas, electric, water, trash): $
Telephone, Cellphone, and e-mail: $
Laundry and cleaning: $
Clothes: $
Education: $
Entertainment, gifts, and vacation: $
Auto Expenses and transportation(Insurance, gas, repairs,bus, etc.): $
Insurance(life,accident, etc.;do not include auto, home, or health insurance): $
Savings and investments: $
Charitable contributions/Tithing: $
Other: $
Amount of expenses paid by others: $
Please list installment payments and debts not listed above.(Please use this format:Paid to, For, Amount, Balance, last payment):
Monthly payments listed in installments(itemize above in box and insert total here): $

Business
Is there a Business Involved?
Business Name:
Type of Business:
Your Title:
Date of Business Acquired:

MonthDayYear
Percent Interest:
Current FMV:
Business Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Real Estate
I/We own real estate
Property Address 1

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Property Address 2

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Names on Title
Names on Title 2
Date of Purchase
Date of Purchase 2
Purchase Price
Purchase Price 2
Fair Market Value
FMV 2
Monthly Payment
Monthly Payment 2
Annual Property Taxes
Annual Property Taxes 2
Dates of refinance
Dates of Refinance 2

Accounts

List ALL financial accounts. Yes, that means PayPal, Venmo, CashApp, and all your crypto.
Checking Accounts
Current Balance
Checking Account 2
Current Balance 2
Checking Account 3
Current Balance 3
Savings Account
Savings Balance
Savings Accounts 2
Savings Balance 2
Brokerage Accounts
Brokerage Balance
Retirement Accounts & Balance
Vehicles

Auto

	Year,Make,Model	Names on Titles	Date Acquired	Fair Market Value	Amount of Loan	Who drives?	Mileage?
Vehicle1
Vehicle2
Vehicle3
Vehicle4

Please list any of the following: Motorcycles, RV's, Trailers, Watercrafts, Airplanes, Precious Metals, Investment Jewelry, Collectibles/Hobbies, Other Assets.
ITEM
Balance and FMV(Fair Market Value)
ITEM
Balance and FMV
ITEM
Balance and FMV
ITEM
Balance and FMV
ITEM
Balance and FMV
ITEM
Balance and FMV
Other

Debts
Credit Cards:
Credit Card Name
Owed?
Credit Card Name
Owed?
Credit Card Name
Owed?
Credit Card Name
Owed?
Credit Card Name
Owed?
Other
Student Loans:
Student Loan Company
Owed?
Student Loan Company
Owed?
Student Loan Company
Owed?

Other Loans:
Loan Name
Owed?
Loan2 Name
Owed?
Loan3 Name
Owed?
Loan4 Name
Owed?
Income Tax Due:
Tax Year
Owed?
Tax Year
Owed?
Tax Year
Owed?