DAVIS LAW FIRM
JOHN PARK DAVIS
BOARD CERTIFIED CONSUMER BANKRUPTCY LAW
www.billkiller.net
TARRANT COUNTY DALLAS COUNTY
1550 N. NORWOOD DRIVE, SUITE 120 P.O. BOX 54861 HURST, TEXAS 76054 (817) 268-8333 Telephone (817) 285-0808 Facsimile
john@johndavislaw.com
5115 N. GALLOWAY AVE #303 MESQUITE, TEXAS 75150 (972) 613-2284 Telephone (972) 613 – 1634 Facsimile
EVERY QUESTION MUST HAVE AN ANSWER OR “N/A” FOR NOT APPLICABLE – Page 1
SPECIAL INSTRUCTIONS FOR THE STAFF OF DAVIS LAW FIRM
Clients:_______________________________________ Date:_____________________
Actual Date of Consultation with John Park Davis:_________________
Postpone filing bankruptcy case for the date of:___________________
Chapter 7 Seven
_______
Retainer Fee Arrangement: ____________________________________ (ALL FEES ARE NON-REFUNDABLE) ____________________________________ ____________________________________ Chapter 13 Thirteen _______ Monthly Trustee payment $ _____________ for #_________ months The cause for filing Bankruptcy: Comments pertaining to the case: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________
(i.e. Loss of Employment, Cut in Income, Over Extended on Credit, Divorce, Medical, etc....)
Expecting any change in any income within six (6) months: ______________________________________________________________________________ ______________________________________________________________________________
EVERY QUESTION MUST HAVE AN ANSWER OR “N/A” FOR NOT APPLICABLE – Page 2
READ THIS VERY IMPORTANT DECLARATION
THE INFORMATION CONTAINED IN THIS QUESTIONNAIRE MAY BE USED TO PREPARE BANKRUPTCY CASE SCHEDULES. IT IS A FEDERAL CRIME TO GIVE FALSE FORMS AND SCHEDULES. I HAVE READ THE FOREGOING AND UNDERSTAND IT. (MUST BE SIGNED PRIOR TO CONSULTATION)
INFORMATION ON BANKRUPTCY
YOU MUST comply with the following: 1) FULLY DISCLOSE ALL ASSETS. nd Resources of all types MUST be listed. 2) FULLY DISCLOSE ALL DEBTS of every type. This includes family loans, and other informal loans, or debts of any kind must be listed. Disputed debts should be listed and so noted.
______________________________ Debtor
Date_____________________
______________________________ Debtor
Date_____________________
EVERY QUESTION MUST HAVE AN ANSWER OR “N/A” FOR NOT APPLICABLE – Page 3
UNDER THE BANKRUPTCY REFORM ACT Each Debtor is required to receive TWO Certificates to obtain a discharge from the U.S. Bankruptcy Court. If you file a Chapter 7 or Chapter 13 bankruptcy case, EACH Debtor is required prior to filing a bankruptcy case to obtain a Credit Counseling Certificate. (BEFORE THE CASE IS FILED) After the bankruptcy case is filed, each Debtor is required to obtain a Personal Financial Management Certificate for the Debtors(s) education course as required under the Reform Act.
CHAPTER 7 DEBTOR(S) Immediately following the filing of your case, PLEASE GET YOUR FINANCIAL EDUCATION COURSE CERTIFICATE. If you fail to get it and file it within 60 days from the time the case is filed, the Court will close your case without issuing a Discharge Order. The Court will require a “Motion to Reopen” after closing your case for failure to file the Certificate. There will be additional attorney’s fees to file the Motion to Reopen your case. **********IMMEDIATELY FOLLOWING THE FILING OF YOUR CASE ************** **********PLEASE GET YOUR FINANCIAL EDUCATION CERTIFICATE************ CHAPTER 13 DEBTOR(S) The Chapter 13 Trustee will provide the Personal Financial Course for FREE. The course will be conducted on the same day as your Meeting of Creditors. The Trustee will give you the Certificate upon completion of the Course. PLEASE forward this Certificate to Mr. Davis, or his staff whomever is attending the Meeting of Creditors that day. A WAGE DIRECTIVE is mandatory. If you’re an employee, then your Chapter 13 payments are to be deducted from your wages. The you and your spouse are filing together, you both can split the Chapter 13 plan payments between you two, or just one, it’s your decision. If your self-employed or an independent contractor, the wage directive may not be applicable to your case. If you owe CHILD SUPPORT, the Court requires you to file a Certificate that states that you have made all amounts that are required to be paid under the domestic support obligation and that you have filed all tax returns for the past 4 years. You may access a list of Credit Counseling Agencies approved by the U.S. Trustee’s office by following the listed weblink: www.usdoj.gov/ust/eo/bapcpa/cc_approved.htm We can refer you to: Consumer Credit Counseling Services of Atlanta Web: www.cccsatl.org Telephone Number: 1-800-251-CCCS (2227) Mr. Davis may give you the Firm’s Code to use after you reimburse the cost to the Firm in order to assist you in paying for the services of CCCS Atlanta.
CHECKLIST OF ITEMS TO BRING WITH YOU FOR BANKRUPTCY CONSULTATION
EVERY QUESTION MUST HAVE AN ANSWER OR “N/A” FOR NOT APPLICABLE – Page 4
1. COPIES of TAX RETURNS for the past two years.
2. COPIES of Proof of Income for ALL of the past (6) six months for the Household. A. Paystubs B. Social Security Deposits C. Bank Statements, if applicable to show deposits made for self-employed or independent contractor work. D. Profit and Loss Statement for your Businesses, or if Self-Employed DO THESE ON A PER MONTH BASIS FOR THE PAST SIX (6) MONTHS. THE FOLLOWING ITEMS MAY BE OF INTEREST TO US. PLEASE BRING THEM IF THEY ARE CURRENTLY AVAILABLE AND APPLICABLE TO YOUR CASE 1. IRS LEVY OR “NOTICE TO LEVY” BY THE INTERNAL REVENUE SERVICE - COPIES
2. MOST RECENT BANK STATEMENTS - COPIES
3. AUTO INSURANCE BINDER(S) PAGE - COPY
4 CONTRACTS OR SECURITY AGREEMENTS ON ANY LOANS - COPIES
For example, INSTALLMENT CONTRACT FOR YOUR CAR(S).
5. IF PAST DUE ON ANY SECURED CREDITORS, BRING ANY “DEMAND LETTERS” TO BECOME CURRENT
6 DOCUMENTS RELATING TO ANY PENDING, OR PAST, LITIGATION, ( LAWSUITS)
7. STUDENT LOAN CONTRACTS OR DEMANDS – COPIES
8. ANY DIVORCE DECREES ENTERED IN LAST TWO YEARS – COPIES
9. ANY DISCHARGE OR DISMISSAL IN PRIOR BANKRUPTCY MATTERS - COPIES PLEASE MAKE A WRTTEN STATEMENT OF ONE HUNDRED (100) WORDS OR LESS EXPLAINING WHY YOU BELEVE BANKRUPTCY IS IN YOUR BEST INTEREST .
EVERY QUESTION MUST HAVE AN ANSWER OR “N/A” FOR NOT APPLICABLE – Page 5
YOU ARE ALSO ENTITLED TO ATTACH THIS STATEMENT TO YOUR CREDIT REPORT. BE AWARE THAT AFTER YOUR RECEIVE THE DISCHARGE ORDER UPON THE COMPLETION OF YOUR BANKRUPCY CASE, PLEASE SEND THE DISCHARGE ORDER TO THE CREDIT REPORTING AGENCIES TO UPDATE YOUR CREDIT REPORT.
______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ _____________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________
HOW DID YOU LEARN ABOUT US __________________
CLIENT QUESTIONNAIRE
EVERY QUESTION MUST HAVE AN ANSWER OR “N/A” FOR NOT APPLICABLE – Page 6
1. PRINT FULL LEGAL NAME Debtor:_____________________________ Spouse:_____________________________
(any other alias names of either debtor or spouse used to obtain credit, list BELOW) (For example: Company or Business name , use of maiden name, previous marriage name) Driver License #’s___________________ DEBTOR (alias name) ____________________________________ Driver License #’s_______________________ SPOUSE/ (alias name) ____________________________________
2. HOME FULL ADDRESS__________________________________________________Apt#_______ City_____________________Zip Code____________ County____________________
3. MAILING ADDRESS:___________________________________________________Apt#________ City_____________________Zip Code____________ County_____________________
4. HOME TELEPHONE NUMBER; (
) ________________________ Answer Machine YES or NO Debtor/CoDebtor
A. CELL PHONE B. CELL PHONE C. E-MAIL B. E-MAIL
(
)____________________
_______________ _______________ _______________ _______________
(______)____________________ ____________________________ ____________________________ DEBTOR
CODEBTOR _________________________ STATE NO. _______________
6. SOCIAL SECURITY NUMBERS: 6A BUSINESS TAX ID NO.
___________________________ FEDERAL NO.______________
7. Have you ever filed BANKRUPTCY? Circle YES OR NO;
Bankr. Case No. _________ Year filed:________ Where: ______________________ Bankr. Case No. _________ Year filed:________ Where: ______________________
CURRENT FINANCIAL STATUS –
PROVIDE ALL INFORMATION FOR THE HOUSEHOLD
EVERY QUESTION MUST HAVE AN ANSWER OR “N/A” FOR NOT APPLICABLE – Page 7
(Please include your Spouse information, even though they MAY NOT file with you) 1. MARITAL STATUS:(ie SINGLE, MARRIED, DIVORCE, SEPARATED)_________________________________
2. LIST DEPENDENTS THAT YOU CAN CLAIM ON YOUR IRS TAX RETURNS AGE _________ _________ _________ _________ ie SON or DAUGHTER ________________________ ________________________ ________________________ ________________________ FOR DAVIS LAW FIRM HOUSEHOLD SIZE _______ MEDIUM INCOME $________________
3. DEBTOR'S OCCUPATION:__________________________ EMPLOYER _________________________ _________________________ _________________________
Work Hours
______ to _______
FULL ADDRESS:
Phone Number to Contact You _________________________
HOW LONG EMPLOYED WITH CURRENT EMPLOYER (YEARS OR MONTHS) __________
4. SPOUSE'S OCCUPATION___________________________
Work Hours
______ to _________
EMPLOYER
_________________________ _________________________ _________________________ Phone Number to Contact You __________________________
FULL ADDRESS:
HOW LONG EMPLOYED WITH CURRENT EMPLOYER (YEARS OR MONTHS) __________
PART TIME EMPLOYMENT (IF APPLICABLE): NAME AND LOCATION __________________________________________
_________________
INCOME CALCULATION
NOTICE
EVERY QUESTION MUST HAVE AN ANSWER OR “N/A” FOR NOT APPLICABLE – Page 8
This is the most important part of the Bankruptcy filing process. Be as accurate as you can. Disclose any and all income that you received. PART I – SIX (6) MONTH AVERAGE INCOME Six (6) month average income (How we deal with your financial problems is largely determined by your six (6) month average household income.) A. EMPLOYEE(S) (W-2 INCOME) (whole dollar amounts, roundup to nearest dollar) Debtor Last Month Gross Income Prior Month Gross Income Prior Month Gross Income Prior Month Gross Income Prior Month Gross Income Prior Month Gross Income __________ __________ __________ __________ __________ __________ Spouse (please include, if not filing) Last Month Gross Income Prior Month Gross Income Prior Month Gross Income Prior Month Gross Income Prior Month Gross Income Prior Month Gross Income ________ ________ ________ ________ ________ ________
B. SELF-EMPLOYED or 1099 Independent Contractor(s) (whole dollar amounts, roundup to nearest dollar) (itemize expenses per month on a separate sheet) Last Month Gross Receipts Prior Month Gross Receipts Prior Month Gross Receipts Prior Month Gross Receipts Prior Month Gross Receipts Prior Month Gross Receipts __________ __________ __________ __________ __________ __________ Last Month Expenses ________ Prior Month Expenses ________ Prior Month Expenses ________ Prior Month Expenses ________ Prior Month Expenses ________ Prior Month Expenses ________
PART II – CURRENT MONTHLY INCOME Calculate your current monthly income and deductions below. If your income varies you may want to try to average your gross income to get an accurate figure.
EVERY QUESTION MUST HAVE AN ANSWER OR “N/A” FOR NOT APPLICABLE – Page 9
For example, if your check is dated 11/30/2007, you would divide the total YTD GROSS by 11 if your check is dated 12/15/2007, you would divide the total YTD GROSS by 11.5.
ALL HOUSEHOLD MONTHLY INCOME
DEBTOR
$__________ CURRENT MONTHLY
SPOUSE
GROSS WAGES
$___________
For example, if your check is dated 11/30/2007, you would divide the total YTD GROSS by 11 if your check is dated 12/15/2007, you would divide the total YTD GROSS by 11.5.
PAYROLL DEDUCTIONS: ___________ ___________ ___________ ___________ ___________ ___________ ____________ Federal Taxes Social Security Medicare Health & Dental Ins. Union Dues Retirement Account (Voluntary ____ or Mandatory _____) Automatic Child Support Deduction ____________ ____________ ____________ ____________ ____________ ____________ ____________
ARE YOU CURRENT WITH YOUR CHILD SUPPORT? THE NEW REFORM ACT STATES WE NEED TO FILE A CERTIFICATE WITH THE COURT STATING THAT YOU ARE.
____________
401k Loan Repayment ____________ (YOU MUST list your 401k provider/management’s full address as a secured creditor ) Life Insurance Long/Short Term Disability ____________ ____________
____________ _____________
_____________
TAKE HOME (NET INCOME)
____________
OTHER INCOME BESIDES EMPLOYMENT
EVERY QUESTION MUST HAVE AN ANSWER OR “N/A” FOR NOT APPLICABLE – Page 10
(Please list other income under “Statement of Financial Affairs” Question No. 2 for annual amount) ______________ ______________ ______________ ______________ ______________ ______________ ______________ Child Support per MONTH Alimony per MONTH Retirement/Pension per MONTH Social Security per MONTH Disability per month Food Card other ____________ ___________ ____________ ____________ ____________ ____________ ____________
_______________
6 MONTH AVERAGE SELF-EMPLOYED INCOME
___________
_____________
TOTAL NET MONTHLY TAKE HOME
________________
ALL HOUSEHOLD MONTHLY EXPENSES PART (1)
EXPENSES SHOULD BE BASED ON A 12-MONTH AVERAGE. RENT, MOBILE HOME, LOT RENT OR HOME MORTGAGE (CIRCLE ONE) $___________ monthly
EVERY QUESTION MUST HAVE AN ANSWER OR “N/A” FOR NOT APPLICABLE – Page 11
ADDITIONAL - Second Mortgage; Home Improvement; or Swimming Pool payment Specify _______________________ Are property taxes included? If not, what is the monthly amount? $____________ monthly $____________ month $____________ month
Is homeowners insurance included? If not, what is the monthly amount? ELECTRICITY WATER PHONE CELL PHONES AND INTERNET COMBINED HOME MAINTENANCE (Repairs, yard, etc) FOOD (GROCERIES FOR THE HOUSEHOLD) HOUSEHOLD SUPPLIES CLOTHING LAUNDRY MEDICAL AND DENTAL EXPENSES. (Not covered by insurance, OUT OF POCKET) TRANSPORTATION (Fuel, tags, inspection, repairs, and tune-ups)
____________ month ____________ month ____________ month ____________ month ____________ month __________ MONTH ___________ month ___________ month ____________ month ____________ month ____________ month ____________ month _____________ month
RECREATION, CLUBS AND ENTERTAINMENT, NEWSPAPERS, CHARITABLE CONTRIBUTION (Must be able to prove/confirm donations) MONTHLY INSURANCE PAYMENTS (not deducted from wages or included in mortgage) Renters' Life Auto Health (omit if payroll deducted) (omit if payroll deducted)
____________ month ____________ month ____________ month ____________ month
INSTALLMENT PAYMENTS OR SECURED DEBTS Monthly payment for AUTO Monthly payment for AUTO #1 #2 Year/Make/Model _____________________________ Year/Make/Model _____________________________ ____________ ____________ _____________ _____________
Monthly payment for Other (furniture) Monthly payment for Other
EVERY QUESTION MUST HAVE AN ANSWER OR “N/A” FOR NOT APPLICABLE – Page 12
TAXES (not deducted from wages or included in mortgage) (Property tax, yearly divide by 12 to get monthly expense, if your responsible for your own payments) Circle PROPERTY or I.R.S. or other ____________________ ALIMONY, Maintenance and Child Support Paid to Others ____________ month ____________ month
ARE YOU CURRENT WITH YOUR CHILD SUPPORT? 11 U.S.C. §1328 (a) - WE NEED TO FILE A CERTIFICATE WITH THE COURT STATING THAT YOU ARE. PAYMENTS for Support of Dependents not Living at Home (ie college) (Explain__________________________________________________________ ____________ month
Regular Expenses from Operations of Business, Profession, Farm (Supply separate; itemized list for Business Income & Expense, Profit & Loss Statement)
____________ monthly
PERSONAL EXPENSES (haircare products, body soap, etc)
_____________ month
ANIMAL CARE (Vet. Care, shots, grooming, etc)
_____________ month
CHILD CARE SERVICES
_____________ month
PUBLIC SCHOOL EXPENSES (supplies, lunches, field trips, etc)
_____________ month
CHRISTMAS AND BIRTHDAYS ALLOWANCES, SPORTS EQUIPMENT & FEES ETC
_____________ month
POOL CLEANING SERVICES NON- FILING SPOUSE monthly debt payments (ITEMIZE A LIST OF CREDITORS) LUNCHES FOR WORK CABLE OR SATELLITE HOME SECURITY SYSTEM NATURAL GAS
_____________ month _____________ month _____________ month ____________ month ____________ month ____________ month _____________
YOU MUST CALCULATE YOUR TOTAL EXPENSES CLASSIFICATION OF DEBTS WHAT ARE SECURED DEBTS
EVERY QUESTION MUST HAVE AN ANSWER OR “N/A” FOR NOT APPLICABLE – Page 13
When an asset has been pledged as collateral for a debt, the debt is considered "SECURED".
1. PURCHASE MONEY LOANS - This is a loan made when you obtain financing to purchase an item. The item becomes the collateral for the loan. Examples: When you borrow money to purchase a new car, the car is the collateral for the loan. When you borrow money to purchase furniture, large appliances, or jewelry, the item purchased is the collateral for the loan. When you borrow money to purchase a house, the house is the collateral for the loan. In a situation like this, it is said that the creditor has a purchase money lien against the collateral.
2. NON-PURCHASE MONEY LOANS - This is a loan made when you put up merchandise that you already own ( usually furniture, appliances or jewelry, etc.) to obtain money from a lending institution. Example: When you use your TV, stereo, or other household items as collateral to obtain a loan.
In a situation like this, it is said that the creditor has a NON-PURCHASE MONEY LIEN against the collateral.
HOW ARE SECURED DEBTS TREATED IN A BANKRUPTCY CHAPTER 7 A. Reaffirm: B. Redeem C. Surrender D. Lien Avoidance (options) Continue making monthly payments for the Collateral(s) Pay the fair market value of the collateral to the Creditor in one lump sum. Give the property back and discharge the debt. Kill the creditors lien against the property. Can be done under some circumstances. (options)
CHAPTER 13
A. Continue to make your payments directly to the Creditor. B. Pay for the fair market value of the collateral through the Chapter 13 plan. C. Give the collateral back and discharge the debt. FAIR MARKET VALUE- "What you could reasonably expect to sell the item for in its current condition today!" WHAT ARE UNSECURED DEBTS
An unsecured debt is a debt which does not have any collateral Examples: Medical bills, signature loans, utility bills, major credit cards charges, department store
EVERY QUESTION MUST HAVE AN ANSWER OR “N/A” FOR NOT APPLICABLE – Page 14
credit card charges ( exceptions; "large ticket items" - refrigerators, TV's, etc) HOW ARE UNSECURED DEBTS TREATED IN A BANKRUPTCY
CHAPTER 7 Discharged (WIPED OUT)
CHAPTER 13 They are paid a percentage ( anywhere from 0% to 100% ) depending on your income and expenses.
WHAT IS A NONDISCHARGEABLE DEBT A nondischargeable debt is the kind that is NOT wiped out by filing bankruptcy.
Examples: Debts involving fraud, child support, employer withholding tax (941 taxes), loan or credit obtained through false information, credit card charge of $1000.00 or more within 60 days of filing bankruptcy for "luxury goods or services", cash advances from a credit card for $1000.00 or more within 60 days of filing bankruptcy, criminal fines or restitution, student loans and recent taxes.
WHAT IS INSOLVENCY
Under the Bankruptcy Code a person is considered to be insolvent if the persons debts are greater than his/her assets.
Under the Bankruptcy Code a person who files bankruptcy is presumed to have been insolvent for a 90 day period before the filing of the bankruptcy. COLLECTION AGENCY
If a collection agency is working for a particular creditor, you should not only list the creditor and its full address but also that of the collection agency in this questionnaire TAX DEBTS
1. FEDERAL
TAXES
YES or NO
DO YOU EXPECT TO RECEIVE A TAX REFUND? Circle HOW MUCH $______________ FOR WHAT YEAR
_____________________
EVERY QUESTION MUST HAVE AN ANSWER OR “N/A” FOR NOT APPLICABLE – Page 15
DO YOU OWE THE I.R.S.? If yes, we need the following information, please.
SOCIAL SECURITY NUMBER (SSN)____________________ and /or BUSINESS TAX I.D. issued by the I.R.S. 75-__________________ KIND OF TAX (EXAMPLE, 1040, 941,940) _________________ __________________ __________________ __________________ YEAR AMOUNT YOU OWE
_________________ _________________ _________________ _________________
__________________ __________________ __________________ __________________
HAS THE I.R.S. FILED A FEDERAL TAX LIEN AGAINST YOU? YES (WE NEED A COPY OF THAT LIEN OR ANY LIEN)
OR
NO
ARE THERE ANY YEARS YOU HAVE NOT FILED YOUR TAXES, If yes, list the YEARS AND JOHN PARK DAVIS MAY ADVISE YOU TO FILE THE LISTED TAX RETURNS TAX RETURN YEAR ___________ TAX RETURN YEAR ___________ TAX RETURN YEAR ___________ ______________________________________________ 2. STATE TAX RETURN YEAR ___________ TAX RETURN YEAR ___________ TAX RETURN YEAR ___________
OR SALES TAXES
If YES,
DO YOU OWE ANY STATE OR SALES TAXES?
please complete the information below:
NAME AND ADDRESS OF THE COLLECTION AGENCY ___________________________________________ ___________________________________________ KIND __________________ __________________ 3. COUNTY, YEAR __________________ __________________ AMOUNT $__________________ $__________________
CITY, AND INDEPENDENT SCHOOL DISTRICT TAXES
YES OR NO YES OR NO
DO YOU OWE ANY COUNTY, CITY, OR IND. SCHOOL DISTRICT TAXES ARE YOUR PROPERTY TAXES IN ESCROW WITH YOUR MORTGAGE COMPANY? (Please provide a full address and account number for the taxing authority)
EVERY QUESTION MUST HAVE AN ANSWER OR “N/A” FOR NOT APPLICABLE – Page 16
IF YOUR IN TARRANT COUNTY, YOU CAN ACCESS THIS WEBSITE TO REVIEW YOUR PROPRETY TAX RECORDS TO SEE WHAT PROPERTY TAXES HAVE BEEN PAID: http://taxoffice.tarrantcounty.com/AccountSearch.asp DO YOU DISPUTE ANY OF THE DEBTS YOU OWE? YEAR __________________ AMOUNT __________________ ____________
YES OR NO
(FOR ATTORNEY USE) (Pay direct or add to Ch 13)
__________________
__________________
____________
(Pay direct or add to Ch 13)
__________________
__________________
____________
(Pay direct or add to Ch 13)
__________________
__________________
____________
(Pay direct or add to Ch 13)
__________________
__________________
____________
(Pay direct or add to Ch 13)
NAME AND FULL ADDRESS OF THE TAX AUTHORITY THAT YOU OWE AND ACCOUNT NUMBER
COUNTY:______________________________________________________________ ______________________________________________________________ ______________________________________________________________ CITY: ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ ISD: ______________________________________________________________ ______________________________________________________________ ______________________________________________________________
SECURED CREDITORS
(HOUSE, Rental Property, Lake Lot, Property Lot, Equity Loans, Pool Loans, Home Improvement Loans)
HOUSE INFORMATION
EVERY QUESTION MUST HAVE AN ANSWER OR “N/A” FOR NOT APPLICABLE – Page 17
************ IF YOU ARE A RENTER DO NOT FILL THIS OUT ************ IF YOUR HOME IS A MOBILE HOME DO NOT FILL THIS OUT BUT LIST IT IN THE SECTION DESIGNATED FOR: SECURED CREDITORS (OTHER DEBTS). DO YOU WANT TO KEEP OR SURRENDER (circle)
THE MORTGAGE OR FINANCE COMPANY NAME FULL ADDRESS ______________________________ (to give them NOTICE) ______________________________ ______________________________
LOAN ACCOUNT NUMBER #
______________________________
WHEN DID YOU INCUR THIS DEBT (month and year) _________________
PAYOFF BALANCE $________________ MONTHLY PAYMENT $___________
TAX APPRAISAL VALUE _______________________ Tarrant County: www.tad.org Dallas County: www.dallascad.org
INTEREST RATE ___________% HOW MUCH ARE YOU BEHIND WITH THE MORTGAGE COMPANY For Attorney’s Use Chapter 13 plan treatment: Arrears $_____________ at ______ % NO APD
$____________ thru ____
How long has the Debtor(s) resided in Texas? 730 DAY DOMICILE RULE (2 YRS) - APPLICABLE STATE LAW 1215 DAY RULE (3.3 YRS) – EXEMPTION CAP $125,000 -
_________ ________ ________
OTHER LIENS ATTACHED TO THE HOMESTEAD;i.e, SECOND HOME, SWIMMING POOL, HOME IMPROVEMENTS, HOME EQUITY LOAN, Etc.
THE SECOND MORTGAGE OR FINANCE COMPANY NAME ______________________________
EVERY QUESTION MUST HAVE AN ANSWER OR “N/A” FOR NOT APPLICABLE – Page 18
FULL ADDRESS
______________________________(to give them NOTICE) ______________________________
LOAN ACCOUNT NUMBER #
______________________________
WHEN DID YOU INCUR THIS DEBT (month and year) _________________ WHAT PURPOSE DID YOU INCUR THIS DEBT FOR? ________________________________________
PAYOFF BALANCE $________________ MONTHLY PAYMENT $______________
TAX APPRAISAL VALUE _______________________ INTEREST RATE ___________%
HOW MUCH ARE YOU BEHIND WITH THE MORTGAGE COMPANY MONTHLY ARREARS: FROM _________ TO ________
$_____________________
Chapter 13 plan treatment:
Arrears $_____________ at ______ %
NO APD
SECURED CREDITORS (DEBTS INVOLVING CARS, TRUCKS, BOATS, MOTORCYCLES, ETC) IF you are behind on your vehicle payment, you MUST NOT inform your vehicle lienholder(s) that you are about to file bankruptcy. If you do, they may repossess your vehicle before you file bankruptcy. INFORMATION ON THE MOTOR VEHICLE FINANCE COMPANY _________________________________________________
EVERY QUESTION MUST HAVE AN ANSWER OR “N/A” FOR NOT APPLICABLE – Page 19
MUST HAVE FULL ADDRESS TO GIVE NOTICE
__________________________________________________ __________________________________________________ ACCOUNT # _______________________
DID YOU USE A “TRADE-IN” TO PURCHASE YOUR CAR? TRADE- IN
(SUPPLY A COPY OF THE CONTRACT)
______________________________AMOUNT $_______________________________
DATE OF PURCHASE PAYOFF BALANCE AVG RETAIL VALUE Monthly Payment VEHICLE YEAR MILEAGE
_______________ (910 RULE) $__________________ $_________________ $____________ _____
MONTHS LEFT TO PAY___________
KEEP OR SURRENDER (CIRCLE) Interest Rate _______% PAYMENTS BEHIND $__________________
_______________ _______________
MAKE___________________ MODEL__________________ (very important) PACKAGE ____________ (XL, XLT, LS, SS, RT, Etc)
1. http://www2.nadaguides.com - PRINT A COP Y FOR OUR RECORDS YOUR REQUIRED TO HAVE FULL COVERAGE AUTO INSURANCE PROVIDE A COPY OF YOUR CURRENT AUTO INSURANCE POLICY OR PAPERWORK THAT LISTS THE COVERAGE AND NOT A COPY OF YOUR INSURANCE CARD. CHAPTER 13 PLAN TREATMENT (FOR ATTORNEY USE) PAY DIRECT ______ INTO THE PLAN $______________________ at ______% (Fixed ) SECURED CREDITORS (DEBTS INVOLVING CARS, TRUCKS, BOATS, MOTORCYCLES, ETC)
IF you are behind on your vehicle payment, you MUST NOT inform your vehicle lienholder(s) that you are about to file bankruptcy. If you do, they may repossess your vehicle before you file bankruptcy. INFORMATION ON THE MOTOR VEHICLE FINANCE COMPANY MUST HAVE FULL ADDRESS _________________________________________________ __________________________________________________
EVERY QUESTION MUST HAVE AN ANSWER OR “N/A” FOR NOT APPLICABLE – Page 20
TO GIVE NOTICE __________________________________________________ ACCOUNT # _______________________ DID YOU USE A “TRADE-IN” TO PURCHASE YOUR CAR? TRADE- IN (SUPPLY A COPY OF THE CONTRACT)
______________________________AMOUNT $_______________________________
DATE OF PURCHASE PAYOFF BALANCE AVG RETAIL VALUE Monthly Payment VEHICLE YEAR MILEAGE
_______________ (910 RULE) $__________________ $_________________ $____________ _____
MONTHS LEFT TO PAY___________
KEEP OR SURRENDER (CIRCLE) Interest Rate _______% PAYMENTS BEHIND $__________________
_______________ _______________
MAKE___________________ MODEL__________________ (very important) PACKAGE ____________ (XL, XLT, LS, SS, RT, Etc)
2. http://www2.nadaguides.com - PRINT A COP Y FOR OUR RECORDS YOUR REQUIRED TO HAVE FULL COVERAGE AUTO INSURANCE PROVIDE A COPY OF YOUR CURRENT AUTO INSURANCE POLICY OR PAPERWORK THAT LISTS THE COVERAGE AND NOT A COPY OF YOUR INSURANCE CARD. CHAPTER 13 PLAN TREATMENT (FOR ATTORNEY USE) PAY DIRECT ______ INTO THE PLAN $______________________ at ______% (Fixed ) SECURED CREDITORS (DEBTS INVOLVING CARS, TRUCKS, BOATS, MOTORCYCLES)
IF you are behind on your vehicle payment, you MUST NOT inform your vehicle lienholder(s) that you are about to file bankruptcy. If you do, they may repossess your vehicle before you file bankruptcy. INFORMATION ON THE MOTOR VEHICLE FINANCE COMPANY MUST HAVE FULL ADDRESS TO GIVE NOTICE _________________________________________________ __________________________________________________
EVERY QUESTION MUST HAVE AN ANSWER OR “N/A” FOR NOT APPLICABLE – Page 21
__________________________________________________ ACCOUNT # _______________________ DID YOU USE A “TRADE-IN” TO PURCHASE YOUR CAR? TRADE- IN (SUPPLY A COPY OF THE CONTRACT)
______________________________AMOUNT $_______________________________
DATE OF PURCHASE PAYOFF BALANCE AVG RETAIL VALUE Monthly Payment VEHICLE YEAR MILEAGE
_______________ (910 RULE) $__________________ $_________________ $____________ _____
MONTHS LEFT TO PAY___________
KEEP OR SURRENDER (CIRCLE) Interest Rate _______% PAYMENTS BEHIND $__________________
_______________ _______________
MAKE___________________ MODEL__________________ (very important) PACKAGE ____________ (XL, XLT, LS, SS, RT, Etc)
3. http://www2.nadaguides.com - PRINT A COP Y FOR OUR RECORDS YOUR REQUIRED TO HAVE FULL COVERAGE AUTO INSURANCE PROVIDE A COPY OF YOUR CURRENT AUTO INSURANCE POLICY OR PAPERWORK THAT LISTS THE COVERAGE AND NOT A COPY OF YOUR INSURANCE CARD. CHAPTER 13 PLAN TREATMENT (FOR ATTORNEY USE) PAY DIRECT ______ INTO THE PLAN $______________________ at ______% (Fixed ) SECURED CREDITORS (DEBTS INVOLVING CARS, TRUCKS, BOATS, MOTORCYCLES)
IF you are behind on your vehicle payment, you MUST NOT inform your vehicle lienholder(s) that you are about to file bankruptcy. If you do, they may repossess your vehicle before you file bankruptcy. INFORMATION ON THE MOTOR VEHICLE FINANCE COMPANY MUST HAVE FULL ADDRESS TO GIVE NOTICE _________________________________________________ __________________________________________________ __________________________________________________
EVERY QUESTION MUST HAVE AN ANSWER OR “N/A” FOR NOT APPLICABLE – Page 22
ACCOUNT # _______________________ DID YOU USE A “TRADE-IN” TO PURCHASE YOUR CAR? TRADE- IN (SUPPLY A COPY OF THE CONTRACT)
______________________________AMOUNT $_______________________________
DATE OF PURCHASE PAYOFF BALANCE AVG RETAIL VALUE Monthly Payment VEHICLE YEAR MILEAGE
_______________ (910 RULE) $__________________ $_________________ $____________ _____
MONTHS LEFT TO PAY___________
KEEP OR SURRENDER (CIRCLE) Interest Rate _______% PAYMENTS BEHIND $__________________
_______________ _______________
MAKE___________________ MODEL__________________ (very important) PACKAGE ____________ (XL, XLT, LS, SS, RT, Etc)
4. http://www2.nadaguides.com - PRINT A COP Y FOR OUR RECORDS YOUR REQUIRED TO HAVE FULL COVERAGE AUTO INSURANCE PROVIDE A COPY OF YOUR CURRENT AUTO INSURANCE POLICY OR PAPERWORK THAT LISTS THE COVERAGE AND NOT A COPY OF YOUR INSURANCE CARD. CHAPTER 13 PLAN TREATMENT (FOR ATTORNEY USE) PAY DIRECT ______ INTO THE PLAN $______________________ at ______% (Fixed )
OTHER SECURED CREDITORS (i.e, Mobile Home) or 401K RETIREMENT REPAYMENT LOANS (401k Provider) (Include loans secured by your Household Items, for example diamond rings, c/d players, dvd, entertainment system used for collateral)
1)
NAME__________________________________________________________________
EVERY QUESTION MUST HAVE AN ANSWER OR “N/A” FOR NOT APPLICABLE – Page 23
ADDRESS______________________________________________________________ CITY_________________________STATE_______________ZIP__________________ ACCT. #______________________MONTHLY PAYMENT$_______________ a. b. c. d. BALANCE REMAINING(PAYOFF) $___________________________ COLLATERAL (OR AMOUNT OF RETIREMENT) _________________________ FAIR MARKET VALUE (TODAY’S VALUE)$___________________________ DO YOU WANT TO KEEP OR SURRENDER____________________
2)
NAME _________________________________________________________________ ADDRESS______________________________________________________________ CITY_________________________STATE_______________ZIP_________________ ACCT #_______________________MONTHLY PAYMENT$________________ a. b. c. d. BALANCE REMAINING(PAYOFF)$____________________________ COLLATERAL (OR AMOUNT OF RETIREMENT) __________________ FAIR MARKET VALUE (TODAY)$___________________________ DO YOU WANT TO KEEP OR SURRENDER_____________________
UNSECURED CREDITORS 1. 2. 3. 4. PLEASE, CALL THE CREDITOR, IF YOU DO NOT KNOW WHAT THE ADDRESS IS LIST the Original Creditor and the Collection Agency separately; both are required. LIST ALL YOUR DEBTS. EVERYONE ADD UP ALL OF THE UNSECURED DEBT $_______________________
Name__________________________________________ Address________________________________________ (FULL address needed for Notification) City_______________________________state_____zip__________ FULL ACCOUNT/REFERENCE #____________________________ BALANCE $_____________
EVERY QUESTION MUST HAVE AN ANSWER OR “N/A” FOR NOT APPLICABLE – Page 24
(roundup to whole dollar) Type of debt OR collecting for -_______________________________ Any charges in the past 90 days if yes, when and _______________________________
Name____________________________________________ Address__________________________________________ City_______________________________state_______zip_________ FULL ACCOUNT/REFERENCE #____________________________ BALANCE $_____________ Type of debt OR collection for - _____________________________ Any charges in the past 90 days if yes, when and _______________________________
Name______________________________________________ Address_____________________________________________ City_______________________________state________zip__________ FULL ACCOUNT/REFERENCE #_____________________________ BALANCE $______________ Type of debt_____________________________ Any charges in the past 90 days if yes, when and _______________________________
UNSECURED CREDITORS
Name__________________________________________ Address________________________________________ (FULL address needed for Notification) City_______________________________state_____zip__________ FULL ACCOUNT/REFERENCE #____________________________ BALANCE $_____________ (roundup to whole dollar) Type of debt OR collecting for -_______________________________
EVERY QUESTION MUST HAVE AN ANSWER OR “N/A” FOR NOT APPLICABLE – Page 25
Any charges in the past 90 days if yes, when and _______________________________
Name____________________________________________ Address__________________________________________ City_______________________________state_______zip_________ FULL ACCOUNT/REFERENCE #____________________________ BALANCE $_____________ Type of debt OR collection for - _____________________________ Any charges in the past 90 days if yes, when and _______________________________
Name______________________________________________ Address_____________________________________________ City_______________________________state________zip__________ FULL ACCOUNT/REFERENCE #_____________________________ BALANCE $______________ Type of debt_____________________________ Any charges in the past 90 days if yes, when and _______________________________
UNSECURED CREDITORS
Name__________________________________________ Address________________________________________ (FULL address needed for Notification) City_______________________________state_____zip__________ FULL ACCOUNT/REFERENCE #____________________________ BALANCE $_____________ (roundup to whole dollar) Type of debt OR collecting for -_______________________________ Any charges in the past 90 days if yes, when and _______________________________
EVERY QUESTION MUST HAVE AN ANSWER OR “N/A” FOR NOT APPLICABLE – Page 26
Name____________________________________________ Address__________________________________________ City_______________________________state_______zip_________ FULL ACCOUNT/REFERENCE #____________________________ BALANCE $_____________ Type of debt OR collection for - _____________________________ Any charges in the past 90 days if yes, when and _______________________________
Name______________________________________________ Address_____________________________________________ City_______________________________state________zip__________ FULL ACCOUNT/REFERENCE #_____________________________ BALANCE $______________ Type of debt_____________________________ Any charges in the past 90 days if yes, when and _______________________________
UNSECURED CREDITORS
Name__________________________________________ Address________________________________________ (FULL address needed for Notification) City_______________________________state_____zip__________ FULL ACCOUNT/REFERENCE #____________________________ BALANCE $_____________ (roundup to whole dollar) Type of debt OR collecting for -_______________________________ Any charges in the past 90 days if yes, when and _______________________________
EVERY QUESTION MUST HAVE AN ANSWER OR “N/A” FOR NOT APPLICABLE – Page 27
Name____________________________________________ Address__________________________________________ City_______________________________state_______zip_________ FULL ACCOUNT/REFERENCE #____________________________ BALANCE $_____________ Type of debt OR collection for - _____________________________ Any charges in the past 90 days if yes, when and _______________________________
Name______________________________________________ Address_____________________________________________ City_______________________________state________zip__________ FULL ACCOUNT/REFERENCE #_____________________________ BALANCE $______________ Type of debt_____________________________ Any charges in the past 90 days if yes, when and _______________________________
UNSECURED CREDITORS (List the Original Creditor and the Collection Agency separately, both are REQUIRED)
Name__________________________________________ Address________________________________________ (FULL address needed for Notification) City_______________________________state_____zip__________ FULL ACCOUNT/REFERENCE #____________________________ BALANCE $_____________ (roundup to whole dollar) Type of debt OR collecting for -_______________________________
EVERY QUESTION MUST HAVE AN ANSWER OR “N/A” FOR NOT APPLICABLE – Page 28
Any charges in the past 90 days if yes, when and _______________________________
Name____________________________________________ Address__________________________________________ City_______________________________state_______zip_________ FULL ACCOUNT/REFERENCE #____________________________ BALANCE $_____________ Type of debt OR collection for - _____________________________ Any charges in the past 90 days if yes, when and _______________________________
Name______________________________________________ Address_____________________________________________ City_______________________________state________zip__________ FULL ACCOUNT/REFERENCE #_____________________________ BALANCE $______________ Type of debt_____________________________ Any charges in the past 90 days if yes, when and _______________________________
UNSECURED CREDITORS (List the Original Creditor and the Collection Agency separately, both are REQUIRED)
Name__________________________________________ Address________________________________________ (FULL address needed for Notification) City_______________________________state_____zip__________ FULL ACCOUNT/REFERENCE #____________________________ BALANCE $_____________ (roundup to whole dollar)
EVERY QUESTION MUST HAVE AN ANSWER OR “N/A” FOR NOT APPLICABLE – Page 29
Type of debt OR collecting for -_______________________________ Any charges in the past 90 days if yes, when and _______________________________
Name____________________________________________ Address__________________________________________ City_______________________________state_______zip_________ FULL ACCOUNT/REFERENCE #____________________________ BALANCE $_____________ Type of debt OR collection for - _____________________________ Any charges in the past 90 days if yes, when and _______________________________
Name______________________________________________ Address_____________________________________________ City_______________________________state________zip__________ FULL ACCOUNT/REFERENCE #_____________________________ BALANCE $______________ Type of debt_____________________________ Any charges in the past 90 days if yes, when and _______________________________
UNSECURED CREDITORS (List the Original Creditor and the Collection Agency separately, both are REQUIRED)
Name__________________________________________ Address________________________________________ (FULL address needed for Notification) City_______________________________state_____zip__________ FULL ACCOUNT/REFERENCE #____________________________ BALANCE $_____________ (roundup to whole dollar) Type of debt OR collecting for -_______________________________
EVERY QUESTION MUST HAVE AN ANSWER OR “N/A” FOR NOT APPLICABLE – Page 30
Any charges in the past 90 days if yes, when and _______________________________
Name____________________________________________ Address__________________________________________ City_______________________________state_______zip_________ FULL ACCOUNT/REFERENCE #____________________________ BALANCE $_____________ Type of debt OR collection for - _____________________________ Any charges in the past 90 days if yes, when and _______________________________
Name______________________________________________ Address_____________________________________________ City_______________________________state________zip__________ FULL ACCOUNT/REFERENCE #_____________________________ BALANCE $______________ Type of debt_____________________________ Any charges in the past 90 days if yes, when and _______________________________
UNSECURED CREDITORS (List the Original Creditor and the Collection Agency separately, both are REQUIRED)
Name__________________________________________ Address________________________________________ (FULL address needed for Notification) City_______________________________state_____zip__________ FULL ACCOUNT/REFERENCE #____________________________ BALANCE $_____________ (roundup to whole dollar)
EVERY QUESTION MUST HAVE AN ANSWER OR “N/A” FOR NOT APPLICABLE – Page 31
Type of debt OR collecting for -_______________________________ Any charges in the past 90 days if yes, when and _______________________________
Name____________________________________________ Address__________________________________________ City_______________________________state_______zip_________ FULL ACCOUNT/REFERENCE #____________________________ BALANCE $_____________ Type of debt OR collection for - _____________________________ Any charges in the past 90 days if yes, when and _______________________________
Name______________________________________________ Address_____________________________________________ City_______________________________state________zip__________ FULL ACCOUNT/REFERENCE #_____________________________ BALANCE $______________ Type of debt_____________________________ Any charges in the past 90 days if yes, when and _______________________________
UNSECURED CREDITORS (List the Original Creditor and the Collection Agency separately, both are REQUIRED)
Name__________________________________________ Address________________________________________ (FULL address needed for Notification) City_______________________________state_____zip__________ FULL ACCOUNT/REFERENCE #____________________________ BALANCE $_____________ (roundup to whole dollar)
EVERY QUESTION MUST HAVE AN ANSWER OR “N/A” FOR NOT APPLICABLE – Page 32
Type of debt OR collecting for -_______________________________ Any charges in the past 90 days if yes, when and _______________________________
Name____________________________________________ Address__________________________________________ City_______________________________state_______zip_________ FULL ACCOUNT/REFERENCE #____________________________ BALANCE $_____________ Type of debt OR collection for - _____________________________ Any charges in the past 90 days if yes, when and _______________________________
Name______________________________________________ Address_____________________________________________ City_______________________________state________zip__________ FULL ACCOUNT/REFERENCE #_____________________________ BALANCE $______________ Type of debt_____________________________ Any charges in the past 90 days if yes, when and _______________________________
UNSECURED CREDITORS (List the Original Creditor and the Collection Agency separately, both are REQUIRED)
Name__________________________________________ Address________________________________________ (FULL address needed for Notification) City_______________________________state_____zip__________ FULL ACCOUNT/REFERENCE #____________________________ BALANCE $_____________ (roundup to whole dollar)
EVERY QUESTION MUST HAVE AN ANSWER OR “N/A” FOR NOT APPLICABLE – Page 33
Type of debt OR collecting for -_______________________________ Any charges in the past 90 days if yes, when and _______________________________
Name____________________________________________ Address__________________________________________ City_______________________________state_______zip_________ FULL ACCOUNT/REFERENCE #____________________________ BALANCE $_____________ Type of debt OR collection for - _____________________________ Any charges in the past 90 days if yes, when and _______________________________
Name______________________________________________ Address_____________________________________________ City_______________________________state________zip__________ FULL ACCOUNT/REFERENCE #_____________________________ BALANCE $______________ Type of debt_____________________________ Any charges in the past 90 days if yes, when and _______________________________
UNSECURED CREDITORS (List the Original Creditor and the Collection Agency separately, both are REQUIRED)
Name__________________________________________ Address________________________________________ (FULL address needed for Notification) City_______________________________state_____zip__________ FULL ACCOUNT/REFERENCE #____________________________ BALANCE $_____________ (roundup to whole dollar)
EVERY QUESTION MUST HAVE AN ANSWER OR “N/A” FOR NOT APPLICABLE – Page 34
Type of debt OR collecting for -_______________________________ Any charges in the past 90 days if yes, when and _______________________________
Name____________________________________________ Address__________________________________________ City_______________________________state_______zip_________ FULL ACCOUNT/REFERENCE #____________________________ BALANCE $_____________ Type of debt OR collection for - _____________________________ Any charges in the past 90 days if yes, when and _______________________________
Name______________________________________________ Address_____________________________________________ City_______________________________state________zip__________ FULL ACCOUNT/REFERENCE #_____________________________ BALANCE $______________ Type of debt_____________________________ Any charges in the past 90 days if yes, when and _______________________________
UNSECURED CREDITORS (List the Original Creditor and the Collection Agency separately, both are REQUIRED)
Name__________________________________________ Address________________________________________ (FULL address needed for Notification) City_______________________________state_____zip__________ FULL ACCOUNT/REFERENCE #____________________________ BALANCE $_____________
EVERY QUESTION MUST HAVE AN ANSWER OR “N/A” FOR NOT APPLICABLE – Page 35
(roundup to whole dollar) Type of debt OR collecting for -_______________________________ Any charges in the past 90 days if yes, when and _______________________________
Name____________________________________________ Address__________________________________________ City_______________________________state_______zip_________ FULL ACCOUNT/REFERENCE #____________________________ BALANCE $_____________ Type of debt OR collection for - _____________________________ Any charges in the past 90 days if yes, when and _______________________________
Name______________________________________________ Address_____________________________________________ City_______________________________state________zip__________ FULL ACCOUNT/REFERENCE #_____________________________ BALANCE $______________ Type of debt_____________________________ Any charges in the past 90 days if yes, when and _______________________________
CAR LEASES, APARTMENT LEASES, Etc.
(Provide a copy of any lease agreements)
(Must have complete address of the Property Management Company or Landlord) 1. APARTMENT COMPLEX OR AUTO LEASE _________________________________ Address__________________________________________________ City_____________________________state________zip__________ Term of the Lease: Month to Month, 6 Month, or 1 year lease
EVERY QUESTION MUST HAVE AN ANSWER OR “N/A” FOR NOT APPLICABLE – Page 36
Date the LEASE started _______________________ Date the LEASE ended ________________ Do you want to keep or reject this lease
2.
APARTMENT COMPLEX OR AUTO LEASE
_________________________________
Address_________________________________________________ City_____________________________state________zip_________ Term of the Lease: Month to Month, 6 Month, or 1 Year Lease Date the LEASE started _______________________ Date the LEASE ended ________________ Do you want to keep or reject this lease
CO-DEBTORS for any of your DEBTS
A co-debtor is a person who is liable on the same debt as you are. In other words, the Co-Debtor SIGNED the same contract as you did and is responsible for the same debt. Please be aware that the Credit Reporting Agencies MAY disclose bankruptcy on the Co-Debtor’s credit report. U.S. BANKRUPTCY LAW REQUIERS CO-DEBTORS TO BE LISTED/DISCLOSED.
Example of a co-debtor are: Ex-Spouse, co-signor, surety, guarantor, etc. If there are any co-debtors on any of your debts (other than your spouse) please list their names as well as the names of the corresponding creditor. You may also included any remarks that you wish.
Name, Address of Creditor MUST HAVE THE NAME, FULL ADDRESS OF THE CO-DEBTOR(S)
EVERY QUESTION MUST HAVE AN ANSWER OR “N/A” FOR NOT APPLICABLE – Page 37
______________________________________ ______________________________________ ______________________________________
____________________________________ ____________________________________ ____________________________________
REAL PROPERTY
(ie. CEMETERY PLOTS, LAKE LOTS) A. OTHER REAL PROPERTY (SPECIFY) Address________________________________________________________________ Physical address, City, State, and Zip Code. Do you wish to KEEP or to SURRENDER your House, or Real Property?
(County Tax Appraisal Value)
Appraisal Value Payoff Balance $_________________ $_________________ HOW MUCH $_______________
Are you behind on any Property Taxes?
EVERY QUESTION MUST HAVE AN ANSWER OR “N/A” FOR NOT APPLICABLE – Page 38
(If you owe property taxes, please list taxing authority as a secured creditor with full address and account number)
B. SECOND REAL PROPERTY (SPECIFY) Address________________________________________________________________ Physical add., City, State, and Zip Code. Do you wish to KEEP or to SURRENDER your other House, or other Real Property? (County Tax Appraisal Value) Appraisal Value Payoff Balance Are you behind on any Property Taxes?
$_____________ $_____________ HOW MUCH $______________
PERSONAL PROPERTY
(IF YOUR SPOUSE IS NOT FILING, YOU STILL HAVE TO LIST ALL PROPERTY IN THE HOUSEHOLD WARNING!!!!!!!!!!!! If you owe money to a financial institution in which you have a checking or savings account, or certificate of deposit, it is advisable that you close your account to that financial institution and withdraw all monies before filing bankruptcy. (For example, Bank of America is your bank, and you have a credit card with Bank of America, they can possibly freeze your account) WELLS FARGO BANK WILL CLOSE YOUR ACCOUNT AS SOON AS THE CASE IS FILED! B. CHECKING OR SAVINGS ACCOUNT, OR SHARES ACCOUNT: (Overdraft Accounts PLEASE list the Bank or Credit Union as an Unsecured Creditor) 1) Name of Bank/Credit Union 2) Type of Account ________________________ ________________________
EVERY QUESTION MUST HAVE AN ANSWER OR “N/A” FOR NOT APPLICABLE – Page 39
Need Average/Current Balance
$___________ Is it OPEN or CLOSED (If CLOSED list in Statement of Financial Affairs Question No. 11) 1) Name of Bank/Credit Union 2) Account Type ________________________ ________________________
Need Average/Current Balance
$___________ Is it OPEN or CLOSED (If CLOSED list in Statement of Financial Affairs Question No. 11) 1) Name of Bank/Credit Union 2) Account Type ________________________ _____________________
Need Average/Current Balance
$___________ Is it OPEN or CLOSED (If CLOSED list in Statement of Financial Affairs Question No. 11) C. SECURITY DEPOSITS - ELECTRICITY, TELEPHONE, APARTMENT, LANDLORD, Etc ________________________ $__________ _______ NOTE: Value of property at what you think you would receive if you sold it at a fair market value D. ALL THE FURNITURE IN YOUR NAME/HOUSEHOLD ( FURNITURE & APPLIANCES) $________________ _______ E BOOKS, PICTURES, AND COLLECTIBLES $_______________________
F. CLOTHING $________________ _______
EVERY QUESTION MUST HAVE AN ANSWER OR “N/A” FOR NOT APPLICABLE – Page 40
G. JEWELRY (Costume and Fine)
$_______________________
H. FIREARMS AND OTHER HOBBY or SPORTS EQUIPMENT $______________________ _
I. LIFE INSURANCE POLICIES (WHOLE OR TERM) NAME ADDRESS POLICY NUMBER
______________________
____________________________________ ____________________________________ _____________________________________
CASH VALUE OR LOAN VALUE $________________ _______
WHOLE LIFE - refers to a policy that pays a lump sum on death or, in some cases, the earlier diagnosis of a critical illness. TERM LIFE - is the original form of life insurance and is considered to be pure insurance protection because it builds no cash value
J. ANNUITIES (PAYABLE AT REGULAR INTERVALS) NAME ADDRESS POLICY NUMBER
$_______________________
____________________________________ ____________________________________ _____________________________________
K. IRA'S, 401K PLANS, ESOP’s, RETIREMEMT PLANS, etc.. Company Name_______________________ (Retirement Loans list Managing Company of the retirement as a Secured Creditor) ACCOUNT NUMBER ___________________________ FULL AMOUNT $___________________
EVERY QUESTION MUST HAVE AN ANSWER OR “N/A” FOR NOT APPLICABLE – Page 41
LOAN AMOUNT $___________________ L. STOCKS AND INTERESTS IN INCORPORATED AND UNINCORPORATED BUSINESSES and PARTNERSHIPS (List on separate sheet your exact interest in any business and what the assets and liabilities of that business are.) __________________________________________________________ ___________________________________________________________
M. GOVERNMENT AND CORPORATE BONDS, OTHER NEGOTIABLE INSTRUMENTS (For Example, U.S. Savings Bonds) How Many ________________ What Amount $_________________
N.
ACCOUNT RECEIVABLES $__________ _______ (Money owed to YOU)
O.
CHILD SUPPORT (that you receive per month) $__________ _______
P.
ANY or PRIOR YEARS TAX REFUNDS OWED TO YOU,
OR EXPECTED TO RECEIVE Have you received a tax refund prior to filing this bankruptcy case? yes Do you still have the funds? or yes $ no or no _
If no, where did the TAX REFUND apply to ?______________________________________________ Do you expect to get a TAX REFUND? _______________________________________________ INHERITANCE (For example, a relative passed away and left you some of their property). ARE YOUR PARENTS DECEASED? If deceased did you or will you receive or inherit ANY property? Yes Yes or or No No
Q. QA..
EVERY QUESTION MUST HAVE AN ANSWER OR “N/A” FOR NOT APPLICABLE – Page 42
(Describe on Letter “S” below) QB. Are you the grantor, trustee, or beneficiary of any trust? Yes or No
QC.
Are you the beneficiary or trustee of any estate?
Yes
or
No
S.
Claims on possible or actual LAWSUITS against anybody. List the attorney handling the claim and the amount you may RECEIVE from the claim. _______________________________________________________________________ _______________________________________________________________________
T. PATENTS, COPYRIGHTS, AND OTHER INTELLECTUAL PROPERTY: Explain
U. LICENSES. FRANCHISES, Etc.. : Explain
V. CARS, TRUCKS, TRAILERS, AND MOTORCYCLES, ETC DO NOT LIST THE SAME VEHICLE AS LISTED UNDER SECURED CREDITOR PORTION FOR MOTOR VEHICLES.
EVERY QUESTION MUST HAVE AN ANSWER OR “N/A” FOR NOT APPLICABLE – Page 43
VEHICLE 1 PAID IN FULL TITLE IN YOUR NAME YEAR____________________________ MAKE___________________________ MODEL__________________________ MILEAGE________________________ FAIR MARKET VALUE $___________ AMOUNT OWED $________________
VEHICLE 2 PAID IN FULL TITLE IN YOUR NAME YEAR_______________________________ MAKE______________________________ MODEL_____________________________ MILEAGE___________________________ FAIR MARKET VALUE$______________ AMOUNT OWED$___________________
VEHICLE 3 PAID IN FULL TITLE IN YOUR NAME YEAR___________________________ MAKE__________________________ MODEL_________________________ MILEAGE_______________________ FAIR MARKET VALUE $__________ AMOUNT OWED $_______________
VEHICLE 4 PAID IN FULL TITLE IN YOUR NAME YEAR_______________________________ MAKE_______________________________ MODEL______________________________ MILEAGE_____________________________ FAIR MARKET VALUE $________________ AMOUNT OWED $__________________
W. BOAT AND MOTORS ( INSURANCE REQUIRED, OR COPY OF BINDERS) ________________________________________________________________________ ________________________________________________________________________
X. AIRCRAFT_________________________________________________________________ Y. OFFICE EQUIPMENT (Please tell us what you have in your possession) $________________ _______ ____ Computer ____ Fax Machine value >>>>> value >>>>>
EVERY QUESTION MUST HAVE AN ANSWER OR “N/A” FOR NOT APPLICABLE – Page 44
____ Printer
value >>>>> $_________________________
AA. MACHINERY AND TOOLS USED IN BUSINESS SPECIFY FORBUSINESS OR PERSONAL _____________________________ _____________________________ _____________________________ BB. INVENTORY FOR YOUR BUSINESS
$________________________
CC. ANIMALS (DOMESTIC PETS) $________________________ (# OF DOGS, OR CATS, and COST OF CARE under Monthly Expenses) (Give a dollar amount for your pet) DD. CROPS (GROWING OR HARVESTED) $_______________________
EE. FARMING EQUIPMENT
$_______________________
FF. FARM SUPPLIES, CHEMICALS, AND FEED
$________________________
GG. OTHER PERSONAL PROPERTY ,OR ANYTHING OF VALUE NOT LISTED MOBILE HOMES ARE LISTED HERE APPRAISAL VALUE $_________________ BALANCE REMAINING $__________ _______
FINANCIAL HISTORY (STATEMENT OF FINANCIAL AFFAIRS)
EVERY QUESTION MUST HAVE AN ANSWER OR “N/A” FOR NOT APPLICABLE – Page 45
1.
HOUSEHOLD GROSS INCOME (PLEASE SUPPLY YOUR SPOUSES INFORMATION EVEN IF SHE/HE IS NOT FILING, OBTAIN FROM TAX RETURNS and/or PAY STUBS. DEBTOR $__________________ EARNED INCOME CURRENT YEAR SPOUSE $____________________
$__________________
Gross Income Previous Year
$____________________
$__________________
Gross Income Prior Year
$____________________
2.
OTHER INCOME BESIDES FROM WORK RECEIVED DURING THE LAST 2 YEARS. (IE Tax Refund, National Guard, Unemployment, and Child Support, or HELP from Relatives, etc...) Debtor $____________ $____________ $____________ Spouse $____________ $____________ $____________ 3. Date _____________________ _____________________ Source of Income _____________________________ _____________________________
______________________ _____________________________ Date Source of Income
______________________ _____________________________ ______________________ _____________________________ ______________________ ______________________________
LIST ANY PAYMENTS MADE TO A SINGLE CREDITOR ACCOUNT TOTALING MORE THAN $600.00 WITHIN 90 DAYS BEFORE FILING BANKRUPTCY. Amounts Dates To Whom ______________________ ______________________ ________ _______ _____________________________ _____________________________
EVERY QUESTION MUST HAVE AN ANSWER OR “N/A” FOR NOT APPLICABLE – Page 46
3B.
LIST ANY PAYMENTS MADE WITHIN THE LAST YEAR TO OR FOR THE BENEFIT OF CREDITORS WHO ARE OR WERE INSIDERS (relatives, general partners, partnerships, corporations in which you have any interest) How Much ________________________ ________________________ When ______________________ ______________________
To Whom _________________ _________________ 4A.
WITHIN ONE YEAR LIST ANY LAWSUITS THAT YOU WERE PART OF, EITHER AS A PLAINTIFF OR DEFENDANT.(Include divorce & domestic relations cases) Parties Case No. Reason Attorney’s Disposition/Result
Cause No. ___________ ___________
______v ___________ ______ v. __________
__________ ________________ Pending/Judgment __________ _________________ Pending/Judgement
4B.
HAS ANY OF YOUR PROPERTY BEEN SEIZED, GARNISHED, OR ATTACHED UNDER ANY LEGAL OR EQUITABLE PROCESS DURING THE LAST YEAR. When Description of Property
5.
HAS ANY PROPERTY BEEN REPOSSESSED, OR FORECLOSED, TAKEN FROM YOUR POSSESSION, DURING THE LAST YEAR. Creditor ________ ________ Date of Repossession __________________ __________________ Description of property ____________________________________ ____________________________________
6A.
LIST ANY ASSIGNMENT OF PROPERTY, GAVE UP ANY OF YOUR PERSONAL PROPERTY TO SATISFY A DEBT WITH SOMEONE WITHIN 120 DAYS OF THIS DATE.
6B.
LIST ALL PROPERTY WHICH HAS BEEN IN THE HANDS OF A CUSTODIAN, RECEIVER, OR COURT-APPOINTED OFFICIAL WITHIN THE LAST YEAR.
EVERY QUESTION MUST HAVE AN ANSWER OR “N/A” FOR NOT APPLICABLE – Page 47
7. LIST ANY CHARITABLE CONTRIBUTIONS YOU HAVE MADE WITHIN ONE YEAR AGGREGATING MORE THAN $100.00. (Church tithes, Mission, or Shelter Contributions) To Whom _____________ _____________ 8. What Amount ___________________ ___________________ Description or Value; $$$ ____________________ _____________________
LIST ALL PROPERTY LOSSES FROM FIRE, THEFT, OTHER CASUALTY OR GAMBLING WITHIN THE LAST YEAR. (For Example, Car Stolen, House Flooded) Description/Value of Property _________________________ __________________________ Circumstances ___________________ ___________________ Date of Loss _____________________ _____________________
9.
LIST ALL PAYMENTS MADE OR PROPERTY TRANSFERRED BY OR ON BEHALF OF THE DEBTOR TO ANY PERSON FOR DEBT RELIEF OR BANKRUPTCY OR DEBT CONSOLIDATION DURING THE LAST YEAR. (Consumer Credit Counseling payments) Description ____________ ____________ Date of Payment(s) ___________________ ___________________ Amount of Money _____________________ _____________________
10.
LIST ANY AND ALL ASSETS SOLD OR TRANSFERRED EITHER ABSOLUTELY OR AS SECURITY WITHIN THE PAST TWO (2) YEARS. (Sold a car, pawned your jewelry,etc) Name Sold/Transferred Property to ______________________________ ______________________________ Date Sold/Transferred ________________ ________________ Description of Property ______________________ ______________________
11.
LIST ALL FINANCIAL ACCOUNTS AND INSTRUMENTS HELD IN THE NAME OF THE DEBTOR.(CHECKING AND SAVINGS ACCTS, CERT. OF DEPOSITS, SHARE ACCTS. HELD IN BANKS, CREDIT UNIONS, ETC....) WHICH WERE CLOSED OR TRANSFERED DURING THE LAST YEAR. Dates CLOSED What Kind of ACCT. Balance remaining.
What BANK
EVERY QUESTION MUST HAVE AN ANSWER OR “N/A” FOR NOT APPLICABLE – Page 48
______________ ______________
_______________ _______________
___________________ ___________________
___________________ ___________________
12.
LIST ANY SAFE DEPOSIT BOXES OR DEPOSITORY IN WHICH DEBTOR HAS HAD IN THE LAST YEAR. Name of the Bank _______________ Address of the Bank ___________________ Description of the Contents ___________________________________
13.
LIST ALL SETOFF MADE BY ANY CREDITOR, INCLUDING A BANK, AGAINST A DEBT OR DEPOSIT OF THE DEBTOR WITHIN 90 DAYS PRECEDING THE FILING OF THIS CASE. (For Example, I.R.S. took your Tax Refund and subtracted it from the amount you owe from a previous tax liability) Name of the Creditor ___________________ ___________________ Date the Funds were taken __________________________ __________________________ Amount of Funds Taken _______________________ _______________________
14.
LIST ANY PROPERTY YOU HAVE IN YOUR POSSESSION THAT DOES NOT ACTUALLY BELONG TO YOU. (Example, driving a friends or relatives car.) Name/Address of Owner _____________________ _____________________ Description/Value of Property _____________________________ _____________________________ Location of Prop _________________ _________________
15.
IF YOU HAVE NOT LIVED IN THE SAME PLACE FOR THREE (3) YEARS, PLEASE LIST THE ADDRESSE(S) BELOW WHERE YOU HAVE PREVIOUSLY LIVED AT. Address __________________ Name Used ___________________ Date of Occupancy ___________________________
EVERY QUESTION MUST HAVE AN ANSWER OR “N/A” FOR NOT APPLICABLE – Page 49
__________________
____________________
___________________________
16.
If the debtor resides or resided in a community property state TEXAS, within the six-year period immediately preceding the commencement of the case, identify the name of the debtor's spouse and of any former spouse who resides or resided with the debtor in the community property state. Name _________________________ DIVORCE DATE: ______________ (of Former Spouse)
REQUIRED INFORMATION ABOUT A BUSINESS OWNED BY THE DEBTOR(S)
18. NATURE, LOCATION AND NAME OF BUSINESS 1 DEBTOR IS AN INDIVIDUAL: BUSINESS NAME (D/B/A)
_____________________________
EVERY QUESTION MUST HAVE AN ANSWER OR “N/A” FOR NOT APPLICABLE – Page 50
Nature of Business Begin to End Dates 2. 3. 19. PARTNERSHIP: CORPORATION:
_____________________________ _____________________________
BOOKS, RECORDS AND FINANCIAL STATEMENTS 1. BOOKKEEPERS AND ACCOUNTS FOR THE LAST SIX YEARS
2.
FIRMS OR INDIVIDUALS WHO HAVE AUDITED THE RECORDS PREVIOUS TWO YEARS
3.
THOSE WHO HAVE POSSESSION OF ACCOUNTS AND RECORDS OF THE DEBTOR
4. 20
FINANCIAL STATEMENT ISSUED TO INSTITUTIONS, CREDITORS, OTHERS
INVENTORIES
21
PARTNERS, OFFICERS, DIRECTORS AND SHAREHOLDERS
22
FORMER PARTNERS, OFFICERS, DIRECTORS AND SHAREHOLDERS
23
WITHDRAWALS FROM PARTNERSHIP OR DISTRIBUTION BY A CORPORATION
EVERY QUESTION MUST HAVE AN ANSWER OR “N/A” FOR NOT APPLICABLE – Page 51