Asset Purchase Agreement Bankruptcy.Doc by ypj88685

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									LAZARD & ASSOCIATES                                 DEBTOR'S DATA                     DATE:_________________________
1-613.567.HELP (4357)
                                                     INTERVIEW                        SIGNING DATE:________________

REFERRED BY: __________________________________      INTERVIEWED BY: ______________

FAMILY NAME: __________________________________     ALL GIVEN NAMES: _____________________________________

PHONE# HOME: __________________________________     WORK: _________________________________________________

PRESENT ADDRESS: Since_________________________     TOWN/CITY                COUNTY           POSTAL CODE

_________________________________________________________________________________________________________________

PREVIOUS ADDRESS: From_________________________ To______________________

_________________________________________________________________________________________________________________

SOCIAL INSURANCE NO: __________________________      DATE OF BIRTH: ________________________________________

MARRIED _______DIVORCED_______SINGLE _______ COMMON-LAW ________WIDOWER _______SEPARATED ________

ALL DEPENDANTS WHO REPLY ON YOU FOR FINANCIAL SUPPORT:

FULL NAMES                   RELATIONSHIP            DATE OF BIRTH           ADDRESS IF DIFFERENT             INCOME

__________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________

NAME OF PRESENT EMPLOYER: _________________________________________________________________________________

SINCE WHEN: ____________________________________     USUAL OCCUPATION: ___________________________________

ADDRESS OF PRESENT EMPLOYER: ______________________________________________________________________________

SELF-EMPLOYED IN LAST 5 YEARS: ______________________________________________________________________________

SPOUSE'S NAME: ________________________________      S.I.N.___________________D.O.B. ___________________________

SPOUSE'S ADDRESS: _____________________________________________________________________________________________

SPOUSE'S EMPLOYER: ___________________________________________________________________________________________

CAUSE OF FINANCIAL PROBLEM: ________________________________________________________________________________

__________________________________________________________________________________________________________________

HAVE YOU BEEN BANKRUPTED BEFORE?             YES ________NO __________WHEN? ________________________________

HAVE YOU FILED A PROPOSAL?                   YES ________NO___________WHEN? _______________________________

ANY OTHER EMPLOYERS FOR CURRENT YEAR?

__________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________




                                                      Pg1 of 6
BUDGET (Monthly)

TAKE HOME PAY-EMPLOYMENT                    ________________________ UIC ______________________          $ ________________

TAKE HOME PAY OF SPOUSE                                                                                  $ ________________

                            ,
ALLOWANCES, PENSION, ALIMONY etc.                                                                        $ _______________

INCOME FROM OTHER SOURCES (Specify) _________________________________________________                    $ ________________

                                                                              TOTAL INCOME               $ ________________


EXPENSES (Monthly Discretionary)                                              EXPENSES (Monthly Non-discretionary)

RENT/MORTGAGE                                         $ _______________       CHILD/SPOUSAL SUPPORT              $ ________________

PROPERTY TAXES                                        $ _______________       CHILD CARE                         $ ________________

HYDRO, PHONE, FUEL                                    $ _______________       MEDICAL / DENTAL                   $ ________________

CABLE                                                 $ _______________       FINES/PENALTIES                    $ ________________

CAR MAINTENANCE                                       $ _______________       Employment Related Expenses        $ ________________

TRANSPORTATION COSTS                                  $ _______________       Debts from Garnishments/           $ ________________
                                                                              Judgements
CAR, LIFE, HOME INSURANCE                             $ _______________
                                                                              TOTAL EXPENSES                     $ ________________
FOOD & MEALS                                          $ _______________

Hygiene Products/Beauty Services                      $ _______________       ASSESSMENT

CLOTHING                                              $ _______________       Required payment per directive     $ ________________

MISCELLANEOUS (specify)                               $ _______________       Amount bankrupt has agreed to pay $ ________________

_________________________________________________________             From: ____________________________________________

OTHER COMMENTS Explain why the required payments are not being made, if applicable.

__________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________

WITHIN THE 12 MONTHS PRIOR TO THE DATE OF THE INTIAL BANKRUPTCY EVENT, HAVE YOU ……………….………

Sold or disposed of any of your assets      ?                                          YES/NO

Made payments in excess of regular payments to a creditor?                             YES/NO

Had any assets seized by any creditor?                                        YES/NO

WITHIN FIVE YEARS PRIOR TO THE DATE OF THE INITIAL BANKRUPTCY EVENT, HAVE YOU …………………………...

Disposed or transferred any real estate?                                      YES/NO

Made any gifts to relatives or others in excess of $500.00?                   YES/NO

Made any arrangements to continue to pay any creditor?                        YES/NO

YES DETAILS: ___________________________________________________________________________________________________

__________________________________________________________________________________________________________________




                                                               Pg 2 of 6
                                                ASSETS
Type of Asset                 Description (be specific)    Exempt     Property   Estimated dollar
                                                             Yes        No       value

1-Cash on hand

2-Furniture

3-Personal Effects

4-Life Insurance Policies,
  RRSP's, etc.

5-Securities

6-Real Estate Properties


                House

                Cottage

                 Land

7-Motorized Vehicle


                 Automobile

                 Motorcycle

                 Snowmobile

                 Other

8-Recreational Equipment

9-Estimated Tax Refund

10-Other Assets




                                                                    TOTAL:   _______




                                               Pg 3 of 6
(Complete or supply invoices, statements, etc. or list)

STATEMENT OF AFFAIRS (LIABILITIES)



Creditor                       Address                    Account No.   Amount    Of         Debit
                                                                        Unsec.    Sec.       Pref.




Details of pledged assets:

__________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________




                                                           Pg 4 of 6
INCOME TAX INFORMATION

NOTE: ALL RETURNS WILL BE FILED ACCORDING TO THE INCOME TAX ACT INCLUDING REPORTING THE
      BANKRUPTS ACTUAL MARITAL STATUS.



LAST YEAR FILED ________________     REFUND ________________           REC'D           YES ________NO _________
                                     OWING ________________            PAID            YES ________NO _________

IF PRIOR YEAR NOT FILED HAS INFORMATION BEEN PROVIDED                  YES ________NO _________


EMPLOYERS AND OTHER INCOME SOURCES SINCE THE LAST RETURN WAS FILED
(IE. EI, SOCIAL ASSISTANCE, WCB, PENSIONS)

NAME                                 FROM    -   TO                    INCOME    -   MONTHLY/WEEKLY

__________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________

ANY RRSP WITHDRAWALS         DATE _________________________ AMOUNT RECEIVED _____________________________

IF SELF-EMPLOYED WILL A STATEMENT OR RECORDS BE PROVIDED                               YES ________NO_________
PERIOD OF SELF-EMPLOYMENT _______________________________

IF FORMERLY OWNED A CORP. ARE FINAL FINANCIALS AVAILABLE                               YES_________NO_________
IF NOT IS THE BANKRUPT OWED MONEY BY THE CORPORATION                                   YES_________NO_________

RENTAL / PROPERTY TAX INFORMATION SINCE THE LAST RETURN WAS FILED
ADDRESS                              LANDLORD                FROM-TO                 RENT/TAXES PAID
__________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________

MARITAL STATUS (PLEASE SPECIFY) __________________________
DATE OF MARRIAGE OR START OF COMMON-LAW RELATIONSHIP _______________________________________________

DATE OF SEPARATION OR DIVORCE                                     _______________________________________________

DID YOU RECEIVE OR PAY ANY CHILD SUPPORT OR ALIMONY?

CHILD SUPPORT REC'D                  _____________________   ALIMONY REC'D _____________________

CHILD SUPPORT PAID           _____________________    ALIMONY PAID      _____________________

DATE OF AGREEMENT/ORDER              _____________________   TAXABLE/DEDUCTIBLE                 YES _________NO_________

CHILD CARE EXPENSES (IF CLAIMABLE)
CAREGIVER                            ADDRESS                 SIN                     AMOUNT PAID
_________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________
DOES THE BANKRUPT HAVE ANY SPECIAL DEDUCTIONS?
(IE. DISABILITY, EMPLOYMENT EXPENSES, RRSP'S, TUITION, MOVING, ETC.)
__________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________




                                                      Pg 5 of 6
OTHER INFORMATION

NAME AND ADDRESS OF BANK                ___________________________________________________________________________________

ACCCOUNT# _________________________________________________            BALANCE _________________________________________

REAL ESTATE            HOUSE, COTTAGE, LAND

                       DATE OF PURCHASE                  __________________________________________________________________

                       TITLE IN NAME OF                  __________________________________________________________________

                       PURCHASE PRICE                    __________________________________________________________________

                       PRESENT VALUE                     __________________________________________________________________


HOUSE INSURANCE
AGENT'S NAME & ADDRESS                                   __________________________________________________________________

                                                         __________________________________________________________________

AMOUNT PAID $ ________________________________           PAID UNTIL _____________________________________________________

OTHER INFORMATION                                                                        YES             NO

1. Have you applied for assistance through credit counseling                             (   )           (    )
    orderly payment of debt, court consolidation, voluntary deposit?
2. Do you expect to receive or have you received an inheritance?                         (   )           (    )
3. Are there any writs, judgements, garnishments, wage assignments                       (   )           (    )
   outstanding against you?
4. Do you have a safety deposit box?                                                     (   )           (    )
5. Does your spouse own any assets?                                                      (   )           (    )
6. Have you any credit cards? Take and list:                                             (   )           (    )
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________

DEBTOR TO BRING WITH HIM/HER ON DATE OF SIGNING


!    Copy of last tax return                             _____________________

!    Vehicle registration & keys                         _____________________

!    Postdated cheques for assessment                    _____________________

!    Stocks, bonds, shares etc.                          _____________________

!    Credit Cards                                        _____________________

!    Pay stubs                                           _____________________

!    Copy of garnishment or writ                         _____________________

!    Title deed & mortgages                              _____________________

!    Guarantee cheques, names & addresses                ____________________

!    Other moveable assets                               List:   __________________________________________________________
                                                                 __________________________________________________________
                                                                 __________________________________________________________

NOTES
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                                                          Pg 6 of 6

								
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