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					                        LAW OFFICE OF CHRISTOPHER D. ANDERSON
                            A Professional Limited Liability Company
                              9500 Roosevelt Way N.E., Suite 300D
                                   Seattle, Washington 98115
                                         (206) 528-7900


   This Law Office is certified by the Federal Government as a Debt Relief Agency and is authorized
                    to file bankruptcy cases in the United States Bankruptcy Court.


                                BANKRUPTCY QUESTIONNAIRE

                                      Preliminary instructions

1. You must sign a fee agreement and comply with your payment obligation in the fee agreement
before the attorney has any obligation to do any work on your case.

2. Provide ANY AND ALL CORRECT INFORMATION asked in the questionnaire.
OMITTING OR INCORRECTLY ANSWERING A QUESTION WILL NOT ASSIST YOU IN
OBTAINING BANKRUPCTY RELIEF. Failing to answer correctly will also complicate your
bankruptcy case and may cause a delay.

3. After you complete this questionnaire, please make an appointment with my office to review
your work and make your payment as agreed.

4. Before you leave your appointment with me, make another appointment to come in to sign the
completed paperwork. YOU WILL NOT HAVE ANY BANKRUPTCY PROTECTION UNTIL
YOUR CASE IS FILED! You will have to sign the final documents and pay your fees before I can
file your case.

5. If you are paying just before filing, pay in cash, money order or cashier's check. If you pay by
check, we have to wait until your check clears before we can file.




                                                 1
     This Law Office is certified by the Federal Government as a Debt Relief Agency and is
           authorized to file bankruptcy cases in the United States Bankruptcy Court.
A. GENERAL INFORMATION: If you are planning on filing bankruptcy with your spouse, provide
the requested information for both you and your spouse.

                                                CLIENT                                 SPOUSE

1. Full name (first, middle, last):


2. All other names you have used in the last 6 years:
   (Include married, maiden and trade names)


3. Street address (street, city, state, zip):


4. Mailing address if different from street address:


5. County of residence:
   a.     When did you move into your present residence?
   b.     When did you move into your previous residence?
   c.     State of previous residence?

6. Social security number:


7. Occupation:


8. Name of employer:


9. Employer's address:


10. Beginning date of employment:


11. Name, ages and relationship to you of your dependents:



12. Have you filed bankruptcy in the last 6 years? If so, provide the location, case number and date filed.


13. List all pending bankruptcies filed by any spouse, partner or affiliate, providing location, case number
    and date filed.




                                                  2
      This Law Office is certified by the Federal Government as a Debt Relief Agency and is
            authorized to file bankruptcy cases in the United States Bankruptcy Court.
14. Marital status (circle appropriate):   single      married divorced   separated   widowed

15. List all members of your household (of any age):




                                                  3
      This Law Office is certified by the Federal Government as a Debt Relief Agency and is
            authorized to file bankruptcy cases in the United States Bankruptcy Court.
B. ASSET INFORMATION

INSTRUCTIONS: Check each item of property that you own, possess or which is held for you by
someone else. LIST ALL OF YOUR ASSETS. In all likelihood, you will retain most if not all of your
assets after the bankruptcy. Do not jeopardize your discharge by omitting anything.

           5.      Give the garage sale value (not purchase price or replacement price) for the following
                   types of items:

                    X      Value           Item

                   _____ $__________       Books, pictures, art objects, collections, etc. (Please
                                           identify, e.g. stamp collection, family pictures, etc.)

                   _____ $__________       Clothing (usually not more than $250)

                   _____ $__________       Furs and jewelry (This pertains only to real jewelry, not
                                           costume jewelry; identify any piece of fur or jewelry worth
                                           more than $500)

                   _____ $__________       Firearms, sports, and other hobby equipment
                                           Please identify:



                   _____ $__________       Office equipment, furnishings, and supplies

                   _____ $__________       Household goods and furnishings, etc. (List this as
                                           "household goods and furnishings - only items worth more
                                           than $450 need to be listed separated, e.g. 50" TV, antique
                                           china hutch, etc.)

           6.      Give the fair market value for the following items:

                   ____    $__________     Fair market value (FMV) of autos, trucks, trailers and other
                                           vehicles.

                   _______________________________________________
                   Make Model Year Amount Owed            Monthly Payment
                   NOTE: Remember to list this creditor the debt information section, Section D.

                   _______________________________________________
                   Make Model Year Amount Owed            Monthly Payment
                   NOTE: Remember to list this creditor the debt information section, Section D.

                   ____    $__________     FMV of autos, trucks, trailers and other vehicles.

                                  ________________________________
                   Make Model Year Amount Owed    Monthly Payment


                                                 4
     This Law Office is certified by the Federal Government as a Debt Relief Agency and is
           authorized to file bankruptcy cases in the United States Bankruptcy Court.
             Are you leasing a vehicle?       If yes, please provide:

                     ________________________________
             Make Model Year Amount Owed    Monthly Payment

             Leasing Company:
             Address of leasing company:
             Date lease started:

             _____ $__________       Boats, motors, and accessories

             _____ $__________       Aircraft and accessories

     7.      Provide actual value for the following items:

             _____ $__________       Cash on hand

             _____ $__________       Checking or savings accounts, certificates of deposits, etc.
                                     (Please give name of bank, address, type of account, and
                                     amount in the account)

             _____ $__________       Security deposits. (Please identify who is holding the
                                     security deposit, e.g. landlord, utility company, etc.)

             _____ $__________       Interests in insurance policies

             _____ $__________       Annuities

             _____ $__________       Interests in IRA, ERISA, VIP, and Keogh plans, etc.
                                     (Identify each type of plan, e.g. Boeing VIP account, 401(k),
                                     etc.)

             _____ $__________       Stock, interests in incorporated and unincorporated
                                     businesses (list the number of shares of each stock)

             _____ $__________       Interests in partnerships or joint ventures

             _____ $__________       Government, corporate, negotiable, and non-negotiable
                                     instruments

             _____ $__________       Accounts receivable

             _____ $__________       Alimony, maintenance, support payments to which you are
                                     or may be entitled

             _____ $__________       Other liquidated debts owing debtor

             _____ $__________       Equitable, future, or life estates, etc.

             _____ $__________       Contingent and noncontingent interests in the estate of a

                                            5
This Law Office is certified by the Federal Government as a Debt Relief Agency and is
      authorized to file bankruptcy cases in the United States Bankruptcy Court.
                                   decedent.

             _____ $__________     Personal injury or other contingent and unliquidated claims
                                   of every nature. Also provide the name of the attorney
                                   handling the case.

             _____ $__________     Patents, copyrights, and other intellectual property

             _____ $__________     Licenses, franchises, and other general intangibles

             _____ $__________     Machinery, fixtures, equipment, and other business
                                   supplies

             _____ $__________     Inventory

             _____ $__________     Animals (only include if used as breeding stock, or has a
                                   value in excess of $250. If so, identify)

             _____ $__________     Crops - growing or harvested

             _____ $__________     Farming equipment and implements

             _____ $__________     Farm supplies, chemicals, and feed

             _____ $__________     Tax refunds or other refunds owed to you (If yes,
                                   identify)

             _____ $__________     Other property interests of any kind, including any
                                   inheritances you expect (inheritance within 6months
                                   after your case is filed will be considered as if it
                                   were your property at the time of filing your
                                   bankruptcy.




                                            6
This Law Office is certified by the Federal Government as a Debt Relief Agency and is
      authorized to file bankruptcy cases in the United States Bankruptcy Court.
C. REAL ESTATE INFORMATION

    1.      Do you own (or are purchasing) your current residence?

    2.      Legal description:




    3.      Complete Address of your home:




Circle person who owns it          Debtor      Spouse       Joint      Community

Is there a co-debtor?                                 If so, provide name and address:


Fair market value of property $                                Method of valuation:

Date of Valuation:                                             Date of original purchase:

Purchase Price:                                                Do you wish to keep?



List the creditors who have liens, judgments, or other security interests such as mortgages, deeds of trust,
or contracts against the property. Please provide name, address, amount owed to them, and monthly
payment amount (if any). Also indicate how many months you are past due on payments (if any).




                                                  7
      This Law Office is certified by the Federal Government as a Debt Relief Agency and is
            authorized to file bankruptcy cases in the United States Bankruptcy Court.
                                        MOBILE HOMES


Do you own a Mobile Home that is not attached to land that you own:

Yes:             No:

If “No”, the move on to next Real Estate subsection: “Timeshares”.

Make:                                     Model:

Year:                           Length:

Single Wide:                    Double Wide:

Condition: (Excellent, Good, or Fair)

Poor:

Year purchased:                           Purchase Price: $

Market Value: $

Location if other than your residential address:



Name of Lender:

Address:



Amount owed: $                            Monthly Payment: $

Interest Rate:          %                 Months behind, if any:



Space Rent: $                   Months behind, if any:

Month-to-month:                           Lease:

                                          If Lease, how long remaining




                                            8
This Law Office is certified by the Federal Government as a Debt Relief Agency and is
      authorized to file bankruptcy cases in the United States Bankruptcy Court.
                                         TIMESHARES

Do you own a time share or vacation points club membership: Yes:         No:

If “No”, then please move on to the next section (Other Real Estate).

If “Yes”, then please provide the following information:

Name of Company/Resort/Club:

Address of Company/Resort/Club:



When did you purchase the Timeshare/Membership)?

Is it owned free and clear: Yes:         No:

If “No”, then how much remains owing: $                    Monthly Payment: $

If “No”, how many months behind?

If “No”, do you wish to keep? Yes:               No:

What is the annual fee, if any: $

How much could you sell the timeshare/membership for? $



DO YOU OWN ANY OTHER TIMESHARES OR VACATION CLUB MEMBERSHIPS?

YES:                    NO:


    IF “YES”, PLEASE PROVIDE DETAILS ON SEPARATE PAPER FOLLOWING THE
                  OUTLINE OF THE QUESTIONS LISTED ABOVE.




                                             9
 This Law Office is certified by the Federal Government as a Debt Relief Agency and is
       authorized to file bankruptcy cases in the United States Bankruptcy Court.
D. DEBT INFORMATION. The most important part of the bankruptcy filing for the debtors' peace of
mind is to list all of their creditors and to provide full and complete addresses for each one. You are
required to complete the names and addresses of all your creditors as well as the names and addresses of
anyone else who should get notice (i.e. a collection agency). You are better off if you provide more
addresses for the creditors than if you do not give enough, since creditors are only able to know about
your filing through the addresses that you provide. A debt cannot be effectively discharged unless the
creditor is notified. Also, for a secured debt, such as a house mortgage or car loan, please provide the
total amount owed, the monthly payment amount, and the interest rate.

It is mandatory that you include ALL of your creditors! No matter how much this is stressed by this
office, it is common for clients to believe that this requirement does not apply to a given creditor. You
may leave some creditors off if those creditors do not consider the obligation owed any longer, as with
family members who are treating the debt as a gift. Client will often fail to include tax debt, student
loans, criminal or civil penalties, debts that have not been pursued by a creditor, car loans, and any
number of other types of debts. There are criminal penalties for debtors who intentionally do not disclose
all of their creditors. Please fill out the information on every creditor and if you have reasons not to
include them in your bankruptcy, then you can discuss those reasons with the attorney.

Current obligations do not need to be included in your list of creditors (for example, a phone bill where all
that is owed is the current month and which you intend to pay). If you have a question about whether or
not to include a particular bill, please discuss it with us.

If you have more creditors than we have provided space for, simply use your own paper and complete the
information requested.

If you and your spouse are filing for bankruptcy, please provide your spouse’s information on a separate
sheet.

1. Creditor name and address:




Amount owed _____________ Date incurred _______________________________

Account number _______________________

Consideration (what is the debt for) ___________________________________

Assignee (name and address of any attorney, collection agency or another who may have an interest in
this claim)




2. Creditor name and address:




                                                 10
      This Law Office is certified by the Federal Government as a Debt Relief Agency and is
            authorized to file bankruptcy cases in the United States Bankruptcy Court.
Amount owed _____________ Date incurred _______________________________

Account number _______________________

Consideration (what is the debt for) ___________________________________

Assignee (name and address of any attorney, collection agency or another who may have an interest in
this claim)



3. Creditor name and address:




Amount owed _____________ Date incurred _______________________________

Account number _______________________

Consideration (what is the debt for) ___________________________________

Assignee (name and address of any attorney, collection agency or another who may have an interest in
this claim)



4. Creditor name and address:




Amount owed _____________ Date incurred _______________________________

Account number _______________________

Consideration (what is the debt for) ___________________________________

Assignee (name and address of any attorney, collection agency or another who may have an interest in
this claim)



5. Creditor name and address:




Amount owed _____________ Date incurred _______________________________


                                                11
     This Law Office is certified by the Federal Government as a Debt Relief Agency and is
           authorized to file bankruptcy cases in the United States Bankruptcy Court.
Account number _______________________

Consideration (what is the debt for) ___________________________________

Assignee (name and address of any attorney, collection agency or another who may have an interest in
this claim)




6. Creditor name and address:




Amount owed _____________       Date incurred _______________________________

Account number _______________________

Consideration (what is the debt for) ___________________________________

Assignee (name and address of any attorney, collection agency or another who may have an interest in
this claim)




7. Creditor name and address:




Amount owed _____________ Date incurred _______________________________

Account number _______________________

Consideration (what is the debt for) ___________________________________

Assignee (name and address of any attorney, collection agency or another who may have an interest in
this claim)




8. Creditor name and address:




Amount owed _____________ Date incurred _______________________________

                                                12
     This Law Office is certified by the Federal Government as a Debt Relief Agency and is
           authorized to file bankruptcy cases in the United States Bankruptcy Court.
Account number _______________________

Consideration (what is the debt for) ___________________________________

Assignee (name and address of any attorney, collection agency or another who may have an interest in
this claim)




9. Creditor name and address:




Amount owed _____________ Date incurred _______________________________

Account number _______________________

Consideration (what is the debt for) ___________________________________

Assignee (name and address of any attorney, collection agency or another who may have an interest in
this claim)




10. Creditor name and address:




Amount owed _____________ Date incurred _______________________________

Account number _______________________

Consideration (what is the debt for) ___________________________________

Assignee (name and address of any attorney, collection agency or another who may have an interest in
this claim)




11. Creditor name and address:




                                                13
     This Law Office is certified by the Federal Government as a Debt Relief Agency and is
           authorized to file bankruptcy cases in the United States Bankruptcy Court.
Amount owed _____________ Date incurred _______________________________

Account number _______________________

Consideration (what is the debt for) ___________________________________

Assignee (name and address of any attorney, collection agency or another who may have an interest in
this claim)




12. Creditor name and address:




Amount owed _____________ Date incurred _______________________________

Account number _______________________

Consideration (what is the debt for) ___________________________________

Assignee (name and address of any attorney, collection agency or another who may have an interest in
this claim)



13. Creditor name and address:




Amount owed _____________ Date incurred _______________________________

Account number _______________________

Consideration (what is the debt for) ___________________________________

Assignee (name and address of any attorney, collection agency or another who may have an interest in
this claim)




14. Creditor name and address:

                                                14
     This Law Office is certified by the Federal Government as a Debt Relief Agency and is
           authorized to file bankruptcy cases in the United States Bankruptcy Court.
Amount owed _____________ Date incurred _______________________________

Account number _______________________

Consideration (what is the debt for) ___________________________________

Assignee (name and address of any attorney, collection agency or another who may have an interest in
this claim)




15. Creditor name and address:




Amount owed _____________ Date incurred _______________________________

Account number _______________________

Consideration (what is the debt for) ___________________________________

Assignee (name and address of any attorney, collection agency or another who may have an interest in
this claim)




16. Creditor name and address:




Amount owed _____________ Date incurred _______________________________

Account number _______________________

Consideration (what is the debt for) ___________________________________

Assignee (name and address of any attorney, collection agency or another who may have an interest in
this claim)




                                                15
     This Law Office is certified by the Federal Government as a Debt Relief Agency and is
           authorized to file bankruptcy cases in the United States Bankruptcy Court.
17. Creditor name and address:




Amount owed _____________ Date incurred _______________________________

Account number _______________________

Consideration (what is the debt for) ___________________________________

Assignee (name and address of any attorney, collection agency or another who may have an interest in
this claim)




18. Creditor name and address:




Amount owed _____________ Date incurred _______________________________

Account number _______________________

Consideration (what is the debt for) ___________________________________

Assignee (name and address of any attorney, collection agency or another who may have an interest in
this claim)




19. Creditor name and address:




Amount owed _____________ Date incurred _______________________________

Account number _______________________

Consideration (what is the debt for) ___________________________________

Assignee (name and address of any attorney, collection agency or another who may have an interest in
this claim)




                                                16
     This Law Office is certified by the Federal Government as a Debt Relief Agency and is
           authorized to file bankruptcy cases in the United States Bankruptcy Court.
20. Creditor name and address:




Amount owed _____________ Date incurred _______________________________

Account number _______________________

Consideration (what is the debt for) ___________________________________

Assignee (name and address of any attorney, collection agency or another who may have an interest in
this claim)




                                                17
     This Law Office is certified by the Federal Government as a Debt Relief Agency and is
           authorized to file bankruptcy cases in the United States Bankruptcy Court.
E. EXECUTORY CONTRACTS. These are contracts such as leases, time shares, real estate contracts,
   etc. for which either or both parties to the contract have not yet fully performed their obligations
   under the contract. In all likelihood, you should list these parties as creditors too. If so, provide:

    Name, address and a brief description:




                                                18
     This Law Office is certified by the Federal Government as a Debt Relief Agency and is
           authorized to file bankruptcy cases in the United States Bankruptcy Court.
F. CODEBTORS. If anyone other than you (and your spouse if this is a joint filing) is responsible for
any of your debts, please provide that person's name, address and creditor to whom s/he may be liable.
For most people, a codebtor is just someone who cosigned a loan. However, partners, spouses and others
who are not part of your petition may be liable on many of your debts without actually cosigning
anything.




                                                19
     This Law Office is certified by the Federal Government as a Debt Relief Agency and is
           authorized to file bankruptcy cases in the United States Bankruptcy Court.
G. INCOME INFORMATION. If you are employed, attach a typical pay stub for the last 3 months. If
your income varies, attach several representative pay stubs that show the range of your pay. If you are
self-employed, attach a financial statement showing your monthly income.

Are you paid:   Monthly (once per month)      Semi-Monthly (twice a month, e.g.1st and
                                              15th)
                Bi-weekly (every 2 weeks)     Weekly

Income from your pay stub:                   _________________________________
Other monthly income:
From business:                               _________________________________
From real property                           _________________________________
From interest and dividends                  _________________________________
From alimony, child support                  _________________________________
From social security, government assistance _________________________________
From pension or retirement                   __________________________________
Other income (specify)                       __________________________________

Deductions:
Federal income tax                          ___________________________________
FICA (social security)                      ___________________________________
Medicare                                    ___________________________________
Insurance                                   ___________________________________
Union Dues                                  ___________________________________
Other (specify)                             ___________________________________
Other (specify)                             ___________________________________




                                                20
     This Law Office is certified by the Federal Government as a Debt Relief Agency and is
           authorized to file bankruptcy cases in the United States Bankruptcy Court.
H. MONTHLY EXPENSES

Rent/mortgage                                          $__________________________
  Insurance included?        Yes     No
  Taxes included?            Yes     No

Electricity & heat                                     $__________________________
Water & sewer                                          $__________________________
Telephone                                              $__________________________
Cable                                                  $__________________________
Home maintenance                                       $__________________________
Food                                                   $__________________________
Clothing                                               $__________________________
Laundry & dry cleaning                                 $__________________________
Medical & dental expenses                              $__________________________
    (Not covered by insurance)
Transportation (do NOT include car payment)            $__________________________
Recreation (clubs, entertainment, publications, etc)   $__________________________
Charitable contributions                               $__________________________
Homeowners or renters insurance                        $__________________________
Life insurance                                         $__________________________
Health insurance                                       $__________________________
Auto insurance                                         $__________________________
Other insurance, specify                               $__________________________
Taxes (identify what type)                             $__________________________
Auto loan payment                                      $__________________________
Other installment loan, specify                        $__________________________
Other installment loan, specify                        $__________________________
Alimony, maintenance, support                          $__________________________
Payments for dependents                                $__________________________
Business expenses (attach detailed statement)          $__________________________
Other expenses, specify                                $__________________________




                                                 21
      This Law Office is certified by the Federal Government as a Debt Relief Agency and is
            authorized to file bankruptcy cases in the United States Bankruptcy Court.
I. STATEMENT OF FINANCIAL AFFAIRS

1. State your gross income from employment, trade, profession or operation of business for this calendar
   year to present, and for the two years immediately preceding this calendar year.

           Your gross income
    2006 __________________________ Source: ________________________________
    2005 __________________________ Source: ________________________________
    2004 __________________________ Source: ________________________________


           Your spouse’s income
    2006 __________________________ Source: ________________________________
    2005 __________________________ Source: ________________________________
    2004 __________________________ Source: ________________________________

    If you or your spouse have had any income other than from wages or business income (such as
    DSHS, SSI, Unemployment, 401k, or IRA cash-outs, sale of property, or stock) please list and be
    specific:

           Your gross Income
    2006 __________________________ Source: ________________________________
    2005 __________________________ Source: ________________________________
    2004 __________________________ Source: ________________________________

           Your spouse’s income
    2006 __________________________ Source: ________________________________
    2005 __________________________ Source: ________________________________
    2004 __________________________ Source: ________________________________


2. State the amount of income received by you other than from employment, trade, profession, or
   operation of business during the two years immediately preceding the filing of this case. Give
   particulars.

                  You                       Your spouse
    2006 __________________________ ________________________________
    2005 __________________________ ________________________________
    2004 __________________________ ________________________________

3. List all payments you have made in the last 90 days that totaled over $600 to any one creditor.
   _______________________________________________________________
   _______________________________________________________________
   _______________________________________________________________
   _______________________________________________________________

    List all payments made within the last year to an insider (the term "insider" includes your relatives,
    general partners and their relatives, corporations of which you are an officer or director, etc.)
    _______________________________________________________________
    _______________________________________________________________

                                                22
     This Law Office is certified by the Federal Government as a Debt Relief Agency and is
           authorized to file bankruptcy cases in the United States Bankruptcy Court.
4.           A.      Were you a party to any lawsuit within the last year? (This includes dissolutions,
                     collections, etc.) ________ No _________ Yes.
                     If yes, provide the case caption (XYZ vs. You), the case number, what court it was
                     filed in, and its status.




             B.      Have you had any property attached, garnished or seized within the last year?
                     ________ No _________ Yes.
                     If yes, provide the name and address of the person who seized the property, the date
                     of seizure, and a description and value of the property.



5. Have you had any property repossessed by a creditor, sold at foreclosure, transferred through a deed
   in lieu of foreclosure, or returned to the seller within the last year?
   ________ No _________ Yes.
   If yes, provide the name and address of the creditor, the date of repossession or foreclosure, and a
   description and value of the property.


6. The following questions 6A and 6B usually do not apply to consumer bankruptcies and the answer
   normally is "No":

             A.      Has any creditor caused property to be ASSIGNED within last 120 days?
                     ______No _____Yes.
                     If Yes, provide the name and address of the person/entity, date of the event,
                     assignment terms, and property description and value.


             B.      Any RECEIVERSHIPS for previously owned property within last year?
                     ________ No _________ Yes.
                     If Yes, provide the name and address of custodian; court name and location; title,
                     number, and date of the order; and property description and value.

7.    Have you made any gifts or charitable contributions in the last year which total more than $200 to
     any one person/recipient?
     ________ No _________ Yes.
     If Yes, provide the name and address of person or organization, their relationship to you, if any, the
     date of the gift and a description and value.



8. Have you had any losses from fire, theft, gambling, etc. within the 365 days?
   ______ No _______ Yes.

                                                 23
      This Law Office is certified by the Federal Government as a Debt Relief Agency and is
            authorized to file bankruptcy cases in the United States Bankruptcy Court.
    If Yes, provide the description and value of the property, a description of the circumstances, whether
    it was covered by insurance, and the date of loss.



9. Any payments to others for DEBT COUNSELING in the last year? This would include Consumer
   Credit Counseling, other attorneys, etc.
   ____No ____Yes.
   If Yes, provide the name and address of attorneys; payment date and amount; and property
   description and value



10. The following question inquires about any transfers of money, assets of any kind, or just about
    anything that is substantial, like the sale of property, a car, real estate, or even household items or
    jewelry. If the value of the item was under $500, then do not include that transfer in this question.
    Any extraordinary TRANSFERS?
    ____No ____Yes.
    If Yes, provide the name and address of person/entity; relationship to you; date of the transfer; and
    property description and value received in return for what you transferred.



11. Have you closed, sold or transferred any financial accounts within the last year (this includes within
    the meaning of "accounts", everything similar to checking and/or saving accounts, certificates of
    deposit, any financial certificate of any kind, anything in credit unions, pensions funds, cooperatives,
    associations, brokerage firms and anything else that could be deemed "financial" in nature.)
    ____No ____Yes.
    If Yes, provide the name and address of institution; type and number of account; final balance; and
    amount and date of sale/closing


12. Do you have a safe deposit box?
    ____No ____Yes.
    If Yes, provide the name and address of depository; name and address of person(s) with access;
    contents description and value; and surrender or transfer date (if any):


13. List all setoffs made by any creditor, including a bank, against a debt or deposit of yours within the
    last 90 days. (This is uncommon for personal bankruptcies; the answer is probably 'no'.)
    ____No ____Yes.
    If Yes, provide the name, address of the person/entity, the date of the event, and amount of setoff.



14. Are you holding any property for another? (This involves property of any kind that you have in your
    control or possession which is not owned by you. This would include a car that you are borrowing or
    storing for someone, furniture on loan, jewelry which is lent to you, and anything else that you have
    which is not owned by you.)
    ____No ____Yes.

                                                 24
      This Law Office is certified by the Federal Government as a Debt Relief Agency and is
            authorized to file bankruptcy cases in the United States Bankruptcy Court.
    If Yes, provide the name and address of owner; and description, location, and value of property.




15. Have you moved in the last two years?
    ____No ____Yes.
    If Yes, provide the address and dates of occupancy.




16. Have you filed all your tax returns?

    _____Yes _____ No.
    If not, which years have you not filed?

    List all of your income tax refunds for the past two years:

    Most recent return:                               The year before:

    TAX DEBTS:

    Tax Agency:                                       Address:


    Type of return (Ex: 1040, 941)                    Tax Year:

    Return Filed: Mo                                  Year:

    Amount Due:



17. List the amount of your tax refund (if any) for the last two years.




Thank you for choosing the Law Office of Christopher D. Anderson for help with your financial situation.
I appreciate your time and honesty in completing this form. Your answers and information will be relied
on to file your bankruptcy claim. Please contact me if you have any questions.

                                                                                 Christopher D. Anderson

                                                ***END***




                                                 25
      This Law Office is certified by the Federal Government as a Debt Relief Agency and is
            authorized to file bankruptcy cases in the United States Bankruptcy Court.