bankruptcy by shuifanglj

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           Bankruptcy
           Questionnaire
           Returning the Questionnaire:
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                                         Bankruptcy Questionnaire


Process:
In order for us to process your paperwork, we will need you to complete this questionnaire. You should save
this questionnaire to your desktop or somewhere on your computer that you can easily find. Once completed use
our secure link located on the first page of this questionnaire or in the right column of each page of our website
to upload your completed questionnaire. Or you may return it by fax, mail or drop it off at our office. We will
review your questionnaire then call you with any questions and for payment.

Exemptions:

You will be required to select exemptions for property you want to protect that you list in the section
“WORKSHEET: YOUR PROPERTY” located later in this questionnaire.

Debtors in the following states may select federal bankruptcy exemptions or use their state exemptions to
protect their assets. 11 U.S.C. § 522. (Arkansas, Connecticut, District of Columbia, Hawaii, Massachusetts,
Michigan, Minnesota, New Hampshire, New Jersey, New Mexico, Pennsylvania, Rhode Island, Texas,
Vermont, Washington, and Wisconsin.) Only you or an attorney may select exemptions to protect your assets.
List of All state exemptions.

Credit Reports

Unless you know all of your creditors and their information, you will need a copy of your credit reports. By
going to our Credit Reports webpage, you will find information to receive your credit reports free from three
credit bureaus.

Credit Counseling

As per the Bankruptcy Reform Act of 2005, you are required to complete a prebankruptcy counseling session
with an approved credit-counseling agency prior to filing. This is mandatory whether you file a Chapter 7
Bankruptcy or Chapter 13 Bankruptcy. You may use any approved credit-counseling agency. We recommend
using GreenPath (866) 332-8435 or Consumer Credit Counseling Service (English 800-251-2227, en Espanola 866-
672-2227) who will complete the entire counseling process in two sessions over the phone or online; however,
if you find it difficult to get through to them use the link below to find an approved credit counseling agency in
your area. You will receive a certificate of completion after your first session, which must be filed with the
court when you file your petition.

                    List of Credit Counseling Agencies Approved Pursuant to 11 U.S.C. § 111

Understanding Bankruptcy

Bankruptcy BASICS provides basic information to debtors, creditors, court personnel, the media, and the general public
on different aspects of the federal bankruptcy laws. It also provides individuals who may be considering bankruptcy with a
basic explanation of the different chapters under which a bankruptcy case may be filed and to answer some of the most
commonly asked questions about the bankruptcy process.



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Select type of bankruptcy:
Presently, Chapter 13’s are only available with attorney option (Washington State only). Select one of each section:

    1.   (    ) Chapter 7                                              3. (      ) Online Service
         (    ) Chapter 13 (Washington State Only)                        (      ) In-Office Service
                                                                                   Select Office...
    2.   (    ) Paralegal option
         (    ) Attorney option (Washington State Only)


Client Information Worksheets:
                                              DEBTOR                                    JOINT DEBTOR
FULL NAME

STREET ADDRESS:


MAILING ADDRESS:


COUNTY:

HOME PHONE NUMBER:

WORK PHONE NUMBER:

FAX (if available)

EMAIL ADDRESS

SOC. SEC. NO.:

OTHER TAX IDS:

What other personal or business names have you used in the last eight (8) years?




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Credit Counseling:
I/we have received approved budget and credit counseling during the 180-day period preceding the filing of this petition.
Yes (     ) No (    )

Name of credit counseling agency

Address of credit counseling agency




I/we request a waiver of the requirement to obtain budget and credit counseling prior to filing based on exigent
circumstances (Must attach certification describing.)




Prior Addresses:
Prior domicile (residence) within 730 days (County and State):

                                              DEBTOR                                   JOINT DEBTOR
County:

State:

County:

State:



Prior domicile (residence) within 180 days (County and State):

                                              DEBTOR                                   JOINT DEBTOR
County:

State:

County:

State:




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Prior/Pending Bankruptcy Actions
PRIOR BANKRUPTCIES: If you have previously filed a bankruptcy petition, please list the case number, date, and the
location where you filed on the lines following.

                                               DEBTOR                                    JOINT DEBTOR
County:

State:

County:

State:

PENDING BANKRUPTCIES: If any immediate family member or business partner has a bankruptcy pending, please list the
case number, name of debtor, relation to you, date and location where filed, and the bankruptcy judge on the lines
following.

                                               DEBTOR                                    JOINT DEBTOR
County:

State:

County:

State:




EXHIBIT "C" TO VOLUNTARY PETITION
If, to the best of the debtor's knowledge, the debtor owns or has possession of property that poses or is alleged to pose a
threat of imminent and identifiable harm to the public health or safety, attach this Exhibit "C" to the petition.

Yes (     ) No (      ) Describe property:


DEBTOR WHO RESIDES AS A TENANT OF
RESIDENTIAL PROPERTY
Landlord has a judgment against the debtor for possession of debtor's residence. (If yes, complete the following). Yes (      )
No (      ) Name of landlord that obtained judgment:

Address of landlord



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WORKSHEET: YOUR PROPERTY
Only you or an attorney may select exemptions to protect your assets. You can find a list of exemptions from many websites
such as List   of All state exemptions and statutes.
          Your Property            Who Owns It?     Market Value of   Your Ownership   Value of Liens      Amount of    Exempt? If so,
    Provide detailed description   S – Single         Property?         Share (%, $)   (claims against      Equity      put exemption
            What is it?            H – Husband                                            property)                     statute; if not
            Where is it?           W – Wife                                                                               write “No”
                                   J –Joint                                                                              (Schedule C)
                                   C - Community
Real Property is land and things permanently attached to land. Included are unimproved land, vacation cabins,
condominiums, duplexes, rental property, business property, mobile home park spaces, agricultural land, airplane hangars,
and any other buildings permanently attached to land. It also includes property you are entitled to by a trust and all property
in which you have any legal, equitable, or future interest. If you are in a community property state, your spouse’s real estate is
also owned by you. (All leases and time shares should be listed on the worksheet for Schedule G.)
REAL ESTATE (Schedule A)
(Legal Desc. and Location)


REAL ESTATE (Schedule A)
(Legal Desc. and Location)


Personal Property (Schedule B)
1. Cash on hand.
2. Checking, savings, or other financial accounts, certificates of deposit, or shares in banks, savings and loan, thrift, building
and loan, and homestead associations, or credit unions, brokerage houses, or cooperatives.




3. Security deposits with public utilities, telephone companies, landlords, and others.




4. Household goods and
furnishings, including audio,
video, and computer
equipment.




Worksheet: Your Property continued:
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Only you or an attorney may select exemptions to protect your assets. You can find a list of exemptions from many websites
such as List   of All state exemptions and statutes.
          Your Property            Who Owns It?    Market Value of   Your Ownership   Value of Liens      Amount of    Exempt? If so,
    Provide detailed description   S – Single        Property?         Share (%, $)   (claims against      Equity      put exemption
            What is it?            H – Husband                                           property)                     statute; if not
            Where is it?           W – Wife                                                                              write “No”
                                   J –Joint                                                                             (Schedule C)
                                   C - Community
5. Books, pictures, and other
art objects, antiques, stamp,
coin, record, tape, compact
disk, and other collections or
collectibles.


6. Wearing apparel.



7. Furs and Jewelry.



8. Firearms and sports,
photographic and other hobby
equipment.


9. Interests in insurance
policies. Name insurance
company of each policy and
itemize surrender or refund
value of each.


10. Annuities. Itemize and
name each issuer.




Worksheet: Your Property continued:
Only you or an attorney may select exemptions to protect your assets. You can find a list of exemptions from many websites
such as List   of All state exemptions and statutes.


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          Your Property            Who Owns It?    Market Value of   Your Ownership   Value of Liens      Amount of    Exempt? If so,
    Provide detailed description   S – Single        Property?         Share (%, $)   (claims against      Equity      put exemption
            What is it?            H – Husband                                           property)                     statute; if not
            Where is it?           W – Wife                                                                              write “No”
                                   J –Joint                                                                             (Schedule C)
                                   C - Community
11. Interests in an education
IRA as defined in 26 U.S.C. §
530(b)(1) or under a qualified
State tuition plan as defined in
26 U.S.C. § 529(b)(1). Give
particulars. (File separately
the record(s) of any such
interest(s). 11 U.S.C. § 521(c);
Rule 1007(b)).


12. Interests in IRA, ERISA,
Keogh, or other pension or
profit sharing plans. Give
Particulars.


13. Stock and interests in
incorporated and
unincorporated businesses.
Itemize.


14. Interests in partnerships or
joint ventures. Itemize.


15. Government and corporate
bonds and other negotiable
and nonnegotiable
instruments.


16. Accounts receivable




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Worksheet: Your Property continued:
Only you or an attorney may select exemptions to protect your assets. You can find a list of exemptions from many websites
such as List of All state exemptions and statutes.
          Your Property            Who Owns It?    Market Value of   Your Ownership   Value of Liens      Amount of    Exempt? If so,
    Provide detailed description   S – Single        Property?         Share (%, $)   (claims against      Equity      put exemption
            What is it?            H – Husband                                           property)                     statute; if not
            Where is it?           W – Wife                                                                              write “No”
                                   J –Joint                                                                             (Schedule C)
                                   C - Community
17. Alimony, maintenance,
support, and property
settlements to which the
debtor is or may be entitled.
Give particulars.


18. Other liquidated debts
owing debtor including tax
refunds. Give particulars.


19. Equitable or future
interests, life estates, and
rights or powers exercisable
for the benefit of the debtor
other than those listed in
Schedule A - Real Property.


20. Contingent and
noncontingent interests in
estate of a decedent, death
benefit plan, life insurance
policy, or trust.


21. Other contingent and
unliquidated claims of every
nature, including tax refunds,
counterclaims of the debtor,
and rights to setoff claims.
Give estimated value of each.


22. Patents, copyrights and
other intellectual property.
Give particulars.




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Worksheet: Your Property continued:
Only you or an attorney may select exemptions to protect your assets. You can find a list of exemptions from many websites
such as List   of All state exemptions and statutes.
          Your Property            Who Owns It?    Market Value of   Your Ownership   Value of Liens      Amount of    Exempt? If so,
    Provide detailed description   S – Single        Property?         Share (%, $)   (claims against      Equity      put exemption
            What is it?            H – Husband                                           property)                     statute; if not
            Where is it?           W – Wife                                                                              write “No”
                                   J –Joint                                                                             (Schedule C)
                                   C - Community
23. Licenses, franchises and
other general intangibles. Give
particulars.


24. Customer lists or other
compilations containing
personally identifiable
information (as defined in 11
U.S.C. § 101(41A)) in customer
lists or similar compilations
provided to the debtor by
individuals in connection with
obtaining a product or service
from the debtor primarily for
personal, family, or household
purposes.


25. Automobiles, trucks,
trailers and other vehicles and
accessories.


26. Boats, motors, and
accessories.


27. Aircraft and accessories.



28. Office equipment,
furnishings and supplies.




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Worksheet: Your Property continued:
Only you or an attorney may select exemptions to protect your assets. You can find a list of exemptions from many websites
such as List   of All state exemptions and statutes.
          Your Property            Who Owns It?    Market Value of   Your Ownership   Value of Liens      Amount of    Exempt? If so,
    Provide detailed description   S – Single        Property?         Share (%, $)   (claims against      Equity      put exemption
            What is it?            H – Husband                                           property)                     statute; if not
            Where is it?           W – Wife                                                                              write “No”
                                   J –Joint                                                                             (Schedule C)
                                   C - Community
29. Machinery, fixtures,
equipment and supplies used
in business.


30. Inventory.


31. Animals.



32. Crops- growing or
harvested. Give particulars.


33. Farming equipment and
implements.


34. Farm supplies, chemicals
and feed.


35. Other personal property of
any kind not already listed.
Itemize.




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WORKSHEET: YOUR DEBTS - Secured –
Schedule D
         Creditor’s        Who Owns It?    Account No. and         Describe Debt   Balance Owed              Others Involved
      Name and Address     S – Single       Date Incurred                                                  Name and Address
                           H – Husband                                                                (i.e. Collection Agency, Co
                           W – Wife                                                                           debtor, etc.)
                           J –Joint
                           C - Community
Mortgage(s) on Principal                                                                          (      ) Collection Agency
Res.                                                                                              (      ) Co debtor
                                                                                                  (      ) Other




Mortgage(s) on Principal                                                                          (      ) Collection Agency
Res.                                                                                              (      ) Co debtor
                                                                                                  (      ) Other




Automobile Loans                                                                                  (      ) Collection Agency
                                                                                                  (      ) Co debtor
                                                                                                  (      ) Other



Automobile Loans                                                                                  (      ) Collection Agency
                                                                                                  (      ) Co debtor
                                                                                                  (      ) Other




List Other Secured Debts                                                                          (      ) Collection Agency
Below:                                                                                            (      ) Co debtor
                                                                                                  (      ) Other



                                                                                                  (      ) Collection Agency
                                                                                                  (      ) Co debtor
                                                                                                  (      ) Other

                                                                                                  (      ) Collection Agency
                                                                                                  (      ) Co debtor
                                                                                                  (      ) Other

                                                                                                  (      ) Collection Agency
                                                                                                  (      ) Co debtor
                                                                                                  (      ) Other




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WORKSHEET: YOUR DEBTS - Priority –
Schedule E
        Creditor’s         Who Owns It?        Desc. Tax Due           Describe Debt         Balance Owed                 Others Involved
     Name and Address      S – Single                                                                                   Name and Address
                           H – Husband                                                                             (i.e. Collection Agency, Co
                           W – Wife                                                                                        debtor, etc.)
                           J –Joint
                           C - Community
FEDERAL TAXES                                                                                                  (      ) Collection Agency
                                                                                                               (      ) Co debtor
                                                                                                               (      ) Other




FEDERAL TAXES                                                                                                  (      ) Collection Agency
                                                                                                               (      ) Co debtor
                                                                                                               (      ) Other




FEDERAL TAXES                                                                                                  (      ) Collection Agency
                                                                                                               (      ) Co debtor
                                                                                                               (      ) Other



STATE TAXES                                                                                                    (      ) Collection Agency
                                                                                                               (      ) Co debtor
                                                                                                               (      ) Other




STATE TAXES                                                                                                    (      ) Collection Agency
                                                                                                               (      ) Co debtor
                                                                                                               (      ) Other




        Creditor’s                         Desc. of Support Due                        Monthly Payment                  Balance Owed
     Name and Address

Child Support



Child Support



Child Support



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Spousal Maintenance




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WORKSHEET: YOUR DEBTS - Unsecured –
Schedule F
Secured debts are car loans, home loans, home equity loans, second mortgages, or any other loans where property is pledged
as security. All other types of debt are unsecured.

         Creditor’s          Who Owns It?    Account No. and        Describe Debt    Balance Owed               Others Involved
      Name and Address       S – Single       Date Incurred                                                   Name and Address
                             H – Husband                                                                 (i.e. Collection Agency, Co
                             W – Wife                                                                            debtor, etc.)
                             J –Joint
                             C - Community
List all Unsecured Debts                                                                             (     ) Collection Agency
Below:                                                                                               (     ) Co debtor
                                                                                                     (     ) Other



                                                                                                     (     ) Collection Agency
                                                                                                     (     ) Co debtor
                                                                                                     (     ) Other

                                                                                                     (     ) Collection Agency
                                                                                                     (     ) Co debtor
                                                                                                     (     ) Other

                                                                                                           Collection Agency
                                                                                                           Co debtor
                                                                                                           Other

                                                                                                     (     ) Collection Agency
                                                                                                     (     ) Co debtor
                                                                                                     (     ) Other

                                                                                                     (     ) Collection Agency
                                                                                                     (     ) Co debtor
                                                                                                     (     ) Other

                                                                                                     (     ) Collection Agency
                                                                                                     (     ) Co debtor
                                                                                                     (     ) Other

                                                                                                     (     ) Collection Agency
                                                                                                     (     ) Co debtor
                                                                                                     (     ) Other

                                                                                                     (     ) Collection Agency
                                                                                                     (     ) Co debtor
                                                                                                     (     ) Other




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WORKSHEET: YOUR DEBTS - Unsecured –
Schedule F, cont.
Secured debts are car loans, home loans, home equity loans, second mortgages, or any other loans where property is pledged
as security. All other types of debt are unsecured.

         Creditor’s          Who Owns It?    Account No. and        Describe Debt    Balance Owed              Others Involved
      Name and Address       S – Single       Date Incurred                                                  Name and Address
                             H – Husband                                                                (i.e. Collection Agency, Co
                             W – Wife                                                                           debtor, etc.)
                             J –Joint
                             C - Community
List all Unsecured Debts                                                                            (     ) Collection Agency
Below:                                                                                              (     ) Co debtor
                                                                                                    (     ) Other



                                                                                                    (     ) Collection Agency
                                                                                                    (     ) Co debtor
                                                                                                    (     ) Other

                                                                                                    (     ) Collection Agency
                                                                                                    (     ) Co debtor
                                                                                                    (     ) Other

                                                                                                    (     ) Collection Agency
                                                                                                    (     ) Co debtor
                                                                                                    (     ) Other

                                                                                                    (     ) Collection Agency
                                                                                                    (     ) Co debtor
                                                                                                    (     ) Other

                                                                                                    (     ) Collection Agency
                                                                                                    (     ) Co debtor
                                                                                                    (     ) Other

                                                                                                    (     ) Collection Agency
                                                                                                    (     ) Co debtor
                                                                                                    (     ) Other

                                                                                                    (     ) Collection Agency
                                                                                                    (     ) Co debtor
                                                                                                    (     ) Other

                                                                                                    (     ) Collection Agency
                                                                                                    (     ) Co debtor
                                                                                                    (     ) Other




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WORKSHEET: Leases/Contracts - Schedule G
LEASES OR CONTRACTS: Are you a party to any leases or contracts? If you owe money on these contracts, they should be
listed on the Schedules above.

Yes (     ) No (       )

If yes, list the parties involved and their addresses.




WORKSHEET: - Schedule I
                                                  DEBTOR                               JOINT DEBTOR
MARITAL STATUS:                (     ) Single (      ) Married (Living Together)   (   ) Married (Living Apart)
                               (     ) Divorced    (    ) Legal Separation

AGE:

OCCUPATION:

LENGTH OF EMP.:

EMPLOYER NAME:

WORK PHONE NUMBER:

EMPLOYER ADDRESS:




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WORKSHEET: - Schedule I, cont.
Dependents:

                NAME                                       AGE                      RELATIONSHIP




Your Income:

                                                                           DEBTOR          JOINT DEBTOR

Current monthly gross wages, salary, commissions (Pro-rate if not paid
monthly)
Estimated monthly overtime

Payroll Taxes and Social Security Deducted

Insurance Deducted

Union dues Deducted

Other payroll deductions- specify

Regular monthly income from business, profession, or farm (Attach a
detail statement)
Monthly income from real property

Monthly interest and dividends

Alimony, maintenance, or support payments (amount received monthly
for debtor’s or debtor’s dependents’ use)
Social Security or government assistance

Pension or retirement

Other monthly income

Describe any increase or decrease of more than 10% in any previous
category anticipated to occur in the year following this filing.




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WORKSHEET: - Schedule I, cont.
STATEMENT OF MONTHLY NET INCOME

INCOME:                              DEBTOR            JOINT DEBTOR

SIX MONTHS AGO

FIVE MONTHS AGO

FOUR MONTHS AGO

THREE MONTHS AGO

TWO MONTHS AGO

LAST MONTH AGO

INCOME FROM OTHER SOURCES

TOTAL NET INCOME FOR SIX
MONTHS PRECEDING FILING




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WORKSHEET: - Schedule J
Your Expenses
                                                                                                       DEBTOR(S)
Rent or home mortgage payment? Rent (          ) Mortgage (       )
Does this include real estate taxes? Yes (   ) No (     )
Does this include property insurance? Yes (      ) No (     )
Electricity and heating fuel (average monthly)
Water and sewer (average monthly)
Telephone (average monthly)
Other utilities (average monthly)
Home maintenance (repairs and upkeep)
Food
Clothing
Laundry and dry cleaning
Medical and dental expenses
Transportation (not including car payments)
Recreation, clubs and entertainment, newspapers, etc.
Charitable contributions
Homeowner’s or renter’s insurance
Life insurance
Health insurance
Auto insurance
Other insurance – specify
Taxes not deducted from wages or in home mortgage payments
Installment auto payments
Other installment payments not included in Chapter 13 Plan
Alimony, maintenance, and support paid to others
Payments for dependents not living at your home
Operation expenses of business, profession, or farm
Other expenses
Other expenses
Other expenses
Describe any increase or decrease in expenditures reasonably anticipate to occur within the year
following the filing of this document.

FORM 7: Statement of Financial Affairs
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Numbers correspond to Form 7’s questions:

   1.   Income from employment or operation of business. Enter each income source for the past two years. Specify the
        amount of income and the fiscal year.

                         Sources (name and address)                                        Amount               Fiscal Period


   2.   Income other than from employment or operation of business. Enter sources of any other income during the past
        two years. Specify the amount of income and the fiscal year.

                         Sources (name and address)                                        Amount               Fiscal Period


   3.
            a.   Individual or joint debtor(s) with primarily consumer debts: List payments made to any creditor during the
                 last 90 days.

                      Creditors                                   Dates of                 Amount                 Amount
                  (name and address)                             Payments                   Paid                 Still Owing




            b. Debtor whose debts are not primarily consumer debts: List payments made to any creditor during the last
               90 days.

                      Creditors                                 Dates of                   Amount                 Amount
                  (name and address)                        Payments/Transfers              Paid                 Still Owing




            c.   List payments made to insider creditors during the last year.

                      Creditors                                   Dates of                 Amount                 Amount
                  (name and address)                             Payments                   Paid                 Still Owing




   4.
            a. Were you sued or did you sue anybody last year (12 months)? Yes (           ) No(     ) if yes, list the following
               in an email, text file or by fax: caption of suit, case number, nature of proceeding, court and location,
               status/disposition; and attorney representing.
            b. Status/disposition; and attorney representing.

             Creditors                                      Date of                                 Description and
         (name and address)                                 Seizure                                 Value of property


   5.   List any repossessions, foreclosures and voluntary returns during the last year.

             Assignee                                       Date of                                 Description and
         (name and address)                              repossession                               Value of property
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   6.
            a.   Describe any assignment of property for the benefit of creditors made within the last 120 days.

             Creditors                                      Date of                                Terms of
         (name and address)                               Assignment                        Assignment or Settlement




            b. List all property which has been in the hands of a custodian, receiver, or court-appointed official during the
               past year.

        Custodian                      Date of                Name Location Of Court                  Description and
    (name and address)                 Order                  & Case Title and Number                 Value of Property




   7.   List all gifts or charitable contributions made during the last year except ordinary and usual gifts to family members
        totaling less than $200 per family member and $100 per charitable recipient.

        Recipient                      Date of                      Relationship                      Description and
    (name and address)                  Gift                          (if any)                         Value of Gift




   8.   List all losses from fire, theft, other casualty or gambling during the past year

        Description                    Date of                    Was Loss Covered                        Value of
        Of Property                     Loss                       By insurance                           Property




   9.   List all payments made or property transferred by or on behalf of the debtor to any persons, including attorneys, for
        consultation concerning debt consolidation, relief under the bankruptcy law or preparation of a petition in
        bankruptcy during the past year.

                 Payee                                 Date of Payment,                           Amount Paid or
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           (name and address)                                  Payor                           Value of property transferred




   10.
              a.   List all other property, other than property transferred in the ordinary course of the business or financial
                   affairs of the debtor, transferred either absolutely or as security during the past two years to creditor or
                   family member.

         Transferee & relationship                             Date                           Describe property transferred
           (name and address)                                                                      And value received




              b. List all other property transferred by the debtor during the past ten years to a self settled trust or similar
                 device of which the debtor is a beneficiary.

           Trust or other device                               Date                       Amount of money or value of property
                  (name)                                                                    or debtor's interest in property




   11. List all financial accounts and instruments held by or for the benefit of the debtor which were closed, sold or
       otherwise transferred in the past year. Include checking, savings, or other financial accounts, CDs, shares and share
       accounts held in banks, credit unions, pension funds, brokerage houses, etc.

               Institution                              Acct type & number                          Amount & date of
           (name and address)                           Amt of Final Balance                         sale or closing




   12. List each safe deposit or other box or depository in which you have had valuables within the past year.

        Institution                  Date of transfer              Who has access?                         Description of
    (name and address)                or surrender                (name and address                          Contents




   13. List all setoffs (money taken from an account to repay a loan at the same bank as where your money has been
       deposited) made by any creditor, including a bank, against a debt of the debtor within the past 90 days.

               Creditor                                       Date of                                   Amount of
           (name and address)                                 Setoff                                     Setoff




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   14. List all property OWNED by another person or entity that the debtor (you or you and your spouse) holds or
       controls.

              Owner                                 Description & Value                              Location of
         (name and address)                            Of Property                                    Property




   15. If the debtor has moved within the last THREE years, list all premises occupied and vacated during that period.

                Address                                  Name Used                               Dates of Occupancy
                                                                                             -
                                                                                             -


   16. Identify the name of debtor's spouse or former spouse who resided with the debtor in a community property state in
       the EIGHT years immediately preceding the commencement of the case.

Name



   17.
           a.   List the name and address of every site for which the corporation has received notice in writing by a
                governmental unit that the corporation may be liable or potentially liable under or in violation of an
                Environmental Law.

                "Environmental Law" means any federal, state or local statute or regulation regulating pollution,
                contamination, releases of hazardous or toxic substances, wastes or material into the air, land, soil, surface
                water, groundwater, or other medium, including, but not limited to, statutes or regulations regulating the
                cleanup of these substances, wastes, or material.

                "Site" means any location, facility, or property as defined under any Environmental Law, whether or not
                presently or formerly owned or operated by you, including, but not limited to, disposal sites.

                "Hazardous Material" means anything defined as a hazardous waste, hazardous substance, toxic substance,
                hazardous material, pollutant, or contaminant or similar term under an Environmental Law.

                Indicate the governmental unit, the date of the notice, and if known, the Environmental Law:

           Site                   Date of Notice       Name and Address of Government                Environmental Law
    (name and address)                                             Unit




           b. List the name and address of every site for which you provided notice to a governmental unit of a release of
              Hazardous Material. Indicate the governmental unit to which the notice was sent and the date of the
              notice.


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            Site                    Date of Notice         Name and Address of Government             Environmental Law
     (name and address)                                                Unit




             c.   List all judicial or administrative proceedings, including settlements or orders, under any Environmental
                  Law with respect to which you are or were a party. Indicate the name and address of the governmental unit
                  that is or was a party to the proceeding, and the docket number.

         Name and Address of                              Docket Number                         Status of Disposition
          Government Unit




    18. If you are an individual, list the names, addresses, taxpayer identification numbers, nature of the business, and
        beginning and ending dates of all businesses in which you were an officer, director, partner, or managing executive
        of a corporation, partnership, sole proprietorship, or were a self-employed professional within the last six years, or
        in which you owned 5 percent or more of the voting or equity securities within the last six years.

        If you are a partnership, list the names, addresses, taxpayer identification numbers, nature of the business, and
        beginning and ending dates of all businesses in which you were a partner or owned 5 percent or more of the voting
        or equity securities, within the last six years.

        If you are a corporation, list the names, addresses, taxpayer identification numbers, nature of the business, and
        beginning and ending dates of all businesses in which the debtor was a partner or owned 5 percent or more of the
        voting or equity securities within the last six years.

         Name              Last four digits of Soc.           Address           Nature of Business      Beginning and Ending
                            Sec. No./Complete                                                                  Dates
                           EIN or other taxpayer
                                  I.D. No.
                                                                                                              –
                                                                                                              -


Identify any business listed above that is "single asset real estate."

                             Name                                                           Address




NOTICE TO INDIVIDUAL CONSUMER DEBTOR UNDER § 342(B)



The following two pages must be read by the Debtor & Co-Debtor and signed and dated by both. You
will need to print these two pages return them to us prior to us completing your documents. If you are

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using our in-office services you may bring them to your appointment. If you are using our online
service you will need to mail them, scan them back to your computer and email them, or fax them.

Mailing address:

1819 South Commons
The Commons Mall
Federal Way, WA 98003

FAX Number: (888) 377-2397




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                                      UNITED STATES BANKRUPTCY COURT



                      NOTICE TO INDIVIDUAL CONSUMER DEBTOR UNDER § 342(b)

                                              OF THE BANKRUPTCY CODE

         In accordance with § 342(b) of the Bankruptcy Code, this notice: (1) Describes briefly the services available from credit;
(2) Describes briefly the purposes, benefits and costs of the four types of bankruptcy proceedings you may commence; and
(3) counseling services; Informs you about bankruptcy crimes and notifies you that the Attorney General may examine all information
you supply in connection with a bankruptcy case. You are cautioned that bankruptcy law is complicated and not easily described. Thus,
you may wish to seek the advice of an attorney to learn of your rights and responsibilities should you decide to file a petition.
Court employees cannot give you legal advice.


        1. Services Available from Credit Counseling Agencies


    With limited exceptions, § 109(h) of the Bankruptcy Code requires that all individual debtors who file for bankruptcy relief
on or after October 17, 2005, receive a briefing that outlines the available opportunities for credit counseling and provides
assistance in performing a budge analysis. The briefing must be given within 180 days before the bankruptcy filing. The briefing
may be provided individually or in a group (including briefings conducted by telephone or on the Internet) and must be provided by a
nonprofit budget and credit counseling agency approved by the United States trustee or bankruptcy administrator. The clerk of the
bankruptcy court has a list that you may consult of the approved budget and credit counseling agencies.

     In addition, after filing a bankruptcy case, an individual debtor generally must complete a financial management
instructional course before he or she can receive a discharge. The clerk also has a list of approved financial management
instructional courses.


        2. The Four Chapters of the Bankruptcy Code Available to Individual Consumer Debtors



        Chapter 7: Liquidation ($245 filing fee, $39 administrative fee, $15 trustee surcharge: Total fee $299)

        1. Chapter 7 is designed for debtors in financial difficulty who do not have the ability to pay their existing debts.
    Debtors whose debts are primarily consumer debts are subject to a “means test” designed to determine whether the case should
    be permitted to proceed under chapter 7. If your income is greater than the median income for your state of residence and
    family size, in some cases, creditors have the right to file a motion requesting that the court dismiss your case under §
    707(b) of the Code. It is up to the court to decide whether the case should be dismissed.


        2. Under chapter 7, you may claim certain of your property as exempt under governing law. A trustee may have the right to
    take possession of and sell the remaining property that is not exempt and use the sale proceeds to pay your creditors.


         3. The purpose of filing a chapter 7 case is to obtain a discharge of your existing debts. If, however, you are found to
    have committed certain kinds of improper conduct described in the Bankruptcy Code, the court may deny your discharge and, if
    it does, the purpose for which you filed the bankruptcy petition will be defeated.

         4. Even if you receive a general discharge, some particular debts are not discharged under the law. Therefore, you may still
    be responsible for most taxes and student loans; debts incurred to pay nondischargeable taxes; domestic support and property
    settlement obligations; most fines, penalties, forfeitures, and criminal restitution obligations; certain debts which are not
    properly listed in your bankruptcy papers; and debts for death or personal injury caused by operating a motor vehicle, vessel, or
    aircraft while intoxicated from alcohol or drugs. Also, if a creditor can prove that a debt arose from fraud, breach of fiduciary
    duty, or theft, or from a willful and malicious injury, the bankruptcy court may determine that the debt is not discharged.



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         Chapter 13: Repayment of All or Part of the Debts of an Individual with Regular Income ($235 filing fee, $39
         administrative fee: Total fee $274)

         1. Chapter 13 is designed for individuals with regular income who would like to pay all or part of

    their debts in installments over a period of time. You are only eligible for chapter 13 if your debts do not exceed certain
    dollar amounts set forth in the Bankruptcy Code.
         2. Under chapter 13, you must file with the court a plan to repay your creditors all or part of the money that you owe them,
    using your future earnings. The period allowed by the court to repay your debts may be three years or five years, depending
    upon your income and other factors. The court must approve your plan before it can take effect.

         3. After completing the payments under your plan, your debts are generally discharged except for domestic support
    obligations; most student loans; certain taxes; most criminal fines and restitution obligations; certain debts which are not
    properly listed in your bankruptcy papers; certain debts for acts that caused death or personal injury; and certain long term
    secured obligations.


         Chapter 11: Reorganization ($1000 filing fee, $39 administrative fee: Total fee $1039)

    Chapter 11 is designed for the reorganization of a business but is also available to consumer debtors. Its provisions are quite
    complicated, and any decision by an individual to file a chapter 11 petition should be reviewed with an attorney.

         Chapter 12: Family Farmer or Fisherman ($200 filing fee, $39 administrative fee: Total fee $239)

    Chapter 12 is designed to permit family farmers and fishermen to repay their debts over a period of time from future earnings
    and is similar to chapter 13. The eligibility requirements are restrictive, limiting its use to those whose income arises
    primarily from a family-owned farm or commercial fishing operation.

    3. Bankruptcy Crimes and Availability of Bankruptcy Papers to Law Enforcement Officials

      A person who knowingly and fraudulently conceals assets or makes a false oath or statement under penalty of perjury, either
    orally or in writing, in connection with a bankruptcy case is subject to a fine, imprisonment, or both. All information
    supplied by a debtor in connection with a bankruptcy case is subject to examination by the Attorney General acting through
    the Office of the United States Trustee, the Office of the United States Attorney, and other components and employees of the
    Department of Justice.



      WARNING: Section 521(a)(1) of the Bankruptcy Code requires that you promptly file detailed information regarding your creditors,
assets, liabilities, income, expenses and general financial condition. Your bankruptcy case may be dismissed if this information is not
filed with the court within the time deadlines set by the Bankruptcy Code, the Bankruptcy Rules, and the local rules of the
court.




Signature of Debtor                 (date)


Signature of Co-Debtor              (date)




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Agreement with Do It Yourself Documents
This is an agreement between us:
Do It Yourself Documents, LLC and you, if you choose to use our services. It contains the basic terms of our agreement to
provide you with document preparation assistance so that you can better represent yourself in your Chapter 7 or 13
Bankruptcy case.

Scope of Legal Advice:
Absolutely none. We are not attorneys and cannot nor will give legal advice. This questionnaire follows the software
program used by Do It Yourself Documents, LLC.

Duration of Document Help:
Our agreement to prepare your bankruptcy documents begins immediately upon our receipt of the questionnaire and
payment for the service you require and will end at the completion of you receiving all of your bankruptcy petition
documents.

Cooperation:
To prepare your documents effectively, we need all information requested within the questionnaire. You must agree to
answer any questions we ask either in the following questionnaire or by follow up telephone conference.

Costs:
There are costs that are part of filing a chapter 7 & 13 bankruptcy petition with the courts and costs for credit counseling. We
will not pay any costs in your case. Rather, you will be responsible for all costs.

Privacy Policy:
Your privacy is of great importance to us and our questionnaires collect highly sensitive information. You are valued by us
and we will take appropriate measures to protect the information collected from you on this site. Everything is considered
confidential and will never be released to any third party. We only request information absolutely essential to respond to
your requests on our products and services.

The following rules govern us and all independent paralegals and explain your recourse if you believe your rights
were violated.

                 Additional Rules governing Bankruptcy Preparers as per the Department of Justice

BANKRUPTCY PETITION PREPARERS
     HERE IS WHAT YOU SHOULD KNOW IF YOU USE A TYPING SERVICE, PARALEGAL, OR DOCUMENT
                   PREPARATION SERVICE TO HELP YOU FILE YOUR BANKRUPTCY

Bankruptcy is a legal proceeding controlled by federal law. As a debtor in bankruptcy, you may retain an attorney to
represent you or you may represent yourself without an attorney. You may also go to a bankruptcy petition preparer,
sometimes called a "typing service" or "paralegal."

Federal law controls the services rendered by bankruptcy petition preparers. The law is designed to protect debtors as
consumers of these services. If you use a bankruptcy petition preparer to assist you in preparing your bankruptcy
documents, you should be familiar with your rights and their duties.



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What is a bankruptcy petition preparer?
A "bankruptcy petition preparer" means a person, other than an attorney or an employee of an attorney, who prepares for a
fee, a document for filing by the debtor in the United States Bankruptcy Court.

What may a bankruptcy petition preparer not do?
Bankruptcy petition preparers are not attorneys. Even the bankruptcy petition preparers who call themselves "paralegals"
are not usually supervised by an attorney. They may not represent debtors in any bankruptcy proceeding and they may not
give debtors any legal advice.

Legal advice includes:

       Telling you which type of bankruptcy to file;
       Telling you not to list certain debts;
       Telling you not to list certain assets;
       Telling you what property to exempt.

Bankruptcy petition preparers may only type bankruptcy documents and must only charge a reasonable fee. A bankruptcy
petition preparer may not sign any bankruptcy document on your behalf. As the debtor, you must personally sign the
bankruptcy documents. A bankruptcy petition preparer may not collect, receive, or handle the court fees in connections
with your bankruptcy case. That means that the bankruptcy petition preparer cannot accept from you, or another person on
your behalf, any money in any form (i.e., cash, check, or money order) to pay your bankruptcy filing fees or other court fees.
A bankruptcy petition preparer is prohibited from advertising using the word "legal" or any similar term, and may not
advertise under any category that includes the word "legal" or any similar term. This is to prevent bankruptcy petition
preparers from misleading the public or a debtor into believing that the bankruptcy petition preparer is authorized to
practice or otherwise give legal advice.

What must a bankruptcy petition preparer do for a debtor?
If a bankruptcy petition preparer prepares a document for you for filing in your bankruptcy case, the bankruptcy petition
preparer must sign the document and print on the document the preparer's name, address, and Social Security account
number. A bankruptcy petition preparer must provide you with a complete copy of the bankruptcy documents which he or
she prepared for you, not later than the time when you sign the documents. A bankruptcy petition preparer must file with
the bankruptcy court a declaration signed under penalty of perjury disclosing any fee or compensation received from you, or
any person on your behalf, for preparing your bankruptcy documents, and the amount of any fees still owing. The
bankruptcy petition preparer must file this declaration with the court not later then ten days after the filing of your
bankruptcy petition.

What can you do if a bankruptcy petition preparer causes you legal or economic injury?
If your bankruptcy case is dismissed because the bankruptcy petition preparer acted negligently or with intentional
disregard for the Bankruptcy Code and Federal Rules of Bankruptcy Procedure, or if the bankruptcy petition preparer
committed any fraud, unfair or deceptive act which cause you damage, then you may have the right to ask the court to order
the bankruptcy petition preparer to pay:

(a) your actual damages;

(b) the greater of -

                (i) $2,000; or

                (ii) twice the amount paid to the bankruptcy petition preparer for the preparer's services; and


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(c) your attorney's reasonable fees and costs for bringing the motion to recover damages.

If the bankruptcy petition preparer charged you an reasonably high fee for typing bankruptcy documents, you may request
that the court review the reasonableness of the fees. If the court determines that the fees charged were excessive, the court
may order the bankruptcy petition preparer to refund to you all or a portion of the fees you paid.

ADMONITION
As a debtor in bankruptcy, you have rights and obligation defined by law. The choices you make when completing your
bankruptcy documents, and throughout your bankruptcy, will have significant, serious, and long term legal and practical
consequences. If you have questions regarding your legal rights and responsibilities, we urge you to consult with an attorney
immediately. Bankruptcy is a civil proceeding and there is no right to free legal counsel. However, if you cannot afford to
consult an attorney, your local Legal Aid Society may be able to provide you with free or affordable legal counsel.

If you believe that your rights have been violated or that a bankruptcy petition preparer failed to comply with the law, you
may wish to contact an attorney, your bankruptcy trustee, or the United States Trustee.

You must accept these terms to download the questionnaire; however, you are not bound in any way to use our
services.




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Florida

Boca Raton, Florida – Affiliate Office   OFFICE: (561) 206-2883
433 Plaza Real Suite 275                 FAX: (888) 377-2397
Boca Raton, Fl 33432                     Email: bocaraton@doityourselfdocuments.com




Washington State

Federal Way, Washington –                    Monday – Saturday 10:00 am – 9:00 pm
Office/Store                                     Sunday 11:00 am – 6:00 pm
Do It Yourself Documents
                                         OFFICE: (253) 946-0325
The Commons Mall
                                         FAX: (888) 377-2397
1819 South Commons
                                         Email:
Federal Way, WA 98003
                                         federalway@doityourselfdocuments.com


Renton, Washington – Office                       Tuesday 10:00 am – 1:00 pm
Do It Yourself Documents                          Saturday 10:00 am – 4:00 pm
Renton Highlands                          Other days & times available by appointment!
401 Olympia Ave. NE
Suite 338, Box 36
Renton, WA 98056                         OFFICE: (425) 226-2457
                                         FAX: (888) 377-2397
                                         Email: renton@doityourselfdocuments.com


Tacoma, Washington – Office/Store            Monday – Saturday 10:00 am – 7:00 pm
Do It Yourself Documents                         Sunday 12:00 pm – 5:00 pm
Freighthouse Square
430 East 25th Street
Suite 107                                OFFICE: (253) 476-2700
Tacoma, WA 98421                         FAX: (888) 377-2397
                                         Email: tacoma@doityourselfdocuments.com




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