Individual Bankruptcy Questionnaire

General Questions

Step 2 of 3

Your answers to these general questions will help me to understand your unique situation, including what you have done or has been done to you. Many people make decisions that do not lead to problems outside bankruptcy, but in a bankruptcy those same innocent decisions can be disastrous. Based on your answers I will customize my advice with the goal of helping you avoid problems, if possible. I realize this is a lot of information, but accurate information will be your best friend. A friend of mine says “garbage in, garbage out”. He is correct because if I get the wrong information from you I will most likely give you the wrong legal advice.

I/We watched the educational videos about the bankruptcy process. It is important to note that these videos are instrumental in helping you undersand how bankruptcy works. Therefore, if you did not watched all 9 videos, please do so before sending this form to our office.*

Yes
No

THE FOLLOWING ARE GENERAL QUESTIONS REGARDING YOUR CURRENT SITUATION. IF YOU ARE MARRIED PLEASE ANSWER THE QUESTIONS THAT ARE APPLICABLE TO EITHER YOU AND/OR YOUR SPOUSE.

Is there an emergency requiring immediate filing?*

Yes
No

If so, why?

Is there a foreclosure or trustee's sale pending?*

Yes
No

If so, what is the scheduled date and time of the foreclosure?*

Do you understand there are two on-line courses required as part of a bankruptcy? The first, a credit counseling course, must be completed BEFORE filing, The second, a financial management course, must be completed AFTER filing the bankruptcy.*

Yes
No

Are creditors calling at work/home/neighbors?*

Yes
No

What is the the most important issue you are having?*

Do you or spouse (if any) owe any back child support or alimony?*

Yes
No

How much do you owe in back child support and/or alimony and to whom?*

If so, do you understand that exempt property (house, cars, etc.) could be sold to pay back child support and/or alimony Section 522(c)(1))? Ask me for more information.*

Yes
No

Is a law suit pending or completed?*

Yes
No

What is the status of the lawsuit? When was it served or approximately when was it completed and a judgment entered?

Are any wages or checking accounts being garnished?*

Yes
No

If so, by whom, approximately how much and when?

Is a landlord trying to evict you?*

Yes
No

If so, did your landlord obtain a Forcible Entry & Detainer Order? When?*

If the landlord already has a court order, bankruptcy might buy you a couple of weelks, but it will not stop the eviction. Bankruptcy will elminate most of your debts, like medical bills, credit cards, personal loans, and some old taxes.

Any participation in any Internet or social media sites where you offered expensive items for sale or discussed expensive items you own or debts you owe?.*

NOTE: If the social media setting is set to "public" then anyone, including creditors and collection companies, can see all the posts. Consider using "private" settings in order to protect you and your family from unwanted stalking.

Yes
No

Briefly explain the sale of property or discussion via social media.

THE FOLLOWING QUESTIONS RELATE TO CERTAIN ISSUES THAT DETERMINE WHETHER OR NOT IT IS APPROPRIATE TO FILE A BANKRUPTCY AND, IF SO, WHEN TO FILE.

Do you (and spouse, if any) understand that every debt must be listed in the bankruptcy?*

Understand that only the debts you owe on the day of filing the bankruptcy will be dealt with in the bankruptcy. But any new debts you incur after bankruptcy will be your obligation.

Yes
No

Do you (and spouse, if any) ) ever expect an inheritance?*

Understand that you will be required to surrender any inheritance after bankruptcy to your creditors. In Chapter 7 that surrender period is 6 months; in Chapter 13, it is the life of the plan (3-5 years).

Yes
No

Briefly describe what you expect may happen.

IMPORTANT: Do you (and spouse, if any) expect to receive a tax refund for this year or any prior tax year?*

Understand that any refunds not collected and spent properly by the date a bankruptcy is filed will be paid to the bankruptcy trustee.

Yes
No

List the year and approximately how much you received or expect to receive.

IMPORTANT: Do you normally receive Earned Income or Child tax credits?*

Yes
No

List the year and approximately how much you received or expect to receive from Earned Income, or Child tax credits.*

Does anyone owe you (or spouse, if any) ) money or you have a right to any assets? Explain even if you never expect to collect the money or receive the asset.*

Yes
No

Explain how much is owed or what rights you may have.

Do you (or spouse, if any) have a right to sue anyone for anything (this includes vehicle accidents, wrongful termination, collection company abuse or any other type of right)? If so, explain what for and how much you might be owed.*

Yes
No

Briefly, what happened which you believe gives you a right to sue someone?

Such as: a car accident. How much are you owed and for what?

In the last 4 years have you (or spouse, if any) sold, traded or gave away any item of value?*

This would include houses, land, cars, businesses, generally any items of value. It is best to explain the circumstances so we can discuss any issues.

Yes
No

What did you (or spouse, if any) transfer (sell, trade or use as collateral)? How much was it worth and how much did you receive?

In the last 10 years have you (or spouse, if any) sold, traded or gave away any item of value at the same time the IRS filed a lien?*

If the IRS has a lien at the time property was transferred, then the bankruptcy trustee can step into the IRS's shoes and attempt to avoid the transfer and collect funds that are owed to the IRS - Section 544(b).

Yes
No

In the last 4 years have you (or spouse, if any) used any of your property (such as vehicle, furniture, jewelry) to obtain a loan? (like those terrible vehicle title or registration loans)*

For instance, using a vehicle to obtain a loan, such as a title loan. It is best to explain the circumstances, so we can discuss any issues.

Yes
No

What was used to secured the loan (such as a car or home)? How much was it worth and how much money was receive?

Do you (or spouse, if any) owe any money to any friend or relative?*

Yes
No

How much do you (or spouse, if any) owe to family or friends?

In the two years have you (or spouse, if any) repaid family or friends on any loans?*

Yes
No

How much was repaid to family or friends in the last two years?

Paying family and friends back while not paying other bills can be a problem. Please talk to me about the ramifications.

CREDIT CARDS, BANKS AND OTHER DEBTS:

Are there any debts which are business or non-consumer debts?*

Business debts include some student loans, taxes, or loans, credit card charges, or leases used for business purposes.

Yes
No

Approximately how much do you (or spouse, if any) owe which is business or non-personal debts. Make sure to include both secured and unsecured*

*Make sure to include debts for investment properties as secured business debts. *Also include any monies you charged on your personal credit cards but used for business purposes.

Did you (or spouse, if any) or your company take out a PPP, EIDL or other government assistance loans?*

PPP loans are payroll protection loans, or COVID-19 Economic Injury Disaster Loan (EIDL), plus there were several other types of SBA loans offered.

Yes
No

If you (or spouse, if any) took out a PPP or EIDL loan - how much was the loan?*

If you (or spouse, if any) took out a PPP or EIDL loan - how were the funds used?*

What did you use the funds for? The lender will want specific details. Make sure to have good business records. If under $25,000, no collateral or guarantee is required. If over $100,000 of collateral was required on the business, if $200,000 or more, a loan on your home was required. IMPORTANT: If you are closing the business, you are required to send the lender and/or SBA a notice that the business is closed and where the business assets are located. Keep a copy of that letter because this could become very important.

If bankruptcy is in your future do you (or spouse, if any) understand that you must stop using credit cards now?*

This is very important.

Yes
No

Do you (or spouse, if any) have credit cards or signature loans (this includes old debts)?*

Answer "yes" if you have any old or new credit cards or signature loans that are not paid in full at this time. Answer "yes" even if the creditor "wrote off" the debt. To write off a debt does not mean the debt is gone, it means the creditor will most likely sell it to a debt collector.

Yes
No

When did you (or spouse, if any) last use a credit card or signature loan, or balance transferred?*

You only need to provide the year and approximate date and month. It is okay to guess as to the day and month, but not the year.

If more than $1,500 been charged on one credit card in the last 3 months?

Briefly explain the total amount charged in the last 3 months, and how the funds were used.

In the last 6 months were there any charges/cash advances/balance transfers of more than $500 on a single credit card or signature loan?*

It is better to include all transfers or charges so we can discuss the specifics in more detail.

Yes
No

Was a store credit card used to finance expensive items at that store? For instance: using a Best Buy credit card to finance a computer at Best Buy.*

Yes
No

What was purchased and how much is still owing on the credit card.

We will talk about secured debts.

Do you (or spouse, if any) have any cash reward cards, gift cards, etc worth more than $100?*

Yes
No

Where do you (or spouse, if any) bank (list all banks)?*

BEWARE: I DO NOT RECOMMEND BANKING AT WELLS FARGO IF YOU ARE CONSIDERING BANKRUPTCY (THEY MAY FREEZE YOUR ACCOUNTS). BEFORE CLOSING ANY ACCOUNT(S), GET 12 MONTHS OF BANK STATEMENTS (YOU WILL NEED THESE LATER).

Do you (or spouse, if any) owe any money (like credit cards, car loans) to the bank where you are currently banking?*

If bankruptcy is in the future please move to a new bank now, after you get 12 months of bank statements. Request and use a debit card. DO NOT PUT YOUR NAME ON ANY ACCOUNT WITH SOMEONE ELSE AND DO NOT PUT YOUR MONEY INTO SOMEONE ELSE'S BANK ACCOUNT.

Yes
No

Is anyone (other than your spouse, if any) an authorized user on any credit card?*

Yes
No

If yes - you should remove them as an authorized user prior to filing a bankruptcy. Talk to Diane about this issue.

Is your name (or spouse, if any) on anyone else's debt (credit card, land, vehicle, etc.)?*

Yes
No

If you file bankruptcy, this may become an issue. Talk to Diane

If so, please explain.*

Do you (or spouse, if any) receive Social Security or VA disability?*

If so, please list it at the end of this form when asked about any type of income. Also, you MUST have Social Security or the VA put those funds into a completely separate account. Ask Diane for instructions on how to protect those funds in a segregated bank account. If you do this right those funds will be protected.

Yes
No

If so, how much do you (or spouse, if any) receive monthly?*

Do you (or spouse, if any) owe any federal or state taxes?*

Yes
No

Back taxes: list the taxing agency (IRS or state), approximately how much and for what tax year.

In the last 5 years were any tax returns filed late?*

Yes
No

In other words, were the returns filed after the date they were due, including extensions.

List year of the returns(s) and approximately when the return(s) was actually filed.

For instance: 2013 federal return, no extension, filed November 2014. Owe $2,400.

In the last 2 years were any credit cards used to pay taxes?*

If so, this debt may survive the bankruptcy.

Yes
No

When and how much was charged on a credit card to pay taxes?*

Has the IRS/or any state taxing authority garnished your (or spouse, if any) wages or recorded a lien? A lien is normally recorded with the County Recorder’s office.*

Yes
No

Garnishment for back taxes or liens. Explain the year the taxes were due, when they were filed and how much was garnished or liened.

Do you (or spouse, if any) have any loans with a credit union?*

Beware of a cross-collateralized accounts with your credit union. I will explain what this means when we talk. BEWARE: CREDIT UNIONS HAVE A SECURED CLAIM ON ANY OF THEIR ACCOUNTS, THIS MAY INCLUDE SOCIAL SECURITY. IF YOU DO NOT PAY A DEBT OWED TO THE CREDIT UNION, THEY CAN SEIZE ANY MONIES THEY ARE HOLDING. MOVE TO A NEW BANK.

Yes
No

List all loans with that one credit union (vehicle, signature or credit cards).*

Most credit unions tie all your loans to any secured debts "cross-collateralized". Which means credit cards and personal loans are tied to your mortgage or vehicle loan.

If so, do you understand that it is best to move ALL your money out of the credit union so they will not set off (take) your money.*

WARNING: Beware of an cross-collateralized accounts with your credit union.

Yes
No

Do you (or spouse, if any) have any payday loans?*

Yes
No

If so, do you understand these bank accounts should be closed so the loan company cannot access your money. Before closing an account make sure to get 12 months of bank statements (otherwise they may charge you for the statements when you need them later).*

Yes
No

Do you (or spouse, if any) have any student loans or did you guaranty a student loan for another person?*

Yes
No

Approximately how much do you (or spouse, if any) owe in federal student loans and from what year(s)?

Approximately how much is owed in private student loans and from what year(s)?

Several types of loans associated with education expenses are dischargeable in bankruptcy, like most other types of unsecured consumer debt. These types of loans for education expenses are not subject to the more difficult standard and extra step. These loans could include, for example: *Loans where the loan amount was higher than the cost of attendance (such as tuition, books, room, and board), which can occur when a loan is paid directly to a consumer. *Loans to pay for education at places that are not eligible for Title IV funding such as unaccredited colleges, a school in a foreign country, or unaccredited training and trade certificate programs. *Loans made to cover fees and living expenses incurred while studying for the bar exam or other professional exams. *Loans made to cover fees, living expenses, and moving costs associated with medical or dental residency. *Loans to a student attending school less than half-time.

If so, do you (or spouse, if any) understand that most of your student loans or student loans you guaranteed are not discharged in bankruptcy without bringing a separate action?*

Link to find out more about student loan programs: https://studentaid.gov/idr/ and Student Loan forgiveness: https://www.consumerfinance.gov/paying-for-college/student-loan-forgiveness/ A separate action is filed in the Bankruptcy Court and will involve additional legal assistance.This firm does not bring student loan complaints.We will try to provide you with recommendations for attorneys who may be able to help. 2023: There is a new process that might be used to address student loans in bankruptcy, assuming you have pursued the administrative options outside bankruptcy. Make sure to discuss this with Diane.

Yes
No

In the last two years has any tuition been paid for dependants over the age of 18?*

Yes
No

If so, do you (or spouse, if any) understand that the bankruptcy judge may require the school that received the tuition repay it to your creditors?*

The school that had to surrender the tuition may then require the student to pay the tuition or they may withhold the diploma or information regarding the status of classes until the tuition is paid. This is a changing area of law.

Yes
No

Do you (or spouse, if any) have any outstanding fines or penalties? (e.g.: court fines or tickets)*

If so, these may not be discharged in bankruptcy.

Yes
No

Have you (or spouse, if any) ever had a criminal conviction?*

If so, these may not be discharged in a bankruptcy.

Yes
No

Do you (or spouse, if any) have any unpaid restitution orders? (either civil or criminal)*

If so, these may not be discharged in bankruptcy.

Yes
No

Do you (or spouse, if any) have a DUI?*

If so, these may not be discharged in bankruptcy.

Yes
No

HOME, LAND AND VEHICLES

Are you (or spouse, if any) renting or leasing anything (apartment, house, equipment, land)?*

Yes
No

Leases

What are you leasing: an apartment or other? When does the lease expire? IMPORTANT NOTE: YOU MUST FILE AN ASSUMPTION OF A RESIDENTIAL LEASE WITHIN 60 DAYS AFTER YOUR BANKRUPTCY IS FILED, OR YOUR LANDLORD COULD TERMINATE YOUR LEASE.

Do you (or spouse, if any) OWN a home, mobile home, timeshare or land anywhere in the world?*

Yes
No

If you said you are not renting and don't own a home, please explain where you live. "Own" means your name is on title to a home, condo, or any other place you live, even if it is paid in full (no mortgage).

The name(s) on the title of the house or land:*

Where is the property located (state and county)? Also, describe (e.g. 2 bed/3 bath, 1340 sq ft):*

IMPORTANT: Do you have an adjustable rate mortgage?*

Yes
No

IMPORTANT: Are you in any mortgage modification programs?*

If so, check with your lender/servicer to make certain bankruptcy will not interfere with the loan modification.

Yes
No

IMPORTANT: Did you purchase the house within the last 3 years, 4 months?*

If so, 522(p) may restrict your exemption below the amount allowed by Arizona law. Discuss with Diane where the money came from to buy your current home.

Yes
No

Where did the funds come from to buy your current home? Also, if you used funds from the sale of a prior property - what state was that property located in?*

How much would your home sell for in its current condition?*

I am asking what your house/land would sell for in today's market, not what you want it to sell for.

Are there any loans (mortgages) on this property?*

Yes
No

Name of first Lender.*

What is the total amount owed to your first lender?*

Are the payments behind to your first lender?*

Yes
No

Approximately how much is owed to your first lender to bring the loan current?*

Suggestion- do you have a problem paying your mortgage?

If you have a delinquent mortgage, talk to Diane about a possible loan modification as part of bankruptcy (chapters 7, 11, 12, and 13), called the Mortgage Modification Mediation Program ("MMMP"). A modification is not guaranteed, but Arizona has high success rates. There are specific requirements and additional legal fees. The MMMP delays your discharge in Chapter 7.

Is there a second lender on this property?*

Yes
No

Name of second lender.*

Debt owed to second lender.*

Are any payments behind to the second lender?*

Yes
No

Payment arrears to second lender?*

How much must be paid to bring the payments current?

Are there any other loans on this property?*

Yes
No

Name of third lender:*

Total amount owed on any other loans secured on this property*

Are you behind on any other mortgage payments besides your first and second mortgages?*

Yes
No

Do you have a reverse mortgage?*

Yes
No

Is there a foreclosure or trustee’s sale pending?*

Yes
No

If so, what is the date and time of foreclosure?*

If there is a trustee's sale pending, please provide us a copy of trustee sale documents.

**It is your responsibility to confirm the trustee sale date and at all times to keep track of that date and any postponements; including the entire time your bankruptcy is pending. This office will not monitor the date of sale for you, but we be happy to answer your questions regarding the trustee sale process.

Are any of the home loans a VA loan?*

VERY IMPORTANT!

Yes
No

If so, do you understand you have personal liability for the debt because the Arizona anti-deficiency statute does not protect you from a deficiency action.*

VERY IMPORTANT!

Yes
No

Is there a homeowner's association?*

Yes
No

Are the homeowner's association payments current?*

Yes
No

When was the last HOA payment made?*

Approximately how much is owed to bring this HOA current?*

Has the homeowners' association filed a lawsuit?*

Do you understand that the bankruptcy will not allow you to keep your home unless you pay the homeowner's dues?*

Yes
No

Do you understand that as long as you own the property the bankruptcy will not protect you from being sued for homeowner's dues owed AFTER filing the bankruptcy?*

Yes
No

In the last 10 years have you made any large mortgage payments in addition to the regular monthly payment?

Yes
No

Please describe:

Do you own another home, land or timeshare?*

Yes
No

Describe (e.g. 2 bed/3 bath, 1340 sq ft):*

Fair Market Value?*

The name(s) on the title of the house or land:*

Are there any loans on this second property?*

Yes
No

First Lender:*

Debt Owed*

If you are behind on payments how much is due in order to bring the loan current?

Are there any additional loans on this second property?*

Yes
No

Name of the second lender*

What is the total amount you owe to the second lender?*

If you are behind on payments to the second lender - how much do you owe in order to bring the loan current?*

Is there a third mortgage on this second property?*

Yes
No

Name of third lender.*

Debt owed to third lender*

If you are behind on paying another lender - how much to bring this(these) loan(s) current?

Is there a pending foreclosure or trustee’s sale on this second property?*

Yes
No

If so, what is the date and time of foreclosure:*

Is there a homeowner's association on this second property?*

Yes
No

Are the homeowner's association payments current on this second property?*

Yes
No

When was the last payment made?*

How much is owed and for how many months?*

Do you own a third real estate? (e.g. house, land, timeshares, etc)*

Yes
No

Describe - such as is it raw land, a timeshare, summer house?*

Fair market value:*

Debt owed:*

Do you own a 4th piece of real estate? (e.g. house, land, timeshares, etc)*

Yes
No

Describe:*

Fair market value:*

Debt owed:*

Do you own a 5th piece of real estate? (e.g. house, land, timeshares, etc)*

Yes
No

Describe:*

Fair market value:*

Debt owed:*

VEHICLE INFORMATION

List all vehicles in your name (or your spouse, if any) that are leased, no matter where they are located or who is driving them.
List all the debts on any of the vehicles.
List the fair market value of each vehicle using the resources below. Resources for fair market value: www.kbb.com (YOU MUST USE PRIVATE PARTY VALUE), www.edmunds.com, or www.NADA.com. I cannot give you good advice without an accurate, fair market value.

Are you leasing a vehicle or equipment?*

Yes
No

Leases of vehicles or equipment*

What are you leasing:? When does the lease expire?

Is your name (or your spouse's, if any) on the title of any type of vehicle (including RV, motorhome, travel trailer, enclosed trailer, truck camper, or 5th wheel) anywhere in the world? This includes vehicles you are paying for and those that are paid off. This also includes a vehicle that your name is on the title, but someone else is driving.*

Yes
No

Do not list leased vehicles.

Handicapped plate or placard - Do you, your spouse or your child have a handicap?*

There is a higher exemption for this vehicle if the debtor or dependent is handicapped.

Yes
No

Description and year of vehicle number one.*

Name(s) on the title of vehicle number one.*

This information should be on the registration.

Month and year vehicle number one was purchased*

Fair Market Value of vehicle number one. MUST BE FROM KELLEY BLUE BOOK, PRIVATE PARTY VALUE. KEEP A COPY OF THE PRINTOUT. DO NOT GUESS AT VALUE.*

You must list the Kelly Blue Book private party value - www.KBB.com. I cannot help you without this information.

Debt Owed*

Do you own a second vehicle?*

Yes
No

Description and year of vehicle number two*

Name(s) on title of the second vehicle.*

Year and month second vehicle was purchased*

Fair market value of second vehicle. MUST BE FROM KELLEY BLUE BOOK, PRIVATE PARTY VALUE. KEEP A COPY OF THE PRINTOUT. DO NOT GUESS AT VALUE.*

You must list the Kelly Blue Book private party value - www.KBB.com. I cannot help you without this information.

Total amount owed on second vehicle*

Do you own a third vehicle?*

Yes
No

Description of third vehicle*

Name(s) on the title of the third vehicle.*

Month and year third vehicle was purchased*

Fair market value of third vehicle. Fair market value of second vehicle. MUST BE FROM KELLEY BLUE BOOK, PRIVATE PARTY VALUE. KEEP A COPY OF THE PRINTOUT. DO NOT GUESS AT VALUE - FOLLOW DIRECTIONS BELOW*

You must list the Kelly Blue Book private party value - www.KBB.com. I cannot help you without this information.

How much is owed on the third vehicle?*

Do you own a fourth vehicle?*

Yes
No

Description of fourth vehicle*

Name(s) on the title of the fourth vehicle.*

Month and year fourth vehicle was purchased*

Fair market value of fourth vehicle. Fair MUST BE FROM KELLEY BLUE BOOK, PRIVATE PARTY VALUE. KEEP A COPY OF THE PRINTOUT. DO NOT GUESS AT VALUE.*

You must list the Kelly Blue Book private party value - www.KBB.com. I cannot help you without this information.

How much is owed on the fourth vehicle?*

Do you own a fifth vehicle?*

Yes
No

Description of fifth vehicle*

Name(s) on the title of the fifth vehicle.*

Month and year fifth vehicle was purchased*

Fair market value of fifth vehicle. MUST BE FROM KELLEY BLUE BOOK, PRIVATE PARTY VALUE. KEEP A COPY OF THE PRINTOUT. DO NOT GUESS AT VALUE.*

You must list the Kelly Blue Book private party value - www.KBB.com. I cannot help you without this information.

How much is owed on the fifth vehicle?*

Of your current vehicles, did you refinance any vehicle after it was originally purchased?*

Yes
No

Refinancing a vehicle includes a title or registration loan. Which vehicle, who is the lender and how much are they owed?

Did you finance any of these vehicles with a credit union? If so, which vehicle and what credit union?*

Yes
No

If so, which vehicle, what credit union and do you have any other debts with that same credit union?*

ASSETS, INCLUDING BUSINESSES:

Other than vehicles or houses, are there any valuable items that you are concerned about losing?

Yes
No

If so, describe the items(s) and include their fair market value.

Do you (or your spouse, if any) have any interest in any business that is operating today (this includes sole proprietorships)?*

This includes a business that does not have a formal LLC or corporate name, which is usually a sole proprietorship.

Yes
No

Briefly describe the business.*

What would a third party pay for that interest in the business?*

Normally you can value a business by subtracting liabilities (debts, including leases) from assets (including accounts receivable). Just provide us with a general guess.

Does the business have any assets, inventory, or contracts?*

Yes
No

Briefly describe, make sure to include accounts receivable, etc.*

Does the business have any leases on anything (vehicles, equipment, land)?*

Yes
No

What property is leased?*

Did you (or your spouse, if any) sign any personal guaranty for any company debts (includes leases, credit cards, or other extensions of credit)?

Such as signing on the business lease or credit card.

Yes
No

Explain

Do you understand that by filing for bankruptcy your (or your spouse, if any) interest in the business may be taken?*

This result will differ if you file chapter 11 or 13.

Yes
No

Did you (or your spouse, if any) have any interest in any business in the last 8 years, even if it is no longer in operation?*

Yes
No

Business name, is the business operating or closed? If closed, approximately when?*

Is your name (or your spouse, if any) on any beneficiary deeds (for instance, Mom signed a beneficiary deed so you become the owner of her property once she passed.*

It's crucial that you understand that the bankruptcy trustee or creditors may sell your rights because they are not exempt.

Yes
No

Do you (or your spouse, if any) have any type of crypto or electronic assets?*

It's crucial that you understand that the bankruptcy trustee or creditors may seize these assets because they are not exempt.

Yes
No

If so, is it important you (and your spouse, if any) disclose all assets, which includes electronic assets.

Here is a link the trustees can use to search for these assets: https://help.coinbase.com/en/coinbase/other-topics/other/bankruptcy-trustee-guide#serving-and-communicating-with-coinbase

Yes
No

Do you (or your spouse, if any) have a trust?*

Yes
No

If so, is it revocable or irrevocable? Revocable means the trust can be changed later. IT IS VERY IMPORTANT TO TALK TO DIANE ABOUT REASSIGNING EXEMPT PROPERTY TO YOU BEFORE FILING BANKRUPTCY. THIS IS YOUR JOB TO ASK DIANE.

Yes
No

Describe the assets in the trust.*

Such as a home, vehicle, business, bank account, etc.

Could your name (or your spouse, if any) be on someone else's trust?*

Yes
No

Please describe the trust.*

For instance - my name is on my mother's trust, but she is in excellent health and does not have valuable property.

Do you (or your spouse, if any) receive any type of disability? This includes any employer owned policies, VA, or other governmental provided disability.*

Yes
No

Do you (or your spouse, if any) own a disability insurance policy? This does not include employer owned, VA, or other governmental provided disability.*

Yes
No

Do you (or your spouse, if any) have stocks, bonds (including savings bonds) or mutual funds?*

Yes
No

Please Describe

Do you (or your spouse, if any) have any retirement accounts?*

Yes
No

Please Describe

In the last 120 days have any contributions be made into those retirement account(s)?*

It is important to discuss if these contributions were required as part of your employment.

Yes
No

Important questions: How long have you (or your spouse, if any) had the IRA? How was it setup? Was it a rollover from another retirement account? Was the retirement plan cashed out and then rolled over? What have the withdrawals been used for?

It is important that you talk to your plan administrator or CPA in order to determine if all changes following the regulations governing the retirement plan. Failure to follow the regulations could result in losing your retirement plan in bankruptcy.

Do you (or your spouse, if any) have any health savings accounts?*

Yes
No

Please Describe. BEWARE health savings may not exempt in Arizona.

Spend any HSA or similar funds before filing a bankruptcy.

Did you (or your spouse, if any) inherit any retirement accounts?*

Inherited 401K are NOT property of the estate. But inherited IRAs ARE, but Arizona has an exemption for inherited IRAs (with some exceptions). If you have any inherited retirement accounts, make sure to discuss this with Diane.

Yes
No

Please Describe

Do you (or your spouse, if any) have any annuities or other such accounts?*

Yes
No

Please Describe, make sure to include the date the annuity was established and if the beneficiary is a family member.

NOTE: it is very important to make absolutely certain that your retirement accounts are ERISA qualified. You can talk to your employer, HR, or plan administrator, or the word ERISA may be on your plan summary..

Do you (or your spouse, if any) have any bitcoin or any type of crypto assets?*

Yes
No

Do you (or your spouse, if any) have any pre-paid tickets, vacations, medical, dental, vehicle warranties or other services?*

Yes
No

If so, how much was paid and what is it for (for instance prepaid dentist for braces, or bought plane or cruise ticket for next month).

At this time have you (or your spouse, if any) pre-paid tuition to any school?*

Yes
No

If so, how much was paid, what period of time does the payment cover and the age of the child:

Do you (or your spouse, if any) have any education IRA (such as 529 or 530 accounts) or a qualified state tuition program (521c)?*

WARNING - THE ACCOUNT MUST BE ESTABLISHED FOR MORE THAN 2 YEARS. ANY MONIES DEPOSITED IN THE 12 MONTHS BEFORE FILING BANKRUPTCY ARE NOT PROTECTED. THERE ARE ADDITIONAL LIMITS ON THE AMOUNTS CONTRIBUTED WITHIN CERTAIN TIME PERIODS.

Yes
No

Have you (or your spouse, if any) deposted any funds in the last 12 months?

Yes
No

Were those funds deposted more than 12 months ago, but less than 24 months?

Yes
No

Were the funds deposited more than twenty four months ago?

Yes
No

MISCELLANEOUS

Are you and your spouse in the middle of a divorce or separation?*

Yes
No

In the middle of a divorce or separation? Briefly explain your situation.*

Have you (or your spouse, if any) been divorced or a spouse passed away in the last 10 years?*

Yes
No

Approximately when was the divorce final or your spouse passed?*

If there was more than one divorce, please explain who and when.

Are there any assets that are still to be delivered to you (or your spouse, if any)?

Yes
No

List the assets, their value.

Are there any sole and separate assets of you (or your spouse, if any)?*

Sole and separate assets are those brought into the marriage, given to you (or your spouse) during marriage by someone who is not your spouse, inherited, or purchased from income of your sole and separate property and THAT WERE NEVER COMINGLED. Make sure to include the resale value.

Yes
No

List items, including fair market value:*

Are there any co-debtors (this includes a business debt that you guaranteed)?*

In other words, did any business or person (parent, friend, or ex-spouse) sign on any of your debts, or did you sign on their debts? For example, a parent is a co-debtor if they sign a loan on a vehicle with their child.

Yes
No

List the co-debtors, include what you (or your spouse, if any) signed for and the current debt owed.

In the last twelve months were there any bounced checks which have not been paid?

Yes
No

Were any household furnishings, jewelry or vehicles used as security for a loan?*

Like those horrible title or registration loans.

Yes
No

What items were used as collateral for a loan? Make sure to include the fair market value of the item and the total debt owed.

(If so, YOU MUST -- USE ACTUAL REPLACEMENT VALUE (506(a)(2)) and additional legal action will be necessary in Bankruptcy Court.)

Do you (or your spouse, if any) have property in pawn?*

Yes
No

Has the redemption period expired to reclaim the property?*

Yes
No

IMPORTANT: IF ANY OF THE FOLLOWING SITUATIONS APPLY TO YOU THEN WE WILL NEED TO DISCUSS THE CONSQUENCES OF FILING FOR BANKRUPTCY.

Were all the loan applications signed in the last 10 years truthful?*

Yes
No

Are there any judgments or threatened lawsuits for destruction of property or for injury inflicted (like DUI)?*

Yes
No

Please Explain

Do you (or your spouse, if any) understand that any debts from obtaining money, property, or services by fraud may survive the bankruptcy?*

Yes
No

Do you (or your spouse, if any) understand that debts based on fraud while acting in a fiduciary capacity (such as embezzlement) may survive the bankruptcy?*

Yes
No

Thanks, only one more section to go!

Please proceed to the final step of this financial Information and we will have all we need to schedule your free consultation. WARNING: TO AVOID LOSING YOUR INFORMATION DO NOT TURN OFF YOUR COMPUTER OR LEAVE THIS SITE UNTIL THE FORM IS SUBMITTED (YOU WILL RECEIVE A CONFIRMATION WHEN IT IS SUBMITTED). PLEASE NOTE - WE DO NOT HAVE ACCESS TO ANY INFORMATION UNTIL THE FORM IS SUBMITTED.

Individual Bankruptcy Questionnaire

General Information

Step 1 of 3

GENERAL INFORMATION FOR AN INDIVIDUAL OR MARRIED COUPLE

Information about your current Spouse

Individual #1

Individual #2

Individual #3

Individual #4

Thanks, you're doing great so far! If information is missing, the software will put a red highlight around the missing information. Fill it out, then proceed.

General Questions

Step 2 of 3

THE FOLLOWING ARE GENERAL QUESTIONS REGARDING YOUR CURRENT SITUATION. IF YOU ARE MARRIED PLEASE ANSWER THE QUESTIONS THAT ARE APPLICABLE TO EITHER YOU AND/OR YOUR SPOUSE.

THE FOLLOWING QUESTIONS RELATE TO CERTAIN ISSUES THAT DETERMINE WHETHER OR NOT IT IS APPROPRIATE TO FILE A BANKRUPTCY AND, IF SO, WHEN TO FILE.

CREDIT CARDS, BANKS AND OTHER DEBTS:

HOME, LAND AND VEHICLES

VEHICLE INFORMATION

ASSETS, INCLUDING BUSINESSES:

MISCELLANEOUS

IMPORTANT: IF ANY OF THE FOLLOWING SITUATIONS APPLY TO YOU THEN WE WILL NEED TO DISCUSS THE CONSQUENCES OF FILING FOR BANKRUPTCY.

Thanks, only one more section to go!

Financial Information & Monthly Budget

MONTHLY LIVING EXPENSES

Taxes

Insurance

Vehicles

Other Monthly Expenses

MEANS TEST - INCOME FROM ALL SOURCES RECEIVED IN THE LAST SIX MONTHS

All income must be GROSS (before taxes and other deductions).

Other income:

***VERY IMPORTANT!*** WE WILL RETURN THE FORM IF YOU DO NOT FILL THE INCOME INFORMATION. WITHOUT ACCURATE INFORMATION IT IS IMPOSSIBLE FOR DIANE TO GIVE YOU ADVICE.

Your spouse or significant other.

How to calculate monthly expenses:

Additional issues:

FABULOUS JOB, BUT BEFORE YOU TAKE A WELL DESERVED BREAK, PLEASE READ THE INFORMATION BELOW AND SIGN (checkbox) WHERE INDICATED.

IMPORTANT NOTICES REQUIRED BY LAW:

UNITED STATES BANKRUPTCY COURT NOTICE TO INDIVIDUAL CONSUMER DEBTOR UNDER § 342(b) OF THE BANKRUPTCY CODE

“THE FOLLOWING DOCUMENT IS INTENDED TO BE ON A SEPARATE PAGE”

IMPORTANT INFORMATION ABOUT BANKRUPTCY ASSISTANCE SERVICES FROM AN ATTORNEY

Helpful Quick Links

Bankruptcy Questions

Resources

VERY IMPORTANT! WE WILL RETURN THE FORM IF YOU DO NOT FILL THE INCOME INFORMATION. WITHOUT ACCURATE INFORMATION IT IS IMPOSSIBLE FOR DIANE TO GIVE YOU ADVICE.