Individual Bankruptcy Questionnaire

Individuals seeking bankruptcy relief can fill out our bankruptcy questionnaire to receive a FREE consultation.

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1General Information

2General Questions

3Financials & Means Test

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Importance of the questionnaire video by Diane L. Drain.

General Information

Step 1 of 3

We realize you are extremely nervous about your financial situation. Most likely you jump every time the phone rings and lose sleep because you are terrified about your financial future. Let us help you get your life back on track. Our commitment is to provide excellent assistance for very reasonable fees.

Estimated time for most to complete the entire form is 45 to 60 minutes. Most of these questions can be answered without the need for financial documents, but some will require a little more detailed information. Step three deals with income, which is a little more complicated but very important.

Filling out this information and talking with me is not a commitment to filing a bankruptcy, nor is it intended to create an attorney-client relationship. I am not your attorney until you sign a retainer agreement. IN ORDER FOR THE FORM TO MOVE TO THE NEXT PAGE, IT IS VERY IMPORTANT YOU FILL IN ANY QUESTION WITH AN * (asterisk) NEXT TO THE QUESTION, EVEN IF YOU NEED TO PUT "NONE" OR "1).

GENERAL INFORMATION FOR AN INDIVIDUAL OR MARRIED COUPLE

First Name*

Complete Middle Name*

Say N/A is you do not have a middle name.

Last Name*

Street Address*

City*

County*

State*

Zip Code*

Your age*

Have you lived in Arizona for*

More than 2 years

Less than 2 years

When did you move to Arizona?*

Approximately the month and year you moved here.

Since you did not live Arizona for the last 2 years, where did you live and for how long?*

Primary Phone*

Secondary Phone

Email*

Are you currently married?*

Yes

If not married now, have you been married in the past 10 years?*

Yes

Are there any unpaid debts from your marriage?*

Yes

Information about your current Spouse

Please fill out your spouse's information, even if you do not live together, or your spouse does not want to participate in learning about bankruptcy, or other options.

Spouse's First Name*

Spouse's Complete Middle Name*

Say N/A is you do not have a middle name.

Spouse's Last Name*

Spouses primary contact phone number*

Spouses e-mail address*

Spouse's age*

Year you were married.*

Do you and your spouse live together?*

Yes

Spouse's street Address*

City*

County*

State*

Zip Code*

If you are not married today, have you been married in the last 10 years?*

Yes

Do you have people who live with you or that you deduct on your taxes?*

Yes

Individual #1

Name*

First Last

Age?*

Relationship to you*

Is this person living with you?*

Yes

1 - Do you have additional people who live with you or that you deduct on your taxes?*

Yes

Individual #2

Name*

First Last

Age?*

Relationship to you*

Is this person living with you?*

Yes

2 - Do you have additional people who live with you or that you deduct on your taxes?*

Yes

Individual #3

Name*

First Last

Age?*

Relationship to you*

Is this person living with you?*

Yes

3 - Do you have additional people who live with you or that you deduct on your taxes?*

Yes

Individual #4

Name*

First Last

Age?*

Relationship to you*

Is this person living with you?*

Yes

How did you find out about our services?*

Referral

AVVO

Google

Teaching

Other

We are always flattered when a prior client, friend or fellow attorney refers a potential client. Please let us know their name so we can thank them. Instead, if you did a search on the Internet please let us know how you found us. Thank you for this information.

If you were referred by someone, what is their name?

What is your primary reason or reasons for wanting to learn more about bankruptcy?*

Bankruptcy is not always the answer so it is important that I understand what you want or need to accomplish. That will help me provide counsel as to whether filing bankruptcy will accomplish your goals.

Have you ever filed bankruptcy before?*

Yes

What year did you file, what chapter, where were you living and the bankrutpcy case number.*

Normally spouses file bankruptcy together, but are not required for various reasons. If you file bankruptcy, are you thinking of filing together?*

Yes

If you are considering filing bankruptcy without your spouse then briefly explain why.*

Did just one spouse incur the debts BEFORE the marriage?*

Yes

If so, please explain.

Have you or your spouse used any other names during the past 8 years?*

Yes

(Example: maiden name, last name from previous marriage, legal name change, etc.)

Your other name Used*

First Last

Dates Used*

Your Spouse's Other Name Used*

First Last

Dates Used*

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.

Please proceed to Step 2 General Questions in the questionnaire so we may get a better understanding of how we can help. 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.

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

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

If so, why?

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

Yes

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

Are creditors calling at work/home/neighbors?*

Yes

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

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

Yes

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

Is a law suit pending or completed?*

Yes

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

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

Is a landlord trying to evict you?*

Yes

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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).

How many bank accounts do you *or spouse, if any) or business have. That includes checking, savings, brokerage, investment, etc. It does not include your credit cards.*

For instance, if you have 2 checking accounts plus a savings account, then you have 3 bank accounts. If your business has 2 checking accounts, then you have a total of 5 bank accounts.

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

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

Yes

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

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

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

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

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

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

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

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

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

Yes

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

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

Yes

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

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

Yes

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

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

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

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

Yes

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

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

If so, these may not be discharged in bankruptcy.

Yes

HOME, LAND AND VEHICLES

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

Yes

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

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

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

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

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

Name of first Lender.*

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

Are the payments behind to your first lender?*

Yes

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

Name of second lender.*

Debt owed to second lender.*

Are any payments behind to the second lender?*

Yes

Payment arrears to second lender?*

How much must be paid to bring the payments current?

Are there any other loans on this property?*

Yes

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

Do you have a reverse mortgage?*

Yes

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

Yes

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

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

Is there a homeowner's association?*

Yes

Are the homeowner's association payments current?*

Yes

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

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

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

Yes

Please describe:

Do you own another home, land or timeshare?*

Yes

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

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

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

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

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

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

Yes

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

Yes

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

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

Describe:*

Fair market value:*

Debt owed:*

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

Yes

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

Leases of vehicles or equipment*

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

PLEASE READ THIS - VERY IMPORTANT: 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

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

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

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

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

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

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

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

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

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

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

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

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

Yes

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

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

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

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

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

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

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

Yes

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

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

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

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

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

Yes

Please Describe

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

Yes

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

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

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

Please Describe

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

Yes

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

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

Yes

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

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

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

Yes

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

Yes

Were the funds deposited more than twenty four months ago?

Yes

MISCELLANEOUS

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

Yes

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

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

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

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

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

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

Like those horrible title or registration loans.

Yes

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

Has the redemption period expired to reclaim the property?*

Yes

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

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

Yes

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

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

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.

Financial Information & Monthly Budget

This form details how much you spend each month for basic living expenses. Be sure to include the MONTHLY (not yearly) amount for these expenses. In Arizona your utility bill is probably higher in the summer than the winter. Therefore take an average covering the last 12-month period. If you are married and your spouse does not reside with you please make a spreadsheet of their expenses and send them to our office. Make sure to include your name on the spreadsheet.

MONTHLY LIVING EXPENSES

How much is your monthly mortgage, rent or mobile home payment*

Second mortgage (if applicable)

Third mortgage (if applicable)

Real estate taxes if it is are not included in house payment.

Home insurance if it is not included in house payment.

Homeowner's Association fees (monthly)

Other real estate payment (house, raw land or timeshare)

Utilities (monthly): Electricity, gas, water, phone, garbage (monthly - just a guess is fine)

Food (Monthly)

Out of Pocket Medical expenses (average monthly) that are not paid by insurance.

Make sure to include co-pays, pharmacy, eye-glasses and dental expenses. This is a monthly average based on what you have been spending. This amount does not include insurance premiums.

Do you have any children that you are supporting?*

Yes

Child Care Expenses (monthly)

School Expenses (do not include lunches) (monthly)

Taxes

Taxes that are not deducted from your wages, Please provide amount and short explanation (such as "self-employed")

Do you owe back taxes?*

Yes

Back taxes*

Please list each year and amount owed for each year.

Monthly payment for back taxes.*

Insurance

Automobile Insurance (monthly)

Renters Insurance (monthly)

Life Insurance that is NOT deducted from a paycheck (monthly)

Health Insurance that is NOT deducted from a paycheck (monthly)

Disability Insurance that is NOT deducted from a paycheck (monthly)

Other Insurance (monthly)

Vehicles

Make sure to list all vehicles you own (whether paid in full or not); include any vehicles you own with someone else. List all payments, including leases.

Vehicle 1 Monthly Payment

Vehicle 2 Monthly Payment

Vehicle 3 Monthly Payment

Is vehicle 1 leased?

Yes

Is vehicle 2 leased?

Yes

Is vehicle 3 leased?

Yes

Monthly average for all vehicles: gas, oil changes, maintenance, tags:

Other Monthly Expenses

Alimony or Child Support (monthly)

Payments for someone outside your home. If so, please explain below.

For instance, sending Grandma $200 per month to help pay her utility. We will need a history in order to show why this should be included as an expense.

Please Explain

Professional Dues or Union Dues not deducted in a paycheck (average monthly)

This may be an annual expenses, but you should divide it by 12 in order to determine the average monthly expense.

Student Loan Repayment(s) (monthly)

College Tuition (do not include student loans) (monthly)

Charitable Giving (if claimed on taxes) (monthly)

(include church, Goodwill, etc.)

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

Are you a disabled vet?*

Yes

Are you currently or within the last 18 months on active duty or performing duties for homeland security?*

Yes

Is your Spouse (if any) a disabled vet?*

Yes

Is your Spouse currently or within the last 18 months on active duty or performing duties for homeland security?*

Yes

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

List income from each employer separately.

List all income in the month it was received, not the month it was due.

Include tips and bonuses in the month they were received.

If you receive a commission, list the amount earned in the month it was received.

Other income:

If income is earned as a sole proprietor - list all income in the month received.

If you receive a salary from your own company list that income in the month you receive it, not when the business received it.

Include retirement income.

Include disability income ; BUT MAKE SURE TO IDENTIFY IF IT IS SOCIAL SECURITY DISABILITY

Include Social Security, BUT MAKE SURE TO IDENTIFY IT AS SOCIAL SECURITY

Include all monies received from any source, including cashing in retirement accounts, sales of large items and tax refunds, etc. Identify the source.

RENTS: include money from rents (after deducting amount paid for mortgage/HOA/utilities, etc).

If someone is living with you - include their net income even if they do not give it to you. To calculate net income deduct their own expenses such as: taxes, insurance, expenses related to vehicles, medical, credit cards, student loans, other housing, business debts, etc.

Include all monies regularly received from gifts or loans from friends or relatives.

The income must be for a full month; therefore use the last full 6 months, do not include the current month.

It is better to list everything and then we can remove what does not apply to your situation.

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.

PLEASE CALL US IF YOU HAVE ANY QUESTIONS at 602-246-7106:

Your Name*

I ask this in order to keep income from multiple sources organized.

Do you have any income? Income includes money from friends, a second job, or welfare - every source of income must be listed.*

Yes

If you have no income, how are you eating?*

If the income is from others (mom pays your phone bill) list the amount they pay monthly.

List each source of "income", such as employer name or other source of income (like Social Security, self-employment, VA disability, gifts from family, etc.) DO NOT COMBINE DIFFERENT SOURCES OF INCOME, PLEASE LIST EACH SEPARATELY. NOTE- this is MONTHLY income.*

Make sure to list GROSS income (before any deductions). Do not list NET income (after deductions like taxes or insurance). If the income is from others (for example, Mom pays your phone bill), list the amount they pay.

Month 1*

Month 2*

Month 3*

Month 4*

Month 5*

Month 6*

Do you have a second source of income? This could be money from friends, a second job, welfare , or someone paying your bills- any source of income must be listed.*

Yes

Employer/Other*

Month 1*

Month 2*

Month 3*

Month 4*

Month 5*

Month 6*

Do you have a third source of income?*

Yes

Employer/Other*

Month 1*

Month 2*

Month 3*

Month 4*

Month 5*

Month 6*

Do you have a fourth source of income?*

Yes

Employer/Other*

Month 1*

Month 2*

Month 3*

Month 4*

Month 5*

Month 6*

Are you married or living with a significant other?*

Yes

Your spouse or significant other.

Spouse or significant other's name*

Is your spouse or significant other receiving any money from any source?*

Yes

This does not mean the spouse or significant other are part of a bankruptcy, but household income is important. Provide the information and ask me to explain.

Identifiy any source of income*

Month 1*

Month 2*

Month 3*

Month 4*

Month 5*

Month 6*

Does your spouse or significant other have a second source of income?*

Yes

Employer/Other*

Month 1*

Month 2*

Month 3*

Month 4*

Month 5*

Month 6*

Does your spouse or significant other have a third source of income?*

Yes

Employer/Other*

Month 1*

Month 2*

Month 3*

Month 4*

Month 5*

Month 6*

How to calculate monthly expenses:

TAXES: If your income fluctuates, then add all taxes for the 6 months above, including anticipated taxes on 1099 income, then divide by 6.

Are you paid the same amount every week? If so, multiply the taxes from one paycheck by 52 and divide by 12 to determine your monthly taxes.

Are you paid the same amount every two weeks? If so, multiply the taxes from one paycheck by 26 and divide by 12 to determine your monthly taxes.

Monthly average taxes (federal, state, FICA, social security, Medicare and self-employment). If you include income for two people (spouse or signficiant other) then add taxes from all income and enter one number.*

Are you withholding the proper amount for taxes?*

Yes

This is very important because you may lose tax refunds when you don't need to. Check out the Tax Withholding Estimator at the IRS's website: https://www.irs.gov/individuals/tax-withholding-estimator

If not, how much should you be withholding (per month) for federal, state, FICA and Medicare taxes*

Monthly MANDATORY payroll deductions (employer forces you to pay: like union dues or forced retirement)

These are expenses that you are required to pay in order to work for this employer. For instance - if you work for the government, they usually require you to contribute to a retirement account.

Monthly life insurance. This may be deducted from a paycheck or you pay the premium directly.

Monthly Court ordered payments (such as child support/alimony)

Monthly education expenses for employment or physically/mentally challenged child.

Monthly childcare costs.*

Monthly health, dental, optical insurance deducted from paycheck or paid directly to the insurance company.

Monthly health care such as co-pays, pharmacy, eye-glasses, dental, etc (out-of-pocket, not paid by insurance)

These expenses need to be averaged over 12 months, then divided by 12 in order to give an average for your "out of pocket" expense. Make sure to include all health care expenses (diabetes medication, eye exams, etc).

Monthly disability Insurance (deducted in paycheck or paid directly)

Monthly health savings account (flex accounts)

Monthly expenses for the care of elderly, chronically ill or disabled member of your household who cannot pay their own expenses:

Monthly education expenses for children under 18 (such as uniforms and books)

Calculate these expenses over a 12 month period and divide by 12 in order to determine the average monthly expense.

Monthly charitable contributions - see your prior tax returns.

Monthly amount withheld to repay loans from retirement accounts.

Additional issues:

Do you owe any back taxes?*

Yes

Amount of back taxes owed.*

Year(s) tax debt due:*

Are you behind on payments to secured creditors (house or car)?*

Yes

If so, the name of Lender. Indicate if home or vehicle.*

Amount owed to bring the loan current:*

Are you behind on any other payments to secured creditors (house or car)?*

Yes

Name of Lender. Indicate if home or vehicle.*

Amount owed to bring the loan current:*

Lender's name and state type of property: home or vehicle*

Amount owed to bring the loan current:*

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

I REALLY APPRECIATE YOUR COMMITMENT TO PROVIDING ACCURATE INFORMATION WHICH WILL ALLOW ME TO GIVE YOU LEGAL ADVICE TAILORED TO YOUR UNIQUE SITUATION. I LOOK FORWARD TO TALKING WITH YOU. PLEASE CALL IF YOU DO NOT HEAR FROM US WITHIN 24 HOURS AFTER SENDING YOUR FORM. YOU ARE VERY IMPORTANT TO US AND WE DO NOT WANT YOU TO FEEL UNNECESSARY STRESS JUST BECAUSE YOU ARE WAITING TO HEAR FROM US. WE ARE REALLY HERE TO HELP YOU. REMEMBER: FILLING OUT THIS INFORMATION AND HAVING THE PHONE DISCUSSION IS NOT A COMMITMENT TO FILING BANKRUPTCY AND IT DOES NOT CREATE AN ATTORNEY-CLIENT RELATIONSHIP. I AM NOT YOUR ATTORNEY UNTIL YOU SIGN A RETAINER AGREEMENT.

IMPORTANT NOTICES REQUIRED BY LAW:

The following notices are required pursuant to 527(a)(2). By signing below you acknowledge that: 1) You understand that all information that you are required to provide to complete any documents filed with the Bankruptcy Court must be complete, accurate and truthful; 2) You will fully and completely disclose all assets and all liabilities in the documents filed with the Bankruptcy Court; 3) You have fully disclosed all sources of income on any documents filed with the court; 4) You understand that any information set forth either in the documents filed with the Bankruptcy Court, or testified to under oath may be audited and that failure to provide accurate information may result in the dismissal of your bankruptcy case or other sanctions, including criminal sanctions; 5) You agree that a faxed or e-mailed signature shall be sufficient to indicate agreement to these notices.

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 counseling services; (2) describes briefly the purposes, benefits and costs of the four types of bankruptcy proceedings you may commence; and (3) 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 budget 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

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 non-dischargeable 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.

Chapter 13: Repayment of All or Part of the Debts of an Individual with Regular Income

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

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

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.

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

Notice required by Bankruptcy Code Section 527(b)

IMPORTANT INFORMATION ABOUT BANKRUPTCY ASSISTANCE SERVICES FROM AN ATTORNEY

If you decide to seek bankruptcy relief, you can represent yourself, hire a qualified bankruptcy attorney, or you are able to answer all questions related to bankruptcy – hire a bankruptcy petition preparer that is not an attorney. Under Arizona law the Arizona Supreme Court must license all Bankruptcy Petition Preparer and they may not give any legal advice, including explaining most of the terms contained in the bankruptcy forms. The law requires that any Attorney or Bankruptcy Petition Preparer give you a written contract specifying the work to be done and the fees to be charged. Before filing any bankruptcy case you and your attorney should analyze your eligibility for different forms of relief available under the bankruptcy code and which type of bankruptcy relief is most beneficial for you. Be sure you understand that relief you can obtain and its limitations. To file a bankruptcy case, documents called a Petition, Schedules, and Statement of Financial Affairs, as well as in some cases a Statement of Intention, must be prepared correctly and filed with the bankruptcy Court. You will have to pay a filing fee to the court. Within a few weeks after your case is filed with the Court you will be required to attend a meeting of creditors where the Trustee assigned to your case will swear you to tell the truth and ask you a few questions. Creditors, should they be present, can also ask questions. In most cases no creditors are ever present. If you choose a chapter 7 case, you may be asked by a creditor who has a lien on your car, computer, appliances or furniture to reaffirm a debt. You should first obtain legal counsel before making any decision related to reaffirming any debt. A creditor is not permitted to coerce or bully you into signing a reaffirmation agreement. If you choose to file a chapter 13 in which you repay your creditors what you can afford over 3 to 5 years, you may also want help with preparing your chapter 13 plan and with the confirmation hearing on your plan. A chapter 13 case can be used to pay arrears on your home, back taxes, child support, or your ca. Normally you will also need legal assistance in planning for a successful chapter 13 filing and the confirmation process, which is part of every chapter 13 case. It is very rare for anyone to successfully complete a chapter 13 filing without being represented by an attorney. If you select another type of relief under the Bankruptcy Code other than chapter 7or 13, you will want to find out what should be done from an attorney familiar with that type of relief. Your bankruptcy case may also involve litigation. This is usually rare in a chapter 7 case. You can represent yourself - but it is a complicated process and one that you will rarely succeed in without legal counsel. Only an attorney can give you legal advice.

Check the box below and submit your form.*

I Confirm I have read and understand the above legal notices

If the form does not submit when you press the button then you need to scroll through the form looking for red paragraphs that need answers. If it is successfully submitted you will receive a notification. Therefore, if you do not receive that email it was not successfully submitted and you need to go back and check what was not completed in the third section.

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:

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