Bankruptcy Questionnaire Template Page 13
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2617. Leases:
Have you had an auto lease, rent-to-own, or rental-purchase transaction in the past four years?
YES _____ NO ______. If YES, give details:
18. Cooperatives:
Are you a member of any type of cooperative (housing, food, agricultural, etc.)? If YES, give
details:
19. Alimony, Child Support, and Property Settlements:
A.
Have you had any previous marriages? YES __ NO __. If YES, what is the name of your former spouse?
Please be sure that any debts from prior marriages which were never paid are listed with your other debts.
B.
Does anybody owe you any money or child support? YES _____ NO _____.
Who? ________________________ How much? $____________________
C.
Have you ever been ordered to pay child support? YES ____ NO ____.
Alimony? YES ____ NO ____.
Property Settlement? YES ____ NO ____.
If yes to any question, state:
(1) To whom do you make the payments?
(2) Are you behind in your payments?
(3) Are the persons you are required to support this way on welfare?
(4) Do you have any family court hearings coming up? If YES, explain and give dates:
D.
Do you expect to be involved in a property settlement with your spouse or former spouse in the near future?
YES _____ NO _____.
20. Accidents and Driver’s License:
A.
Have you been involved in a vehicle accident in the last four years? YES ____ NO ____.
B.
Has your vehicle been involved in an accident in the last four years? YES ____ NO ____.
C.
Have your children ever injured anyone else or their property? YES ____ NO ____.
D.
Have you ever lost your driver’s license? YES ____ NO ____. If YES, give details:
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