Bankruptcy Questionnaire Template Page 17
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2625. Unsecured Debts:
List all creditors, including creditors who have judgments or whose claims you dispute. Anyone who you think may have a claim against
you must be listed even if the claim is old. For each debt, please give all information requested. If a collection agency or an attorney is involved, list it and
the person or company you originally owed.
Name and Address
Current
Which
Creditor’s Name
of Collection Agency
Account
What Is Debt
Amount
Spouse
Any
and Address
and Attorney, If Any
No.
Date of Debt
For?
of Claim
Owes?
Co-signers?
Do you dispute any of these debts? YES ____ NO ____. If YES, which ones?
Now review all the debts you have listed on this page and the last. Have you forgotten any:
medical bills?
mail order bills?
schools?
condominium assessments?
utility or telephone bills?
credit card bills?
judgments?
student loans?
traffic tickets or parking tickets?
loans from relatives?
store charges?
loan companies?
welfare debts?
criminal restitution debts?
money owed to creditors who
cable T.V. bills?
debts you cosigned?
back rent?
bills for goods or services?
repossessed your property?
payday loans?
provided to your dependents?
bills owed to old landlords?
loans on your pension?
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