Bankruptcy Questionnaire Template (Page 2 of 26) in pdf

complete. We will give you a list of organizations that provide approved courses. In a chapter 7 case,

you should sign up for the course soon after your case is filed. If you file a chapter 13 case, we will

discuss with you later when you should take the course.

(1) Fill out every question on all of the pages. Wherever you are given a choice of YES or NO

on these forms, check either YES or NO, whichever is correct. Please fill out these pages as well as you

can. We will help with any questions you don’t understand.

(2) Write clearly or typewrite your answers. We must be able to read them.

(3) Wherever the name of a person or firm is asked for, give the full address. Make the address

accurate. Your discharge from each debt depends upon your giving a complete and correct address.

(4) If you do not know the exact amount you owe, fill in a HIGH estimate. Do not leave the

amount blank and do not say “don’t know.” If you dispute owing a debt or the amount claimed, still list

the debt and note that it is disputed.

(5) Wherever you need more room, turn the page over and put the information on the back

together with the number of the question.

(6) List every creditor and everybody that has had anything to do with your debts, including

cosigners. Please include accurate account numbers. If a bill you owe has been sent to a collection

agency or any attorney, list both the person you originally owed and the collection agency or any

attorney, giving the full address of each. If the collection agency has an attorney, list the person you

originally owed, the collection agency, and the attorney, giving the full address of each.

(7) Whenever a question asks you to be prepared to give details, gather all papers concerning the

matter, including bills and collection letters, and bring them with you when you return this form. In any

event, be sure to bring with you the following items (unless they don’t apply to you):

(a) Picture identification card and Social Security card or other document containing your social

security number;

(b) Deeds and mortgages on your house or other real estate, including any agreements you later

entered into to modify any mortgage loans;

(d) Any papers relating to past bankruptcies you or your spouse have filed or that concerned any

of your property, including chapter 13 cases;

(e) Copies of your tax returns for the past four years;

(f) Copies of your pay check stubs for the last sixty days (and you should keep all pay stubs you

receive until your bankruptcy case is over) and any proof of your income and your spouse’s income for

the past six months (such as pay stubs for the entire period, pay stubs which list year-to-date income, or

W-2 statements);

(g) Copies of your last several statements for each bank, credit union, and investment or

brokerage account, and copies of statements for any retirement or savings accounts, including IRAs,

Roth IRAs, education IRAs, 401(k)s, tuition credit programs and medical savings plans (and you should

Bankruptcy Questionnaire Template Page 2