Bankruptcy Questionnaire Template (Page 7 of 26) in pdf

Bankruptcy Questionnaire Template Page 7

M. Do you have an IRA (including Roth or education IRA) or any other pension plan? YES ____ NO _____. If YES,

give details:

Have you paid or contributed any funds to a tax-exempt tuition program, or purchased any tuition credits or

certificates? YES _____ NO _____. If YES, give details:

O. Are you the beneficiary of a trust or future interest? YES _____ NO _____. If YES, give details:

Do you expect to receive more than a small amount of money or property at any time in the near future by way

of gift or life insurance proceeds? YES _____ NO _____. If YES, give details:

Q. (1) Do you expect to inherit any money or property in the near future? YES ___ NO ___.

If YES, give details:

(2) Has anyone died and left you anything (including insurance benefits)? YES ___ NO ___.

If YES, give details:

Taxes:

(Bring a copy of your W-2 forms and any tax returns you have filed within the past year with you to our

office.)

Have you received any tax refunds this year? YES ___ NO ___.

State $

Federal $

What income tax refunds do you expect to receive this year?

State $

Federal $

Does this amount include an Earned Income Credit? YES _____ NO _____.

Have you already filed for the refund? YES _____ NO _____.

When do you expect to receive the tax refund?

Do you know if anyone intends to take or intercept your tax refund? YES __ NO __. If YES, give details.

G. Did you sign an agreement or refund anticipation loan with a tax preparer to get your refund early?

YES _____ NO _____.

H. (1) Is any other person (such as your spouse) entitled to part of your refund? YES ___ NO ___.

(2) Have you filed income tax returns every year for the last seven years? YES ___ NO ___.

(3) Do you have copies of your income tax returns filed in the last four years? YES ____ NO ____. If NO,

state the years for which you do not have copies:

(4) Do you owe any taxes to the United States? YES ___ NO ___. If YES, give the name and address of the

department or agency to which the tax is owing, the kind of tax that is owing, and the years for which the

tax is owing:

Bankruptcy Questionnaire Template Page 7