Statement Of Financial Affairs Template Page 3
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c. All debtors: List all payments made within one year immediately preceding the commencement of this case
to or for the benefit of creditors who are or were insiders. (Married debtors filing under chapter 12 or chapter 13 must
include payments by either or both spouses whether or not a joint petition is filed, unless the spouses are separated and
a joint petition is not filed.)
NAME AND ADDRESS OF CREDITOR
DATE OF
AMOUNT
AMOUNT
AND RELATIONSHIP TO DEBTOR
PAYMENT
PAID
STILL OWING
$
$
______________________________________________________________________________________________________
4. Suits and administrative proceedings, executions, garnishments and attachments
a. List all suits and administrative proceedings to which the debtor is or was a party within one year immediately
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preceding the filing of this bankruptcy case. (Married debtors filing under chapter 12 or chapter 13 must include
information concerning either or both spouses whether or not a joint petition is filed, unless the spouses are separated
and a joint petition is not filed.)
CAPTION OF SUIT
COURT OR AGENCY
STATUS OR
AND CASE NUMBER
NATURE OF PROCEEDING
AND LOCATION
DISPOSITION
______________________________________________________________________________________________________
b. Describe all property that has been attached, garnished or seized under any legal or equitable process within one
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year immediately preceding the commencement of this case. (Married debtors filing under chapter 12 or chapter 13
must include information concerning property of either or both spouses whether or not a joint petition is filed, unless
the spouses are separated and a joint petition is not filed.)
NAME AND ADDRESS
DESCRIPTION
OF PERSON FOR WHOSE
DATE OF
AND VALUE
BENEFIT PROPERTY WAS SEIZED
SEIZURE
OF PROPERTY
_____________________________________________________________________________________________________
5.
Repossessions, foreclosures and returns
List all property that has been repossessed by a creditor, sold at a foreclosure sale, transferred through a deed in lieu
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of foreclosure or returned to the seller, within one year immediately preceding the commencement of this case.
(Married debtors filing under chapter 12 or chapter 13 must include information concerning property of either or both
spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.)
DATE OF REPOSSESSION,
DESCRIPTION
NAME AND ADDRESS
FORECLOSURE SALE,
AND VALUE
OF CREDITOR OR SELLER
TRANSFER OR RETURN
OF PROPERTY
_
______________________________________________________________________________________________________
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