Statement Of Financial Affairs Template Page 5
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9.
Payments related to debt counseling or bankruptcy
List all payments made or property transferred by or on behalf of the debtor to any persons, including attorneys, for
None
consultation concerning debt consolidation, relief under the bankruptcy law or preparation of a petition in bankruptcy
within one year immediately preceding the commencement of this case.
DATE OF PAYMENT,
AMOUNT OF MONEY OR
NAME AND ADDRESS
NAME OF PAYER IF
DESCRIPTION AND
OF PAYEE
OTHER THAN DEBTOR
VALUE OF PROPERTY
______________________________________________________________________________________________________
10. Other transfers
None
a. List all other property, other than property transferred in the ordinary course of the business or financial affairs of
the debtor, transferred either absolutely or as security within two years immediately preceding the commencement of
this case. (Married debtors filing under chapter 12 or chapter 13 must include transfers 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 TRANSFEREE,
DESCRIBE PROPERTY
RELATIONSHIP TO DEBTOR
TRANSFERRED AND
DATE
VALUE RECEIVED
______________________________________________________________________________________________________
None
G
b. List all property transferred by the debtor within ten years immediately preceding the commencement of this case
to a self-settled trust or similar device of which the debtor is a beneficiary.
NAME OF TRUST OR OTHER
DATE(S) OF
AMOUNT OF MONEY OR DESCRIPTION
DEVICE
TRANSFER(S)
AND VALUE OF PROPERTY OR DEBTOR’S
INTEREST IN PROPERTY
______________________________________________________________________________________________________
11. Closed financial accounts
List all financial accounts and instruments held in the name of the debtor or for the benefit of the debtor which were
None
closed, sold, or otherwise transferred within one year immediately preceding the commencement of this case. Include
checking, savings, or other financial accounts, certificates of deposit, or other instruments; shares and share accounts
held in banks, credit unions, pension funds, cooperatives, associations, brokerage houses and other financial
institutions. (Married debtors filing under chapter 12 or chapter 13 must include information concerning accounts or
instruments held by or for either or both spouses whether or not a joint petition is filed, unless the spouses are
separated and a joint petition is not filed.)
TYPE OF ACCOUNT, LAST FOUR
AMOUNT AND
NAME AND ADDRESS
DIGITS OF ACCOUNT NUMBER,
DATE OF SALE
OF INSTITUTION
AND AMOUNT OF FINAL BALANCE
OR CLOSING
______________________________________________________________________________________________________
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