Free Bankruptcy Questionnaire
This Bankruptcy Questionnaire contains relevant questions you must ask yourself before filing for bankruptcy. This questionnaire will ensure that you thoroughly research your assets and debts before the filing and brings attention to any alternatives you may want to seek.
Disclaimer:This was not drafted by an attorney & should not be used as a legal document.
BANKRUPTCY QUESTIONNAIRE
Applicant Information:
Name _________________________________________________
Social Security Number _______________________
Current Address ______________________________________________________________________________
Mailing Address (if different than above) ____________________________________________
Phone: (Home)______________ (Cell)__________________ (Work)________________
Email _______________________ What is the best way to get in touch with you during the day?_______________
Marital Status (Married, Divorced, Single) ______________
Are you filing jointly with your spouse?_____________
How long have you lived in the State? ___________________
Other names used in last 6 years ___________________
Occupation _____________________ Employer ______________________ How Long
Employed ______________
Employer’s Address ________________________________________________________
Prior Bankruptcy: _________________
Current Monthly Income:
Monthly gross wages $___________________
Payroll deductions $___________________
Taxes + Social Security $___________________
Insurance $___________________
Union Dues $___________________
Other $___________________
Monthly Take-home pay $___________________
Soc Sec or government assistance $___________________
Alimony or Child Support $___________________
Pension or retirement $___________________
Side Business $___________________
Interest + Dividends $___________________
Average Monthly Expenses:
Item Amount
______________________ $ ________________________
______________________ $ ________________________
______________________ $ ________________________
Real Property:
Property Description: ______________________________________________
Current Value: _____________________
When Purchased: ___________________
Purchase Price: _____________________
First Mortgage Balance __________________ Monthly Payment _____________
Second Mortgage Balance __________________ Monthly Payment _____________
Unpaid Property Taxes Owed: _____________________
Unpaid Income tax liens: __________________________
Unpaid Judgment liens: ___________________________
Personal Property:
Cash at hand: ______________ Bank Accounts: _______________
Security Deposits: __________________________________________________________
Assets:
_________________________________________________________________________________________________________
Vehicles:
_________________________________________________________________________________________________________
Other Property:
_________________________________________________________________________________________________________
Debts:
__________________________________________________________________________________________________________________________________________________________________________________________________________________
Tax Information and Debts:
Year Federal State
_____ ______ _____
_____ ______ _____
_____ ______ _____
_____ ______ _____
Unsecured Debts:
_________________________________________________________________________________________________________
____________________ ____________
Debtor Date
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