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  • Debts
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    • Car Repossessions
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    • Medical Bills
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    • Credit Reporting Problems
    • Required Debt Payments
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Bankruptcy QuestionnaireDavid Hilbern2022-03-17T01:20:46-05:00

Bankruptcy

Questionnaire

Step 1 of 19 - Personal Information

5%
Name
Have you been known by any other names in the last 8 years?
Other Name 1
Other Name 2
Other Name 3
MM slash DD slash YYYY
What is your physical address?
Have you lived at this address for at least the last 3 years?
Prior Address #1
MM slash DD slash YYYY
MM slash DD slash YYYY
Have you lived anywhere else in the last 3 years?
Prior Address #2
MM slash DD slash YYYY
MM slash DD slash YYYY
Have you lived anywhere else in the last 3 years?
Prior Address #3
MM slash DD slash YYYY
MM slash DD slash YYYY
Do you have a different mailing address?
Address
Have you ever filed bankruptcy before?
MM slash DD slash YYYY
Are you married?
Is your spouse filing with you?
Spouse Name
Has your spouse been known by any other names in the last 8 years?
Spouse Other Name #1
Spouse Other Name #2
Spouse Other Name #3
MM slash DD slash YYYY
Do you and your spouse live in the same household?
What is your spouse's physical address?
Does your spouse have a different mailing address?
What is your spouse's mailing address?
Has your spouse ever filed bankruptcy before?
MM slash DD slash YYYY
Do you have any dependents who live with you at least 50% of the time?
What is your dependent's name?
What is your second dependent's name?
What is your third dependent's name?
What is your fourth dependent's name?
What is your fifth dependent's name?
Do you own a mobile home?
Who owns the mobile home?

Is there a lien on the mobile home?
What is the lienholder's address?
Do you own any real estate?
Is the address the same as your current residence address?
What is the address of this property?
Max. file size: 20 MB.
Who owns this property?

Is there a mortgage on this property?
What is the mortgage company's address?
Is there a second mortgage on this property?
What is the second mortgage company's address?
Do you own a second property?
What is the address of the second property?
Max. file size: 20 MB.
Who owns the second property?

Do you own a third property?
What is the address of the third property?
Max. file size: 20 MB.
Who owns the third property?

Do you own a fourth property?
What is the address of the fourth property?
Max. file size: 20 MB.
Who owns the fourth property?

Do you own any vehicles?
Max. file size: 512 MB.
Who owns the first vehicle?

Max. file size: 512 MB.
Who owns the second vehicle?

Max. file size: 512 MB.
Who owns the third vehicle?

Max. file size: 512 MB.
Who owns the fourth vehicle?

Max. file size: 512 MB.
Who owns the fifth vehicle?

Do you own any motorcycles?
Max. file size: 512 MB.
Who owns the motorcycle?

Do you own any other motorcycles?
Max. file size: 512 MB.
Who owns the second motorcycle?

Do you own any watercraft?
Max. file size: 512 MB.
Who owns the watercraft?

Do you own any household goods?
Do you own any electronics?
Do you own any collections of value?
Do you own any sporting or hobby equipment?
Do you own any firearms?
Do you own wedding, engagement, or anniversary rings?
Do you own any other miscellaneous jewelry?
Do you own any animals?
Do you have any cash on hand?
Do you have any financial accounts?
Do you have any stocks, bonds or mutual funds?
Do you own any business interests in any non-publicly traded stock, LLC, Partnership or joint venture?
Do you own any government or corporate bonds, or other negotiable and non-negotiable instruments?
Do you have a retirement account?
Do you have any security deposits or prepayments?
Do you have any certificates of deposit?
Do You have an annuity?
Do You have an interest in an education IRA?
Are you the beneficiary of a trust?
Do you have any equitable or future interests, or any beneficial rights or powers?
Do you have intellectual property, patents, copyrights or trademarks?
Do You have any licenses, franchises, or other general intangibles?
Do You have the right to receive a tax refund?
Are you entitled to receive family support?
Does anyone else owe you money?
Do You have an interest in an insurance policy with cash value?
Are you expecting an inheritance?
Do you have a right to file a claim against anyone?
Do you have any other contingent claims?
Do you have any other assets not already listed?
Do you have any other secured debts not already listed?
Address

Unsecured Creditors

List all unsecured creditors in your name. Unsecured debts include things like credit cards, revolving accounts, personal loans, student loans, medical bills, bank overdrafts, repossession deficiencies, past due rent, utility debts, trade debts, and collections.
Do you have a credit report?
If you have a full credit report (e.g. from www.annualcreditreport.com) you can upload that below. If you upload a creditor report with all your creditors, you do not need to fill out the creditors separately.
Max. file size: 512 MB.
Do you need to list creditors that were not on your credit report?

Unsecured Creditor 1

What is the address of the unsecured creditor?
MM slash DD slash YYYY

Unsecured Creditor 2

What is the address of the unsecured creditor?
MM slash DD slash YYYY

Unsecured Creditor 3

What is the address of the unsecured creditor?
MM slash DD slash YYYY

Unsecured Creditor 4

What is the address of the unsecured creditor?
MM slash DD slash YYYY

Unsecured Creditor 5

What is the address of the unsecured creditor?
MM slash DD slash YYYY

Unsecured Creditor 6

What is the address of the unsecured creditor?
MM slash DD slash YYYY

Unsecured Creditor 7

What is the address of the unsecured creditor?
MM slash DD slash YYYY

Unsecured Creditor 8

What is the address of the unsecured creditor?
MM slash DD slash YYYY

Unsecured Creditor 9

What is the address of the unsecured creditor?
MM slash DD slash YYYY

Unsecured Creditor 10

What is the address of the unsecured creditor?
MM slash DD slash YYYY
Do you have any additional unsecured creditors to add?

Unsecured Creditors - Continued

List any additional unsecured creditors in this section.

Unsecured Creditor 11

What is the address of the unsecured creditor?
MM slash DD slash YYYY

Unsecured Creditor 12

What is the address of the unsecured creditor?
MM slash DD slash YYYY

Unsecured Creditor 13

What is the address of the unsecured creditor?
MM slash DD slash YYYY

Unsecured Creditor 14

What is the address of the unsecured creditor?
MM slash DD slash YYYY

Unsecured Creditor 15

What is the address of the unsecured creditor?
MM slash DD slash YYYY

Unsecured Creditor 16

What is the address of the unsecured creditor?
MM slash DD slash YYYY

Unsecured Creditor 17

What is the address of the unsecured creditor?
MM slash DD slash YYYY

Unsecured Creditor 18

What is the address of the unsecured creditor?
MM slash DD slash YYYY

Unsecured Creditor 19

What is the address of the unsecured creditor?
MM slash DD slash YYYY

Unsecured Creditor 20

What is the address of the unsecured creditor?
MM slash DD slash YYYY
Do you have any additional unsecured creditors to add?

Unsecured Creditors - Continued

Unsecured Creditor 21

What is the address of the unsecured creditor?
MM slash DD slash YYYY

Unsecured Creditor 22

What is the address of the unsecured creditor?
MM slash DD slash YYYY

Unsecured Creditor 23

What is the address of the unsecured creditor?
MM slash DD slash YYYY

Unsecured Creditor 24

What is the address of the unsecured creditor?
MM slash DD slash YYYY

Unsecured Creditor 25

What is the address of the unsecured creditor?
MM slash DD slash YYYY

Unsecured Creditor 26

What is the address of the unsecured creditor?
MM slash DD slash YYYY

Unsecured Creditor 27

What is the address of the unsecured creditor?
MM slash DD slash YYYY

Unsecured Creditor 28

What is the address of the unsecured creditor?
MM slash DD slash YYYY

Unsecured Creditor 29

What is the address of the unsecured creditor?
MM slash DD slash YYYY

Unsecured Creditor 30

What is the address of the unsecured creditor?
MM slash DD slash YYYY
Do you have any additional unsecured creditors to add?

Unsecured Creditors - Continued

Unsecured Creditor 31

What is the address of the unsecured creditor?
MM slash DD slash YYYY

Unsecured Creditor 32

What is the address of the unsecured creditor?
MM slash DD slash YYYY

Unsecured Creditor 33

What is the address of the unsecured creditor?
MM slash DD slash YYYY

Unsecured Creditor 34

What is the address of the unsecured creditor?
MM slash DD slash YYYY

Unsecured Creditor 35

What is the address of the unsecured creditor?
MM slash DD slash YYYY

Unsecured Creditor 36

What is the address of the unsecured creditor?
MM slash DD slash YYYY

Unsecured Creditor 37

What is the address of the unsecured creditor?
MM slash DD slash YYYY

Unsecured Creditor 38

What is the address of the unsecured creditor?
MM slash DD slash YYYY

Unsecured Creditor 39

What is the address of the unsecured creditor?
MM slash DD slash YYYY

Unsecured Creditor 40

What is the address of the unsecured creditor?
MM slash DD slash YYYY
Do you have any additional unsecured creditors to add?

Unsecured Creditors - Continued

Unsecured Creditor 41

What is the address of the unsecured creditor?
MM slash DD slash YYYY

Unsecured Creditor 42

What is the address of the unsecured creditor?
MM slash DD slash YYYY

Unsecured Creditor 43

What is the address of the unsecured creditor?
MM slash DD slash YYYY

Unsecured Creditor 44

What is the address of the unsecured creditor?
MM slash DD slash YYYY

Unsecured Creditor 45

What is the address of the unsecured creditor?
MM slash DD slash YYYY

Unsecured Creditor 46

What is the address of the unsecured creditor?
MM slash DD slash YYYY

Unsecured Creditor 47

What is the address of the unsecured creditor?
MM slash DD slash YYYY

Unsecured Creditor 48

What is the address of the unsecured creditor?
MM slash DD slash YYYY

Unsecured Creditor 49

What is the address of the unsecured creditor?
MM slash DD slash YYYY

Unsecured Creditor 50

What is the address of the unsecured creditor?
MM slash DD slash YYYY

Income

What is your employment status?
What is your work address?
Max. file size: 20 MB.
Are you employed anywhere else?
What is your work address of your second employer?
Max. file size: 20 MB.
Max. file size: 20 MB.
Do you receive money from any other source?
Do you receive income from other than employment or business income (e.g social security, workers comp, VA disability, food stamps, gambling, etc.)?
Max. file size: 20 MB.

Spouse Income

What is your spouse's employment status?
What is your spouse's work address?
Max. file size: 20 MB.
Is your spouse employed anywhere else?
What is your spouse's work address of your second employer?
Max. file size: 20 MB.
Max. file size: 20 MB.
Does your spouse receive money from any other source?
Do you receive income from other than employment or business income (e.g social security, workers comp, VA disability, food stamps, gambling, etc.)?
Max. file size: 20 MB.

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