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Bankruptcy Questionnaire
daevoe
2022-06-09T11:13:53-05:00
Bankruptcy Questionnaire
.
Home
Portal
Bankruptcy Questionnaire
"
*
" indicates required fields
Step
1
of
24
- Your Information
4%
1. Your Information
2. Spouse Information
3. Dependents
4. Mobile Home
5. Real Property
6. Vehicles
7. Other Vehicles
8. Personal Property
9. Financial Assets
10. Investment Assets
11. Other Assets
12. Business Assets
13. Secured Creditors
14. Unsecured Creditors 1-10
15. Unsecured Creditors 11-20
16. Unsecured Creditors 21-30
17. Unsecured Creditors 31-40
18. Unsecured Creditors 41-50
19. Your Income
20. Spouse Income
21. Past Income
22. Household Expenses
23. Financial Affairs
What is your name?
*
Enter your full name including your middle initial. If you are a Sr., Jr., III, etc. be sure to include it.
First
Middle
Last
Suffix
Have you been known by any other names in the last 8 years?
*
All other names used by you in the last 8 years. Include married, maiden, and trade names.
Yes
No
Other Name #1
*
First
Middle
Last
Suffix
Other Name #2
First
Middle
Last
Suffix
Other Name #3
First
Middle
Last
Suffix
What is your Social Security Number?
*
What is your date of birth?
*
MM slash DD slash YYYY
What is the best phone number we can reach you at?
*
What is your physical address?
*
List your current physical residence address. If you have a separate mailing address, you can list it below.
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
In what county do you currently reside?
*
Adair
Alfalfa
Atoka
Beaver
Beckham
Blaine
Bryan
Caddo
Canadian
Carter
Cherokee
Choctaw
Cimarron
Cleveland
Coal
Comanche
Cotton
Craig
Creek
Custer
Delaware
Dewey
Ellis
Garfield
Garvin
Grady
Grant
Greer
Harmon
Harper
Haskell
Hughes
Jackson
Jefferson
Johnston
Kay
Kingfisher
Kiowa
Latimer
Le Flore
Lincoln
Logan
Love
Major
Marshall
Mayes
McClain
McCurtain
McIntosh
Murray
Muskogee
Noble
Nowata
Okfuskee
Oklahoma
Okmulgee
Osage
Ottawa
Pawnee
Payne
Pittsburg
Pontotoc
Pottawatomie
Pushmataha
Roger Mills
Rogers
Seminole
Sequoyah
Stephens
Texas
Tillman
Tulsa
Wagoner
Washington
Washita
Woods
Woodward
Have you lived at this address for at least the last 3 years?
*
List all the places you have lived in the last 3 years. Do not include where you live now.
Yes
No
Prior Address #1
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Prior Address #1 move in date?
*
Enter at least the month and year you moved in. The exact date is not important, but try to be as accurate as possible.
MM slash DD slash YYYY
Prior Address #1 move out date?
*
Enter at least the month and year you moved out. The exact date is not important, but try to be as accurate as possible.
MM slash DD slash YYYY
Have you lived anywhere else in the last 3 years?
*
Yes
No
Prior Address #2
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Prior Address #2 move in date?
*
MM slash DD slash YYYY
Prior Address #2 move out date?
*
MM slash DD slash YYYY
Have you lived anywhere else in the last 3 years?
*
Yes
No
Prior Address #3
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Prior Address #3 move in date?
*
MM slash DD slash YYYY
Prior Address #3 move out date?
*
MM slash DD slash YYYY
Do you have a different mailing address?
*
Yes
No
What is your mailing address?
*
Make sure you list any mailing address that is different than your physical address. This will be the address to which all correspondence will be sent.
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Have you ever filed bankruptcy before?
*
If you have filed more than once before, list the last time you filed.
Yes
No
When did you file your last bankruptcy?
*
MM slash DD slash YYYY
What Chapter?
*
7
13
Did you receive a discharge?
*
Yes
No
1. Your Information
2. Spouse Information
3. Dependents
4. Mobile Home
5. Real Property
6. Vehicles
7. Other Vehicles
8. Personal Property
9. Financial Assets
10. Investment Assets
11. Other Assets
12. Business Assets
13. Secured Creditors
14. Unsecured Creditors 1-10
15. Unsecured Creditors 11-20
16. Unsecured Creditors 21-30
17. Unsecured Creditors 31-40
18. Unsecured Creditors 41-50
19. Your Income
20. Spouse Income
21. Past Income
22. Household Expenses
23. Financial Affairs
Are you married?
*
This includes legal messages, as well as common-law marriages.
Yes
No
Is your spouse filing with you?
*
Yes
No
What is your spouse's name?
*
Enter your spouse's full name including middle initial. If your spouse is a Sr., Jr., III, etc. be sure to include it.
First
Middle
Last
Suffix
Has your spouse been known by any other names in the last 8 years?
*
All other names used by your spouse in the last 8 years. Include married, maiden, and trade names.
Yes
No
Spouse's Other Name #1
*
First
Middle
Last
Suffix
Spouse's Other Name #2
First
Middle
Last
Suffix
Spouse's Other Name #3
First
Middle
Last
Suffix
What is your spouse's social security number?
*
What is your spouse's date of birth?
*
MM slash DD slash YYYY
What is your spouse's phone number?
*
Do you and your spouse live in the same household?
*
Yes
No
What is your spouse's physical address?
*
If you and your spouse maintain separate households, list your spouse's current physical residence address. If your spouse has a separate mailing address,list it below.
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
In what county does your spouse currently reside?
*
Adair
Alfalfa
Atoka
Beaver
Beckham
Blaine
Bryan
Caddo
Canadian
Carter
Cherokee
Choctaw
Cimarron
Cleveland
Coal
Comanche
Cotton
Craig
Creek
Custer
Delaware
Dewey
Ellis
Garfield
Garvin
Grady
Grant
Greer
Harmon
Harper
Haskell
Hughes
Jackson
Jefferson
Johnston
Kay
Kingfisher
Kiowa
Latimer
Le Flore
Lincoln
Logan
Love
Major
Marshall
Mayes
McClain
McCurtain
McIntosh
Murray
Muskogee
Noble
Nowata
Okfuskee
Oklahoma
Okmulgee
Osage
Ottawa
Pawnee
Payne
Pittsburg
Pontotoc
Pottawatomie
Pushmataha
Roger Mills
Rogers
Seminole
Sequoyah
Stephens
Texas
Tillman
Tulsa
Wagoner
Washington
Washita
Woods
Woodward
Does your spouse have a different mailing address?
*
Yes
No
What is your spouse's mailing address?
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Has your spouse ever filed bankruptcy before?
*
If your spouse has filed more than once before, list the last time filed.
Yes
No
When did your spouse last file bankruptcy?
*
MM slash DD slash YYYY
What Chapter did your spouse file?
*
7
13
Did your spouse receive a discharge?
*
Yes
No
1. Your Information
2. Spouse Information
3. Dependents
4. Mobile Home
5. Real Property
6. Vehicles
7. Other Vehicles
8. Personal Property
9. Financial Assets
10. Investment Assets
11. Other Assets
12. Business Assets
13. Secured Creditors
14. Unsecured Creditors 1-10
15. Unsecured Creditors 11-20
16. Unsecured Creditors 21-30
17. Unsecured Creditors 31-40
18. Unsecured Creditors 41-50
19. Your Income
20. Spouse Income
21. Past Income
22. Household Expenses
23. Financial Affairs
Do you have any dependents who live with you at least 50% of the time?
*
Yes
No
How many dependents live in your household at lease 50% of the time?
*
-
1
2
3
4
5
Dependent's name?
*
First
Dependent's relationship to you?
*
-
son
daughter
step-son
step-daughter
grandson
granddaughter
nephew
niece
son-in-law
daughter-in-law
father
mother
grandfather
grandmother
great grandfather
great grandmother
brother
sister
uncle
aunt
foster-child
ward
Dependent's age?
*
Second dependent's name?
*
First
Second dependent's relationship to you?
*
-
son
daughter
step-son
step-daughter
grandson
granddaughter
nephew
niece
son-in-law
daughter-in-law
father
mother
grandfather
grandmother
great grandfather
great grandmother
brother
sister
uncle
aunt
foster-child
ward
Second dependent's age?
*
Third dependent's name?
*
First
Third dependent's relationship to you?
*
-
son
daughter
step-son
step-daughter
grandson
granddaughter
nephew
niece
son-in-law
daughter-in-law
father
mother
grandfather
grandmother
great grandfather
great grandmother
brother
sister
uncle
aunt
foster-child
ward
Third dependent's age?
*
Fourth dependent's name?
*
First
Fourth dependent's relationship to you?
*
-
son
daughter
step-son
step-daughter
grandson
granddaughter
nephew
niece
son-in-law
daughter-in-law
father
mother
grandfather
grandmother
great grandfather
great grandmother
brother
sister
uncle
aunt
foster-child
ward
Fourth dependent's age?
*
Fifth dependent's name?
*
First
Fifth dependent's relationship to you?
*
-
son
daughter
step-son
step-daughter
grandson
granddaughter
nephew
niece
son-in-law
daughter-in-law
father
mother
grandfather
grandmother
great grandfather
great grandmother
brother
sister
uncle
aunt
foster-child
ward
Fifth dependent's age?
*
1. Your Information
2. Spouse Information
3. Dependents
4. Mobile Home
5. Real Property
6. Vehicles
7. Other Vehicles
8. Personal Property
9. Financial Assets
10. Investment Assets
11. Other Assets
12. Business Assets
13. Secured Creditors
14. Unsecured Creditors 1-10
15. Unsecured Creditors 11-20
16. Unsecured Creditors 21-30
17. Unsecured Creditors 31-40
18. Unsecured Creditors 41-50
19. Your Income
20. Spouse Income
21. Past Income
22. Household Expenses
23. Financial Affairs
Do you own a mobile home?
*
Yes
No
Who owns the mobile home?
*
You
Your Spouse
You and Your Spouse Jointly
Other
What is the value of the mobile home?
*
Report the current value. Current value is sometimes called fair market value and, for this form, is the fair market value as of the date of the filing of the petition. Current value is how much the property is worth, which may be more or less than when you purchased the property.
Is there a lien on the mobile home?
*
Yes
No
Who is the lienholder on the mobile home?
*
What is the lienholder's address?
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Account number on the mobile home debt?
*
Balance on the mobile home debt?
*
Monthly payment?
*
What do you want to do with the mobile home?
*
Keep it and keep making payments?
Surrender it and discharge the debt?
1. Your Information
2. Spouse Information
3. Dependents
4. Mobile Home
5. Real Property
6. Vehicles
7. Other Vehicles
8. Personal Property
9. Financial Assets
10. Investment Assets
11. Other Assets
12. Business Assets
13. Secured Creditors
14. Unsecured Creditors 1-10
15. Unsecured Creditors 11-20
16. Unsecured Creditors 21-30
17. Unsecured Creditors 31-40
18. Unsecured Creditors 41-50
19. Your Income
20. Spouse Income
21. Past Income
22. Household Expenses
23. Financial Affairs
Do you own any real estate?
*
Real estate includes all real property like your residence, buildings, or land.
Yes
No
Is the address the same as your current residence address?
*
Yes
No
What is the address of this property?
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
What is the legal desccription of this property?
Upload a copy of the deed here.
Max. file size: 20 MB.
Who owns this property?
*
You
Your Spouse
You and Your Spouse Jointly
Other
Is there a mortgage on this property?
*
Yes
No
What is the name of the mortgage company?
*
What is the mortgage company's address?
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
What is the account number for the mortgage?
*
How much is owed on the mortgage?
*
Mortgage monthly payment?
*
Is there a second mortgage on this property?
*
Yes
No
What is the name of the second mortgage company?
*
What is the second mortgage company's address?
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
What is the account number for the second mortgage?
*
How much is owed on the second mortgage?
*
Second mortgage monthly payment?
*
Do you own a second property?
*
Yes
No
What is the address of the second property?
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
What is the legal description of the second property?
You can upload a copy of the deed to your second property here.
Max. file size: 20 MB.
Who owns the second property?
*
You
Your Spouse
You and Your Spouse Jointly
Other
Is there a mortgage on the second property?
*
Yes
No
What is the name of the mortgage company for the second property?
*
What is the mortgage company's address for the second property?
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
What is the account number for the second property mortgage?
*
How much is owed on the second property mortgage?
*
Monthly mortgage payment on the second property?
*
Do you own a third property?
*
Yes
No
What is the address of the third property?
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
What is the legal description of the third property?
You can upload a copy of the deed to your third property here?
Max. file size: 20 MB.
Who owns the third property?
*
You
Your Spouse
You and Your Spouse Jointly
Other
Do you own a fourth property?
*
Yes
No
What is the address of the fourth property?
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
What is the legal description of the fourth property?
You can upload a copy of the deed to your third property here?
Max. file size: 20 MB.
Who owns the fourth property?
*
You
Your Spouse
You and Your Spouse Jointly
Other
1. Your Information
2. Spouse Information
3. Dependents
4. Mobile Home
5. Real Property
6. Vehicles
7. Other Vehicles
8. Personal Property
9. Financial Assets
10. Investment Assets
11. Other Assets
12. Business Assets
13. Secured Creditors
14. Unsecured Creditors 1-10
15. Unsecured Creditors 11-20
16. Unsecured Creditors 21-30
17. Unsecured Creditors 31-40
18. Unsecured Creditors 41-50
19. Your Income
20. Spouse Income
21. Past Income
22. Household Expenses
23. Financial Affairs
Do you own any vehicles?
*
Yes
No
How many vehicles do you own?
*
-
1
2
3
4
5
What is the model year of the first vehicle?
*
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
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1649
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1915
1914
1913
1912
1911
1910
1909
1908
1907
1906
1905
1904
1903
1902
1901
1900
What is the make of the first vehicle?
*
Alfa Romeo
Aston Martin
Audi
Bentley
BMW
Bugatti
Cadillac
Chevrolet
Chrysler
Citroën
Corvette
Daewoo
Daihatsu
Datsun
De Lorean
Dodge
Ferrari
Fiat
Ford
Gumpert
Honda
Hummer
Hyundai
Jaguar
Jeep
Kia
Koenigsegg
Lamborghini
Lancia
Land Rover
Lexus
Lincoln
Lotus
Lexus
Maserati
Maybach
Mazda
McLaren
Mercedes-Benz
Mini
Mitsubishi
Nissan
Opel
Pagani
Peugeot
Pontiac
Porsche
Radical
Ram
Renault
Rolls-Royce
Saab
Shelby
Smart
Spyker
Subaru
Suzuki
Tesla
Toyota
Volkswagen
Volvo
What is the model of the first vehicle?
*
How many miles are on the first vehicle?
*
What is the value of the first vehicle?
*
Upload first vehicle title
Max. file size: 3 GB.
Who owns the first vehicle?
*
You
Your Spouse
You and Your Spouse Jointly
Other
What is the model year of the second vehicle?
*
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
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2001
2000
1999
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1649
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1925
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1921
1920
1919
1918
1917
1916
1915
1914
1913
1912
1911
1910
1909
1908
1907
1906
1905
1904
1903
1902
1901
1900
What is the make of the second vehicle?
*
Alfa Romeo
Aston Martin
Audi
Bentley
BMW
Bugatti
Cadillac
Chevrolet
Chrysler
Citroën
Corvette
Daewoo
Daihatsu
Datsun
De Lorean
Dodge
Ferrari
Fiat
Ford
Gumpert
Honda
Hummer
Hyundai
Jaguar
Jeep
Kia
Koenigsegg
Lamborghini
Lancia
Land Rover
Lexus
Lincoln
Lotus
Lexus
Maserati
Maybach
Mazda
McLaren
Mercedes-Benz
Mini
Mitsubishi
Nissan
Opel
Pagani
Peugeot
Pontiac
Porsche
Radical
Ram
Renault
Rolls-Royce
Saab
Shelby
Smart
Spyker
Subaru
Suzuki
Tesla
Toyota
Volkswagen
Volvo
What is the model of the second vehicle?
*
How many miles are on the second vehicle?
*
What is the value of the second vehicle?
*
Upload second vehicle title
Max. file size: 3 GB.
Who owns the second vehicle?
*
You
Your Spouse
You and Your Spouse Jointly
Other
What is the model year of the third vehicle?
*
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
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1649
1948
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1931
1930
1929
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1926
1925
1924
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1921
1920
1919
1918
1917
1916
1915
1914
1913
1912
1911
1910
1909
1908
1907
1906
1905
1904
1903
1902
1901
1900
What is the make of the third vehicle?
*
Alfa Romeo
Aston Martin
Audi
Bentley
BMW
Bugatti
Cadillac
Chevrolet
Chrysler
Citroën
Corvette
Daewoo
Daihatsu
Datsun
De Lorean
Dodge
Ferrari
Fiat
Ford
Gumpert
Honda
Hummer
Hyundai
Jaguar
Jeep
Kia
Koenigsegg
Lamborghini
Lancia
Land Rover
Lexus
Lincoln
Lotus
Lexus
Maserati
Maybach
Mazda
McLaren
Mercedes-Benz
Mini
Mitsubishi
Nissan
Opel
Pagani
Peugeot
Pontiac
Porsche
Radical
Ram
Renault
Rolls-Royce
Saab
Shelby
Smart
Spyker
Subaru
Suzuki
Tesla
Toyota
Volkswagen
Volvo
What is the model of the third vehicle?
*
How many miles are on the third vehicle?
*
What is the value of the third vehicle?
*
Upload third vehicle title
Max. file size: 3 GB.
Who owns the third vehicle?
*
You
Your Spouse
You and Your Spouse Jointly
Other
What is the model year of the fourth vehicle?
*
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
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1988
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1649
1948
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1935
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1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
1919
1918
1917
1916
1915
1914
1913
1912
1911
1910
1909
1908
1907
1906
1905
1904
1903
1902
1901
1900
What is the make of the fourth vehicle?
*
Alfa Romeo
Aston Martin
Audi
Bentley
BMW
Bugatti
Cadillac
Chevrolet
Chrysler
Citroën
Corvette
Daewoo
Daihatsu
Datsun
De Lorean
Dodge
Ferrari
Fiat
Ford
Gumpert
Honda
Hummer
Hyundai
Jaguar
Jeep
Kia
Koenigsegg
Lamborghini
Lancia
Land Rover
Lexus
Lincoln
Lotus
Lexus
Maserati
Maybach
Mazda
McLaren
Mercedes-Benz
Mini
Mitsubishi
Nissan
Opel
Pagani
Peugeot
Pontiac
Porsche
Radical
Ram
Renault
Rolls-Royce
Saab
Shelby
Smart
Spyker
Subaru
Suzuki
Tesla
Toyota
Volkswagen
Volvo
What is the model of the fourth vehicle?
*
How many miles are on the fourth vehicle?
*
What is the value of the fourth vehicle?
*
Upload fourth vehicle title
Max. file size: 3 GB.
Who owns the fourth vehicle?
*
You
Your Spouse
You and Your Spouse Jointly
Other
What is the model year of the fifth vehicle?
*
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
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1982
1981
1980
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1952
1951
1950
1649
1948
1947
1946
1945
1944
1943
1942
1941
1940
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1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
1919
1918
1917
1916
1915
1914
1913
1912
1911
1910
1909
1908
1907
1906
1905
1904
1903
1902
1901
1900
What is the make of the fifth vehicle?
*
Alfa Romeo
Aston Martin
Audi
Bentley
BMW
Bugatti
Cadillac
Chevrolet
Chrysler
Citroën
Corvette
Daewoo
Daihatsu
Datsun
De Lorean
Dodge
Ferrari
Fiat
Ford
Gumpert
Honda
Hummer
Hyundai
Jaguar
Jeep
Kia
Koenigsegg
Lamborghini
Lancia
Land Rover
Lexus
Lincoln
Lotus
Lexus
Maserati
Maybach
Mazda
McLaren
Mercedes-Benz
Mini
Mitsubishi
Nissan
Opel
Pagani
Peugeot
Pontiac
Porsche
Radical
Ram
Renault
Rolls-Royce
Saab
Shelby
Smart
Spyker
Subaru
Suzuki
Tesla
Toyota
Volkswagen
Volvo
What is the model of the fifth vehicle?
*
How many miles are on the fifth vehicle?
*
What is the value of the fifth vehicle?
*
Upload fifth vehicle title
Max. file size: 3 GB.
Who owns the fifth vehicle?
*
You
Your Spouse
You and Your Spouse Jointly
Other
1. Your Information
2. Spouse Information
3. Dependents
4. Mobile Home
5. Real Property
6. Vehicles
7. Other Vehicles
8. Personal Property
9. Financial Assets
10. Investment Assets
11. Other Assets
12. Business Assets
13. Secured Creditors
14. Unsecured Creditors 1-10
15. Unsecured Creditors 11-20
16. Unsecured Creditors 21-30
17. Unsecured Creditors 31-40
18. Unsecured Creditors 41-50
19. Your Income
20. Spouse Income
21. Past Income
22. Household Expenses
23. Financial Affairs
Do you own any motorcycles?
*
Yes
No
What is the model year of your motorcycle?
*
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
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1969
1968
1967
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1965
1964
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1962
1961
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1955
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1953
1952
1951
1950
1649
1948
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1946
1945
1944
1943
1942
1941
1940
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1938
1937
1936
1935
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1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
1919
1918
1917
1916
1915
1914
1913
1912
1911
1910
1909
1908
1907
1906
1905
1904
1903
1902
1901
1900
What is the make of your motorcycle?
*
What is the model of your motorcycle?
*
What is the value of your motorcycle?
*
Upload motorcycle title
Max. file size: 3 GB.
Who owns the motorcycle?
*
You
Your Spouse
You and Your Spouse Jointly
Other
Do you own any other motorcycles?
*
Yes
No
What is the model year of your second motorcycle?
*
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
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1971
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1969
1968
1967
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1965
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1963
1962
1961
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1959
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1956
1955
1954
1953
1952
1951
1950
1649
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
1919
1918
1917
1916
1915
1914
1913
1912
1911
1910
1909
1908
1907
1906
1905
1904
1903
1902
1901
1900
What is the make of your second motorcycle?
*
What is the model of your second motorcycle?
*
What is the value of your second motorcycle?
*
Upload second motorcycle title
Max. file size: 3 GB.
Who owns the second motorcycle?
*
You
Your Spouse
You and Your Spouse Jointly
Other
Do you own any watercraft?
*
Yes
No
What is the model year of your watercraft?
*
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
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1649
1948
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1943
1942
1941
1940
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1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
1919
1918
1917
1916
1915
1914
1913
1912
1911
1910
1909
1908
1907
1906
1905
1904
1903
1902
1901
1900
What is the make of your watercraft?
*
What is the model of your watercraft?
*
What is the value of your watercraft?
*
Upload watercraft title
Max. file size: 3 GB.
Who owns the watercraft?
*
You
Your Spouse
You and Your Spouse Jointly
Other
Do you own any recreational vehicles or trailers?
*
Yes
No
What is the model year of your RV or trailer?
*
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
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1984
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1982
1981
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1971
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1969
1968
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1951
1950
1649
1948
1947
1946
1945
1944
1943
1942
1941
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1938
1937
1936
1935
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1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
1919
1918
1917
1916
1915
1914
1913
1912
1911
1910
1909
1908
1907
1906
1905
1904
1903
1902
1901
1900
What is the make of your RV or trailer?
*
What is the model of your RV or trailer?
*
What is the value of your RV or trailer?
*
Upload RV or trailer title
Max. file size: 3 GB.
Who owns the RV or trailer?
*
You
Your Spouse
You and Your Spouse Jointly
Other
1. Your Information
2. Spouse Information
3. Dependents
4. Mobile Home
5. Real Property
6. Vehicles
7. Other Vehicles
8. Personal Property
9. Financial Assets
10. Investment Assets
11. Other Assets
12. Business Assets
13. Secured Creditors
14. Unsecured Creditors 1-10
15. Unsecured Creditors 11-20
16. Unsecured Creditors 21-30
17. Unsecured Creditors 31-40
18. Unsecured Creditors 41-50
19. Your Income
20. Spouse Income
21. Past Income
22. Household Expenses
23. Financial Affairs
Do you own any household goods?
*
Examples: Furniture, appliances, linens, dishware, utensils, garden tools, hand tools, etc.
Yes
No
What is the value of your household goods?
*
List the collective garage sale value (not retail value) of all your household goods.
Do you own any electronics?
*
Examples: Televisions and radios; audio, video, stereo, and digital equipment; computers, printers, scanners; music collections; electronic devices including cell phones, cameras, media players, games.
Yes
No
What is the value of your electronics?
*
List the collective garage sale value (not retail value) of all your electronics.
Do you own any collections of value?
*
Examples: Antiques and figurines; paintings, prints, or other artwork; books, pictures, or other art objects; stamp, coin, or baseball card collections; other collections, memorabilia, and collectibles.
Yes
No
Describe what collections you own.
*
Do you own any sporting or hobby equipment?
*
Examples: Sports, photographic, exercise, and other hobby equipment; bicycles, pool tables, golf clubs, skis; canoes and kayaks; carpentry tools; musical instruments.
Yes
No
Describe what sporting or hobby equipment you own.
*
Do you own any firearms?
*
Examples: Pistols, rifles, shotguns, ammunition, and related equipment
Yes
No
Describe what firearms you own.
*
What is the value of your clothes?
*
Examples: Everyday clothes, furs, leather coats, designer wear, shoes, accessories. List the garage sale value of all your clothes, rather than the retail value.
Do you own wedding, engagement, or anniversary rings?
*
Examples: Wedding rings, engagement rings, and anniversary rings. Do not include other jewelry such as everyday jewelry, costume jewelry, heirloom jewelry, watches, gems, or gold.
Yes
No
What is the value of your wedding, engagement, and anniversary rings?
*
List the collective pawn shop value of all your wedding rings, engagement rings, and anniversary rings.
Do you own any other miscellaneous jewelry?
*
Examples: Everyday jewelry, costume jewelry, heirloom jewelry, watches, gems, gold, and silver.
Yes
No
What is the value of your other miscellaneous jewelry?
*
List the collective pawn shop or garage sale value of all your miscellaneous jewelry.
Do you own any animals?
*
Examples: Dogs, cats, birds, horses, cows, chickens, goats, and rabbits.
Yes
No
Describe what animals you own.
*
1. Your Information
2. Spouse Information
3. Dependents
4. Mobile Home
5. Real Property
6. Vehicles
7. Other Vehicles
8. Personal Property
9. Financial Assets
10. Investment Assets
11. Other Assets
12. Business Assets
13. Secured Creditors
14. Unsecured Creditors 1-10
15. Unsecured Creditors 11-20
16. Unsecured Creditors 21-30
17. Unsecured Creditors 31-40
18. Unsecured Creditors 41-50
19. Your Income
20. Spouse Income
21. Past Income
22. Household Expenses
23. Financial Affairs
Do you have any cash on hand?
*
Examples: Money you have in your wallet, in your home, in a safe deposit box, and on hand when you file your petition.
Yes
No
How much cash do you have on hand?
*
Do you have any financial accounts?
*
Examples: Checking, savings, or other financial accounts; certificates of deposit; shares in credit unions, brokerage houses, CashApp, Venmo, PayPal, and other similar institutions. If you have multiple accounts with the same institution, list each.
Yes
No
How many accounts do you have?
*
-
1
2
3
4
5
6
What is the name of the first financial institution?
*
What is the type of the first account?
*
-
Checking
Savings
Prepaid Debit Card
Certificate of Deposit
Brokerage Account
How much money is in the first account now?
*
What is the name of the second financial institution?
*
What is the type of the second account?
*
-
Checking
Savings
Prepaid Debit Card
How much money is in the second account now?
*
What is the name of the third financial institution?
*
What is the type of the third account?
*
-
Checking
Savings
Prepaid Debit Card
How much money is in the third account now?
*
What is the name of the fourth financial institution?
*
What is the type of the fourth account?
*
-
Checking
Savings
Prepaid Debit Card
How much money is in the fourth account now?
*
What is the name of the fifth financial institution?
*
What is the type of the fifth account?
*
-
Checking
Savings
Prepaid Debit Card
How much money is in the fifth account now?
*
What is the name of the sixth financial institution?
*
What is the type of the sixth account?
*
-
Checking
Savings
Prepaid Debit Card
How much money is in the sixth account now?
*
1. Your Information
2. Spouse Information
3. Dependents
4. Mobile Home
5. Real Property
6. Vehicles
7. Other Vehicles
8. Personal Property
9. Financial Assets
10. Investment Assets
11. Other Assets
12. Business Assets
13. Secured Creditors
14. Unsecured Creditors 1-10
15. Unsecured Creditors 11-20
16. Unsecured Creditors 21-30
17. Unsecured Creditors 31-40
18. Unsecured Creditors 41-50
19. Your Income
20. Spouse Income
21. Past Income
22. Household Expenses
23. Financial Affairs
Do you have any stocks, bonds or mutual funds?
*
Examples: Bond funds, investment accounts with brokerage firms, and money market accounts.
Yes
No
Describe what stocks, bonds or mutual funds you have.
*
Do you own any business interests in any non-publicly traded stock, LLC, Partnership or joint venture?
*
Yes
No
Describe your business interests.
*
Do you own any government or corporate bonds, or other negotiable and non-negotiable instruments?
*
Negotiable instruments include personal checks, cashiers’ checks, promissory notes, and money orders. Non-negotiable instruments are those you cannot transfer to someone by signing or delivering them.
Yes
No
Describe the bonds and other instruments.
*
Do you have a retirement or pension account?
*
Examples: Interests in IRA, ERISA, Keogh, 401(k), 403(b), thrift savings accounts, or other pension or profit-sharing plans.
Yes
No
How many retirement accounts do you have?
*
-
1
2
3
4
Type of first retirement account?
*
-
401(k)
457
ERISA
IRA
Keogh
Pension
Profit Sharing Plan
Roth IRA
Thrift Savings Plan
403(b)
Value of first retirement account?
*
Type of second retirement account?
*
-
401(k)
457
ERISA
IRA
Keogh
Pension
Profit Sharing Plan
Roth IRA
Thrift Savings Plan
403(b)
Value of second retirement account?
*
Type of third retirement account?
*
-
401(k)
457
ERISA
IRA
Keogh
Pension
Profit Sharing Plan
Roth IRA
Thrift Savings Plan
403(b)
Value of third retirement account?
*
Type of fourth retirement account?
*
-
401(k)
457
ERISA
IRA
Keogh
Pension
Profit Sharing Plan
Roth IRA
Thrift Savings Plan
403(b)
Value of fourth retirement account?
*
Do you have any security deposits or prepayments?
*
Your share of all unused deposits you have made so that you may continue service or use from a company. Examples: Agreements with landlords, prepaid rent, public utilities (electric, gas, water), telecommunications companies, or others.
Yes
No
How many deposits or prepayments do you have?
-
1
2
3
Type of first deposit or prepayment?
*
-
Electric
Gas
Water
Rental Depost
Telephone
Value of first deposit or prepayment?
*
Type of second deposit or prepayment?
*
-
Electric
Gas
Water
Rental Depost
Telephone
Value of second deposit or prepayment?
*
Type of third deposit or prepayment?
*
-
Electric
Gas
Water
Rental Depost
Telephone
Value of third deposit or prepayment?
*
Do you have any certificates of deposit?
*
Yes
No
What is the name of the financial institution for the CD?
*
What is the cash-out value of the CD (if any)?
*
Do You have an annuity?
*
Yes
No
What is the value of the annuity?
*
Do You have an interest in an education IRA?
*
List all interests in an education IRA, in an account in a qualified ABLE program, or under a qualified state tuition program.
Yes
No
What is the value of the education IRA?
*
Are you the beneficiary of a trust?
*
No
Yes
Describe the trust.
*
Do you have any equitable or future interests, or any beneficial rights or powers?
*
Yes
No
Describe all equitable or future interests, or beneficial rights or powers you have.
*
1. Your Information
2. Spouse Information
3. Dependents
4. Mobile Home
5. Real Property
6. Vehicles
7. Other Vehicles
8. Personal Property
9. Financial Assets
10. Investment Assets
11. Other Assets
12. Business Assets
13. Secured Creditors
14. Unsecured Creditors 1-10
15. Unsecured Creditors 11-20
16. Unsecured Creditors 21-30
17. Unsecured Creditors 31-40
18. Unsecured Creditors 41-50
19. Your Income
20. Spouse Income
21. Past Income
22. Household Expenses
23. Financial Affairs
Do you have intellectual property, patents, copyrights or trademarks?
*
Examples: Internet domain names, websites, proceeds from royalties and licensing agreements
Yes
No
Describe Intellectual Property
*
Do You have any licenses, franchises, or other general intangibles?
*
Examples: Building permits, exclusive licenses, cooperative association holdings, liquor licenses, and professional licenses.
Yes
No
Describe Licenses and Franchises.
*
Do You have the right to receive a tax refund?
*
Examples: Past due or lump sum alimony, spousal support, child support, maintenance, divorce settlement, and property settlement.
Yes
No
Describe all tax refunds you are entitled to.
*
Are you entitled to receive family support?
*
Yes
No
Describe all family support you are entitled to.
*
Does anyone else owe you money?
*
Examples: Unpaid wages, disability insurance payments, disability benefits, sick pay, vacation pay, workers’ compensation, Social Security benefits; and unpaid loans you made to someone else.
Yes
No
Describe all other money that is owed to you.
*
Do You have an interest in an insurance policy with cash value?
*
Examples: Health, disability, or life insurance; health savings account (HSA); credit, homeowner’s, or renter’s insurance.
Yes
No
Describe all insurance policies you have an interest in.
*
Are you expecting an inheritance?
*
If you are the beneficiary of a living trust, expect proceeds from a life insurance policy, or are currently entitled to receive property because someone has died.
Yes
No
Describe all inheritances you have an interest in.
*
Do you have a right to file a claim against anyone?
*
Examples: Accidents, employment disputes, insurance claims, or rights to sue.
Yes
No
Describe all third-party claims you have an interest in.
*
Do you have any other contingent claims?
*
Yes
No
Describe all other contingent claims you have an interest in.
*
Do you have any other assets not already listed?
*
Yes
No
Describe all other assets you have an interest in and not already listed.
*
1. Your Information
2. Spouse Information
3. Dependents
4. Mobile Home
5. Real Property
6. Vehicles
7. Other Vehicles
8. Personal Property
9. Financial Assets
10. Investment Assets
11. Other Assets
12. Business Assets
13. Secured Creditors
14. Unsecured Creditors 1-10
15. Unsecured Creditors 11-20
16. Unsecured Creditors 21-30
17. Unsecured Creditors 31-40
18. Unsecured Creditors 41-50
19. Your Income
20. Spouse Income
21. Past Income
22. Household Expenses
23. Financial Affairs
Have you owned or had an interest in a business (including self-employment) in the last 4 years?
*
Yes
No
Describe what interests you had in any business in the last 4 years.
*
Do you own or have any legal or equitable interest in any business-related property?
*
Yes
No
Describe all legal or equitable interests in any business related property.
*
Do you have any accounts receivable or commissions you have already earned?
*
Yes
No
Describe all accounts receivable or commissions you have already earned.
*
Do you own any office equipment, furnishings, and supplies?
*
Examples: Business-related computers, software, modems, printers, copiers, fax machines, rugs, telephones, desks, chairs, and electronic devices.
Yes
No
Describe all all office equipment, furnishings, and supplies you own.
*
Do you own any machinery, fixtures, equipment, supplies you use in business, and tools of your trade?
*
Examples: Business-related computers, software, modems, printers, copiers, fax machines, rugs, telephones, desks, chairs, and electronic devices.
Yes
No
Describe all all machinery, fixtures, equipment, supplies you use in business, and tools of your trade.
*
Do you own any inventory?
*
Examples: Business-related computers, software, modems, printers, copiers, fax machines, rugs, telephones, desks, chairs, and electronic devices.
Yes
No
Describe the inventory.
*
Do you have interests in partnerships or joint ventures?
*
Examples: Business-related computers, software, modems, printers, copiers, fax machines, rugs, telephones, desks, chairs, and electronic devices.
Yes
No
Describe your interests in all partnerships and joint ventures.
*
Do you own any customer lists, mailing lists, or other compilations?
*
Examples: Business-related computers, software, modems, printers, copiers, fax machines, rugs, telephones, desks, chairs, and electronic devices.
Yes
No
Describe all customer lists, mailing lists, and other compilations you own.
*
Do you own any business-related property you did not already list?
*
Examples: Business-related computers, software, modems, printers, copiers, fax machines, rugs, telephones, desks, chairs, and electronic devices.
Yes
No
Describe any other business-related property you own.
*
1. Your Information
2. Spouse Information
3. Dependents
4. Mobile Home
5. Real Property
6. Vehicles
7. Other Vehicles
8. Personal Property
9. Financial Assets
10. Investment Assets
11. Other Assets
12. Business Assets
13. Secured Creditors
14. Unsecured Creditors 1-10
15. Unsecured Creditors 11-20
16. Unsecured Creditors 21-30
17. Unsecured Creditors 31-40
18. Unsecured Creditors 41-50
19. Your Income
20. Spouse Income
21. Past Income
22. Household Expenses
23. Financial Affairs
Do you have any secured debts not already listed?
*
Yes
No
What is the name of the secured creditor?
*
What is this secured creditor's address?
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
What is the account number for this secured creditor?
*
How much is owed to this secured creditor?
*
What is the monthly payment to this secured creditor?
*
Describe what property this debt secures.
*
1. Your Information
2. Spouse Information
3. Dependents
4. Mobile Home
5. Real Property
6. Vehicles
7. Other Vehicles
8. Personal Property
9. Financial Assets
10. Investment Assets
11. Other Assets
12. Business Assets
13. Secured Creditors
14. Unsecured Creditors 1-10
15. Unsecured Creditors 11-20
16. Unsecured Creditors 21-30
17. Unsecured Creditors 31-40
18. Unsecured Creditors 41-50
19. Your Income
20. Spouse Income
21. Past Income
22. Household Expenses
23. Financial Affairs
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?
*
Yes
No
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.
Upload credit reports here.
Max. file size: 3 GB.
Do you need to list creditors that were not on your credit report?
*
Yes
No
Unsecured Creditor 1
What is the name of the unsecured creditor?
What is the address of the unsecured creditor?
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
What is the account number?
How much is owed?
When was the debt incurred?
MM slash DD slash YYYY
Unsecured Creditor 2
What is the name of the unsecured creditor?
What is the address of the unsecured creditor?
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
What is the account number?
How much is owed?
When was the debt incurred?
MM slash DD slash YYYY
Unsecured Creditor 3
What is the name of the unsecured creditor?
What is the address of the unsecured creditor?
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
What is the account number?
How much is owed?
When was the debt incurred?
MM slash DD slash YYYY
Unsecured Creditor 4
What is the name of the unsecured creditor?
What is the address of the unsecured creditor?
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
What is the account number?
How much is owed?
When was the debt incurred?
MM slash DD slash YYYY
Unsecured Creditor 5
What is the name of the unsecured creditor?
What is the address of the unsecured creditor?
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
What is the account number?
How much is owed?
When was the debt incurred?
MM slash DD slash YYYY
Unsecured Creditor 6
What is the name of the unsecured creditor?
What is the address of the unsecured creditor?
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
What is the account number?
How much is owed?
When was the debt incurred?
MM slash DD slash YYYY
Unsecured Creditor 7
What is the name of the unsecured creditor?
What is the address of the unsecured creditor?
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
What is the account number?
How much is owed?
When was the debt incurred?
MM slash DD slash YYYY
Unsecured Creditor 8
What is the name of the unsecured creditor?
What is the address of the unsecured creditor?
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
What is the account number?
How much is owed?
When was the debt incurred?
MM slash DD slash YYYY
Unsecured Creditor 9
What is the name of the unsecured creditor?
What is the address of the unsecured creditor?
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
What is the account number?
How much is owed?
When was the debt incurred?
MM slash DD slash YYYY
Unsecured Creditor 10
What is the name of the unsecured creditor?
What is the address of the unsecured creditor?
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
What is the account number?
How much is owed?
When was the debt incurred?
MM slash DD slash YYYY
Do you have any additional unsecured creditors to add?
*
Yes
No
1. Your Information
2. Spouse Information
3. Dependents
4. Mobile Home
5. Real Property
6. Vehicles
7. Other Vehicles
8. Personal Property
9. Financial Assets
10. Investment Assets
11. Other Assets
12. Business Assets
13. Secured Creditors
14. Unsecured Creditors 1-10
15. Unsecured Creditors 11-20
16. Unsecured Creditors 21-30
17. Unsecured Creditors 31-40
18. Unsecured Creditors 41-50
19. Your Income
20. Spouse Income
21. Past Income
22. Household Expenses
23. Financial Affairs
Unsecured Creditors - Continued
List any additional unsecured creditors in this section.
Unsecured Creditor 11
What is the name of the unsecured creditor?
What is the address of the unsecured creditor?
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
What is the account number?
How much is owed?
When was the debt incurred?
MM slash DD slash YYYY
Unsecured Creditor 12
What is the name of the unsecured creditor?
What is the address of the unsecured creditor?
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
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State
ZIP Code
What is the account number?
How much is owed?
When was the debt incurred?
MM slash DD slash YYYY
Unsecured Creditor 13
What is the name of the unsecured creditor?
What is the address of the unsecured creditor?
Street Address
Address Line 2
City
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