Basic Client Information

  • Bankruptcy Start-Up Packet - Can Be Used for Chapter 7 or Chapter 13.

  • Your Name
    First Middle Last
  • Age
  • Date of Birth
  • Social Security #
  • Marital Status
    • Married
    • Single
    • Separated
    • Divorced
    • Widowed
  • Are you both filing for Bankruptcy?
    • Yes
    • No
  • Spouse's Name
    First Last
  • Spouse's Age
  • Spouse's Social Security #
  • Cell Phone
  • Home Phone (If different from cell)
  • Email Address
  • Current Address
    Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
  • Who owns the property?
    • I/we
    • Landlord
    • Family
    • Friend
  • Do you presently own; are you buying; or are you involved as a part owner in any real estate (home, land, cottage, rental unit)?
    • Yes
    • No
  • Real Estate (Your House)

  • Address of property
    Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
  • Is this your residence?
    • Yes
    • No
  • Year Bought
  • Price Paid
  • Present fair market value
  • Present balance owed on property mortgage, land contract, or liens
  • Name of Mortgage Company
  • Whose names are on deed?
  • State Equalized Value
  • Have you owned any other REAL ESTATE in the past 5 years?
    • Yes
    • No
  • Vehicles

  • Are you buying, or do you currently own or lease any cars, trucks, mobile homes, boats, motorcycles, snowmobiles, or recreational vehicles?
    • Yes
    • No
  • Please list ALL CARS OWNED (even old ones, click + to add more):
    YearMake and ModelLease or PurchaseName(s) on TitleKeep or give backPresent ValueAmount owedCreditor 
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  • Personal Property

    Property that you currently own that you will keep. Do not leave blank, estimate the value of all possessions. It is important that you list all property you own, so that I can exempt or protect it from the hands of your creditors. The law is very generous in what you are allowed to keep. I will inform you if your assets are over the limit.
  • Deposits in any bank or credit union (click + to add multiple)
    LocationChecking/SavingsAmount 
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  • Security Deposits with Landlord or management co.
    With whom?For What?Value 
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  • Property Value

    Please place the total value if applicable into the boxes below for each item listed. All values should be approximate values you could get if you sold the property at a garage sale or advertised in the newspaper.
  • Household furnitureAppliancesElectronics 
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  • RingsNecklacesBraceletsClothingFurs 
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  • FirearmsValuable CollectionsSports/Hobby EquipmentTools 
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  • Life Insurance Policies with Cash ValueStocksBonds 
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  • IRAs401K PlansPension PlanThrift savings at work 
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  • Anticipated tax refund dueChild support owed to youAny lawsuits for injury/accident, workers' comp claim, or claims for money against anyone or expected inheritance in probate court? 
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  • Income

  • Occupation (Job Title)
  • Employer
  • Employer's Address
    Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
  • Your Employment Information
    How long Employed? YearsMonthsPay Rate/HourHrs. WeekFull Monthly Gross IncomeFull Monthly take Home (After Taxes) 
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  • Spouse's Occupation (Job Title)
  • Spouse's Employer
  • Spouse's Employer's Address
    Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
  • Spouse's Employment Information
    How long Employed? YearsMonthsPay Rate/HourHrs. WeekFull Monthly Gross IncomeFull Monthly take Home (After Taxes) 
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  • Are Union Dues deducted from your pay? If yes, how much per month?
  • Is Child Support deducted from your pay? If yes, how much per month?
  • Is Insurance or Parking or Uniforms deducted from your pay? If yes, how much per month?
  • Current dependents (include children you pay child support for and your spouse, if not working, click + to add more)
    AgeRelation (ie. son, daughter, etc.) 
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  • Monthly Living Expenses

    Please provide me with your average monthly living expenses. Do not list any debts that you are paying on that you will stop paying when your bankruptcy case is filed, such as a car that is being returned, etc.
  • Amount in $
    RentMortgage PaymentSecond MortgageElectric /HeatingWater & SewerPhoneCableFoodClothingLaundry 
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  • School TuitionMedical /DentalHome SecurityInternetHair care /personal /misc.Car Payment /LeaseCar InsuranceTransportation (gas, oil, car washes)RecreationCharity 
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  • Other InsuranceLife InsuranceProperty TaxesChild SupportAlimonyDay CareTobaccoLoan PaymentPet food /careChildren's Activities 
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  • Other expenses, specify
  • Income From Employment

    How much money did you make so far this year, last year, and the year before. This is required information; do your best to estimate the amount.
  • Year-to-Date Gross IncomeGross Income Last YearGross Income Two years Ago 
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  • Spouse's Income From Employment
    Year-to-Date Gross IncomeGross Income Last YearGross Income Two years Ago 
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  • Income Other Than From Employment

    Describe ADC-FIA, Social Security, Unemployment, Disability Insurance, Child Support, etc.
  • This YearLast YearTwo Years Ago 
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  • Spouse's Income Other Than From Employment
    This YearLast YearTwo Years Ago 
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  • Do you collect Child Support now? If so, how much on average per month?
  • The Following Questions Will Help Me Analyze Your Case

  • Have you or your spouse ever filed bankruptcy before? If so, state when and where. Include chapter and case number, if available.
  • Are there any garnishments or other court actions such as divorce going on at this time? If so, please provide the full name of the creditor suing you, the court address in which the action is pending, and the case number.
  • Have you had any property repossessed or foreclosed on within the last two (2) years? If so, please give the name of the creditor and the property taken and the approximate date it was taken.
  • Have you sold or transferred (by sale or gift), any items of real or personal property within the last two (2) years? If so, please indicate the item that was given, the value of the item, and the person to whom it was given, and if they are related, please provide their name and address.
  • Have you lived at any other address within the last three (3) years? If so, please provide the full address and the approximate date you lived at this address. (From when till when-month/year, e.g. from 4/95 to 8/98)
  • Have you owned a business or been self-employed within the last six years? If so, please provide the years of operation and the amount of profit for each year.
  • Have you made any large payments, $600 or more, to any family member, close friend, or business partner that you owed money to in the last year? If so, give name, date, and amount.
  • Have you closed any bank accounts or safety deposit boxes within the last year or suffered any losses from fire, theft or casino gambling? If so, please indicate what.
  • Do you presently lease any property? If so, please indicate what is leased and from whom, such as a car or apartment/house. Provide the complete address of the landlord, if you signed a lease.
  • Is anyone, other than your spouse, liable for any of the debts you listed? If so, please provide the name and complete address of any co-signers and the debt upon which they co-signed.
  • Briefly state any reason causing you to file Bankruptcy at this time. (e.g. loss of job or overtime, illness, accident or disability, divorce, repossession, garnishment, death of spouse, or just poor financial planning credit card interest.)
  • Listing Your Creditors

    The most important rule in filling out the next section is that you try to list every debt you owe. I will pull a bankruptcy specific credit report which will contain most, if not all of your creditors, I will cross check this report with the list that you provide. Please do your best to try to list all your debts. The law says that even if you forget to list a creditor, the money you owe them is still wiped out. Listing a debt does not automatically mean you want to discharge that debt. Many debts you will want to keep, such as a mortgage or car loan. The debt must still be listed so that the trustee can see your whole financial picture. On the following pages, list the FULL NAME AND ADDRESS, INCLUDING THE ZIP CODE of each of your creditors. In the alternative to listing each debt individually, you may provide my office with all collection letters, credit card statements, medical bills, summons & complaints, judgments, etc. YOU MUST LIST ALL PERSONS AND COMPANIES YOU OWE MONEY TO EVEN IF YOU WANT TO KEEP THE DEBT. This includes your obligations under a car lease, apartment lease, car loans, home mortgages, furniture financing, etc. If an account has been turned over to a collection agency or attorney, please list the name and address of both the creditor and the name and address of the collection agency or attorney. This ensures notices will be sent to both agencies to stop them from harassing you. If you are a co-signer for someone on a particular debt, be sure to list this also. If you have a co-signer on a debt, note this in the reason for debt section.
  • Click + to add a new creditor - If a husband and wife are both filing this bankruptcy, put a ‘H’ for debts where only the husband is liable, ‘W’ where only the wife is liable, ‘J’ (Joint) if both are liable, and 'C' if there's a cosigner. The most important information I need, is the complete address of the creditor. You don’t need the exact amount you owe and you don’t necessarily need the account number. List it even if you don’t know how much you owe. Note: Pressing the enter button in this column will attempt to submit the form! Please leave creditor addresses in a single line.
    Creditor NameAddressZIPAmount OwedKind of debt (credit card, medical, car loan, etc.)Liability (H/W/J/C) 
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