2017 Chapter 7 Bankruptcy Questionnaire

Transcription

1 Arizona s leader in legal document preparation since Chapter 7 Bankruptcy Questionnaire North 19 th Ave., Phoenix, AZ Off Fax. DiscountDivorce@msn.com DiscountDivorceAZ.com Rev. 3 May 2017 Bankruptcy Questionniare 2017 Page 1

2 Instructions How to complete this questionnaire 1. Please print legibly; staff must be able to read this document to accurately complete your documents. 2. Should you need additional space please make extra copies of this questionnaire and attach additional pages as needed. 3. Please do not send or bring us your creditor statements. We cannot read the statements for you. 4. Please make a list of all creditors that you owe. The list must contain the name of the company, complete mailing address and approximate payoff amount. You may also complete this list on our website at: (Atlernatively you can bring us a credit report with this information.) 5. As you complete this questionnaire if you have questions please call our office we would be happy to help you. Make an Office Appointment After completing the questionnaire and making or obtaining a list of creditors that you owe please contact the office for an appointment Office Phone: Fax: Monday thru Thursday 9:00 am 12:30pm 1:30pm 5:00pm and Friday 9:00 am 12:30pm Saturday and Sunday Closed Office location: North 19 th Ave., Phoenix, AZ (Northeast corner of Thunderbird Rd. & 19 th Ave., Subway s parking lot) What to Bring to Your Appointment When you meet with us please bring the following items. 1. A completed questionnaire. 2. A copy of any law suits you have been served with. 3. A photo ID, such as a driver s license or state issued ID. 4. A list of creditors that you owe or a copy of your credit report. 5. Payment: $199. NO PERSONAL CHECKS will be accepted. Fees can also be paid prior to your appointment via our secure website link at If you own a business (are a shareholder/partner/are on the board of directors/etc), have made payments for credit counseling, filed prior bankruptcy, paid an attorney, or any other unusual situation please inform us at the time of your appointment. The Court Will Require the Following: After your bankruptcy documents have been prepared by us the court will require all of the following items at the time of the initial filing. 1. Photo ID. 2. Social Security Card. 3. Two (2) months of pay stubs. 4. Money order for Court s filing fee. Current filing fee is $335. The court does offer a waiver or deferral (payment) plan on this fee. The court makes all determination regarding eligablity in all cases. 5. Credit Counseling Certificate. The Court is located at 230 North First Avenue, 1st Floor, Phoenix, AZ (Van Buren & 1st Ave.) There is all day parking for $2.50 just North of Van Buren on 1st Ave. on the East side of 1st Ave Please keep this page as reference. For legal advice we recommend calling the Arizona Bar Assoc. Attorney Referral Service at or Bankruptcy Questionniare 2017 Page 2

3 How to Obtain a Credit Report If you do not know who all of your creditors are, we recommend bringing in a copy of your credit report. You may use whatever service you wish to obtain a credit report but we require that the following information be on the credit report: 1. Name of each creditor; 2. Address of each creditor; and 3. An approximate balance owed. We recommend using Advantage Plus Credit Reporting, Inc., 7998 West Thunderbird Road, Ste. 109, Peoria, AZ Hours: Monday-Friday 8:00-5:00 MST Phone: Website: (Website is informational only. You cannot order your credit report from this site) Pete@advpluscredit.com Advantage Plus Credit Reporting, Inc. charges $25 for a credit report without scores. Note: When ordering your credit report from Advantave Plus Credit Reporting, Inc. let them know that the credit report is for Discount Divorce & Bankruptcy and they will give you the proper report Note: We DO NOT RECOMMEND freecreditreport.com or creditkarma.com due to feedback we have received from past clients that have found that these credit reports do not give a complete and accurate picture of their credit history. You may also order your credit report from: transunion.com experian.com equifax.com Alternatively you can complete this form on our internet site at: Please keep this page as reference. Bankruptcy Questionniare 2017 Page 3

4 Part 1 Name Chapter 7 Bankruptcy-Personal / Non-Business for 2017 Bankruptcy Filings Personal Information An Arizona Legal Document Company Discount Divorce & Bankruptcy PO Box Phoenix, AZ Office Fax DiscountDivorce@msn.com Address First Middle Last Street City State ZIP Date of Birth (MM/DD/YYYY) Social Security No. Cell Phone Name Spouse s information if filing jointly Address First Middle Last Street City State ZIP Date of Birth (MM/DD/YYYY) Social Security No. Cell Phone Bankruptcy Questionniare 2017 Page 4

5 Part 2 Income Test Elilgabitity What has been your average gross monthly income for the past six months from all income sources? (wages, child support, alimony, EBT, retirement benefits, unemployment benefits, etc.) DO NOT include Social Security If filing jointly, what has been your spouse s gross average monthly income for the past six months from all income sources? $ per month $ per month How many dependents do you support? Do all of these dependents reside with you? If yes, are any of these dependents eighteen years of age or older? If yes, do you claim all these dependents on your taxes? Marital Status (Check only one) Unmarried (Single) Married not filing jointly and declaring you and your spouse are not living together Married not filing jointly and you and your spouse are living together Married filing jointly Prior Filing and Consulting Have you filed for a Chapter 7 bankruptcy in the past 8 years? Have resided in Arizona for the past 180 days Have you consulted with an attorney regarding bankruptcy? Only Wages $ Revenue for $ Rent $ Business Interest $ Pension / $ Support $ Dividends Retirement Unemployment $ Other $ Other Line 11 Column A $ Line 11 Column B $ Total Line 12 $ Line 12b (Line 12 x 12) $ Line 13 Number of people in the household and Med. Income Test 1 Earner $46,779 2 People $58,684 3 People $62,227 4 People $72,052 5 People $80,452 6 People $88,852 7 People $97,252 8 People $105,652 Means Test Line 14B: as of 04/01/2017 (add $8400 for each additional) Bankruptcy Questionniare 2017 Page 5

6 Part 3 Assets 1. Do you own any real estate? Who is the mortgage company? Mortgage company s address: Mortgage company s city, state and ZIP: What is the payoff on the mortgage? $ What is your montly payment amount $ 1.1 / 150, Co-Debtor What do you want to do with your real estate? Keep Surrender Where is your property located? Address: City, State and ZIP: What is the fair market value? $ Do you own any more real property? 2. Are you on a lease for an apartment, home, or other real estate? Who is your landlord? Landlord s address: Landlord s city, state and ZIP: 3a. Do you own or lease any cars, vans, trucks, tractors, sport utility vehicles, motorcycles? Who is the lender company? Lender company s address: Lender company s city, state and ZIP: What is the payoff on the loan? $ What is your montly payment amount $ 3.1 / (8) Co-Debtor What do you want to do with your vehicle? Keep Surrender Describe your vehicle: Make: Model: Year: Mileage: What is the fair market value of the motor vehicle? $ Bankruptcy Questionniare 2017 Page 6

7 Part 3 Assets (Continued) 3b. Do you own or lease any other cars, vans, trucks, tractors, sport utility vehicles, motorcycles? Who is the lender company? Lender company s address: Lender company s city, state and ZIP: What is the payoff on the loan? $ What is your montly payment amount $ 3.1 / (8) Co-Debtor What do you want to do with your vehicle? Keep Surrender Describe your vehicle: Make: Model: Year: Mileage: What is the fair market value of the motor vehicle? $ Do you own or lease any more motor vehicles? 4. Do you own or lease any watercraft, aircraft, motor homes, ATVs and other recreational vehicles, other vehicles, and accessories? Who is the lender company? Lender company s address: Lender company s city, state and ZIP: What is the payoff on the loan? $ What is your montly payment amount $ Co-Debtor What do you want to do with your vehicle? Keep Surrender Describe your vehicle: Make: Model: Year: Mileage: What is the fair market value of this vehicle? $ Do you own or lease any more vehicles? 5. Do you own any major appliances, furniture, linens, china, kitchenware? What is the fair market value of these items? $ 6 / Bankruptcy Questionniare 2017 Page 7

8 Part 3 Assets (Continued) 6. Do you own any televisions and radios; audio, video, stereo, and digital equipment; computers, printers, scanners; music collections; electronic devices including cell phones, cameras, media players, games? What is the fair market value of these items? $ 7 / Do you own any antiques and figurines; paintings, prints, or other artwork; books, pictures, or other art objects; stamp, coin, or baseball card collections; other collections, memorabilia, collectibles? What is the fair market value of these items? $ 8 / None 8. Do you own any sports, photographic, exercise, and other hobby equipment; bicycles, pool tables, golf clubs, skis; canoes and kayaks; carpentry tools; musical instruments? What is the fair market value of these items? $ 9 / (2) 9. Do you own any pistols, rifles, shotguns, ammunition, and related equipment? What is the fair market value of these items? $ 10. Clothes, furs, leather coats, designer wear, shoes, accessories. What is the fair market value of these items? $ 11. Do you own any jewelry, costume jewelry, engagement rings, wedding rings, heirloom jewelry, watches, gems, gold, silver? What is the fair market value of these items? $ 10 / (7) 11/ 1125(1) (4) / (6) /150 watch 12. Do you own any dogs, cats, birds, horses? What is the fair market value of these items? $ 13 / (3) 13. Do you have a checking, savings, or other financial accounts; certificates of deposit; shares in credit unions, brokerage houses, and other similar institutions? What is the fair market value of these accounts? $ 17.1 / (A)(9) Name of institution(s) your accounts are with? 14. Do you have any bond funds, investment accounts with brokerage firms, money market accounts? What is the fair market value of these accounts? $ 18 / None Name of issuer(s) your accounts are with? Bankruptcy Questionniare 2017 Page 8

9 Part 3 Assets (Continued) 15. Do you have an interests in IRA, ERISA, Keogh, 401(k), 403(b), thrift savings accounts, or other pension or profit-sharing plans? Type of account What is the fair market value of these accounts? $ Name of institution(s) your accounts are with? 21 / 100% AZ Retirement (B) Other (C) IRA Police Fire 16. Do you have any 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 Type of deposit (ie rent, gas, electric, etc.) Amount? $ Name of institution(s) or person (s) your deposit is with? 22 / (C) Residence only 17. Are currently expecting a tax refund? State Amount? $ Office use 26 / None Federal other Amount? $ Amount? $ 18. Have you owned any interest in any business in the last four years? Name of the business? Type of business: Sole proprietor Limited liablity (LLC) or limited partnership (LP) Partnership Officer, director or managing executive of a corporation Owner of at least 5% of the voting or equity securities of a corporation. Location of business: City, state and ZIP of business: Type of business: Bankruptcy Questionniare 2017 Page 9

10 Part 4 Co-Debtors 1. Has anyone co-signed any loans for you in the past eight years? What is that person s name? Person s address: Person s city, state and ZIP: What is the name of the lender that the person co-signed for: Lender company s address: Lender company s city, state and ZIP: Has this person co-signed for any other loans? Are there anymore co-signors for anyother loans? 2. Within the last 8 years, were you married and did you live in a community property state or territory? (Community property states and territories include Arizona, California, Idaho, Louisiana, Nevada, New Mexico, Puerto Rico, Texas, Washington, and Wisconsin.) If this person is not filing jointly with you what is this person s: Name? Address: City, state and ZIP: Person s whereabouts are unknown to me. Have you been married to anyone else in the past 8 years and did you live in a community property state or territory? Bankruptcy Questionniare 2017 Page 10

11 Part 5 Income and Employment 1. Are you employed? Your occupation? Name of employer? Address of employer s payroll dept.: City, state and ZIP: How long have you been employed there? years. If filing jointly: Is your spouse employed? Spouse s occupation? Name of spouse s employer? Address of spouse s employer s payroll dept.: City, state and ZIP: How long has your spouse been employed there? years List monthly gross wages, salary, and commissions Estimate and list monthly overtime pay. You Spouse $ $ $ $ Total Income (Add line 2 and 3) 4. $ $ 5. Payroll Deductions 5a. Tax, Medicare, and Social Security Deductions $ $ 5a. 5b. Mandatory contributions for retirement plans $ $ 5b. 5c. Voluntary contributions for retirement plans $ $ 5c. 5d. Required repayments of retirement loans $ $ 5d. 5e. Insurance. $ $ 5e. 5f. Domestic Support Obligations $ $ 5f. 5g. Union Dues.. $ $ 5g. 5h. Other Deductions $ $ 5h. 6. Total Deductions Add lines 5a though 5h $ $ 7. Take Home Pay. Subtract Line 6 from Line 4 $ Bankruptcy Questionniare 2017 Page 11

12 Part 5 Income and Employment (Continued) 8. You Spouse 8a. Net Income from rental property or from operating a business. $ $ 8a. Interest and dividends. 8b. $ $ 8b. 8c. Family support payments (alimony, child support, etc) $ $ 8c. 8d. Unemployment compensations $ $ 8d. 8e. Social Security.. $ $ 8e. 8f. Other government assistance $ $ 8f. 8g. Pensions or retirement income.. $ $ 8g. 8h. All other monthly income. $ $ 8h a. and 10b. Total Other Income Add Lines 8a through 8h. $ $ Calculate montly income Add line 7 and 9 10a.$ 10b.$ Total Add line 10a and 10b $ State all other regular contributions to the expenses that you list. 11. (ie. Include contributions from an unmarried partner, members of your household, your dependents, your roommates, and other friends or relatives.) $ 12. Total Add line 10 and 11. $ Enter this number in Part 6 Line 23a. Do you expect an increase or decrease within the next year? Bankruptcy Questionniare 2017 Page 12

13 Part 6 Expenses 1. Is this a joint case? 2. If yes, does your spouse live in a separate household? 3. Do you have dependants? If yes, complete the information below for each child: Son Daughter Age Does this child live with you? Son Daughter Age Does this child live with you? Son Daughter Age Does this child live with you? Son Daughter Age Does this child live with you? Son Daughter Age Does this child live with you? Son Daughter Age Does this child live with you? 4. The rental or home ownership expenses for your residence. Include first mortgage payments and any rent for the ground or lot. 4 $ 4a. Real estate taxes.. 4a $ 4b. Property, homeowner s, or renter s insurance. 4b $ 4c. Home maintenance, repair, and upkeep expenses. 4c $ 4d. Homeowner s association or condominium dues 4d $ 5. Additional mortgage payments for your residence, such as home equity loans 5 $ 6. Utilities: 6a. Electricity, heat, natural gas... 6a $ 6b. Water, sewer, garbage collection.. 6b $ 6c. Telephone, cell phone, Internet, satellite, and cable services.. 6c $ 6d. Other. Specify: 6d $ Bankruptcy Questionniare 2017 Page 13

14 Part 6 7. Expenses (Continued) Food and housekeeping supplies 7 $ 8. Childcare and children s education costs.. 8 $ 9. Clothing, laundry, and dry cleaning 9 $ 10. Personal care products and services. 10 $ 11. Medical and dental expenses.. 11 $ Transportation. Include gas, maintenance, bus or train fare Do not include car payments. 12 $ 13. Entertainment, clubs, recreation, newspapers, magazines, and books 13 $ 14. Charitable contributions and religious donations 14 $ 15. Insurance. Not deducted from payroll 15a. Life insurance. 15a $ 15b. Health insurance 15b $ 15c. Vehicle insurance.. 15c $ 15d. Other insurance. Specify: 15d $ 16. Taxes. Not deducted from payroll.. 16 $ 17. Installment or lease payments: 17a. Car payments for Vehicle 1. 17a $ 17b. Car payments for Vehicle 2. 17b $ 17c. Other. Specify:.. 17c $ 17d. Other. Specify:.. 17d $ Your payments of alimony, maintenance, and support that you did not report as deducted in Part 5 18 $ Other payments you make to support others who do not live with you. Specify 19 $ 20. Other real property expenses not included in Part 5 20a. Mortgages on other property 20a $ 20b. Real estate taxes 20b $ 20c. Property, homeowner s, or renter s insurance 20c $ 20d. Maintenance, repair, and upkeep expenses.. 20d $ 20e. Homeowner s association or condominium dues.. 20e $ Bankruptcy Questionniare 2017 Page 14

15 Part 6 Expenses (Continued) Other expenses: Calculate your monthly expenses. Add lines 4 through Calculate your monthly net income. 23a. Copy line 12 from Part 5 (monthly income) 21 $ 22 $ 23a $ 23b. Copy your monthly expenses from line 22 above.. 23b $ 23c. Subtract your monthly expenses, line 23b from your monthly income, line 23a The result is your monthly net income. 23c $ 24. Do you expect an increase or decrease in your expenses within the year after you file this form? For example, do you expect to finish paying for your car loan within the year or do you expect your mortgage payment to increase or decrease because of a modification to the terms of your mortgage?, explain: If you and your spouse are not living together but are filing jointly copy and complete a separate Part 6 for them. Bankruptcy Questionniare 2017 Page 15

16 Part 7 Information Regarding Your Financial Affairs 1. During the last three years, have you lived anywhere other than where you live now? Home no. 1 Address: City, state and ZIP: Office use 2 Date you moved in: Date you moved out: Home no. 2 Address: City, state and ZIP: Date you moved in: Date you moved out: 2. Did you receive any income from employment or the operation of a business during the last two calendar years and this current year? Your Income If Filing Jointly Your Spouse s Income Income year to date Last year s income $ $ Income year to date Last year s income $ $ Office use 4 Previous year s income $ Previous year s income $ 3. Did you receive any income from any other source other than employment or the operation of a business during the last two calendar years and this current year? ie: Social Serurity, Retirement, Pension, Nutrional Assistance Program, Child Support, Alimoney, Unemployement Benefits. Your Income Income year to date $ If Filing Jointly Your Spouse s Income Income year to date $ Office use 5 Last year s income $ Last year s income $ Previous year s income $ Previous year s income $ Bankruptcy Questionniare 2017 Page 16

17 Part 7 Information Regarding Your Financial Affairs (Continued) 4. During the last 90 days have you paid any of your creditors $600 or more? Lender s name? Lender s address: Lender s city, state and ZIP: Office use 6 How much was paid? $ How much is still owed? $ What was this payment for? 5. Within 1 year were you a party in any lawsuit, court action, or administrative proceeding? Please attach a copy of all lawsuits. Office use 9 How much are you being sued for $ 6. Within 1 year was any of your property repossessed, foreclosed, garnished, attached, seized, or levied? What was taken? When was it taken? Office use 10 What was the market value of the item taken? $ Who was the creditor that took the item? 7. Have you closed any financial accounts in the past year? Name of financial institution? Financial institution s address: Financial institution s city, state and ZIP: Office use 20 What type of account: Checking Savings Money Market Brokerage Other Last balance $ Date of closing Last four digits of account 8. Have you gone by any other name in the past 8 years? (maiden name, etc.) What was or is that name? Bankruptcy Questionniare 2017 Page 17

18 Part 8 A. Federal Tax Debt Do you have any federal (IRS) tax debt? If yes, for what tax year(s) do you owe this debt for? How much is owed? $ B. State Do you have any state tax debt? If yes, for what tax year(s) do you owe this debt for? How much is owed? $ What is their mailing address? State Tax Authorty (agency s) Name Street address City, State, and ZIP C. Other Do you have any other government tax debt? If yes, for what tax year(s) do you owe this debt for? How much is owed? $ What is their mailing address? State Tax Authorty (agency s) Name Street address City, State, and ZIP Bankruptcy Questionniare 2017 Page 18

19 Part 9 Court s Required Filing Fee 1. How are you planning on paying the the court s required filing fee of $335 at the time of filing of your Chapter 7 Bankruptcy? In Full Partrial Part 10 Preferred Contact By Text: Yes Many of our clients love to keep up to date on the status of their case. Would you like to receive text status updates to your cell phone regarding your case? Yes If yes, who is your cell phone provider? AT&T Verizon T-Mobile Sprint Virgin Mobile US Cellular Nextel Boost Alltel Cricket Other By Yes By Phone: Yes Part 11 Release We never release any information about you or your case to anyone other than the Court or 3 rd parties that we contract to process your case (i.e. process servers, etc.) unless we are compelled by Court Order or with your permission. Is there anyone you want to authorize to call for information or pickup documents on your behalf? Yes If, yes who? Name: Relationship to you: Part 12 Signature and Disclosers You certify that all the information contained herein is accurate to the best of your belief. You acknowledge that purposely misleading the Court is a crime. You acknowledge that Discount Divorce Pro., LLC is not a law firm and cannot provide legal advice. You acknowledge that all fees are earned when paid and that there are no refunds or any partial refunds. You acknowledge that it is your responsibility to proof read your legal documents once they have been prepared. You acknowledge that there may be additional fees and court costs should you want to amened your documents once they have been produced or you have instructed us to begin preparation of your documents. x Date: dd/mm/yyyy Bankruptcy Questionniare 2017 Page 19