- What is your marital status? (e.g. single, married, separated, divorced, widowed)
- How many children/dependents do you claim for income tax purposes?
- Have you ever filed for bankruptcy before? If yes, when?
- Have you resided at a different address in the past two years? If yes, where?
- Are you employed? What is your salary, or your pay rate and average hours per week?
- Currently, or in the past six months, have you had income from any of the following sources?
- business
- rent
- child support / alimony / maintenance
- pension / retirement disbursements
- unemployment
- social security, ssi, or ssdi
- workman's compensation
- short-term or long-term disability
- tribal per capitas
- public assistance (food stamps, rental or utility assistance, etc.)
- contributions to household expenses from others
- gambling winnings
- sale of property
- disbursements from a whole life policy or 401(k)
- If you own a business, be prepared to discuss the nature and type (sole-proprietorship, LLC, corp., etc.) of the business, income and expenses, assets and debts.
- Have you incurred any debt (e.g. taken out loans or used credit cards) in the past 90 days other than necessary medical care?
- Have you paid any single unsecured creditor a total of $600 or more over the past 90 days?
- Have you repaid a debt to a friend or relative in the past year? If yes, to whom, how much did you pay, and when?
- In the past four years, have you sold or given away any real estate? If yes, to whom, how much was the property worth, how much did it sell for, and when was it sold?
- In the past year, have you sold or given away any personal property worth more than $1,000? If yes, what was sold, to whom, how much was the property worth, how much did it sell for, and when was it sold?
- In the past year, have you suffered any losses from theft, fire, flooding, other casualty, or gambling?
- In the past year, have you been involved in any lawsuits? Have you lost property (or are you at risk of losing property) due to wage garnishments, repossession, or foreclosure?
- Do you own any real estate (e.g. residence, rental property, business property, hunting land, timeshares)? If yes, how much is it worth (tax assessed value and your opinion, if different), how much do you owe, is the property insured, and are you current on mortgage payments?
- Do you own any vehicles (e.g. automobiles, motorcycles, boats, ATVs, snowmobiles, campers, mobile homes, aircraft)? If yes, what kind (year/make/model)? Clear title or does it have a lien? If there is a lien, how much is owed? Is it insured? Are you current on payments? How long ago was it financed? What is the interest rate?
- Do you have any other loans that are secured by collateral, such as a furniture, appliance, or jewelry loan?
- Where do you have bank accounts, and what type are they (checking, savings, business, etc.)? What are the average maximum balances?
- Do you have a life insurance policy? What is the cash surrender value of any whole life policy you hold?
- Do you have any retirement accounts (IRAs, pensions, 401(k)s)? What are their values?
- Do you have any stocks or bonds?
- Does anyone owe you money for alimony, maintenance, or child support? Are you owed anything as the result of a pending marital property settlement?
- Are you expecting a tax refund?
- Are you named as the beneficiary to a will or trust? Do you otherwise expect to inherit any property in the next 12 months?
- Do you have a claim against anyone, or could you sue anyone for any reason, for money, property, or damages?
- Are you the owner of any property owned jointly with a third party (someone other than your spouse)?
- Are you in possession of any property belonging to a third party?
- Have you cosigned for anyone, or has anyone cosigned for you?
- Do you owe any tax debt to the state or IRS?
- Do you owe support (child support, alimony, or maintenance) to anyone?
- Do you have any student loans? 401(k) loans? Fines, tickets, or any other type of government debt?
- Please provide a ballpark estimate of your other unsecured debts (e.g. credit cards, personal loans, medical bills, judgments, utilities, deficiencies, etc.).

