Updated July 25, 2011.
- Have you ever filed for bankruptcy before? If yes, when?
- Provide any additional addresses you have resided at in the past 3 years and when you moved in and moved out of each address.
- What is your marital status: single, engaged, married, separated, divorced, or widowed?
- How many children or others do you claim as dependents for tax purposes? What are their dates of birth?
- Which of the following sources of income (a) have you had in the past six months, (b) do you currently have, and (c) do you expect to receive in the near future? How much gross income do you receive per year from each source?
- Employment (wages, salaries, commissions, tips, etc.)
- Business Income
- Rental Income
- Child Support, Alimony, or Maintenance
- Pension
- Social Security, SSDI, or SSI
- Unemployment Benefits
- Workman's Compensation
- Short-Term or Long-Term Disability, VA Disability
- Income from Trusts or Annuities
- Public Assistance (food stamps, rent or utility assistance, etc.)
- Household Contributions (assistance from friends/family to pay bills)
- Sale Profits
- Gambling
- Tribal Per Capita
- Lawsuit Settlements
- Insurance Payouts
- Retirement Disbursements
- Loan Income
- Have you incurred any debt in the past 90 days other than necessary medical care (i.e. have you used credit cards or taken out any loans)?
- If yes, how much debt did you incur and when? Which creditor(s)?
- Have you paid any one unsecured creditor a total of $600 or more over the past 90 days?
- If yes, which creditor(s) did you pay? How much did you pay and when?
- Have you paid money to a relative in the past year?
- If yes, who did you pay? How much did you pay and when?
- In the past four years, have you sold, gifted, or transferred any real estate?
- If yes, I will need the address of the real estate, the name (and address, if different) of the buyer, date of sale, sale price, fair market value of the property (if different from sale price), amount of mortgage balances, whether the mortgages were satisfied, and how the profit (if any) was spent.
- In the past two years, have you sold, gifted, or transferred any personal property worth more than $1,000?
- If yes, I will need a description of the asset, the name and address of the buyer, date of sale, sale price, fair market value of the asset (if different from sale price), amount of lien balances (if any), whether the liens were satisfied, and how the profit (if any) was spent.
- In the past year, have you suffered any losses from theft? Losses from fire, flooding, or any other "act of God"? Losses from gambling?
- If yes, what happened and when? What specifically was damaged or lost? Were police reports or insurance claims filed? If an insurance claim was filed, how much money did you receive and when?
- In the past year, have you been involved in any lawsuits where you were a defendant (small claims, civil claims, foreclosures, etc.)?
- In the past year, have you lost property (or are you currently at risk) due to wage garnishments, repossession, or foreclosure?
- Do you own real estate (e.g. your home, rental properties, business properties, hunting land, vacant lots, timeshares, etc.)?
- If yes, I need a description / address for each piece of real estate owned. What is the taxed assessed value (and do you think that is an accurate reflection of the real estate's value)? How many mortgages / home equity loans do you have? What is your total balance on each loan? Do you intend to keep the property? Are you current on mortgage payments? Is the property insured? Are your property taxes escrowed, and if not, are you current on your property taxes?
- Do you currently (or have you in the past six years) own or operate a business? What type of business is it? Is it organized (Corporation, Partnership, LLC) or a sole proprietorship? Be prepared to discuss income, expenses, assets, and debts of the business.
- What types of vehicles do you own (e.g. automobiles, motorcycles, ATVs, snowmobiles, campers, RVs, trailers, boats, watercraft, mobile homes, aircraft, etc.)? For each vehicle, what is the year, make, and model? Is the title clear or is there a lien on it? If there is a lien, what is the remaining balance on the loan? What is the interest rate? How long ago was the loan financed? Is the vehicle insured? Do you intend to keep the vehicle or let it go back to the lender? Are you current on loan payments?
- Do you have any debts secured by personal assets, such as a furniture, appliance, or jewelry loan?
- Do you have bank accounts? What bank or credit union? What kind (checking, savings, business, etc.)? What is the average maximum balance in each account (i.e. on pay day)? Do you have loans, credit cards, or owe any other debt to that bank or credit union?
- Do you have a life insurance policy through your employer or some other provider? Who holds the policy? Is it a term life (pays only upon death) or a whole life policy (has a cash value that can be borrowed)? For whole life policies, what are their cash value?
- Do you have any pensions or retirement accounts (401(k)s, 403(b)s, IRAs, deferred comp, proft-sharing, ESOP)? What kind, who is the provider, and what is its value?
- Do you have any stocks or bonds?
- Are you expecting a tax refund?
- Do you have any accounts receivable?
- Does anyone owe you money for alimony, maintenance, or child support?
- Are you potentially owed any real estate, personal property, or money as the result of a marital property settlement from a divorce?
- Are you named as the beneficiary to a will, trust, or annuity? Do you otherwise expect to inherit any real estate, personal property, money, or life insurance proceeds in the next 12 months (because someone has died recently or a potential benefactor is in poor health and expected to pass in the near future)?
- Do you have a potential claim against anyone or can you file a lawsuit against anyone for any reason (e.g. personal injury, breach of contract, etc.)?
- Are you the joint owner of any property with a third party?
- Are you in possession of property that belongs to a third party?
- Is a third party in possession of property that belongs to you?
- Have you cosigned for anyone, or has anyone cosigned for you (where there is an outstanding balance)?
- Do you owe any tax debt to the IRS or any state taxing authority (other than property taxes)? What kind of tax? For what year? For how much?
- Do you owe child support, alimony, or maintenance to anyone? Are you current on your domestic support obligations, or do you owe arrears?
- Do you have any student loans?
- Do you have any 401(k) loans?
- Do you owe any fines, tickets, or any other type of debt owed to a government unit?
- Provide a ballpark estimate of your other unsecured debts (e.g. credit cards, personal loans, medical bills, judgments, utilities, deficiencies - essentially every other type of debt not discussed in the previous questions).

