Individual Bankruptcy Questionnaire

Online Bankruptcy Questionnaire for Individual Filing

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III. Your Debts
Your attorney will obtain a tri-merge credit report which will provide a list of your consumer debts. The credit report will provide the names, addresses, account numbers, and balances of each consumer account reported in your name. The credit report typically shows all mortgages, car loans, credit cards, department store cards, and most debts being serviced by a collection company.

However, some debts are typically not reported to the credit bureaus (i.e., doctor bills, old utility bills, personal loans from private individuals, etc.). Prior to filing your case, your attorney will review the final list of creditors with you to make sure they are all properly listed and included.
Your Non-Consumer Debts
Please provide a list of your non-consumer debts (i.e., doctor bills, hospital bills, old utility bills, personal loans from private individuals, etc.). Be sure to include the name of the creditor, the creditor's address, and the approximate amount owed.
Child Support or Alimony*
Are you required by court order to pay Child Support, Spousal Support, or Alimony?
- Yes
- No
Tax Debt
If you owe any taxing authority (i.e., IRS, State, County, or City) back taxes, please describe each debt below. Be sure to include the type of debt, the approximate amount, and the year the debt was incurred.

Some taxes may be dischargeable and your attorney will review the information and advise how your tax debt will be handled in your bankruptcy.

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IV. Wage & Employment
Please skip to the next page if any of the following apply to you...
- You are self-employed, a sole proprietor, or an independent contractor
- You are retired
- You are currently unemployed
- You are not paid with a pay stub and do not receive a W2
Your Current Employer
Your Current Occupation
Approximate Hire Date?
The approximate month and year you began working for the above employer.

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VI. Other Income
Non-Filing Spouse's Income
If you are married and your spouse is not joining you in the bankruptcy filing, please provide her gross monthly income and whether he/she is a W2 employee receiving pay stubs or an independent contractor receiving a 1099. Even if your non-filing spouse is not filing for bankruptcy, we will still have to provide his/her pay stubs to prove the total household income to satisfy the bankruptcy court's Means Test.
Your average monthly income from Rental Property (if any)
Your average monthly income from Child Support or Alimony (if any)
Your average monthly income from Pension (if any)
Your average monthly income from Social Security (if any)
Your average "other" monthly income (if any)

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VII. Monthly Expenses
Rent or Mortgage
How much do you pay per month for your Rent or Mortgage Payments. If you pay a mortgage, provide the Principal + Interest + Tax + Insurance (PITI) payment. If you have a 2nd mortgage (a.k.a. Home Equity Line of Credit) do not include that payment on this line.
2nd Mortgage / Home Equity Loan / HELOC
If you have a 2nd Mortgage (a.k.a. Home Equity Loan, Home Equity Line of Credit, HELOC) please enter the regular scheduled monthly payment amount here.
Condo/HOA Dues
FPL/Power
Water
Cell Phone
Cable and/or Internet
Food and Housekeeping Supplies
Childcare and Children’s Education Costs
Clothing, Laundry, and Dry Cleaning
Personal Care Products and Services
Medical and Dental Expenses
Transportation
Include gas, maintenance, bus or train fare. Do not include car payments.
Leisure
Entertainment, movies, clubs, recreation, newspapers, magazines, and books.
Charitable Contributions and Religious Donations
Car Insurance
Health Insurance (not deducted from paycheck)
Car Payment(s)
Monthly lease or finance payment(s)
Installment Payments
Tax payment plans, financed vehicle or boat loans, mortgage payments for non-homestead property, etc.
Child Support or Alimony (not deducted from your paycheck)

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Your Bankruptcy Questionnaire