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Online Bankruptcy Questionnaire for Joint Filing
Step 1 of 8
Thank you for getting started! This questionnaire is divided in to 8 steps...
1) Personal Info
4) Wage Income
5) Self Employed Income
6) Other Income
7) Monthly Expenses
Your attorney will use the information you provide to draft your bankruptcy petition, schedules, and statements. Prior to filing your case, you will review all of the documents with your attorney. If there are any last minute errors that need to be corrected or changes that need to be made, your attorney will do so prior to filing the documents.
At the end of the questionnaire you will be presented with the option to upload the required documents. If you have already provided these documents to your attorney or will email them separately, please disregard and finalize the questionnaire.
If you have any questions or problems with the questionnaire, please fee free to contact us at 954-484-9987 or send an email to email@example.com.
Current Address(Required)Enter the address of your primary residence. Previous AddressIf you have been at your current residence for less than 3 years, please enter your prior address.Phone Number(Required)Provide the best phone # for us to reach you. Your Email Address(Required)Your Date of Birth(Required)MM slash DD slash YYYYYour Spouse's Date of Birth(Required)MM slash DD slash YYYYYour Social Security Number(Required) Your Spouse's Social Security Number(Required)
Let us know the amount of people living in your home with you. This may include your spouse, children, or elderly dependents.Two (Husband & Wife)ThreeFourFive or more
Have you filed a Bankruptcy case in the last 8 years?YesNoOther
Has your Spouse filed a Bankruptcy case in the last 8 years?YesNoOther
You or your spouse filed a Ch. 7 case less than 8 years agoYou or your spouse filed a Ch. 13 case less than 8 years agoYou or your spouse received your discharge (all the debts were permanently removed)Your or your spouse's case was dismissed before receiving a dischargeYou or your spouse filed your bankruptcy case in FloridaYou or your spouse filed your bankruptcy case in a state other than Florida
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a.k.a. "Your Stuff"
Do you Own or Rent the home you live in?OwnRentOther
Husband onlyWife onlyHusband & WifeOther
Other Real EstateIf either of you own any other Real Estate (i.e., investment property, vacant land, vacation home, etc.) please list the address and brief description of each property.Your VehiclesPlease list the year, make, model, and approximate mileage for any cars, vans, trucks, motorcycles, ATVs, RVs, watercraft, or aircraft registered and/or titled in your name.Your Spouse's VehiclesPlease list the year, make, model, and approximate mileage for any cars, vans, trucks, motorcycles, ATVs, RVs, watercraft, or aircraft registered and/or titled in your spouse's name.
Please check all of the items owned by you and/or your spouse.WasherDryerBedroom Set (Master)Bedroom Set (2nd Bedroom)Bedroom Set (3rd Bedroom)Bedroom Set (4th Bedroom)Living Room SetKitchen/Dining TableKitchen/Dining ChairsKitchenwareLinensWall ArtDesk or Floor LampsRugsCoffee TablesClothingCostume Jewelry (inexpensive)Fine Jewelry (expensive)
Additional Household Goods & FurnishingsIf you or your spouse own any additional household goods or furnishings not listed above, please list the item(s) here and provide their approximate value(s)
Please check all of the items owned by you and/or your spouse.Television(s)Receiver/Radio/StereoSpeakersDVD PlayerDesktop ComputerLaptop ComputerPrinterScannerCell PhoneCameraVideo Game Console
Additional ElectronicsIf you or your spouse own any additional electronics not listed above, please list the item(s) here and provide their approximate value(s)CollectiblesIf you or your spouse own any collectibles of value (i.e., authenticated antiques, sports cards, sports memorabilia, rare stamps, rare coins, etc.) list the item(s) here along with the approximate value(s).Sporting or Hobby EquipmentIf you or your spouse own any sporting or hobby Equipment (i.e., exercise equipment, bicycles, pool table, golf clubs, musical instruments, etc.) list the item(s) here along with the approximate value(s).FirearmsIf you or your spouse own any firearms (i.e., pistols, rifles, shotguns, etc.) list the item(s) here along with the approximate value(s).Anything Else?If you or your spouse own any other personal/household items you did not already list, including health aids, please list the item(s) here along with the approximate value(s).Bank AccountsPlease provide the account # and the name of the bank for each checking and/or savings account in your name (and in your spouse's name if owned separately). If the account is owned jointly with someone other than your spouse, let us know that as well.Investment Accounts (Non-Retirement)Please provide the account # and the name of the institution for each non-retirement investment account in your name (and in your spouse's name if owned separately). These may include stock, stock accounts, mutual funds, bonds, etc. If the account is owned jointly with someone else, let us know that as well. Do not add your IRA or 401(k) accounts here.Undeposited FundsIf you or your spouse are currently holding any checks, money orders, certified funds, etc. made payable to you please list the item(s) here along with the amount(s). This is common where a property insurance company has drafted a check payable to you, your contractor, and the mortgage bank.
Please check any of the retirement accounts that you own. While retirement accounts are protected in your bankruptcy, they must be in one of these particular investment vehicles to enjoy the exemption/protected status. In other words, if you are using an ordinary savings account as your retirement fund, it will probably not be protected.NoneIndividual Retirement Account (IRA)Keogh Retirement Plan401(k)403(b)PensionEducation Savings Account (ESA)Education IRA - 530(b)(1), 529A(b), or 529(b)(1)AnnuityOther
Please check any of the retirement accounts that your spouse owns. While retirement accounts are protected in your bankruptcy, they must be in one of these particular investment vehicles to enjoy the exemption/protected status. In other words, if you are using an ordinary savings account as your retirement fund, it will probably not be protected.NoneIndividual Retirement Account (IRA)Keogh Retirement Plan401(k)403(b)PensionEducation Savings Account (ESA)Education IRA - 530(b)(1), 529A(b), or 529(b)(1)AnnuityOther
How much of a refund do you expect to receive from the IRS after filing your next tax return? If you file your taxes as "married filing separately" please combine the anticipated refunds and check the appropriate box below.$0 (either $0 refund or you will owe the IRS)Up to $1,000$1,000 - $3,000$3,000 - $5,000More than $5,000
Lawsuits or ClaimsIf you or your spouse have any lawsuits or claims pending against someone else and you expect to receive money or other compensation as a result of the lawsuit(s) or claim(s) please briefly describe each lawsuit or claim in this space.Common examples of such a lawsuit or claim would be a car accident where you were injured and not at fault; a property damage insurance claim for which you have not yet been paid; etc.
The following is a list of less commonly owned assets. Please review the list and check any/all that apply.You own Bitcoin or Crypto CurrencyYou or your spouse are a beneficiary of a WillYou or your spouse have a "future interest" in valuable propertyYou or your spouse own a PatentYou or your spouse own a CopyrightYou or your spouse own a TrademarkYou or your spouse own other Intellectual PropertyYou or your spouse own a FranchiseYou or your spouse own a valuable License that can be sold or transferredYou or your spouse own a Whole Life Insurance Policy which lists you as both the "insured" and the "beneficiary"You or your spouse are owed past due or lump sum Alimony or Child SupportYou or your spouse are owed Unpaid Wages, Disability Benefits, Workers’ Compensation, or Social Security Benefits
Anything Else?In the unlikely event you or your spouse own or have an interest in any other asset not disclosed above, please describe the item(s) here along with the approximate value(s). Save and Continue Later
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.Non-Consumer DebtsPlease provide a list of your and your spouse's 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.
Are you or your spouse required by court order to pay Child Support, Spousal Support, or Alimony?YesNoOther
Tax DebtIf you or your spouse 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. Save and Continue Later
You are self-employed, a sole proprietor, or an independent contractorYou are retiredYou are currently unemployedYou are not paid with a pay stub and do not receive a W2
Your Current Employer Your Spouse's Current Employer Your Current Occupation Your Spouse's Current Occupation Your Approximate Hire Date?The approximate month and year you began working for the above employer. Your Spouse's Approximate Hire Date?The approximate month and year you began working for the above employer. Save and Continue Later
You or your spouse are Self-EmployedYou or your spouse are a Sole ProprietorYou or your spouse are an Independent Contractor (receiving a 1099)
What's your business?Please provide a brief description of the business or contracting work. Please let us know whether the business is yours or your spouse's. Include the name of the business ,the business address, the products or services provided, etc.Average monthly income from operation of the business(es)Please provide the net income and not the gross revenue.
What is the total approximate value of the business assets and inventory? This includes the equity in vehicles owned by the business; the balances in any bank accounts owned by the business; etc.$0 - $500$500 - $2,000$2,000 - $5,000$5,000 - $10,000More than $10,000
What is the total approximate amount of debt owed by the business to vendors. This includes the total balance on any SBA loans; an office or warehouse lease; factoring loans, etc.$0 - $1,000$1,000 - $5,000$5,000 - $10,000$10,000 - $20,000More than $20,000
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Average monthly income from Rental Property (if any) Average monthly income from Child Support or Alimony (if any) Average monthly income from Pension (if any) Average monthly income from Social Security (if any) Average "other" monthly income (if any) Save and Continue Later
Rent or MortgageHow 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 / HELOCIf 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 DuesFPL/PowerWaterCell PhoneCable and/or InternetFood and Housekeeping SuppliesChildcare and Children’s Education CostsClothing, Laundry, and Dry CleaningPersonal Care Products and ServicesMedical and Dental ExpensesTransportationInclude gas, maintenance, bus or train fare. Do not include car payments.LeisureEntertainment, movies, clubs, recreation, newspapers, magazines, and books.Charitable Contributions and Religious DonationsCar InsuranceHealth Insurance (not deducted from paycheck)Car Payment(s)Monthly lease or finance payment(s)Installment PaymentsTax payment plans, financed vehicle or boat loans, mortgage payments for non-homestead property, etc.Child Support or Alimony (not deducted from your paycheck) Save and Continue Later
Just a few more miscellaneous questions to answer...
Insiders include your relatives; any general partners; relatives of any general partners; partnerships of which you are a general partner; corporationsof which you are an officer, director, person in control, or owner of 20% or more of their voting securities; and any managing agent, including one fora business you operate as a sole proprietor.YesNoOther
If yes, please list each payment (amount, recipient, and date) below.
Have you or your spouse settled any lawsuits or claims in the last year?YesNoOther
If yes, please describe the settlement below.
Within the last year, was any of your or your spouse's property repossessed, foreclosed, garnished, attached, seized, or levied?YesNoOther
If yes, please describe the Repossession, Foreclosure, or Garnishment below.
Within the last 2 years, did you or your spouse give any gifts with a total value of more than $600 per person or charity?YesNoOther
If yes, please describe the gift below.
Within the last year, did you or your spouse lose anything because of theft, fire, other disaster, or gambling?YesNoOther
If yes, please describe the losses below.
Within the last 2 years, did you or your spouse sell, trade, or otherwise transfer any property to anyone, other than property transferred in the ordinary course of your business or financial affairs? Examples include selling or transferring Real Estate, Automobiles, Personal Valuables, etc.YesNoOther
If yes, please describe the transfers below.
Have you paid off or refinanced a mortgage loan in the last 2 years?YesNo
If yes, please describe each payoff or refinance below.Include the date(s) and whether you received any cash back at closing.
Have you finalized or filed for a divorce in the last 2 years?YesNoOther
If yes, please provide the date of the divorce filing or date the Marital Settlement Agreement (MSA) was finalized.
Within the last year, were any financial accounts or instruments held in your names, or for your benefit, closed,sold, moved, or transferred? Examples may include checking, savings, money market, or other financial accounts; certificates of deposit; shares in banks, credit unions, brokerage houses, pension funds, cooperatives, associations, and other financial institutions.YesNoOther
If yes, please list each transferred or closed account below.Include the date the account was closed/transferred, the balance in the account when it was closed/transferred, and the name of the bank/financial institution.
Do you or your spouse now have, or did you have within the last year, any safe deposit box or other depository for securities, cash, or other valuables?YesNoOther
If yes, please describe the contents of the safe deposit box below.
Have you or your spouse stored property in a storage unit or place other than your home within the last year?YesNoOther
If yes, please describe the contents of the storage unit below.
Within the last 4 years, did you or your spouse own a business or have any of the following connections to any business?A sole proprietor or self-employed in a trade, profession, or other activity, either full-time or part-timeA member of a limited liability company (LLC) or limited liability partnership (LLP)A partner in a partnershipAn officer, director, or managing executive of a corporationAn owner of at least 5% of the voting or equity securities of a corporationNone of the Above
If yes, please describe each ownership interest/connection below.
If you have not already submitted the required documents to your attorney, you may do so by uploading them below. You may also email the required documents to firstname.lastname@example.orgTax ReturnsPlease provide your 2 most recent personal income tax returns. If you field a business tax return (1120 or 1120S) please provide those as well.Drop files here orSelect filesAccepted file types: jpg, gif, png, pdf, Max. file size: 20 MB.
Bank StatementsPlease provide the 6 most recent monthly bank statements for any accounts with your name on them.Drop files here orSelect filesAccepted file types: jpg, gif, png, pdf, Max. file size: 20 MB.
Pay StubsPlease provide all pay stubs received by you and your spouse in the last 6 months.Drop files here orSelect filesAccepted file types: jpg, gif, png, pdf, Max. file size: 20 MB.
Automobile Registration or TitleIf you or your spouse own any automobiles that are paid off, please upload the title here. If you can't find the title, or if you have any automobiles registered to you that are leased or financed, please upload the registration(s) here.Drop files here orSelect filesAccepted file types: jpg, gif, png, pdf, Max. file size: 20 MB.
Automobile InsuranceIf you or your spouse have any automobiles titled or registered in your names, please upload proof of insurance here. Our clients typically provide a copy of the wallet card they keep in their car near the registration.Drop files here orSelect filesAccepted file types: jpg, gif, png, pdf, Max. file size: 20 MB.
Misc.If you have any additional documents you would like to provide to your attorney (i.e., additional creditors, bills, statements, etc.) please upload them here.Drop files here orSelect filesAccepted file types: jpg, gif, png, pdf, Max. file size: 20 MB.