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Joint Bankruptcy Questionnaire
Joint Bankruptcy Questionnaire
Bankruptcy Questionnaire (Joint)
Online Bankruptcy Questionnaire for Joint Filing
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Your Bankruptcy Questionnaire
Thank you for getting started! This questionnaire is divided in to 8 steps...
1) Personal Info
2) Assets
3) Debts
4) Wage Income
5) Self Employed Income
6) Other Income
7) Monthly Expenses
8) Misc.
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
info@fleysherlaw.com
.
I. Personal Info
Your Name
*
First
Last
Your Spouse's Name
*
First
Last
Current Address
*
Enter the address of your primary residence.
Previous Address
If you have been at your current residence for less than 3 years, please enter your prior address.
Phone Number
*
Provide the best phone # for us to reach you.
Your Email Address
*
Your Date of Birth
*
MM slash DD slash YYYY
Your Spouse's Date of Birth
*
MM slash DD slash YYYY
Your Social Security Number
*
Your Spouse's Social Security Number
*
Have you been a Florida Resident for more than 2 years?
*
Yes
No
Other
Are you legally married to each other?
*
Yes
No
Other
Household Size
*
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)
Three
Four
Five or more
Prior Bankruptcy Filings
*
Have you filed a Bankruptcy case in the last 8 years?
Yes
No
Other
Prior Bankruptcy Filings
*
Has your Spouse filed a Bankruptcy case in the last 8 years?
Yes
No
Other
If yes, please check all that apply
You or your spouse filed a Ch. 7 case less than 8 years ago
You or your spouse filed a Ch. 13 case less than 8 years ago
You or your spouse received your discharge (all the debts were permanently removed)
Your or your spouse's case was dismissed before receiving a discharge
You or your spouse filed your bankruptcy case in Florida
You or your spouse filed your bankruptcy case in a state other than Florida
II. Assets
a.k.a. "Your Stuff"
Real Estate
*
Do you Own or Rent the home you live in?
Own
Rent
Other
If the home is owned, in whose name is the home titled?
Husband only
Wife only
Husband & Wife
Other
Other Real Estate
If 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 Vehicles
Please 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 Vehicles
Please 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.
Household Goods and Furnishings
*
Please check all of the items owned by you and/or your spouse.
Washer
Dryer
Bedroom Set (Master)
Bedroom Set (2nd Bedroom)
Bedroom Set (3rd Bedroom)
Bedroom Set (4th Bedroom)
Living Room Set
Kitchen/Dining Table
Kitchen/Dining Chairs
Kitchenware
Linens
Wall Art
Desk or Floor Lamps
Rugs
Coffee Tables
Clothing
Costume Jewelry (inexpensive)
Fine Jewelry (expensive)
Additional Household Goods & Furnishings
If 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)
Your Electronics
*
Please check all of the items owned by you and/or your spouse.
Television(s)
Receiver/Radio/Stereo
Speakers
DVD Player
Desktop Computer
Laptop Computer
Printer
Scanner
Cell Phone
Camera
Video Game Console
Additional Electronics
If you or your spouse own any additional electronics not listed above, please list the item(s) here and provide their approximate value(s)
Collectibles
If 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 Equipment
If 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).
Firearms
If 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 Accounts
Please 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 Funds
If 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.
Your Retirement Accounts
*
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.
None
Individual Retirement Account (IRA)
Keogh Retirement Plan
401(k)
403(b)
Pension
Education Savings Account (ESA)
Education IRA - 530(b)(1), 529A(b), or 529(b)(1)
Annuity
Other
Your Spouse's Retirement Accounts
*
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.
None
Individual Retirement Account (IRA)
Keogh Retirement Plan
401(k)
403(b)
Pension
Education Savings Account (ESA)
Education IRA - 530(b)(1), 529A(b), or 529(b)(1)
Annuity
Other
Pending IRS Tax Refund
*
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 - $5,000
More than $5,000
Lawsuits or Claims
If 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.
Less Common Assets
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 Currency
You or your spouse are a beneficiary of a Will
You or your spouse have a "future interest" in valuable property
You or your spouse own a Patent
You or your spouse own a Copyright
You or your spouse own a Trademark
You or your spouse own other Intellectual Property
You or your spouse own a Franchise
You or your spouse own a valuable License that can be sold or transferred
You 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 Support
You 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).
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.
Non-Consumer Debts
Please 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.
Child Support or Alimony
*
Are you or your spouse required by court order to pay Child Support, Spousal Support, or Alimony?
Yes
No
Other
Tax Debt
If 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.
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 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.
V. Self-Employed Income
Please skip to the next page unless one or more of the following apply...
You or your spouse are Self-Employed
You or your spouse are a Sole Proprietor
You 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.
Business Assets & Inventory
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 - $10,000
More than $10,000
Business Debts & Liabilities
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 - $20,000
More than $20,000
VI. Other Income
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)
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)
VIII. Almost finished...
Just a few more miscellaneous questions to answer...
Within 1 year before you filed for bankruptcy, did you or your spouse make a payment on a debt you owed anyone who was an insider?
*
Insiders include your relatives; any general partners; relatives of any general partners; partnerships of which you are a general partner; corporations of 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 for a business you operate as a sole proprietor.
Yes
No
Other
If yes, please list each payment (amount, recipient, and date) below.
Recent Settlements
*
Have you or your spouse settled any lawsuits or claims in the last year?
Yes
No
Other
If yes, please describe the settlement below.
Recent Repossessions, Foreclosures, Garnishments, etc.
*
Within the last year, was any of your or your spouse's property repossessed, foreclosed, garnished, attached, seized, or levied?
Yes
No
Other
If yes, please describe the Repossession, Foreclosure, or Garnishment below.
Gifts
*
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?
Yes
No
Other
If yes, please describe the gift below.
Losses
*
Within the last year, did you or your spouse lose anything because of theft, fire, other disaster, or gambling?
Yes
No
Other
If yes, please describe the losses below.
Transfers of Property
*
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.
Yes
No
Other
If yes, please describe the transfers below.
Mortgage Payoff or Refinance
*
Have you paid off or refinanced a mortgage loan in the last 2 years?
Yes
No
If yes, please describe each payoff or refinance below.
Include the date(s) and whether you received any cash back at closing.
Recent Divorce
*
Have you finalized or filed for a divorce in the last 2 years?
Yes
No
Other
If yes, please provide the date of the divorce filing or date the Marital Settlement Agreement (MSA) was finalized.
Transferred or Closed Accounts
*
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.
Yes
No
Other
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.
Safe Deposit Boxes
*
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?
Yes
No
Other
If yes, please describe the contents of the safe deposit box below.
Storage Units
*
Have you or your spouse stored property in a storage unit or place other than your home within the last year?
Yes
No
Other
If yes, please describe the contents of the storage unit below.
Business/Corporate Interests
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-time
A member of a limited liability company (LLC) or limited liability partnership (LLP)
A partner in a partnership
An officer, director, or managing executive of a corporation
An owner of at least 5% of the voting or equity securities of a corporation
None of the Above
If yes, please describe each ownership interest/connection below.
Congrats! You've reached the end of the questionnaire.
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
info@fleysherlaw.com
Tax Returns
Please 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 or
Select files
Accepted file types: jpg, gif, png, pdf, Max. file size: 20 MB.
Bank Statements
Please provide the 6 most recent monthly bank statements for any accounts with your name on them.
Drop files here or
Select files
Accepted file types: jpg, gif, png, pdf, Max. file size: 20 MB.
Pay Stubs
Please provide all pay stubs received by you and your spouse in the last 6 months.
Drop files here or
Select files
Accepted file types: jpg, gif, png, pdf, Max. file size: 20 MB.
Automobile Registration or Title
If 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 or
Select files
Accepted file types: jpg, gif, png, pdf, Max. file size: 20 MB.
Automobile Insurance
If 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 or
Select files
Accepted 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 or
Select files
Accepted file types: jpg, gif, png, pdf, Max. file size: 20 MB.
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