Bankruptcy Worksheet

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About Us
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Office Location
- Northern California Offices
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Video Library
- Watch First
- Family Law Videos
Links
Make Payment

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Fields marked with an * are required

First Name

Last Name

Address

City

State

Zip/Post Code

Phone

Email

Marital Status

Married Single Separated Divorced

f Married or Divorced within last 8 years: Name of Spouse *

Have you (or your spouse) used any other name or trade name in the last 6 years?

Yes No

Have you lived at your present address for the last 90 days?

Yes No

Have you (or your spouse) ever filed bankruptcy before?

Yes No

State

Do you (or your spouse) owe any money as a result of a DUI or criminal fine?

Yes No

Do you (or your spouse) owe any money from a student loan or tuition?

Yes No

Do you (or your spouse) owe any money for past taxes to either the State or IRS?

Yes No

Are you (or your spouse) the beneficiary of anyone's will or trust

Yes No

Have you (or your spouse) paid back any family members or friends within the last year?

Yes No

Have you (or your spouse) sold, transferred, or given away any property within the last year?

Yes No

Do you (or your spouse) have the right to file or have filed a claim against anyone for money (including personal injury or workers compensation matters)?

Yes No

Has anyone obtained a judgment against (or your spouse) or have an active lawsuit pending?

Yes No

Are you (or your spouse) a co-signor for anyone's debt?

Yes No

Has anyone co-signed for any of your (or your spouse's) debt?

Yes No

If you own any Real Property (including raw land, timeshares or cematery plots) please list the address

City

Zip/Post Cod

Do you (or your spouse) own any other real property?

Yes No

Name of the lender holding the first mortgage

Is there a second mortgage or any other secured lien against this property?

Yes No

List the amount of cash on hand

List the total in all bank checking and savings accounts

List any amounts paid to anyone for a security deposit

List the value of all household goods and furniture you (or your spouse) owns using a "yard sale" value

List the value of all books and art

List the value of all clothing

List the value of all jewelry

List the value of any guns, hobby or sports equipment

List the value of any whole life or universal life insurance policies

List the value of any annunities

List the value of any stocks or bonds

Do you (or your spouse) own any interest in a partnership or joint venture?

Yes No

Do you (or your spouse) receive alimony or support?

Yes No

Are you (or your spouse) entitled to a tax refund?

Yes No

Do you (or your spouse) own or hold any licenses or franchise agreements?

Yes No

How many vehicles do you (or your spouse) own?

1 2 3 More

Do you (and your spouse) own any motorcycles, boats or aircraft?

Yes No

Do you (or your spouse) own any business equipment, tools or inventory?

Does anyone owe you (or your spouse) any money?

Yes No

List your occupation

Who do you work for:

Employer's address

Spouse's occupation

Spouse's Employer's address

How often are you paid?

weekly bi-weekly semi-monthly monthly

How often is your Spouse paid?

weekly bi-weekly semi-monthly monthly

Net income per pay period

Spouse's Net income per pay period

List your monthly expenses for: Rental / Mortgage

Property Tax / Insurance

Electricity / Heat / Water / Sewer / Trash

Cable / Internet

Home Repairs

Food

Personal Grooming / Care

Clothing / Dry Cleaning

Gas / Oil / Repairs for Vehicles

Out of Pocket Medical

Charitable Contributions

Life Insurance

Auto Insurance

Other Insurance

Taxes (not property tax or tax deducted from wages)

Other Installment Payments

Business Expenses

Gross Income reported on last tax return

Income received last year from sources other than wages / earnings

Income received this year from sources other than wages / earnings

Did you (or your spouse) pay anyone for bankruptcy services within the last year?

Yes No

Were you (or your spouse) a party to any lawsuits in the last year?

Yes No

Did you (or your spouse) lose any property as a result of theft or fire last year?

Yes No

Do you (or your spouse) have a safety deposit box?

Yes No

Have you (or your spouse) closed any bank accounts last year?

Yes No

Have you (or your spouse) a member of any corporation, LLC or partnership within the last 2 years?

Yes No

1+5

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