Statement of Fnancial Affairs
Bankruptcy
Debtor:
Last:
Bankruptcy Statement of Financial Affairs Questionnaire Page 2
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3)c.ALL DEBTORS:  List all payments made within one year immediately preceding the filing of this case to or for the benefit of creditors who were or are insiders (CLICK HERE to see definition of insider). (Married debtors filing chapter 12 or 13 must state income for each spouse whether or not a joint petition is filed, unless spouses are separated and a joint petition is not filed).

Name and Address of CreditorDate of Amount Amount
  and Relationship to Debtor  Payment  Paid Still Owing















4)Lawsuits, Administrative Proceeding, Executions, Garnishments and Attachments
  a.List all lawsuits and administrative proceedings to which the debtor is or was a party within one year immediately preceding the filing of this bankruptcy case. (Married debtors filing chapter 12 or 13 must state income for each spouse whether or not a joint petition is filed, unless spouses are separated and a joint petition is not filed).

Caption of SuitCourt or AgencyStatus or
  and Case #Type of Proceeding           and Location  Disposition












    b.Describe all property that has been attached, garnished or seized under any legal process within one year immediately preceding the filing of this case. (Married debtors filing under Chapter 12 or 13 must state income for each spouse whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed).

Name and Address   Description
      of Person for whose           Date ofand Value of
Benefit Property was Seized     Seizure    Property











5)Repossessions, Foreclosures and Returns
List all property that has been repossessed by a creditor, sold at a foreclosure sale, transferred through a deed in lieu of foreclosure or returned to the seller, within one year immediately preceding the filing of this case. (Married debtors filing under Chapter 12 or 13 must state income for each spouse whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed).

           Date of  Repossession,
Name and AddressForeclosure Sale, Description and
      of Creditor or Seller      Transfer or ReturnValue of Property












6)Assignments and Receiverships
a.Describe any assignment of property for the benefit of creditors made within 120 days immediately preceding the filing of this case. (Married debtors filing under Chapter 12 or 13 must state income for each spouse whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed).

Name and Address Date ofTerms of Assignment
   of Assignee     Assignment   or Settlement





b.List all property which has been in the hands of a custodian, receiver, or court-appointed official within one year immediately preceding the filing of this case. (Married debtors filing under Chapter 12 or 13 must state income for each spouse whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed).

Name and LocationDescription
Name and Address of CourtDate of      and Value of
    of Custodian  Case Title and Number    Order   Property








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