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Bankruptcy Statement of Financial Affairs Questionnaire Page 3
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Gifts
GiftsList all gifts or charitable contributions made within one year immediately preceding the filing of this case except ordinary and usual gifts to family members less than $200.00 in value and charitable contributions less than $100.00 per recipient. (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 an Address ofRelationship to DebtorDate ofDescription and Value Person or Organization (if any) Gift of Gift8)Losses
Losses List all losses from fire, theft, other casualty or gambling within one year immediately preceding the filing of this 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. Description Description or Circumstances and, if and Value ofLoss was covered in Whole or PartDate of Property By Insurance, Give Details Loss9)Payments Related to Debt Counseling or Bankruptcy
Payments Related to Debt Counseling or BankruptcyList all payments made or property transferred by or on behalf of the debtor to any persons, including attorneys, for consultation concerning debt consolidation, relief under the bankruptcy law or preparation of a petition in bankruptcy within one year immediately preceding the filing of this case. Name and AddressDate or Payment, Name of PayerAmount of Money or Description of Payeeif other than the Debtor and Value of Property10)Other Transfers
Other Transfersa.List al other property, other than property transferred in the ordinary course of the business or financial affairs of the debtor, transferred either absolutely or as security within two years 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 of TransfereeDescribe Property Transferred Relationship to DebtorDate and Value Receivedb.List all property transferred by the debtor within 10 years immediately preceding the commencement of this case to a self-settled trust or similar device of which the debtor is a beneficiary.Name of Trust orDate(s) ofAmount of Money or Description Other Device Transfer(s) and Value of Property or Debtor's Interest11)Closed Financial Accounts
Closed Financial AccountsList ALL financial accounts and instruments held in the name of the debtor or for the benefit of the debtor which were closed, sold, or otherwise transferred within one year immediately preceding the filing of this case. Include checking, savings, or other financial accounts, certificates of deposit, or other instruments held in banks, credit unions, pension funds, cooperatives, associations, brokerage houses and other financial institutions. (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 Type of Account, Last Four Digits of Amount and Date of of Institution Account #, and Amount of Final Balance of Sale or Closing1)2)3)12)Safe Deposit Boxes
Safe Deposit BoxesList 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 Address of BankNames and Addresses of ThoseDescription ofDate of Transfer or or Other Depository with Access to Box or Depository Contents Surrender, if anySelf-representation may not always be the right way to go. We recognize our limitations and understand that some cases will require attorney services. If so, we will help you find a competent, reasonably-priced, attorney at your request. Remember, you must click the link for personal assistance from us to get an attorney referral.
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