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Bankruptcy Questionnaire

Contact Information

What You Owe: Please State Amount

Please check all that apply:

You: Yes No

Spouse: Yes No

You: Yes No

Spouse: Yes No

You: Yes No

Spouse: Yes No

You: Yes No

Spouse: Yes No

You: Yes No

Spouse: Yes No

You: Yes No

Spouse: Yes No

You: Yes No

Spouse: Yes No

You: Yes No

Spouse: Yes No

You: Yes No

Spouse: Yes No

You: Yes No

Spouse: Yes No

You: Yes No

Spouse: Yes No

Things You Own

Vehicle 1

Vehicle 2

Vehicle 3

Property 1

Property 2

Property 3

Approximate balance of all bank accounts or other financial accounts:

Note: Do not include IRA or other retirement accounts.

Additional Info

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