Bankruptcy Questionnaire

Thomas K.

Atwood

Attorney at Law

1595 NW Gilman Blvd, Suite 8-C, Issaquah, WA 98027 18820 Aurora Avenue North, Suite #202, Shoreline, WA 98133 Voice (425) 996-4145 or (206) 569-4685 - Fax (815) 550-1378 Email: tom@tomlaw.com Web Page: www.tomlaw.com

BANKRUPTCY WORKSHEET
PLEASE ANSWER ALL QUESTIONS TO THE BEST OF YOUR ABILITY. IF YOU DO NOT HAVE THE INFORMATION REQUESTED, LEAVE BLANK AND BRING IT TO MY ATTENTION DURING OUR FREE CONSULTATION. PLEASE FEEL FREE TO CALL ME AT THE NUMBER ABOVE WITH ANY QUESTIONS CONCERNING THIS FORM OR THE BANKRUPTCY PROCESS.

NAME & OTHER INFORMATION:(DEBTOR)
NAME: ADDRESS: CITY/STATE/ZIP: PHONE NUMBER: SOCIAL SECURITY NUMBER: ALT NUMBER: Email: AGE:

OTHER NAMES USED IN LAST 6 YEARS:(Include maiden, aka, etc.):

PRIOR ADDRESSES/PAST THREE YEARS:
1. ADDRESS: CITY/STATE/ZIP: DATES OF RESIDENCY: FROM: 2. ADDRESS: CITY/STATE/ZIP: DATES OF RESIDENCY: FROM: to to

WHERE DID YOU HEAR ABOUT THOMAS K. ATWOOD, ATTORNEY AT LAW? (Please Circle One) Yellowpages.com Sign at Office Other: PRINT or ONLINE? Thomas K. Atwood - Attorney at Law - 425-996-4145 or 206-569-4685 - Bankruptcy PAGE 1 Verizon Yellow Pages DexOnline Community Newspaper Dex Yellow Pages Nolo.com Google or Yahoo King5.com

Craigslist Seattle Weekly

Seattle Times Online/NW Source The Stranger Referral

Seattle Weekly/Backpage.com

JOINT-DEBTOR (spouse if filing jointly):
NAME: ADDRESS: CITY/STATE/ZIP: PHONE NUMBER: SOCIAL SECURITY NUMBER: ALT NUMBER: Email: AGE:

OTHER NAMES USED IN LAST 6 YEARS:(Include maiden, aka, etc.):

PRIOR BANKRUPTCY
Have you or your spouse filed for Bankruptcy before? (circle one) When?: Where?: Chapter 7 or Chapter 13?: (circle one if applicable) Please provide your case # if available: What was the disposition of your case?: 7 13 Yes No

FILING INFORMATION Will you be filing by yourself or with your spouse? Please check the statement that applies: Filing as: Individual Individual married and living apart Individual married and living together Joint and living together Joint and living apart Are you or your spouse in business? Not in business Currently in business Prior business with the past 2 years

Type of business:(briefly describe operation):

Sole proprietor, Partnership or Corporation?:

Thomas K. Atwood - Attorney at Law - 425-996-4145 or 206-569-4685 - Bankruptcy

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CREDIT COUNSELING SESSION
A “Credit Counseling Session” is mandatory PRIOR to filing your Bankruptcy. A list of the independent organizations who have programs approved by the United States Trustee’s Office can be found at: http://www.usdoj.gov/ust/eo/bapcpa/ccde/cc_approved.htm, or please ask me to email or print out the current list for you. You must complete the credit counseling session within the 180 days PRIOR to filing Bankruptcy. Programs are available in person, via the internet, or by telephone, and take about an hour to complete. The class usually costs approximately $50. I also have an account set up at www.bkcert.com which charges a reduced $40 fee per credit counseling class if I register you from my office. There is also only one $40 fee for husband and wife if you take the course at the same time. They automatically send my office your certificate of completion when the class is completed which is very convenient, and you can pay for the course online with your debit card, or pay through my office. I would need your full names and social security numbers if you want me to register you with www.bkcert.com .

PERSONAL FINANCIAL MANAGEMENT COURSE
There is also a mandatory “Personal Financial Management” program that can be taken AFTER you file but must completed PRIOR to discharge. The current list of approved providers can be found at: http://www.usdoj.gov/ust/eo/bapcpa/ccde/de_approved.htm , or please ask me to email or print out the current list for you. This fee for this class runs anywhere from $15 - $40 online. www.123debtor.com is currently charging $12 for this class.

Thomas K. Atwood - Attorney at Law - 425-996-4145 or 206-569-4685 - Bankruptcy

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Last 60 days of pay statements received for you and your spouse. and all reports can be obtained for free online once per year from www. I can assist you in obtaining these credit reports if you run into difficulty getting them online. so that information will be necessary to properly prepare your case. Tax returns for the last two years if completed and filed. Atwood . You can bring copies if you wish. unemployment compensation or other income. If you have a business or are self-employed. 5. 6. or print them out to bring in.425-996-4145 or 206-569-4685 .com . Also please bring 2 or 3 of your pay statements from 6 months ago . Equifax and TransUnion.Attorney at Law .I WILL NEED THE FOLLOWING DOCUMENTS PRIOR TO FILING YOUR CASE. If your income is close to the means test limits. If you have internet access. don’t be concerned.com . you may wish to contact your employer to see if they can reissue your pay statements from that period. The three major reporting bureaus are Experian. It is important to ascertain when the vehicle was purchased and/or financed. If you do not have all of these documents for the consultation. Registrations for all automobiles that you or your spouse own. please obtain your credit reports online per the instructions on the last page of this questionnaire and bring them to the consult. but requires an additional fee of $50. If you have unfiled returns.Bankruptcy PAGE 4 . If you do obtain them online. 3. Thomas K. along with your last 2 months of bank statements. please email a copy to my office at tom@tomlaw. bring in the most recent ones you have. please bring in a recent year-to-date profit and loss statement. Also bring in any statements regarding retirement. I will be requesting that you bring in all pay statements received within the last 6 months. 4. There will be plenty of time to obtain the required supporting documents. or I can have your originals scanned when you come in. please bring that to my attention at the consult. disability.annualcreditreport. Please bring these documents with you to the consult if available. 2. 1. even if your spouse is not filing for bankruptcy with you. 7. I am required to analyze your income for the past 6 months.if you do not have them. Copies of the automobile purchase contracts if you have your automobiles financed and the contracts are available. There is also a commercial source for this information that is streamlined. If you do not have the last 60 days of statements.

Bankruptcy PAGE 5 .Attorney at Law . Thomas K. If you own real estate. plus your most recent mortgage statements. Atwood . please bring in your closing statement to your purchase or your last refinance. please bring those with you. It will also be important to determine the current value of your real estate. please bring a copy of that also.425-996-4145 or 206-569-4685 . If you have had any recent appraisals or comparables done on the property (within 6 months). If you have a recorded homestead on the property.9.

Atwood . HOW MANY/HOW MUCH?: Thomas K.PROPERTY QUESTIONS REAL PROPERTY: (Circle One) HOUSE CONDO VACANT LOT OTHER: LOCATION OF PROPERTY IF DIFFERENT FROM RESIDENCE: NATURE OF INTEREST: WHOLE 1/2 1/3 DO YOU HAVE A CO-OWNER?: WHEN DID YOU PURCHASE THIS PROPERTY? MARKET VALUE OF PROPERTY: ARE PROPERTY TAXES OWED? FIRST TRUST DEED HOLDER: ADDRESS: CITY/STATE/ZIP: AMOUNT OWED: ACCOUNT #: ARE PAYMENTS CURRENT?: YES NO OTHER: FROM WHAT YEARS?: YEAR LOAN TAKEN OUT: IF BEHIND IN PAYMENTS.Bankruptcy PAGE 6 .Attorney at Law .425-996-4145 or 206-569-4685 .

it may be a good idea to obtain a preliminary title report to show exactly what is in your chain of title. Atwood . If you are not sure. HOW MANY/HOW MUCH?: Please list any additional encumbrances or liens against the property.Bankruptcy PAGE 7 .425-996-4145 or 206-569-4685 . ATTACH ADDITIONAL SHEETS FOR OTHER REAL PROPERTY ANSWERING ALL THE QUESTIONS I ABOVE FOR EACH PROPERTY Thomas K.SECOND TRUST DEED HOLDER: ADDRESS: CITY/STATE/ZIP: AMOUNT OWED: ACCOUNT #: ARE PAYMENTS CURRENT?: YES NO YEAR LOAN TAKEN OUT: IF BEHIND IN PAYMENTS.Attorney at Law .

Bankruptcy PAGE 8 . AND YOU WILL BE SIGNING A DECLARATION UNDER PENALTY OF PERJURY THAT THE LIST OF PROPERTY YOU FILE WITH THE COURT IS CORRECT AND COMPLETE. jewelry.PERSONAL PROPERTY YOU MUST LIST ALL OF YOUR PROPERTY. CASH: $ (Total for currency.ALL OTHER SMALLER ITEMS CAN BE GROUPED (“Misc.Attorney at Law . coins) LIST ALL BANK ACCOUNTS INCLUDING CHECKING/SAVINGS/CD'S/MONEY MARKET FUNDS BANK: ADDRESS: TYPE OF ACCOUNT: ACCOUNT #: BALANCE: BANK: ADDRESS: TYPE OF ACCOUNT: ACCOUNT #: BALANCE: USE ADDITIONAL SHEETS IF NECESSARY Thomas K. THIS INCLUDES EVERYTHING . etc.WHEREVER IT MAY BE LOCATED INCLUDING PROPERTY IN OTHER STATES OR COUNTRIES. household furnishings.WHAT THE PROPERTY IN ITS CURRENT CONDITION AND AGE WOULD BRING IN A PRIVATE SALE. Atwood . PLEASE PROVIDE CURRENT “AS IS” VALUE .425-996-4145 or 206-569-4685 .THE BANKRUPTCY CODE REQUIRES THAT ALL PROPERTY BE LISTED. EVEN IF YOU DO NOT HAVE POSSESSION OF IT.”) IT IS EXTREMELY IMPORTANT TO LIST ALL PROPERTY SO WE CAN DETERMINE WHAT CAN BE CLAIMED EXEMPT AND RETAINED . THIS ALSO INCLUDES ANY COMMUNITY PROPERTY IN POSSESSION OF YOUR CURRENT OR EX-SPOUSE. Misc. PLEASE ITEMIZE ALL ITEMS WITH A VALUE IN EXCESS OF $500 PER ITEM . tools. Misc.

necklaces. rings.): ITEM: ITEM: ITEM: ITEM: ITEM: VALUE: $ VALUE: $ VALUE: $ VALUE: $ VALUE: $ FIREARMS.Bankruptcy PAGE 9 .Attorney at Law . etc. Atwood . Prints.SECURITY DEPOSITS WITH LANDLORDS OR UTILITIES: NAME OF PERSON OR COMPANY HOLDING DEPOSIT: AMOUNT OF DEPOSIT: NAME OF PERSON OR COMPANY HOLDING DEPOSIT: AMOUNT OF DEPOSIT: BOOKS/PICTURES/COLLECTIONS (Paintings. SPORTING & HOBBY EQUIPMENT: ITEM: ITEM: ITEM: ITEM: ITEM: VALUE: $ VALUE: $ VALUE: $ VALUE: $ VALUE: $ Thomas K.425-996-4145 or 206-569-4685 . Stamp Collections/Baseball Cards): ITEM: ITEM: ITEM: ITEM: ITEM: VALUE: $ VALUE: $ VALUE: $ VALUE: $ VALUE: $ JEWELRY & FURS (Wedding bands.

Attorney at Law . Atwood .425-996-4145 or 206-569-4685 .Bankruptcy PAGE 10 .FURNITURE: ITEM: ITEM: ITEM: ITEM: ITEM: ITEM: VALUE: $ VALUE: $ VALUE: $ VALUE: $ VALUE: $ VALUE: $ STEREOS/TVs/CAMERAS/CAMCORDERS/OTHER ELECTRONICS: ITEM: ITEM: ITEM: ITEM: ITEM: ITEM: ITEM: VALUE: $ VALUE: $ VALUE: $ VALUE: $ VALUE: $ VALUE: $ VALUE: $ ALL OTHER HOUSEHOLD FURNISHINGS/PROPERTY: ITEM: ITEM: ITEM: ITEM: ITEM: ITEM: ITEM: ITEM: VALUE: $ VALUE: $ VALUE: $ VALUE: $ VALUE: $ VALUE: $ VALUE: $ VALUE: $ Thomas K.

ANNUITIES.) COMPANY: COMPANY: COMPANY: COMPANY: CASH VALUE: CASH VALUE: CASH VALUE: CASH VALUE: STOCKS. WHEN AND HOW?: WHAT IS THE CASH VALUE?: Thomas K. Atwood .LIFE INSURANCE POLICIES/WHOLE LIFE POLICIES: (Please indicated whether insurance is "term" or "whole life" and provide cash surrender value if applicable. WHEN AND HOW?: WHAT IS THE CASH VALUE?: PLAN: WHERE: CAN YOU WITHDRAW THESE FUNDS?: IF SO.425-996-4145 or 206-569-4685 . BONDS.: (Attached additional sheet if necessary .please provide current statement from all brokerage accounts held showing stocks and portfolio value: COMPANY: SHARES: COMPANY: SHARES: COMPANY: SHARES: PRESENT VALUE: PRESENT VALUE: PRESENT VALUE: IRAs. KEOGHs. ETC. 401Ks.Bankruptcy PAGE 11 . PENSION OR PROFIT SHARING PLAN: Please provide recent statements from each pension. IRA or profit sharing Plan PLAN: WHERE: CAN YOU WITHDRAW THESE FUNDS?: IF SO.Attorney at Law .

TRUCKS.425-996-4145 or 206-569-4685 .MONEY OWED TO YOU INCLUDING: JUDGMENTS. Atwood . TAX REFUNDS. SUPPORT ARREARS. SOURCE: EXPECTED AMOUNT: WHEN DO YOU EXPECT THESE FUNDS?: SOURCE: EXPECTED AMOUNT: WHEN DO YOU EXPECT THESE FUNDS?: SOURCE: EXPECTED AMOUNT: WHEN DO YOU EXPECT THESE FUNDS?: AUTOMOBILES.Attorney at Law . EXPECTED INHERITANCES: LIST ALL POSSIBLE SOURCES. TRAILERS AND OTHER MOTOR VEHICLES: PLEASE PROVIDE COPY OF PURCHASE CONTRACT IF FINANCED VEHICLE #1 MAKE: OPTIONS: MILEAGE: CONDITION: GOOD FAIR POOR YEAR: MODEL: CURRENT FAIR MARKET VALUE: IS VEHICLE SECURITY FOR A LOAN?: YES NAME OF CREDITOR: ADDRESS: CITY/STATE/ZIP: DATE OF PURCHASE: (IMPORTANT IF FINANCED!!) AMOUNT PAID: CURRENT BALANCE ON LOAN: DO YOU PLAN TO KEEP THIS VEHICLE?: DO YOU HAVE A CO-SIGNER ON THIS LOAN?: NAME OF CO-SIGNER/ADDRESS: ARE PAYMENTS CURRENT?: NO Thomas K. PROPERTY SETTLEMENTS.Bankruptcy PAGE 12 . BOATS.

Attorney at Law .Bankruptcy PAGE 13 . Atwood .VEHICLE #2 MAKE: OPTIONS: MILEAGE: CONDITION: GOOD FAIR POOR YEAR: MODEL: CURRENT FAIR MARKET VALUE: IS VEHICLE SECURITY FOR A LOAN?: YES NAME OF CREDITOR: ADDRESS: CITY/STATE/ZIP: DATE OF PURCHASE: (IMPORTANT IF FINANCED!!) AMOUNT PAID: CURRENT BALANCE ON LOAN: DO YOU PLAN TO KEEP THIS VEHICLE?: DO YOU HAVE A CO-SIGNER ON THIS LOAN?: NAME OF CO-SIGNER/ADDRESS: VEHICLE #3 MAKE: MILEAGE: YEAR: CONDITION: GOOD MODEL: FAIR POOR ARE PAYMENTS CURRENT?: NO CURRENT FAIR MARKET VALUE: IS VEHICLE SECURITY FOR A LOAN?: YES NAME OF CREDITOR: ADDRESS: CITY/STATE/ZIP: DATE OF PURCHASE: (IMPORTANT IF FINANCED!!) AMOUNT PAID: CURRENT BALANCE ON LOAN: DO YOU PLAN TO KEEP THIS VEHICLE?: DO YOU HAVE A CO-SIGNER ON THIS LOAN?: ARE PAYMENTS CURRENT?: NO Thomas K.425-996-4145 or 206-569-4685 .

PLEASE MAKE CERTAIN YOU HAVE LISTED ALL OF YOUR PROPERTY: WHAT: WHERE: FMV: WHAT: WHERE: FMV: WHAT: WHERE: FMV: WHAT: WHERE: FMV: WHAT: WHERE: FMV: WHAT: WHERE: FMV: WHAT: WHERE: FMV: Thomas K.PLEASE ATTACH ADDITIONAL SHEETS FOR OTHER VEHICLES/BOATS/ETC.Attorney at Law . ANY OTHER PROPERTY NOT MENTIONED ABOVE . Atwood .425-996-4145 or 206-569-4685 .Bankruptcy PAGE 14 .

425-996-4145 or 206-569-4685 . BUSINESS EQUIPMENT AND OFFICE SUPPLIES: WHAT: FAIR MARKET VALUE (FMV): HOW MANY: WHAT: FAIR MARKET VALUE (FMV): HOW MANY: WHAT: FAIR MARKET VALUE (FMV): HOW MANY: WHAT: FAIR MARKET VALUE (FMV): HOW MANY: WHAT: FAIR MARKET VALUE (FMV): HOW MANY: Thomas K. 15. Atwood .Attorney at Law . FROM WHOM AND WHEN INCURRED.BUSINESS DEBTORS ONLY 14. PLEASE ATTACH AN ACCOUNTING SHOWING AMOUNTS.Bankruptcy PAGE 15 . ACCOUNTS RECEIVABLE: HOW MUCH?: HOW OLD ARE THESE RECEIVABLES?: DO YOU EXPECT THESE RECEIVABLES TO BE PAID?: IF YOU HAVE SUBSTANTIAL RECEIVABLES.

BUSINESS DEBTORS ONLY 16.Bankruptcy PAGE 16 . INVENTORY: WHAT: FAIR MARKET VALUE: HOW DID YOU COME BY THIS VALUATION?: HOW MANY: WHAT: FAIR MARKET VALUE: HOW DID YOU COME BY THIS VALUATION?: HOW MANY: WHAT: FAIR MARKET VALUE: HOW DID YOU COME BY THIS VALUATION?: HOW MANY: WHAT: FAIR MARKET VALUE: HOW DID YOU COME BY THIS VALUATION?: HOW MANY: Thomas K.425-996-4145 or 206-569-4685 .Attorney at Law . Atwood .

Personal income tax? Federal or State? YES FEDERAL NO STATE YES NO From what years & for how much? b. . Property taxes? YES NO From what years.Bankruptcy PAGE 17 . etc.TAX LIABILITIES DO YOU HAVE ANY OUTSTANDING TAX LIABILITIES? a. for how much and on which property? DOES THE FEDERAL OR STATE GOVERNMENT HOLD A LIEN AGAINST YOUR PROPERTY? (Federal tax lien.Attorney at Law .Please describe .425-996-4145 or 206-569-4685 . Atwood .attach lien notices) ANY OTHER TAX LIABILITIES? PLEASE ATTACH ANY NOTICES AND/OR STATEMENTS YOU HAVE RECEIVED FROM THE FEDERAL OR STATE TAXING AUTHORITIES REGARDING TAX LIABILITY Thomas K. 941 taxes? (Payroll/Employee taxes)? From what years & for how much? YES NO c.

Atwood .Bankruptcy PAGE 18 . etc. PROFESSION.425-996-4145 or 206-569-4685 . TRADE.please locate and provide your tax returns for these years if possible) (SELF EMPLOYED please provided a current year to date profit and loss statement showing gross income and deductible expenses) HUSBAND INCOME 2010 (SO FAR): SOURCE: WIFE INCOME 2010 (SO FAR): SOURCE: INCOME 2009: SOURCE: INCOME 2009: SOURCE: INCOME 2008: SOURCE: INCOME 2008: SOURCE: ANY OTHER SOURCES OF INCOME (Rentals. BUSINESS INCOME: (Please list your annual gross income for the years requested .CURRENT AND PAST INCOME GROSS INCOME FROM EMPLOYMENT.Attorney at Law .): HUSBAND INCOME 2010 (SO FAR): SOURCE: AMOUNT: WIFE INCOME 2010 (SO FAR): SOURCE: AMOUNT: INCOME 2009: SOURCE: AMOUNT: INCOME 2009: SOURCE: AMOUNT: INCOME 2008: SOURCE: AMOUNT: INCOME 2008: SOURCE: AMOUNT: Thomas K.DEBTOR QUESTIONS . disability.. pension. Unemployment comp.

WHO? ADDRESS: ITEMIZE PAYMENTS: HAVE YOU MADE ANY LARGE PAYMENTS TO A FAMILY MEMBER.Bankruptcy PAGE 19 . WHO? ADDRESS: ITEMIZE PAYMENTS: Thomas K. WHO? ADDRESS: ITEMIZE PAYMENTS: b. FRIEND OR ASSOCIATE)? a.HAVE YOU MADE ANY PAYMENTS TO ANY CREDITOR OVER THE LAST 3 MONTHS ADDING UP TO MORE THAN $600 TO THAT CREDITOR? a. WHO? ADDRESS: ITEMIZE PAYMENTS: b. Atwood .Attorney at Law .425-996-4145 or 206-569-4685 . WHO? ADDRESS: ITEMIZE PAYMENTS: c. FRIEND OR BUSINESS ASSOCIATE OVER THE LAST YEAR (OVER $1000 IN TOTAL TO THAT ONE FAMILY MEMBER. WHO? ADDRESS: ITEMIZE PAYMENTS: c.

Atwood .425-996-4145 or 206-569-4685 . FORECLOSURES AND RETURNS WITHIN ONE YEAR OF FILING THIS BANKRUPTCY?(Please describe): LOSSES FROM FIRE. THEFT OR GAMBLING?(Please describe): PAYMENTS MADE TO OTHERS FOR DEBT COUNSELING OR BANKRUPTCY?: Thomas K.Bankruptcy PAGE 20 . GARNISHMENTS AND ATTACHMENTS WITHIN ONE YEAR OF FILING THIS BANKRUPTCY?(Please describe): REPOSSESSIONS. EXECUTIONS.Attorney at Law .LAWSUITS AND ADMINISTRATIVE PROCEEDINGS.

Atwood .425-996-4145 or 206-569-4685 . SOLD OR TRANSFERRED ACCOUNTS WITHIN THE LAST YEAR?: SAFE DEPOSIT BOXES MAINTAINED WITHIN THE PAST YEAR?: PROPERTY YOU ARE HOLDING FOR ANOTHER PERSON?: EXECUTORY CONTRACTS.Bankruptcy PAGE 21 .ANY TRANSFERS OF PROPERTY (HOUSES/LARGE SUMS OF MONEY OR OTHER BIG TICKET ITEMS) WITHIN ONE YEAR PROCEEDING THIS BANKRUPTCY?: CLOSED. UNEXPIRED LEASES OR TIMESHARES?: Thomas K.Attorney at Law .

BUDGET OF DEBTOR AND SPOUSE INCOME DEBTOR EMPLOYER'S NAME: EMPLOYER'S ADDRESS CITY/STATE/ZIP: OCCUPATION AND/OR NATURE OF BUSINESS: WHEN DID YOU START THERE?: JOINT DEBTOR/SPOUSE EMPLOYER'S NAME: EMPLOYER'S ADDRESS CITY/STATE/ZIP: OCCUPATION AND/OR NATURE OF BUSINESS: WHEN DID YOU START THERE?: CURRENT INCOME/MONTHLY: PLEASE ATTACH YOUR 3 MOST RECENT PAY STATEMENTS AND LAST YEAR'S TAX RETURN .425-996-4145 or 206-569-4685 . SIT & FICA (TAXES): INSURANCE: UNION DUES: SUBTOTAL DEDUCTIONS: NET WAGES.Bankruptcy PAGE 22 .Attorney at Law .IF YOU ARE SELF-EMPLOYED. SALARY & COMMISSIONS: ESTIMATED MONTHLY OVERTIME: SUBTOTAL CURRENT INCOME: PAYROLL DEDUCTIONS: FIT. SALARY & COMMISSION: INCOME CONTINUED: WIFE Thomas K. Atwood . ATTACH A DETAILED PROFIT AND LOSS STATEMENT YEAR TO DATE AND YOUR LAST 2 TAX RETURNS HUSBAND CURRENT MONTHLY GROSS WAGES.

Bankruptcy PAGE 23 . Atwood .NET INCOME FROM OPERATION OF BUSINESS: (ATTACH PROFIT & LOSS STATEMENT) INCOME FROM REAL PROPERTY: INTEREST AND DIVIDENDS: SPOUSAL OR CHILD SUPPORT RECEIVED: SOCIAL SECURITY OR GOVERNMENT BENEFITS: PENSION OR RETIREMENT INCOME: OTHER MONTHLY INCOME: TOTAL MONTHLY INCOME: DESCRIBE ANY INCREASE OR DECREASE OF MORE THAN 10% ANTICIPATED IN ANY OF THE ABOVE INCOME CATEGORIES OVER THE NEXT YEAR: DEPENDENTS OF DEBTOR AND SPOUSE(minors 18 & under): NAME: NAME: NAME: NAME: NAME: NAME: AGE: AGE: AGE: AGE: AGE: AGE: SEX: SEX: SEX: SEX: SEX: SEX: Thomas K.Attorney at Law .425-996-4145 or 206-569-4685 .

7. Atwood . ETC. MOVIES. 5. 9. 4. ENTERTAINMENT NEWSPAPERS. OIL & REPAIRS): RECREATION. 16. VIDEO RENTALS. 6.PERSONAL INCOME TAXES): INSTALLMENT PAYMENTS: AUTO PAYMENTS: SPOUSAL & CHILD SUPPORT PAID TO OTHERS: JOB EXPENSES TOTAL MONTHLY EXPENSES: Thomas K. TAXES (PROPERTY .Attorney at Law . 15. 12.425-996-4145 or 206-569-4685 . 13. combine expenditures under HUSBAND) HUSBAND WIFE 1.Bankruptcy PAGE 24 . UTILITIES: ELECTRIC AND HEATING FUEL: WATER AND SEWER: TELEPHONE: GARBAGE: CABLE: 3. RENT OR MORTGAGE PAYMENT: INCLUDES TAXES?: YES INCLUDES INSURANCE?: YES NO NO 2.: CHARITABLE CONTRIBUTIONS: INSURANCE: HOMEOWNERS: LIFE: HEALTH: AUTO: 10.CURRENT MONTHLY EXPENDITURES OF DEBTOR AND JOINT DEBTOR: (Fill out separate column for wife only if separated. HOME MAINTENANCE: FOOD: CLOTHING: LAUNDRY AND DRY CLEANING: MEDICAL AND DENTAL EXPENSES (UNCOVERED): TRANSPORTATION (GAS. 8. 14. otherwise. MAGAZINES. 11.

STATE AND ZIP CODE: LAST FOUR DIGITS OF ACCOUNT NUMBER IF KNOWN: DATE(S) DEBT WAS INCURRED: through / (MONTH/YEAR) (DATE OF LAST CHARGE) (YEAR THAT ACCOUNT WAS LAST PAID OFF OR AT ZERO) BASIS FOR DEBT: Credit Card/Consumer Goods & Services Other: APPROXIMATE AMOUNT OWED: IS THIS DEBT SECURED BY ANY PROPERTY?: ANY CO-SIGNERS FOR DEBT?: YES WHO?: ADDRESS : NO Cash advances Loan WHAT?: Thomas K. PLEASE ATTACH THE 2 MOST RECENT STATEMENTS/BILLS FROM EACH CREDITOR. FAILURE TO LIST ALL CREDITORS WILL RESULT IN AN INCOMPLETE PETITION FOR BANKRUPTCY AND MAY AFFECT THE COST AND VALIDITY OF YOUR BANKRUPTCY. IF AVAILABLE. IT IS IN YOUR BEST INTEREST TO LIST ALL CREDITORS AND IS REQUIRED UNDER BANKRUPTCY LAW.DATE(S) MONEY WAS BORROWED (Please provide exact dates if debt incurred within the past three months) FOR CREDIT CARDS. CORRECT ADDRESSES WITH ZIP CODE ARE VERY IMPORTANT FOR PROPER NOTICE SO PLEASE BE ACCURATE AND COMPLETE. PLEASE GIVE THE RANGE OF DATES THAT ITEMS WERE CHARGED ON THE CARD (Example .Attorney at Law . NAME OF CREDITOR: ADDRESS: CITY. please indicate that the debt was incurred "2006 through March/2009") PLEASE LIST ALL CO-SIGNERS AND PROVIDE A COPY OF THE ORIGINAL CONTRACT SHOWING COSIGNER LIAIBILITY : (Co-signers . THESE CREDITORS WILL BE LISTED IN YOUR PETITION FOR BANKRUPTCY WHICH YOU WILL BE SIGNING UNDER PENALTY OF PERJURY.If you have a Visa card that has a balance left from charges made in 2006 and your last charge was in March of 2009. PLEASE INDICATE THE BASIS FOR THE DEBT: (Loan. ALSO PLEASE PROVIDE AN ESTIMATE OF AMOUNT OWED AND ACCOUNT NUMBER IF KNOWN. credit line.LIST OF CREDITORS PLEASE LIST ALL CREDITORS COMPLETE WITH ADDRESSES INCLUDING ZIP CODE.425-996-4145 or 206-569-4685 . Atwood .) AND WHETHER THE DEBT IS SECURED AND BY WHAT PROPERTY. consumer goods.Other parties who also signed the contract with your creditor) PLEASE INCLUDE EVERYONE THAT YOU OWE MONEY TO INCLUDING RELATIVES AND PERSONAL LOANS. PLEASE GIVE THE DATE(S) THE DEBT WAS INCURRED .Bankruptcy PAGE 25 . etc. services. credit card. 1.

NAME OF CREDITOR: ADDRESS: CITY.425-996-4145 or 206-569-4685 .2. Atwood . NAME OF CREDITOR: ADDRESS: CITY.Bankruptcy PAGE 26 .Attorney at Law . STATE AND ZIP CODE: LAST FOUR DIGITS OF ACCOUNT NUMBER IF KNOWN: DATE(S) DEBT WAS INCURRED: through / (MONTH/YEAR) (DATE OF LAST CHARGE) (YEAR THAT ACCOUNT WAS LAST PAID OFF OR AT ZERO) BASIS FOR DEBT: Credit Card/Consumer Goods & Services Other: APPROXIMATE AMOUNT OWED: IS THIS DEBT SECURED BY ANY PROPERTY?: ANY CO-SIGNERS FOR DEBT?: YES WHO?: ADDRESS : NO Cash advances Loan WHAT?: Thomas K. STATE AND ZIP CODE: LAST FOUR DIGITS OF ACCOUNT NUMBER IF KNOWN: DATE(S) DEBT WAS INCURRED: through / (MONTH/YEAR) (DATE OF LAST CHARGE) (YEAR THAT ACCOUNT WAS LAST PAID OFF OR AT ZERO) BASIS FOR DEBT: Credit Card/Consumer Goods & Services Other: APPROXIMATE AMOUNT OWED: IS THIS DEBT SECURED BY ANY PROPERTY?: ANY CO-SIGNERS FOR DEBT?: YES WHO?: ADDRESS : NO Cash advances Loan WHAT?: 3.

STATE AND ZIP CODE: LAST FOUR DIGITS OF ACCOUNT NUMBER IF KNOWN: DATE(S) DEBT WAS INCURRED: through / (MONTH/YEAR) (DATE OF LAST CHARGE) (YEAR THAT ACCOUNT WAS LAST PAID OFF OR AT ZERO) BASIS FOR DEBT: Credit Card/Consumer Goods & Services Other: APPROXIMATE AMOUNT OWED: IS THIS DEBT SECURED BY ANY PROPERTY?: ANY CO-SIGNERS FOR DEBT?: YES WHO?: ADDRESS : NO Cash advances Loan WHAT?: 5. STATE AND ZIP CODE: LAST FOUR DIGITS OF ACCOUNT NUMBER IF KNOWN: DATE(S) DEBT WAS INCURRED: through / (MONTH/YEAR) (DATE OF LAST CHARGE) (YEAR THAT ACCOUNT WAS LAST PAID OFF OR AT ZERO) BASIS FOR DEBT: Credit Card/Consumer Goods & Services Other: APPROXIMATE AMOUNT OWED: IS THIS DEBT SECURED BY ANY PROPERTY?: ANY CO-SIGNERS FOR DEBT?: YES WHO?: ADDRESS : NO Cash advances Loan WHAT?: Thomas K. NAME OF CREDITOR: ADDRESS: CITY. Atwood .425-996-4145 or 206-569-4685 . NAME OF CREDITOR: ADDRESS: CITY.Bankruptcy PAGE 27 .4.Attorney at Law .

STATE AND ZIP CODE: LAST FOUR DIGITS OF ACCOUNT NUMBER IF KNOWN: DATE(S) DEBT WAS INCURRED: through / (MONTH/YEAR) (DATE OF LAST CHARGE) (YEAR THAT ACCOUNT WAS LAST PAID OFF OR AT ZERO) BASIS FOR DEBT: Credit Card/Consumer Goods & Services Other: APPROXIMATE AMOUNT OWED: IS THIS DEBT SECURED BY ANY PROPERTY?: ANY CO-SIGNERS FOR DEBT?: YES WHO?: ADDRESS : NO Cash advances Loan WHAT?: 7.Bankruptcy PAGE 28 .Attorney at Law .6. NAME OF CREDITOR: ADDRESS: CITY.425-996-4145 or 206-569-4685 . Atwood . NAME OF CREDITOR: ADDRESS: CITY. STATE AND ZIP CODE: LAST FOUR DIGITS OF ACCOUNT NUMBER IF KNOWN: DATE(S) DEBT WAS INCURRED: through / (MONTH/YEAR) (DATE OF LAST CHARGE) (YEAR THAT ACCOUNT WAS LAST PAID OFF OR AT ZERO) BASIS FOR DEBT: Credit Card/Consumer Goods & Services Other: APPROXIMATE AMOUNT OWED: IS THIS DEBT SECURED BY ANY PROPERTY?: ANY CO-SIGNERS FOR DEBT?: YES WHO?: ADDRESS : NO Cash advances Loan WHAT?: Thomas K.

Atwood . STATE AND ZIP CODE: LAST FOUR DIGITS OF ACCOUNT NUMBER IF KNOWN: DATE(S) DEBT WAS INCURRED: through / (MONTH/YEAR) (DATE OF LAST CHARGE) (YEAR THAT ACCOUNT WAS LAST PAID OFF OR AT ZERO) BASIS FOR DEBT: Credit Card/Consumer Goods & Services Other: APPROXIMATE AMOUNT OWED: IS THIS DEBT SECURED BY ANY PROPERTY?: ANY CO-SIGNERS FOR DEBT?: YES WHO?: ADDRESS : NO Cash advances Loan WHAT?: Thomas K. STATE AND ZIP CODE: LAST FOUR DIGITS OF ACCOUNT NUMBER IF KNOWN: DATE(S) DEBT WAS INCURRED: through / (MONTH/YEAR) (DATE OF LAST CHARGE) (YEAR THAT ACCOUNT WAS LAST PAID OFF OR AT ZERO) BASIS FOR DEBT: Credit Card/Consumer Goods & Services Other: APPROXIMATE AMOUNT OWED: IS THIS DEBT SECURED BY ANY PROPERTY?: ANY CO-SIGNERS FOR DEBT?: YES WHO?: ADDRESS : NO Cash advances Loan WHAT?: 9.Bankruptcy PAGE 29 .8.Attorney at Law . NAME OF CREDITOR: ADDRESS: CITY. NAME OF CREDITOR: ADDRESS: CITY.425-996-4145 or 206-569-4685 .

NAME OF CREDITOR: ADDRESS: CITY. STATE AND ZIP CODE: LAST FOUR DIGITS OF ACCOUNT NUMBER IF KNOWN: DATE(S) DEBT WAS INCURRED: through / (MONTH/YEAR) (DATE OF LAST CHARGE) (YEAR THAT ACCOUNT WAS LAST PAID OFF OR AT ZERO) BASIS FOR DEBT: Credit Card/Consumer Goods & Services Other: APPROXIMATE AMOUNT OWED: IS THIS DEBT SECURED BY ANY PROPERTY?: ANY CO-SIGNERS FOR DEBT?: YES WHO?: ADDRESS : NO Cash advances Loan WHAT?: Thomas K.10. Atwood . STATE AND ZIP CODE: LAST FOUR DIGITS OF ACCOUNT NUMBER IF KNOWN: DATE(S) DEBT WAS INCURRED: through / (MONTH/YEAR) (DATE OF LAST CHARGE) (YEAR THAT ACCOUNT WAS LAST PAID OFF OR AT ZERO) BASIS FOR DEBT: Credit Card/Consumer Goods & Services Other: APPROXIMATE AMOUNT OWED: IS THIS DEBT SECURED BY ANY PROPERTY?: ANY CO-SIGNERS FOR DEBT?: YES WHO?: ADDRESS : NO Cash advances Loan WHAT?: 11.425-996-4145 or 206-569-4685 .Attorney at Law . NAME OF CREDITOR: ADDRESS: CITY.Bankruptcy PAGE 30 .

STATE AND ZIP CODE: LAST FOUR DIGITS OF ACCOUNT NUMBER IF KNOWN: DATE(S) DEBT WAS INCURRED: through / (MONTH/YEAR) (DATE OF LAST CHARGE) (YEAR THAT ACCOUNT WAS LAST PAID OFF OR AT ZERO) BASIS FOR DEBT: Credit Card/Consumer Goods & Services Other: APPROXIMATE AMOUNT OWED: IS THIS DEBT SECURED BY ANY PROPERTY?: ANY CO-SIGNERS FOR DEBT?: YES WHO?: ADDRESS : NO Cash advances Loan WHAT?: 13. NAME OF CREDITOR: ADDRESS: CITY. NAME OF CREDITOR: ADDRESS: CITY.12. Atwood .Attorney at Law .425-996-4145 or 206-569-4685 . STATE AND ZIP CODE: LAST FOUR DIGITS OF ACCOUNT NUMBER IF KNOWN: DATE(S) DEBT WAS INCURRED: through / (MONTH/YEAR) (DATE OF LAST CHARGE) (YEAR THAT ACCOUNT WAS LAST PAID OFF OR AT ZERO) BASIS FOR DEBT: Credit Card/Consumer Goods & Services Other: APPROXIMATE AMOUNT OWED: IS THIS DEBT SECURED BY ANY PROPERTY?: ANY CO-SIGNERS FOR DEBT?: YES WHO?: ADDRESS : NO Cash advances Loan WHAT?: Thomas K.Bankruptcy PAGE 31 .

Bankruptcy PAGE 32 . NAME OF CREDITOR: ADDRESS: CITY. STATE AND ZIP CODE: LAST FOUR DIGITS OF ACCOUNT NUMBER IF KNOWN: DATE(S) DEBT WAS INCURRED: through / (MONTH/YEAR) (DATE OF LAST CHARGE) (YEAR THAT ACCOUNT WAS LAST PAID OFF OR AT ZERO) BASIS FOR DEBT: Credit Card/Consumer Goods & Services Other: APPROXIMATE AMOUNT OWED: IS THIS DEBT SECURED BY ANY PROPERTY?: ANY CO-SIGNERS FOR DEBT?: YES WHO?: ADDRESS : NO Cash advances Loan WHAT?: Thomas K.14. NAME OF CREDITOR: ADDRESS: CITY.Attorney at Law . Atwood . STATE AND ZIP CODE: LAST FOUR DIGITS OF ACCOUNT NUMBER IF KNOWN: DATE(S) DEBT WAS INCURRED: through / (MONTH/YEAR) (DATE OF LAST CHARGE) (YEAR THAT ACCOUNT WAS LAST PAID OFF OR AT ZERO) BASIS FOR DEBT: Credit Card/Consumer Goods & Services Other: APPROXIMATE AMOUNT OWED: IS THIS DEBT SECURED BY ANY PROPERTY?: ANY CO-SIGNERS FOR DEBT?: YES WHO?: ADDRESS : NO Cash advances Loan WHAT?: 15.425-996-4145 or 206-569-4685 .

16. STATE AND ZIP CODE: LAST FOUR DIGITS OF ACCOUNT NUMBER IF KNOWN: DATE(S) DEBT WAS INCURRED: through / (MONTH/YEAR) (DATE OF LAST CHARGE) (YEAR THAT ACCOUNT WAS LAST PAID OFF OR AT ZERO) BASIS FOR DEBT: Credit Card/Consumer Goods & Services Other: APPROXIMATE AMOUNT OWED: IS THIS DEBT SECURED BY ANY PROPERTY?: ANY CO-SIGNERS FOR DEBT?: YES WHO?: ADDRESS : NO Cash advances Loan WHAT?: 17. Atwood . NAME OF CREDITOR: ADDRESS: CITY.Attorney at Law .425-996-4145 or 206-569-4685 . STATE AND ZIP CODE: LAST FOUR DIGITS OF ACCOUNT NUMBER IF KNOWN: DATE(S) DEBT WAS INCURRED: through / (MONTH/YEAR) (DATE OF LAST CHARGE) (YEAR THAT ACCOUNT WAS LAST PAID OFF OR AT ZERO) BASIS FOR DEBT: Credit Card/Consumer Goods & Services Other: APPROXIMATE AMOUNT OWED: IS THIS DEBT SECURED BY ANY PROPERTY?: ANY CO-SIGNERS FOR DEBT?: YES WHO?: ADDRESS : NO Cash advances Loan WHAT?: Thomas K. NAME OF CREDITOR: ADDRESS: CITY.Bankruptcy PAGE 33 .

18. STATE AND ZIP CODE: LAST FOUR DIGITS OF ACCOUNT NUMBER IF KNOWN: DATE(S) DEBT WAS INCURRED: through / (MONTH/YEAR) (DATE OF LAST CHARGE) (YEAR THAT ACCOUNT WAS LAST PAID OFF OR AT ZERO) BASIS FOR DEBT: Credit Card/Consumer Goods & Services Other: APPROXIMATE AMOUNT OWED: IS THIS DEBT SECURED BY ANY PROPERTY?: ANY CO-SIGNERS FOR DEBT?: YES WHO?: ADDRESS : NO Cash advances Loan WHAT?: Thomas K. Atwood .Attorney at Law . STATE AND ZIP CODE: LAST FOUR DIGITS OF ACCOUNT NUMBER IF KNOWN: DATE(S) DEBT WAS INCURRED: through / (MONTH/YEAR) (DATE OF LAST CHARGE) (YEAR THAT ACCOUNT WAS LAST PAID OFF OR AT ZERO) BASIS FOR DEBT: Credit Card/Consumer Goods & Services Other: APPROXIMATE AMOUNT OWED: IS THIS DEBT SECURED BY ANY PROPERTY?: ANY CO-SIGNERS FOR DEBT?: YES WHO?: ADDRESS : NO Cash advances Loan WHAT?: 19.Bankruptcy PAGE 34 . NAME OF CREDITOR: ADDRESS: CITY.425-996-4145 or 206-569-4685 . NAME OF CREDITOR: ADDRESS: CITY.

NAME OF CREDITOR: ADDRESS: CITY.20. Atwood .Attorney at Law . STATE AND ZIP CODE: LAST FOUR DIGITS OF ACCOUNT NUMBER IF KNOWN: DATE(S) DEBT WAS INCURRED: through / (MONTH/YEAR) (DATE OF LAST CHARGE) (YEAR THAT ACCOUNT WAS LAST PAID OFF OR AT ZERO) BASIS FOR DEBT: Credit Card/Consumer Goods & Services Other: APPROXIMATE AMOUNT OWED: IS THIS DEBT SECURED BY ANY PROPERTY?: ANY CO-SIGNERS FOR DEBT?: YES WHO?: ADDRESS : NO Cash advances Loan WHAT?: 21.Bankruptcy PAGE 35 . NAME OF CREDITOR: ADDRESS: CITY. STATE AND ZIP CODE: LAST FOUR DIGITS OF ACCOUNT NUMBER IF KNOWN: DATE(S) DEBT WAS INCURRED: through / (MONTH/YEAR) (DATE OF LAST CHARGE) (YEAR THAT ACCOUNT WAS LAST PAID OFF OR AT ZERO) BASIS FOR DEBT: Credit Card/Consumer Goods & Services Other: APPROXIMATE AMOUNT OWED: IS THIS DEBT SECURED BY ANY PROPERTY?: ANY CO-SIGNERS FOR DEBT?: YES WHO?: ADDRESS : NO Cash advances Loan WHAT?: PLEASE USE ATTACHMENTS IF YOU HAVE MORE CREDITORS PLEASE LIST ALL CREDITORS! Thomas K.425-996-4145 or 206-569-4685 .

com . Atwood . If you need to contact the credit bureaus directly.Attorney at Law . Box 105281 Atlanta.CREDIT REPORT BUREAUS . If you prefer.O. Sincerely. their contact information is below: 1. or save them to your hard drive and email them directly to me at docs@tomlaw.transunion.CONTACT INFORMATION The Fair and Accurate Credit Transactions Act (FACT) now allows you to obtain a free credit report from each major credit reporting bureau once per year. Experian P. GA 30374 Website: www. PA 19022 Website: www.com Phone: 800-916-8800 2.425-996-4145 or 206-569-4685 . The free reports can be obtained via the internet at: www.O. TX 75013-2104 Website: www. Thomas K. Box 740241 Atlanta.com or by phone: 877-322-8228 or by mail: Annual Credit Report Request Service P.experian.O.com Phone: 800-685-1111 TransUnion Post Office Box 2000 Chester.com Phone: 888-397-3742 Equifax Credit Information Services.equifax. I can obtained a tri-bureau merged report for you for a fee of $50.annualcreditreport. GA 30348-5281 Please PRINT out the credit reports and bring or mail them to my office. 3. Inc P. Atwood 425-996-4145 206-569-4685 Thomas K. Box 2104 Allen. I urge you to get the free reports which are very useful in making certain you have listed all creditors.Bankruptcy PAGE 36 .

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