BANKRUPTCY INTERVIEW SHEET

NAME:    __________________________ADDRESS: _________________________________
______________________________________________________________________________
Your email address: __________________________________________________
Spouse’s Name (if you are married) __________________________________________________
If you are divorced, do you and your spouse still jointly own property or owe debts.   Or do you guarantee that she or he doesn’t have to pay a debt? If so, please explain what debts or property.
_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Are you filing jointly? ____________________________________________________________
State and County you live in: ______________________________________________________
You will have a hearing about 4-6 weeks after you file.   You must give us your correct address and make certain it is correct on your copy of the bankruptcy.  If you do not give us your correct address you may not get notice of your hearing and you may miss your hearing.  If you fail to attend your hearing, you will have additional court costs and attorney fees. Additionally, you will have to file for bankruptcy all over again.  DO NOT MISS YOUR HEARING!  The Court will not continue your hearing and your case will be dismissed.  
Social Security Numbers: 
Husband _____________________________________________
Wife_________________________________________________
TELEPHONE NO:  work: __________________home: ________________________                                
1.	List the Names and Ages of any Children or Dependants _________________________ ______________________________________________________________________ ______________________________________________________________________
2.	Name Address and Telephone number of someone in case we have to reach you_________
______________________________________________________________________________

BUSINESS SECTION

(IF YOU DO NOT OWN A BUSINESS, SKIP TO THE NEXT PAGE AND THE PERSONAL SECTION ITEM 3)
                                             
Describe Type? ___________________________________________________________
Sole Proprietorship ___ Partnership___Corporation___ Other_____________________       
A. Business Assets:                                                                                       
       Inventory FMV _____________________                                                         
       Accounts Receivable _______________                                                    
       Equipment FMV____________________                                                 
       Cash ______________________________                                                         
       Other _____________________________                                                        
B.  Business Debts:  If this is a business bankruptcy list the debts on the last pages in the secured or unsecured sections List any Special problems or questions here _____________________
C.  Attach any financial information Balance Sheets, Income Statements and Cash Flow Statements 
                                               
D.  Net Profit (Loss) YTD: ____________________ 
     Net Profit (Loss) Last year _______________  
                
E.  Do you want to liquidate the business by filing a Chapter 7 Bankruptcy?  ______________

F.  Do you want to file for Chapter 13 or 11 to request court to give you 3 to 5 years to pay your debts?_________   (A Chapter 13 can be used for debt levels up to $1,250,000).

G.  List any transfers from the business to yourself or related persons within the last year that were valued at over $600.00.   
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________

H.  List any payments that were made that were more than the regular payments for services and materials.  
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________

I.  If you are paid compensation, list it and how you are paid.   

_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

PERSONAL BANKRUPTCY SECTION

PERSONAL ASSETS:

A.  DO YOU OWN A HOME OR ANY OTHER REAL PROPERTY? ___________________
APPROXIMATE VALUE: _____________ Address of your home________________________
Who do you jointly own the Home with? _____________________________________________
If you have any second homes or other real property list it’s address the value of it and any mortgage on it that you owe:
Name of 1st Mortgage___________________________________Amount ____________________    
Name of 2nd Mortgage__________________________________Amount ____________________
Name of 3rd Mortgage__________________________________Amount ____________________
Name of any other lein_________________________________Amount______________
List all other Real Property Interests                                                       
B. OTHER REAL ESTATE? 
Type of Real Property	Value	Debt on the Property	Mortgage company	

				
C. List all other Autos, Boats, Jet Skis, 4 Wheelers, MOTORCYCLES 
Do you have any of these items or AUTOS: Yes _____ No _____
      a.)  YEAR _____________________ MAKE _______________________ VALUE ________
           AMOUNT OF LOAN ____________________
      b.)  YEAR _____________________ MAKE _______________________ VALUE ________
           AMOUNT OF LOAN ____________________
      c.)  YEAR _____________________ MAKE _______________________ VALUE ________
           AMOUNT OF LOAN ____________________
      d.)  YEAR ______________________ MAKE ______________________ VALUE ________
           AMOUNT OF LOAN ____________________

Rooms of Furniture:

Bedrooms	Living Rooms	Dinettes
	Tvs	
Stereos	Other Items	Value of Your Furniture(normally less than 2000)

D.  LIST ANY OTHER ASSETS WITH VALUE GREATER THAN $1,000 
(List the Item its value and the amount of any lien on the item and who that lien is to 
Include specifically checking and bank accounts even if less than 1000 dollars and 
the nature of any bank account and where it is
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________

E.  . List any transfers to yourself or related persons within the last year of items over 600 dollars in value if this was an exchange for something of equal value or payment for services list what services. 
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________F.	List all Lawsuits or Judicial Proceedings that you are involved in: ____________
____________________________________________________________________________________________________________________________________________________________
G.	Have you been garnished?  Have you had any real or personal property attached by liens?  Have you had any property repossessed or taken away?  ____________________________________________________________________________________________________________________________________________________________
______________________________________________________________________________
H.	 	Have you given anyone a lien on property within a year or has a lien been taken on any of your property within the last year?   _______________________________________________
___________________________________________________________________________________________________________________________________________________________
I	Have you lost sold or had any property stolen or destroyed within the last year?   
____________________________________________________________________________________________________________________________________________________________
J	Does anyone have any property that belongs to you or have you given any property away?   ______________________________________________________________________
K	Have you seen any other attorney within the last year?  ________________________
______________________________________________________________________________L	Have you filed bankruptcy before if so when and where and what Chapter did you file? _
______________________________________________________________________________

M	When did you file your Taxes last and are you due a refund?  ______________________________________________________________________________
N	Are you involved in any divorce proceeding if so this may affect your divorce? _________
______________________________________________________________________________

O	Do you have any inheritance that you will be getting soon? _____________________________________________________________

4.  INCOME _ NET MONTHLY ("take home pay if employee or "average net profit per month" if self-employed)
HUSBAND $____________
Name and Address of Employer____________________________________________________
______________________________________________________________________________
Your Type of Work and Name of Your Position_______________________________________
WIFE $_____________
Name and Address of Employer___________________________________________________
_____________________________________________________________________________
Your Type of Work and Name of Your Position ______________________________________
ANY OTHER INCOME List Amount and Type ______________________________________
$_____________   TOTAL INCOME $_________________

Income earned for the last 2 years 
2000________
1999________
1998_________

If you live in the Eastern District of Kentucky attach the last 2 years of Income taxes last 6 months of bank statements and titles of any vehicles and a copy of your Deed and Mortgage.  (The Eastern District is the Lexington Area and Eastern half of the state East of Frankfort and Shelbyville Kentucky).  
A.  WHAT ARE YOUR APPROXIMATE MONTHLY LIVING EXPENSES EXCLUDING ANY DEBT YOU WANT TO DISCHARGE IN BANKRUPTCY?
(i.e., RENT OR MORTGAGE, UTILITIES, FOOD, MEDICAL, AUTO GAS, REPAIR,
AND PAYMENTS, CLOTHING, CHILD SUPPORT, INSURANCE, RECREATION)
Rent 				___________________
Taxes				___________________
Home Maintenance if any	___________________
Utilities Electric and Gas	___________________	
	Phone			___________________
	Water			___________________
	Garbage		___________________
	Cable			___________________
Clothing 			___________________
Laundry			___________________
Food 				___________________
Entertainment			___________________
Medical			___________________
Dental				___________________
Car Payment			___________________
Car Repair 			___________________
Gasoline			___________________
Insurance	Life		___________________
		Health		___________________
		Auto		___________________
Child Support			___________________
Alimony Payments		___________________
Day Care			___________________
Any Other Expenses List	___________________
				___________________
				___________________

TOTAL EXPENSES:  	$______________

NET INCOME:      		$______________	

Income Minus Expenses	$______________
NOTE If you have Income greater than your Expenses this is your ability to pay a Chapter 13.   DO you really want to pay into a Chapter 13?  If your income is greater than your expenses and you don’t want to pay into a Chapter 13 you may want to go back and look at your income and expenses.   
5.  DEBTS:
A.  APPROXIMATE TOTAL AMOUNT OF CREDIT CARD DEBT ____________________
B.  APPROXIMATE AMOUNT OF OTHER DEBTS _______________________________
    (excluding Real Estate & Auto Loan)
C.  TOTAL APPROXIMATE DEBTS _________________________________
D.  TYPES AND AMOUNTS OF Non Dischargeable Debts indicate these debts here including tax debts and student loan debts.   Non Dischargeable Debts include Criminal Acts, Fraud, Drunk Driving Accidents, Child Support, or Alimony?  Many of these debts may be discharged anyway if you tell us we can discuss with you how you may be able to get a discharge anyway such as a hardship discharge.  Fraud includes if you charged over 1000 dollars within 60 days of filing.  Please give the Names Address Amounts and Nature of these Debts. If you charged over 1000 dollars to any creditor within the last 90 days identify the creditor and the Debt.  If you have any Judgments against you list that or judgment liens on your home.   You must tell us if you have a judgment on your home.  You may not know that you have one and you may want to get a title check.   During your bankruptcy will be your only chance to remove a judgment or tax lien on your home.   Include these debts in your list of debts in your bankruptcy they may be bankruptable anyway and be certain to discuss the possibility of bankrupting any of these debts anyway even if you have been told by other attorneys that you cant bankrupt these debts.    If you have any of these list them now for discussion and in the unsecured section of debts at the end as well.   Failure to list a debt may cost you extra time court costs and attorney fees to include it later.     Also indicate if any finance company has a lien on your household goods.   Certain taxes are dischargeable if they are over 2 years old and you filed your returns on time.  Talk to us about it the calculation of time is odd.  During 2001 2000 and 1999 returns are not dischargeable 1998 is.  Taxes can be bankrupted in a 13 but there are rules that must be followed.
___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________   ____________________________________________________________________________________________________________________________________________________________
E.  STUDENT LOANS: DUE DATE: _____________ OWE ______________________
To Whom Name Amounts and Addresses If you owe for a student loan talk to us about the possibility of a hardship discharge.  
____________________________________________________________________________
________________________________________________________________________________________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
F.  TAX DEBTS: AGENCY __________ TAX YEAR ___________ OWE ___________
G.  Any JUdgment Lien on your house.  CREDITOR ________________________
JUDGMENT DATE __________ OWE ______________  
H.   Any special Concerns or questions you have place it here and go over it with us_________
______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

H.  SECURED DEBTS?  SUCH AS REAL ESTATE, AUTO) ____________________       
 
Name_____________________________________________________________________
Address___________________________________________________________________
Type of Security____________________________________________________________
Amount___________________________________________________________________

Name_____________________________________________________________________
Address___________________________________________________________________
Type of Security____________________________________________________________
Amount___________________________________________________________________

Name_____________________________________________________________________
Address___________________________________________________________________
Type of Security____________________________________________________________
Amount___________________________________________________________________

Name_____________________________________________________________________
Address___________________________________________________________________
Type of Security____________________________________________________________
Amount___________________________________________________________________

Name_____________________________________________________________________
Address___________________________________________________________________
Type of Security____________________________________________________________
Amount___________________________________________________________________

Name_____________________________________________________________________
Address___________________________________________________________________
Type of Security____________________________________________________________
Amount___________________________________________________________________

Name_____________________________________________________________________
Address___________________________________________________________________
Type of Security____________________________________________________________
Amount___________________________________________________________________

Name_____________________________________________________________________
Address___________________________________________________________________
Type of Security____________________________________________________________
Amount___________________________________________________________________

Name_____________________________________________________________________
Address___________________________________________________________________
Type of Security____________________________________________________________
Amount___________________________________________________________________

Unsecured Debts and Debts with cosigners if you need additional pages copy last the last page

Indicate if the Debt is Cosigned and Indicate if Debt is to Government or for Alimony or Support 

Nature of Debt___________________________________________________________________
Name__________________________________________________________________________
Address________________________________________________________________________
Amount________________________________________________________________________

Nature of Debt___________________________________________________________________
Name__________________________________________________________________________
Address________________________________________________________________________
Amount________________________________________________________________________

Nature of Debt___________________________________________________________________
Name__________________________________________________________________________
Address________________________________________________________________________
Amount________________________________________________________________________

Nature of Debt___________________________________________________________________
Name__________________________________________________________________________
Address________________________________________________________________________
Amount________________________________________________________________________

Nature of Debt___________________________________________________________________
Name__________________________________________________________________________
Address________________________________________________________________________
Amount________________________________________________________________________

Nature of Debt___________________________________________________________________
Name__________________________________________________________________________
Address________________________________________________________________________
Amount________________________________________________________________________

Nature of Debt___________________________________________________________________
Name__________________________________________________________________________
Address________________________________________________________________________
Amount________________________________________________________________________

Nature of Debt___________________________________________________________________
Name__________________________________________________________________________
Address________________________________________________________________________
Amount________________________________________________________________________

Nature of Debt___________________________________________________________________
Name__________________________________________________________________________
Address________________________________________________________________________
Amount________________________________________________________________________

Nature of Debt___________________________________________________________________
Name__________________________________________________________________________
Address________________________________________________________________________
Amount________________________________________________________________________

Nature of Debt___________________________________________________________________
Name__________________________________________________________________________
Address________________________________________________________________________
Amount________________________________________________________________________

Nature of Debt___________________________________________________________________
Name__________________________________________________________________________
Address________________________________________________________________________
Amount________________________________________________________________________

Nature of Debt___________________________________________________________________
Name__________________________________________________________________________
Address________________________________________________________________________
Amount________________________________________________________________________

Nature of Debt___________________________________________________________________
Name__________________________________________________________________________
Address________________________________________________________________________
Amount________________________________________________________________________

Nature of Debt___________________________________________________________________
Name__________________________________________________________________________
Address________________________________________________________________________
Amount________________________________________________________________________

Nature of Debt___________________________________________________________________
Name__________________________________________________________________________
Address________________________________________________________________________
Amount________________________________________________________________________

Nature of Debt___________________________________________________________________
Name__________________________________________________________________________
Address________________________________________________________________________
Amount________________________________________________________________________

Nature of Debt___________________________________________________________________
Name__________________________________________________________________________
Address________________________________________________________________________
Amount________________________________________________________________________