Confidential Worksheet
Needed to Start the Process
Attorney Paul Strouse - Chapter 7, Chapter 13, State Action 128

MASTER INFORMATION LIST
YOU		SPOUSE
Full Name:		Full Name:
Address:		Address:
Street:		Street:
City:		City:
State:		State:
Zip:		Zip:
County:		County:
Home Phone:		Home Phone:
Work Phone:		Work_Phone:
Fax:		Fax:
Social Security Number:		Social Security Number:
Current Occupation:		Current Occupation:
Employer's Name:		Employer's Name:
Are you currently a member of the US Armed Forces?	No Yes	Are you currently a member of the US Armed Forces?	No Yes
Branch:		Branch:
Dates_of_Service:		Dates_of_Service:
List any prior bankruptcies including district filed, case number, year of filing and chapter:
List any pending bankruptcies of a family member including district to be filed, full name and relationship:
YOUR ASSETS CASH AND DEPOSIT ACCOUNTS
Do you or your spouse have any bank accounts? No Yes If yes , please furnish the following. Be sure to include all checking, savings and credit union accounts.
Type of Account 1: Checking Savings		Name of Institution: Current Balance:
Type of Account 2: Checking Savings		Name of Institution: Current Balance:
Type of Account 3: Checking Savings		Name of Institution: Current Balance:
Type of Account 4: Checking Savings		Name of Institution: Current Balance:
In general how much cash do you keep on hand?
SECURITY DEPOSITS
Do you or your spouse have any security deposits? No Yes If yes please state how much:
SECURITIES, STOCKS, BONDS, AND MUTUAL FUND ACCOUNTS
Do either you or your spouse own any stocks, bonds, commodities, mutual funds or other securities? No Yes If yes please provide the following:
Name of Brokerage Firm		Account Number





STOCKS
No. of Shares	Name of Company		Current Value




BONDS
Name of Issuer		Current Value




US SAVINGS BONDS
Series	Face Value		Date of Maturity




MUTUAL FUNDS AND COMMODITY ACCOUNTS
Name of Institution		No. of Shares	Current Value




LIFE INSURANCE
Do either you or your spouse own any life insurance or are you aware of the existence of any life insurance on either of your lives that has cash value? No Yes If yes please provide the following:
Name of Company	Name of Insured	Face Value	Cash Value



Are you aware of any loans against any of the above policies? No Yes If yes please furnish details concerning original amount of loan, balance on loan and purpose of loan:
PROFIT SHARING, PENSION PLANS, AND RETIREMENT ACCOUNTS
Do either you or your spouse have any interest in any profit sharing plan, pension plan, employment stock option plan, employee stock purchase plan, deferred income, 401 (K) plan? No Yes If yes, please furnish the following:
Type of Account	Name on Account		Current Value



IRA AND ANNUITY PLANS
Do either you or your spouse have any interest in any IRA plans or Annuity Plans? No Yes If yes, please furnish the following:
Name of Institution		Type of Account	Current Value



TAX REFUNDS AND OTHER LIQUIDATED DEBTS OWED DEBTOR
Are either you or your spouse expecting any income (not yet received) from either tax refunds or court awards? No Yes If yes, please furnish the following:
Source of expected income			Amount of expected income



INTEREST IN LIFE ESTATES
Are either you or your spouse expecting any income (not yet received) from either tax refunds or court awards? No Yes If yes, please furnish the following:
From whom:	Amount	Relationship	Estate in trust
			No Yes
FAMILY SUPPORT
Are you or your spouse eligible to receive any family support such as child support, alimony, etc.? No Yes If yes, please furnish the following:
From Whom:		Amount	Rate of receipt



OTHER INCOME
Please use the rest of this page to provide information on any other income excluding that of employment of benefit programs such as social security.
AUTOMOBILES, MOTORCYCLES, ETC.
Do either you or your spouse own or lease any vehicles? No Yes If yes, list the detailed information requested for each vehicle. If there is a lien upon any vehicle, indicate the lien amount and the creditor’s name. If you or your spouse have the use of any car leased, please describe.
Vehicle 1
Year:	Make:	Model:
Design (2 Door, 4 Door, etc):	Optional Equipment (air conditioning, power equipment, stereo, other):
Approximate Mileage:	Condition: Excellent Good Fair Poor	Creditor and Creditor Address:
Account Number:		Account Balance:
Vehicle 2
Year:	Make:	Model:
Design (2 Door, 4 Door, etc):	Optional Equipment (air conditioning, power equipment, stereo, other):
Approximate Mileage:	Condition: Excellent Good Fair Poor	Creditor and Creditor Address:
Account Number:		Account Balance:
Vehicle 3
Year:	Make:	Model:
Design (2 Door, 4 Door, etc):	Optional Equipment (air conditioning, power equipment, stereo, other):
Approximate Mileage:	Condition: Excellent Good Fair Poor	Creditor and Creditor Address:
Account Number:		Account Balance:
BOAT
Do either you or your spouse own a boat? No Yes If yes, please list the detailed information for each boat. If there is a lien upon any boat, indicate the lien amount and the creditor’s name.
Year:	Make:	Model:
Length:
Creditor and Creditor Address:
Account Number:		Account Balance:
AIRPLANE
Do either you or your spouse own an airplane? No Yes If yes, please list the detailed information for each airplane. If there is a lien upon any airplane, indicate the lien amount and the creditor’s name.
Year:	Make:	Model:
Approximate Air Miles:
Creditor and Creditor Address:
Account Number:		Account Balance:
FARMING
Do either you or your spouse own a farm? No Yes If yes, please list the following information:
Farming Supplies	Value	Farming Equipment	Value



Farming Machinery	Value	Crops	Value



ANIMALS
Do either you or your spouse own any livestock and/or pedigreed animals? No Yes If yes, please list the following information:
Breed		Number	Value




YOUR DEBTS SECURED
Please list information regarding any secured debts you may have. Please note that in lieu of this section, submitting your most recent statements will suffice.
Creditor Name and Address	Account No.	Type of Item	Date of Debt










TAXES
Do either you or your spouse owe any taxes? No Yes If yes, please provide the following:
Government To Whom Taxes are Due		Year	Amount




YOUR DEBTS UNSECURED
Please list information regarding any unsecured debts you may have. Please note that in lieu of this section, submitting your most recent statements will suffice.
Creditor Name and Address	Account No.	Balance	Date of Debt










MARITAL STATUS AGE AND EMPLOYMENT INFORMATION
Please check one of the following: Single Married Divorced Separated
If married, are you presently living with your spouse? Yes No If no, date separated
Have either of you started an action for divorce, legal separation, annulment, or support against the other? Yes No If so, state the following Year started: In what court (state and county): Case No.: Date of dismissal or decree:
If divorce proceedings were completed within the last year, please provide a copy of the decree along with the rest of your documents by faxing them to 414-220-5115.
Do you or your spouse intend to file for divorce within the next six months? Yes No If yes, do you anticipate the other party to oppose the petition for divorce? Yes No
Please provide the following information regarding your age and employment information
YOU		YOUR SPOUSE
Age:		Age:
Occupation:		Occupation:
Employer:		Employer:
Length of Employment:		Length of Employment:
Employer Address:		Employer Address:
WRITTEN AGREEMENTS & CONTRACTS
Have either you or your spouse entered into any written agreements or contracts for example housing leases or automobile leases? Yes No
If yes, please list the name of the parties involved in any agreements, contracts or leases and their addresses:
Please use the rest of this page to describe any other debts owed not covered in the previous pages.
CHILDREN OR OTHER DEPENDENTS
Child/Dependent Name		Age	Relationship










Other than children, do you have any dependents? Yes No
If yes, please explain
Do you have substantial business interests or are you self-employed? Yes No

Get a Fresh Start Through Our Wisconsin Bankruptcy Attorneys!

Milwaukee Bankruptcy Attorney Paul Strouse
633 W. Wisconsin Ave., Suite 1010
Milwaukee, WI 53203

Racine Bankruptcy Lawyer Paul Strouse
6233 Durand Ave., Suite 102
Racine, WI 53406

Confidential WorksheetNeeded to Start the Process Attorney Paul Strouse - Chapter 7, Chapter 13, State Action 128

Confidential Worksheet
Needed to Start the Process
Attorney Paul Strouse - Chapter 7, Chapter 13, State Action 128