Bankruptcy Questionnaire

Law Office of Michael J. Hemming

333 W. Mission Blvd, Pomona, CA 91766 · (909) 469-6087 · michaeljhemming@gmail.com

Submission

Preferred Contact Email

We’ll send you a confirmation copy.

Preferred Phone

Fields marked with * are required.

Debtor Information

Full Legal Name

Date of Birth

SSN (last 4 OK for web form)

For security, last four digits are sufficient here; full SSN can be provided securely later.

County of Residence

Street Address

City

State

Zip

Marital Status

Former Spouse(s) Name(s)

Aliases / AKA

Prior Bankruptcy

Ever filed before?

Case Number (if known)

Year & District Filed

Disposition

Any pending filings by spouse/affiliate?

Household & Dependents

# in Household

# of Dependents

Dependents (names/ages)

Home Ownership

Do you own real estate?

Lender / Mortgage Company

Approx. Balance Owed

Liens / Second Mortgages

Monthly Payment

Are you current?

Employment

Employment Status

Employer / Business Name

Position / Title

Employer Address

How long employed?

Do you own a corporation / LLC?

If yes, name & % ownership

Income & Statements

Year-to-Date Income (gross)

Social Security Income (YTD)

SSI deposit timing

Upload Pay Stubs (last 3 months)

Multiple files allowed.

Bank Statements (last 120 days)

You can also email documents later to michaeljhemming@gmail.com if you prefer.

Assets

Bank Accounts (name & approx. balance)

Retirement (401k/IRA/etc.)

Vehicles (year/make/model/VIN/mileage)

Other assets (jewelry, firearms, collectibles, business inventory, etc.)

Taxes, Lawsuits & Domestic Support

IRS / FTB balances due (years & approx. amount)

Pending lawsuits, judgments, garnishments

Domestic support obligations (payor/payee, case #, county, arrears)

Child Support obligations?

Credit Counseling

Completed pre-filing course?

Provider

Certificate Date

AccessBK instructions (attorney code MH16701). Visit AccessBK.org or call (800) 210?0522.

Tax Returns & Accountant

Last two years of tax returns

Accountant Name & Contact (if any)

Certification

By checking this box, I declare the information provided is true and correct to the best of my knowledge.

I agree

Type your full name as signature

Today’s date

Upon submission, your answers and any files will be securely sent to: ryanhemmingrealtor@gmail.com and michaeljhemming@gmail.com.

☰

(909) 413-6666

(909) 469-6108

Bankruptcy Questionnaire

Law Office of Michael J. Hemming

Submission

Debtor Information

Prior Bankruptcy

Household & Dependents

Home Ownership

Employment

Income & Statements

Assets

Taxes, Lawsuits & Domestic Support

Credit Counseling

Tax Returns & Accountant

Certification

Get in Touch

Get in touch