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Statement Of Assistance For Debtor Without An Attorney Form. This is a South Carolina form and can be use in Bankruptcy Court Federal.
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Tags: Statement Of Assistance For Debtor Without An Attorney, South Carolina Federal, Bankruptcy Court
EXHIBIT A TO SC LBR 9010-4
UNITED STATES BANKRUPTCY COURT
DISTRICT OF SOUTH CAROLINA
IN RE:
CASE NO:
CHAPTER:
STATEMENT OF ASSISTANCE FOR DEBTOR
WITHOUT AN ATTORNEY
Debtor(s).
Debtor(s) telephone no.: ____________________________
E-mail address: ___________________________________
Please circle your response to the “YES/NO” questions:
(1)
I paid someone to assist me in preparing my bankruptcy documents. YES NO
(2)
Who (other than the debtor) prepared your bankruptcy petition or documents, or assisted or advised you?
Name of person: __________________________________________
Company: _______________________________________________
Telephone no.: _____________ Address:______________________________________________
E-mail address:_________________________________________
(3)
I heard about this person from/by ___________________________ .
(4)
I paid $ __________ for assistance with my case or document. I made this payment on: ____/____/____.
(5)
I still owe money to the person assisting me.
YES
NO
If yes, state the amount owed:
_______________________________________________________________ .
(6)
I paid the person assisting me a filing fee to file a bankruptcy case or document.
YES
If yes, state the amount paid the and purpose of the fee:
_____________________________________________________________________ .
(7)
I used the following method(s) to make payments to the person assisting me (circle all applicable):
credit card
cash
check
money order
other (please describe)
_____________________________________________________________ .
(8)
I was given a receipt for any payment that I made to the person assisting me.
(9)
I paid for services other than assistance with my bankruptcy case or bankruptcy document preparation.
YES
NO
YES
NO
NO
If yes, state the services provided:
______________________________________________________________________ .
(10)
I gave the person assisting me a security interest in my property or transferred title to this person. YES
If yes, list the property subject to the security interest or transferred:
____________________________________________
NO
(11)
I was given a copy of the petition and schedules or other document by the person assisting me before these
documents were filed with the Court. YES
NO
(12)
I personally signed my own name on the petition, schedules, and any document which I filed. YES
NO
(13)
I was directed to say that I had no assistance in preparing documents for filing with the Court. YES
NO
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(14)
I was told by the person assisting me that this person was an attorney or an employee of an attorney.
NO
If yes, state the name of the attorney: ____________________________________ .
(15)
The person who assisted me discussed with me the subject of exemptions. YES
(16)
The person assisting me explained to me the difference between Chapter 7 and Chapter 13. YES
(17)
There is false or incomplete information in a document or petition which I filed with the Court. YES
If yes, the false information is:
_____________________________________________________________________ .
(18)
I listed all of my assets and my debts in my schedules. YES
NO
If no, list the debts or assets excluded, and state the reason(s) for the exclusion:
_____________________________________________________________________ .
(19)
I completed this form with the assistance of the person who assisted me in my bankruptcy case.
NO
YES
NO
NO
NO.
YES
I declare under penalty of perjury that the foregoing is true and correct.
Signature of debtor: _____________________________________Date: ______________________
Signature of joint debtor: _______________________________
Date:______________________
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