IN THE UNITED STATES BANKRUPTCY COURT FOR THE SOUTHERN DISTRICT OF TEXAS HOUSTON DIVISION IN RE: Debtor(s) § § § § CASE NO. Chapter 7 341(a) MEETING QUESTIONNAIRE AND SWORN TESTIMONY The answers and information provided by the Debtor(s) in this document are a part of the Debtor(s) sworn testimony given before the Chapter 7 Trustee or the Trustee's designated representative. Debtor(s), you must read the questions stated below and answer fully and completely (Singular tense shall be interpreted as Plural tense when the case is a joint filing). TO THE EXTENT THAT ANY OF THE FOLLOWING INFORMATION IS NOT SHOWN IN YOUR PETITION, SCHEDULES, OR STATEMENT OF FINANCIAL AFFAIRS OR, IF ANY OF THIS INFORMATION IN THOSE DOCUMENTS HAS CHANGED, PLEASE ANSWER THE FOLLOWING AND IMMEDIATELY AMEND YOUR PETITION, SCHEDULES, OR STATEMENT OF FINANCIAL AFFAIRS HIGHLIGHTING THE INFORMATION THAT HAS BEEN ADDED, CHANGED, OR DELETED: Debtor Name(s): Address: Joint Debtor Telephone (home): Employer(s): Address: Telephone (work): Non-Filing Spouse Name: Address: Telephone (home): Telephone (work) Final Revised Questionnaire 11072012:2487859_1 American LegalNet, Inc. www.FormsWorkFlow.com GENERAL INFORMATION 1. Have you ever filed bankruptcy before? a. If yes, when? ________ Where?_________ b. Chapter?_________ Did you receive a discharge? I have the following outstanding liabilities: a. Child Support (See Question No. 44) b. Student Loans c. Taxes d. Claims for death or personal injury e. Obligations to pension or profit sharing Debtor Yes No Yes No Yes No Yes No Yes No Yes No Yes No Joint Debtor Yes No Yes No Yes No Yes No Yes No Yes No Yes No 2. KNOWLEDGE OF IMPORTANT BANKRUPTCY ISSUES 3. I am an individual debtor. I know my case will be dismissed on the 46th day after I filed this bankruptcy if certain documents are not timely filed. I have provided my attorney or the Trustee with the following documents: All bank statements for the three months prior to the bankruptcy filing Last two years tax returns Disabled Veteran's letter (if applicable) The majority of my debts were incurred primarily for personal, family or household purposes. I understand that I must provide to my attorney or the Trustee all bank statements for the month of filing. I received, read, and understand my duty to comply with the Duties and Responsibilities of a Debtor Under Chapter 7. I received, read, and understand the Statement of Information required by 11 U.S.C. § 341 prepared by the Office of the United States Trustee. I read and signed the Bankruptcy Petition, Schedules, and Statement of Financial Affairs before these documents were filed with the Court. I understand the questions and information contained in my Bankruptcy Petition, Schedules, Statement of Financial Affairs and this written Sworn Testimony. I personally signed my Bankruptcy Petition, Bankruptcy Schedules and Statement of Financial Affairs, and Means Test before these documents were filed with the Court. I understand that all property owned by me may be liable for my domestic support obligations. Yes No Yes No Yes No Yes No Yes No Yes No Yes No 4. 5. 6. 7. 8. 9. 10. 11. Yes No 12. Yes No n/a Final Revised Questionnaire 11072012:2487859_1 American LegalNet, Inc. www.FormsWorkFlow.com 13. I understand that within thirty days of my initial meeting of creditors I must reach an agreement with my secured creditor(s) (with purchase money collateral) and either surrender the asset, redeem the asset or reaffirm the debt or the automatic stay will terminate. Yes No QUESTIONS RELATED TO ASSETS 14. In my Bankruptcy Schedules, I have accurately listed everything that I own including real estate, personal property and money. I understand that any unreceived tax refund for this and any prior tax years is an asset of the bankruptcy estate and that I must tell my Trustee when I receive these refunds if such funds exceed the amount reflected in my schedules or are not listed in my Schedules. (Please refer to the debtor's Duties and Responsibilities). I have lived in Texas for the last 730 days (2 years). a. If no, list the States you resided in the last 730 days (2 years): State:__________________ From: _________ To:______________ State:__________________ From: _________ To:______________ I have listed, on Schedule C, real estate located in Texas: a. If yes, were you living there on the date of your bankruptcy filing? b. Is it within the city limits? c. If it is located outside the city limits, how many acres is it?______ d. Is the equity in the property in excess of $146,450.00? Did you purchase your home during the four years before filing this bankruptcy? a. If yes, state the date the property was acquired:___________ Have you, within the last 10 years, owned any interest in real estate anywhere that is NOT listed in your schedules? a. With respect to any real estate not listed in Schedule A, has it been sold or foreclosed? Foreclosed Sold When? ___________ b. If sold, were you paid in full at closing? c. If sold, did you sell it to a friend or relative or family member? Do you receive or are you entitled to receive any payments from a loan of any kind (such as a contract for deed, promissory note, personal loan, etc.)? Do you currently have any nonbanking deposit accounts such as PayPal, Amazon, online gambling, casinos, etc? Do you have any unused reward points, gift cards, gift certificates, or airline tickets? Do you own any rental property? a. If yes, what are the rental payments? _______. Yes No Yes No 15. 16. Yes No 17. Yes No Yes No Yes No Yes No Yes No 18. 19. Yes No Yes No Yes No Yes No Yes No 20. 21. Yes No Yes No Yes No 22. 23. Final Revised Questionnaire 11072012:2487859_1 American LegalNet, Inc. www.FormsWorkFlow.com b. If there is a lien against the rental property, how much is the monthly payment? ______ Lender:________ Lien Amount: __________ 24. Have you operated a business during the last six years? a. If yes, state the name of the business(es): ______________ b. State the amount of gross revenues to each business: This year: _____________ Last year: _____________ c. Do you intend to continue operating the business(es)? d. If yes, please list which business(es):__________________ Is all non-exempt property insured, other than cash on hand? Did you transfer, sell or convey any real or personal property with a fair market value of more than $2,500 in the last four (4) years? Have you ever been the trustee, beneficiary or settlor of a trust? Have you transf