Questions for Debtor's Examination - Pacific Rim Commercial Collections

Pacific Rim Commercial Collections

Questions for Debtor's Examination

What is your full name and your spouse's full name (if married):

______________________________________________________________________

______________________________________________________________________

Have you ever used another name on any documents such as a driver's license, credit application or other important paper? If so:

• Give name:

______________________________________________________________________

______________________________________________________________________

• Give location and approximate time when name was used:

______________________________________________________________________

______________________________________________________________________

What is you current address and length of time you have lived there:

______________________________________________________________________

______________________________________________________________________
What was your previous address:

______________________________________________________________________

______________________________________________________________________

What are your current phone numbers:

• Home (     )_________________

• Work (      )_________________

• Cell (        )_________________

What were your previous phone numbers:

• Home (     )_________________

• Work (      )_________________

• Cell (        )_________________

What is your California driver's license (or California identification card) number:______________________________________________________________________
What is your social security number: ______________________________________________________________________
What is your date of birth:______________________________________________________________________
If married, what is your spouse's maiden name:______________________________________________________________________
Are you employed as an employee, either part time or full time? If so:• Name, address and phone number of employer:

______________________________________________________________________

• Frequency of payroll check (weekly, bi-weekly, monthly, etc.):

______________________________________________________________________

• Gross pay:

$______________________________________________________________________

• Take home pay:

$______________________________________________________________________

• Commissions, if any:

______________________________________________________________________

• How much is due you at the present time:

______________________________________________________________________

• How long on this job:

______________________________________________________________________
Where and with whom was your previous job:
______________________________________________________________________
Do you perform labor or services for someone else as an independent contractor rather than as an employee? If so:
• Names, addresses, and phone numbers of persons or businesses for whom you perform services:

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

• Nature of services performed for each such person or business:

______________________________________________________________________

• Frequency of services:

______________________________________________________________________

• Method of billing (e.g., flat rate, hourly rate, job rate):

______________________________________________________________________
Do you own a business (in whole, in part, as a partner, or as a corporation), or have you owned a business within the past five years? If so:

• Describe the business:

______________________________________________________________________

• Who you do business with:

______________________________________________________________________

• Describe major people or businesses who owe you money (names, addresses and telephone numbers):

______________________________________________________________________

• Describe any business assets such as tools, equipment, computers, furniture, fixtures, machinery, etc. wholly owned by the business:

______________________________________________________________________

• Identify which of these assets you still owe money on and the approximate amount owed:

______________________________________________________________________

* Describe, generally, method of doing business:

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

• Provide names and addresses of partners (if the business is a partnership), and corporate officers (if the business is a corporation):

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________
Do you own stock in any corporation? If so:

• Name of corporation:

______________________________________________________________________

• Location of stock certificates:

______________________________________________________________________

• Amount of ownership and approximate value:

______________________________________________________________________
Do you maintain a brokerage account with any stock broker? If so:

• Name and address of broker:

______________________________________________________________________

• Account number(s):

______________________________________________________________________

• Approximate amount in brokerage account:

______________________________________________________________________
Do you or your spouse have any funds in banks, savings and loans, money market accounts, certificates of deposit, escrow accounts, credit unions, or any other financial institutions, either in your name or jointly with any other individual? If so:

• Name of each financial institution and address of branch possessing the funds:

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

• The account number of each account:

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

• Name(s) the account is under:

_____________________________________________________________________

_____________________________________________________________________

• The approximate balance in the account:

_____________________________________________________________________

_____________________________________________________________________

Date the last deposit was made:

_____________________________________________________________________

_____________________________________________________________________

Source of the funds in the account:

_____________________________________________________________________

_____________________________________________________________________

When you typically make deposits and withdrawals:

_____________________________________________________________________

_____________________________________________________________________
Do you or your spouse own a safe deposit box? If so:

• Name of bank and address of branch:

_____________________________________________________________________

_____________________________________________________________________

• Name(s) of holder of safe deposit box:

_____________________________________________________________________

_____________________________________________________________________

* Contents of box:

_____________________________________________________________________

_____________________________________________________________________
Do you own any securities (that is, any document which grants a share of ownership in exchange for a loan or investment) such as bonds, annuities, etc? If so:

• Describe nature of security, bond, annuity, etc.:

_____________________________________________________________________

Institution or person issuing it:

_____________________________________________________________________

Approximate worth: $

_____________________________________________________________________
Do you own any whole life insurance policies? If so:

• The name of the insurance company:

_____________________________________________________________________

• The name of your insurance agent:

_____________________________________________________________________

• The face amount of the policy: $

____________________________________________________________________

• The cash value of the policy, if any: $

____________________________________________________________________
Do you own any of the following items? If so, describe the item, the item's location, approximate value, and any joint owner:

• Office equipment:

____________________________________________________________________

• Gemstones, gems or jewelry:

____________________________________________________________________

• Camera equipment:

____________________________________________________________________

• Computers:

____________________________________________________________________

• Antiques:

____________________________________________________________________

• Precious metals (gold, silver):

____________________________________________________________________

• Musical instruments including pianos and organs:

____________________________________________________________________

• Weapons (guns, swords, other):

____________________________________________________________________

• Watches:

____________________________________________________________________

• Stamp or coin collections:

____________________________________________________________________

• China:

____________________________________________________________________

• Original art works:

____________________________________________________________________

• Crystal:

____________________________________________________________________

• Sports equipment, including exercise machines:

____________________________________________________________________

• Stereo or musical equipment:

____________________________________________________________________

• Any other items of value not mentioned above:

____________________________________________________________________
Do you own, in your own name, or jointly with others, an automobile, truck, motorcycle, RV, motor home, mobile home, boat or plane? If so, provide the following information:

• Brief description (make, model and year):

____________________________________________________________________

• Approximate value: $

____________________________________________________________________

• Legal owner:

____________________________________________________________________

• Registered owner:

____________________________________________________________________

• License number:

____________________________________________________________________

• Vehicle identification number:

____________________________________________________________________

• Amount owned, if any, to a legal owner: $

____________________________________________________________________

• Any other lienholder you are aware of:

____________________________________________________________________
Does a person, company or institution owe you money? If so:

• Name, address and telephone number of person or institution:

____________________________________________________________________

• Amount of each debt: $

____________________________________________________________________

• How each debt arose (e.g., judgment, loan, inheritance):

____________________________________________________________________
Do you owe money to anyone else besides this current judgment where you have been sued and the other person or business has received a judgment? If so:

• To whom (address and telephone no.):

____________________________________________________________________

• Amount owed: $

____________________________________________________________________

• Amount currently paid: $

____________________________________________________________________
Did you ever file for bankruptcy? If so:

• When:

____________________________________________________________________

• Where (district and branch):

____________________________________________________________________

• Type of bankruptcy (Chapter 7 or Chapter 13):

____________________________________________________________________

• Case number of the bankruptcy:

____________________________________________________________________
Are you a party (e.g., defendant or plaintiff) in any current action? This could be an action brought against you for a money judgment, an action in which you are the plaintiff, or any other action (including divorce, will contest, etc.)? If so:

• Who are the parties in each action:

____________________________________________________________________

• Who are the attorneys in each action (names, addresses and phone numbers; include information for parties if they are appearing in pro per):

____________________________________________________________________

• A brief description of each lawsuit:

____________________________________________________________________

• What is you position in the lawsuit, and do you expect to win:

____________________________________________________________________
Does your wife or husband receive any salary, commissions, or other income, as an employee or independent contractor, from an employer or business? If so:

• Name, address and telephone number of employer:

____________________________________________________________________

• Approximate amount and rate of income: $

____________________________________________________________________
Any other sources of income? If so:

• Amount of income: $

____________________________________________________________________

• When do you receive income, and is it received on a regular basis:

____________________________________________________________________

• Brief description of source:

____________________________________________________________________
Do you own any real estate individually or jointly (single family home, vacation home, co-op I condominium, duplex, rental property, business property, mobile home park, time share, undeveloped land, agricultural land, boat I marina dock space, airplane hangar, stationary mobile home)? If so:

• Address and country:

____________________________________________________________________

• Approximate fair market value: $

____________________________________________________________________

• Amount owed (first mortgage, second deed of trust):

____________________________________________________________________

1. To Whom:

____________________________________________________________________

2. Amount and frequency of payments:

____________________________________________________________________

• When the property was obtained:

____________________________________________________________________

• What names are on the deed:

____________________________________________________________________

• Has title to the property been transferred since its acquisition by you:

____________________________________________________________________

• Known debts or claims that affect the title (easements, tax liens, judgment liens, etc.):

____________________________________________________________________

• Approximate amount of your actual ownership (equity) in the property: $

____________________________________________________________________

• Does anyone live on the property:

____________________________________________________________________

• Is the property developed, and if so, what kind of building(s):

____________________________________________________________________
Are you a landlord? If so:

• Name and address of tenants:

____________________________________________________________________

• Amount of rent paid and interval of payment: $

____________________________________________________________________
Do you rent where you are now living? If so:

• Amount of rent paid: $

____________________________________________________________________

• Landlord's name:

____________________________________________________________________

• Landlord's address and phone number:

____________________________________________________________________
Are you the trustee for, or beneficiary of, any property held in trust for yourself or a third person? If so:

• Briefly describe type of trust (e.g., living, bank account, spousal, Q-TIP):

____________________________________________________________________

• Identify whether you are the trustee or beneficiary, or both:

____________________________________________________________________

• Describe what the nature of the property s that is being held in trust (trust corpus):

____________________________________________________________________
Do you receive benefits from any government agency (e.g., unemployment insurance, disability insurance, workers compensation, social security, retirement, pension)? If so:

• Name of agency:

____________________________________________________________________

• Type of benefit:

____________________________________________________________________

• Amount of benefit: $

____________________________________________________________________

• Frequency of benefit:

____________________________________________________________________

• The expected duration of the payments:

____________________________________________________________________

• Basis for the benefit (.e.g., unemployment, industrial injury, etc.):

____________________________________________________________________
How much cash do you have on you right now: $
____________________________________________________________________

Pacific Rim Commercial Collections
PRCCollections.net
818-991-5200