Questionnaire #3 - Property

List your value of your UNSECURED bankruptcy property for your property protection.

If you own a vehicle, home or other secured property, please complete those questionnaires after submitting your unsecured property.

Please see the Bankruptcy Basics Glossary for a complete list of definitions such as secured or unsecured property or debt if you are not sure.

This Form cannot be submitted until the missing fields (labelled below in red) have been filled in
Questionnaire 3 - Property & Exemptions
Your Name (and spouse if married)*
email address
Are you claiming a homestead exemption of more than $170,350?	If yes, stop here and consult an attorney. Reference the referral I provided at our first contact or one of your choice. No. Continue
Which set of exemptions are you claiming?	State and Federal Nonbankruptcy Exemptions §522(b)(3) Federal Exemptions §522(b)(2)
California Only	System 1 §704 System 2 §703
FINANCIAL ACCOUNTS	NONE OF THESE, SKIP TO HOUSEHOLD Cash Bank or Deposit Accounts
Cash - Current value of the portion you own
Amount of exemption You Claim & Specific laws that allow exemption
First Bank Account
Checking and Savings Checking only Savings only Money Market Account Deposit Account
First Bank or Deposit Account
Current value of the portion you own
Amount of exemption You Claim & Specific laws that allow exemption
Second Bank or Deposit Account
Checking and Savings Checking only Savings only Money Market Account Deposit Account
Credit Union, Bank or Deposit Account Name & Address
Current value of the portion you own
Amount of exemption You Claim & Specific laws that allow exemption
Do you have a security deposit with anyone
Yes No
Name, Address of the one holding the security deposit
Current value of the portion you own of the Security Deposit
Amount of exemption You Claim & Specific laws that allow exemption
HOUSEHOLD FURNITURE & FURNISHINGS	NONE, Please skip to Personal Belongings I have household furnishings and furniture and personal belongings
Current value couch $
Current value recliner $
Current value television size, make, $
Current value linens
Current value coffee table $
Current value dishes, pots, pans, etc $
Current value kitchen table & chairs $
Current value refrigerator $
Current value microwave $
Current value stove/range $
Current value bed $
Current value bed $
Current value dresser $
Current value dresser $
Any other furniture - Description and Current value of the portion you own, amount of exemption you clam
Household Items: Amount of exemption you claim (100% or amount) & Specific laws that allow exemption
Current value computer $
Current value printer $
Current value dvd, vcr, combo, or similiar - type & $
Current value of electronics - description
Amount of exemption you claim (100% or amount) & Specific laws that allow exemption
Current value patio furniture $
Amount of exemption you claim (100% or amount) & Specific laws that allow exemption
Current value lawn furniture or equipment $
Amount of exemption you claim (100% or amount) & Specific laws that allow exemption
Current value pool and accessories $
Amount of exemption you claim (100% or amount) & Specific laws that allow exemption
Current value bbq grill or similiar - item and $
Amount of exemption you claim (100% or amount) & Specific laws that allow exemption
Current value Books, Pictures, Art objects, antiques, stamp, coin, record, tape, compact disc, or other collections or collections TYPE AND VALUE
Amount of exemption you claim (100% or amount) & Specific laws that allow exemption
Current value stamp, record, coin collections - item & $
Amount of exemption you claim (100% or amount) & Specific laws that allow exemption
Current value shoes, clothing, jackets $
Amount of exemption you claim (100% or amount) & Specific laws that allow exemption
Current value furs and jewelry (ex: necklace $10)
Amount of exemption you claim (100% or amount) & Specific laws that allow exemption
Current value Firearms & sport, photographic, & other hobby equipment
Amount of exemption you claim (100% or amount) & Specific laws that allow exemption
Investment Assets	NONE OF THESE, SKIP TO VEHICLES Annuities Educational IRA IRA ERISA Pension Profit Sharing Plan Stocks Interest in Incorporated Businesses Interest In Unincorporated Businesses Interest in Partnerships Interest in Bonds Accounts Receivable Contingent claims of any nature Customer lists or other compilations containing personally identifiable information
Current value Asset #1 describe
Amount
Current value Asset #2 describe
Amount
Current value Asset #3 describe
Amount
Investment Assets: Amount of exemption you claim (100% or amount) & Specific laws that allow exemption
VEHICLES	I do not have ANY type of vehicles, skip to additional property I have vehicles and owe money - skip this section and complete the Vehicle Questionnaire I have the following vehicles WITH OUT A LEIN
Vehicle #1	Truck or Car Boat Aircraft Trailer Accessories for vehicle
Vehicle #1 year make model
Vehicle #1 color, mileage, damage
Vehicle #1 Current, as is, Market Value
Vehicle #1 Amount Due & Name of Lender
Amount of exemption you claim (100% or amount) & Specific laws that allow exemption
Vehicle #2	Truck or car Boat Aircraft Trailer Accessories for Vehicle
Vehicle #2 year make model
Vehicle #2 color, mileage, damage
Vehicle #2 Current, as is, Market Value
Vehicle #2 Amount Due & Name of Lender
Amount of exemption you claim (100% or amount) & Specific laws that allow exemption
ADDITIONAL PROPERTY	I have additional property - continue I do not have additional property - submit
Current value Office equipment, furnishings and supplies - only if you have a business
Current value Crops, farming equipment, supplies chemicals, and feed
Current value Anticipated Federal Tax Refund
Current value Anticipated State Tax Refund
Anything else: Current value Description & Value of anything else
Additional Property: Description Amount of exemption you claim (100% or amount) & Specific laws that allow exemption
Additional Property: Description Amount of exemption you claim (100% or amount) & Specific laws that allow exemption
Additional Property: Description Amount of exemption you claim (100% or amount) & Specific laws that allow exemption
Additional Property: Description Amount of exemption you claim (100% or amount) & Specific laws that allow exemption
If in California, I select the following exemptions to be used in my case
California 703 California 704

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