Bankruptcy
Bankruptcy Petition
Debtor:
Last:
Bankruptcy Statement of Financial Affairs Questionnaire Page 4
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13)Setoffs A claim made by someone who allegedly owes money, that the amount should be reduced because the other person owes him money).
List all setoffs made by any creditor, including a bank, against a debt or deposit of the debtor within 90 days preceding the filing of this case. (Married debtors filing chapter 12 or 13 must state income for each spouse whether or not a joint petition is filed, unless spouses are separated and a joint petition is not filed).

Name an Address ofDate ofAmount of
         Creditor  Setoff    Setoff





14)Property Held for another Person
List all property owned by another person that the debtor holds or controls.

    Name and Address Description and Value              Location of
     of Ownerof Property                    Property




15)Prior Address of Debtor
If debtor has moved within three years immediately preceding the filing of this case, list all premises which the debtor occupied during that period and vacated prior to the filing of this case. If a joint petition is filed, report also any separate address of either spouse.

       AddressName UsedDates of Occupancy

                  1)


                  2)


                   3)
                    


16)Spouses and Former Spouses
If the debtor resides or resided in a community property state, commonwealth, or territory (including Alaska, Arizona, California, Idaho, Louisiana, Nevada, New Mexico, Puerto Rico, Texas, Washington or Wisconsin) within eight years immediately preceding the filing of this case, identify the name of the debtor's spouse and of any former spouse who resides or resided with the debtor in the community property state.












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