Your Statement of Financial Affairs for Individuals Filing for Bankruptcy

Produced by Attorney Mariah Jennings-Rampsi for MassLegalHelp
Created October 2016

The Statement of Financial Affairs is about you and your finances. Some of the questions may not apply to you. Some of the questions are just for business owners. If a question does not apply to you, check the box that says “No”.

Get the Statement of Financial Affairs form from the US Bankruptcy Court website.

Save the form on your computer.

In the top box put your name and your spouse’s if you are both filing.

Skip the box that asks for the District.

Put “Mass” in the box that asks for your state.

The clerk will give you the Case No. when you file your Bankruptcy Petition.

The top box of most Bankruptcy forms.

Most of the Statement of Financial Affairs is easy to fill out. Some parts of the form are not as easy. It is important to understand the question before you answer it. Some of the questions that could use a little more explanation are:

Part 2

Line 5

List any income you got that is not from a job or unemployment. This includes

TAFDC, Social Security, Social Security Disability, and Food Stamps (“SNAP”).

It also includes child support and alimony.

If you did not get any of these kinds of income in the past three years, this question does not apply to you. Check the box marked “No.”

Part 3

Line 6

If you or your spouse’s debts were mostly for personal, family or household reasons, not for a business, they are ‘consumer’ debts, check “Yes.”

If you check yes, tell the court if you paid any creditor more than $600 in the past 90 days.


If you have been paying your $250 car payment for the past three months, that is a total of $750. $750 is more than $600. So you have to list your auto loan creditor. List:

  • the creditor’s name and address,
  • the dates of your payments,
  • the amount paid, and how much you still owe.

This includes mortgages, car loans, and credit cards. It includes any person you paid money. But do not list child support or alimony payments.

Do not include garnishments. This question is only for voluntary payments.

If you did not pay any creditor more than $600 in the past 90 days, check the box marked “No.”

Line 7

List any money you paid anyone you are related to or a business partner in the past year. This person is called an “insider.”

  • Give their name, address, and relationship to you.
    • List the dates of any payments you made,
    • The total amount paid, and
    • Any amount you still owe.

If you made alimony or child support payments, list your ex-spouse and the amount you paid here.

Line 8

List any money you paid that benefited someone you are related to or a business partner.

For example, making a car payment for a car loan you co-signed with your child.

Part 4

Line 9

Tell the court about any lawsuits you were in during the past year. Only list lawsuits where you were a party. This means you filed the suit, or someone else filed the suit against you. Include debt collection lawsuits, family law cases, criminal cases, and any other lawsuits. If you were not involved in any court cases in the past year, check the box marked “No” and go to the next section.

If you were involved in any court cases in the past year, list them here. You must list five things for each case.

  1. List the name of the case. For example, Collection Bureau v. John Smith, or State of Massachusetts v. John Smith. The case name and number will be on any paperwork you got from the court.
  2. List the case or docket number. You can find this number at the top of any paperwork from the court. It is usually in the top right corner.
  3. Describe the type of case. For example: collection lawsuit, criminal case, landlord tenant case or divorce. Write this under “Nature of Proceeding.”
  4. List the name of the court and the town it is in. For example, “Quincy District Court, Quincy, Massachusetts.” The name of the court will be listed on any paperwork you got from the court. If your lawsuit was in front of an agency, such as the Workers’ Compensation Appeals Board, list the name of the agency. Put this under “Court or Agency and Location.”
  5. Finally, check the right box:
    • “Concluded” to tell the court if the case ended,
    • “Pending” if it is still going on or
    • "On appeal” if someone in the case is appealing the judge’s decision on appeal.

Line 10

List any property that creditors or debt collectors took from you in the past year.

This includes money taken from your paycheck or bank account for “garnishment”.

Also list any property that was “attached” with a lien or a judgment.

If someone sued you in court and got a judgment against you they can attach the judgment to your property. After it is attached, they can sell your property. Then they can take the money from the sale to pay the judgment.

  • List the name and address of the person or business that garnished, or attached a lien to, or foreclosed on your property. These actions are called “seizure.” The original creditor might have seized your property. Or, if the creditor gave your debt to collections, the collection agency may have seized your property. Put the creditor who actually came after your property under “Name and Address of Person for Whose Benefit Property Was Seized.”
  • List the date of the seizure. If it is a monthly garnishment, put the date that it started and that it is monthly. For example you owe money to your lender after a foreclosure. They sued you for the amount owed and won. A judge could say you can afford to pay $100 a month on the debt starting the week after you were in court June 5, 2015. Put, “June 5, 2015 and each month after”
  • Finally, describe the property and its value. For example, if your wages are being garnished, write “Wages, $400 a month” if it was a car list the make, model and how much you could sell it for.

Line 11

List any “setoffs” that creditors have given you in the past 90 days. A setoff is when part of your debt is forgiven because a creditor took some of your money or assets in exchange for reducing your bill. If you did not get any setoffs in the past 90 days, check the box marked “No.”

If you did get a setoff within the past 90 days, list it. List:

  • the name of the creditor
  • address of the creditor,
  • the date of the setoff, and
  • the amount.

Part 6

Line 15

List financial losses from the past year.

Include losses from fire, theft, property damage or gambling losses.

If the loss was covered by insurance, describe the insurance coverage.

Part 7

Line 18

List any property in the past two years that:

  • You sold.
  • You put up as security for a loan.
  • You traded with someone but did not get money of the same value back.

If you did not transfer any property like this in the past two years, check the box marked “No.”

Part 9

Line 23

List any property you have that belongs to someone else.

For example

  • You may be using a car that is titled in your mother’s name. Or
  • you may be storing someone else’s belongings in your garage or yard.

If you do not have anyone else’s property, check the box marked “No.”

If you have property that belongs to someone else, list it here.

  1. Name and address of the person who actually owns the property.
  2. What the property is and how much it is worth. For example, “Household Goods, $100.”
  3. Where the property is located. For example, if it is in your garage, put “Debtor’s Garage.”

Part 10

Lines 24-26

These questions probably do not apply to you.

They ask if you have any property that holds an environmental hazard that has resulted in government involvement.

Most Chapter 7 debtors do not have this type of property.

If you think you may own property that contains an environmental hazard, list it here.

Otherwise, check the box marked “No.”

Part 11

Lines 27 & 28

These questions apply to debtors who have owned their own business within the past six years.

Part 12

Review your Financial Statement form.

Make sure you have answered every question.

If a question did not apply to you, make sure you checked the box marked “No.”

Sign and date at the bottom of the last page.

Use today’s date. It does not need to be the date you actually file your bankruptcy.

Filing without a lawyer

  • Bankruptcy is complicated. Filing without a lawyer is risky.
  • You can lose property and money. You can go to jail if you do not tell the truth.

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