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Statement Of Assistance For Debtor Without An Attorney - South Carolina
| Statement Of Assistance For Debtor Without An Attorney Form. This is a South Carolina form and can be used in General Bankruptcy Court Federal . |
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EXHIBIT A TO SC LBR 9010-4 UNITED STATES BANKRUPTCY COURT DISTRICT OF SOUTH CAROLINA IN RE: CASE NO: CHAPTER: STATEMENT OF ASSISTANCE FOR DEBTOR WITHOUT AN ATTORNEY Debtor(s). Debtor(s) telephone no.: ____________________________ E-mail address: ___________________________________ Please circle your response to the "YES/NO" questions: (1) (2) I paid someone to assist me in preparing my bankruptcy documents. YES NO Who (other than the debtor) prepared your bankruptcy petition or documents, or assisted or advised you? Name of person: __________________________________________ Company: _______________________________________________ Telephone no.: _____________ Address:______________________________________________ E-mail address:_________________________________________ I heard about this person from/by ___________________________ . I paid $ __________ for assistance with my case or document. I made this payment on: ____/____/____. I still owe money to the person assisting me. YES NO If yes, state the amount owed: _______________________________________________________________ . I paid the person assisting me a filing fee to file a bankruptcy case or document. YES If yes, state the amount paid the and purpose of the fee: _____________________________________________________________________ . NO (3) (4) (5) (6) (7) I used the following method(s) to make payments to the person assisting me (circle all applicable): credit card cash check money order other (please describe) _____________________________________________________________ . I was given a receipt for any payment that I made to the person assisting me. YES NO (8) (9) I paid for services other than assistance with my bankruptcy case or bankruptcy document preparation. YES NO If yes, state the services provided: ______________________________________________________________________ . (10) I gave the person assisting me a security interest in my property or transferred title to this person. YES If yes, list the property subject to the security interest or transferred: ____________________________________________ NO (11) I was given a copy of the petition and schedules or other document by the person assisting me before these documents were filed with the Court. YES NO I personally signed my own name on the petition, schedules, and any document which I filed. YES I was directed to say that I had no assistance in preparing documents for filing with the Court. YES NO NO (12) (13) 166 American LegalNet, Inc. www.FormsWorkflow.com (14) I was told by the person assisting me that this person was an attorney or an employee of an attorney. NO If yes, state the name of the attorney: ____________________________________ . The person who assisted me discussed with me the subject of exemptions. YES NO YES (15) (16) (17) The person assisting me explained to me the difference between Chapter 7 and Chapter 13. YES There is false or incomplete information in a document or petition which I filed with the Court. YES If yes, the false information is: _____________________________________________________________________ . I listed all of my assets and my debts in my schedules. YES NO If no, list the debts or assets excluded, and state the reason(s) for the exclusion: _____________________________________________________________________ . I completed this form with the assistance of the person who assisted me in my bankruptcy case. NO I declare under penalty of perjury that the foregoing is true and correct. NO NO. (18) (19) YES Signature of debtor: _____________________________________Date: ______________________ Signature of joint debtor: _______________________________ Date:______________________ 167 American LegalNet, Inc. www.FormsWorkflow.com
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