BUSBY & ASSOCIATES
ATTORNEYS & COUNSELORS AT LAW, P.C.
Return to: 1726 Augusta Drive, Suite 160
Houston, Texas 77057
Telephone: (713) 974-1151
Facsimile: (713) 974-1181
Please answer these questions carefully. The information you give us will be used to compile the schedules
the Court requires to have your bankruptcy case approved. Your answers will determine what will be on
your bankruptcy petition. Any errors, omissions or misrepresentations may seriously affect the discharge of
your debts (meaning that you may need to pay them despite your having filed for bankruptcy). Discuss this
with your attorney.
Where space permits, answer the questions on this questionnaire. However, do not let the size of the space
available determine the extent of your response. If additional space is necessary, use a separate sheet or the
back of this form, identifying by number and letter the question answered. A question asking for a date, or
when something happened, can usually be answered with the month and year only. A question asking for an
address must include the ZIP code, along with a complete street or post office box address.
There are many parts of the worksheet that will ask you to place a value on property that you own. Please use
the following as a guideline for determining those values:
Warning: The F.B.I. investigates bankruptcy crimes. Federal Law provides criminal penalties for bankruptcy
crimes, which include bribery, concealment of assets, false statements, fake claims, filing under fictitious
name, and perjury. Title 18, United States Code, Sec. 152, et seq. provides penalties of up to 5 years
imprisonment or a fine not more than $250,000, or both.
Bankruptcy is a privilege provided by law to people who are deeply in debt and in need of a fresh start.
Bankruptcy will discharge many of your debts and you will not have to pay them, except, in some cases,
secured debts for the purchase of particular merchand