Voluntary Petition Intake — Bordeaux Law, P.C.

Official Form 101

Voluntary Petition — Debtor Identification

Part 1 & Part 2 of Official Form 101 · Central District of California

Attorney–Client Privileged. All information you provide is confidential and protected. Complete every field as fully and accurately as possible.

Part A — Primary Debtor Information

Last Name *

First Name *

Middle Name

Other names used in the last 8 years (married, maiden, trade names)?

No Yes

Other names used:

Social Security Number *

Date of Birth *

Driver's License Number

DL State

DL Expiration Date

Employer ID (EIN) if any

Chapter Sought *

Part B — Current Address

Street Address *

Unit / Apt #

City *

ZIP *

County of Residence

How long at this address?

Have you lived at this address for at least 180 days?

Yes No

Previous Address:

Mailing address (if different from above):

Same as above Different

Part C — Contact Information

Home Phone

Cell Phone

Work Phone

Email Address *

⚠ Provide an email you check frequently — this is our primary means of correspondence.

Part D — Filing Type & Marital Status

Filing as: *

Individual Individual & Spouse (Joint)

Current Marital Status: *

Never Married Married & Living Together Married but Separated Divorced Widowed

Part F — Prior Bankruptcy History

Have you or your spouse ever filed bankruptcy at any time?

No Yes

Is any bankruptcy case pending by or against a spouse, partner, or business affiliate?

No Yes

Debtor Name

Case No.

Relationship

Part G — Household Members

List all persons living in your household. Schedule I requires this information.

Part H — Eviction & Sole Proprietorship

Do you have an eviction pending against you?

No Yes

Landlord Name & Address:

Are you the sole proprietor of a business?

No Yes

Business Name

EIN (if any)

Business Address Nature of Business

Schedule A/B — Part 1

Real Property

Official Form 106A/B · All real estate interests must be disclosed

List ALL real property in which you have any ownership interest — primary residence, vacation homes, rental properties, vacant land, timeshares, and any interest regardless of how small. Use current market value, not what you paid.

Do you own or have an interest in the property in which you now live?

No Yes

Describe any pending sale, foreclosure, or dispute involving this property:

Which best describes your current living situation?

I rent my residence I live in a property owned by family or friends I live with one or more roommates Other

Describe any pending or completed eviction proceedings:

Do you own or have any interest in any real estate that is not your principal residence (rental property, timeshare, funeral plot, etc.)?

No Yes

Describe any pending sale, foreclosure, or dispute involving any of the above properties:

Schedule A/B — Parts 2–11

Personal Property & Financial Assets

Official Form 106A/B · Use current fair market value for all items

Do NOT skip items you believe are worthless. The bankruptcy trustee determines value. List everything you own or have any interest in.

Cash & Bank Accounts

Include all checking, savings, money market, PayPal, CashApp, Venmo, and similar balances as of the filing date.

Vehicles & Motorized Equipment

Cars, trucks, motorcycles, boats, RVs, ATVs, trailers, jet skis. List ALL even if paid off.

Household Goods & Personal Items

Category	Own?	Brief Description & Est. Value (shown when Yes selected)
Household goods & furnishings	Yes No
Electronics (TVs, computers, phones)	Yes No
Clothing	Yes No
Jewelry & watches	Yes No
Collectibles, art, antiques	Yes No
Sports, hobby & exercise equipment	Yes No
Firearms & ammunition	Yes No
Livestock / farm animals	Yes No

Category

Own?

Brief Description & Est. Value (shown when Yes selected)

Household goods & furnishings

Yes No

Electronics (TVs, computers, phones)

Yes No

Clothing

Yes No

Jewelry & watches

Yes No

Collectibles, art, antiques

Yes No

Sports, hobby & exercise equipment

Yes No

Firearms & ammunition

Yes No

Livestock / farm animals

Yes No

Financial Assets

Asset Type	Own?	Institution / Description & Value (shown when Yes selected)
Cash on hand	Yes No
Bonds, mutual funds, stocks	Yes No
Retirement / 401(k) / IRA #1	Yes No
Retirement / 401(k) / IRA #2	Yes No
Cash value life insurance	Yes No
Security deposits	Yes No
Cryptocurrency / digital assets	Yes No
Tax refunds owed to you	Yes No
Interests in businesses / LLCs	Yes No
Intellectual property (patents, copyrights)	Yes No
Lawsuits / claims / personal injury awards	Yes No
Money owed to you by others	Yes No
Other personal property not listed	Yes No

Asset Type

Own?

Institution / Description & Value (shown when Yes selected)

Cash on hand

Yes No

Bonds, mutual funds, stocks

Yes No

Retirement / 401(k) / IRA #1

Yes No

Retirement / 401(k) / IRA #2

Yes No

Cash value life insurance

Yes No

Security deposits

Yes No

Cryptocurrency / digital assets

Yes No

Tax refunds owed to you

Yes No

Interests in businesses / LLCs

Yes No

Intellectual property (patents, copyrights)

Yes No

Lawsuits / claims / personal injury awards

Yes No

Money owed to you by others

Yes No

Other personal property not listed

Yes No

Schedule C

Property Claimed as Exempt

Official Form 106C · California exemption elections

Schedule D

Secured Debts (Creditors with Collateral)

Official Form 106D · Mortgages, car loans, liens, deeds of trust

List every creditor that holds a lien, mortgage, deed of trust, or security interest in any property you own. Include mortgages, car loans, judgment liens, tax liens, and any other debt secured by collateral. Do not include mortgages already listed in Schedule A/B.

Schedule E/F

Unsecured Debts

Official Form 106E/F · Priority & Non-Priority creditors

Part 1 — Priority Unsecured Debts (generally NOT discharged)

Priority debts include: domestic support obligations (child support, alimony), federal/state/local taxes, student loans (in most cases), and certain fines.

Do you owe any back child support or alimony?

No Yes

Paid To (Name)

Payee Address

Monthly Obligation

Total Arrears

Do you owe any federal, state, or local taxes?

No Yes

Do you have any student loans?

No Yes

Part 2 — Non-Priority Unsecured Debts

List EVERY unsecured debt — credit cards, medical bills, personal loans, payday loans, gym memberships, utilities, collection accounts. The Bankruptcy Code does not allow you to pick and choose. Include debts you are unsure about.

Schedule G

Executory Contracts & Unexpired Leases

Official Form 106G

List any contracts or leases that have obligations remaining on both sides — apartment leases, car leases, equipment leases, cell phone contracts, gym memberships, software subscriptions, business contracts. Indicate whether you want to assume (keep) or reject (terminate) each.

Do you have any unexpired leases or executory contracts?

No Yes

Schedule H

Co-Debtors

Official Form 106H

List every person or entity that is also liable on any debt you have listed — co-signers, guarantors, and joint account holders.

Do you have any co-debtors on any of your debts?

No Yes

Schedules I & J

Current Income & Monthly Expenses

Official Forms 106I & 106J

Schedule I — Current Monthly Income

Employment Status

Employed Full-Time Employed Part-Time Self-Employed Unemployed Retired Disabled

Employer Name

Length of Employment

Employer Address

Job Title / Occupation

Employer Phone

Gross Monthly Wages / Salary

Net (Take-Home) Monthly Pay

All Other Income Sources (Debtor + Household) — Past 6 Months

Source of Income

Recipient

Frequency

Monthly Avg

Overtime / commission / bonus

Self-employment / business income

Rental income

Social Security

Disability benefits

Pension / retirement

Alimony / spousal support received

Child support received

Unemployment compensation

Workers' compensation

Government assistance (CalWORKs, etc.)

Interest & dividends

Other income (describe)

Schedule J — Current Monthly Expenses

Enter your actual average monthly expenses. Do not include amounts for debts listed in Schedules D or E/F (such as mortgage and car payments — list those separately).

Monthly Expenses

Expense Category	Monthly Amount
Rent or mortgage payment
Real estate taxes (if not escrowed)
Home insurance (if not escrowed)
HOA / condo fees
Electricity & gas
Water, sewer, trash
Telephone (home & cell)
Internet / cable / satellite
Car insurance
Gas / fuel
Vehicle maintenance & registration
Public transportation / rideshare
Groceries / food at home
Dining out / takeout
Clothing & laundry
Personal care / grooming
Health / dental / vision insurance premiums
Out-of-pocket medical / dental / vision
Prescriptions & medications
Mental health / therapy
Childcare / daycare
Children's school, tuition & activities
Child support paid (court-ordered)
Alimony / spousal support paid
Life insurance premiums
Pet care / veterinary
Charitable contributions / tithes
Union dues / professional memberships
Entertainment / subscriptions
Other installment payments (not in Sch. D)
Other expenses (describe below)

Expense Category

Monthly Amount

Rent or mortgage payment

Real estate taxes (if not escrowed)

Home insurance (if not escrowed)

HOA / condo fees

Electricity & gas

Water, sewer, trash

Telephone (home & cell)

Internet / cable / satellite

Car insurance

Gas / fuel

Vehicle maintenance & registration

Public transportation / rideshare

Groceries / food at home

Dining out / takeout

Clothing & laundry

Personal care / grooming

Health / dental / vision insurance premiums

Out-of-pocket medical / dental / vision

Prescriptions & medications

Mental health / therapy

Childcare / daycare

Children's school, tuition & activities

Child support paid (court-ordered)

Alimony / spousal support paid

Life insurance premiums

Pet care / veterinary

Charitable contributions / tithes

Union dues / professional memberships

Entertainment / subscriptions

Other installment payments (not in Sch. D)

Other expenses (describe below)

Describe other expenses & any expected changes in income or expenses:

Official Form 107

Statement of Financial Affairs (SOFA)

Complete disclosure of financial history — all questions are mandatory

Complete this section as fully and accurately as possible.

Q1–Q3: Income History

List gross income for the current year to date and the two prior full calendar years.

Year	Source (Employer / Business)	Gross Amount

Q3: Other income in the past year (gifts, lottery, alimony received, rental, etc.):

Q4–Q5: Payments to Creditors

Q4: Have you made payments to any creditor within the last 90 days totaling more than $600?

No Yes

Q5: Have you made payments to family members, friends, or business associates within the last 1 year?

No Yes

Q6–Q9: Legal Actions, Repossessions, Foreclosures

Q6: Has any creditor offset or withheld any amount owed to you within the past 90 days?

No Yes

Creditor Name

Amount Offset

Date

Q7: Are you a party to any lawsuit or administrative proceeding (past year)?

No Yes

Q7b: Has any property been repossessed, foreclosed on, or returned in the past year?

No Yes

Property Description

Creditor

Date

Value of Property

Q8: Within the past 10 days has any creditor attached, garnished, or seized your wages, bank account, or other property?

No Yes — describe to your attorney immediately

Q10–Q11: Gifts and Losses

Q10: Have you given any gifts or charitable contributions exceeding $600 in aggregate per person in the past 2 years?

No Yes

Q11: Have you suffered any losses from fire, theft, accident, or gambling in the past year?

No Yes

Description of Loss

Date

Amount

Insurance claim filed?

No Yes

Q13–Q15: Transfers, Accounts & Safe Deposit Boxes

Q13: Have you transferred, sold, donated, or disposed of any property (other than in the ordinary course of business) in the past 2 years?

No Yes

Q14: Have you closed, sold, or transferred any financial accounts in the past year?

No Yes

Institution

Account Type

Date Closed

Closing Balance

Q15: Do you have or have you had a safe deposit box or storage facility in the past year?

No Yes

Institution / Facility

Description of Contents

Q19: Business Ownership History

Within the past 4 years, have you operated a business, been self-employed, or been a general partner?

No Yes

Q20: Have you been an officer, director, managing member, or controlling partner of any business in the past 4 years?

No Yes — provide details to your attorney

Credit Counseling Certification (11 U.S.C. § 109(h))

Mandatory: All individual debtors must complete an approved credit counseling course within 180 days before filing. Approved providers: ccadvising.com or beadvisor.com. When asked, identify your court as "Central District of California" and your attorney as "Clifford Bordeaux."

Have you completed the required pre-filing credit counseling course?

No (must complete before filing) Yes

Agency Name

Date Completed

Certificate Number

Final Step

Declaration & Electronic Signature

Penalty of perjury statement — read carefully before signing

DECLARATION UNDER PENALTY OF PERJURY
I/We declare under penalty of perjury that the information provided in this questionnaire is true and correct to the best of my/our knowledge, information, and belief. I/We understand that providing false information may result in dismissal of the bankruptcy case, denial of discharge, and/or criminal prosecution under 18 U.S.C. §§ 152 and 3571.

Required Documents — Please confirm you are gathering the following *

Government-issued photo ID (driver's license, passport, or state ID) Social Security card or proof of SSN Pay stubs — last 60 days (all employers; both debtors if joint filing) Last 2 years' federal & state tax returns (all pages + W-2s/1099s) Bank statements — all accounts — last 6 months Retirement account statements (401k, IRA, pension) — current value Mortgage statement(s) — most recent Credit counseling completion certificate (required before filing)

Debtor Printed Name *

Date *

Debtor Electronic Signature * — Type your full name to sign

Additional Notes for Your Attorney