Page 1 of 2 Last Name 	First 	Middle 	_

Spouse name if joint 	Date:

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Record # 	-	

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CREDITOR LIST Law Offices of Peter Francis Geraci READ THESE INSTRUCTIONS AND INITIAL EACH ONE
    1. List ALL debts whether you want to keep them or not!!! Put a star next to number if “keeping” You must be current unless a 13.
    2. You can’t keep credit cards unless with credit union secured w/other debts. List debts you dispute, debts you owe friends, etc.
    3. First list debts with collateral like mortgages, vehicles, credit unions, finance companies; ALL SECURED DEBTS FIRST!
    4. List any child support agency you owe, and tax debts. List credit cards, medical, payday loans, unsecured debts etc. last.
    5. Get the name of the creditor right! List the co-signer, collector or attorney in the space for Collection Agency
    6. If you don’t know the CREDITOR ADDRESS, go on Google (free at library) and FIND IT.
    7. FILL IN ALL BLANKS & list the date originally opened & the date last used. Joint filers must specify Husb,wife, joint, community.
    8. Failure to list any debt is fraudulent!! If you have more than 15 creditors, make a copy of page 2 and re-number it.	
1	Creditor	Address	City	State	Zip	
A D E F H	Date opened
/	Date last used
/	What for	Account #	BAL$	
Husb-indiv wife	Describe collateral (house, vehicle, cr union Personal property account pension) or NONE	Collection agency Co-signer Collector or attorney name, address, acct #	
Joint			
Community			
2	Creditor	Address	City	State	Zip	
A D E F H	Date opened
/	Date last used
/	What for	Account #	BAL$	
Husb-indiv wife	Describe collateral (house, vehicle, cr union Personal property account pension) or NONE	Collection agency Co-signer Collector or attorney name, address, acct #	
Joint			
Community			
3	Creditor	Address	City	State	Zip	
A D E F H	Date opened
/	Date last used
/	What for	Account #	BAL$	
Husb-indiv wife	Describe collateral (house, vehicle, cr union Personal property account pension) or NONE	Collection agency Co-signer Collector or attorney name, address, acct #	
Joint			
Community			
4	Creditor	Address	City	State	Zip	
A D E F H	Date opened
/	Date last used
/	What for	Account #	BAL$	
Husb-indiv wife	Describe collateral (house, vehicle, cr union Personal property account pension) or NONE	Collection agency Co-signer Collector or attorney name, address, acct #	
Joint			
Community			
5	Creditor	Address	City	State	Zip	
A D E F H	Date opened
/	Date last used
/	What for	Account #	BAL$	
Husb-indiv wife	Describe collateral (house, vehicle, cr union Personal property account pension) or NONE	Collection agency Co-signer Collector or attorney name, address, acct #	
Joint			
Community			
6	Creditor	Address	City	State	Zip	
A D E F H	Date opened
/	Date last used
/	What for	Account #	BAL$	
Husb-indiv wife	Describe collateral (house, vehicle, cr union Personal property account pension) or NONE	Collection agency Co-signer Collector or attorney name, address, acct #	
Joint			
Community			
7	Creditor	Address	City	State	Zip	
A D E F H	Date opened
/	Date last used
/	What for	Account #	BAL$	
Husb-indiv wife	Describe collateral (house, vehicle, cr union Personal property account pension) or NONE	Collection agency Co-signer Collector or attorney name, address, acct #	
Joint			
Community			

Page 2 of 2 Last Name 	First 	Middle 	_

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Spouse name if joint 	Date:

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Record # 	-	

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8	Creditor	Address	City	State	Zip	
A D E F H	Date opened	
/	Date last used
/	What for	Account #	BAL$	
Husb-indiv wife
Joint
Community	Describe collateral or NONE	Collection agency Co-signer Collector or attorney name, address, acct #	
9	Creditor	Address	City	State	Zip	
A D E F H	Date opened	
/	Date last used
/	What for	Account #	BAL$	
Husb-indiv wife
Joint
Community	Describe collateral or NONE	Collection agency Co-signer Collector or attorney name, address, acct #	
10	Creditor	Address	City	State	Zip	
A D E F H	Date opened	
/	Date last used
/	What for	Account #	BAL$	
Husb-indiv wife
Joint
Community	Describe collateral or NONE	Collection agency Co-signer Collector or attorney name, address, acct #	
11	Creditor	Address	City	State	Zip	
A D E F H	Date opened
/	Date last used
/	What for	Account #	BAL$	
Husb-indiv wife
□Joint
Community	Describe collateral or NONE	Collection agency Co-signer Collector or attorney name, address, acct #	
12	Creditor	Address	City	State	Zip	
A D E F H	Date opened
/	Date last used
/	What for	Account #	BAL$	
Husb-indiv wife
Joint
Community	Describe collateral or NONE	Collection agency Co-signer Collector or attorney name, address, acct #	
13	Creditor	Address	City	State	Zip	
A D E F H	Date opened
/	Date last used
/	What for	Account #	BAL$	
Husb-indiv wife
Joint
Community	Describe collateral or NONE	Collection agency Co-signer Collector or attorney name, address, acct #	
14	Creditor	Address	City	State	Zip	
A D E F H	Date opened
/	Date last used
/	What for	Account #	BAL$	
Husb-indiv wife
Joint Community	Describe collateral or NONE	Collection agency Co-signer Collector or attorney name, address, acct #	
15	Creditor	Address	City	State	Zip	
A D E F H	Date opened
/	Date last used
/	What for	Account #	BAL$	
	Husb-indiv wife
Joint	Describe collateral or NONE	Collection agency Co-signer Collector or attorney name, address, acct #	

Community			

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I/We have	15 debts or less	 more debts, see next page
x 	x 	_ Date: 	/ 	/