Questionnaire #11 - Means Test

Please complete this questionnaire regarding your last six months income. The are the instructions on the Form 122A-1 form, "Be as complete and accurate as possible.  If two married people are filing together, both are equally responsible for being accurate.  If more space is needed, attach a separate sheet to this form.  Include the line number to which the additional information applies.  On the top of any additional pages, write your name and case number (if known).  If you believe that you are exempted from a presumption of abuse because you do not have primarily consumer debts or because of qualifying military service, complete and file Statement of Exemption from Presumption of Abuse Under § 707(b)(2) (Official Form 122A-1Supp) with this form."

 

This Form cannot be submitted until the missing fields (labelled below in red) have been filled in

Questionnaire 11 - Means Test

Hello! Please provide as much information as you would like for a prompt and complete search. Thank-you, Rica

First Name*

Last Name*

Email Address

Phone

*

Primary Filer last six months Gross Wages

Secondary Filer last six months Gross Wages

Primary Filer last six months Unemployment

Joint Filer last six months Unemployment

Primary Filer last six months Pension or Retirement

Joint Filer last six months Pension or Retirement

Primary Filer last six months Alimony

Joint Filer last six months Alimony

Primary Filer last six months Child Support

Joint Filer last six months Child Support

All amounts from any source which are regularly paid for household expenses of you or your dependents, including child support. Include regular contributions from an unmarried partner, members of your household, your dependents, parents, and roommate and separated, non-filing spouse

Net income from operating a business, profession, or farm List Business Owner(s) Gross receipts (before all deductions) AND Ordinary and necessary operating expenses from a business, profession, or farm

Income from all other sources not listed above. Specify the source and amount. Do not include any benefits received under the Social Security Act or payments received as a victim of a war crime, a crime against humanity, or international or domestic terrorism. If necessary, list other sources on a separate page and put the total below.

PLEASE HIT SUBMIT

THANK-YOU

Rica J. Gilmore, Broker, Realtor® 

• Virginia License VA #0225235314 
• Rica Jo Ann Gilmore,​ ​Realtor®​ ​ ​
• Graduate, REALTOR® Institute
• ​​Rica Realty​​​ ​​​VA #0225235314​
• ​Accredited Buyer's Agent
• ​Seller Representative Specialist​ 
• ​REALTORS® Commitment to Excellence​
• ​Military Relocation Professional
• Seniors Real Estate Specialist®
• Short Sales and Foreclosure Resource
• Pricing Strategy Advisor
• Home Measurement Specialist
• ​Real Estate Negotiation Expert​
• ​Certified Team Specialist​

Rica Jo Ann Gilmore, Broker  Realtor®144 Shoe Lane, Newport News, VA 23606 1-757-932-7422  

North Carolina License NC 305512:  Rica J. Gilmore, Broker The Virtual Realty Group - Independent Firm Main office: 8116 Arlington Blvd, Ste 115, Falls Church, VA 22042 Telephone 1-888-407-2410 

The listings data displayed on this medium comes in part from the Central Virginia Regional MLS, (CVR MLS) and has been authorized by participating listing Broker Members of Central Virginia Regional MLS, (CVR MLS) for display. Central Virginia Regional MLS, (CVR MLS)  listings are based upon Data submitted by its Broker Members, and Central Virginia Regional MLS, (CVR MLS) therefore makes no representation or warranty regarding the accuracy of the Data. All users of Central Virginia Regional MLS, (CVR MLS) listings database should confirm the accuracy of the listing information directly with the listing agent.

CVR MLS and/or Rica J. Gilmore and information is protected under federal copyright laws. Federal law prohibits, among other acts, the unauthorized copying or alteration of, or preparation of derivative works from, all or any part of copyrighted materials, including certain complications of Data and information. COPYRIGHT VIOLATORS MAY BE SUBJECT TO SEVERE FINES AND PENALTIES UNDER FEDERAL LAW.

Information Deemed Reliable But Not Guaranteed