Collins & Arnove 555 Republic Dr., Ste 200 Plano, TX Office Fax

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Collins & Arnove 555 Republic Dr., Ste 200 Plano, TX 75074 Office 972-516-4255 Fax 972-516-4256"

Transcription

1 Collins & Arnove 555 Republic Dr., Ste 200 Plano, TX Office Fax Bankruptcy is an honest disclosure of a person(s) assets, liabilities, income, and expenses. This paperwork, as well as the documents we ask for, are designed for our office to present your case to the Court and the trustee in the proper format so that your case goes through correctly. There is no way our office can know this information unless we get it from you. So please help us help you. Don t be overwhelmed by the size of this packet. Many of the questions will be inapplicable to you. Nonetheless, you should thoroughly review each question and be certain that you do not have information that is non-responsive. If you can, answer the questions on this questionnaire. If you can t, add extra sheets of paper. If you have the information in another format (spread sheet, Quicken printout), you may attach that. Just remember, this is your financial future, please take the time to do this correctly. It will save both of us time in the end. Initial Here: Page 1

2 Items Needed: Tax Return and W2s (if married) Tax Return and W2s (if married) 3. Any paycheck stubs from either spouse (where or not filing jointly) for the previous six months. 4. Any other evidence of income such as Social Security, Pension, Unemployment, etc Attorney Notes Initial Here: Page 2

3 Client Questionnaire Section 1 - Basic Information Part A. Name and Address 1. Name: Have you used any other names in the past eight years? No Yes If yes, please list other names used: 2. Telephone Numbers\ address: Home: Work: Cell: 3. Social Security Number: Driver's License Number: Expiration Date: State: 5. Date of Birth: 6. Address: City: State: Zip: County: 7. Have you lived at this address for at least 180 days? No Yes If you have a different mailing address, please list: Mailing Address: City: State: Zip: County: Part B. Name and Address of Spouse 1. If you are filing jointly with your spouse, fill in the following information about your spouse: Name: Has your spouse used any other names in the past eight years? No Yes If yes, please list other names used: 2. Telephone Numbers\ address: Home: Work: Cell: 3. Social Security Number: Driver's License Number: Expiration Date: State: 5. Date of Birth: 6. Address:(enter only if different address) City: State: Zip: County: Initial Here: Page 3

4 Part C. Prior/Pending Bankruptcy Cases 1. Has a bankruptcy case been filed by you or against you in the last 8 years? No Yes If yes, in which district of which state was the case filed? Case Number: Date filed: 2. Are there currently any bankruptcy cases pending against you, your business, your spouse, or your spouse s business? No Yes If yes, name of debtor: Relationship to you: Case Number: Date filed: Judge: In which district of which state was the case filed? Initial Here: Page 4

5 READ CAREFULLY: Bankruptcy requires that you report ali of your assets. The questions below are designed to help us report your assets to the court in the format that they require. Please take this seriously and go through the all the types of assets. Remember to list household items at a replacement value (garage sale or craigslist value). I have no way of knowing what you own unless you tell me. Some commonly left off assets are: 401K balances, IRA balances, Insurance policies, and other "soft" assets. Many items will not apply to you, but I am still required by law to ask. So please check the "no" box if you do not own this type of asset. Section 2 Property Part A. Real Estate (Schedule A) A. Do you rent? No Yes If yes, please provide the name and address of the landlord: Name: Date you moved in?: Security deposit Amount: $ City: State: Zip: B. Do you own your house? No Yes Is this your homestead? (where you permanently live: No Yes What is the value of your house? (we generally use the tax appraised value) $ Are you current with all mortgage payments? No Yes C. Do you own any other properties? (Such as land, rental properties, time shares) No Yes Part B. Personal Property (Schedule B) 1. List ALL Checking/Savings Account, Certificates of deposit, other bank accounts: Initial Here: Page 5

6 Name of bank: Type of account: Last 4 digits of account number: Name of bank: Type of account: Last 4 digits of account number: Name of bank: Type of account: Last 4 digits of account number: Name of bank: Type of account: Last 4 digits of account number: 2. Do you have any security deposits held by utility companies, landlord? No Yes Name security held by: Amount of deposit: $ Name security held by: Amount of deposit: $ Initial Here: Page 6

7 LIVING ROOM FAMILY ROOM KITCHEN Sofa $ Sofa Bed $ Dinette Table/Chairs $ Armchair $ Sofa $ Kitchen clock $ Loveseat $ Chair $ Microwave $ Cocktail Table $ Loveseat $ Toaster Oven $ End Table $ Coffee Table $ Dishwasher $ Picture $ Cocktail Table $ Dishes/silverware $ Lamp $ Desk $ Pots/Pans $ Credenza $ Lamp $ Refrigerator $ Bookcase $ Bookcase $ Stove $ Desk $ Ent. Center $ TV (Size ) $ Wall Unit $ Stereo $ DINING ROOM Bar $ TV (Size ) $ Dining Table $ Piano $ Bridge Table/Chairs $ Dining Chairs $ Drapes $ Recliner $ Étagère $ Recliner $ CD Player $ Buffet $ Painting $ Telephone $ China Cabinet $ Plant $ Answering Mach. $ Picture $ $ $ Plant $ $ $ Armoire $ Total $ Total $ Total $ MASTER BEDROOM BEDROOM #2 BEDROOM #3 Mattress (size ) $ Mattress (size ) $ Mattress (size ) $ Box Spring (size ) $ Box Spring (size ) $ Box Spring (size ) $ Frame (size ) $ Frame (size ) $ Frame (size ) $ Water Bed $ Water Bed $ Water Bed $ Headboard (size ) $ Headboard (size ) $ Headboard (size ) $ Dresser $ Dresser $ Dresser $ Night Tables $ Night Tables $ Night Tables $ Lamp $ Lamp $ Lamp $ Vanity $ Vanity $ Vanity $ Chair $ Chair $ Chair $ Picture $ Picture $ Picture $ Footstool/ Chest $ Footstool/ Chest $ Footstool/ Chest $ TV (size ) $ TV (size ) $ TV (size ) $ VCR/ DVD $ VCR/ DVD $ VCR/ DVD $ Bedding $ Bedding $ Bedding $ Painting $ Painting $ Painting $ Plant $ Plant $ Plant $ Total $ Total $ Total $ Initial Here: Page 7 craigslistvalue)

8 BEDROOM #4 OFFICE PATIO Mattress (size ) $ Copy Machine $ Patio Table $ Box Spring (size ) $ Typewriter $ Patio Chairs $ Frame (size ) $ Telephone $ Umbrella $ Water Bed $ Cell Phones $ Lounge $ Headboard (size ) $ Car Phone $ Grill $ Dresser $ Fax Machine $ $ Night Tables $ Computers/ Laptops $ $ Lamp $ Comp. Printer $ $ Vanity $ Comp. Scanner $ $ Chair $ File Cabinet $ $ Picture $ Books $ POOL AREA Footstool/ Chest $ CD's/ DVD's/Records $ Lounge $ TV (size ) $ TV (size ) $ Chairs $ VCR/ DVD $ VCR/ DVD $ Table $ Bedding $ Camera/ Recorders $ Umbrella $ Painting $ MP3 Players $ Pool equip. $ Plant $ Desk $ Pool Supplies $ $ Chair $ $ $ Computer Equip. $ $ Total $ Total $ Total $ OTHER (if not already listed) FAMILY BELONGINGS OTHER Description Washer $ Adults Clothing $ Collectables $ Dryer $ Children's Clothing $ Art Objects $ Freezer $ Baby Clothing $ Art $ Compactor $ Jackets/Coats $ Hobby equip. $ Microwave $ $ Fire Arms $ TV (size ) $ $ Fire Arms Equip $ Window A/C $ $ Fire Arms Supplies $ A/C Compress $ $ Sports Equipment $ VCR/ DVD $ $ Furs & Jewelry $ Video Games/System $ $ Antiques $ Vacuum Cleaners $ $ Musical Instruments $ Baby Furniture $ $ Public Storage $ Baby Equipment $ $ Bicycles $ Children's Toys Sewing Machine Lawn Mower Garden Equip. Total $ Total $ Total $ Initial Here: Page 8

9 3. Interest in a universal or whole insurance policies (You only have this if it has a cash value -- not term life)? No Yes Name: Amount of value: $ Name: Amount of value: $ 4. Annuities? No Yes Name of Institution: Amount: $ Name of Institution: Amount: $ 5. Interests in an education IRA, as defined in 26 USC 530(b)(1)? No Yes Name of Institution: Amount: $ Name of Institution: Amount: $ 6. Interests in pension or profit sharing plans (This is a 401K, IRA, 403B, etc).? No Yes (YOU HAVE THIS IF A DEDUCTION IS COMING OUT OF YOUR CHECK. Name of Institution: Amount: $ Name of Institution: Amount: $ 7. Stock and interests in incorporated/unincorporated business? No Yes Value: $ Description: Initial Here: Page 9

10 8. Bonds? No Yes Value: $ Description: 9. Alimony/family support to which you are entitled? No Yes Value: $ Description: 10. Other liquidated debts owed to you, including tax refunds? No Yes Value: $ Description: 11. Can you sue anyone or any business for any reason OR does anybody owe you any money for any reason? No Yes Value: $ Description: 12. Patents, copyrights, other intellectual property? No Yes Value: $ Description: Initial Here: Page 10

11 13. Automobiles, trucks, trailers, and accessories? No Yes Year/Make/Model: Value: $ Name of owner: Year/Make/Model: Value: $ Name of owner: Year/Make/Model: Value: $ Name of owner: Year/Make/Model: Value: $ Name of owner: Year/Make/Model: Value: $ Name of owner: Year/Make/Model: Value: $ Name of owner: 14. Boats, motors, and accessories? No Yes Description: Year/Make/Model: Value: $ Name of owner: Description: Year/Make/Model: Value: $ Name of owner: 15. Animals or pets? No Yes Value: $ Description: Initial Here: Page 11

12 READ CAREFULLY: I will pull your credit report to find out a good portion of your debts. In some cases, the credit report will be an exclusive list of your debts. If that is the case, then it is unnecessary to fill this section out. However, some debts do not appear on credit reports. Examples include: payday loans, medical bills, old unpaid bills (phone, electricity, etc), broken apartment leases, and loans from family or friends. The best thing to do is to attach a copy of these statements. I will be able to gather the appropriate information from these statements. IF YOU CHOOSE TO NOT ATTACH STATEMENTS THEN I WILL NEED YOU TO FILL OUT ANY OTHER CREDITORS THAT YOU WANT LISTED. IT IS IMPOSSIBLE FOR TO KNOW ANY CREDITORS THAT ARE NOT LISTED ON THE CREDIT REPORT OR GIVEN TO ME (FROM A STATEMENT OR THIS PAPERWORK). Section 3 Debts List below all debts that you owe, or that creditor s claim that you owe which is not listed on your credit report or for which you have not provided documentation Initial Here: Page 12

13 Initial Here: Page 13

14 Section 4 Unexpired Leases and Contracts (Schedule G) 1. Do you have any unexpired leases and or contracts? No Yes Initial Here: Page 14

15 If yes, list below any leases or contracts that are still current that you are a party to. Include residential, car and business leases, and service or business contracts. Nature and Description of Contract: Name & address of other parties: Date contract expires: Nature and Description of Contract: Name & address of other parties: Date contract expires: Nature and Description of Contract: Name & address of other parties: Date contract expires: Initial Here: Page 15

16 READ CAREFULLY: Bankruptcy requires that you report ali of your income from all sources. Section 5 Current Income 1. What is your marital status? Married Single Divorced Separated Widowed 2. Do you have dependents? No Yes Name: Name: Age: Relationship: Age: Relationship: Name: Age: Relationship: Name: Age: Relationship: Part A. Debtor s Income 1. What is your official occupation title? 2. Name and address of your employer: 3. How long employed there? (MONTH/YEAR) 4. Do you receive: a. A b. S i. If so, how much per month? $ i. If so, how much per month? $ c. R Yes i. If so, how much per month? $ 5. Do you have any other income not listed? Yes a. If yes, for what? How much: $ Part B. Joint Debtor s Income 1. What is their official occupation title? 2. Name and address of your employer: 3. How long employed there? MONTH/YEAR 4. Do they receive: a. A i. If so, how much per month? $ b. S i. If so, how much per month? $ c. R Yes i. If so, how much per month? $ 5. Do they have any other income not listed? Yes a. If yes, for what? How much: $ Initial Here: Page 16

17 READ CAREFULLY: Bankruptcy requires that you report the expenses for your household. This budget does not include payments on unsecured debts such as credit cards, medical bills, payday loans, etc. This is the point of the Bankruptcy, to see what kind of budget your household has without payments for these types of items. Please provide an exact number for items that have an exact number. EX: cell phone, cable, internet, car insurance. The trustee looks at cases very SKEPTICALLY if every expense item is $100. For other items, try to use a rolling average. EX: food, clothing, medical expenses. Do not include any expenses that are itemized in your paycheck stubs. Section 6 Current Expenses 1. Do you and your spouse maintain separate households? No Yes. If so, fill one page out for your household and another for your spouse s. Indicate how much you pay for each item each month 1. your rent or your home mortgage $ Does that amount include real estate taxes? No Yes Does it include property insurance? No Yes 2. electricity and heating $ 3. water and sewage $ 4. Cell phone $ 5. Internet $ 6. Cable $ 7. home maintenance, including repairs and general upkeep $ 8. food $ 9. clothing $ 10. laundry and dry cleaning $ 11. Out of pocket medical and dental co-pays $ 12. transportation (gas, maintenance, tolls, etc) $ 13. entertainment, recreation, newspapers, magazines $ 14. charitable contributions $ 15. insurance not deducted from paycheck a) homeowner s (if not escrowed) or renter s insurance $ b) life insurance $ c) health insurance $ d) auto insurance $ e) other insurance $ 16. taxes not deducted from paycheck $ 17. installment payments for car, furniture, etc. (Specify) $ $ $ 18. alimony, maintenance, support paid to others $ 19. payments for support of dependents not living at home $ Initial Here: Page 17

18 20. childcare $ 21. Student Loan Payments (not on deferment) $ $ 22. ANY other expenses not listed above $ $ $ $ Initial Here: Page 18

19 READ CAREFULLY: Below is a list of questions that I am required to ask you by law. Many of these will questions will not apply to you. However, I still need you to check the box NO for those items. Section 7 Statement of Financial Affairs If you are filing jointly with your spouse, include information about both you and your spouse. If you are filing under chapter 12 or 13, and you are married and not separated, you must provide information about your spouse even if you are not filing jointly. 1. Payments to creditors a. Have you made your mortgage payment(s) in the last 90 days? b. Have you made your car payment(s) in the last 90 days? c. Have you paid ANY OTHER creditors OVER $600 in the last 90 days? (PLEASE ITEMIZE THESE PAYMENTS BELOW) NAME DATES OF PAYMENTS TOTAL AMOUNT PAID 2. Have you given or transferred any money/ property to any family members, relatives, friends, business partners and their relatives, your corporations, or your affiliates, in the past year? If you have answered yes to the above questions please list below the payments you have made: NAME & ADDRESS DATES OF PAYMENTS TOTAL AMOUNT PAID Initial Here: Page 19

20 3. Have you any lawsuits, executions, garnishments and attachments in the last year? List all suits and administrative proceedings to which you are or were a party within one year preceding the filing of this case. CAPTION OF SUIT & CASE # NATURE OF PROCEEDING COURT/AGENCY STATUS 4. Have you had any property that has been garnished, seized, or attached under any legal or equitable process within one year immediately preceding the commencement of this case? NAME & ADDRESS OF PERSON/COMPANY DATE OF SEIZURE DESCRIPTION & VALUE OF PROPERTY 5. Have you had any repossessions, foreclosures? List all property that has been repossessed by a creditor, sold at a foreclosure sale, transferred through a deed in lieu of foreclosure, or returned to the seller, within one year immediately preceding the commencement of this case. NAME & ADDRESS OF PERSON/ CREDITOR DATE OF REPOSSESSION/ FORECLOSURE/ TRANSFER DESCRIPTION & VALUE OF PROPERTY 6. Have you had any assignments and receiverships in the past 120 days? (If you don t know what this is then the answer is probably no) Initial Here: Page 20

21 NAME & ADDRESS OF ASSIGNEE DATE OF ASSIGNMENT TERMS OF ASSIGNMENT 7. Have you had any property which has been in the hands of a custodian, receiver, or court-appointed official within one year immediately preceding the commencement of this case? NAME & ADDRESS OF CUSTODIAN NAME & LOCATION OF COURT, CASE TITLE & # DESCRIPTION & VALUE OF PROPERTY 8. Have you given any gifts or charitable contributions within one year immediately preceding the commencement of this case except ordinary and usual gifts to family members aggregating less than $200 in value per individual family member and charitable contributions aggregating less than $100 per recipient? NAME & ADDRESS OF RECIPIENT RELATIONSHIP TO YOU IF ANY DATE OF GIFT DESCRIPTION & VALUE OF GIFT 9. Have you had any losses from fire, theft, gambling or other casualty within one year immediately preceding the commencement of this case or since the commencement of this case? DESCRIPTION & VALUE OF PROPERTY CIRCUMSTANCES & AMOUNT COVERED BY INSURANCE DATE OF LOSS 10. Have you had other property transferred in your ordinary course of business or financial affairs, transferred either absolutely or as a security within two years immediately preceding the commencement of this case (including sale of your property)? Initial Here: Page 21

22 NAME & ADDRESS OF TRANSFEREE & RELATIONSHIP DATE OF TRANSFER DESCRIPTION OF PROPERTY & VALUE RECEIVED 11.In the past 10 years have you had any property transferred to a self-settled trust, or a similar device of which you are the beneficiary? NAME OF TRUST OR SIMILAR DEVICE DATE OF TRANSFER AMOUNT OF MONEY OR VALUE OF PROPERTY OF INTEREST 12. Have you had any financial accounts and instruments held in your name or for your benefit which were closed, sold, or otherwise transferred within one year immediately preceding the commencement of this case? NAME & ADDRESS OF INSTITUTION TYPE/ ACCOUNT # & FINAL BALANCE AMOUNT & DATE OF SALE OR CLOSING 13. Have you have or have had a safe deposit or other box or depository in which you have or have had securities, cash, or other valuables within one year immediately preceding commencement of this case? NAME & ADDRESS OF BANK OR DEPOSITORY NAME/ ADDRESS WITH ACCESS DESCRIPTION OF CONTENTS DATE IF TRANSFER Initial Here: Page 22

23 14. Have you had any setoffs made by any creditor, including a bank, against a debt or deposit of yours within 90 days preceding the commencement of this case? NAME & ADDRESS OF CREDITOR DATE OF SETOFF AMOUNT OF SETOFF 15. Do you have any property that you hold or control that is owned by another person? NAME & ADDRESS OF OWNER DESCRIPTION & VALUE OF PROPERTY LOCATION OF PROPERTY 16. LIST ALL ADDRESS where you have resided in the last three years immediately preceding the commencement of this case. ADDRESS TO (MONTH & YEAR) FROM (MONTH & YEAR) 17. Do you have spouses or former spouses? (The last eight years) NAMES Initial Here: Page 23

Greg Gouner, Attorney at Law 11750 Bricksome Avenue, Suite C Baton Rouge, LA 70816 (225) 293-6200

Greg Gouner, Attorney at Law 11750 Bricksome Avenue, Suite C Baton Rouge, LA 70816 (225) 293-6200 Bankruptcy Forms: Chapters 7/Chapter 13 Instructions: Please fill out this form completely. You are providing this office with the information required to prepare the filing of a Chapter 7 or Chapter 13

More information

M. Caroline Cantrell & Associates, PC Attorney at Law

M. Caroline Cantrell & Associates, PC Attorney at Law M. Caroline Cantrell & Associates, PC Attorney at Law 8800 SE Sunnyside Road, Suite 207N, Clackamas, OR 97015 (503) 236-9211 549 NW 2nd Avenue, Canby Oregon 97013 (503) 266-0382 Date: PENDING FORECLOSURE,

More information

Banning Law Firm. 10801 Lomas NE Ste. 104 Albuquerque, NM 87112 Office 883-9577 Fax 866-677-0508

Banning Law Firm. 10801 Lomas NE Ste. 104 Albuquerque, NM 87112 Office 883-9577 Fax 866-677-0508 Banning Law Firm 10801 Lomas NE Ste. 104 Albuquerque, NM 87112 Office 883-9577 Fax 866-677-0508 Questionnaire Taxes Credit Report Paper Work Needed To File Counseling Certificate Pay Check Stubs Payment

More information

LEIDEN AND LEIDEN A Professional Corporation

LEIDEN AND LEIDEN A Professional Corporation LEIDEN AND LEIDEN A Professional Corporation Terrance Patrick Leiden (also Ohio) 330 Telfair Street C. Christopher CoCroft, Jr. Zane P. Leiden (also SC) Augusta, Georgia 30901-2450 (1941-1974) (706) 724-8548

More information

Honolulu, Hawaii 96813-5010 (808) 593-2199

Honolulu, Hawaii 96813-5010 (808) 593-2199 Honolulu, Hawaii 96813-5010 (808) 593-2199 BUSINESS BANKRUPTCY -- CLIENT INFORMATION WORKSHEETS DEBTOR JOINT DEBTOR FULL NAME: STREET ADDRESS: MAILING ADDRESS: COUNTY: HOME PHONE: WORK PHONE: FAX (if available)

More information

Legal Name: All other names you have used in the last 6 years: Address, City, State, Zip: Mailing Address if different:

Legal Name: All other names you have used in the last 6 years: Address, City, State, Zip: Mailing Address if different: BANKRUPTCY INTERVIEW INSTRUCTIONS: The interview sheet contains basic information needed for your bankruptcy. Do the best to complete the information. If you do not know the answer, then write "I do not

More information

Chapter 7/13 Bankruptcy Worksheet NOTICE!! IMPORTANT!! This page must be read and signed before your case will be filed.

Chapter 7/13 Bankruptcy Worksheet NOTICE!! IMPORTANT!! This page must be read and signed before your case will be filed. Chapter 7/13 Bankruptcy Worksheet NOTICE!! IMPORTANT!! This page must be read and signed before your case will be filed. If this set of worksheets is not filled out completely, we cannot properly prepare

More information

~ BANKRUPTCY PACKET ~

~ BANKRUPTCY PACKET ~ ~ BANKRUPTCY PACKET ~ BANKRUPTCY INFORMATION You must list EVERYTHING you own and ALL of your debts. You cannot fail to list something because I do not want to file on that. TAX DEBTS: Tax debts and liens

More information

Name: Last First Middle. Telephone Number Home: Work: Have you used any other names in the past six years? No

Name: Last First Middle. Telephone Number Home: Work: Have you used any other names in the past six years? No Client questionnaire for bankruptcy cases 1 N. Marshall St. Suite 100 Winston-Salem, NC 27101 www.attorneygates.com Section 1 Basic Information Part A. Name and Address Name: Last First Middle Telephone

More information

Bankruptcy Petition Preparation Checklist

Bankruptcy Petition Preparation Checklist Chapter 7 / 13 Bankruptcy Worksheet IMPORTANT! This page must be read and signed before your case will be filed. If this set of worksheets is not filled out completely, WE CANNOT PREPARE THE PETITION AND

More information

LAW OFFICES OF MICHAEL O. HAYS

LAW OFFICES OF MICHAEL O. HAYS LAW OFFICES OF MICHAEL O. HAYS In order to file your case quickly, you must complete this questionnaire. You can bring the completed form to your consultation appointment or mail it to my office. Eventually,

More information

Client Questionnaire Section 1 - Basic Information

Client Questionnaire Section 1 - Basic Information Client Questionnaire Section 1 - Basic Information Part A. Name and Address Name: Have you used any other names in the past eight years? If yes, please list other names used: Telephone Numbers\Email address:

More information

Client Questionnaire Section 1 - Basic Information

Client Questionnaire Section 1 - Basic Information Client Questionnaire Section 1 - Basic Information Part A. Name and Address Name: Have you used any other names in the past eight years? If yes, please list other names used: Telephone Numbers\Email address:

More information

Your Full Name Age Social Security #

Your Full Name Age Social Security # Walter A. Metzen Attorney at Law 3156 Penobscot Building 645 Griswold Street Detroit, MI 48226 (313) 962-4656 www.bankruptcydetroit.com Fax (313) 962-4241 REQUEST FOR BANKRUPTCY PROTECTION-START-UP PACKET

More information

INITIAL CLIENT QUESTIONNAIRE Financial. Name: SSN: DOB: Spouse: SSN: DOB: Address: City: State: Zip: Length of Residence:

INITIAL CLIENT QUESTIONNAIRE Financial. Name: SSN: DOB: Spouse: SSN: DOB: Address: City: State: Zip: Length of Residence: FOR OFFICE USE ONLY Chapter 7 13 Individual Joint Attorney s Fee: Filing Fee: INITIAL CLIENT QUESTIONNAIRE Financial Date: Name: SSN: DOB: Spouse: SSN: DOB: Address: City: State: Zip: County: Length of

More information

Debtor s Full Legal Name: Spouse s Full Legal Name: Other Names Ever Used: Email: Tel#: Cell#: Emergency Contact (name & number):

Debtor s Full Legal Name: Spouse s Full Legal Name: Other Names Ever Used: Email: Tel#: Cell#: Emergency Contact (name & number): Law Office of Jeffrey B. Kelly, P.C. Chapter 7 Chapter 13 Bankruptcy Questionnaire DEBTOR INFO: How did you first hear about my office? Office Location Debtor s Full Legal Name: SS# DOB: Spouse s Full

More information

PIEDMONT DEBT RELIEF

PIEDMONT DEBT RELIEF PIEDMONT DEBT RELIEF Ferguson, Scarbrough, Hayes Hawkins and DeMay, PA 65 McCachern Blvd., SE P.O. Box 444 Concord, North Carolina 28026-0444 Telephone: (704) 788-3211 Debt Management Worksheet Chapter

More information

The Thorpe Law Firm, P.A. Attorney at Law

The Thorpe Law Firm, P.A. Attorney at Law The Thorpe Law Firm, P.A. Attorney at Law Gulf South Center Tel. (813) 933-5051 7819 N. Dale Mabry Hwy. Fax (813) 933-5061 Suite 108 thorpefirm@yahoo.com Tampa, Florida 33614 www.thorpelawfirm.com BANKRUPTCY

More information

Client Questionnaire For Business Debtor

Client Questionnaire For Business Debtor Client Questionnaire For Business Debtor Section 1 Basic Information Part A. Name and Address Name of business: Contact Person s name: Telephone Number: ext.: Alternative Number: Has the business gone

More information

In addition to filling out the attached schedules, you will need to provide me with the following documents:

In addition to filling out the attached schedules, you will need to provide me with the following documents: Buckley & Jensen 1257 Gun Club Road White Bear Lake, MN 55110 (651) 486-7475 phone (651) 486-7468 facsimile email: maryjo@buckleyjensen.com In addition to filling out the attached schedules, you will need

More information

CONSULTATION DATE. We are a debt relief agency. We help people file for bankruptcy under the bankruptcy code.** Legal. Name

CONSULTATION DATE. We are a debt relief agency. We help people file for bankruptcy under the bankruptcy code.** Legal. Name CONSULTATION DATE We are a debt relief agency. We help people file for bankruptcy under the bankruptcy code.** Legal Name: First Middle Last Social Security No. Spouse s Name: First Middle Last SSN#( if

More information

BANKRUPTCY CHECKLIST ITEMS NEEDED TO COMPLETE YOUR BANKRUPTCY HELPFUL TO HAVE SOME INFO BELOW FOR INITIAL CONSULT

BANKRUPTCY CHECKLIST ITEMS NEEDED TO COMPLETE YOUR BANKRUPTCY HELPFUL TO HAVE SOME INFO BELOW FOR INITIAL CONSULT NAME: DATE: Complete and return the attached List of Property Descriptions; Income Information and Monthly Expenses Provide any actual bills showing creditor s name, address, account number, balance due

More information

BANKRUPTCY WORKSHEET

BANKRUPTCY WORKSHEET BANKRUPTCY WORKSHEET GRAND LAW FIRM BANKRUPTCY CLIENT QUESTIONNAIRE PAGE 1 PERSONAL INFORMATION Your Full Name: Your SSN: Spouse s Full Name: Spouse s SSN: Street City/State/Zip: Mailing Address (if different):

More information

BANKRUPTCY INTAKE FORM

BANKRUPTCY INTAKE FORM BANKRUPTCY INTAKE FORM Instructions: Fill out this form in its entirety. Upon completion, you may fax the form with a cover sheet with my name on it to (804) 796 6775, you may email the form to my attention

More information

MARK S. ZUCKERBERG, P.C. ATTORNEY AT LAW

MARK S. ZUCKERBERG, P.C. ATTORNEY AT LAW LAW OFFICE OF MARK S. ZUCKERBERG, P.C. ATTORNEY AT LAW Full Legal Name: (Last, First, Middle) Spouse's Full Legal Name: (Last, First Middle) All other names used in the past 6 years: All other names used

More information

Client Questionnaire For Business Debtor

Client Questionnaire For Business Debtor Part A. Name and Address Name of business: Contact Person s name: Client Questionnaire For Business Debtor Section 1 Basic Information Telephone Number: ext.: Alternative Number: Has the business gone

More information

Client Questionnaire For Business Debtor Section 1 - Basic Information

Client Questionnaire For Business Debtor Section 1 - Basic Information Part A. Name and Address Name of business: Contact Person's Name: Client Questionnaire For Business Debtor Section 1 - Basic Information Telephone Number: ext: Alternative Number: Email: Has the business

More information

LENZ LAW FIRM, LLC P.O. Box 965 236 Boston Post Road, 2 nd floor Orange, CT 06477

LENZ LAW FIRM, LLC P.O. Box 965 236 Boston Post Road, 2 nd floor Orange, CT 06477 LENZ LAW FIRM, LLC P.O. Box 965 236 Boston Post Road, 2 nd floor Orange, CT 06477 Kenneth E. Lenz, Attorney at Law Board-Certified in Consumer Bankruptcy Law By the American Board of Certification We are

More information

BANKRUPTCY "SELF HELP CENTER"

BANKRUPTCY SELF HELP CENTER BANKRUPTCY "SELF HELP CENTER" Self Help Center Rules and Policies: 1) Prior to meeting with a Self Help Center volunteer attorney you must: a. Read and sign the Disclaimer, b. Complete the General Information

More information

CLIENT INFORMATION OFFICE USE ONLY. TODAY'S DATE: Name: Any other names you may be known by: INFORMATION ABOUT YOU: SS#

CLIENT INFORMATION OFFICE USE ONLY. TODAY'S DATE: Name: Any other names you may be known by: INFORMATION ABOUT YOU: SS# CLIENT INFORMATION INFORMATION ABOUT YOU: TODAY'S DATE: Name: Any other names you may be known by: SS# Date of Birth Physical Address Mailing (if different) City State Phone #s Hm Cell Wk E-mail address

More information

UTAH BANKRUPTCY CLINIC, LC BANKRUPTCY QUESTIONNAIRE

UTAH BANKRUPTCY CLINIC, LC BANKRUPTCY QUESTIONNAIRE UTAH BANKRUPTCY CLINIC, LC BANKRUPTCY QUESTIONNAIRE Please fill out ALL the information requested in these forms. If a question or section does NOT apply to you, write N/A in the space. (N/A means not

More information

STEP 1: DOCUMENT COLLECTION

STEP 1: DOCUMENT COLLECTION STEP 1: DOCUMENT COLLECTION Because your filing will require many details and documents and because the court is both picky and strict about information, documents are needed from you. Income Tax Returns

More information

Dear Client, MANTY & ASSOCIATES, P.A. MANTY & ASSOCIATES, P.A. Attorneys at Law

Dear Client, MANTY & ASSOCIATES, P.A. MANTY & ASSOCIATES, P.A. Attorneys at Law & MANTY & ASSOCIATES, P.A. Attorneys at Law Andrea Cobery, Attorney (612) 465-0909 andrea@mantylaw.com Lauren Paulbick, Paralegal (612) 465-0341 lauren@mantylaw.com Dear Client, Thank you for the opportunity

More information

Personal Property Home Inventory

Personal Property Home Inventory STATE OF WISCONSIN Personal Property Home Inventory OFFICE OF THE COMMISSIONER OF INSURANCE PI-224 (R 02/2015) If your home was damaged by a fire or a burglar made off with your valuables would you be

More information

JUDGE LAW FIRM 2123 E. GRANT ROAD TUCSON, ARIZONA 85712 (520) 388-5665

JUDGE LAW FIRM 2123 E. GRANT ROAD TUCSON, ARIZONA 85712 (520) 388-5665 JUDGE LAW FIRM 2123 E. GRANT ROAD TUCSON, ARIZONA 85712 (520) 388-5665 ARIZONA BANKRUPTCY REPORT A decision to file for bankruptcy should be made only after careful consideration of your financial situation

More information

DETAILED APPLICATION FOR INSOLVENCY SERVICES. Legal Name (in full) Last Name First Name Middle Name

DETAILED APPLICATION FOR INSOLVENCY SERVICES. Legal Name (in full) Last Name First Name Middle Name Initial Deposit: $ cash or money order Estimated monthly payments: $ x months How did you find our firm? DETAILED APPLICATION FOR INSOLVENCY SERVICES PERSONAL DATA Legal Name (in full) Last Name First

More information

JEFFREY S. ARNOLD ATTORNEY AT LAW, P.C. Toll Free: LAWS

JEFFREY S. ARNOLD ATTORNEY AT LAW, P.C. Toll Free: LAWS 209 W. Van Buren St Columbia City, IN 46725 Phone: 260.248.2169 Fax: 260.248.2176 JEFFREY S. ARNOLD ATTORNEY AT LAW, P.C. Toll Free: 1.888.600.LAWS www.jeffarnoldlaw.com 5612 W. Jefferson Blvd. Fort Wayne,

More information

CURRENT MONTHLY INCOME

CURRENT MONTHLY INCOME Client Questionnaire Section 1 - Basic Information Part A. Name and Address Name: Have you used any other names in the past eight years? No Yes If yes, please list other names used: Telephone Numbers\Email

More information

DAVID GAFFNEY, ATTORNEY AT LAW Gaffney Law Firm Post Office Box 3966 West Columbia, SC 29171

DAVID GAFFNEY, ATTORNEY AT LAW Gaffney Law Firm Post Office Box 3966 West Columbia, SC 29171 DAVID GAFFNEY, ATTORNEY AT LAW Gaffney Law Firm Post Office Box 3966 West Columbia, SC 29171 Tel. 803-781-0500; Fax 803-454-9900 Tel. 864-573-9100 Fax 864-752-1324 david@gaffneylawfirm.com TO: FROM: RE:

More information

INSTRUCTIONS FOR COMPLETING OFFICIAL FORM 7. STATEMENT OF FINANCIAL AFFAIRS (Revised 2/01) I. INTRODUCTION

INSTRUCTIONS FOR COMPLETING OFFICIAL FORM 7. STATEMENT OF FINANCIAL AFFAIRS (Revised 2/01) I. INTRODUCTION INSTRUCTIONS FOR COMPLETING OFFICIAL FORM 7 STATEMENT OF FINANCIAL AFFAIRS (Revised 2/01) I. INTRODUCTION The Statement of Financial Affairs provides a summary of the debtor's financial history, transactions,

More information

Date of Interview: NAME DURATION REASON FOR LEAVING. Marital status: Single Married Separated Divorced Widowed Common Law

Date of Interview: NAME DURATION REASON FOR LEAVING. Marital status: Single Married Separated Divorced Widowed Common Law Date of Interview: CRAWFORD SMITH & SWALLOW INC. Page 1 531 LAKE STREET, ST. CATHARINES, ONTARIO L2N 4H6 Tel: (905) 937-2100 Fax: (905) 937-7363 Website: www.crawfordss.com Email: css@crawfordss.com APPLICATION

More information

Students can use the handouts provided or any other insurance industry standard tool.

Students can use the handouts provided or any other insurance industry standard tool. PROJECT 11: INSURANCE INVENTORY INSTRUCTOR OVERVIEW Before a catastrophe strikes and students are faced with a loss, they should make a home inventory: lists, pictures or videos of the contents of their

More information

HOME INVENTORY CHECKLIST

HOME INVENTORY CHECKLIST Determining the value of your personal property requires an extensive analysis on your part. You should go through each room of your house and list every piece of furniture and fixture within it. Some

More information

Home Inventory Checklist

Home Inventory Checklist Home Inventory Checklist A room-by-room inventory for your home Ohio Department of Insurance Home Inventory Checklist www.insurance.ohio.gov Keeping an inventory of the items in your house can be helpful

More information

Personal Property Inventory

Personal Property Inventory Personal Property Inventory www.libertymutualinsurance.com Why Do I Need an Inventory? Your homeowners insurance provides you with the security of knowing that your personal possessions are protected in

More information

Client Bankruptcy Questionnaire Philip G. Jones, 853 West Center, Orem, Utah 84057 (801) 224-5750 Basic Instructions

Client Bankruptcy Questionnaire Philip G. Jones, 853 West Center, Orem, Utah 84057 (801) 224-5750 Basic Instructions Client Bankruptcy Questionnaire Philip G. Jones, 853 West Center, Orem, Utah 84057 (801) 224-5750 Basic Instructions 1. It is important that you be as complete, accurate and truthful as possible in answering

More information

MAXWELL LAW FIRM,PLLC

MAXWELL LAW FIRM,PLLC MAXWELL LAW FIRM,PLLC Please fill in the answers to the questions below, so we can properly evaluate your unique financial situation. Please note that Debt, Bankruptcy, and Tax Laws are often the same

More information

Household Inventory. Household Inventory Record

Household Inventory. Household Inventory Record Household Inventory Household Inventory Record Initial Inventory Date Revision Dates Summary Room Totals/RC Living Room Family Room Dining Room Recreation Room Kitchen Bathroom Your personal belongings

More information

Different agencies proved the counseling inperson, by telephone or over the Internet.

Different agencies proved the counseling inperson, by telephone or over the Internet. Bankruptcy Questionnaire Bankruptcy is a right provided by law to people who are deeply in debt and need of a fresh start. Bankruptcy will discharge many of your debts and you will not have to pay them,

More information

***THIS FORM MUST BE COMPLETED IN FULL***

***THIS FORM MUST BE COMPLETED IN FULL*** BANKRUPTCY/PROPOSAL APPLICATION CHECKLIST 1. Application - complete all questions - bring 2 pieces of identification when you sign up (i.e. driver s licence & birth certificate) 2. Vehicles - copy of vehicle

More information

Bankruptcy Questionnaire

Bankruptcy Questionnaire Bankruptcy Questionnaire This questionnaire is also available in English and Spanish versions, in both Microsoft Word and Adobe Acrobat (PDF) format, on this manual s companion website. Use the PDF format

More information

Thanks for making an appointment to see us!

Thanks for making an appointment to see us! Thanks for making an appointment to see us! Please fill out the following forms before your first bankruptcy consultation at Friedman Iverson. These forms help us understand your financial issues and quickly

More information

Home Contents Inventory Worksheet

Home Contents Inventory Worksheet Home Contents Inventory Worksheet Your homeowners insurance provides coverage for the contents of your home, up to the limit you selected with your insurance agent. In the event of a covered loss, you

More information

Form M-433-OIS Statement of Financial Condition and Other Information

Form M-433-OIS Statement of Financial Condition and Other Information Form M-433-OIS Statement of Financial Condition and Other Information Rev. 6/09 Massachusetts Department of Revenue Complete all entries with the most current information available. For entries that do

More information

LAW OFFICES OF JAMES H. MAGEE WASHINGTON BANKRUPTCY ATTORNEY

LAW OFFICES OF JAMES H. MAGEE WASHINGTON BANKRUPTCY ATTORNEY James H. MaGee LAW OFFICES OF JAMES H. MAGEE WASHINGTON BANKRUPTCY ATTORNEY Main Office Address: 1108 rth 6th Street Tacoma, WA 98403 Phone: (253) 383-1001 Mailing Address: Post Office Box 1132 Facsimile:

More information

LAW OFFICES OF. Main Office: 4905 Chiquita Blvd. S., Suite 103 Cape Coral, Florida 33914 Telephone: (239) 443-5900 Facsimile: (888) 267-9061

LAW OFFICES OF. Main Office: 4905 Chiquita Blvd. S., Suite 103 Cape Coral, Florida 33914 Telephone: (239) 443-5900 Facsimile: (888) 267-9061 Naples Office: 999 Vanderbilt Beach Road, Suite 200 Naples, Florida 34108 Telephone: (239) 206-4971 Facsimile: (888) 267-9061 LAW OFFICES OF JUAN J. PILES Main Office: 4905 Chiquita Blvd. S., Suite 103

More information

Home inventory DIFP. Department of Insurance, Financial Institutions & Professional Registration. Jeremiah W. (Jay) Nixon Governor

Home inventory DIFP. Department of Insurance, Financial Institutions & Professional Registration. Jeremiah W. (Jay) Nixon Governor Home inventory Checklist Homeowners and renters should prepare a list of their belongings in the event their home or apartment is burglarized or destroyed by a tornado or fire. A checklist also can let

More information

BANKRUPTCY QUESTIONNAIRE. Name of Debtor: first middle last Name of Co-Debtor: first middle last

BANKRUPTCY QUESTIONNAIRE. Name of Debtor: first middle last Name of Co-Debtor: first middle last BANKRUPTCY QUESTIONNAIRE Name of Debtor: first middle last Name of Co-Debtor: first middle last I. By completing this document and returning it to Broc E. Whitehead, I/we certify that it is my/our duty

More information

BANKRUPTCY QUESTIONNAIRE

BANKRUPTCY QUESTIONNAIRE BANKRUPTCY QUESTIONNAIRE In order to properly complete your bankruptcy, it is necessary to obtain certain information from you, especially concerning the names and complete addresses of all creditors,

More information

Home Inventory Worksheet

Home Inventory Worksheet T 408-739-8300 F 866-826-6781 W www.asibrokers.com 4300 Stevens Creek, Ste #100 San Jose, CA 95129 Home Inventory Worksheet All Spectrum Insurance Brokers is providing this Home Inventory Worksheet as

More information

HOME OWNER INFORMATION WORKSHEET

HOME OWNER INFORMATION WORKSHEET HOME OWNER INFORMATION WORKSHEET Homeowner (A) Homeowner (B) Homeowner (A) Street Address City State Zip Code Homeowner (B) Street Address City State Zip Code Property Address (if different) City State

More information

Civil Criminal Incarcerated On Supervised Release Neither

Civil Criminal Incarcerated On Supervised Release Neither Civil Criminal Incarcerated On Supervised Release Neither United States Department of Justice Office of the United States Attorney District of Idaho (Submitted for Government Action on Claims Due the United

More information

SELF STORAGE SPACE ESTIMATOR AND INVENTORY SHEET

SELF STORAGE SPACE ESTIMATOR AND INVENTORY SHEET SELF STORAGE SPACE ESTIMATOR AND INVENTORY SHEET Our units are 10 feet in height but most people don t like to stack items much higher than 8 feet. In our units stacking 8 feet is perfect as it leaves

More information

Pre-Bankruptcy Filing Certification Credit Counseling DISCLOSURE AGREEMENT

Pre-Bankruptcy Filing Certification Credit Counseling DISCLOSURE AGREEMENT Pre-Bankruptcy Filing Certification Credit Counseling DISCLOSURE AGREEMENT Thank you for contacting Comprehensive Credit Counseling of Rural Services of Indiana, Inc. for you Pre- Bankruptcy Filing Certification.

More information

Thomas K. Atwood BANKRUPTCY WORKSHEET

Thomas K. Atwood BANKRUPTCY WORKSHEET Thomas K. Atwood Attorney at Law 19427 SE 14th St, Sammamish, WA 98075 18820 Aurora Avenue North, Suite #202, Shoreline, WA 98133 Voice (425) 996-4145 or (206) 569-4685 - Fax (815) 550-1378 Email: tom@tomlaw.com

More information

INFORMATION WORKSHEET INSTRUCTIONS

INFORMATION WORKSHEET INSTRUCTIONS CLIENT BANKRUPTCY CHAPTER 7 INDIVIDUAL Instructions Page 1 Fehr Law Office 205 Green Street, Onalaska, WI 54650, 608-783-3647 INFORMATION WORKSHEET INSTRUCTIONS DO NOT DO ANYTHING THAT WOULD INCREASE OR

More information

PERSONAL FINANCIAL ORGANIZER

PERSONAL FINANCIAL ORGANIZER PERSONAL FINANCIAL ORGANIZER SENIOR SOLUTIONS OF AMERICA, INC. www.todaysseniors.com COPYRIGHT 2007 SENIOR SOLUTIONS OF AMERICA, INC. ALL RIGHTS RESERVED. ORGANIZING YOUR PERSONAL FINANCES Are your financial

More information

MACHI & ASSOCIATES, P.C. 1521 N. Cooper, Suite 550 990 N. Walnut Creek, Suite 2016 Arlington, Texas 76011 Mansfield, Texas 76063

MACHI & ASSOCIATES, P.C. 1521 N. Cooper, Suite 550 990 N. Walnut Creek, Suite 2016 Arlington, Texas 76011 Mansfield, Texas 76063 DATE: MACHI & ASSOCIATES, P.C. 1521 N. Cooper, Suite 550 990 N. Walnut Creek, Suite 2016 Arlington, Texas 76011 Mansfield, Texas 76063 Local 817-335-8880 Metro 972-445-5387 Toll Free 866-DEBTDRS (866-332-8377)

More information

Homeowners Insurance. Inventory your home inside and out

Homeowners Insurance. Inventory your home inside and out Homeowners Insurance Inventory your home inside and out Protecting what matters most is an important part of your financial plan Wells Fargo works with you to help you meet your financial needs and succeed

More information

Why you should complete a household inventory: Tips for completing this household inventory: Tips for completing this household inventory:

Why you should complete a household inventory: Tips for completing this household inventory: Tips for completing this household inventory: Why you should complete a household inventory: ersonal Household Inventory Form Years of experience has taught our claims representatives that it can be difficult for our customers to remember what possessions

More information

v. No. MARITAL SETTLEMENT AGREEMENT

v. No. MARITAL SETTLEMENT AGREEMENT STATE OF NEW MEXICO COUNTY OF BERNALILLO SECOND JUDICIAL DISTRICT, Petitioner, v. No., Respondent. MARITAL SETTLEMENT AGREEMENT (Husband=s name) and (Wife=s name) are married. We agree to this entire agreement.

More information

Home Inventory Worksheet

Home Inventory Worksheet www.flinsagency.com 850-994-9211 customerservice@flinsagency.com 3763 Hwy 90 Pace, FL 32571 6231 North W St, Ste 12 Pensacola, FL 320505 7250 Pine Forest Rd Pensacola, FL 32526 Home Inventory Worksheet

More information

CLIENT CHECKLIST - BANKRUPTCY

CLIENT CHECKLIST - BANKRUPTCY L A W O F F I C E of D O U G L A S L. B A R R E T T, LLC 1149 West Center Street - Orem, UT - 84057 Tel:(801) 221-9911 E-address: dbarrett@dlblaw.com CLIENT CHECKLIST - BANKRUPTCY Your next appointment

More information

PERSONAL WEALTH DEVELOPMENT QUESTIONNAIRE

PERSONAL WEALTH DEVELOPMENT QUESTIONNAIRE PERSONAL WEALTH DEVELOPMENT QUESTIONNAIRE Canby Financial Advisors, LLC 161 Worcester Road, Suite 408 Framingham, MA 01701 Phone 508-598-1082 Fax 508-598-1087 www.canbyfinancial.com Securities and some

More information

Home Inventory Worksheet

Home Inventory Worksheet T 225-293-0450 W LAinsurance.net 4606 Bluebonnet Blvd Baton Rouge, LA 70809 Home Inventory Worksheet Insurance Network of Louisiana is providing this Home Inventory Worksheet as a supplement to your Homeowners

More information

Disclosure Pursuant to 11 U.S.C. 527(a)(2)

Disclosure Pursuant to 11 U.S.C. 527(a)(2) Disclosure Pursuant to 11 U.S.C. 527(a)(2) You are notified: 1. All information that you are required to provide with a petition and thereafter during a case under the Bankruptcy Code is required to be

More information

UNITED STATES BANKRUPTCY COURT FOR THE NORTHERN DISTRICT OF OHIO BENCH BAR RETREAT OCTOBER 30, 2015 HOLIDAY INN INDEPENDENCE

UNITED STATES BANKRUPTCY COURT FOR THE NORTHERN DISTRICT OF OHIO BENCH BAR RETREAT OCTOBER 30, 2015 HOLIDAY INN INDEPENDENCE UNITED STATES BANKRUPTCY COURT FOR THE NORTHERN DISTRICT OF OHIO BENCH BAR RETREAT OCTOBER 30, 2015 HOLIDAY INN INDEPENDENCE CHAPTER 7 BEST PRACTICES PREPARING FOR THE PERFECT 341 HEARING Mary K. Whitmer,

More information

PRE-BANKRUPTCY CONSULTATION FORM

PRE-BANKRUPTCY CONSULTATION FORM TOLL FREE - 1 (888) 713-7137 PRE-BANKRUPTCY CONSULTATION FORM Personal Information Name: last first middle initial Address: Social Security No. street city zip - - Phone: Email: Marital status: single

More information

Home Inventory Worksheet

Home Inventory Worksheet T 619-283-9999 F 619-282-5484 2848 El Cajon Blvd San Diego, CA 92104 Home Inventory Worksheet California Brokerage Insurance Associates is providing this Home Inventory Worksheet as a supplement to your

More information

ALL WASHINGTON LEGAL CLINIC OF SEATTLE/EVERETT A LEGAL SERVICE PROVIDED BY:

ALL WASHINGTON LEGAL CLINIC OF SEATTLE/EVERETT A LEGAL SERVICE PROVIDED BY: ALL WASHINGTON LEGAL CLINIC OF SEATTLE/EVERETT SEATTLE OFFICE: TACOMA OFFICE EVERETT OFFICE: 212 Pioneer Building Suite 1204 Suite 602 600 First Avenue 1119 Pacific Ave. 2722 Colby Ave. Seattle, WA 98104

More information

PREPARING THE PETITION, SCHEDULES, STATEMENT OF FINANCIAL AFFAIRS, MEANS TEST (FORM 22C) AND CHAPTER 13 PLAN

PREPARING THE PETITION, SCHEDULES, STATEMENT OF FINANCIAL AFFAIRS, MEANS TEST (FORM 22C) AND CHAPTER 13 PLAN PREPARING THE PETITION, SCHEDULES, STATEMENT OF FINANCIAL AFFAIRS, MEANS TEST (FORM 22C) AND CHAPTER 13 PLAN THE PETITION Provide complete information for each debtor. Full name Any aka, dba or fdba Complete

More information

REQUEST TO INCUR DEBT Refinance Home Mortgage (Type or Print Clearly) Case No. Name(s) Day time telephone number (including area code and number)

REQUEST TO INCUR DEBT Refinance Home Mortgage (Type or Print Clearly) Case No. Name(s) Day time telephone number (including area code and number) REQUEST TO INCUR DEBT Refinance Home Mortgage (Type or Print Clearly) Case No. Name(s) Address Day time telephone number (including area code and number) I/we hereby request your approval of our incurring

More information

Names of all Co-owners w/ Address (if different)

Names of all Co-owners w/ Address (if different) Foreclosure Prevention Intake Form I. CLIENT INFORMATION Date: Name(s) Address Home Phone Work Phone Best Times to Reach Marital Status Spouse (if any) Children (names and ages) Others in Household: II.

More information

CHAPTER 123 HOUSE BILL 2325 AN ACT

CHAPTER 123 HOUSE BILL 2325 AN ACT House Engrossed State of Arizona House of Representatives Fifty-first Legislature First Regular Session CHAPTER HOUSE BILL AN ACT AMENDING SECTIONS -, -, - AND -, ARIZONA REVISED STATUTES; RELATING TO

More information

DEALING WITH CREDIT AND BANKRUPTCY. INTAKE QUESTIONNAIRE: Hiring an Attorney Bankruptcy

DEALING WITH CREDIT AND BANKRUPTCY. INTAKE QUESTIONNAIRE: Hiring an Attorney Bankruptcy DEALING WITH CREDIT AND BANKRUPTCY INTAKE QUESTIONNAIRE: Hiring an Attorney Bankruptcy A bankruptcy filing can be legally complicated, as well as time-consuming and timeintensive. In many cases, the first

More information

CAMPBELL LAW FIRM, P.A. CLIENT INFORMATION SHEET

CAMPBELL LAW FIRM, P.A. CLIENT INFORMATION SHEET CAMPBELL LAW FIRM, P.A. CLIENT INFORMATION SHEET Please provide us with the following information to help us serve you better (please print). Name: Social Security Number: Date: DOB: Address: City, State,

More information

Returning Nationals. Exemptions of Customs Duties. Personal and Household Effects

Returning Nationals. Exemptions of Customs Duties. Personal and Household Effects Returning Nationals Exemptions of Customs Duties On Personal and Household Effects 1 A Returning national is: (a) A citizen of Saint Lucia by birth, of eighteen years and above, returning to Saint Lucia

More information

Initial Data Gathering Workbook

Initial Data Gathering Workbook Initial Data Gathering Workbook Client Name: Date returned from client: / / Version 06.10 1 Overview This worksheet is designed to help you gather the required information for your customized financial

More information

Estate. Settlement. In Utah

Estate. Settlement. In Utah Estate Settlement In Utah Marc A. Austin, P.C. All rights reserved. No portion of this booklet may be reproduced without written permission. Marc A. Austin, P.C. Attorney at Law 3521 North University Avenue

More information

BANKRUPTCY QUESTIONNAIRE and DOCUMENT REQUEST. Documents due to your Trustee no later than TEN days prior to your Meeting of Creditors.

BANKRUPTCY QUESTIONNAIRE and DOCUMENT REQUEST. Documents due to your Trustee no later than TEN days prior to your Meeting of Creditors. TO: ALL DEBTOR(S) FROM: BANKRUPTCY TRUSTEE and/or UNITED STATES TRUSTEE RE: BANKRUPTCY QUESTIONNAIRE and DOCUMENT REQUEST Documents due to your Trustee no later than TEN days prior to your Meeting of Creditors.

More information

IN THE CIRCUIT COURT OF THE TWENTIETH JUDICIAL CIRCUIT ST. CLAIR COUNTY, ILLINOIS FINANCIAL STATEMENT GROSS INCOME

IN THE CIRCUIT COURT OF THE TWENTIETH JUDICIAL CIRCUIT ST. CLAIR COUNTY, ILLINOIS FINANCIAL STATEMENT GROSS INCOME IN THE CIRCUIT COURT OF THE TWENTIETH JUDICIAL CIRCUIT ST. CLAIR COUNTY, ILLINOIS IN RE THE MARRIAGE OF: and Petitioner No.: Respondent FINANCIAL STATEMENT 1 2 GROSS WAGES OR SALARY ADDITIONAL INCOME (State

More information

HOUSEHOLD INVENTORY HOME INFORMATION

HOUSEHOLD INVENTORY HOME INFORMATION HOUSEHOLD INVENTORY Name Street City & State Date Revised Insurance Co. Policy No. HOME INFORMATION Year Built Builder Square Footage Date Purchased Price Paid Previous Owners Mortgage Company Complete

More information

RYAN & GRINDE, LTD. A T T O R N E Y S A T L A W

RYAN & GRINDE, LTD. A T T O R N E Y S A T L A W RYAN & GRINDE, LTD. A T T O R N E Y S A T L A W James P. Ryan, Jr. 407 14 th Street NW (507) 282-8118 Paul H. Grinde Post Office Box 6667 (507) 282-2275 FAX Kristine L. Dicke Rochester, Minnesota 55903-6667

More information

Home Inventory Worksheet

Home Inventory Worksheet T 206-284-4886 F 206-281-8688 W www.magnolia-insurance.com 3424 W McGraw St Seattle, WA 98199 Home Inventory Worksheet Magnolia Insurance is providing this Home Inventory Worksheet as a supplement to your

More information

INSTRUCTIONS FOR BANKRUPTCY FORMS - PLEASE READ CAREFULLY!

INSTRUCTIONS FOR BANKRUPTCY FORMS - PLEASE READ CAREFULLY! NAME: BANKRUPTCY PROFESSIONAL CENTER, James O. Wyre II, Attorney at Law CHAPTER: RUSH: Y N WHY? INSTRUCTIONS FOR BANKRUPTCY FORMS - PLEASE READ CAREFULLY! YOUR CASE CANNOT BE FILED UNTIL THESE FORMS ARE

More information

From Karen Weldin Stewart, CIR-ML Delaware s Insurance Commissioner

From Karen Weldin Stewart, CIR-ML Delaware s Insurance Commissioner Make A Home Inventory From Karen Weldin Stewart, CIR-ML Delaware s Insurance Commissioner A home inventory serves two main purposes: To help you estimate the value and replacement cost of your possessions

More information

Personal Financial Planning Questionnaire

Personal Financial Planning Questionnaire Part I: Personal and Family Information 1. Your General Information Your Full Name Your Date of Birth Your Place of Birth Your State of Residency s Full Name s Date of Birth s Place of Birth s State of

More information

OFFICE: FARGO GRAND FORKS CANDO DEVILS LAKE ATTORNEY:

OFFICE: FARGO GRAND FORKS CANDO DEVILS LAKE ATTORNEY: INITIAL CONSULTATION WORKSHEET: NAME: PHONE: APPOINTMENT DATE: TIME: OFFICE: FARGO GRAND FORKS CANDO DEVILS LAKE ATTORNEY: CREDIT COUNSELING: Under the current bankruptcy law, you must go through a credit

More information

Collection Information Statement for Wage Earners and Self-Employed Individuals

Collection Information Statement for Wage Earners and Self-Employed Individuals Form 433-A (Rev. December 2012) Department of the Treasury Internal Revenue Service Collection Information Statement for Wage Earners and Self-Employed Individuals Wage Earners Complete Sections 1, 2,

More information

Designing Your Budget

Designing Your Budget 2 Designing Your Budget Budgeting is needed to get the most mileage out of your income. It is your road map for managing your money. Planning your spending is called Budgeting. Smart investing@your library

More information