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

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1 209 W. Van Buren St Columbia City, IN Phone: Fax: JEFFREY S. ARNOLD ATTORNEY AT LAW, P.C. Toll Free: LAWS W. Jefferson Blvd. Fort Wayne, IN Phone & Fax: BANKRUPTCY PACKET CONTACT INFORMTION NAME(S): ADDRESS: HOME PHONE: CELL PHONE: WORK PHONE: ADDRESS:

2 209 W Van Buren St Columbia City, IN Phone/fax JEFFREY S. ARNOLD ATTORNEY AT LAW, P.C. Toll Free: LAWS 5612 W. Jefferson Blvd. Fort Wayne, IN Fax/phone CHECKLIST FOR FILING NEW BANKRUPTCY Chapter 7 complete Copies of Tax returns for 2013 (Federal) & 2014 (State & Federal with W-2s). Chapter 13 complete copies of Tax returns for 2013 & 2014 Last _6 Months of Pay Stubs (or report from employer listing gross pay YTD, itemized deductions and net for each pay period). From to present. Any bills, collection notices, lawsuits, repossessions not listed on credit report or already provided. Need to contain the original debts company name & address with rough amount. Credit Counseling Certificate for 1 st class (note: Certificate is only valid for 180 days) ** Please forward copies of the pdf certificate(s) to once completed. If applicable: 401k/Retirement/stocks/CDs Payroll fax # or to stop garnishments

3 PERSONAL PROPERTY For each type of property listed below, indicate whether you own any property of that category, and if you do, fill in the remaining information. For the value think of what it would cost if you had to replace it, considering the age and condition of the property. For property acquired for personal use, replacement value is the price a retail merchant would charge for property of that kind, again considering the age and condition of that property. 1 Cash on hand (wallet, purse, safe, emergency cash, etc.) value 2 Checking, savings accounts Banks name value 3 Security Deposits (utilities, landlords, etc.) value 4 Household goods (Example: beds x2, dressers x3, TVs x2, DVD player, couch, fridge, stove, washer/dryer, etc.) value

4 PROPERTY List all real estate which you own or are a joint owner, even if you still owe money on the property. H/W/ joint Address of property Fair market value 1 st Mortgage payment 2 nd Mortgage (if applicable) payment Land contract (address of owner or person/company you pay) payment Rental payment Child Support Pay or Receive (circle) Amount $ If you pay support we need their address: Name: Address: City/State/Zip Code:

5 5 Misc. home décor, collectibles, books, CDs, DVDs value 6 Clothing value 7 Jewelry, Furs, wedding bands value 8 Firearms, sports, hobby, cameras, etc. value 9 Life Insurance (with cash value, please include name of company & policy #) value 10 Annuities value 11 Educational IRAs value 12 IRAs/401Ks/403B/retirement accounts/pensions/etc. (Company who controls & value) value 13 Stocks & Bonds value 14 Interest in partnership/joint ventures value

6 15 Government & corporate bonds value 16 Accounts receivable value 17 Alimony/child support owed to you value 18 Earned Income tax refunds value 19 Equitable or future interest or life estates value 20 Licenses or franchises value 21 Automobiles, trucks, trailers, etc (make, model, market value) value 22 Boats, motors, etc (make, model, market value) value 23 Aircraft & accessories value

7 24 Office equipment, machinery, for business value 25 Inventory value 26 Animals (pets or farm) value 27 Farming equipment, farm supplies, chemicals or feed value 28 Other personal property of any kind not already listed value

8 Monthly Expenses Be as complete and accurate as possible. If two married people are filing together, both are equally responsible for supplying correct information. If more space is needed, attach another sheet to this form. Answer every question. Describe Your Household 1. Is this a joint case yes no Name of dependant Dependent s age Does dependent live with you Do you have dependents? Do your expenses include expenses of people other than yourself or your dependants? yes no No Yes No Yes No Yes No Estimate your ongoing monthly expenses as of your bankruptcy filing date Your expenses 4. The rental or home ownership expenses for you residence. Include the 1st mortgage payments and any rental for the ground or lot If not included in line 4: 4. $ 4a. Real estate taxes 4b. Property, homeowner's or renter's insurance 4c. Home maintenance, repair and upkeep expenses 4d. Homeowner's association or condo dues 4a. $ 4b. $ 4c. $ 4d. $ 5. Additional mortgage payments for your residence, such as home equity loans 5. $

9 6. Utilities: 6a. Electricity, heat, natural gas 6b. Water, sewer, garbage collection 6c. Telephone, cell phone, Internet, satellite, and cable services 6d. Other. Specify: 6a. $ 6b. $ 6c. $ 6d. $ 7. Food and housekeeping supplies 7. $ 8. Childcare and children s education costs 8. $ 9. $ 9. Clothing, laundry, and dry cleaning 10. $ 10. Personal care products and services 11. Medical and dental expenses 11. $ 12. Transportation. Include gas, maintenance, bus or train fare. Do not include car payments. 12. $ 13. Entertainment, clubs, recreation, newspapers, magazines & books 13. $ 14. Charitable contributions and religious donations 14. $ 15. Insurance. Do not include insurance deducted from your pay or included in lines 4 or a. Life insurance 15a. $ 15b. Health insurance 15b. $ 15c. Vehicle insurance 15c. $ 15d. Other insurance. Specify: 15d. $ 16. Taxes. Do not include taxes deducted from your pay or included in lines 4 or 20. Specify: 16. $ 17. Installment or lease payments: 17a. Car payments for Vehicle 1 17a. $ 17b. Car payments for Vehicle 2 17b. $ 17c. Other. Specify: 17c. $ 17d. Other. Specify: 17d. $ Your payments of alimony, maintenance, and support not included on your pay check Other payments you make to support others who do not live with you. Specify: 18. $ 19. $ 20. Other real property expenses not included in lines 4 or 5 of this form 20a. Mortgages on other property 20b. Real estate taxes 20a. $ 20c. Property, homeowner s, or renter s insurance 20b. $ 20d. Maintenance, repair, and upkeep expenses 20c. $ 20e. Homeowner s association or condominium dues 20d. $ 21. $ 21. Other: Specify: Glasses & Contacts Cigarettes School Fees (books, lunches) Child Care

10 209 W Van Buren St Columbia City, IN JEFFREY S. ARNOLD ATTORNEY AT LAW, P.C. Phone: Fax: Toll Free: LAWS 5612 W. Jefferson Blvd. Fort Wayne, IN Ж Debtor(s) Gathers Required Info From Provided Checklist + Must have at least $ of the total $ retainer paid or $ if paid in full. + Office prepares case (all checklist items are required) + Debtor completes & provides 1 st required credit counseling class or confirms counseling agency has provided certificate to our office for the debtor(s). + Debtor(s) provide any additional information required/requested that will be required to complete your petition. Ж Sign & Review Petition (appointment required) + May be required to provide additional information that may be necessary to complete your petition - After Signing + Make sure your bank accounts are below the allowed amount on the date filed. ($ single $ married) + Check your petition to ensure every creditor is listed; call immediately if any creditor is missing. Ж We Will Electronically File Your Petition w/ The Bankruptcy Court 30 Days + This will stop any collection notices or garnishments as long as they were listed on your petition. + You will receive a letter from our office stating your case # and date your petition was filed. As well as the date, time and location of your 341 hearing that you are required to attend. + Need to complete 2 nd required debtor education class utilizing your case # from the letter you received. (verify our office has received it) + Need to provide our office with a copy of your bank statements for the date your petition was filed, again utilizing the date from the letter aforementioned. + Make sure you know where, when and how to get to your hearing, again utilizing the address from the letter aforementioned. + Locate and bring your Social Security card and government issued photo I.D. to your 341 hearing (required) Ж 341 Hearing / Meeting of Creditors + Reaffirm all secured debts you want to keep. (contact these lenders if not received by now) + Verify your 2 nd class has been filed w/ the court. (please call/ us) days, on average time for your case to be discharged and closed. (chapter 7) *This is a general checklist your case may differ

11 BANKRUPTCY RETAINER AGREMENT In Consideration of legal services to be rendered by JEFFREY S. ARNOLD, Attorney at Law, P.C., Client hereby employs said counsel to represent Client in bankruptcy proceedings. The flat fee for handling your Chapter 7 case to its conclusion is $ OR $ if paid in full, up front. This includes a 3-credit bureau report, the filing fee, and attorney fees for the basic proceedings. Your petition will be filed with the Bankruptcy Court when $ is paid (Chapter 7 or Chapter 13). Full basic fee for a Chapter 12 case varies. Please see the fee disclosure form filed with the Court and discuss this with the office. ***THE REMAINDER OF FEES OWED MUST BE PAID BY THE FRIDAY BEFORE YOUR SECTION 341 HEARING OR THE ATTORNEY CANNOT COUNTINUE TO REPRESENT YOU IN THIS CASE. **** The Client understands that the funds paid in this matter will NOT be segregated and filing fees will be kept in the normal interest bearing account of attorney, along with fees paid, until paid to the court. This flat fee includes representation in a basic Chapter 7 case. This includes preparation of your initial filing paperwork (petition, schedules, and the like), representation at the Initial Meeting of Creditors, and processing reaffirmation agreements as needed and provided. The flat fee does not include representation in adversary proceedings related to the bankruptcy, representation in Motions to Dismiss proceedings, proceedings outside the normal course in a Bankruptcy, proceedings related to the conversion of Chapters, including dealings with the U.S. Trustee related to substantial abuse motions. Retainer fee for services described in this paragraph is at least $800.00, which is payable prior to our office agreeing to perform these additional services. Fees for court proceedings will be billed on an hourly basis according to the fee schedule set out below and will be billed in addition to the flat fee. You will be notified when you will be billed in this manner. Additional fees are charged on an hourly basis for proceedings in a Chapter 12 case post Chapter 13 Plan Confirmation, whether for Plan Modification or Motions to Dismiss proceedings, or any other services provided after Confirmation of the Chapter 13 Plan. Specific additional services billed on Flat fee basis are listed below as well. Hourly charges for the attorney and office staff are as follows: Jeffrey S. Arnold, Attorney Legal Assistant $ per hour $65.00 per hour

12 If the foregoing hourly rates are changed you will be given twenty (20) days written notice of the change. After such notice, and without objection, your fees will be based on the revised hourly rate. Flat Fees for the additional services are as follows: Preparation of Reaffirmation Agreement: $50.00 per Agreement Preparation of Amendment: $ added $ added Motion to Avoid Lien: $ per Lien Missed Hearing: $ Incorrect Personal Information on Filings $ Motion to Redeem Property $ initial fee If your case requires expenditures for appraisals, expert s depositions, investigations, extraordinary long distance phone calls, extraordinary photocopying or other related expenses that are advanced by this firm, your statement will reflect those expenditures. You will receive a detailed statement every month describing the legal service performed on your behalf. If expenditures are advanced by this firm, you will be expected to reimburse this firm promptly after billing. Other expenditures may require your advancement of funds before the expenditure is made, and you will be contacted accordingly. All month billings must be paid in full within Thirty (30) days of receipt, unless specific arrangements are made with this firm prior to the commencement of representation. All delinquent accounts will be charged interest at the rate of one and one half percent (1 ½%) per month (18% annual rate). You will be required to advance all court costs. NO GAURANTEES OR PROMISES REGARDING THE OUTCOME OF THIS CASE HAVE BEEN MADE BY THE ATTORNEY. IF INCORRECT INFORMATION IS GIVEN TO THE ATTORNEY OR A MEMBER OF THE OFFICE STAFF IN ORDER TO MISLEAD OR PRESENT A FALSE IMPRESSION, CLIENT ACKNOWLEDGES THAT COUNSEL HAS A DUTY TO DISCHOLSOSE THAT INFORMATION TO THE COURT AND TO CEASE REPRESENTATIN OF CLIENT. Executed this day of,. Signature of Client Signature of Client Jeffrey S. Arnold, Attorney at Law, P.C., By: Jeffrey S. Arnold, Attorney at Law (888) 600- LAWS 5297)

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