TIDEWATER LAW GROUP. Client Intake. Full Name: Street Address: City: State: Zip: Mailing Address: Home Phone: Work Phone: Cell Phone: address:

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1 TIDEWATER LAW GROUP ATTORNEYS AND COUNSELORS AT LAW 468 Investors Place, Suite 202 VIRGINIA BEACH, VA (757) Telephone (757) Facsimile Seth A. Schoenfeld, Esquire John W. Tripp, Esquire Kevin D. Frank, Esquire Admitted in VA and NY Admitted in VA and GA Admitted in VA Client Intake Date: Full Name: D.O.B: SS# Street Address: City: State: Zip: Mailing Address: Home Phone: Work Phone: Cell Phone: address: Spouse s Name (if applicable): D.O.B: Phone No: Address: Mailing Address: City: State: Zip: What type of matter are you here to discuss? (Circle One) Bankruptcy Divorce Separation Agreement Custody Visitation Support Criminal Landlord / Tenant Adoption Power of Attorney Will Court Appointed Personal Injury Civil Suit Social Security Juvenile/Domestic Relation Traffic Other: Results of Conflict Check Ran:

2 Bankruptcy Questionnaire Please answer each question as completely and accurately as possible. This information will help the attorney assist you and give you excellent legal advice. If you don t know the exact answer, then guess or estimate. 1. How many cars do you have? 2. List the year/ Make/ Model of each car that you own: 3. How much do you owe (total or payoff balance) on each car? $ 4. What is your total monthly car payment (on each car)? 5. How many pieces of real estate (houses, land, etc.) do you own? 6. What is your monthly house payment or rent? $ First Mortgage payment: $ Second Mortgage payment $ 7. If you own a house, then what is the total amount you owe on it? (First and second mortgages) $ 8. How much is the city tax assessment for your house? $ 9. How much do you think your house is worth? $ 10. Is your house in foreclosure? Yes / No. How many months are you behind? 11. Do you want to keep your house? Yes / No 12. How many different creditors do you have? 13. What is your total credit card debt? (estimate) $ 14. What is you total debt? (estimate) $ 15. Do you want to do a Chapter 7 or Chapter 13 Bankruptcy? (Circle One) 16. What is your main reason for your wanting to file a bankruptcy? 17. Estimate how much you owe in each of the following categories: Child Support: $ Back Taxes: $ Student Loans: $ Mortgage Arrears: $ Furniture: $ Jewelry: $ 17. Where do you work and how much money do you make per month? $

3 Where does your spouse work and how much does your spouse make per month? $ 18. List all sources of income (including retirement, social security, subsidies, part time work, unemployment, etc.) and monthly amounts: 19. List all current garnishments on your wages or bank accounts: 20. List all Judgments or liens against you: 21. How much of a tax refund did you receive? $ 22. What did you spend it on? 23. Did you give any of your tax refund to friends or family? 24. Is this going to be Single or Joint (with your spouse) Bankruptcy? 25. Do you have any stocks, bonds, mutual funds, 401K or retirement plans or any other assets of value? 26. Have you lived in Virginia for at least two (2) full years? (circle one) YES NO 27. List all states in which you have lived in the last two (2) years: 28. List the name, age, job, income level, and your relationship to every person living in the house with you, whether or not they are related to you. Name Age Job Income Relationship

4 29. Have you transferred an asset or property out of your name in the last 2 years? If so, describe what you transferred and when. 30. How many bankruptcies have you filed (even if you did not finish then, or receive a discharge), and what were the dates that you filed them? 31. Have you taken any cash advances from credit cards over $ in the last 90 days? If so list the date, amount and credit card that you took the cash advance(s) on. 32. Have you purchased and luxury items (jewelry, furs, vacations, recreational equipment, etc.) in the last 90 days? If so, describe and date. 33. Have you purchased an automobile, boat, or mobile home (any titled vehicle) in the last 90 days? If so, list the date, make/model/year, location of purchase, and amount financed. 34. List your (and your spouse s) gross income for the last three years.

5 Required Notice to Consumer Debtor Pursuant to Code sections 11 USC 528 (a) (1), 11 USC 527(a), 11 USC 527 (b) & (c) 1. A Chapter 7 bankruptcy is referred to as the liquidation bankruptcy. Under chapter 7 bankruptcy the debtor receives a discharge for all consumer debts except most student loans, domestic obligations, taxes and fines, and debts incurred through drunk driving and fraud. A Chapter 13 bankruptcy is the referred to as the wage earners plan. In a chapter 13 bankruptcy, the debtor makes monthly payments to a trustee for a period of 3 to 5 years (in some cases more). The monthly payments paid to the trustee are then dispersed to the creditors that file proof of claims with the court. A Chapter 11 bankruptcy is referred to as business reorganization bankruptcy and is normally filed by corporations. A Chapter 12 bankruptcy is filed by farmers or fisherman. Credit counseling agencies may provide services to debtors, including payment plans, debt workouts, educational, budgeting, and credit repair training. 11 USC 528 (a)(1) and 342(b)(1). 2. A person who knowingly and fraudulently conceals assets or makes a false oath or statement under penalty of perjury in connection with a case under this title (bankruptcy) shall be subject to fine, imprisonment, or both; and all information supplied by the debtor in connection with a case under this title (bankruptcy) is subject to examination by the Attorney General. 11 USC 342 (2) (A) & (B). 3. I understand that I must complete an approved non-profit budget and credit-counseling course within six months before filing for bankruptcy. I further understand that I will NOT be granted a discharge in bankruptcy unless after filing the petition, I complete an instructional course concerning personal financial management. Credit Counseling organizations may be able to work out payment plans for me, reduce interest rates, or work out lower payments or balances for me. I may take my credit counseling courses in person at a brick and mortar location, over the telephone or Internet. 4. I understand that if I file a chapter 7, 11, or 13 bankruptcy within one year of having received a discharge in a previous bankruptcy, then the automatic stay will automatically terminate 30 days after filing the second bankruptcy. If a second repeat bankruptcy is filed within one year, then no automatic stay goes into effect. This means that creditors do not have to stop collection activity after the filing of the bankruptcy. In the case of a second or third filing, the debtor may request that the court extend the automatic stay for cause. I understand that I may not file a chapter 7 if I have filed for chapter 7 bankruptcy in the last eight (8) years. It is my responsibility to inform John W. Lee, PC of ALL previously filed bankruptcies including in the past eight (8) years. 5. Tidewater Law Group, PLLC. cannot and will not advise any debtor to incur additional debt prior to filing a bankruptcy. Any information that you receive during any consultation from any employee or attorney associated with the firm is not to be construed by you as the firm advising you to incur any additional debt. 6. I understand that I must make certain disclosures regarding my assets and financial situation. I understand that the information I provide to my attorney, in my bankruptcy petition, and attached to my petition must be complete, accurate and truthful. I must disclose all assets and liabilities, and monthly income. Failure to be complete, accurate, and truthful may result in the loss of my bankruptcy, sanctions or criminal prosecution. I further realize the US Trustee and Department of Justice may audit my bankruptcy. Information that I provide during my case may be audited and that failure to provide such information may result in dismissal of the case or other sanctions including criminal sanction. 11 USC 527 (A) & (D). 7. Tidewater Law Group is required to state that we are a debt relief agency. We help people file for bankruptcy relief under the Bankruptcy Code. under the new Bankruptcy Code. You are not required to use a licensed attorney to file a bankruptcy. You may file your own bankruptcy, or hire a person who is not licensed by the Virginia State Bar to practice law in assisting you in preparing your bankruptcy. 11 USC 528(a) (4)

6 8. You must disclose ALL of your assets and their replacement value. Replacement value is not garage or yard sale value, unless that is how you would intend to replace it. Replacement value is how much you would have to spend to replace that particular item. Replacement value is the price a retail merchant would charge for an item of like kind, age, and condition without deducting for marketing. For example, you may want to look your item up on e-bay or the Trading Post and see what other people are selling similar items for. This does not just mean that you disclose you house and car, this also means you disclose every item that you own regardless of how insignificant or inexpensive. Failure to properly list every item and value may result in you being prosecuted for bankruptcy fraud. 11 USC 527(B). 9. You must disclose your current monthly income. This means you must disclose the total amount of money that you have received from every source in the last six months. This includes money from your current job, your past job, dividends, social security, unemployment, disability, TANAF, food stamps, part time jobs, roommate income, spouses income, even if he/she is not filing bankruptcy, and any other income of any kind that you have received in the last six months. Disposable income is any money that you have left over after paying your allowed monthly expenses. In some cases, if I have too much disposable income, then I may not be eligible for a chapter 7 bankruptcy. 11 USC 527 (C) and 707 (b) (2) 10. You MUST disclose the names and addresses of ALL of your creditors, even the ones you would like to repay and non-dischargeable debts in the bankruptcy. You MUST disclose the CORRECT mailing address of each creditor. The creditor s address that should be listed in your schedules are as follows: (1) an address that the creditor has provided to you in the last two correspondence letters from the creditor; (2) if sending a notice to the debtor would violate non bankruptcy law, then any two communications to the debtor from the creditor with current account number, with requested address, such address along with account number shall be used by the debtor, (3) a creditor may file an address with the court for bankruptcy use. 11. Certain property is exempt, this means that the debtor may retain this property and the Trustee will NOT take it for liquidation. There are different sets of exemptions for every state. If you have lived in Virginia for over two years, then you qualify for Virginia s exemptions. If you have moved to Virginia within the last two years, then you may qualify for your previous state s exemptions. You may find Virginia s exemption in the Virginia Code. If you hire this firm then we will look up the exemptions for you. If you hire a non-attorney petition preparer he may not look up these exemptions for you as that is a crime for him to participate in the unauthorized practice of law. I/WE HAVE READ AND UNDERSTAND THE FORGOING NOTICES Printed Name Signature Printed Name Signature

7 IMPORTANT INFORMATION ABOUT BANKRUPTCY ASSISTANCE SERVICES FROM AN ATTORNEY OR BANKRUPTCY PETITION PREPARER. If you decide to seek bankruptcy relief, you can represent yourself, you can hire an attorney to represent you, or you can get help in some localities from a bankruptcy petition preparer who is not an attorney. THE LAW REQUIRES AN ATTORNEY OR BANKRUPTCY PETITION PREPARER TO GIVE YOU A WRITTEN CONTRACT SPECIFYING WHAT THE ATTORNEY OR BANKRUPTCY PETITION PREPARER WILL DO FOR YOU AND HOW MUCH IT WILL COST. Ask to see the contract before you hire anyone. The following information helps you understand what must be done in a routine bankruptcy case to help you evaluate how much service you need. Although bankruptcy can be complex, many cases are routine. Before filing a bankruptcy case, either you or your attorney should analyze your eligibility for different forms of debt relief available under the Bankruptcy Code and which form of relief is most likely to be beneficial for you. Be sure you understand the relief you can obtain and its limitations. To file a bankruptcy case, documents called a Petition, Schedules and Statement of Financial Affairs, as well as in some cases a Statement of Intention need to be prepared correctly and filed with the Bankruptcy Court. You will have to pay a filing fee to the bankruptcy court. Once your case starts, you will have to attend the required first meeting of creditors where you may be questioned by a court official called a trustee and by creditors. If you choose to file a Chapter 7 case, you may be asked by a creditor to reaffirm a debt. You may want help deciding whether to do so. A creditor is not permitted to coerce you into reaffirming your debts. If you choose to file a Chapter 13 case in which you repay your creditors what you can afford over 3 to 5 years, you may also want help with preparing your Chapter 13 plan and with the confirmation hearing on your plan which will be before a bankruptcy judge. If you select another type of relief under the Bankruptcy Code other than Chapter 7 or Chapter 13, you will want to find out what should be done from someone familiar with that type of relief. Your bankruptcy case may also involve litigation. You are generally permitted to represent yourself in litigation in bankruptcy court, but only attorneys, not bankruptcy petition preparers, can give you legal advice. Debtor Date Co Debtor Date VALUING ASSETS

8 You have a duty to truthfully and accurately disclose to the Court ALL of your assets and there values. The following information will assist you in determining the values of your possessions. If you fail to list, or accurately value any item, then you may loose your discharge or be imprisoned. Determining the value of Real Estate you would need to look at your city assessment used to determine your real estate taxes, and check with a realtor (CMA), or go online and see what the similar houses in your neighborhood are selling for. We have the resources to assist you in determining the value of your automobile. At your appointment provide our office with the identification number (VIN) of the car, including any options and special maintenance, and any physical damage and current mileage. Determining the value of furniture depends on the type of furniture. There are 3 classifications for furniture soft (cloth), which have a life of three years, case goods (wood) that have a life span of five to seven years, and brown goods (washer, dryer, stove) that hold an economical life of 10 years. Cloth furniture will depreciate at about 33% per year, so if you bought a cloth couch for $300, then when it was two year old, it would have deprecated by $200, so it would only be worth $ If your items are older then the life span you would base the replacement value on the age and condition of the property. Items that are considered case goods are generally made out of wood or materials used in construction. Items that are made of laminated woods and particleboard have a five-year live span, or they deprecate at rate of 20% per year. Items made of wood or a stronger construction material has a 7-year life span, or 14% per year. Therefore, if you have a laminate or particleboard desk that you purchased for $ two years ago, then it would be worth 40% less or $ now. Also, by way of example, a brown good such as a refrigerator would deprecate at a rate of 10% per year. So your refrigerator that you purchased for $1, three years ago would have deprecated by 30%, and would be worth $ today. Determining the value of clothing and jewelry, determining the value of clothing can be tricky. Value of clothing is not the value that you paid for it or the replacement value. It is the actual value in its current condition, unless it is designer labels or furs the value is normally small on clothing. Real jewelry is considered a fair trade item, which means that jewelry made of precious metals does not decline in value. If you have a question to the worth of your jewelry, you should take it to a jeweler or certified appraiser. If you have costume jewelry it may be worth much less than what you paid for it. Determining the value of electronic equipment, usually electronic equipment has a useful life of 7 years with the exception of computers, which decrease in value 50% per year for the first 3 years of useful life, leaving it with no useful value at the 4 th year. Compact discs and tapes are valued at low rates, however if the music discs or movie tapes are in good condition you should value it at the same amount it would cost to download the music or movie from the web. Your electronic equipment will deprecate at a rate of approximately 14% per year. Therefore if you purchased a VCR/DVD combo for $ four years ago, it would have deprecated by 56%, or it would be worth $ today. Determining the value of other assets, valuing such as stocks, bonds, life insurance policies, retirement accounts, and other bank accounts you would receive monthly statements regarding the assets and those would be necessary to prove the value. Debtor Signature Co-Debtor Signature Date Date