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Bankruptcy Info Form
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Attorney Profile
Contact Us
Home
About Us
Blog
Bankruptcy Info Form
Testamentary Will Questionnaire
Power of Attorney Form
Healthcare Power of Attorney/Living Will Form
Practice Areas
Bankruptcy
Bankruptcy Disclosures
Estate Planning
Agricultural Law
Attorney Profile
Contact Us
BANKRUPTCY INTAKE FORM
Name
*
First Name
Last Name
Email
*
Phone
*
(###)
###
####
What County do you live in?
*
Marital Status
*
Single
Married
If married how will you be filing?
*
Jointly
Single w/o spouse
Do you have any children?
*
Yes
No
If you do have children how much do you pay in child support per month?
What is your estimated amount of debt?
*
Below $10,000
$10,000 - $30,000
$30,000 - $50,000
$50,000 - $70,000
$70,000 +
Do you owe debt to the IRS ?
*
Yes
No
What type of bankruptcy are you interested in filing?
*
Chapter 7 (credit card/medical debt)
Chapter 13 (foreclosure)
Have you filed bankruptcy in the past eight years?
*
Yes
No
Gross Monthly Income
$
Monthly Expenses
Please do not include expenses you are trying to write-off in filing bankruptcy.
$
If you have a roommate or live in partner please only include the expenses that you pay for per month.
If you are married and filing single, please note the non-filing's spouse income and expenses must be included in your monthly income and expenses breakdown below.
Please list all of your monthly expense i.e. rent, utilities, vehicle payment/insur., vehicle maintenance/registration, gasoline, phone/internet, food, chartiable contributions, all related living expenses (per month).
To qualify for a Chapter 7 filing your gross monthly income must be lower than your monthly expenses. After adding up all of your monthly expenses does the amount exceed your income?
*
Yes
No
If you have a mortgage, are you and your spouse’s name on the mortgage and deed? If not whose name is on the deed and mortgage note?
*
Mortgage
Have you gifted any money to anyone within the past two years?
*
If so who and was it over $600? Please describe below
Have you received a personal loan from a family member or friend in the past six months?
*
Please state below if you paid the loan back and if so when was it paid back?
Date
*
MM
DD
YYYY
Have you lived in your present state less than 2 years?
*
Determine state residency.
Yes
No
Are you facing an eviction or expect to be evicted from your rental unit soon?
*
Yes
No
Thank you!
