Bankruptcy Client Intake Forms, English Version - Di Giacomo

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IMPORTANT Instructions For Filling Out Client Intake Forms Your Assets Everything you have in your possession, from the coffee pot to the house you live in (and everything in between) is an asset. Even if you still owe money to a creditor, the asset you are paying for is still in your possession and its value must be disclosed when you are filing bankruptcy. Your attorney may be able to help you estimate the value of some property, but in most cases, values can be obtained by you from current mortgage statements, receipts and even bank records. VERY IMPORTANT The extra time you spend in providing detailed answers to the questions on these Client Intake Forms will prevent your case from being delayed. If you do not provide the answers, we will need to speak with you at a later time to obtain the information anyway. So please take the time now and do not allow your case to be delayed over a few unanswered questions. Please provide COMPLETE addresses Providing the complete names and addresses for every debt you owe (as well as the company collecting for this debt [if applicable]) is extremely important. Without this crucial information, the company you owe money to may not be properly notified by the court and the debt may not be eligible for discharge. Additionally, in some instances, it can even be considered “fraud” not to provide complete mailing addresses for all creditors because it denies a creditor the right to file a Proof of Claim or Motion for Relief from Stay in a timely manner and could even delay the discharge of your bankruptcy case.

credit report may or may not contain all the addresses you need to properly complete the debt sheets. You have the right to request one FREE credit report a year online at http://www.annualcreditreport.com/. This 3-in-1 report contains addresses and other detailed information not provided in other credit reports. However to help you in locating addresses for creditors, the best place to start is to call the tollfree national information line at 1-800-555-1212 and see if a toll-free number is listed under the company’s name. If not, you may need to look in your phone directory or do an online search from Google at http://www.google.com. which we found to be the fastest method of locating current name and address information for companies. Listing the address of the original company you owe money to as well as the collection agency collecting on the debt is also just as important. By doing this, all parties concerned with the debt are notified by the court and it will greatly aide in deceasing all collection phone calls you may be currently receiving. What do you do after you have retained an attorney but the credit collectors continue to call you? Provide the credit collector with the name and telephone number of your bankruptcy attorney. If you have a case number you can provide that also. But do NOT provide any other information whatsoever. Allow your attorney to deal with the creditor. That is what you hired him or her for - to represent you. Other Tips for Filling Out the Debt Sheets:

What if you don’t know the address of the company you owe money to?

Š Make sure all company names are spelled out. (For example, instead of writing “HSB” for a company name, write out the words “Home Secure Bank” or whatever the case may be.)

If you or your attorney requested a credit report before filling out these Client Intake Forms, the

Š Make sure the street address is readable and any abbreviations are spelled out.

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Š Make sure the city, state, and ZIP are included for all addresses. If the zip code is not known, it can be obtained online: http://www.usps.com. Š Make sure all the information for each creditor is completely filled in. Every piece of this information is important in preparing a detailed bankruptcy petition for you. If you do not know the exact date you made a debt, or charged on the account, a “year” is sufficient. The “year” can also be within a 2-year time frame. Not providing dates or years will delay the processing of your petition as we must contact you to obtain the information. Š For the “last date charged on this account” line, do not provide the last date you received a statement. We are only interested in the last date you actually made a purchase using this particular charge account. Means Test Page To meet the requirement of the changes in the bankruptcy law on October 17, 2005 - you are now required to pass a Means Test to determine if you are eligible to file a Chapter 7 or 13. In order to make this determination, the court requires that you provide the amount of income you earned for the last 6 months. Even if your income has drastically increased or decreased recently, the amount of income you received is still disclosed on the Means Test. This information may or may not be the same for the form named “Income History for You Page” (see below.) Income History for You An often overlooked piece of vital information we need on the Income History for You form is your year-to-date income, plus the income you made in the last 2 years. This question appears right below your name on the form page. Your year-todate income should appear on your recent paycheck stub. However, if you have had more than one employer this year, you will need to provide us with the TOTAL amount of income you made working for ALL employers. In addition, if you also receive (or have received) another type of income (child support, unemployment, social security, pension, etc.) within the past 2 years, turn the page over (or use an

additional sheet of paper) and provide the income for this year and the last 2 years for each separate type of income. Social security income is not considered to be income under the bankruptcy law but your attorney still needs to have this information available in your file for reference purposes. Statement of Affairs Form Make sure that every box is answered with either a “yes” or “no” on the Statement of Affairs forms within this package. These pages serve as a written statement concerning your current financial condition. If a box is left unanswered, you will need to provide a written statement that specifically answers this question before your petition can be finalized. Please double-check and make sure you have answered every question on the form pages titled “Statement of Affairs.” In addition, if any question on the Statement of Affairs forms is answered “yes,” it is extremely important that you fill in all the required information under the question you checked “yes” to. For instance, some people check “yes” to the item on the Statement of Affairs referring to previous addresses; however, they do not include the city, state and zip code of the address they lived at. Or, if a car has been repossessed, don’t just call it a “car” but provide the make, model and year. It is important for you to be as detailed as possible when answering any question “yes.” Also, if you run out of room, turn the paper over and write on the back. The higher level of detail you provide at this initial stage will greatly aide in moving your case along at a fast pace and prevent long delays and additional paperwork later down the road. Motor Vehicles Please remember to ALWAYS provide the make, model and year of your motor vehicle. We must obtain market values of all motor vehicles from the Blue or Black Book for the bankruptcy court. We need all the information on the vehicle, including the present mileage to obtain the correct market value. Example: 2001 Kia should be 2001 Kia Rio, or 2001 Kia Spectra, or whatever the case may be. Simply writing the word “car”

These Client Intake Forms were developed and distributed by http://www.713training.com

does not tell us anything and delays the filing of your bankruptcy petition.

Š Š

Court Documents

Š

If you have been involved in a court proceeding of any type within the past 12 months, including a foreclosure, wage garnishment, traffic tickets, other fines, lawsuits, judgments for debt collection, etc. -- we need to know the following information, which can be obtained directly from the court pleading you received in the mail:

Š

Š Š Š Š Š Š

Court Heading -- (example: John Doe, Plaintiff -vs- Jane Doe, Defendant) Case Number Name and address of court where document was filed Date document was filed with the court Names and complete addresses of any attorneys or parties involved with the case (including the Plaintiff) Current status -- Has a hearing already taken place? If so, what was the result? If the hearing has not taken place and a decision has not been reached yet, provide the date of the court hearing and let us know if the case is still “pending.”

How many months the contract is for; How much you pay per month (installment payment); If you want to continue paying the contract or not assume the lease; and Any details about this contract (lease).

Summary Thank you for taking the time to read these important instructions before filling out the Client Intake Forms. We understand that filing bankruptcy is not something people enjoy doing. In fact, we know this is a stressful time in your life. However, we want to make the experience as easy as possible. The only way we can do this is to obtain all the information that is needed for the attorney to represent you in court. Thank you for taking the extra steps necessary to help us make this time in your life a little less stressful. And please do not hesitate to call our office if we can assist you in any way. We sincerely hope you are happy with our law firm and will want to recommend us to others.

Famous People who filed bankruptcy: You may find it easier to simply make a copy of the court document and include it with your Client Intake Forms when you return them to your attorney. If you no longer have a copy of the court pleading that provides this information, you may be able to go online and get a copy. Go to a search engine like Google at http://www.google.com. Type in a search for your county (example: Franklin County Ohio). If your county is online, you can normally do a simple search by your last name and locate public records that may be helpful in locating the information needed for your bankruptcy petition. Contracts Contracts you have may include cell phones, a lease for an automobile or even a contract you entered into with another party to pay back a debt. Be sure to provide the following: Š

1871 - Phineas Taylor Barnum (Barnum and Bailey’s Circus) 1872 - Mathew Brady (famous photographer) 1875 - Henry John Heinz (Heinz catsup developer) 1884 - Henry Ford (automobile manufacturer) 1892 - Milton Snavely Hershey (Hershey chocolate) 1894 - Mark Twain (famous writer) 1962 - Mickey Rooney (famous actor) 1988 - Jerry Lee Lewis (famous singer) 1991 - Johnny Unitas (famous quarterback) 1992 - Debbie Reynolds (famouse actress) 1992 - Wayne Newton (famous singer) 1993 - Kim Basinger (famous actress) 1996 - Burt Reynolds (famous actor) 1996 - MC Hammer (famous singer) 1999 - Sherman Hemsley (George Jefferson on the hit 1970s TV show) 2000 - Marjorie Margolies Mezvinsky (U.S. House of Representatives) * Online Source: Thomson-West, an article by Laura J. Margulies of Laura J. Margulies & Associates LLC

The date or year the contract began; These Client Intake Forms were developed and distributed by http://www.713training.com

GENERAL INFORMATION 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 applicable.”) The more information you provide in these forms, the faster your bankruptcy petition can be prepared. There will be a delay if we need to verify or obtain more information concerning a specific asset, debt or creditor; so please provide as much detail as you can and fill in ALL the information requested on these forms. Thank you for taking the time to be thorough and complete, resulting in faster turnaround.

Name, First

Middle (spell out)

Social Security Number

Last

Date of Birth

Street Address City

State

County of Residence

Length of Time at This Address

Home Phone

Zip

Other Phone

Email address MAILING ADDRESS - If you would like any correspondence by the bankruptcy court to be sent to a different mailing address than the physical address you provided above (i.e, PO Box, etc.), please provide that address below:

INFORMATION ABOUT YOUR SPOUSE SPOUSE, First Name

Middle (spell out)

Social Security Number

Last

Date of Birth

Address (if living separately) City

State

Have you resided in the same county for at least 180 days (6 months)?

Zip † Yes

† No

† Yes

† No

If not, where have you resided? Are you filing this bankruptcy petition with your spouse? If “no” please check one:

† Unmarried † Spouse filing separately † Other Reason

Have you filed bankruptcy within the last eight (8) years?

† Yes

If “yes” provide date(s): Have you met the Debt Counseling requirement for your state? Please check one of the choices below: † Counseling not completed † Received counseling within the past 180 days † Request waiver † Does not apply to my district These Client Intake Forms were developed and distributed by http://www.713training.com

† No

GENERAL INFORMATION (continued) † Check this box if you are a disabled veteran with debts incurred primarily during active duty or homeland defense.

DEPENDENTS Name

Age

Relationship to You

Is this person/child living with you?

1.

†YES

†NO

2.

†YES

†NO

3.

†YES

†NO

4.

†YES

†NO

OTHER INFORMATION † Yes

Has either you or your spouse been known by any other name during the past 8 years? (Example: maiden name, last name from previous marriage, legal name change, etc.) If yes, write the NAME KNOWN AS and DATE(S) THIS NAME WAS USED below: Name Used

Dates Used

thru

Name Used

Dates Used

thru

† No

Has your income significantly increased or decreased during the past six (6) months? If so, please provide details below:

CREDIT COUNSELING The bankruptcy code requires that you obtain a Credit Counseling Certificate before you file bankruptcy. If not directed by your attorney, you can complete this requirement online at http://yourbankruptcypartner.com/ These Client Intake Forms were developed and distributed by http://www.713training.com

NOTICE: IF YOU OWN A MOBILE HOME, PLEASE FILL OUT NEXT PAGE

YOUR REAL ESTATE

† Check this box if you have a homestead exemption that exceeds $125,000.00 PRINT OUT ADDITIONAL PAGES FOR EVERY SEPARATE PIECE OF REAL ESTATE THAT YOU OWN. Check the type of real estate you own: † House † Condominium † Vacant Lot

† Other

Name(s) on Deed Address of Real Estate Description of Real Estate: (example: 1,250 square foot home with 2 bedrooms, 2 baths, attached 2-car garage situated on 2 acres of ground with outbuildings.) Name of Mortgage Company Address City

State

Account Number

Date obtained this mortgage?

What are the monthly payments? $

Zip

What is the pay-off amount on this mortgage?

$

Are you behind in payments? † YES † NO If so, what months? What interest rate do you pay?

%

What year was your real estate last appraised?

Amount to catch up back payments?

$

What was the appraised value?

Do you have a second mortgage on the real estate? † YES † NO

$

Intention: † KEEP † SURRENDER

SECOND MORTGAGE INFORMATION (IF APPLICABLE) Name of Mortgage Company Address City

State

Account Number

Date obtained this mortgage?

What are the monthly payments? $

Zip

What is the pay-off amount on this mortgage? $

Are you behind in payments? † YES † NO If so, what months? What interest rate do you pay?

%

Amount to catch up back payments?

$

COLLECTION INFORMATION (IF APPLICABLE) Name of Collector or Attorney Address City

State

Is this real estate in the process of foreclosure or replevin action? † YES

Zip † NO

If in collection, please provide a copy of the court documents you were served. These Client Intake Forms were developed and distributed by http://www.713training.com

† Check this box if you have a homestead exemption that exceeds $125,000.00

YOUR MOBILE HOME

PRINT OUT ADDITIONAL PAGES FOR EVERY MOBILE HOMES THAT YOU OWN. Name(s) on Title Address of Mobile Home Are the wheels completely removed from your mobile home and it is attached to the ground? † YES † NO Does your mobile home sit in a mobile home park? † YES † NO What is the monthly lot rent?

$

Does your mobile home sit on a piece of ground you own? † YES † NO Size of ground Do you make separate payments for the ground your mobile home sits on? If so, explain: If you own the ground free and clear, what is the resell value for this piece of ground? Description of Mobile Home: (example: 28x40 doublewide, 2 bedrooms, 1 bath, on wheels with skirting and steps and 1 outbuilding shed, situated in mobile home park.) Name of Mortgage Company Address City

State

Zip

Account Number

Date obtained this mortgage? What is the pay-off amount on this mortgage? $

What are the monthly payments? $

Are you behind in payments? † YES † NO If so, what months? What interest rate do you pay?

%

Amount to catch up back payments?

What year was your mobile home last appraised?

$

What was the appraised value?

Do you have a second mortgage on this mobile home? † YES

$

† NO

SECOND MORTGAGE INFORMATION (IF APPLICABLE) Name of Mortgage Company Address City

State

Account Number

Date obtained this mortgage?

What are the monthly payments? $

Zip

What is the pay-off amount on this mortgage? $

Are you behind in payments? † YES † NO If so, what months? What interest rate do you pay?

%

Amount to catch up back payments?

$

COLLECTION INFORMATION (IF APPLICABLE) Name of Collector or Attorney Address City

State

Zip

If in collection, please provide a copy of the court documents you were served. These Client Intake Forms were developed and distributed by http://www.713training.com

YOUR HOUSEHOLD INVENTORY Please check the items below that you currently have in your home. Then, provide the YARD SALE VALUE of each item -NOT the replacement cost.

Yard Sale Value † † † † † † † † † † † † † † †

† † † † †

† † † † †

† † † †

Stove/Cooking Unit $ ________________ Refrigerator $ ________________ Washer/Dryer $ ________________ Microwave $ ________________ Cooking Utensils $ ________________ Silverware/Flatware $ ________________ Cookware (Pots/Pans) $ ________________ Living Room Furniture $ ________________ Dining Room Furniture $ ________________ Tables and Chairs $ ________________ Televisions(s) $ ________________ VCR(s) $ ________________ DVD(s) $ ________________ Compact Disks $ ________________ All Other Stereo Equipment $ ________________ Describe item(s): __________________________ ________________________________________ Bedroom Furniture $ ________________ Dressers/Nightstands $ ________________ Lamps and Accessories $ ________________ Wedding Rings $ ________________ Other Jewelry/Watches $ ________________ Describe item(s): __________________________ ________________________________________ Furs $ ________________ Computer(s) $ ________________ Computer Printers $ ________________ Desks/Office Furniture $ ________________ Other Computer Equipment $ ________________ Describe item(s): __________________________ ________________________________________ Photography Equipment $ ________________ Satellite Disks $ ________________ All Clothing $ ________________ (including shoes, coats, hats, etc.) Collectibles $ ________________ Describe item(s): __________________________

† Paintings/Art $ ________________ Describe item(s): __________________________ ________________________________________ † Carpenters Tools $ ________________ Describe item(s): __________________________ ________________________________________ † Mechanics Tools $ ________________ Describe item(s): __________________________ ________________________________________ † Guns and Firearms $ ________________ Describe item(s): __________________________ ________________________________________ † Lawnmower $ ________________ † Boats $ ________________ † Trailers $ ________________ † Campers $ ________________ † Yard Tools/Equipment $ ________________ † Swimming Pool $ ________________ † Cell Phones $ ________________

†

† † † † † † † † † † † † † †

OTHER ASSETS Rent deposit with landlord $ ________________ Name of Landlord _________________________ Address _________________________________ City _____________State _____ Zip __________ Government Bonds $ ________________ Certificate of Deposits $ ________________ Copyrights/Patents $ ________________ Aircraft $ ________________ Interests in education IRA $ ________________ Customer lists $ ________________ ____________________ $ ________________ ____________________ $ ________________ ____________________ $ ________________ ____________________ $ ________________ ____________________ $ ________________ ____________________ $ ________________ ____________________ $ ________________ ____________________ $ ________________

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YOUR MOTOR VEHICLES Motor vehicles include cars, trucks, SUV’s, motorcycles, mobile homes, boats, trailers, campers, etc. that are TITLED IN YOU (OR YOUR SPOUSE’S NAME) Print out more sheets if you own more than 2 vehicles. Type: † Automobile Year

† Truck

† Motorcycle

Make

† Mobile Home (Title Only)

Model

Condition † Excellent

† Good

† Fair

† Poor

† Other: † 2dr † 4dr † Other

Style † Not Running

Mileage

Name(s) on vehicle title? Is vehicle leased? † YES † NO If yes, what is the “buy out” on the lease? Name of company you make payments to for this vehicle: Address City

State

Account Number

Date Established Loan

Monthly Payment

$

Zip

How many months are you behind in payments?

What is the “pay off” amount on this vehicle?

Check one: † Keep

$

† Surrender

† YES † NO

Have you went to a loan company and listed this vehicle as collateral for a personal loan? If so, name of loan company for personal loan:

Type: † Automobile Year

† Truck

† Motorcycle

Make

Condition † Excellent

† Mobile Home (Title Only)

Model † Good

† Fair

† Poor

† Other: † 2dr † 4dr † Other

Style † Not Running

Mileage

Name(s) on vehicle title? Is vehicle leased? † YES † NO If yes, what is the “buy out” on the lease? Name of company you make payments to for this vehicle: Address City

State

Account Number

Date Established Loan

Monthly Payment

$

Zip

How many months are you behind in payments?

What is the “pay off” amount on this vehicle?

$

Check one: † Keep

Have you went to a loan company and listed this vehicle as collateral for a personal loan?

† Surrender

† YES † NO

If so, name of loan company for personal loan:

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DEBT SHEET 1 OF 5 z PRINT OUT MORE PAGES IF YOU HAVE MORE THAN 15 TOTAL DEBTS. z DO NOT JUST LIST DEBTS YOU WANT TO INCLUDE -- BUT EVERY DEBT YOU OWE, EVEN LOAN FROM RELATIVES Name of Creditor Address City

State

Total amount you owe on this debt

Account No:

Zip

Date (or year) you originally obtained this debt or established credit: If this debt is for a credit card, what date (or year) did you last make a purchase? What is this debt for? † Medical † Credit Card † Loan † Other Who is financially responsible for this debt? † HUSBAND † WIFE † BOTH † OTHER Has this debt been turned over to a collection agency?

† YES

† NO

Name of collection agency or law firm Address City

State

Zip

City

State

Zip

Total amount you owe on this debt

Account No:

Name of Creditor Address

Date (or year) you originally obtained this debt or established credit: If this debt is for a credit card, what date (or year) did you last make a purchase? What is this debt for? † Medical † Credit Card † Loan † Other Who is financially responsible for this debt? † HUSBAND † WIFE † BOTH † OTHER Has this debt been turned over to a collection agency?

† YES

† NO

Name of collection agency or law firm Address City

State

Zip

City

State

Zip

Total amount you owe on this debt

Account No:

Name of Creditor Address

Date (or year) you originally obtained this debt or established credit: If this debt is for a credit card, what date (or year) did you last make a purchase? What is this debt for? † Medical † Credit Card † Loan † Other Who is financially responsible for this debt? † HUSBAND † WIFE † BOTH † OTHER Has this debt been turned over to a collection agency? † YES † NO Name of collection agency or law firm Address City

State

Zip

These Client Intake Forms were developed and distributed by http://www.713training.com

DEBT SHEET 2 OF 5 z PRINT OUT MORE PAGES IF YOU HAVE MORE THAN 15 TOTAL DEBTS. z DO NOT JUST LIST DEBTS YOU WANT TO INCLUDE -- BUT EVERY DEBT YOU OWE, EVEN LOAN FROM RELATIVES Name of Creditor Address City

State

Total amount you owe on this debt

Account No:

Zip

Date (or year) you originally obtained this debt or established credit: If this debt is for a credit card, what date (or year) did you last make a purchase? What is this debt for? † Medical † Credit Card † Loan † Other Who is financially responsible for this debt? † HUSBAND † WIFE † BOTH † OTHER Has this debt been turned over to a collection agency?

† YES

† NO

Name of collection agency or law firm Address City

State

Zip

City

State

Zip

Total amount you owe on this debt

Account No:

Name of Creditor Address

Date (or year) you originally obtained this debt or established credit: If this debt is for a credit card, what date (or year) did you last make a purchase? What is this debt for? † Medical † Credit Card † Loan † Other Who is financially responsible for this debt? † HUSBAND † WIFE † BOTH † OTHER Has this debt been turned over to a collection agency?

† YES

† NO

Name of collection agency or law firm Address City

State

Zip

City

State

Zip

Total amount you owe on this debt

Account No:

Name of Creditor Address

Date (or year) you originally obtained this debt or established credit: If this debt is for a credit card, what date (or year) did you last make a purchase? What is this debt for? † Medical † Credit Card † Loan † Other Who is financially responsible for this debt? † HUSBAND † WIFE † BOTH † OTHER Has this debt been turned over to a collection agency? † YES † NO Name of collection agency or law firm Address City

State

Zip

These Client Intake Forms were developed and distributed by http://www.713training.com

DEBT SHEET 3 OF 5 z PRINT OUT MORE PAGES IF YOU HAVE MORE THAN 15 TOTAL DEBTS. z DO NOT JUST LIST DEBTS YOU WANT TO INCLUDE -- BUT EVERY DEBT YOU OWE, EVEN LOAN FROM RELATIVES Name of Creditor Address City

State

Total amount you owe on this debt

Account No:

Zip

Date (or year) you originally obtained this debt or established credit: If this debt is for a credit card, what date (or year) did you last make a purchase? What is this debt for? † Medical † Credit Card † Loan † Other Who is financially responsible for this debt? † HUSBAND † WIFE † BOTH † OTHER Has this debt been turned over to a collection agency?

† YES

† NO

Name of collection agency or law firm Address City

State

Zip

City

State

Zip

Total amount you owe on this debt

Account No:

Name of Creditor Address

Date (or year) you originally obtained this debt or established credit: If this debt is for a credit card, what date (or year) did you last make a purchase? What is this debt for? † Medical † Credit Card † Loan † Other Who is financially responsible for this debt? † HUSBAND † WIFE † BOTH † OTHER Has this debt been turned over to a collection agency?

† YES

† NO

Name of collection agency or law firm Address City

State

Zip

City

State

Zip

Total amount you owe on this debt

Account No:

Name of Creditor Address

Date (or year) you originally obtained this debt or established credit: If this debt is for a credit card, what date (or year) did you last make a purchase? What is this debt for? † Medical † Credit Card † Loan † Other Who is financially responsible for this debt? † HUSBAND † WIFE † BOTH † OTHER Has this debt been turned over to a collection agency? † YES † NO Name of collection agency or law firm Address City

State

Zip

These Client Intake Forms were developed and distributed by http://www.713training.com

DEBT SHEET 4 OF 5 z PRINT OUT MORE PAGES IF YOU HAVE MORE THAN 15 TOTAL DEBTS. z DO NOT JUST LIST DEBTS YOU WANT TO INCLUDE -- BUT EVERY DEBT YOU OWE, EVEN LOAN FROM RELATIVES Name of Creditor Address City

State

Total amount you owe on this debt

Account No:

Zip

Date (or year) you originally obtained this debt or established credit: If this debt is for a credit card, what date (or year) did you last make a purchase? What is this debt for? † Medical † Credit Card † Loan † Other Who is financially responsible for this debt? † HUSBAND † WIFE † BOTH † OTHER Has this debt been turned over to a collection agency?

† YES

† NO

Name of collection agency or law firm Address City

State

Zip

City

State

Zip

Total amount you owe on this debt

Account No:

Name of Creditor Address

Date (or year) you originally obtained this debt or established credit: If this debt is for a credit card, what date (or year) did you last make a purchase? What is this debt for? † Medical † Credit Card † Loan † Other Who is financially responsible for this debt? † HUSBAND † WIFE † BOTH † OTHER Has this debt been turned over to a collection agency?

† YES

† NO

Name of collection agency or law firm Address City

State

Zip

City

State

Zip

Total amount you owe on this debt

Account No:

Name of Creditor Address

Date (or year) you originally obtained this debt or established credit: If this debt is for a credit card, what date (or year) did you last make a purchase? What is this debt for? † Medical † Credit Card † Loan † Other Who is financially responsible for this debt? † HUSBAND † WIFE † BOTH † OTHER Has this debt been turned over to a collection agency? † YES † NO Name of collection agency or law firm Address City

State

Zip

These Client Intake Forms were developed and distributed by http://www.713training.com

DEBT SHEET 5 OF 5 z PRINT OUT MORE PAGES IF YOU HAVE MORE THAN 15 TOTAL DEBTS. z DO NOT JUST LIST DEBTS YOU WANT TO INCLUDE -- BUT EVERY DEBT YOU OWE, EVEN LOAN FROM RELATIVES Name of Creditor Address City

State

Total amount you owe on this debt

Account No:

Zip

Date (or year) you originally obtained this debt or established credit: If this debt is for a credit card, what date (or year) did you last make a purchase? What is this debt for? † Medical † Credit Card † Loan † Other Who is financially responsible for this debt? † HUSBAND † WIFE † BOTH † OTHER Has this debt been turned over to a collection agency?

† YES

† NO

Name of collection agency or law firm Address City

State

Zip

City

State

Zip

Total amount you owe on this debt

Account No:

Name of Creditor Address

Date (or year) you originally obtained this debt or established credit: If this debt is for a credit card, what date (or year) did you last make a purchase? What is this debt for? † Medical † Credit Card † Loan † Other Who is financially responsible for this debt? † HUSBAND † WIFE † BOTH † OTHER Has this debt been turned over to a collection agency?

† YES

† NO

Name of collection agency or law firm Address City

State

Zip

City

State

Zip

Total amount you owe on this debt

Account No:

Name of Creditor Address

Date (or year) you originally obtained this debt or established credit: If this debt is for a credit card, what date (or year) did you last make a purchase? What is this debt for? † Medical † Credit Card † Loan † Other Who is financially responsible for this debt? † HUSBAND † WIFE † BOTH † OTHER Has this debt been turned over to a collection agency? † YES † NO Name of collection agency or law firm Address City

State

Zip

These Client Intake Forms were developed and distributed by http://www.713training.com

INCOME HISTORY FOR YOU Your Name as listed on your current paycheck stub: Year-to-Date Total for this current year? VERY IMPORTANT:

Gross Income last year

Gross Income 2 Yrs Ago

Employer’s Name Address City, State, Zip Telephone Number Length of Time at This Job?

Years

Months

Job Title (do not abbreviate) How often do you get paid? (circle or check one) † every week

† bi-weekly (sometimes I get paid 3 times a month

† once a month

† semi-monthly (on the same 2 days of each month) What is your “average” gross wages before deductions? How much “average” extra money do you receive in overtime and commissions per pay period? What is the total amount of taxes deducted (FICA, Federal, State, Local) from your paycheck? How much Insurance is deducted from your paycheck?

How much in Union Dues? Are you court ordered to pay this?† YES † NO

How much do you pay in Alimony or Child Support if any? Are there any other deductions from your paycheck?

† YES † NO If yes, how much?

What is this “other” deduction for?

If 401K Plan, how long have you participated?

How much additional income do you make monthly from a business, flea market, etc? Monthly Income from real property (rentals)

Monthly Interests and Dividends

Monthly Alimony or Child Support received

Monthly Social Security

Monthly Government Assistance

Monthly Food Stamps

Monthly Public Assistance

Monthly Pension or Retirement

Other Income (Reason and amount received monthly)?

Do you have a second job?

† YES

† NO

If yes, name of employer:

Address City, State, Zip Telephone Number Length of Time at This Job?

Job Title

How often do you get paid? (check one) † every week

† bi-weekly (sometimes I get paid 3 times a month

† once a month

† semi-monthly (on the same 2 days of each month) What is your “average” gross wages before deductions? Do you receive any income from a home-based business?

† YES

† NO

How much per month?

These Client Intake Forms were developed and distributed by http://www.713training.com

INCOME HISTORY FOR YOUR SPOUSE Your Name as listed on your current paycheck stub: Year-to-Date Total for this current year? VERY IMPORTANT:

Gross Income last year

Gross Income 2 Yrs Ago

Employer’s Name Address City, State, Zip Telephone Number Length of Time at This Job?

Years

Months

Job Title (do not abbreviate) How often do you get paid? (circle or check one) † every week

† bi-weekly (sometimes I get paid 3 times a month

† once a month

† semi-monthly (on the same 2 days of each month) What is your “average” gross wages before deductions? How much “average” extra money do you receive in overtime and commissions per pay period? What is the total amount of taxes deducted (FICA, Federal, State, Local) from your paycheck? How much Insurance is deducted from your paycheck?

How much in Union Dues? Are you court ordered to pay this?† YES † NO

How much do you pay in Alimony or Child Support if any? Are there any other deductions from your paycheck?

† YES † NO If yes, how much?

What is this “other” deduction for?

If 401K Plan, how long have you participated?

How much additional income do you make monthly from a business, flea market, etc? Monthly Income from real property (rentals)

Monthly Interests and Dividends

Monthly Alimony or Child Support received

Monthly Social Security

Monthly Government Assistance

Monthly Food Stamps

Monthly Public Assistance

Monthly Pension or Retirement

Other Income (Reason and amount received monthly)?

Do you have a second job?

† YES

† NO

If yes, name of employer:

Address City, State, Zip Telephone Number Length of Time at This Job?

Job Title

How often do you get paid? (check one) † every week

† bi-weekly (sometimes I get paid 3 times a month

† once a month

† semi-monthly (on the same 2 days of each month) What is your “average” gross wages before deductions? Do you receive any income from a home-based business?

† YES

† NO

How much per month?

These Client Intake Forms were developed and distributed by http://www.713training.com

BUSINESS OWNERS If you have been self-employed during the past 12 months, please list below the normal income and expenses your business generated for an average month. If you did not have an average monthly income due to extreme highs and lows in your business, estimate your total yearly income and divide by 12 to get the average monthly income. Use the same method of determining your average monthly expenses and enter those figures into the spaces below: Average monthly business income

$

Did you withhold any earnings for tax purposes? † Yes † No If yes, how much did you withhold monthly?

$

Average monthly business expenses (if applicable) Rent and utilities

$

Office Supplies

$

Product Supplies

$

Wages

$

Equipment Leases

$

Other Business Leases

$

Other

$

Other

$

Other

$

Other

$

Other

$

Other

$

Other

$

Other

$

Total Average Monthly Income

$

Total Average Monthly Expenses

$

Average Monthly Business Profit

$

Did you file income taxes for the years you operated your business? † Yes † No If not, what years did you NOT file taxes? These Client Intake Forms were developed and distributed by http://www.713training.com

MONTHLY BUDGET This form is necessary to determine how much you spend each month on living expenses. Be sure to write in the MONTHLY (not yearly) amounts in the spaces below each expenditure. For utilities, your bill may be higher in the winter than in the summer, so write an amount that is “average” covering the whole 12 month period. Housing Expenses

Taxes Are any other taxes deducted from your wages? If so, what type of taxes are they? $_________

Rent (if you do not own your home) First Mortgage payment or mobile home monthly payment

$_________

Second mortgage (if applicable)

$_________

Other Expenses

Third mortgage (if applicable)

$_________

$_________

Lot Payment (if applicable) Are real estate taxes included in your mortgage payment? † Yes

$_________

Alimony or Child Support Payments for someone outside your home

† No

Union Dues (not payroll deducted)

$_________

$_________

Professional Dues (not payroll deducted) $_________

Taxes not included in house payment Is your home insurance included in

$_________

$_________

Child Care Expenses

$_________

Babysitter/Day Care Expenses

$_________

Insurance not included in house payment $_________

School Expenses

$_________

Utilities (Normal Monthly Average)

School Lunch Expenses

$_________

your mortgage payment?

† Yes

† No

Electricity and Gas

$_________

College Tuition (Not Loans)

$_________

Water

$_________

Student Loan Repayment

$_________

Telephone (Basic Service)

$_________

Newspapers, Books, Magazines

$_________

Trash Pick-Up

$_________

Personal Care Items

$_________

Other

$_________

Other

$_________

Basic Needs Home Maintenance (home owners)

$_________

Food (Monthly)

$_________

Clothing (Monthly Expense)

$_________

Laundry, dry cleaning, soap, etc.

$_________

Medical expenses not paid by insurance

$_________

Use the space below to describe any additional monthly expenses that you must pay out of your pocket that are not covered here. Explain the type of expense, amount of expense and how long you will continue to have this expense:

Transportation Gasoline/auto maintenance

$_________

Recreation, Entertainment

$_________

Charitable Giving (if claimed on taxes)

$_________

Insurance Renters Insurance

$_________

Life Insurance (other than employer)

$_________

Health Insurance (other than employer)

$_________

Automobile Insurance

$_________

Other Insurance

$_________

These Client Intake Forms were developed and distributed by http://www.713training.com

STATEMENT OF AFFAIRS (1 of 11) The following pages contain extremely IMPORTANT QUESTIONS, many of which will be asked you again by the Trustee when you attend your first hearing. Please take your time and go through every question thoroughly and provide as much detail as possible to the questions you answer “yes” to. List the names of all spouses (past and present) that you have been married to, as well as the dates you were married to this spouse: Full Name (First, Middle, Last) Dates Married:

From

To

Full Name (First, Middle, Last) Dates Married:

From

To

Full Name (First, Middle, Last) Dates Married:

From

To

Full Name (First, Middle, Last) Dates Married:

From

To

Have you ever provided a notice to any governmental unit of a † Yes † No Release of Hazardous Materials? If so, list the name and address of every site for which you have provided notice to a governmental unit of a release of Hazardous Material. Indicate the governmental unit to which the notice was sent and the date of the notice. Name/Address of Site Governmental Unit Notice Sent To Date Notice Sent to Governmental Unit Do you share the ownership of any real property with another person, such as a co-tenancy or joint tenancy? (This does not apply to your spouse.) Name of person

† Yes

† No

Do you have a future interest in any real estate, such as putting money down on a property you have not purchased yet? If so, provide details:

† Yes

† No

† Yes

† No

† Yes

† No

Do you own or are you buying a time-share in a vacation property or resort? If so, provide details: Do you have a car, truck, motorcycle, boat or camper in your possession titled in someone else’s name? Year, Make, Model of Vehicle Whose name is the motor vehicle titled to? Address City

State

Zip

What is this person’s relationship to you? Why are you holding this property?

These Client Intake Forms were developed and distributed by http://www.713training.com

STATEMENT OF AFFAIRS (2 of 11) Are you buying any of your furniture or appliances with installment payments?

† Yes

† No

† Yes

† No

† Yes

† No

† Yes

† No

† Yes

† No

Description of Item(s) 1.

Yard Sale Value

2.

Yard Sale Value

3.

Yard Sale Value

Name of company you make installment payments to: ** MAKE SURE TO LIST THESE DEBTS ON THE DEBT SHEETS.

Are you renting-to-own any of your furniture or appliances? Description of Item(s) 1.

Yard Sale Value

2.

Yard Sale Value

3.

Yard Sale Value

Name of company you make installment payments to: ** MAKE SURE TO LIST THES DEBTS ON THE DEBT SHEETS. Have you gone to a loan company or bank and listed any of your furniture, appliances or personal possessions at the time you obtained the loan? Description of Item(s) 1.

Yard Sale Value

2.

Yard Sale Value

3.

Yard Sale Value

Name of company you make installment payments to: ** MAKE SURE TO LIST THES DEBTS ON THE DEBT SHEETS.

Do you own or are you buying any tools or equipment that you use for your work? Description of Item(s): Value of the item if sold at a flea market or yard sale: If making payments on, who do you pay? ** MAKE SURE TO LIST THESE DEBTS ON THE DEBT SHEETS At present, do you have any inventory (stock in trade) that could be sold for $200 or more in profit? Description of Item(s) Value of the item if sold at a flea market or yard sale

These Client Intake Forms were developed and distributed by http://www.713training.com

STATEMENT OF AFFAIRS (3 of 11) Are you buying any jewelry with installment payments?

† Yes

† No

† Yes

† No

† Yes

† No

† Yes

† No

Description of Item(s) 1.

Yard Sale Value

2.

Yard Sale Value

3.

Yard Sale Value

Name of company you make installment payments to: ** MAKE SURE TO LIST THESE DEBTS ON THE DEBT SHEETS.

Do you have any animals, livestock or pets you could sell for $200 or more? Description of Animal(s) Value of the animals if you had to sell them

Do you have any checking or savings account(s) at this time? Name of Bank Address of Branch: City

State

Zip

Type of account: Checking, Savings or Both? Name(s) on the Account Account Number for Checking

Present Balance

Account Number for Savings (if applicable)

Present Balance

Name of Second Bank (if applicable) Address of Branch: City

State

Zip

Type of account: Checking, Savings or Both? Name(s) on the Account Account Number

Present Balance

Have you closed any bank accounts within the past two (2) years? Name of Bank Address of Bank City

State

Account Number

Date Closed

Zip Name on Account

Did you owe a balance when you closed this account? † Yes † No

Balance owed:

If you did not owe a balance when you closed this account, how much money did you receive?

These Client Intake Forms were developed and distributed by http://www.713training.com

STATEMENT OF AFFAIRS (4 of 11) Do you or have you rented a safe deposit box during the past two (2) years?

† Yes

† No

† Yes

† No

† Yes

† No

Name of Financial Institution Address of Financial Institution City

State

Zip

What are the contents of the safe deposit box?

What monthly amount do you pay for rental of this deposit box? If you no longer have the safe deposit box, what date/year did you surrender it? If you transferred the safe deposit box, who did you transfer it to? Do you have a Christmas Club Account or any other special purpose accounts? Name of Financial Institution Address City

State

Type of account:

Zip

Account Number

Name(s) on the Account

Present Balance

Do you currently have any security deposits being held by a utility company? If yes, what is the amount?

Name of Utility Company:

Address of Utility Company City

State

Zip

Account Number Present Balance ** Remember to include any past-due utility bills that you owe from previous addresses on your Debt Sheets. † Yes

Do you have any life insurance?

† No

Name of Insurance Company If a “whole life” policy -- what is the current cash value? If your life insurance is only payable upon death, what is the face value of the policy? Who is the beneficiary?

Relationship

** If you have other life insurance policies, please list the information above for each one on BACK of this page.

Do you or your spouse participate in a retirement, 401K or pension plan?

† Yes

Type of pension plan (i.e., 401-K, PERS, etc.) When did you first enroll in this plan?

Current cash value:

These Client Intake Forms were developed and distributed by http://www.713training.com

† No

STATEMENT OF AFFAIRS (5 of 11) Have you set up your own separate retirement not provided by employer?

† Yes

† No

† Yes

† No

† Yes

† No

† Yes

† No

† Yes

† No

† Yes

† No

† Yes

† No

Name of Financial Institution (if applicable) Amount in this separate retirement account?

Who is the beneficiary?

Will you be receiving retirement benefits from a previous employer within the next six (6) months? Date you expect to start receiving retirement benefits:

Do you have any stocks, bonds (including savings bonds) or mutual funds? Type of bond, stock, mutual fund: Does this bond, stock or mutual fund have a cash value? † Yes † No Cash value:

Do you have a cell phone? Name of cell phone company Address City

State

Account Number Is this a month-to-month contract?

Zip

Date contract began † Yes

If not, what is the length of the contract? † 1 year

† No † 2 years

† 3 years

† Other:

What is the normal monthly contract payment? (i.e.: $19.95, $29.95, etc) Do you wish to keep the cell phone and continue paying the monthly contract? ** If you have more than one cell phone, list the same information above on the BACK of this page.

Do you live with a roommate/relative that pays part of your expenses? Name of roommate or relative:

Relationship?

What expenses do they pay?

What is the total amount they contribute on a monthly basis to your living expenses? How long have they been paying this amount?

From

To

Do relatives or other parties help to pay part or all of your monthly expenses? Name of relatives providing additional support: Relationship of this relative to you: What is the total amount they contribute on a monthly basis to your living expenses? How long have they been paying this amount?

From

To

These Client Intake Forms were developed and distributed by http://www.713training.com

STATEMENT OF AFFAIRS (6 of 11) Are you currently attending college?

† Yes

† No

† Yes

† No

† Yes

† No

Name of college Anticipated graduation date

Major of Study

Do you have a student loan? Name of institution you will make payments to: Address City

State

Zip

Date student loan first obtained?

Date payment is/was to begin:

Total amount to pay off student loan

Average monthly payment

Do you currently owe any fines? (includes parking tickets, moving violations, etc) Name of court you owe fines to Address City

State

Zip

Date of occurrence

Amount owed

Case number assigned by court

Name of party † Husband † Wife † Other

What was this fine for?

If you pay child support, are you currently behind in any payments?

† Yes

† No

† Yes

† No

Name of person/agency you pay child support to Address City

State

Zip

What is the total amount you owe in back child support? What date (or year) were you supposed to start paying child support? If so, what are the payment arrangements? Even if you never expect to collect any money, does an ex-spouse owe you money for alimony or child support? Name of Ex-Spouse Address of Ex-Spouse City

State

Total amount he/she owes you Has this ex-spouse been court ordered to pay you?

Zip

Date originally started owing you Year of court order?

These Client Intake Forms were developed and distributed by http://www.713training.com

STATEMENT OF AFFAIRS (7 of 11) Over the last year, have you, your children or your spouse been involved in an accident where someone was hurt, for example, a car accident? Date accident occurred

† Yes

† No

† Yes

† No

† Yes

† No

† Yes

† No

† Yes

† No

† Yes

† No

Who was at fault?

Who was involved in the accident? Was any insurance money received? † Yes † No If yes, how much?

During the next six (6) months, do you expect to inherit anything? How much do you expect to inherit?

Date expected

Reasons for inheritance During the next six (6) months, do you expect to recover on anyone’s life insurance policy? How much do you expect to receive?

Date expected

Reasons for receiving this money: Do you expect to receive any money from any insurance claim, for any reason, during the next six (6) months? How much do you expect to receive?

Date expected

Reasons for receiving this money:

Are you the beneficiary of a trust fund? What is the amount of the trust fund? Relationship to you:

Name of trust fund owner When will you have access to this trust fund?

Are you owed any back wages, commissions, or vacation pay from your current or previous employer? Employer Name Amount expected to receive

Date expected to receive

** Provide details about this amount owed you. (Feel free to use the back of this page if necessary) Is any of your property in the hands of a repairman, storage company or pawnbroker?

† Yes

Name of Place Holding Your Property Address City

State

Zip

Description of Items and yard sale value: 1.

Yard Sale Value

These Client Intake Forms were developed and distributed by http://www.713training.com

† No

STATEMENT OF AFFAIRS (8 of 11) 2.

Yard Sale Value

3.

Yard Sale Value

What is the total amount you need to pay in order to get these items released?

In the near future, do you expect to settle, win or begin a case for personal injury? How much do you expect to receive?

† Yes

† No

Date you expect to receive this money?

Provide details about this personal injury claim: Name of attorney or law firm handling this claim? In the near future, do you expect to enter into any property settlement with a former spouse?

† Yes

† No

† Yes

† No

† Yes

† No

List all items you expect to receive or turn over in the property settlement (including cash):

What is the total market value (yard sale value) of these items? When do you expect to receive this money or property? or When do you expect to turn over this cash or property?

Does anyone owe you any money for a judgment you have obtained against them? Name of party you filed a lawsuit on Address City

State

Date you filed this lawsuit?

Zip

Money amount awarded you in judgment:

Even if you never expect to collect, does anyone owe you any money for any reason whatsoever? Name of Person who owes you money Address City

State

Zip

Explain why they owe you money: Amount they owe you

Date they originally started owing you

Have you made any payments on your loans or bills other than ordinary payments? In other words, have † Yes † No you made catch-up payments, paid off or borrowed to pay on or off bills or loans? Name of Creditor You Paid Date Paid

Amount Paid

Current Balance Due

Amount Paid

Current Balance Due

Name of Creditor You Paid Date Paid

These Client Intake Forms were developed and distributed by http://www.713training.com

STATEMENT OF AFFAIRS (9 of 11) Are there any lawsuits pending against you now?

† Yes

† No

† Yes

† No

Name of party suing you (Plaintiff)? Case Number

Date Lawsuit Filed

Type of Lawsuit From Court Pleading (Complaint, Summons, etc.) Attorney for the Plaintiff (found on court pleading): Address City

State

Zip

State

Zip

Court when lawsuit was filed (at the top of the pleading) Address City

** If lawsuit is LESS THAN 1 YEAR OLD, please make a copy and include with these forms

Have your wages or property been garnisheed or attached? Who garnisheed your wages or attached your property? When item did they repossess? (If car, provide the year, make, model) How much money do they take from your paycheck?

How often is this deducted?

Have you returned any property to creditors or was any of your property repossessed from you, sold at † Yes † No foreclosure, transferred through a deed or returned to a seller? What property did you turn over to a receiver? When and where did this take place?

Is any of your property in receivership or other legal custody?

† Yes

† No

† Yes

† No

† Yes

† No

When did you file your receivership? In what court was this done?

Have you made any gifts to friends or relatives? What gifts or transfers have you made? Who did you give the gift to? What date/year did you make the gift?

What is the approximate value?

Have you transferred any money or property to family members or friends or paid them any money on debts you might owe them? Type of property transferred: What date/year was it transferred?

What is the approximate value?

These Client Intake Forms were developed and distributed by http://www.713training.com

STATEMENT OF AFFAIRS (10 of 11) Have you have any unusual losses, such as fire, theft, gambling or otherwise? † Fire

Type of loss?

† Theft

† Gambling

† Yes

† No

† Yes

† No

† Yes

† No

† Yes

† No

† Yes

† No

† Yes

† No

† Other:

What item(s) or amount of money was lost? What date/year was it lost?

Amount insurance paid?

Have you had any losses covered by insurance? Describe loss: Date/year of loss?

Amount insurance paid?

Have you consulted with any other attorney about your financial affairs or paid money to a debt counseling service? Name of attorney or service Address City

State

Consultation Date

Zip Total paid for service

Have you filed any bankruptcy within the last eight (8) years? Did you file a Chapter 7, Chapter 13, or a Chapter 11? Date your bankruptcy was filed?

City, State Filed?

Name(s) of persons who filed? Was the case discharged?

† Yes

† No

Case Number

Is anyone holding any property that belongs to you? Item(s) in someone else’s possession that belong to you?

Name of person holding these items: Address City

State

Zip

Beside your current address, have you lived at any other addresses within the past six (6) years? Previous Address lived at: City

State

Time period lived at this address: From (date/year)

Zip To (date/year)

Name(s) of parties who lived at this address:

These Client Intake Forms were developed and distributed by http://www.713training.com

STATEMENT OF AFFAIRS (11 of 11) Previous Address lived at: City

State

Time period lived at this address: From (date/year)

Zip To (date/year)

Name(s) of parties who lived at this address:

Previous Address lived at: City

State

Time period lived at this address: From (date/year)

Zip To (date/year)

Name(s) of parties who lived at this address: Have you been self-employed or had any financial interest in any business (or been involved in a † Yes † No partnership with someone who owned a business) within the past eight (8) years? Name of business Business address Type of business (what type of products were sold)? Date business began

Date business ended

Name of your partners, co-investors, or associates? What were your net profits for this year?

Last year?

2 Yrs Ago?

How much income tax do you pay from the income you make with your business? During the past two (2) years, have either you or your spouse had any other income source outside † Yes † No normal pay from your employer? (includes flea market dealers) Income this year?

Last year?

2 Yrs Ago?

What is the amount of the TAX REFUND you received this year? † I did not file taxes † I had to pay taxes and did not receive a refund

By signing below, I state that all the information provided in the these Client Intake Forms are true, accurate and complete to the best of my (our) knowledge.

Signature of Debtor #1

Signature of Debtor #2

Date:

Date:

These Client Intake Forms were developed and distributed by http://www.713training.com

Bankruptcy Client CheckList Page 1 of 2 Due to changes in the bankruptcy law, clients must provide the following documents (where applicable) to their bankruptcy attorney prior to the preparation of their bankruptcy petition. 1. 6 months of paycheck stubs if you are employed. 2. 6 months of bank account statements that verify the income provided on the paycheck stubs, or social security and pension deposits, etc. 3. Copies of titles to all motor vehicles. 4. If you own property: Recorded mortgage and deed for all real property. These documents are normally obtained from the Recorder's Office for the county where the real property is located. 5. Copies of any and all lease agreements, including motor vehicle leases, rent-to-own property, contracts, etc. 6. A copy of appraisals made within the past 12 months for all real property. If you are buying or own any other real property, and it has not been appraised within the past 12 months, you must pay for an appraisal prior to filing bankruptcy. Note: There are two different types of appraisals: (1) Full appraisal completed by a real estate agent when a home is sold through the real estate market; and (2) Drive by appraisal that accurately reflects the current market value for your bankruptcy filing. Make sure your appraiser knows the difference and you will save money 7. Copies of any lawsuits, foreclosures, judgments, liens or garnishments filed within the past two (2) years. 8. Copies of all insurance policies including life, disability insurance, homeowners, renters, motor vehicles or any other insured assets. Be sure to include any "riders" which cover any specific items of personal property with insured values. 9. Income tax returns for the past two (2) years. 10. All documents relating to retirement accounts, IRAs, 401Ks, etc. 11. Separation agreements, decrees of dissolution, divorce decrees or support obligations filed within the past one (1) year. 12. Security agreements, financing statements and any or all personal property leases. (continued on next page) These Client Intake Forms were developed and distributed by http://www.713training.com

Bankruptcy Client CheckList Page 2 of 2 13. Copies of credit reports from all 3 credit reporting agencies: Equifax, TransUnion and Experian. Under law, you are entitled to one free credit report per year which you can obtain online at: http://www.annualcreditreport.com/ 14. Stock certificates, bonds, credit union and passbook savings accounts and statements evidencing investments or savings. 15. Documents verifying interest in any future property (such as a Will) 16. Consumer credit counseling documents. If you have not obtained your credit counseling, you may obtain them online at: http://www.yourbankruptcypartner.com/prebankruptcy_certificates/ 17. Copies of any previous bankruptcy cases filed within the past eight (8) years. 18. Copies of the most recent statement from any educations IRS and/or Tuition Trust account. 19. Copies of the most recent statements from any student loans. 20. List of prior addresses you have lived at within the past three (3) years. 21. Copies of utility bills for the past six (6) months. 22. Driver's license or state identification card which provides verification of your social security number. 23. Any documents relating to a "disabled veteran" status. Note: If you wish to retain the original of your documents, you may either copy them at a copy shop or scan them into PDF format and place on a CD-Rom for your attorney prior to your meeting. Thank you for taking the time to provide your attorney with as much detailed information as possible. The more detail you provide along with the required documentation, the faster your bankruptcy petition can be prepared and filed with the bankruptcy court. Please do not hesitate to contact your bankruptcy attorney if you have any questions during the bankruptcy process.

These Client Intake Forms were developed and distributed by http://www.713training.com

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Bankruptcy Client Intake Forms, English Version - Di Giacomo

IMPORTANT Instructions For Filling Out Client Intake Forms Your Assets Everything you have in your possession, from the coffee pot to the house you li...

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