Thank you for asking us to assist you in reviewing your options, including possible bankruptcy. The following questions will assist us in giving you advice such as whether bankruptcy is appropriate, the best time for filing and what danger points you need to be aware of. No one can guarantee a flawless legal process, but these documents get us a close to that goal as possible. Please take your time to complete as much as possible. Make sure to note any questions that are confusing.
Please understand that just because you fill out this information and forwarded it to our office you have not committed to filing for bankruptcy protection. Nor, have we committed to representing you in a bankruptcy. There are occasions when the best course is for someone to wait for some period before filing, if a bankruptcy is ever filed; or taking another route. We will discuss any alternatives that may apply to your situation at our first meeting.
Once this form is completed please forward to our office (by mail, e-mail or fax). Put a note on the cover page with directions – when is the best time to call you to discuss your options. Normally, this will be a 15-20 minute phone interview. Most likely you will have some questions. I suggest that you write them down so that you are prepared for our phone discussion. There is no fee for this initial discussion. Nor, is there any requirement that either party continue with any future representation. No further services will be rendered by our office, unless you request them and you sign a retainer agreement.
Our job is to help you understand your rights under the bankruptcy laws and prepare for the process. In doing so we help relieve you of certain debts and get the fresh start that the Constitution of the United States guarantees every resident. Congress has decided that any attorney who provides legal assistance in bankruptcy must call themselves Debt Relief Agents. Should bankruptcy be appropriate we help people file for bankruptcy relief under the Bankruptcy Code.
We look forward to hearing from you. IF YOU ARE E-MAILING PLEASE SEND TO JAY@DIANEDRAIN.COM; IF YOU INTEND ON FAXING, THEN PLEASE TYPE OR USE ONLY BLACK PEN.
GENERAL INFORMATION
__ Yes ___No Have you ever filed bankruptcy before? If yes, list year, state and case number. _____________ This includes any case which may have been filed, but not completed – no discharge entered. __ Yes ___No Have you ever used a false social security number or someone else's name to acquire debt? If so, this action is very serious and could be grounds for criminal action and deportation. __ Yes ___No Do you own any property that has been part of a bankruptcy in the last 2 years? ___________ Are both
you and your spouse filing this bankruptcy together? ٱ Yes ٱ
No
Have either you or your spouse been known by any other name during the past 6 years? (Example: maiden name, last name from previous marriage, legal name change, etc.) ٱ Yes ٱ No If yes, write the NAME and DATE(S) USED below:
Name Used__________________________________ Dates Used thru_____________________
Name Used__________________________________ Dates Used thru_____________________
Who referred you to our office? __________________________________ PLEASE ANSWER THE FOLLOWING QUESTIONS:
__ Yes
___No Do you have a foreclosure or trustee's sale
pending?
VERY IMPORTANT:
What do you expect bankruptcy to do for you:
_________________________________________________________________________ The following are general questions to determine your current situation. If you are married then please fill out these forms with the husband as the "client" and the wife as the "co-client". This is not meant to be deferential, but is done so that we can keep each person's situation clearly defined. Thank you. __ Yes __ No Is there an emergency requiring immediate filing? If so, why?
________________________ If not, explain __________________________________________________________________ _ Yes __ No Do you (or your spouse) owe any back child support or alimony? If so, explain
__________________________________________________________________
If so, what and how much: ________________________________________________________ __ Yes __No Is a landlord trying to evict you from your property? If so, did you
landlord obtain a
Forcible Entry & Detainer Order? When? __________ __ Yes __ No Other problems? Explain ____________________________________________ __ Yes __ No If married, did just one spouse incur the debts before the marriage? If so, explain
__________________________________________________________ There are certain issues that determine whether or not it is appropriate to file now. Check if any apply to your circumstances.
__ Yes __ No Have your taken the required credit counseling briefing in the last 6 months? If so, list name of provider and date of certificate_____________________________ __ Yes __ No Do you (or your spouse) have a probable inheritance in the next 6 months? If so, explain ________________________________________________________ __ Yes __ No Did you (or your spouse) refuse any inheritance in the last 4 years? If so, explain
________________________________________________________
If so, explain
________________________________________________________ If so, when and
how much. ______________________________________________ If so, when and how much. ______________________________________________ __ Yes __ No Even if you never expect to collect, does anyone owe you money for any reason whatsoever? If so, when and how much. ______________________________________________ __ Yes __ No Do you (or your spouse) have a personal injury claim pending or payable? If so, when and how much. ______________________________________________ __ Yes __ No Do you (or your spouse) have a right to sue anyone for anything? If so, explain
__________________________________________________________ __ Yes __ No Did you (or your spouse) use a credit card to pay taxes within the last year before filing? If so, when and
how much.
______________________________________________ If so, what card
and for what purchase? ____________________________________ __ Yes __ No Did you (or your spouse) bounce any checks? If so, explain
__________________________________________________________
__ Yes __ No Have you (or your spouse) been divorced in the last 3 years? __ Yes __ No If so, are there any assets that are still to be delivered to you (or your spouse)? If so, List the assets, their value and when you are to take control. __________________________________ __ Yes __ No Do you have any student loans? If so, describe _________________________________________________________ __ Yes __ No Are there any judgments or threatened actions against you (or your spouse) for destruction of property or for injury inflicted? If so, explain:__________________________________________________________________ __ Yes __ No Do you (or your spouse) understand that any debts from obtaining money, property, or services by fraud may survive the bankruptcy? If so, explain
________________________________________________________ If so, explain _________________________________________________________ __ Yes __ No Do you (or your spouse) owe any fines or penalties? (e.g.: court fines, or tickets) If so, describe _________________________________________________________ __ Yes __ No Do you (or your spouse) have any stocks, bonds (including savings bonds) or mutual funds? If so, describe
________________________________________________________ If so,
were those funds deposited more than 1 year ago? ___ 2 years
ago___? (541(b)(5) &(6)) __ Yes __ No Do you (or your spouse) owe any money to any friend or relative. If so, describe ________________________________________________________ __ Yes __ No Have you (or your spouse) paid any money or transferred any assets to a friend or relative in the last year? If so, describe __________________________________
HOME, LAND AND VEHICLES
__ Yes __ No Do you (or your spouse) own a home or land? If so, describe: ______________________ Fair market value $_________, Total amount owed: $________ __ Yes __ No Are the mortgage payments to your first lender current? If not, when was a last payment made?_____________________ __ Yes __ No Do you have a second/third lien on your home? __ Yes __ No Are those payments current? If not, when was a last payment made?_____________________ __ Yes __ No Is there a pending foreclosure or trustee’s sale? If so, what is the date and time of foreclosure: _____________________________________________ If there is a sale, then provide copies of trustee sale documents and make sure that the trustee's name is listed below as a creditor. It is your responsibility to confirm this date and to keep track of the date at all times; including the entire pendency of your bankruptcy. This office will not monitor it for you. We will help to answer questions that you may have. __ Yes __ No Is your home loan a VA
loan (personal liability for VA loan)? __ Yes __ No Do you (or your spouse) own other real estate, (e.g. time shares, land, etc)? Describe: ______________________ Fair market value $_________, Debt owed $ ______ Describe: ______________________ Fair market value $_________, Debt owed $ ______ Describe: ______________________ Fair market value $_________, Debt owed $ ______ __ Yes __ No Do you (or your spouse) own any vehicles? List all cars in your name, including those that you are making payments on. Fair market value: www.kbb.com (private party value). I cannot give you good advice without the fair market value. Describe: __________________ Fair market value $______, Debt owed $ ______ Date Purchased ______ Mileage __________ Name on title _____________ Describe: __________________ Fair market value $______, Debt owed $ ______ Date Purchased ______ Mileage __________ Name on title _____________ Describe: __________________ Fair market value $______, Debt owed $ ______ Date Purchased ______ Mileage __________ Name on title _____________ Describe: __________________ Fair market value $______, Debt owed $ ______ Date Purchased ______ Mileage __________ Name on title _____________ (no redemption in 13 if purchased in last 2 1/2 years) (Means test- $200.00 is allowed under IRM (Internal Revenue Manual) 5.8.5 for vehicles that are not encumbered with a loan or lease, more that six years old and/or more than 75,000 miles of usage.) __ Yes __ No Did you refinance any of these vehicles after they were originally purchased?
__ Yes __ No Do you (or your spouse) any luxury items that total more than $150,000 (businesses, stock, investments, land, etc)? If so, explain __________________________________________________________________ __ Yes __ No Do you (or your spouse) own any valuable items that you are concerned about losing? If so describe, include their value: __________________________________________________ __ Yes __ No Did you (or your spouse)
use any household furnishings, jewelry or vehicles as collateral for a
loan
YOU MUST USE ACTUAL REPLACEMENT VALUE (506(a)(2) and additional legal action will be necessary __ Yes __ No Do you (or your spouse) own any items that are not on the attached exemption list? If so, list
item, including fair market value:
____________________________________________ If so, explain
_____________________________________________________________________________ __ Yes __ No Do you (or your spouse) have any sole and separate assets? Make sure to include the resale value. (Sole and separate assets are those brought into the marriage, given to you (or your spouse) during marriage by someone who is not your spouse, or purchased from income of your sole and separate property.) If so, list item, including fair market value: ____________________________________________
INCOME AND TAXES What is the total amount of your gross
income (before taxes/insurance) over the last 6 months?
$___________ __ Yes __ No Do you have a regular income? If so, what is your monthly gross (before taxes)? $________ Net (after taxes and insurance) $_______ __ Yes __ No Spouse have a regular income? If so, what is their monthly gross (before taxes)? $_________ Net (after taxes and insurance) $_______ __ Yes __ No Do you (or your spouse) receive any money from other sources (alimony, child support, rent, gifts)? If so, how much per month _____________________________________________________________ __ Yes __ No Do you (or your spouse) have any back wages, vacation or sick pay owing? If so, how much per month (average): ____________________________________________________ __ Yes __ No Have you (or your spouse) filed all required income tax returns, both federal and state? IF NOT THOSE RETURNS MUST COMPLETED BEFORE YOUR BANKRUPTCY DOCUMENTS CAN BE COMPLETED, UNLESS THERE IS A REAL EMERGENCY. If not, explain
_______________________________________________________________________ If so, explain
what type of debt, year due, when was return filed,
etc.___________________________ If so,
explain what type of debt, year due, when was return
filed._______________________________ MONTHLY BUDGET This form details how much you spend each month on living expenses. Be sure to write in the MONTHLY (not yearly) amount for each expenditure. For utilities, your bill may be higher an the summer than in the winter, so write an amount that is an average covering the last 12-month period. If your spouse does not reside in your home then make a second copy of this budget for their expenses.
TOTAL AMOUNT OF MONTHLY EXPENSES: ___________________
BUSINESSES __ Yes __ No Do you (or your spouse) own any businesses? If so describe:
What would a third party pay for your interest in the
business: _____________________ __ Yes __ No Do you (or your spouse) have any interests in any companies? If so, explain:
_______________________________________________________________________ If so, explain _____________________________________________________________________________
NOTES: This is more of what Congress decided to burden you with. Neither you or I like it but it is the law.
Example: John and Mary are filling out this form on the 23rd of the June. They have a renter and their mother has been giving them $200.00 a month for the last 5 months.
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