Bankruptcy Analysis - Summary Of All Your Debts

The goal of this form is to determine if you qualify for bankruptcy, and if so, which type of bankruptcy is the best option for you. With that in mind, please take the time and answer all these questions to the best of your ability. These questions are designed to give us the information necessary for us to advise you. Once we receive the completed form, we will contact you within 2 business days with an analysis of your situation, as well as an outline of what we can do for you and our fees for our service. The information you provide will be encrypted for your protection when you submit it. If you have any questions, call 757-461-9455 or 757-549-4357.

PERSONAL INFORMATION

Name:
Address:
City:
State:
Zip:
Phone:
Cell:
Pager:
Work:
Email:

CREDIT CARDS

How Many Credit Cards:
Total Amount Owed ($):
Have you used any in the last 90 days:	yes no
If yes, list dates, amounts, nature of charges:

HOUSEHOLD

Are You Married:	yes no
Number of Dependents:
Filing Yourself/Spouse:	alone with spouse
Have you been in Virginia over 6 months:	yes no

DEBTS WITH COLLATERAL

Furniture Owed ($):
Appliances Owed ($):
Jewelry Owed ($):
Loans Owed ($):
Medical Bills ($):
Reposession Owed ($):
Miscellaneous Debt ($):

ASSETS

Balance in Savings/Checking Accounts ($):
IRA, 401(k), or Other Investment ($):
Amount of 401(k)/TSP Loan ($):
Value of Any Cash-Value Life Insurance ($):

AUTOMOBILES (even if paid in full)

Car 1...
Year/Make/Model:
Monthly Payment ($):
Balanced Owed ($):
Market Value ($):
Are Payments Behind:	yes no
If So, How Many Months:
Total Amount Behind ($):
Do You Want To Keep The Car?:	yes no
Car 2...
Year/Make/Model:
Monthly Payment ($):
Balanced Owed ($):
Market Value ($):
Are Payments Behind:	yes no
If So, How Many Months:
Total Amount Behind ($):
Do You Want To Keep The Car?:	yes no
Car 3...
Year/Make/Model:
Monthly Payment ($):
Balanced Owed ($):
Market Value ($):
Are Payments Behind:	yes no
If So, How Many Months:
Total Amount Behind ($):
Do You Want To Keep The Car?:	yes no

HOME

Rent or Own/Buying:	rent own/buying
Monthly Payment ($):
How is the House Titled:
Do You Want To Keep:	yes no
Behind On Any Mortgage Payments (inc. 1st, 2nd, Etc�):	yes no
If So, How Many Months:
Amount Behind ($):
Foreclosure Pending:	yes no
Balance Owed (including all mortgages) ($):
Market Value ($):

TAXES

Have All Federal Taxes Been Filed Up To Date:	yes no
Amount Owed ($):
If Not, Which Years Have Not Been Filed:
Have All State Taxes Been Filed Up To Date:	yes no
Amount Owed ($):
If Not, Which Years Have Not Been Filed:

MISCELLANEOUS BILLS

Do You Owe Any Student Loans?:	yes no
Amount Owed ($):
Child Support:	pay receive
Per Month ($):
Arrearage ($):
Alimony:	pay receive
Per Month ($):
Arrearage ($):
Court Costs/Traffic Fines:

JUDGEMENTS, GARNISHMENTS, ETC.

Any Court Proceedings Against You:	yes no
When:
Type of Proceeding:
Personal Injury Claims:
Garnishments/Liens:	yes no
Who:
Amount Owed ($):
Repossession:	yes no
Balance Owed ($):
Recent Divorce or Separation:	yes no
Did You Have a Separation Agreement:	yes no
Recent Inheritance:	yes no
When:
Amount ($):

INCOME/EXPENSES (Including any pension, government payments or other income)

Your Income...
Monthly Gross ($):
Monthly Net ($):
Yearly Gross ($):
Spouse's Income...
Monthly Gross ($):
Monthly Net ($):
Yearly Gross ($):
Roommate Contribution...
Monthly ($):
Other...
If You Had No Debt (only paying regular monthly expenses, such as rent/mortgage, groceries, utilities, etc�), How Much Money Would You Have Left At The End Of The Month ($):
Have You Transferred Any Money Or Property To Any Relative In The Last Year:	yes no
If So, When, To Whom, And What Was The Value Of The Property:
How Many People/Companies Do You Owe Money:
What Is Your Total Debt (not including vehicle or home):
Main Reason For Filing Bankruptcy:
Have You Previously Filed A Bankruptcy:	yes no
If So, How Many Times:
When:
Status:	discharged dismissed
What Chapter Was It:	7 13
If Dismissed, Why:
Are You Interested in Emergency Filing:	yes no

ADDITIONAL SERVICES

Guaranteed 14 day completion with letters to up to 20 creditors for additional $200.00.	yes no
We obtain all 3 credit reports and transfer information to bankruptcy petition for you.	yes no

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