Bankruptcy Questionnaire

Bankruptcy Questionnaire

Name: First Last
Text
Phone: - ### - ### ####
Email:
Marital Status:
Spouse's Full Name: First Last
What type of Debt to you have?
Credit Cards: $ . Dollars Cents
Medical Bills: $ . Dollars Cents
Back Taxes: $ . Dollars Cents
Back Child Support: $ . Dollars Cents
Student Loans: $ . Dollars Cents
Payday Loans: $ . Dollars Cents
Other: $ . Dollars Cents
Real Estate
Do you own Real Estate?
Yes No
If yes, what are your intentions with this Real Estate?
Purchase Date: / MM / DD YYYY
Purchase Price: $ . Dollars Cents
Have you refinanced in the last two years?
Yes No
First mortgage amount: $ . Dollars Cents
Second mortgage amount: $ . Dollars Cents
Fair market value: $ . Dollars Cents
Have you sold or transferred any real estate in the last four years?
Yes No
Vehicles
Do you own any vehicles?
Yes No
Make/Model/Year:
Balance owed: $ . Dollars Cents
Make/Model/Year:
Balance owed: $ . Dollars Cents
Other Assets
Please describe any other significant assets:
Approximate value: $ . Dollars Cents
Additional Information
Have you filed bankruptcy before?
Yes No
If yes, when?
Your net monthly income: $ . Dollars Cents
Your spouse's net monthly income: $ . Dollars Cents
Your average total monthly expenses: $ . Dollars Cents
Is there any additional information that may be relevant to your case?