Bankruptcy Interview Form Hidden H2 Δ Step 1 of 4 25% CompanyThis field is for validation purposes and should be left unchanged.PLEASE FILL OUT AS BEST AS YOU CAN & BRING TO YOUR CONSULTATION Client InformationClient's Full Name(Required)AddressZipCountyPhoneCellWorkEmail Social Security NoDOB Marital Status Single Married Divorced Partner Separated Date Divorced Spouse InformationSpouse(Required)AddressZipCountyPhoneCellWorkEmail Social Security NoSpouse DOB Section BreakName and age of dependents living with youLength of time at above addressAddresses, names used, and dates for last three years or current mailing address if different from above Yes No NameAddressesDates Any Prior names used in the last six years that may be connected to your bills Yes No Prior Names Used (Last 6 Years)Creditor InformationPlease provide one billing statement per creditorPlease provide one billing statement per creditor Drop files here or Select files Max. file size: 256 MB. For any creditor that you may not have a bill for: list on a separate sheet, address, account number and amount you think you owe. Yes No AddressAccount NumberAmountIf you own a home, please contact your county Recorder’s office and get a copy of your recorded mortgage (s). We will need the document number and date recorded. Yes No Document NumberDate Category of PropertyReal Property: Yes No Property Value $Provide legal description from abstract or deed: Time Share?List Mortgage Company(s) name and amount owed:NameAmount owed Add RemoveCash And Bank Accounts DetailsCash on hand $All Banks and/or Credit Union Accounts:Name of BankDo you owe them money?Current amount in checking $Current amount in savings $ Add Remove*****Wells Fargo will freeze if large sum in acct day of filing.Security deposits for public utilities, landlords $Household goods, furnishings and Collectables $Computer? Ipad? $Clothing $Furs and jewelry describe $Firearms (list Make & Model(s)) $Life insurance policies w/cash value $IRA, PERA, 401k, Annuities $People who owe you money $Alimony, maintenance paid to you $Amount of last year’s tax refunds (Federal) $(property tax) $(State) $Autos, trucks and other vehicles InformationAutos, trucks and other vehiclesYearMileageMake/Model$Amount owed $Creditor Add RemoveBoats, motors, trailers, 4 wheeler, snowmobiles InformationBoats, motors, trailers, 4 wheeler, snowmobilesYearMake/ModelAmount Owed $ Add RemoveOtherOffice equipment, furnishings, and supplies $Riding Lawn Mower? Snow Blower? Make model and value $Stocks or bonds (bitcoin?) $Pets $ Gross Income – Provide last 6 months of paystubsDebtor:2x Monthly income Debtor $Weekly income Debtor $Bi-weekly income Debtor $ Spouse:2x Monthly income Spouse $Weekly income Spouse $Bi-weekly income Spouse $Any other income (employer, pension, social security) $Do you receive any child support: Yes No $Personal Monthly ExpensesMonthly Rent or Mortgage Rent Mortgage Rent $Mortgage $Second Mortgage payment $Does Mortgage include Taxes and Insurance? Yes No Home maintenance $Electricity and heating fuel $Water and sewer $Telephone $Cell phone $Garbage $Internet $Cable $Other Utilities $Food $Clothing $Laundry/Dry Cleaning $Medical/dental $Transportation $Recreation/entertainment $Charitable contribution $Homeowner or renter insurance (if not escrowed) $Life insurance $Health insurance $Auto insurance $Other insurance $Real estate taxes (if not escrowed) $Other taxes (additional federal or state taxes-not from wages) $Auto installments (which vehicle) $Auto Installments $Student Loan $Other installments $Child support payments $Toiletries and household needs $Spousal support paid $Other expenses $Pet expenses $Auto tabs and postage $School Supplies $Total Monthly Expenses $Employment InformationDebtor:Employers NameAddress 1Address 2PositionLength of time employedSpouse:Employers NameAddress 1Address 2PositionLength of time employedHave you been self-Employed in last 8 years? Yes No Business nameAddress of businessHow long in businessEINBusiness Entity Type Sole Proprietorship Corporation Limited Liability Corporation Engaged in BusinessName of person who kept books for youName and address of person doing audit in last six yearsName and address of person who has recordsDescribe any financial statementsDescribe the last two inventoriesPrevious Years Income InformationCurrent Year $2017 Gross Income from taxes $2018 Gross Income from taxes $ Describe Any of the Following BelowAttached, garnishment, or seizure of wages or bank accounts?: Yes No Explain HereGifts or contribution of $600 or more to family members in the last year? Yes No Explain HereHas any family members loaned you money that you’ve paid back within the last year? Yes No Have you transferred any property to a family member or friend for under fair market value in the past 6 years? If yes, please explain Yes No Explain HereHave you closed a bank account in the past year? Yes No When?Where?How did you hear about our office?Do you have a safe deposit box? If so, where? What is inside? Yes No whereWhat is insideAre you storing any property for someone else? Storage Unit? Name Address, contents Yes No NameAddressContentsExecutory contract, lease, etc Yes No Have you co-signed for on a loan for anyone? If so Yes No Who did you sign forWho is the creditorHas anyone co-signed for you? If so Yes No Who signedWho is the creditorHave you given any ONE credit card or unsecured creditor $600 total within 90 days? Yes No Have you used your credit cards within 90 days? Yes No Amount charged $Have you taken any cash advances in the last 70 days? Yes No Amount $Have you had anything repossessed in the last year? If so, please explain: Yes No Explain HereHave you had a foreclosure in the last year or are you currently in foreclosure? Please explain: Yes No Explain HereDo you expect to come into an inheritance, trust, life estate or legal settlement -Work Comp, Personal Injury? Do you expect to come into money from a previous surgery? Yes No Is your name on someone else’s land or bank accounts? If so, please explain: Yes No Explain HerePlease list on the back any asset (vehicle, boat, camper, 4 wheeler, snowmobile, etc.) that you have sold within the last 2 years. Please list name of person item sold to, date sold, and amount sold for. Yes No Please list on the back any asset (vehicle, boat, camper, 4 wheeler, snowmobile, etc.) that you have sold within the last 2 years. Please list name of person item sold to, date sold, and amount sold for.Vehicle NameBuyer NameDateAmount Add RemoveHave you ever filed for bankruptcy before? Yes No When?Where?How did you hear about our office?You can download a copy of this form by Clicking Here.
