New Clients

1Contact Access Information

2Confidential Bankruptcy Worksheet

CONFIDENTIAL CLIENT WORKSHEET
First Name*
Last Name*
Phone Number*
Email Address

Marital Status
Address
City
State
Zipcode
Are you filing jointly with your spouse or individually?
Spouse Name
Marital Status
Address
City
State
Zipcode
Prior Bankruptcy Filed? If Yes: Where
When
Judge’s Name
Status of Case
TYPES OF DEBT OWED
Please list the amount of each type of debt you currently owe.
Medical
Student Loans
Credit Cards
Home Mortgage
Title/Car Loans
Finance Loans
Check Adv./PayDay Loans
Taxes/Fed/State
Child Support
Other
PROPERTY INFORMATION
Real Property: (i.e.: home or land)
1. Location of property: (Full Address) Value: $
2. Cash on hand: $
3. Checking Account: $
Bank
Acct.No.
4. Savings Account: $
Bank
Acct.No.
5. Security deposits
$
6, Home Furnishings: Make a separate itemized list of all home furnishings broken down by room. (I.e.: Bedroom 1:bed - $25, dresser - $50, TV - $10)
7. Furs or Jewelry
Value
8. Firearms, sports or other hobby equipment:
Value
9. Interest in insurance policies, annuities, IRA, ERISA, 401k etc.
Value
10. Stock interest in an incorporat e d or un in corporated business.
Value
11. Interest in partnerships or joint ventures
12. Alimony, maintenance, support payments you are entitled to
13. Any tax refund s you are expecting $
14. Auto, truck, trailer, other v e hicle : Year
Make
Model
Value
15. Auto, truck, trailer, other v e hicle : Year
Make
Model
Value
16. Boats, Motors, Accessories
Value
EMPLOYER INFORMATION
Your Employer
Name
Occupation
Address (Full)
How Often Paid
Gross Pay (before deductions)
Spouse Employer
Name
Occupation
Address (Full)
Any other source of income not listed
(Child support, pension, unemployment compensation, disability etc.)
$
ESTIMATED MONTHLY LIVING EXPENSES
We put in standard amounts the court allows for transportation, home maintenance, recreation and clothing. Please fill out to the best of your ability. Thank you.
Rent or Mortgage payment $
Property Taxes $
(if not included in mortgage payment)
Property Insurance $
Electric $
Water / Sewer $
Phone $
Garbage $
Cable $
Food $
Car Payment 1 $
Car Payment 2 $
Car Insurance $
Health Insurance $
Life Insurance $
Medical Insurance $
Cell Phone $
Other $
Nature of Payment
Comments
This field is for validation purposes and should be left unchanged.

CONFIDENTIAL CLIENT WORKSHEET

TYPES OF DEBT OWED

PROPERTY INFORMATION

EMPLOYER INFORMATION

ESTIMATED MONTHLY LIVING EXPENSES

Bankruptcy Answers & Issues

From B. David Sweeney