CLIENT CONFIDENTIAL WORKSHEET

personalbankruptcylawyer.com

Walter Metzen-Bankruptcy Lawyer-(313) 962-4656-Suite 3156 Penobscot Building, Detroit Michigan 48226

Toll Free 1-800-398-DEBT

For a free evaluation, complete this worksheet and call for an appointment or fax to 313-962-4241

Your name _________________________________________ SSN # _______-______-__________

Address _________________________________ City ________________________State__________

Zip ______________-________

Marital Status: ___________________________________

Are you filing jointly with your spouse or individually? __________________________________

Spouse name _________________________________________ SSN#  _______-______-_________

Address _________________________________ City ________________________State__________

Zip ______________-________

Prior Bankruptcy filed? If yes:  Where__________________________ When ____________________

Case Number (if known) _________________________ Status of  Case ________________ Chapter 7 or 13 (circle one)

LIST OF CREDITORS

You must list mortgage and car payments even if you are keeping them. Make sure you provide complete addresses for all creditors.  If we do not have the correct address, the creditor will not be discharged.
 

Attach additional sheets listing creditor information, if necessary.

PROPERTY INFORMATION

Real Property: (i.e. home or land)

1.         Location of property:

City ________________________________State _______ Zip __________-________

Value: $_______________

2.         Cash on hand: $_____________

3.         Checking Account: $_____________

4.         Savings Account: $ ______________

5.         Security deposits with public utilities: Company _____________________How much: $ ___________

6.         Home Furnishings (estimated "garage sale" value of all household items):  __________________________ 

7.         Furs or Jewelry: __________________________ Value: $________________________

8.         Firearms, sports, and other hobby equipment: ___________________________________

Value: $________________________

9.         Interest in insurance policies, annuities, IRA, ERISA, 401 K, etc.

________________________________________ Value: $________________________

10.       Stock interest in any incorporated or unincorporated businesses:

________________________________________ Value: $________________________

11.       Interest in partnerships or joint ventures: ______________________________________

12.       Alimony, maintenance, support payments you are entitled to: ______________________

13.       Any tax refunds you are expecting: $____________

14.       Auto, truck, trailers, and other vehicles:  Year ________________ Make ______________

            Model _____________ Value: $__________

Second Auto: Year  _______________Make __________________ Model _____________

Value: $__________

15.       Boats, Motors, and Accessories: ____________________________ Value: $__________

Employer information:

Your Employer

Name: _________________________________________ Occupation: ________________________
Address: ________________________________________________________ Apt # _____________

City ________________________________________State ________ Zip: ___________-__________

How often paid: (Circle one)     Weekly     Bi-weekly       Twice a month        Monthly

Gross pay: $_______________  (before deductions)

Taxes withheld: $_____________________ Insurance deducted: $______________

Other withholding: (child support, alimony, etc.) __________________ $___________

Gross income: This year to date $________________ Last Year $_______________ Year before last $______________

Spouse Employer:

Name: ________________________________________ Occupation: _________________________
Address: ________________________________________________________ Apt # _____________

City _________________________________________State ________ Zip: ___________-_________

How often paid: (Circle one)     Weekly     Bi-weekly       Twice a month        Monthly

Gross pay: $_______________ (before deductions)

Taxes withheld: $_____________________ Insurance deducted: $______________

Other withholding: (child support, alimony, etc.) __________________ $____________

Gross income: This year to date $________________ Last Year $_______________ Year before last $______________

Any other source of income not listed: _____________________________________ $_____________

ESTIMATED MONTHLY LIVING EXPENSES

Rent or mortgage payment:       $________________

Property taxes:             $________________ (if not included in mortgage payment)

Property insurance:                   $________________ (if not included in mortgage payment)

Electric:                                    $________________                         

Water/Sewer                            $________________                         

Phone:                                      $________________                         

Garbage:                                  $________________                         

Cable:                                      $________________

Food:                                       $________________

Car payment:                            $________________  Car payment 2: $_______________

Car insurance:                           $________________

Health insurance:                       $________________

Life:                                          $________________

Medical:                                   $________________ (co-payments, prescriptions, etc.)

Cell phone:                               $________________

Other:                                       $________________ Nature of payment _______________

List name, age, and relationship for any dependant living with you:

Name: ______________________ Age: _________ Relationship: __________________

Name: ______________________ Age: _________ Relationship: __________________

Name: ______________________ Age: _________ Relationship: __________________

We put in standard amounts the court allows for transportation, home maintenance, recreation, and clothing