BANRUPTCY INTAKE FORM
First Name:
Your answer
Last Name:
Your answer
Home address:
Your answer
How long at this address:
Your answer
Marital Status:
If married, is your spouse included in all of your debt?
Your answer
Do you have any children living at home?
Your answer
What is your immigration status?
Are you making mortgage payments where you are living?
Your answer
Have you ever filed for bankruptcy before?
If yes, please indicate the year and chapter that you filed?
Do you have any prior or are you now in foreclosure proceedings?
Your answer
If yes, how many months have you not paid your mortgage?
Your answer
Aside from the current foreclosure (if any), have you ever had a home foreclosed by the bank?
Your answer
If yes, please indicate when and where this happened:
Your answer
Do you have a second or third loan on your home?
Your answer
If yes, with which bank?
Your answer
How many homes do you own?
Your answer
Where are they located?
Your answer
Have you ever had any vehicle or boat repossessed in the past?
Your answer
If yes, when did this happen?
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Please indicate below the type of debt that you have now:
How many vehicles do you own?
Your answer
How much do you earn per year?
Your answer
For each vehicle, please indicate the make, model and miles:
Your answer
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