Bankruptcy Intake Form
Badillo Law Group, P.C.
Email address *
How did you hear about us? ¿Cómo se enteró de nuestra oficina? *
First Name/Nombre *
Middle name/initial
Last name/Apellido *
Phone number/telefono *
Full address with city/direccion completa con ciudad ex: 1234 S. Main Street, Chicago, IL 60609 *
Previous address (including city) /Direccion anterior (incluyendo ciudad)
Marital Status/estado civil
Clear selection
If married, will your spouse will bankruptcy too?/Su esposo/esposa tambien va a declarar bancarrota?
Clear selection
Date of birth/fecha de nacimiento *
MM
/
DD
/
YYYY
Social Security Number/Seguro Social , format: 311-22-3344
Driver's License Number/Numero de licensia de manejar, example: B321-1234-5678
Are you working now? Esta trabajando ahora? *
Required
Employer name/Nombre de empleador
Occupation/Ocupacíon
Pay frequency/frequencia de pago
Clear selection
Apx. gross pay per pay frequency/ingresos brutos cada cheque
Net or take home pay per pay frequency/ingresos netos cada cheque
Number of years at job/Numero de años en su trabajo
Other income and amount such as part time income/otro ingresos por mes?
Does your spouse work? Trabaja su pareja?
Clear selection
Total monthly income for spouse/Ingreso mensual para esposo/esposa
Name of previous employer(s)/Nombre de empleador anterior
Have you filed bankruptcy before?/Se ha declarado en quiebra antes? *
Chapter of Bankruptcy you need to file/Tipo de bancarrato que necesita
Clear selection
Do you have children under age 21?/Hijos menores de 21 años?
Clear selection
Number of children under 21/Cuantos niños tiene menores de 21 años?
Clear selection
How many of your children live at home with you?Cuantos niños viven en su casa?
Clear selection
Do you pay child support?/Paga manutencia de hijos?
Clear selection
If you pay child support how much do you pay per month/Cuanto paga por mes de manutencia?
Do you own real estate?/Es dueño de propiedades? *
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