Bankruptcy Intake Form
Badillo Law Group, P.C.
Email address/Correo electronico *
Your answer
First Name/Nombre *
Your answer
Middle name/initial
Your answer
Last name/Apellido *
Your answer
Phone number/telefono *
Your answer
Marital Status/Estado civil *
Address/direccion *
Your answer
Previous Address/Direccion anterior
Your answer
Date of birth/fecha de nacimiento *
MM
/
DD
/
YYYY
Social Security Number/Seguro Social
Your answer
Employer name/Nombre de empleador
Your answer
Occupation/Ocupacíon
Your answer
Pay frequency/frequencia de pago
Number of years at job/Numero de años en su trabajo
Your answer
Apx. gross pay/ingresos brutos
Your answer
Net or take home pay/ingresos netos
Your answer
Other income and amount/otro ingresos por mes?
Your answer
Name of previous employer(s)/Nombre de empleador anterior
Your answer
Have you filed bankruptcy before?/Se ha declarado en quiebra antes? *
Chapter of Bankruptcy you need to file
Do you have children under age 21?/Hijos menores de 21 años?
Number of children under 21 who live at home/Cuantos hijos en su casa?
Your answer
Do you pay child support?/Paga manutencia de hijos?
If you pay child support how much do you pay per month/Cuanto paga por mes de manutencia?
Your answer
Do you own real estate?/Es dueño de propiedades? *
Next
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms