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Married

Legally Separated

Divorced

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Occupation:

I have the following personal assets, in approximate total $ amounts:

Home $:

Vehicle(s) $:

Investment / Vacation Property $:

Stocks / Bonds $:

Cash / Savings / Checking $:

Other:

Type of personal debts and approximate total $ amounts owed:

Credit Card $:

Mortgage $:

Vehicle Loan(s) $:

Personal Loan $:

Medical Bills $:

Rental Unit $:

IRS $:

Other:

I have filed for personal bankruptcy in the past:

Yes. Chapter 7 (liquidation) in this Year:

Yes. Chapter 13 (reorganization) in this Year:

Yes. Chapter 7 (liquidation) in this Year:

Yes. Chapter 13 (reorganization) in this Year:

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I understand my legal issue.

I have a couple of questions.

I have a lot of questions.

Gross annual income:

$25,000 or less

$25,001-$50,000

$75,001-$100,000

$100,001-$125,000

$125,000+

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