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The information you provide on this form is secure, confidential and cannot be shared with anyone. You do not have to answer all the questions in this form, but the more information you provide us will allow our banruptcy professionals to better adivse you when they respond to your inquiry.
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| Your Information |
| First & Last Name: |
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| Your Spouse's Name: |
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| Address Street 1: |
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| Address Street 2: |
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| City: |
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| County: |
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| Zip Code: |
(5 digits) |
| State: |
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| Main Phone Number: |
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| Secondary Phone: |
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| Email: |
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| Marital Status: |
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| How many people, including you, are living in your house?: |
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| How Much Do You (and your spouse) Owe For Unsecured Debts. . .? |
| Credit Cards?: |
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| Personal Loans? |
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| Income Taxes?: |
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| Child / Spousal Support?: |
(non-dischargeable debt) |
| Student Loans?: |
(generally non-dischargeable debt) |
| Business Related Debt?: |
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| Other?: |
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| How Much Do You Owe For Secured Debts. . . ? |
| 1st Mortgage on your home: |
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| 2nd Mortgage / Equity Loan?: |
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| Any other /additional loans secured by your home?: |
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| Preliminary Bankruptcy Qualification Information |
| Have you ever filed bankruptcy? |
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| Have you lived in Michigan for the last 6 months?: |
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| If you are married, has your spouse ever filed for bankruptcy protection?: |
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| If you are married, has your spouse lived in Michigan for the last 6 months?: |
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| Property Information |
| Property Type: |
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| Occupancy: |
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| Purchase Price: |
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| Fair Market Value: |
(In today's market, how much do you realistically think you can sell the home for?) |
| Mortgage Balance: |
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| Second mortgage balance:: |
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| Monthly Household Income and Expenses |
| Monthly Household Income (before taxes and other deductions are taken from your pay): |
(Include debtor and co-debtor information. You will also need to include income of your non-filing spouse, even if they are not filing for bankruptcy with you. This is required under the bankruptcy code.) |
| Monthly mortgage or rent payment: |
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| Second mortgage payment: |
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| 1st Car payment (loan or lease payment): |
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| 2nd Car payment (loan or lease): |
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| Monthly child support and/or alimony: |
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| How many people are living in your house?: |
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