Bankruptcy Client Intake Sheet

Are you married?

Yes

Are you filing a joint petition?

Yes

List all assets in your name alone or held jointly with another and the approximate amout you would likely receive if you were to sell each asset:

Asset

House you live in:

Other real estate:

Furniture:

Automobile 1:

Automobile 2:

Boat:

Jewelry:

Asset

Money in the bank:

Cash on hand:

Cash surrender value of life insurance:

List all oustanding debt obligations

Liability Type

Total Credit Card Debt:

Total Medical Bills:

Total Personally Guaranteed Business Debt:

Total Debt owed by business alone:

Mortgage on Home:

Mortgage on other real estate:

Liability Type

Auto Loan for Vehicle 1:

Auto Loan for Vehicle 2:

Judgments against you:

IRS Debt:

Other Debt:

* = Input is required