Bankruptcy & Taxes Evaluation EspaƱol GUARANTEE: Your confidential, security-encrypted responses can only be viewed by local lawyer J. David Hopkins with strict attorney secrecy for your personal benefit. Please complete this secure form as thoroughly as possible to get the best legal advice! (Sending this Evaluator to the Attorney does not obligate you to hire this law firm.) You Your Full Name (required) Are you Married? Why do we ask?YesNo Spouse's Full Name (required) Children Number of children living with you: Why does it matter?0123456 Ages: Do you pay child support?YesNo Monthly amount: Are you behind?YesNo Arrearage Amount: Does your Spouse pay child support?YesNo Monthly amount: Is your Spouse behind?YesNo Arrearage Amount: Income Your Gross Monthly Income from ALL sources: Your Income Type(s) (choose all that apply) NoneWagesUnemploymentRetirementWorker's CompensationDisabilityChild SupportAlimonySocial SecurityRental PropertySelf-EmploymentOther - State Type: Are you being garnished?YesNo NOTICE: Every bankruptcy filer must provide 6 months of paystubs (employees) & all proof of income. Regarding the Child Support you receive: Are the payments current?YesNo Monthly Amount: Arrearage Amount: Spouse's Gross Monthly Income from ALL sources: Your Spouse's Income Type(s) (choose all that apply)NoneWagesUnemploymentRetirementWorker's CompensationDisabilityChild SupportAlimonySocial SecurityRental PropertySelf-EmploymentOther - State Type: Is your Spouse being garnished?YesNo NOTICE: Every bankruptcy filer must provide 6 months of paystubs (employees) & all proof of income. Regarding the Child Support your Spouse receives: Are the payments current?YesNo Monthly Amount: Arearrage Amount: General 1. Have you/spouse filed bankruptcy in the last 8 years? What's the rule?YesNo 1.a. What type?Ch 7Ch 13 1.b. List date(s): 1.c. Did you get a discharge?YesNo 2. Did you/spouse use Credit Cards within the last 90 days? Why do we ask?YesNo 2.a.What did you buy? 3. Do you have a recent (6 mos) Credit Report?YesNo 4. Were you/spouse ordered to pay any divorce debts? Why is this important?YesNo 5. Did you/spouse own a Business within the last 2 years? What are the implications?YesNo 6. How many years have you lived in Colorado? Why does it matter? 7. Have you given any money or property for any reason to Family or Friends in the last year, including gifts, wages, loans & loan repayments? Why do we ask?YesNo 8. How many creditors do you have? 9. How much is your (& your Spouse's) Total Debt? 9.a. How much of this debt is Secured with property (Cars, Houses. etc.) as collateral? Why is this important? 9.b. How much of this debt is Unsecured - credit cards, medical bills, etc.? Where are you living? What county do you live in? What is your residence type?—Please choose an option—I am buying or I own a Home or TrailerI am buying a CondominiumI am buying a TimeshareRentingLiving with Family or Friend Rent-Free State the value of property you are buying or own: List your mortgage balances & monthly payments Balance - 1st Mtg: Monthly Payment 1st Mtg: Balance - 2nd Mtg: Monthly Payment 2nd Mtg: Keep the house?YesNo Payments current?YesNo In foreclosure?YesNo How much are you behind? Vehicles, RV's, Motorcycles, Boats Did you buy a vehicle within the last 90 days? Why do we ask?YesNo How many vehicles do you have? —Please choose an option—12345 List ALL vehicles below: 1. Year: Make: Model: Amt Owed: Are you Co-owners?YesNo Payments current?YesNoN/A Keep the vehicle?YesNo 1. Year: Make: Model: Amt Owed: Are you Co-owners?YesNo Payments current?YesNoN/A Keep the vehicle?YesNo 2. Year: Make: Model: Amt Owed: Are you a Co-owner?YesNo Payments current?YesNoN/A Keep the vehicle?YesNo 1. Year: Make: Model: Amt Owed: Are you a Co-owner?YesNo Payments current?YesNoN/A Keep the vehicle?YesNo 2. Year: Make: Model: Amt Owed: Are you a Co-owner?YesNo Payments current?YesNoN/A Keep the vehicle?YesNo 3. Year: Make: Model: Amt Owed: Are you a Co-owner?YesNo Payments current?YesNoN/A Keep the vehicle?YesNo 1. Year: Make: Model: Amt Owed: Are you a Co-owner?YesNo Payments current?YesNoN/A Keep the vehicle?YesNo 2. Year: Make: Model: Amt Owed: Are you a Co-owner?YesNo Payments current?YesNoN/A Keep the vehicle?YesNo 3. Year: Make: Model: Amt Owed: Are you a Co-owner?YesNo Payments current?YesNoN/A Keep the vehicle?YesNo 4. Year: Make: Model: Amt Owed: Are you a Co-owner?YesNo Payments current?YesNoN/A Keep the vehicle?YesNo 1. Year: Make: Model: Amt Owed: Are you a Co-owner?YesNo Payments current?YesNoN/A Keep the vehicle?YesNo 2. Year: Make: Model: Amt Owed: Are you a Co-owner?YesNo Payments current?YesNoN/A Keep the vehicle?YesNo 3. Year: Make: Model: Amt Owed: Are you a Co-owner?YesNo Payments current?YesNoN/A Keep the vehicle?YesNo 4. Year: Make: Model: Amt Owed: Are you a Co-owner?YesNo Payments current?YesNoN/A Keep the vehicle?YesNo 5. Year: Make: Model: Amt Owed: Are you a Co-owner?YesNo Payments current?YesNoN/A Keep the vehicle?YesNo Taxes What issues? Have you filed all your taxes?YesNoN/A Refund last year: Did you get the Earned Income Credit? Why?YesNoUnknown Years with taxes owed: Student Loans Do you owe Student Loans? Why ask this?YesNo Are you Current?YesNo Are you:In DefermentIn Default Uploads Although not required at this point you may upload to us any documents (such as credit reports or lawsuits against you) that you feel may help in our analysis. Please DO NOT send any sensitive information! That's the end of the Questions! We will review your answers in detail, construct a bankruptcy plan (including the cost to you) & call or email you with our written Professional Evaluation. To ensure privacy & security when we call, please give us your private telephone & email: (Contacting our office for attorney guidance does not obligate you to hire this law firm.) Your Phone (required) (xxx-xxx-xxxx) Your Email (required) NOTICE:The US Federal Bankruptcy Court is very concerned with honesty & truthful disclosure in bankruptcies. Therefore, they require us to obtain your affirmation that we have disclosed Notice 11 USC 342(b)(2) Notice & 11 USC 527(a)(1) Supplement, (Bankruptcy Disclosures & Court-Ordered Advisements) found here. You will also receive these as attachments in our return email to you. Yes, I received these disclosures. Additional Information you would like us to know By contacting our office for honest advice you verify that the information you have provided above is true & correct so we may give you proper guidance. What to Expect: Please set an in-person or telephone Appointment on the following screen for the hour, date & time of your Attorney Evaluation.