PLEASE COMPLETE THIS FORM BEFORE MEETING ATTORNEY
Part 1: List General Creditors
Include any loans, credit cards, medical bills, finance company debts, delinquent taxes, Judgments, student loans, installment purchases, delinquent child support, etc.
Note: Any real-estate that you own and any mortgage debts will be listed in Part 2. Any vehicles that you own and any vehicle debts will be listed in Part 3.
Amount Owed Name Of Creditor Monthly Payment Notes
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
Part 2: Real Estate
a) Circle One:         Renting         Buying House         Buying Mobile Home        
         If Buying Mobile Home. Made By:____________  Size:_________ Year:_______
b) Purchase Price: $____________________     Purchase Date: _____________   
         Approximate Down Payment: $____________________
c) Monthly Payment (1st. mtg): _________  Payments Current? _____ Months In Arrears:_____ Balance:___________
    Monthly Payment (2nd. mtg):_________  Payments Current? _____ Months In Arrears:_____ Balance:___________
d) Name Of First Mortgage Company:_______________________________________

    Name Of Second Mortgage Company (if any): ___________________________________

   Value of Property:________________________
List Other Real Estate
a) Describe any other land or homes that you own or have a part interest in: ______________
_______________________________________________________________________
_______________________________________________________________________
b) Purchase Price: $____________________     Purchase Date: _____________   
         Approximate Down Payment: $____________________
c) Monthly Payment (1st. mtg): _________  Payments Current? _____ Months In Arrears:_____ Balance:___________
    Monthly Payment (2nd. mtg):_________  Payments Current? _____ Months In Arrears:_____ Balance:___________

d) Name Of First Mortgage Company:_______________________________________

   Value of Property:________________________
    Name Of Second Mortgage Company (if any): ___________________________________
e) If you own or have interest in other property, please use separate sheet and complete sections
    a, b, c, and d with the appropriate information.
Part 3 List Vehicles You Own
Vehicle 1
a) Year: ______ Make: ___________ Model: __________ Suffix such as LX, SE, LS:_____
b) Circle One:   2 door     4 door     hatchback
    Circle One:   4 cylinder     6 cylinder     8 cylinder
c) Odometer miles: ________________     Lease or purchase:_______________
d) Purchase or lease date: _____________
          If owned less than 1 year, purchase price:________________
Complete section e and f if financed or under lien to a creditor
e) Finance Company: _____________ Monthly Payment:____________
          Pay off amount:_______________
f) Was credit life insurance and/or an extended warranty purchased? ________ Keep?________
Staff Use Only NADA Retail:_________________ Use for value: _________________
Vehicle 2
a) Year: ______ Make: ___________ Model: __________ Suffix such as LX, SE, LS:_____
b) Circle One:   2 door     4 door     hatchback
    Circle One:  4 cylinder     6 cylinder     8 cylinder
c) Odometer miles: ________________     Lease or purchase:_______________
d) Purchase or lease date: _____________
          If owned less than 1 year, purchase price:________________
Complete section e and f if financed or under lien to a creditor
e) Finance Company: _____________ Monthly Payment:____________
          Pay off amount:_______________
f) Was credit life insurance and/or an extended warranty purchased? ________ Keep?________
Staff Use Only NADA Retail:_________________ Use for value: _________________
Vehicle 3
a) Year: ______ Make: ___________ Model: __________ Suffix such as LX, SE, LS:_____
b) Circle One:   2 door     4 door     hatchback
    Circle One:     4 cylinder     6 cylinder     8 cylinder
c) odometer miles: ________________     Lease or purchase:_______________
d) Purchase or lease date: _____________
          If owned less than 1 year, purchase price:________________
Complete section e and f if financed or under lien to a creditor
e) Finance Company: _____________ Monthly Payment:____________
          Pay off amount:_______________
f) Was credit life insurance and/or an extended warranty purchased? ________ Keep?________
Staff Use Only NADA Retail:_________________ Use for value: _________________
Part 4 Excluding household goods, list any other items that you own which have a value of more than $500 (boats, computers, expensive items of Jewelry, collectibles, etc):
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Part 5 Attach a copy of a typical pay stub for you & for your spouse.
Note: If you are married and living together, a copy of your spouses pay stub will be needed, even if the spouse will not file.

Part 6 Items that would be especially helpful for you to bring to your initial interview:

  1. Copy of your tax bill for any land or home that you own or have a partial ownership interest in. Tax bills provide the tax map number for your property and often tell us the tax value of the property.
  2. Copy of loan contracts, copy of lawsuits, purchase documents for vehicles and mobile homes.