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      DOAN LAW FIRM BANKRUPTCY INTAKE SHEET

      Complete this Bankruptcy Intake Sheet to the best of your ability and we can immediately let you know whether you qualify to file Chapter 7 or Chapter 13 Bankruptcy Relief. Upon submission, it will be reviewed by an attorney, not a paralegal, who will assess your case and let you know whether or not you qualify to file. All information submitted is confidential and is fully protected by the attorney-client privilege. If you qualify to file, you would STOP paying your creditors immediately and we would start representing you with as little as $100.00 down.

      Date

      Have you Consulted for Bankruptcy Before?

      Filed Bankruptcy Before?

      How did you hear about us?
      InternetReferralPennysaverPhonebookYelpOther

      WE FILE 2 TYPES OF CONSUMER BANKRUPTCIES: Which do you prefer?
      Ch 7 - Remove debt forever!Ch 13 - Consolidate & Repay debt over 3-5 years

      A. PERSONAL INFORMATION

      First Name

      Middle Name

      Last Name

      Street Address (Residence)

      City

      Zip Code

      Have you lived in California for the last 2 years?
      YesNo

      If not California, where did you live 2 years ago?

      Day Phone

      Work Phone

      Cell Phone

      Age

      Marital Status
      SingleMarriedDivorcedSeparatedWidowed

      Number of Dependents

      SPOUSE'S INFORMATION

      First Name

      Middle Name

      Last Name

      Street Address (Residence)

      City

      Zip Code

      Have you lived in California for the last 2 years?
      YesNo

      If not California, where did you live 2 years ago?

      Email

      Day Phone

      Work Phone

      Cell Phone

      Social Security Number

      Age

      Marital Status
      SingleMarriedDivorcedSeparatedWidowed

      Number of Dependents

      B. DO YOU OR YOUR SPOUSE OWN ANY REAL ESTATE? NoYes
      ( if No, skip to C. )

      Description
      (Home, Condo, etc. )      		Present ValueValue Based Upon? (appraisal/comps/etc)Year PurchasedPurchase Price

      $

      $

      Estimate if unknownBalance OwedMonthly PaymentInterest Rate# Months LateReinstatement Amount (Arrears)
      First Mortgage

      $

      $

      Second Mortgage

      $

      $

      Other Liens

      $

      $

      Have you filed a Homestead Declaration?
      NoYesDon't Know

      Have you received a "Notice of Default"?
      NoYes
      When?

      Is there a Sale Date Pending?
      NoYes
      When?

      C. CAR/MOTORCYCLE INFORMATION – Give your best estimates. List all cars, whether PAID OR NOT, IN YOUR NAME OR NOT.

      YearAuto MakeAuto ModelMileageMo/Yr BoughtFair Market ValueLoanName of Lien HolderBalance OwedMonthly Payment# Mo's Late

      PurchaseLease

      PurchaseLease

      PurchaseLease

      D. OTHER DEBT INFORMATION – Give your best estimates

      Please Give Your Best EstimatesApprox # of ItemsApprox Total Combined BalancesApprox Total Charges within last 6 MonthsApprox Total Payments within last 6 MonthsMonths Late
      1.Credit Cards (i.e. Visa, MC, AMEX, Discover )

      2.Medical Bills

      3.Personal Loans (i.e. Credit Union, Family, Friends)

      4.Repossessions

      5.Student Loans

      6.Support Obligations

      7.Taxes

      8.Traffic Fines or Restitution

       Totals:

      E. RETIREMENT, 401K, IRA, EDUCATIONAL IRA, STOCK, BANK ACCOUNTS & OTHER VALUABLE ASSETS – Give your best estimates.

      Retirement Plan (i.e. 401K, IRA, PERS, Profit Sharing)

      Vested Value
      $

      Loans Taken Against It
      $

      Monthly Contribution You Make
      $

      Bank/Savings Accounts
      $

      Stocks
      $

      Cash value of life insurance
      $

      Other valuable assets worth > $300
      $

      F. EMPLOYMENT & INCOME INFORMATION – Please estimate you and your spouse’s GROSS INCOME (income before taxes & deductions)

      Current Occupation

      Last year gross income
      $

      Hours work each week

      Hourly Rate
      $ /hour

      Total Past 6 Months Income
      $

      Current Monthly Gross
      $

      Spouse's Current Occupation

      Last year gross income
      $

      Hours work each week

      Hourly Rate
      $ /hour

      Total Past 6 Months Income
      $

      Current Monthly Gross
      $

      G. Monthly Living Expenses IF NO DEBT – Give your best estimates

      Monthly ExpenseEstimate
      Rent/Total Mortgage Payments$
      Gas & Electricity$
      Water & Sewage$
      Phone$
      Cable/Satellite/Internet$
      Home Maintenance$
      Food$
      Clothing/Laundry/Dry Cleaning$
      Out-of-pocket medical & dental expenses$
      Transportation/Gas$
      Recreation, entertainment, magazines$
      Charitable Contributions$
      Insurance - Homeowner's/Renter's$
      Insurance - Medical/Dental/Eye (out of pocket)$
      Insurance - Auto$
      Car Payments$
      PAST Taxes (not already deducted from pay)$
      Childcare/Daycare$
      Spousal/Child Support (court ordered)$
      Support -other (not court ordered)$
      Business Expenses/Tools of Trade$
      Student Loan Payments$
      Storage$
      Pets$
      Gardener$
      Gym,Parking,Bank Fees$
      Auto Upkeep$
      Fines/Tickets$
      School/Books/Education for Trade$
      TOTAL (Automatically added)$

      Do you have or expect to receive any income or property from the following:

      Royalties?
      YesNo

      Trust Fund?
      YesNo

      Inheretance?
      YesNo

      Second Job?
      YesNo

      Life Insurance?
      YesNo

      MSA or Divorce?
      YesNo

      Overtime/Commissions?
      YesNo

      If Yes, please explain:

      Have you transferred/sold assets > $1000 in last 2 years?
      YesNo
      Please explain:

      Are you expecting a tax refund this year?
      YesNo
      Please explain:

      Are there any co-signers on any of your accounts?
      YesNo
      Please explain:

      Are you suing anyone? (i.e. Work Comp, MVA, etc)?
      YesNo
      Please explain:

      Has any of the following occurred in the past 90 DAYS?

      1. $600 or more of wages garnished?
      2. $600 or more of bank account money taken?
      3. Judgment lien entered against you or lien on home?

      If you answered yes on any of the above, please explain (who/how much/when):

      Please check mark any other legal areas that may apply to you:


      The San Diego Bankruptcy Attorneys of the Doan Law Firm, California’s Largest Family of Attorneys, Specializing in Bankruptcy, and Non-Bankruptcy Alternatives.

      At Doan Law our Bankruptcy Attorneys will answer all your Chapter 7 and Chapter 13 Bankruptcy questions. Call us now to meet with one of our expert bankruptcy attorneys, at any of our San Diego Bankruptcy offices, call (760) 450-3333.

      For more information from an experienced San Diego Bankruptcy Attorney from Doan Law Firm, please CLICK HERE. Hablamos Espanol.

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      Oceanside Bankruptcy

      Doan Law Firm
      1930 S Coast Hwy #206
      Oceanside, CA 92054
      Phone: (760) 450-3333

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      Doan Law Firm
      312 S Juniper #101
      Escondido, CA 92025
      Phone: (760) 746-4476
      Fax: (760) 746-4436

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      Doan Law Firm
      4817 Palm Ave.
      Suite I
      La Mesa, CA 91942
      Phone: (760)-746-4476

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      Doan Law Firm
      333 H Street
      Suite 5000
      Chula Vista, CA 91910
      Phone: (760)-746-4476

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      Doan Law Firm
      185 West F Street,
      Suite 100
      San Diego CA 92101
      Phone: (760)-450-3333

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