Free Consolutation

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1Contact Information

2Watch Videos

3Review Exemptions

4Step 1 of 3 (General Information)

5Step 2 of 3 (General Questions)

6Step 3 of 3 (Financial & Budget)

Hello, I would like to provide you with FREE information, first you need to do the following:

Step 1 :

You must learn what creditors can do and what your rights are, including a little about the about the bankruptcy process.

Step 2 :

I will also need to learn about your unique situation.

To get started, please provide your full legal name, phone number and email. We will not share your information with anyone. This is simply a way for us to get in contact with and understand your current situation.

Full Legal Name (please include middle name)*

Phone*

Email*

Type of Bankruptcy*

Individual

Business

General Questions
Step 2 of 3
Your answers to these general questions will help me to understand your unique situation, including what you have done or has been done to you. Many people make decisions that do not lead to problems outside bankruptcy, but in a bankruptcy those same innocent decisions can be disastrous. Based on your answers I will customize my advice with the goal of helping you avoid problems, if possible. I realize this is a lot of information, but accurate information will be your best friend. A friend of mine says “garbage in, garbage out”. He is correct because if I get the wrong information from you I will most likely give you the wrong legal advice.

SOME REQUIREMENTS OF THE BANKRUPTCY LAWS ARE “JUST MEAN AND SCARY FOR NO OBVIOUS BENEFIT” TO QUOTE A PROMINENT BANKRUPTCY JUDGE
Effective October 17, 2005, the Bankruptcy Code was amended in such a way as to try to interfere with the relationship between attorneys and clients. Clients are now described as “assisted persons” and attorneys are referred to a “debt relief agency.” To quote a prominent Bankruptcy Judge [the new legislation provisions] “require debt relief agencies to give notices and warnings that are not relevant in many of the circumstances in which they must be given, that will be false in some required contexts and that are just mean and scary for no obvious benefit.” This legislation (sponsored at great expense by the lobbyists and executives of the consumer credit industry) shall not stop me from rendering the proper advice and information to which you are entitled to. Particularly, I question the assertion that filing a bankruptcy is “routine.” I advise you to question me about any provision of these forms that contradicts anything that I may have said to you.

General Questions
Step 2 of 3
Your answers to these general questions will help me to understand your unique situation, including what you have done or has been done to you. Many people make decisions that do not lead to problems outside bankruptcy, but in a bankruptcy those same innocent decisions can be disastrous. Based on your answers I will customize my advice with the goal of helping you avoid problems, if possible. I realize this is a lot of information, but accurate information will be your best friend. A friend of mine says “garbage in, garbage out”. He is correct because if I get the wrong information from you I will most likely give you the wrong legal advice.

I / We watched the educational videos about the bankruptcy process.*
It is important to note that these videos are instrumental in helping you understand how bankruptcy works. Therefore, if you did not watched all 9 videos, please do so before sending this form to our office.

Yes

No
THE FOLLOWING ARE GENERAL QUESTIONS REGARDING YOUR CURRENT SITUATION. IF YOU ARE MARRIED PLEASE ANSWER THE QUESTIONS THAT ARE APPLICABLE TO EITHER YOU AND/OR YOUR SPOUSE
Is there an emergency requiring immediate filing?*

Yes

No
Explain Why*
Is there a foreclosure or trustee's sale pending?*

Yes

No
Are creditors contacting the company demanding payment?*

Yes

No
Is a lawsuit pending or completed?*

Yes

No
What is the status of the lawsuit? When was it served or approximately when was it completed and a judgment entered?*
Do you understand there are two on-line courses required as part of a bankruptcy?*
The first, a credit counseling course, must be completed before filing, The second, a financial management course, must be completed after filing the bankruptcy.

Yes

No
Are creditor calling at work/home/neighbors?*

Yes

No
Do you owe any back child support or alimony?*

Yes

No
Do you understand that your exempt property could be sold to pay back child support and/or alimony Section 522(c)(1))?*

Yes

No
How much do you owe in back child support and/or alimony and to whom?*

Is a law suit pending or completed?*

Yes

No
What is the status of the lawsuit? When was it served or approximately when was it completed and a judgment entered?*
Have your wages or checking accounts been garnished?*

Yes

No
By whom? Approximately how much and when?*
Is a landlord trying to evict you from your property?*

Yes

No
Did your landlord obtain a Forcible Entry & Detainer Order? Or the creditor obtain a court order appointing a receiver? If so, when?*
Do you participate in any Internet or social media sites where you offered expensive items for sale or discussed expensive items you own or debts you owe?*
NOTE: If the social media setting is set to "public" then anyone, including creditors and collection companies, can see all your posts. Consider using "private" settings in order to protect you and your family from unwanted stalking.

Yes

No
Briefly explain the sale of property or discussion via social media.*
Are there any co-signers for any company debts?*
This includes yourself

Yes

No
Briefly explain who the co-signers are and what they guaranteed to pay.*
Other debt problems?*

Yes

No
Please Explain*
THE FOLLOWING QUESTIONS RELATE TO CERTAIN ISSUES THAT DETERMINE WHETHER OR NOT IT IS APPROPRIATE TO FILE A BANKRUPTCY AND, IF SO, WHEN TO FILE.
Do you ever expect an inheritance?*
Understand you will be required to surrender any inheritance after a bankruptcy to your creditors. In a chapter 7 that surrender period is 6 months; in a chapter 13 it is the life of the plan (3-5 years).

Yes

No
Briefly describe what you expect may happen*
Do you understand that every debt you owe or might owe must be listed in the bankruptcy?*
Understand that only the debts you owe on the day of filing the bankruptcy will be dealt with in the bankruptcy. So any new debts you incur after bankruptcy will be your obligation.

Yes

No
IMPORTANT: Do you normally receive a tax refund?*
Understand that any refunds you have not collected by the date a bankruptcy is filed will be sent to the bankruptcy trustee.

Yes

No
List the year and approximately how much you received or expect to receive.*
Does anyone owe you money or you have a right to any assets?*
Explain even if you never expect to collect the money or receive the asset.

Yes

No
Explain how much you are owed or what rights you may have.*
Do you have a right to sue anyone for anything (this includes vehicle accidents, wrongful termination, collection company abuse or any other type of right)?*
If so, explain what for and how much you might be owed.

Yes

No
Briefly, what happened which you believe gives you a right to sue someone?*
Such as: a car accident. How much are you owed and for what?
In the last 4 years have you sold, traded or gave away any item of value?*
This would include houses, land, cars, businesses, generally any items of value. It is best to explain the circumstances so we can discuss any issues.

Yes

No
What did you transfer (sell, trade or use as collateral)? How much was it worth and how much did you receive?*
In the last 4 years have you used your property to obtain a loan? (like those terrible title or registration loans)*
For instance: using your vehicle to obtain a loan, such as a title loan. It is best to explain the circumstances so we can discuss any issues.

Yes

No
What did you use as collateral for a loan? How much was it worth and how much did you receive?*
Do you owe any money to any friend or relative?*

Yes

No
How much do you owe to family or friends?*
In the two years have you paid family or friends back on any loan they made to you?*

Yes

No
How much did you repay family or friends in the last two years?*
If you repaid any loans from family or friends we must discuss the ramifications.
CREDIT CARDS, BANKS AND OTHER DEBTS:
Are there any debts which are business or non-consumer debts?*
Business debts include student loans, taxes, or loans, credit card charges or leases used for business purposes.

Yes

No
Approximately how much do you owe which is business or non-personal debts. Make sure to include both secured and unsecured*
* Make sure to include debts for investment properties as secured business debts.
* Also include any monies you charged on your personal credit cards but used for business purposes.

Do you owe money on any credit cards or signature loans (this includes old debts)?*
Answer "yes" if you had credit cards in the past that you did not pay off. Answer "yes" even if the creditor "wrote off" the debt. To write off a debt does not mean the debt is gone, it means the creditor will mostly likely sell it to a debt collector.

Yes

No
Approximately when did you last use a credit card, signature loan or balance transfer?*

You only need to provide the year and approximate date and month. It is okay to guess as to the day and month, but not the year.
If bankruptcy is in your future do you understand that you must stop using credit cards now?*
This is very important.

Yes

No
In the last 6 months did you make any charges/cash advances/balance transfers of more than $500 on a single credit card or signature loan?*
It is better to include all transfers or charges so we can discuss the specifics in more detail.

Yes

No
Did you use a store credit card to finance expensive items at that store? For instance: using a Best Buy credit card to finance a computer at Best Buy.*

Yes

No
What did you buy and how much is still owing on the credit card.
We will talk about secured debts.
Do you have any cash reward cards, gift cards, etc worth more than $100?*

Yes

No
Where do you bank (list all banks)?*

BEWARE: I DO NOT RECOMMEND THAT ANYONE BANK AT WELLS FARGO IF THEY ARE CONSIDERING BANKRUPTCY (THEY WILL FREEZE YOUR ACCOUNTS). BEFORE CLOSING YOUR ACCOUNT(S) MAKE SURE TO GET 12 MONTHS OF BANK STATEMENTS (YOU WILL NEED THESE LATER).
Do you owe any money to your current bank (credit cards, car loans)?*
If bankruptcy is in your future please move to a new bank now, after you get 12 months of bank statements. Request and use a debit card.
DO NOT PUT YOUR NAME ON ANY ACCOUNT WITH SOMEONE ELSE AND DO NOT PUT YOUR MONEY INTO SOMEONE ELSE'S BANK ACCOUNT.

Yes

No
Unable to open a bank account?

Try: Walmart's Blue Bird American Express pre-paid debit card. Make a deposit in Walmart and the funds are immediately available. Another option: PayNearMe. It is an easy way to use cash for making online purchases, paying bills and more. You can pay by scanning a barcode in one of 28,000 stores near you. Once the payment code is scanned by the store cashier, simply hand your payment in cash to the cashier and you will receive a receipt as proof of payment. www.paynearme.com/en
Is anyone an authorized user on your credit card?*
If yes - you should remove them as an authorized user prior to filing a bankruptcy. Talk to Diane about this issue.

Yes

No
Is your name on anyone else's debt (credit card, land, vehicle, etc.)?*

Yes

No
Please explain what type of debt.*
Do you owe any federal or state taxes?*

Yes

No
Back taxes: list who you owe (IRS or state), approximately how much and for what tax year.
In the last 5 years did you file any tax returns late?*
In other words, were the returns filed after the date they were due, including extensions.

Yes

No
List year of the returns(s) and approximately when the return(s) was actually filed.
For example: 2013 federal return, no extension, filed November 2014. Owe $2,400.
In the last 2 years did you use a credit cards to pay taxes?*

Yes

No
When and how much did you charge on a credit card to pay taxes?
For example: 2013 federal return, no extension, filed November 2014. Owe $2,400.
Has the IRS/or any state taxing authority garnished your wages or recorded a lien? A lien is a document recorded with the County Recorder’s office.*

Yes

No
Garnishment for back taxes or liens. Explain the year the taxes were due, when they were filed and how much was garnished or liened.
Do you have any payday loans?*

Yes

No
Do you understand that you should close any bank account the loan company may be able to access. Make sure you get 12 months of bank statements before closing any bank account (otherwise they may charge you for the statements when you need them later).*

Yes

No
Do you have any loans with a credit union?*
Beware of an cross-collateralized accounts with your credit union. I will explain what this means when we talk.

Yes

No
List all loans with the credit union (vehicle, signature or credit cards).*
Most credit unions tie all your loans to any secured debts "cross-collateralized". Which means credit cards and personal loans are tied to your mortgage or vehicle loan.
Do you understand that it is best to move ALL your money out of the credit union so they will not set off (take) your money.*
WARNING: Beware of an cross-collateralized accounts with your credit union.

Yes

No
Do you have any student loans or did you guaranty a student loan for another person?*
Beware of an cross-collateralized accounts with your credit union. I will explain what this means when we talk.

Yes

No
Do you understand that your student loans or student loans you guaranteed are not discharged in bankruptcy without bringing a separate action?*
A separate action is filed in the Bankruptcy Court and will involve additional legal assistance. This firm does not prosecute student loan complaints. We will try to provide you with recommendations for attorneys who may be able to help.

WARNING - 3/9/18 - In direct violation of 11 USC 525, I have received distressing news from other lawyers across the county that the Department of Education and its student loan servicers are kicking bankruptcy debtors out of their Income Driven Repayment plans. This can happen if debtors file Chapter 7 or Chapter 13 and regardless of whether they were current on the student loan payments. This potentially illegal expulsion, even if temporary, can upend the debtor's progress towards getting a Public Student Loan Forgiveness or other cancellation of their loans.

Yes

No
In the last two years did you pay any tuition for dependants over the age of 18?*
Beware of an cross-collateralized accounts with your credit union. I will explain what this means when we talk.

Yes

No
Do you understand that the bankruptcy judge may require the school that received the tuition repay it to your creditors?*
The school that had to surrender the tuition may then require the student to pay the tuition or they may withhold the diploma or information regarding the status of classes until the tuition is paid. This is a changing area of law.

Yes

No
Do you have a paid warranty (such as a vehicle warranty), or have you pre-paid for anything: plane tickets, vacations, medical/dental procedure, summer camp or any other advanced deposit?*
If so, the trustee may go after these funds.

Yes

No
Do you have any outstanding fines or penalties? (e.g.: court fines or tickets)*
If so, these may not be discharged in a bankruptcy.

Yes

No
Are you renting or leasing anything (cars, apartment, house, equipment, land)?*

Yes

No
Leases
What are you leasing: an apartment, vehicle, or other?
HOME, LAND AND VEHICLES
Do you (or your spouse) own a home, mobile home, timeshare or land anywhere in the world?*

Yes

No
Describe (e.g. 2 bed/3 bath, 1340 sq ft):*

How much is your home worth at this time and in its current condition?*

The name(s) on the title of the house or land:*

SPOUSE Are there any loans on this property?*

Yes

No
Name of first Lender*

What is the total amount owed to your first lender?*

Are you behind on payments to your first lender?*

Yes

No
Approximately how much is owed to your first lender in order to being the loan current?*

SPOUSE Is there a second lender on this property?*

Yes

No
Name of second lender*

Debt owed to second lender*

SPOUSE Are you behind on any payments to your second lender?*

Yes

No
Payment arrears to second lender?*

How much must you pay in order to bring the payments current?
SPOUSE Are there any other loans on this property?*

Yes

No
Name of third lender:*

Total amount owed on any other loans secured on this property*

Are you behind on any other mortgage payments besides your first and second mortgages?*

Yes

No
How much would you need to pay in order to bring any other debts, not including the first or second mortgages, current?*

Is there a foreclosure or trustee’s sale pending?*

Yes

No
What is the date and time of foreclosure?
If there is a trustee's sale pending, please provide us a copy of trustee sale documents.

**It is your responsibility to confirm the trustee sale date and at all times to keep track of that date and any postponements; including the entire time your bankruptcy is pending. This office will not monitor the date of sale for you, but we be happy to answer your questions regarding the trustee sale process.

Are any of the home loans a VA loan?*
VERY IMPORTANT!

Yes

No
Is there or has there been a modification of any of the home loans?*

Yes

No
Was this a permanent modification?*

Yes

No
Is there a homeowner's association?*

Yes

No
Are the homeowner's association payments current?*

Yes

No
When was the last payment made?*

Approximately how much is due in order to bring this HOA current?*

Has the homeowners' association filed a lawsuit?*

Do you understand that the bankruptcy will not allow you to keep your home unless you pay the homeowner's dues?*

Yes

No
Do you understand that as long as you own the property the bankruptcy will not protect you from being sued for homeowner's dues owed AFTER filing the bankruptcy?*

Yes

No
Was there a short sale or foreclosure in the last 6 years?*

Yes

No
Please describe:*

In the last 10 years have you made any large mortgage payments in addition to the regular monthly payment?*

Yes

No
Please describe:*

Do you own another home, land or timeshare?*

Yes

No
Describe (e.g. 2 bed/3 bath, 1340 sq ft):*

Fair Market Value?*

The name(s) on the title of the house or land:*

Are there any loans on this second property?*

Yes

No
List of Lenders*
Lender
Debt Owed
If you are behind on payments how much is due in order to bring the loan current?

Is there a pending foreclosure or trustee’s sale on this second property?*

Yes

No
what is the date and time of foreclosure:*

Is there a homeowner's association on this second property?*

Yes

No
Are the homeowner's association payments current on this second property?*

Yes

No
When was the last payment made?*

How much is owed and for how many months?*

Do you own any other real estate? (e.g. house, land, timeshares, etc)*

Yes

No
List of Real Estate*
All fields must be filled out
Describe - such as is it raw land, a timeshare, summer house?
Fair Market Value
Debt Owed

Important Notice
If you are behind on your house payments: here is a link to the Home Affordable Modification Program (HAMP): http://www.justice.gov/ust/eo/public_affairs/consumer_info/docs/HAMP_Fact_Sheet.pdf (Link opens in new tab)
You can also go to: Making Home Affordable at www.makinghomeaffordable.gov (federal web site). (Link opens in new tab)
Vehicle Information
List all vehicles in your name (or that of your spouse), no matter who is driving that vehicle. List all debts on any of those vehicles. List the fair market value of each vehicle using the resources below. Resources for fair market value: www.kbb.com (YOU MUST USE PRIVATE PARTY VALUE) or www.edmunds.com or www.NADA.com I cannot give you good advice without an accurate fair market value.
Do you own any vehicles?*
This includes both vehicles you are paying for and those that are completely paid off. This also includes any vehicles your name is on, even if someone else drives it.

* Do no answer yes if you only own leased vehicles.

Yes

No
Do you, your spouse or your child have a handicapped plate or placard?*

Yes

No
List of Vehicles*
* You must list the Kelly Blue Book private party value - www.KBB.com. I cannot help you without this information.
* Do not list leased vehicles
Model / Make / Year
Name(s) on the title
Year Purchased
Fair Market Value
Debt Owed

Of your current vehicles, did you refinance any vehicle after it was originally purchased?*

Yes

No
Refinancing a vehicle includes a title or registration loan. Which vehicle, who is the lender and how much are they owed?*
Did you finance any of these vehicles with a credit union?*

Yes

No
ASSETS, INCLUDING BUSINESSES
Other than vehicles or houses, are there any valuable items that you are concerned about losing?*

Yes

No
Describe the items(s) and include their fair market value
Do you have any interest in any business that is operating today?*
This includes a business that does not have a formal LLC or corporate name "sole proprietorship".

Yes

No
Briefly describe the business*
What would a third party pay for that interest in the business?*

Normally you can value a business by subtracting liabilities (debts, including leases) from assets (including accounts receivable). Just provide us with a general guess.
Does the business have any assets, inventory, or contracts?*

Yes

No
Briefly describe, make sure to include accounts receivable, etc.*

Does the business have any leases on anything (cars, equipment, land)?*

Yes

No
What property is leased?*

Did you sign any personal guaranty for any company debts?*
(includes leases, credit cards, or other extensions of credit) Such as signing on the business lease or credit card.

Yes

No
Explanation of personal guaranty*

Do you understand that by filing for bankruptcy you may surrender your ability to control your business?*
This result will differ if filing a chapter 11 or 13

Yes

No
Did you have any interest in any business in the last 8 years, even if it is no longer in operation?*

Yes

No
Do you have a trust?*

Yes

No
Is the trust revocable or irrevocable?*
Revocable means you can change the trust

Yes

No
Describe the assets in the trust.*
Could your name(s) be on someone else's trust?*

Yes

No
Please describe the trust your name is on*
For instance - my name is on my mother's trust, but she is in excellent health and does not have valuable property.
Do you have stocks, bonds (including savings bonds) or mutual funds?*

Yes

No
Please describe*
For instance - my name is on my mother's trust, but she is in excellent health and does not have valuable property.
Do you have any retirement accounts?*

Yes

No
Please describe*
For instance - my name is on my mother's trust, but she is in excellent health and does not have valuable property.
In the last 120 days have any contributions be made into those retirement account(s)?*
It is important to discuss if these contributions were required as part of your employment.

Yes

No
Important questions:How long have you had the IRA? How was it setup? Was it a rollover from another retirement account? Did you cash out your retirement plan and then roll it over? What have you used withdrawals on?*
It is important that you talk to your plan administrator or CPA in order to determine if all changes following the regulations governing the retirement plan. Failure to follow the regulations could result in losing your retirement plan in bankruptcy.
Do you have any health savings accounts?*

Yes

No
Please describe*
Did you inherit any retirement accounts?*

Yes

No
Please describe*
Do you have any annuities or other such accounts?*

Yes

No
Please Describe, make sure to include the date the annuity was established and if the beneficiary is a family member.*
NOTE : it is very important to make absolutely certain that your retirement accounts are ERISA qualified. You can talk to your employer, HR, or plan administrator, or the word ERISA may be on your plan summary..
Do you have any education IRA (such as 529 or 530 accounts) or a qualified state tuition program (521c)?*
WARNING : THE ACCOUNT MUST BE ESTABLISHED FOR MORE THAN 2 YEARS. ANY MONIES DEPOSITED IN THE 12 MONTHS BEFORE FILING BANKRUPTCY ARE NOT PROTECTED. THERE ARE ADDITIONAL LIMITS ON THE AMOUNTS CONTRIBUTED WITHIN CERTAIN TIME PERIODS.

Yes

No
Have you deposted any funds in the last 12 months?*

Yes

No
Were those funds deposted more than 12 months ago, but less than 24 months?*

Yes

No
Were the funds deposited more than twenty four months ago?*

Yes

No
Miscellaneous
Have you (or your spouse) been divorced in the last 10 years?*

Yes

No
Are there any assets that are still to be delivered to you (or your spouse)?*

Yes

No
List the assets, their value and when you are to take control.
Are there any co-debtors?*
In other words did anyone else (parent, friend or ex-spouse) sign on any of your debts or you signed on their debts. For example a parent is a co-debtor if they sign a loan on a vehicle along with their child.

Yes

No
List the co-debtors, include what you signed for and the current debt amount.
In the last twelve months were there any bounced checks which have not been paid?*

Yes

No
Were any household furnishings, jewelry or vehicles used as security for a loan?*
Like those horrible title or registration loans.

Yes

No
What items were used as collateral for a loan? Make sure to include the fair market value of the item and the total debt owed.
YOU MUST -- USE ACTUAL REPLACEMENT VALUE (506(a) (2)) and additional legal action will be necessary in Bankruptcy Court.)
Do you have property in pawn?*

Yes

No
Has the redemption period expired to reclaim your property?*

Yes

No
IMPORTANT:
IF ANY OF THE FOLLOWING SITUATIONS APPLY TO YOU THEN WE WILL NEED TO DISCUSS THE CONSQUENCES OF FILING FOR BANKRUPTCY.
Were all the loan applications signed in the last 10 years truthful?*

Yes

No
Are there any judgments or threatened lawsuits for destruction of property or for injury inflicted (like DUI)?*

Yes

No
Please Explain
Do you understand that any debts from obtaining money, property, or services by fraud may survive the bankruptcy?*

Yes

No
Do you understand that debts based on fraud while acting in a fiduciary capacity (such as embezzlement) may survive the bankruptcy?*

Yes

No
Thanks, only one more section to go!
Please proceed to the final step of this financial Information and we will have all we need to schedule your free consultation. WARNING: TO AVOID LOSING YOUR INFORMATION DO NOT TURN OFF YOUR COMPUTER OR LEAVE THIS SITE UNTIL THE FORM IS SUBMITTED (YOU WILL RECEIVE A CONFIRMATION WHEN IT IS SUBMITTED). PLEASE NOTE - WE DO NOT HAVE ACCESS TO ANY INFORMATION UNTIL THE FORM IS SUBMITTED.

Step 3 of 3 - Financial Information & Monthly Budget
This form details how much you spend each month for basic living expenses. Be sure to include the MONTHLY (not yearly) amount for these expenses. In Arizona your utility bill is probably higher in the summer than the winter. Therefore take an average covering the last 12-month period. If you are married and your spouse does not reside with you please make a spreadsheet of their expenses and send them to our office. Make sure to include your name on the spreadsheet.
MONTHLY LIVING EXPENSES
First Mortgage
monthly rent or mobile home payment
Second mortgage (if applicable)
Third mortgage (if applicable)
Real estate taxes
If it is not included in mortgage payment(s).
Home insurance
if it is not included in house payment(s).
Homeowner's Association (HOA) fees
Other real estate payment
(house, raw land or timeshare)
Average Monthly Expenses
Utilities
Electricity, gas, water, phone, garbage (monthly - just a guess is fine)
Food (Monthly)
Out of Pocket Medical expenses
Not paid by insurance
Do you have any children that you are supporting?*

Yes

No
Child Care Expenses*
School Expenses (do not include lunches)*
Taxes
Taxes that are not deducted from your wages
Please provide amount and short explanation (such as "self-employed")

Do you owe back taxes?*

Yes

No
List Back Taxes*
Click the plus icon to add up to 25 entries
Year
Amount
Monthly Payment

Insurance
Automobile Insurance
Monthly / Quarterly

Life Insurance
NOT deducted from a paycheck

Health Insurance
NOT deducted from a paycheck

Disability Insurance
NOT deducted from a paycheck

Other Insurance
Any other insurance not specified

Vehicles
Make sure to list all vehicles you own (whether paid in full or not); include any vehicles you own with someone else. List all payments, including leases.
List of Vehicles
Click the plus icon to add up to 25 entries
Monthly Payment
Leased? (Yes / No)

Monthly average
all vehicles: gas, oil changes, maintenance, tags
Other Monthly Expenses
Alimony or Child Support
Payments for someone outside your home
For instance, sending Grandma $200 per month to help pay her utility. We will need a history in order to show why this should be included as an expense.
Please Explain
Professional Dues or Union Dues not deducted in a paycheck
This may be an annual expenses, but you should divide it by 12 in order to determine the average monthly expense.
Student Loan Repayment(s)
(do not include student loans)
College Tuition
(do not include student loans)
Charitable Giving
(only if claimed on taxes)
MEAN'S TEST ANALYSIS
MEANS TEST
INCOME FROM ALL SOURCES RECEIVED IN THE LAST SIX MONTHS

* Note on this income and means test

This test comes from the 2005 changes to the bankruptcy law. Neither you nor I like going through this analysis, but it is the law (somewhat like taking nasty tasting medicine).

Please read the directions below because this is the most complicated area we will be discussing, but it is extremely important. If you provide me with accurate information I can give you good legal advice. Please call if you have any questions.

Thanks in advance for your understanding and patience.
Are you a disabled vet?*

Yes

No
Are you currently or within the last 18 months on active duty or performing duties for homeland security?*

Yes

No
All income must be GROSS (before taxes and other deductions).

List income from each employer separately.

List all income in the month it was received, not the month it was due.

Include tips and bonuses in the month they were received.

If you receive a commission, list the amount earned in the month it was received.

Other Income

If income is earned as a sole proprietor - list all income in the month received.

If you receive a salary from your own company list that income in the month you receive it, not when the business received it.

Include retirement income.

Include disability income ; BUT MAKE SURE TO IDENTIFY IF IT IS SOCIAL SECURITY DISABILITY.

Include Social Security, BUT MAKE SURE TO IDENTIFY IT AS SOCIAL SECURITY.

Include all monies received from ANY source, including cashing in retirement accounts, sales of large items and tax refunds, etc. Identify the source.

RENTS: include money from rents (after deducting amount paid for mortgage/HOA/utilities, etc).

If someone is living with you - include their NET income even if they do not give it to you. To calculate NET income deduct their own expenses such as: taxes, insurance, expenses related to vehicles, medical, credit cards, student loans, other housing, business debts, etc.

Include all monies regularly received from gifts or loans from friends or relatives.

The income must be for a FULL month; therefore use the last FULL 6 months, do NOT include the current month.

* It is better to list everything and then we can remove what does not apply to your situation.

The following chart is an example of how to fill out the means test form:

***NOW IT IS YOUR TURN. DO YOUR BEST!***
WITHOUT ACCURATE INFORMATION IT IS VERY DIFFICULT FOR DIANE TO GIVE YOU GOOD ADVICE ABOUT BANKRUPTCY AND HOW IT WILL HELP YOU, OR EVEN IF IT WILL HELP YOU.
PLEASE CALL IF YOU HAVE ANY QUESTIONS at 602-246-7106
Information About You
Please take your time and accurately fill out information about your income. I cannot give you good advice without this information.
First Name*
I ask this in order to keep income from multiple sources organized.

Are you working or do you have income from any source (like retirement)?*
Is someone paying some of your bills? All of this is "income" and must be listed so we can do our best to give you good advice.

Yes

No
Employer name or other source of income*
If dad is paying your phone bill this is "income" and must be listed.

Month 1*

Month 2*

Month 3*

Month 4*

Month 5*

Month 6*

You said you DO NOT have any income*
please explain how you are eating, how you have a place to sleep or the ability to take care of yourself.
Are you married or living with a significant other?*

Yes

No
Your spouse or significant other.
Spouse or significant other's name*

Is your spouse or significant other receiving any money from any source?*

Yes

No
List Income Sources*
Employer/Other
Month 1
Month 2
Month 3
Month 4
Month 5
Month 6

NOW STOP!
Finish the following page ONLY if your average gross income (ANNUAL income before taxes and other deductions) exceeds the amount permitted for the number of people that live in your home. Normally that means the number of people you deduct on your tax returns, but there are always exceptions. The more accurate job you do here the more accurate legal advice I can give you.

For now include income for everyone who lives in your home. Prepare an explanation if your family has unusual income. Do not include anyone’s social security income as part of the following calculation.

Annual Gross Income (before any deductions):
Family of 1 - $51,338
Family of 2 - $64,543
Family of 3 - $70,428
Family of 4 - $85,403
Family of 5 - $94,403

each additional person: $9,000 Even if you income does NOT exceed these amounts, you must answer 'yes' or 'no' to the next question.

Does your average gross income*
(income before taxes and other deductions) exceed the amount permitted for a family of your size.

Yes

No
Instructions for the following questions:

IMPORTANT: The following expenses are monthly, not annual and not per pay check.

These questions pertain NOT to what you were actually paid or received over the last six months. Instead, these are for expenses you will spend or should spend in the future. In other words, unlike income this is a forward looking review of your expenses.

(e.g.: what is the correct amount you should be deducting from your paycheck(s). Or, if you want but do not have life insurance, disability insurance, or health savings plan, etc. Make sure you talk to Diane about this.

Include all expenses, those deducted from your paychecks AND those that you pay directly in cash or by check.

How to calculate monthly expenses:

TAXES: If your income fluctuates then add all taxes for the 6 months above, including anticipated taxes on 1099 income then divide by 6.

Are you paid the same amount every week? If so, multiply the taxes from one paycheck by 52 and divide by 12 to determine your monthly taxes.

Are you paid the same amount every two weeks? If so, multiply the taxes from one paycheck by 26 and divide by 12 to determine your monthly taxes.

Monthly average taxes*
(federal, state, FICA, social security, Medicare and self-employment). If you include income for two people (spouse or signficiant other) then add taxes from all income and enter one number.
Monthly MANDATORY payroll deductions
(employer forces you to pay: e.g. union dues or forced retirement) These are expenses that you are required to pay in order to work for this employer. For instance - if you work for the government they usually require you to contribute to a retirement account.
Monthly life insurance
This may be deducted from a paycheck or you pay the premium directly.
Monthly Court ordered payments
(such as child support/alimony)
Monthly education
expenses for employment or physically/mentally challenged child
Monthly childcare costs
Monthly health insurance deducted from paycheck or paid directly to the insurance company
Make sure to include dental and all other insurance.
Monthly health care such as co-pays, pharmacy, eye-glasses, dental, etc (out-of-pocket, not paid by insurance)
These expenses need to be averaged over 12 months, then divided by 12 in order to give an average for your "out of pocket" expense. Make sure to include all health care expenses (diabetes medication, eye exams, etc).
Monthly disability Insurance (deducted in paycheck or paid directly)
Monthly health savings account (flex accounts)
Monthly expenses for the care of elderly, chronically ill or disabled member of your household who cannot pay their own expenses
Monthly education expenses for children under 18 (such as uniforms and books)
Calculate these expenses over a 12 month period and divide by 12 in order to determine the average monthly expense.
Monthly charitable contributions - see your prior tax returns.
Monthly amount withheld to repay loans from retirement accounts.
Additional issues:
Do you owe any back taxes?*

Yes

No
Amount of back taxes owed*
Year(s) tax debt due*
Are you behind on payments to secured creditors (house or car)?*

Yes

No
Name of Lender. Indicate if home or vehicle

Amount owed to bring the loan current:
Are you behind on any other payments to secured creditors (house or car)?*

Yes

No
Name of Lender. Indicate if home or vehicle

Amount owed to bring the loan current:
Lender's name and state type of property: home or vehicle

Amount owed to bring the loan current:
FABULOUS JOB, BUT BEFORE YOU TAKE A WELL DESERVED BREAK, PLEASE READ THE INFORMATION BELOW AND SIGN (checkbox) WHERE INDICATED.
I REALLY APPRECIATE YOUR COMMITMENT TO PROVIDING ACCURATE INFORMATION WHICH WILL ALLOW ME TO GIVE YOU LEGAL ADVICE TAILORED TO YOUR UNIQUE SITUATION. I LOOK FORWARD TO TALKING WITH YOU. PLEASE CALL IF YOU DO NOT HEAR FROM US WITHIN 24 HOURS AFTER SENDING YOUR FORM. YOU ARE VERY IMPORTANT TO US AND WE DO NOT WANT YOU TO FEEL UNNECESSARY STRESS JUST BECAUSE YOU ARE WAITING TO HEAR FROM US. WE ARE REALLY HERE TO HELP YOU. REMEMBER: FILLING OUT THIS INFORMATION AND HAVING THE PHONE DISCUSSION IS NOT A COMMITMENT TO FILING BANKRUPTCY AND IT DOES NOT CREATE AN ATTORNEY-CLIENT RELATIONSHIP. I AM NOT YOUR ATTORNEY UNTIL YOU SIGN A RETAINER AGREEMENT.
IMPORTANT NOTICES REQUIRED BY LAW:
The following notices are required pursuant to 527(a)(2). By signing below you acknowledge that: 1) You understand that all information that you are required to provide to complete any documents filed with the Bankruptcy Court must be complete, accurate and truthful; 2) You will fully and completely disclose all assets and all liabilities in the documents filed with the Bankruptcy Court; 3) You have fully disclosed all sources of income on any documents filed with the court; 4) You understand that any information set forth either in the documents filed with the Bankruptcy Court, or testified to under oath may be audited and that failure to provide accurate information may result in the dismissal of your bankruptcy case or other sanctions, including criminal sanctions; 5) You agree that a faxed or e-mailed signature shall be sufficient to indicate agreement to these notices.
UNITED STATES BANKRUPTCY COURT NOTICE TO INDIVIDUAL CONSUMER DEBTOR UNDER § 342(b) OF THE BANKRUPTCY CODE
In accordance with § 342(b) of the Bankruptcy Code, this notice: (1) describes briefly the services available from credit counseling services; (2) describes briefly the purposes, benefits and costs of the four types of bankruptcy proceedings you may commence; and (3) informs you about bankruptcy crimes and notifies you that the Attorney General may examine all information you supply in connection with a bankruptcy case. You are cautioned that bankruptcy law is complicated and not easily described. Thus, you may wish to seek the advice of an attorney to learn of your rights and responsibilities should you decide to file a petition. Court employees cannot give you legal advice.

1. Services Available from Credit Counseling Agencies

With limited exceptions, § 109(h) of the Bankruptcy Code requires that all individual debtors who file for bankruptcy relief on or after October 17, 2005, receive a briefing that outlines the available opportunities for credit counseling and provides assistance in performing a budget analysis. The briefing must be given within 180 days before the bankruptcy filing. The briefing may be provided individually or in a group (including briefings conducted by telephone or on the Internet) and must be provided by a nonprofit budget and credit counseling agency approved by the United States trustee or bankruptcy administrator. The clerk of the bankruptcy court has a list that you may consult of the approved budget and credit counseling agencies.

In addition, after filing a bankruptcy case, an individual debtor generally must complete a financial management instructional course before he or she can receive a discharge. The clerk also has a list of approved financial management instructional courses.

2. The Four Chapters of the Bankruptcy Code Available to Individual Consumer Debtors

Chapter 7: Liquidation

1. Chapter 7 is designed for debtors in financial difficulty who do not have the ability to pay their existing debts. Debtors whose debts are primarily consumer debts are subject to a “means test” designed to determine whether the case should be permitted to proceed under chapter 7. If your income is greater than the median income for your state of residence and family size, in some cases, creditors have the right to file a motion requesting that the court dismiss your case under § 707(b) of the Code. It is up to the court to decide whether the case should be dismissed.

2. Under chapter 7, you may claim certain of your property as exempt under governing law. A trustee may have the right to take possession of and sell the remaining property that is not exempt and use the sale proceeds to pay your creditors.

3. The purpose of filing a chapter 7 case is to obtain a discharge of your existing debts. If, however, you are found to have committed certain kinds of improper conduct described in the Bankruptcy Code, the court may deny your discharge and, if it does, the purpose for which you filed the bankruptcy petition will be defeated.

4. Even if you receive a general discharge, some particular debts are not discharged under the law. Therefore, you may still be responsible for most taxes and student loans; debts incurred to pay non-dischargeable taxes; domestic support and property settlement obligations; most fines, penalties, forfeitures, and criminal restitution obligations; certain debts which are not properly listed in your bankruptcy papers; and debts for death or personal injury caused by operating a motor vehicle, vessel, or aircraft while intoxicated from alcohol or drugs. Also, if a creditor can prove that a debt arose from fraud, breach of fiduciary duty, or theft, or from a willful and malicious injury, the bankruptcy court may determine that the debt is not discharged.

Chapter 13: Repayment of All or Part of the Debts of an Individual with Regular Income

1. Chapter 13 is designed for individuals with regular income who would like to pay all or part of their debts in installments over a period of time. You are only eligible for chapter 13 if your debts do not exceed certain dollar amounts set forth in the Bankruptcy Code.

2. Under chapter 13, you must file with the court a plan to repay your creditors all or part of the money that you owe them, using your future earnings. The period allowed by the court to repay your debts may be three years or five years, depending upon your income and other factors. The court must approve your plan before it can take effect.

3. After completing the payments under your plan, your debts are generally discharged except for domestic support obligations; most student loans; certain taxes; most criminal fines and restitution obligations; certain debts which are not properly listed in your bankruptcy papers; certain debts for acts that caused death or personal injury; and certain long term secured obligations.

Chapter 11: Reorganization

Chapter 11 is designed for the reorganization of a business but is also available to consumer debtors. Its provisions are quite complicated, and any decision by an individual to file a chapter 11 petition should be reviewed with an attorney.

Chapter 12: Family Farmer or Fisherman

Chapter 12 is designed to permit family farmers and fishermen to repay their debts over a period of time from future earnings and is similar to chapter 13. The eligibility requirements are restrictive, limiting its use to those whose income arises primarily from a family-owned farm or commercial fishing operation.

3. Bankruptcy Crimes and Availability of Bankruptcy Papers to Law Enforcement Officials

A person who knowingly and fraudulently conceals assets or makes a false oath or statement under penalty of perjury, either orally or in writing, in connection with a bankruptcy case is subject to a fine, imprisonment, or both. All information supplied by a debtor in connection with a bankruptcy case is subject to examination by the Attorney General acting through the Office of the United States Trustee, the Office of the United States Attorney, and other components and employees of the Department of Justice.

WARNING: Section 521(a)(1) of the Bankruptcy Code requires that you promptly file detailed information regarding your creditors, assets, liabilities, income, expenses and general financial condition. Your bankruptcy case may be dismissed if this information is not filed with the court within the time deadlines set by the Bankruptcy Code, the Bankruptcy Rules, and the local rules of the court.

“THE FOLLOWING DOCUMENT IS INTENDED TO BE ON A SEPARATE PAGE”
Notice required by Bankruptcy Code Section 527(b)
IMPORTANT INFORMATION ABOUT BANKRUPTCY ASSISTANCE SERVICES FROM AN ATTORNEY
If you decide to seek bankruptcy relief, you can represent yourself, hire a qualified bankruptcy attorney, or you are able to answer all questions related to bankruptcy – hire a bankruptcy petition preparer that is not an attorney. Under Arizona law the Arizona Supreme Court must license all Bankruptcy Petition Preparer and they may not give any legal advice, including explaining most of the terms contained in the bankruptcy forms. The law requires that any Attorney or Bankruptcy Petition Preparer give you a written contract specifying the work to be done and the fees to be charged. Before filing any bankruptcy case you and your attorney should analyze your eligibility for different forms of relief available under the bankruptcy code and which type of bankruptcy relief is most beneficial for you. Be sure you understand that relief you can obtain and its limitations. To file a bankruptcy case, documents called a Petition, Schedules, and Statement of Financial Affairs, as well as in some cases a Statement of Intention, must be prepared correctly and filed with the bankruptcy Court. You will have to pay a filing fee to the court. Within a few weeks after your case is filed with the Court you will be required to attend a meeting of creditors where the Trustee assigned to your case will swear you to tell the truth and ask you a few questions. Creditors, should they be present, can also ask questions. In most cases no creditors are ever present. If you choose a chapter 7 case, you may be asked by a creditor who has a lien on your car, computer, appliances or furniture to reaffirm a debt. You should first obtain legal counsel before making any decision related to reaffirming any debt. A creditor is not permitted to coerce or bully you into signing a reaffirmation agreement. If you choose to file a chapter 13 in which you repay your creditors what you can afford over 3 to 5 years, you may also want help with preparing your chapter 13 plan and with the confirmation hearing on your plan. A chapter 13 case can be used to pay arrears on your home, back taxes, child support, or your ca. Normally you will also need legal assistance in planning for a successful chapter 13 filing and the confirmation process, which is part of every chapter 13 case. It is very rare for anyone to successfully complete a chapter 13 filing without being represented by an attorney. If you select another type of relief under the Bankruptcy Code other than chapter 7or 13, you will want to find out what should be done from an attorney familiar with that type of relief. Your bankruptcy case may also involve litigation. This is usually rare in a chapter 7 case. You can represent yourself - but it is a complicated process and one that you will rarely succeed in without legal counsel. Only an attorney can give you legal advice.
Check the box below and submit your form.*
I Confirm I have read and understand the above legal notices
If the form does not submit when you press the button then you need to scroll through the form looking for red paragraphs that need answers. If it is successfully submitted you will receive a notification. Therefore, if you do not receive that email it was not successfully submitted and you need to go back and check what was not completed in the third section.

Diane L. Drain | Arizona Bankruptcy Lawyer

Free Consolutation

Hello, I would like to provide you with FREE information, first you need to do the following:

YOU AND I WILL HAVE A FREE PHONE CONSULTATION ONCE YOU HAVE FINISHED THIS PROCESS.

Arizona Exemptions

Steps 1.

Steps 2.

General Information Step 1 of 3

Individual

Business Address

Information about your Spouse

Individuals

Thank you! You are doing great so far.

General Questions

Step 2 of 3

SOME REQUIREMENTS OF THE BANKRUPTCY LAWS ARE “JUST MEAN AND SCARY FOR NO OBVIOUS BENEFIT” TO QUOTE A PROMINENT BANKRUPTCY JUDGE

General Questions

Step 2 of 3

THE FOLLOWING ARE GENERAL QUESTIONS REGARDING YOUR CURRENT SITUATION. IF YOU ARE MARRIED PLEASE ANSWER THE QUESTIONS THAT ARE APPLICABLE TO EITHER YOU AND/OR YOUR SPOUSE

THE FOLLOWING QUESTIONS RELATE TO CERTAIN ISSUES THAT DETERMINE WHETHER OR NOT IT IS APPROPRIATE TO FILE A BANKRUPTCY AND, IF SO, WHEN TO FILE.

CREDIT CARDS, BANKS AND OTHER DEBTS:

HOME, LAND AND VEHICLES

Important Notice

Vehicle Information

ASSETS, INCLUDING BUSINESSES

Miscellaneous

IMPORTANT:

Thanks, only one more section to go!

Step 3 of 3 - Financial Information & Monthly Budget

MONTHLY LIVING EXPENSES

Average Monthly Expenses

Taxes

Insurance

Vehicles

Other Monthly Expenses

MEAN'S TEST ANALYSIS

MEANS TEST

All income must be GROSS (before taxes and other deductions).

Other Income

The following chart is an example of how to fill out the means test form:

***NOW IT IS YOUR TURN. DO YOUR BEST!*** WITHOUT ACCURATE INFORMATION IT IS VERY DIFFICULT FOR DIANE TO GIVE YOU GOOD ADVICE ABOUT BANKRUPTCY AND HOW IT WILL HELP YOU, OR EVEN IF IT WILL HELP YOU.

PLEASE CALL IF YOU HAVE ANY QUESTIONS at 602-246-7106

Information About You

Your spouse or significant other.

NOW STOP!

Instructions for the following questions:

How to calculate monthly expenses:

Additional issues:

FABULOUS JOB, BUT BEFORE YOU TAKE A WELL DESERVED BREAK, PLEASE READ THE INFORMATION BELOW AND SIGN (checkbox) WHERE INDICATED.

IMPORTANT NOTICES REQUIRED BY LAW:

UNITED STATES BANKRUPTCY COURT NOTICE TO INDIVIDUAL CONSUMER DEBTOR UNDER § 342(b) OF THE BANKRUPTCY CODE

“THE FOLLOWING DOCUMENT IS INTENDED TO BE ON A SEPARATE PAGE”

IMPORTANT INFORMATION ABOUT BANKRUPTCY ASSISTANCE SERVICES FROM AN ATTORNEY

Helpful Quick Links

Bankruptcy Questions

Resources

NOW IT IS YOUR TURN. DO YOUR BEST!
WITHOUT ACCURATE INFORMATION IT IS VERY DIFFICULT FOR DIANE TO GIVE YOU GOOD ADVICE ABOUT BANKRUPTCY AND HOW IT WILL HELP YOU, OR EVEN IF IT WILL HELP YOU.