David M. McCormick & Associates

Bankruptcy Analysis

	Personal Information

	Name	*
	Address	*
	City	*
	State	*
	Zip	*
	Home phone	*
	Cell phone	*
	E-Mail Address	*

	Credit Cards

	Number of credit cards
	Total amount owed ($)
	Have you used a credit card in the last 90 days?	yes no
	If yes, list dates, amounts & nature of charges




	Household

	Are you married?	yes no
	Number of dependents
	Filing	alone with spouse
	Have you lived in VA for the past 6 months?	yes no

	Debts With Collateral

	Furniture owed ($)
	Appliances owed ($)
	Jewelry owed ($)
	Loans owed ($)
	Medical bills ($)
	Reposession owed ($)
	Miscellaneous debt ($)

	Assets

	Balance in checking / savings accounts ($)
	IRA, 401K or other investments ($)
	Amount of 401K / TSP loan ($)
	Value of life insurance ($)

	Automobiles (even if paid in full)

	Car 1...
	Year / Make / model
	Monthly payment ($)
	Balance owed ($)
	Market value ($)
	Are you behind on payments?	yes no
	If yes, how many months behind
	Amount behind ($)
	Do you want to keep the vehicle?	yes no
	Car 2...
	Year / make / model
	Monthly payment ($)
	Balance owed ($)
	Market value ($)
	Are you behind on payments?	yes no
	If yes, how many months behind
	Amount behind ($)
Do you want to keep the vehicle?	yes no
Car 3...
Year / make / model
Monthly payment ($)
Balance owed ($)
Market value ($)
Are you behind on payments?	yes no
If yes, how many months behind
Amount behind ($)
Do you want to keep the vehicle?	yes no

Home

Rent or own / buying	own rent
Monthly payment ($)
How is the home titled
Do you want to keep the home?	yes no
Are you behind on the mortgage?	yes no
If yes, how many months behind
Amount behind ($)
Pending foreclosure?	yes no
Balance owed ($)
Market value ($)

Taxes

Have all federal taxes been filed up to date?	yes no
If no, amount owed ($)
If no, which years have not been filed
Have all state taxes been filed up to date?	yes no
If no, amount owed
If no, which years have not been filed

Miscellaneous Bills

Do you owe any student loans?	yes no
Amount owed ($)
Child support	pay receive
Per month ($)
Arrearage ($)
Alimony	pay receive
Per month ($)
Arrearage ($)
Court costs / traffic fines ($)

Judgements, Garnishments, Etc.

Are there any court proceedings against you?	yes no
If yes, when
If yes, what type of proceeding
Personal injury claims
Garnishment / liens?	yes no
If yes, against who
Amount owed ($)
Reposession?	yes no
Balance owed
Recent divorce or seperation?	yes no
If yes, did you have a seperation agreement?	yes no
Recent inheritance?	yes no
If yes, when
If yes, what amount

Income / expenses (including any pension, government payments or other income)

Your Income...
Monthly gross ($)
Monthly net ($)
Yearly gross ($)
Spouse's Income...
Monthly gross ($)
Monthly net ($)
Yearly gross ($)
Roomate Contribution...
Monthly ($)
Other...
If you had no debt (only paying regular monthly expenses, such as rent / mortgage, groceries, utilities, etc), how much money would you have left at the end of the month ($)

Have you transferred any money or property to any relative in the last year?	yes no
If yes, when, to whom and what was the value of the property
How many people / companies do you owe money to
What is your total debt (not including vehicle or home)
Main reason for filing bankruptcy
Have you previously file for bakruptcy?	yes no
If yes, how many times
If yes, when
If yes, what was the outcome?	discharged dismissed
What chapter was it?	7 13
If dismissed, why
Are you interested in emergency filing?	yes no

Additional Services

Guaranteed 14 day completion with letters to up to 20 creditors for additional $200	yes no

We obtain all 3 credit reports and transfer information to bankruptcy petition for you	yes no

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