Intake Sheet - Hollins Bankruptcy Law Office

Step 1 of 9 - Basic Information

Name

This field is for validation purposes and should be left unchanged.

Startup Packet - Basic Information

Please provide your personal details to initiate the case.

First Name*

Middle Name

Last Name*

Date of Birth*

Age

Social Security #*

Marital Status*

If married, are you both filing for Bankruptcy?

Yes

Spouse's Information (REQUIRED)

Spouse's Full Name*

Age*

Spouse's SSN

Spouse's email address*

Case Analysis & Creditors

Final details to assess your bankruptcy eligibility.

Have you or your spouse ever filed bankruptcy before?

Are you currently being sued or wages garnished?*

Property repossessed/foreclosed in last 2 years?

Briefly state any reason causing you to file Bankruptcy at this time:*

Creditors List

(Optional) We will pull your credit report to identify your creditors, but you may also list any specific creditors that you would like us to verify.

Creditor

Creditor Name

Amount Owed

Address

City/State/Zip

Type of Debt

Additional information

Here are a few follow-up questions:

List any other names or alias that you or your spouse have used over the last 6 years.

Do you own any firearms? If so, list the make and caliber for each firearm owned.*

Is your check currently being garnished? If so, which creditor/company is garnishing your check?*

Do you have a safe deposit box?

Yes

Do you have a storage unit? If so, what is the name and address of the storage facility and what type of items are kept there?*

Have you closed any bank accounts within the last 90 days? If so, what was the name of the bank, and in which month/year was the account closed?*

Have you filed all of the tax returns that you are required to file for the last 5 years? If not, what years do you still need to file?*

Have you given, sold, or transferred any property worth more than $4,000 (ie, home/car) to a family member or friend in the last 4 years? If so, explain below.*

Have you paid back any money to family members or friends in the past year? If yes, list the name and amount.*

Have you gambled and won or lost money within the last year? If so, where did you gamble? And, how much did you win or lose?*

Do you own a timeshare? If so, list the details below.*

Have you given a gift of more than $600 to any charity or family member within the last 2 years? If so, list their name, the amount given, and your relationship with them.*

Have you owned any real estate within the last 4 years? If so, please list each full address:*

Do you own a business? If so, how many? List the name and complete address for each business.*

Do you have a landlord?*

If so, type their name and complete address here.

FREE CONSULTATION CALL

888-936-6844

Startup Packet - Basic Information

Spouse's Information (REQUIRED)

Contact Information & Address

Real Estate Ownership

Personal Property & Assets

Property Values (Estimate Resale Value)

Employment & Income

Deductions, Dependents & Expenses

Monthly Living Expenses

Income History

Case Analysis & Creditors

Creditors List

Additional information