Bankruptcy Analysis Form

Please enable JavaScript in your browser to complete this form.

– Step 1 of 3

DISCLAIMERS: This analysis is for informational purposes only. By completing this online questionnaire, you acknowledge that you are not represented by an attorney at Caldwell Law and have not been provided legal advice until such time as both parties have signed a fee agreement and paid a fee creating that relationship. By filling out the questionnaire, you are not obligated to file for bankruptcy with Caldwell Law or for any attorney. The information you provide will remain confidential. *

I have read the above statement and agree.

Name *

First

Last

Phone *

Email *

Have you lived in the State of Nebraska for at least the past two and half years continuously? *

Other States Resides: *

If you have not resided in Nebraska for the past two and half years, what State did you previously reside?

Date Moved to Nebraska: *

Approximately what date did you move to Nebraska?

Household Size: *

Please include only those individuals who rely upon you for financial support (No roommates, adult children, parents, or friends unless they rely on you for financial support).

Household Income:

Check all that apply within the last 6 months: *

Receive Wages
Receive Social Security Income, Social Security Disability, or VA Disability
Receive Disability and/or Workman’s Compensation
Receive Pension/Retirement Income (Not social security)
Receive Alimony and/or Child Support
Receive Rental Income
Receive Business Income
Receive Unemployment Compensation
Other Income Sources

Total Monthly Wages (Before Taxes): *

Include your monthly household (you and spouse) income you and/or your spouse received from wages. Make sure to include regular overtime and average annual or semi-annual bonuses.

Total Monthly Social Security or VA Disability Income: *

Include the before tax amount of social security income and/or VA Disability you and/or your spouse receives each month.

Total Monthly Disability and/or Workman's Compensation: *

Include all monthly short/long term disability and/or Workman’s Compensation income you and/or your spouse receives each month.

Total Retirement or Pension Income: *

Include the monthly income you and/or your spouse receives from a retirement account (401k, IRA, etc) or Pension plan.

Total Monthly Alimony and Child Support: *

Include the monthly income you and/or your spouse receives from alimony and/or child support.

Support Termination *

Please list when the alimony/child support will terminate.

Total Monthly Rental Income: *

Include the monthly income received from rental properties you and/or your spouse owns.

Total Monthly Business Income: *

Include the average monthly net income you and/or your spouse receives from operating a business.

Total Monthly Unemployment Income: *

Include the monthly unemployment compensation income you and/or your spouse receive.

Unemployment Expiration: *

Please list when the unemployment compensation listed above will expire.

Other Monthly Income: *

Describe the type of income you and/or your spouse receives monthly.

Include the amount of other income you and/or your spouse receives each month.

Household Debts:

Check all types of debt that you and/or your spouse have: *

Credit Card Debt
Medical Debt
Tax Debt
Student Loan Debt
Child Support/Alimony Arrears
Legal Judgments
Collections
Other Debt

Total Credit Card Debt: *

Please provide an estimate of the total credit card debt you and/or your spouse has.

Total Medical Debt: *

Please provide an estimate of total medical debt you and/or your spouse has.

Tax Debt Information:

Check each type of tax debt you and/or your spouse has: *

Federal Taxes
Nebraska Taxes
Other State Taxes

Federal Income Tax: *

Please list the total amount owed in federal income taxes.

Is any portion of the taxes listed more than 3 years old? *

Nebraska Income Tax: *

Please list the total amount owed in Nebraska income taxes.

Is any portion of the taxes listed more than 3 years old? *

Other State Taxes: *

Please list each State where you owe taxes.

Other State Tax Total: *

Please list the total amount owed for all other State income taxes.

Is any portion of the taxes listed more than 3 years old? *

Total Student Loan Debt: *

Please provide an estimate of the total student loans you and/or your spouse have.

Total Child Support/Alimony Arrears: *

Please provide an estimate of the total amount of child support and/or alimony that you and/or your spouse are behind.

Total Legal Judgments: *

Please provide an estimate of the total legal judgments you and/or your spouse have against you.

Are your wages currently being garnished? *

How much is being garnished from each paycheck? *

Total Collections Debt: *

Please provide an estimate of the total collections debt you and/or your spouse have against you.

Total Other Debt: *

Please provide an estimate of the total other debt you and/or your spouse have against you.

Property:

Housing Situation: *

Own/Buying Home
Renting
Living with someone without paying rent.

What is the value of your home? *

What do you think you could sell it for if you chose to do so?

What is the total amount owed? *

Include all mortgages and home equity lines of credit. If the home is paid off, put down $0.

Are you current on your mortgage? *

How much are you behind on your mortgage? *

Is there a foreclosure pending? *

Yes
No
I don’t know

What date is your home scheduled to be auctioned/foreclosed? *

How many vehicles do you and/or your spouse own?

Selected Value: 0

Include all vehicles where you and/or your spouse are listed on the title. Do not include rented vehicles or vehicles you borrow from others.

Vehicle #1: Year, Make, and Model *

Have you owned this vehicle for more than 3 years? *

Vehicle #1: Value *

What do you think this vehicle is worth if you tried to sell it?

Vehicle #1: Loan *

How much do you owe on this vehicle? If vehicle is paid off, put down $0.

Vehicle #1: Interest Rate *

What is the interest rate of this vehicle?

Vehicle #1: Arrears *

If you are behind on this vehicle’s loan, how much? If not, please put $0.

Vehicle #2: Year, Make, and Model *

Have you owned this vehicle for more than 3 years? *

Vehicle #2: Value *

What do you think this vehicle is worth if you tried to sell it?

Vehicle #2: Loan *

How much do you owe on this vehicle? If vehicle is paid off, put down $0.

Vehicle #2: Interest Rate *

What is the interest rate of this vehicle?

Vehicle #2: Arrears *

If you are behind on this vehicle’s loan, how much? If not, please put $0.

Vehicle #3: Year, Make, and Model (copy) *

Have you owned this vehicle for more than 3 years? *

Vehicle #3: Value *

What do you think this vehicle is worth if you tried to sell it?

Vehicle #3: Loan *

How much do you owe on this vehicle? If vehicle is paid off, put down $0.

Vehicle #3: Interest Rate *

What is the interest rate of this vehicle?

Vehicle #3: Arrears *

If you are behind on this vehicle’s loan, how much? If not, please put $0.

Vehicle #4: Year, Make, and Model *

Have you owned this vehicle for more than 3 years? *

Vehicle #4: Value *

What do you think this vehicle is worth if you tried to sell it?

Vehicle #4: Loan *

How much do you owe on this vehicle? If vehicle is paid off, put down $0.

Vehicle #4: Interest Rate *

What is the interest rate of this vehicle?

Vehicle #4: Arrears *

If you are behind on this vehicle’s loan, how much? If not, please put $0.

Vehicle #5: Year, Make, and Model *

Have you owned this vehicle for more than 3 years? *

Vehicle #5: Value *

What do you think this vehicle is worth if you tried to sell it?

Vehicle #5: Loan *

How much do you owe on this vehicle? If vehicle is paid off, put down $0.

Vehicle #5: Interest Rate *

What is the interest rate of this vehicle?

Vehicle #5: Arrears *

If you are behind on this vehicle’s loan, how much? If not, please put $0.

Miscellaneous Items:

Have you filed all required Federal and State tax returns for the past 4 years? *

NOTE: In order to file bankruptcy, you must file all required tax returns in the past 4 years. You must file even if you will owe taxes.

Have you taken a cash advance from any credit card or bank within the last 70 days? *

Do you have any gambling losses within the past year? *

Have you received an inheritance within the last year or expect to receive one in the next 6 months? *

Have you sold or refinanced any real estate within the past 2 years? *

What is the estimated total amount you currently have in all bank accounts? *

Bankruptcy Analysis Form

Household Income:

Household Debts:

Tax Debt Information:

Property:

Miscellaneous Items:

Recent Posts

Disclaimers

Caldwell Law provides legal services to the following areas in Nebraska:

Lincoln, Nebraska Office

Caldwell Law Answers Your Questions!

Find Articles about specific topics

Categories

Tags