Can I file?

Can I file?

Name *
Phone Number (If you don't want me to contact you by phone, write "none" and provide your e-mail instead in this form) *
E-mail (If you don't have an e-mail, write "none" but be sure to give me your phone number in this form) *
City where you live *
Ever filed bankruptcy before? *	Yes No
If so, what year?
Have you sold or purchased a home within the last 1 year?	Yes No
Have you transferred a title or deed to a relative or close friend within the last 2 years?	Yes No
Have you transferred money or paid off a loan to a relative or close friend within the last 2 years?	Yes No
Have you received any non-work-related lump sum of money (gift, award, tax refund) over $5,000 in the last 6 months?	Yes No
Are you expecting to receive a judgment, award, or other lump sum money amount over $5,000 in the next 6 months?	Yes No
How many automobiles do you have with your name on the title? *
Of those automobiles, how many do you still owe money on?
Do you own a boat, motorcycle, tractor or travel trailer? *	Yes No
Do you own any stocks, bonds or other investments outside of a retirement account? *	Yes No
Do you own the home you live in? *	Yes No
Do you own land other than the land you live on?	Yes No
Have you been employed within the last 6 months? *	Yes No
If so, did you change, start of lose jobs within the 6 months?	Yes No
Have you been self-employed or owned a business within the last 5 years?	Yes No
What is your current gross income from work per month?
Are you currently living with a spouse or other adult? *	Yes No
If so, what is that person's current gross income per month?
How much did you report as your gross income on last year's taxes (if you are/were married, combined with spouse's income)?
How many children under 18 reside in your home with you?
How much do you and/or a spouse residing with you receive, if anything, for child support?
How much is your monthly mortgage/rent payment?
How much are your total monthly automobile payments, if any?
How much do you pay each month for boats, motorcycles, tractors and travel trailers?
How much do you spend each month on uninsured prescription medications?	True False
How much do you pay each month, if anything, for child care expenses?
How much do you pay each month, if anything, for alimony and/or child support for children living outside your home?
How much do you pay, if anything, each month toward student loans?
Do you plan to file bankruptcy within the next month? *	Yes No
If you retain me, do you wish to meet me in my office or retain me by mail?