Santa Rosa Bankruptcy Attorney

Edmund Dechant, Santa Rosa Bankruptcy Attorney

707-525-8810 - 2 E St. Santa Rosa, CA 95404

*For a free consultation, please supply the following information which
will be of assistance in my answering your questions and concerns.

The information you supply is CONFIDENTIAL.

Must fill out----->Name:
Must fill out----->E-mail:
Subject:
How did you find out about this site?
Spouse's Name:
Your Age:	Spouse's Age:
Marital Status:	Married		Single
	Divorced		Widowed
Number of Dependents:
Address:
City:
State and Zip code:
Telephone Home (you and spouse):
Telephone Work (you):
Telephone Work (spouse):
Your Occupation:
Your Employer:
Length of your employment:
Total monthly wages before any deductions:
Spouse's Occupation:
Spouse's Employer:
Length of spouse's employment:
Total spouse's monthly wages before any deductions:
Other Income Source:
Gross Monthly income:
Average Monthly Expenses:
What Are Your Special Concerns:
Loss of Job:	Yes No
Bothered by creditors:	Yes No
Being Sued:	Yes No		As of:
Wages attached:	Yes No		On:
Vehicle Repossessed:	Yes No
Behind on house payments:	Yes No
House in foreclosure:	Yes No
Are you in business?	Yes No
Been in business in the last two years?	Yes No
If so, type of business:
Are there any business Debts?	Yes No
Prior Bankruptcy Filings?	Yes No Year
Co-Signed Debts?	Yes No
Personal Injury /other Suits brought by you?	Yes No
Received or expect inheritances in the near future ?	Yes No
Sold or given away property within last 12 months?	Yes No
Do you owe wages to any person?	Yes No
Caused any intentional injury or damage to another?	Yes No
Do you owe Federal Taxes?	Yes No		Amount:
			Year:
Do you owe State Taxes?	Yes No		Amount:
			Year:
Other Taxes?	Yes No		Amount:
			Year:
Do you owe support to anyone?	Yes No		Amount:
			Year:
Do you owe for Student Loans?	Yes No		Amount:
			Year:
Do you owe any Fines?	Yes No		Amount:
What were the fines for?
Used Credit Cards used in last 90 days?	Yes No		Amount:
Please, estimate total Credit Card Debt:			Amount:
Estimate total number of Creditors:	Amount:
Estimate your total other Debt:	Amount:
Do you own Real Property (home, building, lot)?	Yes No
List the Fair Market Value:	Amount:
Are any mortgages owed on the property?	Yes No
Name of First Mortgager:
Total Amount Owed:
Are you current?	Yes No
Name of Second Mortgager:
Total Amount Owed:
Are you current?	Yes No
Name of Third Mortgager:
Total Amount Owed:
Are you current?	Yes No
If not current, please list the amount you are behind on each loan:		First:
		Second:
		Third:
Date of Foreclosure Notice:
Sale Date:
Do you own an interest in other Real Property?	Yes No
If yes, explain:
Do you own Vehicles?	Yes	No
First Vehicle - Year & Make:
Monthly Payment:			Paid Off? Yes No
Creditor:
Amount Owed:			Value:
Second Vehicle - Year & Make:
Monthly Payment:			Paid Off? Yes No
Creditor:
Amount Owed:			Value:
Third Vehicle - Year & Make:
Monthly Payment:			Paid Off? Yes No
Creditor:
Amount Owed:			Value:
Do you own anything worth more than $500.00?	Yes No
Please list the property and indicate the fair market value of each item:
Comments about Your Situation:
Dear Mr. Dechant: I am interested in some advice concerning my financial situation and what if anything I can do to improve my financial affairs. I understand that your review of this material is at no charge to me, and I assure you that the information I have given on this form is truthful and pertains to me. I understand that until I sign a written contract with you or another attorney concerning this matter, I am not represented by an attorney. I understand that until specific action is taken on my behalf, I am not protected from actions by my creditors even though I may have submitted this form and spoken with an attorney.
Yes, I Agree to these terms Yes No
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Whether you are looking for a bankruptcy attorney in Santa Rosa, the best Sonoma County bankruptcy attorneys, or maybe a Ukiah bankruptcy attorney in Mendocino County, or the right bankruptcy lawyers in Santa Rosa call me now.

Edmund Dechant, Santa Rosa Bankruptcy Attorney

2 E St. Santa Rosa, CA 95404