Case Evaluation Page for Youngstown | Warren Bankruptcy Attorney Lawyer Ohio Bankruptcy Law Firm Mahoning Trumbull

Cleveland Federal & Bankruptcy Courthouse

Youngstown Federal & Bankruptcy Courthouse

Case Evaluation Form For

Chapter 7 & 13 Cases

*Name, including middle initial

*E-mail address

*Phone Number

Does your spouse intend to file also?
YesNo

If yes, include information for both yourself and your spouse below:

Name of spouse, including middle initial

*Residence address, including county

Have you ever filed bankruptcy before?
YesNo

*Provide date filed, type of bankruptcy and result obtained.

Have you been a resident of Ohio for longer than 2 years?
YesNo

How long have you been at above address?

Other Address w/in 2 years	How Long?

Other telephone number(s)

Work

Cell

Other

Have you used any other name(s) in the last six years?
YesNo

If yes, please list here

SingleSeparatedMarriedDivorced

If married, how long?

If divorced, how long?

Ages of dependants living with you

Ages, and amount of child support paid:

Age	Amount
	$
	$
	$
	$

Are you behind on your child support?
YesNo

Are you making payments on this child support arrearage?
YesNo

Amount of child support arrearage
$

Husband's employer:

How long at this job?

Husband's occupation

Husband's pay period:
weeklysemi-monthlymonthlyother

Husband's gross pay last year:

Husband's Net income per pay:

Wife's employer:

How long at this job?

Wife's occupation

Wife's pay period
weeklysemi-monthlymonthlyother

Wife's gross income last year:

Wife's net income per pay:

Income from other sources (contributions from other members of household, second job, cash-only jobs, unreported income, rental income, investments, social security, child support, worker's compensation, etc.) (state sources and amount):

Do you owe any income taxes?
YesNo

If yes, for what year(s)?

How much (total)?
$

Do you have any unpaid student loans?
YesNo

Amount
$

Do you pay anyone spousal support (alimony)
YesNo

If yes, to whom and how much?

Do you own or are you purchasing a home or other real property?
YesNo

County Valuation of Parcel # 1
$

Parcel #1: First Mortgage Loan Balance
$

Are you Current?

Amount Behind
$

Monthly payment
$

Parcel # 1: 2nd Mortgage Loan Balance
$

Are you Current?

Amount behind
$

Monthly payment
$

Parcel #1: 3rd Mortgage Loan Balance
$

Are you current?

Amount behind
$

Monthly payment
$

Has foreclosure been filed?
YesNo

Date filed or when papers were received?

County Valuation of Parcel # 2
$

Parcel #2: First Mortgage Loan Balance
$

Are you Current?

Amount Behind
$

Monthly payment
$

Parcel # 2: 2nd Mortgage Loan Balance
$

Are you Current?

Amount behind
$

Monthly payment
$

Parcel #2: 3rd Mortgage Loan Balance
$

Are you current?

Amount behind
$

Monthly payment
$

Has foreclosure been filed?
YesNo

Date filed or when papers were received?

Amount of liens against Parcel # 2 $

List all vehicle loans (car, truck, motorcycles; boat, dentify vehicle type)

Vehicle	Loan Balance	Date of Loan	Amount Behind
	$		$
	$		$
	$		$

List all vehicles you own outright (no loan balance)

Vehicle	Est. Value
	$
	$

Have you purchased any items (electronics, boats, jet ski, appliances, etc.) in the last two years on which you still owe money?
YesNo

Have you taken out a loan from a finance company, credit union, bank or any other place and secured the loan by household items or other type of secured collateral?
YesNo

Creditors' Names

Estimate balances owed on all other types of debt listed below

$	Medical Bills
$	NSF Checks
$	Credit Cards
$	Family
$	Misc. Bills

When was the last time you used any of your credit cards? (approx. date)

How much new debt was added to the cards in the last 12 months?

Have you paid back money to relatives within the last 12 months?
YesNo

How much?
$

When was the money paid to such relative?

Do you anticipate receiving a tax refund?
YesNo

How much?
$

Are you eligible for the Earned Income Credit?
YesNo

How much?
$

List all judgments, lawsuits, liens, and garnishments against you.

If you have a business, please descibe it. Is it Incorporated?.

List all property transferred out of your name within last 24 months OR being held by someone for you (no time limit):

How did you learn about us?

NOTE: The use of this means of communication with the Bodor Law Firm will not establish an attorney-client relationship and messages containing confidential or time-sensitive information should not be sent. If you do not hear from us within 5 working days, please call us.

Law Offices of Andrew Bodor
Call us toll free at (800) 924-7403 to make an appointment

for that FREE CONSULTATION before it's too late.

Cleveland
5005 Rockside Rd.
Suite 600
Independence, OH 44131
Phone: (216) 476-1730
Fax: (330) 393-0855

Cleveland
1991 Crocker Rd.
Sixth Floor
Westlake, OH 44320
Phone: (216) 476-1730
Fax: (330) 393-0855

Cleveland
3401 Enterprise Pkwy.
Third Floor
Beachwood, OH 44122
Phone: (216) 476-1730
Fax: (330) 393-0855

Akron
755 White Pond Dr.
Suite 403
Akron, OH 44320
Phone: (330) 253-0130
Fax: (330) 393-0855

Canton
116 Cleveland Avenue, NW
Suite 709
Canton, OH 44702
Phone: (330) 453-4357
Fax: (330) 393-0855

Painesville
56 Liberty St.
Suite 309
First Merit Bank Bldg.
Painesville, OH 44077
Phone: (800) 924-7403
Fax: (330) 393-0855

Jefferson

35 West Jefferson St.
Jefferson, OH 44047
Phone: (800) 924-7403
Fax: (330) 393-0855

Youngstown
565 East Main St. (Rt224)
Suite 225
Canfield, OH 44512
Salem Phone: (330) 332-5531
Phone: (330) 782-0799
Fax: (330) 393-0855

Warren
8256 E. Market Street
Suite 115
Warren, OH 44484
Phone: (800) 924-7403
Phone: (330) 393-4060
Fax: (330) 393-0855

As seen on TV: "Don't close the door to your future. . . ."

Representing clients in the Youngstown, Warren, Salem, Jefferson, Cleveland, Akron, and Painesville, Ohio areas, including the neighboring cities and throughout the counties of Ashtabula, Trumbull, Mahoning and Columbiana, Cuyahoga, Lorain, Medina, Summit, Stark and Lake.
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All information you may obtain is not, nor is it intended to be, legal advice. You should consult an attorney for specific information relevent to your situation.