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Bankruptcy Analysis Worksheet

Your submission of and our receipt of this worksheet does not create an attorney-client relationship.

Name:
City:		State:		Zip:
(H)Phone:		(W)Phone:		(C)Phone:
E-mail:		Number of People Living in Your Home
Debts:
Tax Debts:
IRS:	(total debt)		How Long:	(tax years)
Georgia Revenue:	(total debt)		How Long:	(tax years)
Real Estate:
Home Value:			Date Purchased:
First Mortgage:
Monthly Payment:			Delinquency Total:
Mortgage Payoff:
Second Mortgage:
Monthly Payment:			Delinquency Total:
Mortgage Payoff:
Motor Vehicles:
Type of Vehicle #1:
Year:
Make:		Model:		Mileage:
Monthly Payment:			Delinquency Total:
Loan Payoff:
Type of Vehicle #2:
Year:
Make:		Model:		Mileage:
Monthly Payment:			Delinquency Total:
Loan Payoff:
Credit Cards and Medical Bills:
Total Credit Card Debt:
Total Medical Bills:
Other Debts:
Who:
Total Debt:
Who:
Total Debt:
Who:
Total Debt:
Who:
Total Debt:
Income:
Your Annual Income:
Spouse's Annual Income:
Have you ever filed bankruptcy before? If so, on what date and was it a Ch. 7 or 13?

THE FRISON FIRM represents clients throughout Georgia, including those in Downtown and Midtown Atlanta, Decatur, Alpharetta, Duluth, East Point, Lilburn, Stone Mountain, Lithonia, Covington, Clarkston, Peachtree City, Marietta, Conyers, Dallas, Savannah, Brunswick, Smyrna, Jonesboro, Lawrenceville, Sandy Springs, Buckhead, Gainsville, Athens, Austell, Carrollton, Macon, McDonough, Newnan, Norcross, Riverdale, Rockmart, Roswell, Stockbridge, Villa Rica and all cities within Fulton County, Dekalb County, Cobb County, Rockdale County, Gwinnett County, Bibb County, Whitfield County, Clarke County, Richmond County, Chatham County, Muscogee County, Floyd County, Houston County, Dougherty County, Clayton County, Carroll County, Henry County and Lowndes County.