Law Firm

Bankruptcy Screening Disclosure

Please complete this form even if you discussed your situation with an attorney or staff member. Your answers help us protect your rights and meet important deadlines. Answer every question honestly — if you are not sure, choose "I'm not sure" rather than guessing. Dates, amounts, case numbers, and documents are never required to submit.

1

Real Estate / Foreclosure

What best describes your current living situation? *

This helps us understand whether your home is at risk.

Besides your current residence, do you own or have an ownership interest in any other real estate? *

This includes a rental, land, a second home, or any other real estate. Answer Yes even if you also own your home.

2

Vehicles / Repossession

Do you have any financed or leased vehicles? *

This includes cars, trucks, motorcycles, RVs, or any other vehicle you are financing or leasing.

4

Garnishment & Bank Levy

Is money currently being taken from your paycheck because of a wage garnishment? *

This means money is being withheld from your paycheck by your employer.

Has your employer received or been served with papers telling them to begin garnishing your wages, even if money has NOT been taken from your paycheck yet? *

Is any money in your bank account currently frozen, on hold, levied, or unavailable because of a creditor or court action? *

Have you received a lawsuit, summons, garnishment notice, bank levy notice, or other court papers indicating that wage garnishment or a bank levy may begin soon? *

3

Prior Bankruptcy

Have you filed ANY bankruptcy case within the last 12 months? *

Has ANY bankruptcy case involving you been dismissed within the last 12 months? *

Do you currently have another bankruptcy case that is still open or pending? *

Have you filed ANY bankruptcy case within the last 8 years? *

Our office will determine any legal effect from the prior case information you provide. You do not need to figure out which time limit applies.

Why we ask: Prior bankruptcy cases and prior discharges can affect whether and when another bankruptcy discharge may be available. Our office will review the prior case information and determine how it affects your options. You do not need to determine whether you are eligible for another discharge.

Have you ever received a bankruptcy discharge? *

Answer Yes even if the discharge was a long time ago — it is still useful for our office to know.

Our office will determine any legal effect of your prior bankruptcy history from the information you provide. You do not need to figure out whether you are eligible or barred — just tell us the facts you know. Dates, case numbers, and documents are never required to submit.

Your Disclosure Summary

REAL ESTATEAnswer required questions
VEHICLESAnswer required questions
GARNISHMENT / LEVYAnswer required questions
PRIOR BANKRUPTCYAnswer required questions

Client Certification

I have personally reviewed the information above. I certify that my answers are true and complete to the best of my knowledge. I understand that I must immediately notify the office if any of this information changes before my bankruptcy case is filed. I understand that retaining counsel does not mean that a bankruptcy case has been filed and does not, by itself, stop a foreclosure sale, repossession, garnishment, levy, or other collection activity.

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Date and time are captured automatically when you submit.

Please answer all required Real Estate questions.