Law Offices of
Michele M. Poteracke
  


     707 571-1109
     
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Bankruptcy Questionnaire

Initial Consultation Questionnaire

Bankruptcy representation by an attorney provides multiple benefits, including optimizing your rights to keep property through legal exemptions and discharge debt.  Your decision to hire legal counsel and our advice to you regarding how bankruptcy may help you, starts with an initial consultation to review and analyze your specific financial issues. 

Please provide  the following information prior to your consultation.  The better the information you provide here, the more productive our time will be during the consultation.

First Name:
Last Name:
Address Street 1:
Address Street 2:
City:
Zip Code: (5 digits)
State:
Daytime Phone:
Evening Phone:
Email:
1. Do you prefer a telephone or in-person initial consultation?  telephonein-office
2.  Are you considering bankruptcy for yourself or with a spouse? Company?  Provide the name here:
3. List several available times/date for you

4. Do you have any time-sensitive matters, like a pending foreclosure sale, or lawsuit? Describe briefly:

5. Provide the name of each employer, for both you and spouse, if applicable

6. For each employer, provide address

7. For each employer listed, provide your/your spouse's job title/position

8. How long at each job you listed above

9. Your gross income year-to-date; and your spouse's gross ytd - list ALL sources of income

10. Do you have dependents? If yes, list the age/sex of each dependent. Are they listed on your tax returns?

11. How did you hear about the Law Offices of Michele M. Poteracke? Please list the website, if you used the internet.

12. Have you or your spouse ever filed bankruptcy before? If yes, when?

13. How many outstanding credit accounts do you have - credit cards, medical bills, personal loans, business loans?

14. Have you used any of the above accounts in the last three (3) months? If yes, when and amount?

15. Do you own any real estate? If yes, provide the address and your estimate of current value.

16. Are you current on all mortgages for the real estate? If no, how many months behind are you and has a Notice of Default or Notice of Sale been sent to you?

17. Please fill in the following to list your personal property; starting with
A. Cash

B. Funds in bank, credit union

[name of institution / last 4 digits of acct]

C. Fund in pension, 401k, IRA

[name of institution / last 4 digits of acct]

D. Deposits w/landlord, etc.

[name/address]

E. Pending inheritances

[name of deceased/trust]

F. All household items - furniture, appliances, hobby & recreational items

[list only items valued more than $500]

G. Jewelry [describe/value]

H. Photo equipment [describe/value]

I. Collections [describe/value]

J. Guns [list model/value]

K. Tools/equipment/supplies used in your trade or business [describe/value]

L. Does anyone owe you money - like tax refunds, lawsuits pending, loans you’ve made

M. Vehicles – land, sea and air

[year/make/model/mileage]

18. List all names you have used within the last 8 years

19. List all addresses where you have lived in the last 3 years

20. List all business you have operated within the last 6 years

21. If you have a safe deposit box, list its contents and where located.

22. If you borrowed money from a relative and paid any or all of it back within the past 12 months, list the name and address of the relative and the amount paid back

23. If you have paid any creditors in the past 90 days, list how much and to whom

24. If you created a trust within the past 10 years and transferred any property from your name into the trust, list it and provide a copy of the trust documents

25. Within the last 12 months, has anyone sued you? If yes, provide a copy of the lawsuit or at least list its caption and case number.

26. Has anyone obtained a judgment against you in the last 12 months and as a result, taken any money from you by garnishment, attachment, receivership or other collection method? If yes, list.

27. Have you taken any cash advances or used any convenience checks provided by your credit cards in the last 12 months? If yes, provide date and amount of advance.

Security Code: *  

The information you provide, helps us determine if a chapter 7 bankruptcy or a chapter 13 bankruptcy would benefit you, and which one you qualify for based on your income and other considerations.   Our bankruptcy attorney represents clients throughout Solano County, Sonoma County and Napa County, including but not limited to the cities of Fairfield, Vacaville, Vallejo, Santa Rosa, Petaluma, Rohnert Park, Napa and Sonoma, California.

PLEASE TAKE NOTE:  THE U.S. BANKRUPTCY COURT HAS PROVIDED SEVERAL INFORMATIONAL NOTICES WHICH IT WISHES EACH POTENTIAL FILER TO REVIEW BEFORE MAKING THE DECISION TO FILE FOR BANKRUPTCY RELIEF.  CLICK HERE TO READ SOME OF THOSE NOTICES NOW.  A COPY WILL ALSO BE PROVIDED FOR YOU DURING THE CONSULTATION TO KEEP IN YOUR FILE.
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