Michael P. O'Donnell Attorney at Law
 


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Debt Questionnaire - Complete with as much information as you have available and send to me for a personal response concerning your specific debt situation.

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*Name
*E-mail address
*Phone Number
  
Do you intend to file a joint bankruptcy petition?
YesNo
If yes, include information for both yourself and your spouse below:
Name(s), including middle initial
*Residence address, including county
How long have you been at this address?
AddressHow 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 minor children living with you
Ages, and amount of child support paid:
AgeAmount
 $
 $
 $
 $
Is any child support past due?
YesNo
Amount
$
Husband's employment:
How long at this job?
Occupation
Income paid
weeklysemi-monthlymonthlyother
Gross
Net
Wife's employment(name and addr.):
How long at this job?
Occupation
Income paid
weeklysemi-monthlymonthlyother
Gross
Net
Income from other sources (second job, investments, social security, child support, worker's compensation, etc.) (state sources and amount):
Do you owe any money to the Internal Revenue Service?
YesNo
If yes, for what year(s)?
How much?
$
Do you have any unpaid student loans?
YesNo
Amount
$
Monthly Expenses
Rent Real Estate Taxes 
Electric Home Maintenance 
Gas Life Insurance 
Water Health Insurance 
Phone Auto Insurance 
Cable Homeowner/Rent Ins. 
Trash House Payment 
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
Tax Assessed Value
$
First Mortgage Loan Balance
$
Loan Current?
Amount Behind
$
2nd Mortgage Loan Balance
$
Loan Current?
Amount Behind
$
3rd Mortgage Loan Balance
$
Loan current?
Amount Behind
$
Are you facing foreclosure?
YesNo
Foreclosure Date
List any liens against your property
List all vehicle loans (car, truck, motorcycles; identify vehicle type)
VehicleEst. Loan BalanceLoan CurrentAmount Behind
 $ $
 $ $
 $ $
List all vehicles you own outright (no loan balance)
VehicleEst. Value
 $
 $
Have you purchased any secured 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

$

Misc. Bills

When was thelast time you used any of your credit cards? (approx. date)
How much has total owed on cards gone up in the last 12 months?
Have you had any new cards issued in the last 12 months?
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.
Special concerns
Where did you hear about this website?
*Name
*E-mail address
*Phone Number
  
Do you intend to file a joint bankruptcy petition?
YesNo
If yes, include information for both yourself and your spouse below:
Name(s), including middle initial
*Residence address, including county
How long have you been at this address?
AddressHow 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 minor children living with you
Ages, and amount of child support paid:
AgeAmount
 $
 $
 $
 $
Is any child support past due?
YesNo
Amount
$
Husband's employment:
How long at this job?
Occupation
Income paid
weeklysemi-monthlymonthlyother
Gross
Net
Wife's employment(name and addr.):
How long at this job?
Occupation
Income paid
weeklysemi-monthlymonthlyother
Gross
Net
Income from other sources (second job, investments, social security, child support, worker's compensation, etc.) (state sources and amount):
Do you owe any money to the Internal Revenue Service?
YesNo
If yes, for what year(s)?
How much?
$
Do you have any unpaid student loans?
YesNo
Amount
$
Monthly Expenses
Rent Real Estate Taxes 
Electric Home Maintenance 
Gas Life Insurance 
Water Health Insurance 
Phone Auto Insurance 
Cable Homeowner/Rent Ins. 
Trash House Payment 
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
Tax Assessed Value
$
First Mortgage Loan Balance
$
Loan Current?
Amount Behind
$
2nd Mortgage Loan Balance
$
Loan Current?
Amount Behind
$
3rd Mortgage Loan Balance
$
Loan current?
Amount Behind
$
Are you facing foreclosure?
YesNo
Foreclosure Date
List any liens against your property
List all vehicle loans (car, truck, motorcycles; identify vehicle type)
VehicleEst. Loan BalanceLoan CurrentAmount Behind
 $ $
 $ $
 $ $
List all vehicles you own outright (no loan balance)
VehicleEst. Value
 $
 $
Have you purchased any secured 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

$

Misc. Bills

When was the last time you used any of your credit cards? (approx. date)
How much has total owed on cards gone up in the last 12 months?
Have you had any new cards issued in the last 12 months?
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.
Special concerns
Where did you hear about this website?
*Name:
*Address:
*City:
*State:
*Zip:
*E-mail address:
*Home Phone:
BusinessPhone:
Cellular or Pager:
Facsimile:
Does this matter involve a business you own or run?
YesNo
If yes, provide the business name, address, and phone:
Describe your situation, including any relevant dates:
Have you been in contact with any government agency or official regarding this matter?
YesNo
If yes, please provide the name and address of the agency or official:
Have any civil or administrative agency proceedings been started regarding this matter?
YesNo
If yes, please set out the type of proceedings, the court or agency in which the action is brought, and the date commenced:
How would you rate your legal needs described here?
Are any other people involved?
YesNo
If yes, provide names, addresses (if known), and their relationship to you, if any:
Do you have any documents that could help explain your situation?
YesNo
If yes, list those documents and their dates:
Are there other documents that you do not have access to that could be of assistance?
YesNo
If yes, list those documents and their dates and locations (if known):
Describe how this situation has impacted you:
Describe what you would like to happen to resolve your issue (your preferred outcome):
Have other attorneys worked on this matter?
YesNo
If yes, provide names, addresses, and a brief description of their involvement:
Special concerns:
Where did you hear about this website?
 

NOTE: The use of the Internet for communications with the firm will not establish an attorney-client relationship and messages containing confidential or time-sensitive information should not be sent.

Copyright © 2010 by Michael P. O'Donnell Attorney at Law. All rights reserved. You may reproduce materials available at this site for your own personal use and for non-commercial distribution. All copies must include this copyright statement.


"We are a debt relief agency. We help people file for bankruptcy under the Bankruptcy Code." The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for individual advice regarding your own situation. Unless otherwise indicated, attorneys listed on this site are not certified by the Texas Board of Legal Specialization. Some links within this site may lead to other websites, including those operated and maintained by third parties. These links are included solely as a convenience to you, and the presence of such a link does not imply an endorsement of the linked site, its operator, or its contents. This site does not incorporate any materials appearing in such linked sites by reference. THIS SITE AND ITS CONTENTS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND, EITHER EXPRESSED OR IMPLIED, INCLUDING, BUT NOT LIMITED TO, THE IMPLIED WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, OR NON-INFRINGEMENT.