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Which of the following has happened to you RECENTLY?(select all that apply)
Creditor Harassment Disability or Illness Divorce Foreclosure Lawsuits of Judgments License Suspension Loss of Income Loss of Job Repossession None of the above Other
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What kind of bills do you CURRENTLY have?(select all that apply)
Auto Loans Child Support Credit Cards or Charge Cards Income Taxes Medical Bills Mortgage or Rent Payday Loans Personal Loans Other
What kind of assets do you CURRENTLY own?
Do you own a house? If Yes, are you behind in these payments? Besides a house, do you own other real estate? If yes, are you behind on these payments? Do you own a car, truck or motorcycle? If Yes, are you behind in these payments? Other assets: Tip: If you own other assets not mentioned above, please list them in the box. Then click NEXT.
Yes No Yes No Yes No Yes No Yes No Yes No
What are your CURRENT sources of income (select all that apply)
Full-time job Part-time job(s) Social Security Pension or Retirement Child Support Payments Dividends or Interest I currently have no income Other
Contact Information This information is required because we want your personal bankruptcy evaluation to be as accurate and thorough as possible.
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