MINKA, PLC
5937 West Main Street
(mailing address)
5945 West Main Street
(physical location)
Kalamazoo, MI 49009
269.353.0100
269.353.1337 fax


©2009 Minka Law
 

Financial Evaluation Form

If you are married and anticipate filing a joint petition for bankruptcy, your spouse should complete this form separately. If your spouse does not plan on filing, but you still maintain a household together, your spouse's name and income information for anyone (not just spouse) who is part of your household will still have to be provided.

Full name
Age
Contact email address
Contact phone number
Mailing address
City
State
Zip
County of residence
Have you ever filed for bankruptcy before? Yes    No    
   If so, when?

Have you filed all of your tax returns including those that are currently due? Yes    No  
Are you married? Yes    No  
Do you have joint debt with your spouse? Yes    No  
How many people in your household including yourself?
If you are currently employed, what is your occupation?
What was your total income for last year?
What are your earning(s) for the 6 months prior to this month?
What other income, from any other sources including social security, unemployment compensation, inheritances, and gifts of money or the like, have you received in the 6 months prior to this month?
Are you behind in payments on a mortgage, land contract or lease relating to any interest in real estate you have? Yes    No  
Have you received a notice from your mortgage lender that your home will be soon foreclosed or subject to a sheriff's sale? Yes    No  
Are you a party to any lawsuits? Yes    No  
Do you have any judgments against you? Yes    No  
Are you subject to garnishments? Yes    No  
Are you behind on car payments? Yes    No  
Do you owe taxes to the IRS? Yes    No  
Do you owe taxes to any state or local government? Yes    No  
What is the approximate total amount of your credit card debt?
What is the approximate total amount of other debt you have?
Verification Code
Please enter the code		 verify
[Disclaimer: Completion of this form does not create an attorney client relationship]