Bankruptcy Attorney for Los Angeles, Riverside, and Ventura County

BANKRUPTCY ATTORNEY Bankruptcy Attorney for Los Angeles, Riverside, and Ventura County Questionnaire Confidential Questionnaire - Law Offices of Tyson Takeuchi				1. FILL OUT THEFORM 2. GET REVIEWED BY SPECIALIST 3. RECEIVE FREE CONSULTATION
First Name First Name (spouse) DOB Marital Status Home Phone Adress State Zip Email Address:			Last Name Last Name (spouse) DOB (spouse) Number of children at home Business Phone City
Financial Information Monthly Income Owned a business in the past year? Yes No Filed Prior Bankruptcy Yes No Year and chapter of prior bankruptcy Any credit union loans? Yes No Balance of credit union loans Any student loans? Yes No Balance of student loans Has anyone co-signed with you? Yes No Relationship Any cash advances in the past 90 days? Yes No Amount From Do you pay or receive child support? Yes No Amount Paid Amount Received Are you Behind? Yes No Do you owe back taxes? Yes No Federal State Other Vehicle Information List all Vehicles (include paid-in-full) Year \| Make \| Model \| Mileage \| Monthly payment \| Amount behind \| Balance owed (est) \| Leased Residential Information Rent Own Complete if you own your residence 1st Liens
Monthly Payment	Amount Behind	Loan Balance
2nd Lien
Monthly Payment	Amount Behind	Loan Balance
3rd Lien
Monthly Payment	Amount Behind	Loan Balance
Other Assets List other assets (exclude household goods and clothing) Year \| Make \| Model \| Mileage \| Monthly payment \| Amount behind \| Balance owed (est) \| Leased Secured Debts List secured debts (exclude real property and vehicles) Year \| Make \| Model \| Mileage \| Monthly payment \| Amount behind \| Balance owed (est) \| Leased UnSecured Debts List unsecured debts (credit cards, medical bills, other) Approximate Total Unsecured Debt Monthly Budget (estimate)
Mortgage/ Rent Property Insurance Telephone Clothing Medical Expense Gas & Oil Vehicle Insurance Child Support Entertainment Other			Property Tax Utilities Food Laundry Vehicle Payments Vehicle Repair Spouse Support Child Care Miscellaneous Total Monthly
Yes I understand all the terms of Tyson Takeuchi & Associates.

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