Bankruptcy Worksheet - Keegan & Co Attorneys, LLC

Name(Required)

First Last

Cell Phone Number(Required)

Alternative Phone Number

Spouse Name

First Last

Email(Required)

List Your Dependents and Age

Dependent Name

Dependent age

Marital Status

If you have used, or been known by, any other names within the last 6 years (include maiden names, nicknames, or business names), list them here

Address 1

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

List all other addresses During the last three years.

Date range

Address, City and State

ZIP

Your Occupation

Employer's Name

Employer's Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Work Phone

Years Employed

Spouses Occupation

Spouses Employer's Name

Spouses Employer's Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Spouses work Phone

Spouses Years Employed

List all bank accounts in your name that you have maintained or used in the last year

Bank/Credit Union Name

Account Type

Current Balance

Names on Account

If Closed, Date closed

Checkings/savings, safety deposit boxes, Venmo, PayPal, Apple Cash, etc. (Include all accts in your name: even for a minor child, even accounts with negative balance)

Have you sold, traded, transferred or given away any property or vehicles in the past 24 months (2 years)?

Yes

Are you holding property for another person?

Yes

Is any of your property currently in someone else's possession?

Yes

Have you ever filed bankruptcy or Chapter 13 before?

Yes

Are you being sued now?

Yes

If yes, list who sued you, the date, case number and in which court the lawsuit is in. Attach any papers you may have

Name of Case

Type of Case

Case Status

Case Number

Location of Court

Are you now being evicted, or is your real estate being foreclosed?

Yes

Have you paid back any loans to family members in the last 12 months?

Yes

Have you sold, traded, transferred or given away any real estate in the past 4 years?

Yes

Has any of your personal property been repossessed or returned to a creditor during the past 2 years?

Yes

Have you suffered any losses from fire, theft or gambling in the past year?

Yes

Have you been involved in an automobile accident or other accident during the last five (5) years?

Yes

If so, who was at fault?

If yes, was it alcohol or drug related in any way?

Yes

Does anyone owe you money?

Yes

Are you expecting any money from any other sources in the next six months including worker's comp., compensation, social security, accident claims, or an inheritance?

Yes

Do you owe any taxes (Federal, State, or Local)?

Yes

Have you obtained any money, property, credit or services by means of false pretense, fraud, misrepresentation or by a false financial statement?

Yes

Do you have any debts you are required to pay for intentional or malicious injury caused to another person or property?

Yes

Do you have any debts for student loans? (for you or a child)

Yes

Are you self employed in any way?

Yes

Have you been in business alone or with anyone else during the last 6 years?

Yes

Have you ever been divorced?

Yes

List the last time you used any of your credit cards for any purpose.List the last time you used any of your credit cards for any purpose.

Have you borrowed any money or gotten any money on credit in the last 90 days? ( example: cash advances, convenience checks or personal loans)

Yes

Are you expecting any money or property from a divorce settlement, bonus or Income Tax Refund, back social security clam or workers compensation claim?

Yes

Have you purchased an automobile within the last one year?

Yes

Are you currently contributing to a 401(K) or other Retirement Plan?

Yes

If yes, are you currently paying back a loan from your retirement plan?

Yes

If you have a retirement loan - when does it pay off?

Do you owe any money for child support or spousal support?

Yes

Name and address of recipient:

If yes, are you paying back a support arrearage?

Yes

Have you participated in a credit counseling program within the past six months?

Yes

If so, did any of your creditors refuse to participate in your program?

Yes

Have you paid any one person or creditor more than $600 in the past 90 days?

Yes

Are you current on your house payment?

Yes

If not, how far behind is it?

If you have vehicle loan, was it used to purchase or refinance?

NOTE: If you file bankruptcy against Duke Energy for past due gas and electric bills, Duke Energy will require a security deposit from you within 20 days after filing your case. The deposit will be figured by Duke Energy by computing your average bill over the last 12 months and adding 30%. If you are filing a bankruptcy or bill consolidation case, you should immediately stop using any credit cards and should not take out any more loans or incur any additional debt. If you have used your credit cards or incurred any debt in the last 3 months, please discuss it at your next meeting. Also, do not sell any of your property while your bankruptcy is pending and do not purchase anything of value unless you talk with us first. Federal law requires that we have a record of your last six (6) months pay history. You must submit your pay stubs or provide some other proof of income for this time period. Federal law requires your current monthly income and disposable income bet stated.

List

Keegan and Co Attorneys, LLC

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Middletown Location

Ohio Bankruptcy Attorney