Bankruptcy Contact Form

A debtor considering bankruptcy must bear in mind that a bankruptcy stays on his or her credit report for up to 10 years, making it difficult to get future credit such as mortgages and that any credit extended will probably cost more in terms of interest rates and fees. A debtor should also keep in mind that some debts must still be paid. Accordingly, it is essential to seek the advice of an experienced bankruptcy attorney before making potentially life-altering financial decisions.

Debt, whether from credit cards, medical expenses, mortgages, car loans or other sources, can mount quickly, and you may find yourself unable to keep up. At the Phoenix law office of Joseph C. McDaniel, P.C., our attorney has more than 30 years of bankruptcy law experience, and is one of fewer than 30 lawyers in the state designated as a Certified Specialist in Bankruptcy Law. If you are struggling with overwhelming debt, we can help you understand your bankruptcy options and get the debt relief you need.

We encourage you to learn more about our Arizona bankruptcy law practice. Our firm is dedicated to combining high-quality legal representation with the personal attention and service. Call 602-297-3025 or contact us online to schedule an appointment with an experienced Arizona bankruptcy lawyer. Your initial consultation is free.

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Bankruptcy Contact Form

Name

Email Address

Phone Number

Do you intend to file a joint bankruptcy petition with your spouse?
Yes No

If yes, include information for both you and your spouse below.

Name(s), including middle initial.

Residence address, including county.

How long have you been at this address?

Other addresses in the last ten years.

Address	How Long?

Other telephone number(s)

Work

Cell

Other

Have you used any other name(s) in the last six years?
Yes No

If yes, please list here

Single Separated Married Divorced

If married, how long?

If divorced, how long?

Ages of minor children living with you

Age(s), and amount(s) of child support paid:

Age	Amount
	$
	$
	$
	$

Is any child support past due?
Yes No

Amount
$

Husband's employment (name and addr.):

How long at this job?

Occupation

Income paid
weekly semi-monthly monthly other

Gross

Net

Wife's employment (name and addr.):

How long at this job?

Occupation

Income paid
weekly semi-monthly monthly other

Gross

Net

Income from other sources (second job, investments, social security, child support, workers' compensation etc.) State source and amount.

Do you owe any money to the Internal Revenue Service? (IRS)
Yes No

If yes, for what year(s)?

How much?
$

Do you have any unpaid student loans?
Yes No

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)?
Yes No

If yes, to whom and how much?

Do you own or are you purchasing a home or other real estate?
Yes No

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?
Yes No

Foreclosure date

List any liens against your property.

List all vehicle loans, including vehicle type (car, truck, motorcycle etc.)

Vehicle
Est. loan balance	$
Loan current
Amount behind	$

Vehicle
Est. loan balance	$
Loan current
Amount behind	$

Vehicle
Est. loan balance	$
Loan current
Amount behind	$

List all vehicles you own outright (no loan balance).

Vehicle	Est. value
	$
	$

Have you purchased any secured items (electronics, boats, jet skis®, appliances, etc.) in the last two years on which you still owe money?
Yes No

Have you taken out a loan from a finance company, credit union, bank, or any other source, and secured the loan by household items or other types of secured collateral?
Yes No

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 increased in the last 12 months?

Have you had any new cards issued in the last 12 months?

Do you anticipate receiving a tax refund?
Yes No

How much?
$

Are you eligible for the Earned Income Credit (EIC)?
Yes No

How much?
$

List all judgments, lawsuits, liens, and garnishments against you.

Special concerns

DISCLAIMER: This site and any information contained herein are intended for informational purposes only and should not be construed as legal advice. Seek competent legal counsel for advice on any legal matter.

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