DiSante Law Offices
Frank L. DiSante, Attorney at Law
CONSULTATION FORM
Confidential
Consultation Information Form
You may use this form to organize your facts and print the form for your personal use or to bring with you
to our office for your consultation.
BIOGRAPHY & GENERAL INFORMATION:
Contact Information:
( You may
use a "screen name" here to protect your identity)
Name
,
If you would
like us to call you, best days and times to reach you:
Home Telephone
Number:
Work
Telephone Number:
Biographical / General Information:
Marital Status
Are you
considering not filing with your spouse?
Including
yourself, how many
people are in your household?
Have you filed bankruptcy before?
YESNO
If so,
Chapter? Date?
Have you
owned or operated a business, such as a corporation,
partnership, sole proprietorship, in the past six years?
If so, please briefly describe:
In the past twelve months have you given or paid more than $600
to any friend or relative?
YES
NO
If anyone
owes you money, please list Amount $
Are you, or
have you been,
involved in a legal action in the past twelve months?
YES
NO
If so, briefly
describe:
Are your wages
or any bank account being being garnished?
YES
NO
ASSETS:
Real Estate:
Do you own any real estate? This
would include houses, lots, timeshares, etc.
If yes,
Property #1
When purchased?
Purchase Price $
Market value? $
How many mortgages
or liens do you have on your property?
First
Mtg/Lien $
Second
Mtg.Lien $
Third Mtg/Lien $
Are you behind on
the payments for any of the above?
YES
NO
How much money are you in arrears in total? $
What do you want to do with this property?
Property #2
When purchased?
Purchase Price $
Market value? $
How many mortgages
or liens do you have on your property?
First
Mtg/Lien $
Second
Mtg.Lien $
Third Mtg/Lien $
Are you behind on
the payments for any of the above?
YES
NO
How much money are you in arrears in total? $
What do you want to do with this property?
Have you transferred
, sold or gifted any real estate in the last four years? YES
NO
Vehicles:
Do you own any vehicles? If
yes,
Vehicle #1 YR
,
MAKE
,
MODEL
Market Value $
Balance Owed $
Monthly Payment $
What
do you want to do about this vehicle?
Vehicle #2 YR
,
MAKE
,
MODEL
Market Value $
Balance Owed $
Monthly Payment $
What do you want to do about this vehicle?
Vehicle #3 YR
,
MAKE
,
MODEL
Market Value $
Balance Owed $
Monthly Payment $
What
do you want to do about this vehicle?
Other
Valuable Assets:
If you have any other assets
that could be sold for a significant amount of money, please
list here. Since there are exemptions that protect a
certain amount of you property, for now you do not need to
list here the following items whose market or garage sale
value do not exceed the following amounts: Jewelry
under $1,000; Household good under $3,000 per spouse;
Retirement accounts such as IRA's, 401(k)'s, etc.
DescriptionApprox. Market Value $
Description
Approx. Market Value $
DescriptionApprox. Market Value $
DescriptionApprox. Market Value $
DescriptionApprox. Market Value $
DescriptionApprox. Market Value $
DEBTS:
General
Debt Information:
Check boxes that are appropriate and
give a ballpark amount for each type of debt.
About how many creditors do you have?
About
how much debt do you have, not counting real estate or vehicle
loans? Check those that apply and insert amounts.
Charge cards
$
Medical bills
$
Child support
$
Student loans
$
Taxes
$
Signature loans
$
Deficiency balances on repossessions
$
Ready Reserve accounts
$
Other
type of debt
, $
Have you made
any cash advances or charges for "luxury" items of over
$1,000 on your credit cards in the past 60 days?
If
so, when?
and how much was charged? $
Taxes
Issues:
Do you owe the IRS or a state for back taxes?
YES
NO
If you have not filed tax returns for any years now
overdue, please list years:
Are you expecting a tax refund that you have not yet
received, even on a return that you have not yet filed?
If so,
how much to you expect to receive? $
BUDGET:
Income:
What is your six month average monthly net income of your household, after taxes
and normal deductions, but not including deductions for
401(k) contributions? You need to include your
spouse's income, even if your spouse does not intend to file
with you. If you live with a significant other person,
and that person contributes to household expenses, we will
have to discuss how it affects your budget.
You $
Spouse $
List your approximate monthly expenses
of living (not deducted from your payroll) below:
