Hartford Bankruptcy Attorney | Chapter 7 | Chapter 13 | Stop Foreclosure | Waterbury | New Britain | Bristol | Meriden

Serrano & Serrano, LLC

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800 856-6400

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690 Flatbush Avenue West Hartford, CT 06110-1308

860 236-9350 800 856-6400 toll free 860 523-9101 fax

10 Church St, Naugatuck 203 729-6100


Bankruptcy Inquiry Form - Single

Name
Phone Number(s)
Address
E-Mail
How Long Have You Lived in Connecticut
Gross Weekly Income (Before Taxes and Other Deductions Are Taken Out) No Dollar Sign
How Many Minor Children Do You Support If None, Enter 0
Do You Own Your Home?	Yes No
If So, Please Answer These Questions:
Year Purchased Use 4 digits
Purchase Price No Dollar Sign
Total Mortgage Debt No Dollar Sign
Present Home Value No Dollar Sign
How Many Months Are You Behind on Your Mortgage	None 1 2 3 4 or More
Has a Foreclosure Case Been Filed Against Your Home	Yes No Not Sure
Do You Own Other Real Estate	Yes No
If So, Please Answer These Questions:
How Many Properties
Are Any Properties In Foreclosure	Yes No Not Sure
Have You Filed All Your Income Tax Returns For the Last 4 Years	Yes No Not Sure
Do You Owe Back Federal Income Taxes	Yes No Not Sure
Do You Owe Back State Income Taxes	Yes No Not Sure
Are You Under A Court Order to Pay Alimony or Child Support	Yes No Not Sure
If So, Are You Behind In Payments	Yes No Not Sure
Have You Filed Bankruptcy in the Last 10 Years	Yes No Not Sure
If So, Please Answer These Questions for Each Previous Case:
Most Recent Case	Chapter 7 Chapter 13
	When Filed Where Filed
	Discharge Entered Dismissed Not Sure
2nd Most Recent Case	Chapter 7 Chapter 13
	When Filed Where Filed
	Discharge Entered Dismissed Not Sure
3rd Most Recent Case	Chapter 7 Chapter 13
	When Filed Where Filed
	Discharge Entered Dismissed Not Sure
4th Most Recent Case	Chapter 7 Chapter 13
	When Filed Where Filed
	Discharge Entered Dismissed Not Sure
Have You Paid Back Any Money to Relatives During the Last 12 Months	Yes No Not Sure
Have You Paid Back Any Money to Business Partners During the Last 12 Months	Yes No Not Sure
Have You Transferred or Given Away Any Property During the Last 3 Years	Yes No Not Sure
Are You Behind On Any Car Loans	Yes No Not Sure
Do Have Any Lawsuits Against Anyone	Yes No
If So, Please Indicate	Which Court Case Number Type of Case
Do You Have a Reason to File a Lawsuit Against Anyone	Yes No Not Sure
If So, Please Explain
Have You Been Hurt in a Car or Other Accident in the Last 3 Years	Yes No Not Sure
Do You Have Your Own Business	Yes No
Have You Closed a Business in the Last 6 Years	Yes No Not Sure
Is Anyone Suing You	Yes No Not Sure
Does Anyone Owe You Money	Yes No Not Sure

Please include the area codes for your phone number(s).

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