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New Orleans Attorney David D. Kervin, Jr. > Bankruptcy Evaluation

Louisiana Bankruptcy Evaluation

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Personal Information

First Name:

Last Name:

Email:

Address:

City:

State:

Zip:

Phone:

Specify day/time for a return call:


Bills

What type of bills do you have? Check all that apply:

Credit Cards
Tax Debts
Medical Bills
Student Loans

Total amount of bills:

Under $5,000
$5,000 - $15,000
$15,000 - $20,000
$20,000 - $30,000
$30,000 - $50,000
$50,000 - $75,000
Over $75,000


Property

Approx. home value:

1st Mortgage Balance:

2nd Mortgage Balance:

Are you up to date on your mortgage payments?:

Yes
No

Are there any other mortgages on this property?:

Yes
No


Vehicles

Vehicle 1

Year:

Make:

Model:

Value:

Balance:

Monthly Payment:

Are your payments up-to-date?:

Yes
No

Vehicle 2

Year:

Make:

Model:

Value:

Balance:

Monthly Payment:

Are your payments up-to-date?:

Yes
No



Income

You

How often do you get paid?:

Every Week
Every 2 Weeks
Twice a Month
Monthly

Gross Pay:

Spouse

How often do you get paid?:

Every Week
Every 2 Weeks
Twice a Month
Monthly

Gross Pay:



Other Income

What other types of income do you have Check all that apply?:

Disability
Social Security
Pension
Rental Property
Part-time Job
Child Support
Unemployment
Worker's Comp

Monthly Amount:




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A Debt Relief Agency
201 St. Charles Avenue, Suite 2500, New Orleans, LA 70170

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