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Debts
Your Name
*
First
Last
Secured Debts
Do you own real estate?
Click "yes" even if your home is in foreclosure but not yet sold
Yes
No
Do you have a car loan?
Yes
No
Do you have a loan for jewelry?
Yes
No
Complete the following sections if they apply to your case
For example, if you have a mortgage for 1 home but no car loans, complete House #1 but leave Car #1 blank.
House #1
Date of purchase
Name of Creditor for 1st mortgage
Name of Creditor for 2nd mortgage or home equity line of credit
House #2
Date of purchase
Name of Creditor for 1st mortgage
Name of Creditor for 2nd mortgage or home equity line of credit
Priority Debts
Domestic Support
Do you owe alimony or child support?
Yes
No
If yes, who do you owe?
Include government collection agencies
If yes, what is the address of the person you owe?
If yes, how much do you owe?
Your Employees
Do you owe wages, salaries or commissions to employees or independent sales representatives?
Yes
No
If yes, who do you owe?
If yes, what is their address?
If yes, how much do you owe?
Employee Benefit Plan
Do you owe money to an employee benefit plan
Yes
No
Deposits you accepted
Have you accepted monetary deposits for property or services you did not provide?
Yes
No
Taxes
Do you have tax debt?
click "yes" if you owe income taxes, property taxes, or penalties to the federal, state or local government.
Yes
No
Tax Debt #1
Tax Authority: Federal, State or Other
Tax Year
Amount Owed
Tax Lien Filed? (Yes or No)
Tax Return Filed? (Yes or No)
Tax Debt #2
Tax Authority: Federal, State or Other
Tax Year
Amount Owed
Tax Lien Filed? (Yes or No)
Tax Return Filed? (Yes or No)
Tax Debt #3
Tax Authority: Federal, State or Other
Tax Year
Amount Owed
Tax Lien Filed? (Yes or No)
Tax Return Filed? (Yes or No)
Tax Debt #4
Tax Authority: Federal, State or Other
Tax Year
Amount Owed
Tax Lien Filed? (Yes or No)
Tax Return Filed? (Yes or No)
Tell us about any other tax debt you owe
Death or Personal Injury Due To Operation of a Motor Vehicle while Intoxicated or High
Do you have a debt resulting from your operation of a motor vehicle while intoxicated or high?
Yes
No
If yes, explain
Unsecured Creditors
Do you owe money to friends or family members?
Yes
No
If yes...
Their Name
Amount You Owe
Date Incurred
Their Address
If yes...
Their Name
Amount You Owe
Date Incurred
Their Address
Did an insurance company pay you money and is now seeking reimbursement?
Yes
No
If yes, explain
Debts NOT on your Credit Report
List all debts that are NOT on your credit report or already listed above.
Instead of listing all your debts here, would you rather send Sacramento Law Group all your bills and collection letters and a list of any other debts?
If you check "YES" you do not need to complete this section, but you will need to send us the requested information.
Yes
No
Creditor #1
Name
Address
Account # (last 4 digits)
Date Incurred
Amount Owed
Has this debt been assigned to a collection agency?
Yes
No
If yes, type the collection agency's name, address, account number, and amount owed
Creditor #2
Name
Address
Account # (last 4 digits)
Date Incurred
Amount Owed
Has this debt been assigned to a collection agency?
Yes
No
If yes, type the collection agency's name, address, account number, and amount owed
Creditor #3
Name
Address
Account # (last 4 digits)
Date Incurred
Amount Owed
Has this debt been assigned to a collection agency?
Yes
No
If yes, type the collection agency's name, address, account number, and amount owed
Creditor #4
Name
Address
Account # (last 4 digits)
Date Incurred
Amount Owed
Has this debt been assigned to a collection agency?
Yes
No
If yes, type the collection agency's name, address, account number, and amount owed
Tell us about any other debts you owe. Please list the creditor's name, address, account #, date incurred, and amount owed.
Bankruptcy Attorney
Adam Garcia
Bankruptcy Attorney
(916) 500-0704
Mon-Sat
8 AM – 6 PM
Related Pages
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