Confidential Case Assessment

Have you filed bankruptcy before?

Are you leasing your residence?

Do you intend to assume/keep the lease?

DO YOU OWN OR HAVE ANY INTEREST IN ANY OF THE FOLLOWING:

Have you had a workrelated injury or other medical condition within the last 2 years?

If yes, have you filed a claim?

Have you had any other injuries in the last 5 years?

If yes, have you filed a claim?

Have you transferred any property or money to another individual in the last 4 years?

Have you filed all tax returns that you are required to file?

Were you/are you entitled to a tax refund?

Have you taken any cash advances in the last 70 days totaling $750 or more?

Have you made any luxury purchases in the last 90 days totaling $500 or more?

Do you owe money to the bank with which you also have a bank account?

Have you signed any nonresidential leases or rental agreements (e.g. RentACenter, car, etc.)?

The use of the Internet or this form for communication with the firm or any individual member of the firm does not establish an attorney-client relationship. Confidential or time-sensitive information should not be sent through this form.

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