Intake Questionnaire

1. Please include your contact information so we can add this data to your file.

2. Do you possess any real estate or personal property that actually belongs to someone else?
YesNo

3. Have you sold any assets in the past four (4) years?
YesNo

4. Have you transferred, retitled, or donated anything of value in the past four (4) years?
YesNo

5. Have you given any family member over $600.00 in the past year?
YesNo

6. If you own real estate, have you refinanced in the past three (3) years?
YesNo

7. Have any real estate, cars or other assets been foreclosed or repossessed in the past year?
YesNo

8. Have you voluntarily returned any real estate, cars, or other assets to a creditor in the past two years?
YesNo

1. Have you filed all of your tax returns in the past four (4) years?
YesNo

2. Do you owe any back income, property or employment taxes?
YesNo

3. Has any taxing authority given you notice that they will place a lien on any of your assets?
YesNo

4. Are you entitled to any tax refunds that you haven't yet received?
YesNo

1. Does anyone besides you contribute to the expenses of your household?
YesNo

2. Do you expect significant changes in your household income or expenses in the next six (6) months?
YesNo

3. Do you receive any income from a trust, pension or annuity?
YesNo

4. Has anyone died and left you an inheritance that you have not yet received?
YesNo

5. Did you roll any previous loan or lease balances into a car loan in the past three (3) years?
YesNo

6. Have you financed a car in the past three (3) years?
YesNo

7. Have you taken any loans against or withdrawn funds from retirement savings in the past four (4) years?
YesNo

8. Have you created a trust in the past four (4) years?
YesNo

9. Have you been in business for yourself in the past six (6) years?
YesNo

10. Have you been an officer or a partner in a business in the past six (6) years?
YesNo

1. Are you separated from your spouse or considering a separation?
YesNo

2. Have you been a party to a divorce in the past four (4) years?
YesNo

3. Do you owe any money on account of a marital settlement of judgment of divorce?
YesNo

4. Do you pay child or spousal support?
YesNo

1. If you owe child or spousal support, is any amount owed past due?
YesNo

2. Are you owed any spousal or child support?
YesNo

3. Are you currently suing anyone? Do you have a claim against anyone for an accident, injury, debt or employment claim that you may sue later?
YesNo

4. Does anyone owe you money?
YesNo

1. Have you paid any other lawyer or credit counseling agency for advice about your debts or filing bankruptcy in the past year?
YesNo

2. Have you been served with any lawsuit or arbitration proceeding in the past three (3) years?
YesNo

3. Is anyone threatening to sue you?
YesNo

4. Do you have any lawsuits pending?
YesNo

5. Are you behind on your mortgage or car payments?
YesNo

6. Have you purchased any item worth more than $500.00 in the past 90 days?
YesNo

7. Have you taken any cash advance or payday loans in the past 90 days?
YesNo

8. Have you made any balance transfers between credit cards in the past six (6) months?
YesNo

9. Are you wages being garnished now?
YesNo

10. Have you lived outside of New Hampshire or Massachusetts in the past two (2) years?
YesNo

11. Have you filed bankruptcy in the past eight (8) years?
YesNo