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BANKRUPTCY COURT

United States Bankruptcy Court
Middle District of Florida

135 West Central Blvd.
Orlando, FL 32801-2443

Website

US Bankruptcy Court
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Bankruptcy Evaluation

 Customer Information
Items marked with Praver Law - evaluation form required field marker are required fields.
Customer Name: diving for fun - information request form edit field - customer name
Address: diving for fun - information request form edit field - address
City: diving for fun - information request form edit field - city St: diving for fun - information request form edit field - state    Zip: diving for fun - information request form edit field - zipcode
Home Phone:   (   )   -    [Ex: (321) 555-3333]
Work Phone:   (   )   - 
Cell Phone:   (   )   - 
Best contact:   Home     Work     Cell
E-mail: Required Field

 Mortgage Information
Approx. Home Value:     [currency entries can be entered with]
1st Mortgage Mo. Payment:     ["$" or "," or "." or without any punctuation.]
1st Mortgage Balance:     [Ex: $12,500.00 or $12500 or 12500.]
2nd Mortgage Mo. Payment:  
2nd Mortgage Balance:  
Current on Mortgage Payments:   Yes     No
   
Annual Homeowners Insurance:  
Annual Property Taxes:  
Ins. & Taxes Paid in Escrow:   Yes     No
   
Any Other Mortgages:   Yes     No

 Vehicles
Vehicle 1 Year:     [Ex: 2005]
Vehicle 1 Make:     [Ex: Ford, Dodge, etc.]
Vehicle 1 Model:     [Ex: LS 400]
Vehicle 1 Retail Value:  
Vehicle 1 Balance (Payoff):  
Vehicle 1 Monthly Payment:  
Vehicle 1 Monthly Ins. Pmt:  
Current on Vehicle 1 Payments:   Yes     No
   
Vehicle 2 Year:     [Ex: 2005]
Vehicle 2 Make:     [Ex: Ford, Dodge, etc.]
Vehicle 2 Model:     [Ex: LS 400]
Vehicle 2 Retail Value:  
Vehicle 2 Balance (Payoff):  
Vehicle 2 Monthly Payment:  
Vehicle 2 Monthly Ins. Pmt:  
Current on Vehicle 2 Payments:   Yes     No

 Other Debt
Credit Cards (Payoff):  Credit Cards (Mo. Pmt): 
Medical Bills (Payoff):  Medical Bills (Mo. Pmt): 
Tax Debt (Payoff):  Tax Debt (Mo. Pmt): 
Student Loans (Payoff):  Student Loans (Mo. Pmt): 
Other Debt (Payoff):  Other Debt (Mo. Pmt): 

 Other Monthly Expenses
Groceries:  Maint. (Lawn & Pool): 
Electricity:  Home Maint. (Pest): 
Water & Sewer:  Clothing: 
Telephone:  Laundry & Dry Cleaning: 
Cell Phone:  Medical & Dental: 
Cable & TV:  Trans (Fuel & TollTag): 
Internet:  Alimony/Child Support: 
HOA Dues:  Other Payments: 

 Income
My Gross Mo. Income:  Weekly  Bi Weekly  Bi Monthly  Monthly
Spouse Gross Mo. Income:  Weekly  Bi Weekly  Bi Monthly  Monthly
       
Other Monthly Income:  Disability Social Security
    Pension Rental Property
    Part Time Job Child Support
    Unemployment Worker's Comp

 Questions and/or Comments

  
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