The Cooper Law Firm

Initial List of Creditors

FIRST APPOINTMENT SHEET

FIRST APPOINTMENT SHEET

News

Contact information

News

Contact information

864-271-9911

864-232-5236

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First Appointment Form Profit & Loss Statement Average Monthly Expense Form

RHC	KLH	MRW	Others
Exceeds median income? Yes No

You are going to be meeting with a Bankruptcy Attorney shortly. You will probably be in our office about an hour. Our policy is to treat this meeting as one that will help you to better understand your options.

You are not going to be asked to decide whether or not you want to hire us to take any actions. Instead, we will review your financial situation, counsel with you, and establish the fees and costs of the various options if there are any. We will, of course, answer your questions and put what we can into writing so that you can take it home to review.

Please answer as completely as possible

Today’s date is

Your full name is

Your Social Security Number is

Your date of birth is

Your Spouse’s full name is

Your Spouse’s Social Security Number is

Your Spouse’s date of birth is

If your creditors have ever known you by any other name(s), please provide:

Yourself:

Spouse:

Email Address:

Have you or your spouse owned a business or been self employed in the last 6 years?

Yes No If so, state the name and dates (beginning and ending or operation of each)

Your mailing address:

Your ZipCode

In which county do you live:

Phone numbers.

Home:

Yourself Work:

Spouse Work:

Have you lived in South Carolina for at least 91 days? Yes No

If not, when did you move here?

Initial List of Creditors
If you have brought with you a list of your creditors you do not need to complete this sheet. However, you must ensure that every single creditor or person you owe (including houses, car, etc) is listed on your list with the estimated amounts owed. If you did not bring a list with you, please complete this page. Please also state whether or not any of your debts have been cosigned or whether or not you have cosigned any debts for any other person.
Please list all of your creditors here:
S/U	Creditor Name	Total Owed	Monthly Payment	Past Due	Security for Debt
		$	$	$
		$	$	$
		$	$	$
		$	$	$
		$	$	$
		$	$	$
		$	$	$
		$	$	$
		$	$	$
		$	$	$
		$	$	$
		$	$	$
		$	$	$
		$	$	$
		$	$	$
		$	$	$
		$	$	$
		$	$	$
		$	$	$
If you need more space, please ask for additional sheets.

Please estimate you “take home” pay:
Yourself:
Hourly rate:	$	Hours per period:		Overtime rate:	$
Hours:		Anuual Salary:	$ Per Year	Commission:	$

How often are you paid:

Weekly Every Two Weeks Bi-MonthlyMonthly Monthly Other (explain)

Spouse:
Hourly rate:	$	Hours per period:		Overtime rate:	$
Hours:		Anuual Salary:	$ Per Year	Commission:	$

How often are you paid:

Weekly Every Two Weeks Bi-MonthlyMonthly Monthly Other (explain)

Do you receive income from any other source whatsoever?	No Yes

How many children live at home with you?
Is there anyone else living in your home with you? List
Are you buying, or renting the place where you live?	Buying Renting
How much are your monthly payments for your residence?
Is the place where you live a house, mobile home, or an apartment?
If you own a house, mobile home or land please answer the following:
(A) In whose name is it titled?
(B) In what year did you buy it?
(C)How much did you pay?	$
(D) How much was the down payment?	$
(E) If you own a mobile home, what size is it?
(F)If you own land, what is the acreage?	acres.
(G) Please state your estimate of the value and amount owed on your property	acres.

Property	Value	Amount Owed
House
Mobile Home
Land
* If you own, or own interest in more than one house, mobile home, or parcel of land, please make sure you answer the questions above for all of them.
Have you owned any other real estate in the past 6 years (including property you inherited or that you may own with others)?

Have you had any property repossessed, seized, or have you voluntarily surrendered any in the last 6 years? If so, please describe property and approximate date(s).

What is their estimated value?
How many vehicles do you own? (registered in your name or your spouses)

Please note the year, make, model, miles, amount owed and value of each:
	Year	Make/Model	Miles	Amount Owed	Value
Auto#1
Auto#2
Auto#3
Auto#4

Please state whether or not you have sold or given away any of your property whatsoever within the past year. If so, please explain:Please state whether or not you have sold or given away any of your property whatsoever within the past year. If so, please explain:

Have you or your spouse repaid or given a friend or relative $600 or more in the last 6 years?

Do you own any stock, bonds, IRA’s, 401(k), pension or other annuities? If so please list:

Have you cashed in or taken a loan against these accounts?

Please state the amount of cash, checking and savings you currently have and the name of the institution in which it is deposited:

Do you owe any of these money? CAUTION: If you place funds in a bank or credit union to whom you owe money, they are allowed by law to take your money. Therefore, you may want to place your money in an institution you do not owe.
Have all of your tax returns (Federal, State) been filed in the past 6 years? Yes No
If you are a sole proprietor are you paying quarterly estimated taxes? Yes No
Did you receive a tax refund last year, or this year? Yes No
If "Yes" How much Federal and State refund did you receive ? Date:
Do you owe any Federal or State taxes? Yes No amount
Have you ever been separated or divorced? Yes No When
If Yes were you ordered by the Domestic Court to pay certain debts? Yes No
If Yes please list:

If you own any Life Insurance, does it have any cash or loan value? Yes No
amount
Do you have any student loans or have you co-signed on any? Yes No
Do you own any tools, machinery or equipment that you use in your work or business?
If yes:

If Yes, what is your estimate of its value? $
Does anyone owe you more than $600.00 including family members and friends? Yes No
Have you ever filed bankruptcy before? Yes No
If so, when, and what was the outcome?
Date Outcome
Do you have any auto accidents, worker's compensation or medical malpractice claims pending?

Have you received money from these types of claims in the past three years?

Has anyone gotten a judgment against you in a Court?

How did you hear about our law firm?

Please list all of your dependents, and any others living in your household

Full Name	Age	Relationship

Please state the reason(s) you are considering bankruptcy

Is there any other information you feel we need to know in order to provide counsel to you in this matter? If so, please make a note of it here:

The Cooper Law Firm
3523 Pelham Rd # B, Greenville

Greenville Number		864-271-9911
Spartanburg Number		864-232-5236

Do you own a Boat? If yes, please provide the following:

Amount Owed