Bankruptsy Form

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Bankruptsy Form

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Grosskopf & Black, LLC
1324 West Clairemont Avenue, Suite 10
Eau Claire, Wisconsin 54701
715.835.6196
info@eclawyers.com

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* Required fields
Name *
E-mail Address *
Address
County of residence
City
State
Do you have a spouse?	Yes No
Do you have children?	Yes No
How many still claimed as dependent?
If you own a home, what is its value?
Is there a mortgage?	Yes No NA
What amount is owed?
Are you current on monthly payments?	Yes No NA
Is there a second mortgage?	Yes No NA
What amount is owed?
Are you current on monthly payments?	Yes No NA
Do you have one or more cars?	Yes No
What kinds and what are their current values?
Do you owe any Federal taxes?	Yes No
If yes, How much?
Do you owe and State taxes?	Yes No
If yes, How much?
Do you owe any student loans?	Yes No
If yes, How much?
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© 2000-2008, Grosskopf & Black, LLC
1324 West Clairemont Avenue, Suite 10
Eau Claire, Wisconsin 54701
715.835.6196
info@eclawyers.com

Serving Clients from Eau Claire, Chippewa Falls, Elk Mound, Osseo, Fairchild, Fall Creek, Augusta, Altoona, Cadott, Boyd, Stanley, Eleva, Strum, Mondovi, Durand, Caryville, Mondovi, Boyceville, Wheeler, New Auburn, Cornell and surrounding communities.