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| FINANCIAL ANALYSIS | ||||||
| Number of People that live in your home |
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| County in which you live |
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| Have you ever filed a bankruptcy case before? If yes, please indicate the year you filed and whether you filed a Chapter 13 case or a Chapter 7 case. | Year of Filing | Type of Case Filed | ||||
| NET MONTHLY INCOME: | $ | |||||
| Name of Employer | Number of Yrs Employed There | |||||
| Name of Employer | Number of Yrs Employed There | |||||
| MONTHLY EXPENSES: | ||||||
| Rent or home mortgage payment (include lot rented for mobile home) | $ | |||||
| Real Estate Taxes NOT included in monthly mortgage payment | $ | |||||
| Real Property Insurance NOT included in monthly mortgage payment | $ | |||||
| Utilities | Electricity and heating Fuel | $ | ||||
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| Water and Sewer | $ | ||||
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| Telephone (House) | $ | ||||
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| Cell Phone | $ | ||||
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| Cable | $ | ||||
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| Garbage | $ | ||||
| Home maintenance (repairs and upkeep) | $ | |||||
| Food | $ | |||||
| Clothing | $ | |||||
| Laundry and Dry Cleaning | $ | |||||
| Medical and dental expenses | $ | |||||
| Transportation (not including car payments) | $ | |||||
| Recreation, clubs and entertainment, newspapers, magazines, etc. | $ | |||||
| Charitable contributions | $ | |||||
| Insurance | Life | $ | ||||
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| Health | $ | ||||
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| Auto | $ | ||||
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| Other | $ | ||||
| Taxes not deducted from Wages | $ | |||||
| Installment Payments | Auto | $ | ||||
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| Other | $ | ||||
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| Other | $ | ||||
| Alimony, maintenance, and support paid to others | $ | |||||
| Payments for support of additional dependents not living at your home | $ | |||||
| Regular expenses for operation of business | $ | |||||
| Other | $ | |||||
| ARE YOU BEHIND ON YOUR HOME MORTGAGE? If yes, please indicate the number of months and the total arrearage owed. | Number of Months: | $ | ||||
| ARE YOU BEHIND ON YOUR CAR PAYMENTS? If yes, please indicate the number of months and the total arrearage owed. | Number of Months: | $ | ||||
| Indicate the value of your home and the total amount owed on the property. 1 st Mortgage Monthly Payment Amount: $ | Value: | Total Arrearage: | Total Owed | |||
| Indicate the value of your home and the total amount owed on the property. 2nd Mortgage Monthly Payment Amount: $ | Value: | Total Arrearage: | Total Owed | |||
| Indicate the value of your home and the total amount owed on the property. 3 rd Mortgage Monthly Payment Amount: $ | Value: | Total Arrearage: | Total Owed | |||
| Please indicate the value of your car and the total amount owed on the car (CAR #1) Monthly Payment Amount: $ | Value: | Total Arrearage: | Total Owed | |||
| Please indicate the value of your car and the total amount owed on the car (CAR #2) Monthly Payment Amount: $ | Value: | Total Arrearage: | Total Owed | |||
| Please indicate the value of your car and the total amount owed on the car (CAR #3) Monthly Payment Amount: $ | Value: | Total Arrearage: | Total Owed | |||
| Do you want to keep your house or surrender it? |
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| Do you want to keep your car or surrender it? (Car #1) |
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| Do you want to keep your car or surrender it? (Car #2) |
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| Do you want to keep your car or surrender it? (Car #3) |
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| Total Unsecured Debt (Credit Cards, Medical Bills etc.) | $ | |||||
| Total Taxes Owed | $ | |||||
| Total of Any other Debt not shown above | $ | |||||
Dionne & Dionne
6726 Old Greensboro Road, Suite A
Tuscaloosa, AL 35405-5979
Phone: (205) 349-5911
Inside 205 Area Code Toll Free: 1-800-BANKRUPT (1-800-226-5787)
Nationwide Toll Free: 1-888-263-1525
Fax: (205) 409-0294
E-mail