Online Bankruptcy Evaluation

For a bankruptcy evaluation with Leslie Burgk, PA, you can either schedule a free consultation by calling her Stuart (772-403-2343) or West Palm Beach (561-932-0900) Offices, or you can fill out the evaluation form below. Mrs. Burgk will contact you as soon as she has reviewed your information.

Personal Information

Name (required)

Email (required)

Address

City

State

Zip

Phone

Best time to reach you

Bills

What type of bills do you have? Check all that apply.

 Credit Cards
 Tax Debts
 Medical Bills
 Student Loans

Total Amount of Bills

 Under $5,000
 $5,000 -$15,000
 $15,000 – $20,000
 $20,000 – $30,000
 $30,000 – $50,000
 $50,000 – $75,000
 Over $75,000

Property

Approx. Home Value

First Mortgage Balance

Second Mortgage Balance

Are you up to date on your mortgage payment?

 yes
 no

Are there any other mortgages on this property?

 yes
 no

Vehicles

Vehicle 1

Make

Model

Year

Value

Balance

Monthly payment

Are your payments up to day?

 yes
 no

Vehicle 2

Make

Model

Year

Value

Balance

Monthly payment

Are your payments up to day?

 yes
 no

Income
How often do you get paid?

 Every Week
 Every two weeks
 Monthly

How often does your spouse get paid?

 Every Week
 Every two weeks
 Monthly

Your Gross pay

Your Spouse’s Gross pay

Other Income

What other types of income do you have?

 Disability
 Social Security
 Pension
 Rental Property
 Part-time Job
 Child Support
 Worker's Comp.
 Unemployment
Monthly Amount

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  1. Are your personal income tax debts dischargeable in a Chapter 7 bankruptcy? | West Palm Bankruptcy Attorney says:
    September 15, 2010 at 7:09 pm

    [...] – TequestaRoyal Palm Beach – North Palm BeachStuart – Hobe SoundBlogContact UsFree Bankruptcy EvaluationPractice Areas ← Switching Your Bank Account Prior to Filing [...]

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