BANKRUPTCY WORKSHEET INSTRUCTIONS

Please go through these worksheets carefully. Provide as much information as you can.Fill out what applies to you and cross out the rest.If you need more sheets, most of the forms are designed to be duplicated. If necessary, attach a sheet and label it, for example: "Client Info cont'd, Other Names Used in Past 6 Years ".

PERSONAL INFORMATION:

Name (FULL LEGAL):___________________________________________________________

Please list all previous names used : including maiden name, and all names used in the past to apply for credit.

a.k.a./ f.k.a. _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________   Social Security Number:__________-__________-___________   Phone #: (_________) ______________________

Street Address: _____________________________________________________________ City, State, & Zip: ___________________________________________________________ County: ______________________________ Mailing Address: ___________________________________________________________ Line 2: ___________________________________________________________ Line 3: ___________________________________________________________

SPOUSE INFORMATION:

Name (FULL LEGAL):___________________________________________________________

Please list all previous names used : including maiden name, and all names used in the past to apply for credit.

a.k.a./ f.k.a. _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________   Social Security Number:__________-__________-___________   Phone #: (_________) ______________________

Street Address: _____________________________________________________________ City, State, & Zip: ___________________________________________________________ County: ______________________________ Mailing Address: ___________________________________________________________ Line 2: ___________________________________________________________ Line 3: ___________________________________________________________

Prior Address of Debtor:

If you have moved during the last 24 months, list all previous addresses. Address: __________________________________________ Line 2: __________________________________________ Name(s) used: __________________________________________ Dates: __________________________________________ Spouse's Address: __________________________________________ Line 2: __________________________________________ Name(s) used: __________________________________________ Dates: __________________________________________

BANKRUPTCIES FILED DURING LAST 6 YEARS FOR EITHER PARTNER: (INCLUDING CASES THAT WERE DISMISSED) Where filed:__________________ (CITY) ___________________________________ (STATE) Case Number:_____________________ Date filed: __________________________________

DEBTS:

Please list all secured and unsecured debt including: MORTGAGES; VEHICLE LOANS; FURNITURE; JEWELRY; FINANCE COMPANIES; STUDENT LOANS; PERSONAL LOANS; CREDIT CARDS; MEDICAL BILLS; UTILITY BILLS; RENT ARREARAGE; ETC.

***************************************************************************************** Creditor's Name: ____________________________ Collection Agency or Representative: ______________________________ Address: ____________________________ Address: ______________________________ City, State, Zip: ____________________________ City, State, Zip: ______________________________ Account Number: ____________________________ Amount Owed: $_____________________________

***************************************************************************************** Creditor's Name: ____________________________ Collection Agency or Representative: ______________________________ Address: ____________________________ Address: ______________________________ City, State, Zip: ____________________________ City, State, Zip: ______________________________ Account Number: ____________________________ Amount Owed: $_____________________________

***************************************************************************************** Creditor's Name: ____________________________ Collection Agency or Representative: ______________________________ Address: ____________________________ Address: ______________________________ City, State, Zip: ____________________________ City, State, Zip: ______________________________ Account Number: ____________________________ Amount Owed: $_____________________________

***************************************************************************************** Creditor's Name: ____________________________ Collection Agency or Representative: ______________________________ Address: ____________________________ Address: ______________________________ City, State, Zip: ____________________________ City, State, Zip: ______________________________ Account Number: ____________________________ Amount Owed: $_____________________________

***************************************************************************************** Creditor's Name: ____________________________ Collection Agency or Representative: ______________________________ Address: ____________________________ Address: ______________________________ City, State, Zip: ____________________________ City, State, Zip: ______________________________ Account Number: ____________________________ Amount Owed: $_____________________________

***************************************************************************************** Creditor's Name: ____________________________ Collection Agency or Representative: ______________________________ Address: ____________________________ Address: ______________________________ City, State, Zip: ____________________________ City, State, Zip: ______________________________ Account Number: ____________________________ Amount Owed: $_____________________________

***************************************************************************************** Creditor's Name: ____________________________ Collection Agency or Representative: ______________________________ Address: ____________________________ Address: ______________________________ City, State, Zip: ____________________________ City, State, Zip: ______________________________ Account Number: ____________________________ Amount Owed: $_____________________________

***************************************************************************************** Creditor's Name: ____________________________ Collection Agency or Representative: ______________________________ Address: ____________________________ Address: ______________________________ City, State, Zip: ____________________________ City, State, Zip: ______________________________ Account Number: ____________________________ Amount Owed: $_____________________________

***************************************************************************************** Creditor's Name: ____________________________ Collection Agency or Representative: ______________________________ Address: ____________________________ Address: ______________________________ City, State, Zip: ____________________________ City, State, Zip: ______________________________ Account Number: ____________________________ Amount Owed: $_____________________________

***************************************************************************************** Creditor's Name: ____________________________ Collection Agency or Representative: ______________________________ Address: ____________________________ Address: ______________________________ City, State, Zip: ____________________________ City, State, Zip: ______________________________ Account Number: ____________________________ Amount Owed: $_____________________________

***************************************************************************************** Creditor's Name: ____________________________ Collection Agency or Representative: ______________________________ Address: ____________________________ Address: ______________________________ City, State, Zip: ____________________________ City, State, Zip: ______________________________ Account Number: ____________________________ Amount Owed: $_____________________________

***************************************************************************************** Creditor's Name: ____________________________ Collection Agency or Representative: ______________________________ Address: ____________________________ Address: ______________________________ City, State, Zip: ____________________________ City, State, Zip: ______________________________ Account Number: ____________________________ Amount Owed: $_____________________________

***************************************************************************************** Creditor's Name: ____________________________ Collection Agency or Representative: ______________________________ Address: ____________________________ Address: ______________________________ City, State, Zip: ____________________________ City, State, Zip: ______________________________ Account Number: ____________________________ Amount Owed: $_____________________________

***************************************************************************************** Creditor's Name: ____________________________ Collection Agency or Representative: ______________________________ Address: ____________________________ Address: ______________________________ City, State, Zip: ____________________________ City, State, Zip: ______________________________ Account Number: ____________________________ Amount Owed: $_____________________________ *****************************************************************************************

BUDGET: DEBTOR & FAMILY INFORMATION

Marital Status:   [  ] Married   [  ] Single   [  ]  Divorced   [  ] Separated    [  ] Separate Expenses

Individual Debtor Spouse Occupation: ______________________________ ______________________________ Employer: ______________________________ ______________________________ How Long?: ______________________________ ______________________________ Address: ______________________________ ______________________________ Line 2:: ______________________________ ______________________________

Dependents: Name: Age: Relationship: Monthly $Amt: R/P/S/D* _______________________ ________ ___________________ _____________ R/P/S/D _______________________ ________ ___________________ _____________ R/P/S/D _______________________ ________ ___________________ _____________ R/P/S/D _______________________ ________ ___________________ _____________ R/P/S/D

* Payment Codes: R=receiving payments; P=making payments; S=spouse's dependent;   D=expenses(non-statutory payments) for dependents not living at home

Debtor Spouse Pay Period ...........   (Circle One) Weekly Weekly   Bi-Weekly Bi-Weekly   2-Month 2-Month   Monthly Monthly   Debtor Spouse EARNINGS PER PAY PERIOD Gross Pay Per Pay Period $___________ $___________ Estimated Overtime per Pay Period $___________ $___________ PAYROLL DEDUCTIONS DURING PAY PERIOD Payroll Taxes and Social Security $___________ $___________ Insurance $___________ $___________ Union Dues $___________ $___________ Other Deductions $___________ $___________   $___________ $___________   $___________ $___________   $___________ $___________ OTHER INCOME Debtor Spouse Regular Income from Business, Profession or Farm $___________ $___________ Income from Real Property $___________ $___________ Interest and Dividends $___________ $___________ Pension or Retirement Income $___________ $___________ Alimony Received $___________ $___________ Social Security/ Assistance – Explain below: $___________ $___________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ Other Monthly Income: 1:_____________________________ $___________ $___________ 2:_____________________________ $___________ $___________

Please provide income information for the past three (3) years:

Husband Wife Year to Date: $___________ $___________ Last Year: $___________ $___________ Prior Year: $___________ $___________

Law Suits, Judgments, Garnishments, etc. Please indicate all lawsuits to which the debtor is or was a party within one year immediately preceding the filing of this bankruptcy case.PLEASE PROVIDE COPIES OF ALL COURT DOCUMENTS, SUMMONS, ETC.

PLEASE COMPLETE AS FULLY AS POSSIBLE AND BRING TO YOUR MEETING WITH MR. McCURDY, ALONG WITH RECENT PAYCHECK INFORMATION.