Client-Interview-Form

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Client Interview Sheet
The following information is needed in order for the attorney to properly evaluate your situation. It is
very important for you to supply all relevant information, as the attorney cannot properly advise you
without a complete understanding of your situation. If you are in doubt or have any questions, talk to
the attorney about it.
Remember, it is necessary for you to be completely honest and candid with the attorney.
Date of your appointment:
Time of your appointment: ______________
Please fill out each question completely. Amounts can be estimated.
This is for consultation purposes only.
No attorney client relationship is established until you retain Thompson & King.
How did you learn about our office?
Radio? _________
Television? ________
If so, what station? ___________________________
Yellow Pages? _______
Website? ______
Prior Consultation? _______ when?______________
Who may we thank for referring you? ____________________________________________________________
Your Information:
*Full Name: ______________________________
Name you go by: __________________________
Complete Home Address: ___________________
_________________________________________
_________________________________________
County: __________________________________
Home Phone #: ____________________________
Cell Phone #: ______________________________
Email: ___________________________________
Social Security #: ___________________________
Date of Birth: __________________________
Maiden/other names used: ________________
Occupation: _________________________________
Business Name & Address:_____________________
___________________________________________
___________________________________________
__________________________________________
Business Phone #: ________________Ext ________
Length of time with company: _________________
Estimated Gross Monthly Income: ______________
Estimated Gross Yearly Income: _______________
How often do you get paid? ___________________
Monthly: 1 time per month
Weekly: 1 time per week
Bi Monthly: Paid on the same 2 days
of each month (example 1st & 15th)
Bi Weekly: Paid every other week
(26 times per year)
Spouse’s Information (even if not filing):
*Full Name: ______________________________
Name you go by: __________________________
Complete Home Address: ___________________
_________________________________________
_________________________________________
Home Phone #: ____________________________
Cell Phone #: ______________________________
Email: ___________________________________
Social Security #: __________________________
Date of Birth: _____________________________
Maiden/other names used: ___________________
Occupation: _________________________________
Business Name & Address:_____________________
__ ___________________________________________
___________________________________________
_ ___________________________________________
Business Phone #: ____________________________
Extension: __________________________________
Length of time with company: __________________
Estimated Gross Monthly Income: _______________
Estimated Gross Yearly Income: _________________
How often do you get paid? ____________________
May we leave a message at: Home ____ Work ____ Cell ____ With Spouse _______ All ____
Marital and Family Status:
______ Never Married ________ Married, living together
________ Married, living apart
Living with a domestic partner
_______ Divorced
________ Widowed
If divorced, when did it become final? ___________________________________________________________
Where you ordered to pay support or give up any property or pay any bills? ______________________________
Have you or your spouse EVER filed for bankruptcy? ____________ If so, year filed? _____________________
If you are separated or divorced, has your spouse/former spouse filed for bankruptcy? ______________________
If so, who was / is the attorney? _________________________________________________________________
Has the Thompson & King Firm, LLC consulted with or represented your former or separated spouse?
Yes ______ No _____ Not Sure ______
Any one in your household other than spouse with income? _________
If so describe who and income. _________________________________________________________________
Number of dependent children? ______________ Any other person dependent on you? ____________
What is your age?
Your spouse’s age?
Are you or your spouse receiving any disability, workers comp or retirement income? ______________________
If so, how much per month?
_________________________________________________________________
Lawsuits and Foreclosures:
Have you been served with foreclosure papers? ________
What month and year were you served? ___________ Has a sale date been set for the property? ________
Do you have any pending lawsuits or judgments? ________
Business Associates:
Please list the name(s) of any business, partnership, corporation and / or L.L.C. you have owned any interest in
within the past six years and/or any name you have used to collect 1099 income within the past six years:
___________________________________________________________________________________________
___________________________________________________________________________________________
Annualized Current Gross Monthly Income:
Have you been employed in last 6 months:
Debtor: Yes or No
Spouse: Yes or No
In the last 6 months have received any money from the following:
_______ back time social security if so amount $ ___________________________________________________
_______car wreck or any other type of settlement (Workers compensation etc) $___________________________
_______withdrawal from IRA, 401K, etc $_________________________________________________________
_______sell of any property such as car, land, boast etc $ _____________________________________________
_______any other income in last 6 months
Total income from work in last 6 months: Debtor $_________________ Spouse $_______________
Residence:
Are you a resident of South Carolina? ________,
Have you been for last 6 months?____________________
Where have you lived in the last 3 years? (give place and dates)
_______________________________________
_______________________________________
_______________________________________
_______________________________________
Please note: This list is for consultation purposes only. If you decide to file for
bankruptcy protection a more extensive list will be required. When filing for bankruptcy
protection, all debts must be listed.
ASSETS:
Are you buying a house?________ or
Renting a house? _________
What is payoff on your Mortgage?____________
How much is your mortgage payment? ________
Are you behind on Mortgage Payment? _________
If so How Much? _________________________
How much is your house worth? _______________
Do you own any land other than your house/residence? _______________________________________
List ALL VEHICLES in your name and the value for each vehicle:
Vehicle:
Value:
Monthly Payment:
Payoff:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Do You Have Any of the Following?
_____Bank Account or Savings Account
_____Jewelry over $1000.00
_____Household goods Valued over $4000.00
_____Guns
_____Life estates or remainder estates in Land
_____Mobile Home
_____Inventory, machinery, Tools used in business over $1500
_____Boats, 4 wheelers RV Camper
Types of Debts:
Credit Cards (total owed on ALL cards) ………………………………………… $ ______________________
Medical Bills
(total owed) …………………………………………………….. $ ______________________
Mortgage (1st) (Balance) ………………………………………………………… $ ______________________
Mortgage (2nd) (Balance)………………………………………………………… $ ______________________
Car Loan (Balance)
…………………………………………………………. $ ______________________
Car Loan (Balance)
…………………………………………………………. $ ______________________
Tax Debt (IRS and Dept. of Revenue) ………………………………………….. $ ______________________
Student Loans (Total Owed)
………………………………………………… $ ______________________
Check Cashing Loans (Total Owed)
………………………………………... $ ______________________
Personal Loans Secured with personal items (Total owed) …………………….. $ ______________________
Personal Loans Secured with car titles (Total owed)
………………………. $ ______________________
Unsecured Personal Loans (Signature only) (Total owed) ………………………. $ ______________________
Secured Debts………………………………………………………………...
$ ______________________
Other types of Debts (Child Support back payments, private loans, leases,
$ ______________________
additional car loans, co-sign loans, additional mortgages,
$ ______________________
or any other debt not included in the above referenced list.)
$ ______________________
Debts: Secured: ** List what you put up for collateral:
_______________________________________
_______________________________________
_______________________________________
_______________________________________
_______________________________________
_______________________________________
PLEASE LIST ANY OTHER DEBTS IN YOUR NAME:
_______________________________________
_______________________________________
_______________________________________
_______________________________________
_______________________________________
_______________________________________
Transfer of Property:
List anything given away, traded or transferred worth more than $1,000.00 in the past 6 years, including to family
members.
Item:
Value:
Date transferred:
To whom:
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
Tax Information:
Do you have any tax refund due you at this time? ___________________________________________________
When was the last tax return you filed? ___________________________________________________________
Did you get a refund?
______________ If so, how much was it? _____________________________________
When did you receive it? _______________________________________________________________________
Have you filed all tax returns for the past 4 years?
_____________________________________________
Other Property or Financial Questions:
Have you received, or are you entitled to, any inheritance, property settlement agreement,
or proceeds from a life insurance? ………………………….….……………………………
______
Will you receive any inheritance, property settlement agreement, or proceeds from a life
Insurance within the next 2 years? ……………………………………………………………
______
Have you sold, transferred or closed any business (or an interest in) within the past 6 years?
______
Have you co-signed on a loan for anyone else? ……………………………………………..
______
Do you have your name on anyone else’s bank account, real property or vehicle? …………
______
Are you suing anyone or have the right to sue them? ………………………………………
______
Have you made any major purchases (over $200) on any credit card in the past 3 months?
______
Have you taken any cash advances in the past 3 months? ……………………………………
______
Have you made any balance transfers on any credit card in the past 3 months? ……………
______
Do you owe any money from a marital settlement or judgment of divorce? …………………
______
Have you been ordered to pay child or spousal support? …………………………………….
______
Is any support past due? ……………………………………………………………………….
______
Do you receive any income from a trust or annuity?
………………………………………
______
Do you have income from royalties, gas or mineral rights, copyrights, licenses, agreements
or patents now or in the future? …………………………………………………………….
______
Do you have a life estate or the right to use anyone else’s property? ………………………….
______
Anything else you think the attorney should be made aware of?
__________________________________________________________________________________________
__________________________________________________________________________________________
Your problem:
This page must be
(Check all that apply)
completed and signed.

Cannot pay my credit cards

Behind on house payments
____________________Months

Behind on car payments
____________________Months

Behind on Child support
____________________Months

Behind on Alimony
____________________Months

IRS
____________________Years

State Taxes
____________________Years

Law Suites

Judgments

Loan Companies

Secured with household goods

Unsecured

Have you renewed any loans within the last 6 months
 yes
 no

Have you taken out a loan within the last 6 months
 yes
 no

Medical bills

Student loans

Are your self employed

About to lose income and don’t know what to do
_______________
Other
Explain: ____________________________________________________________________
____________________________________________________________________________
Sign: ______________________________
Date: ______________________________
This page must be completed
How many persons in house hold? _____________________ (including yourself)
How many are over 18? ________________
Ages: ________________________
How many are under 18? _______________
Ages: ________________________
CURRENT MONTHLY INCOME OF DEBTOR AND DEBTORS' SPOUSE
(Even if spouse is not filing – Answer each
question)
In the Past 6 Months :
1) Have you been employed consecutively with the same company? _____________________
2) Has your spouse been employed consecutively with the same company? ________________
3) Do you receive rent on land or property? Per Month $ ______________________________
4) Have you received income on the sale of property? $ _______________________________
5) Withdrawn any money from IRA or 401K (past 6 Months) $ _________________________
6) You or your spouse received any unemployment compensation? Per Month $ ____________
7) Is your job a seasonal job? _____________ Is your spouse’s job a seasonal job? __________
8) Have you received a bonus in the past 6 months? $__________________________________
9) Has your spouse received a bonus in the past 6 months? $____________________________
OFFICE USE ONLY
SC Median for household
_________________________________
Monthly income 1
_________________________________
Monthly income 2
_________________________________
Total Monthly Income
_________________________________
x 12
_________________________________
below
_________________________________
CMI
above
October 2015 Client Interview Sheet
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