CLIENT CONFIDENTIAL WORKSHEET



GLENN WARD CALSADA

LAW OFFICES OF GLENN WARD CALSADA

9924 RESEDA BOULEVARD

NORTHRIDGE, CA 91324

PHONE NUMBER: (818) 477-0314

FAX NUMBER: (818) 473-4277

EMAIL: glenn@

Website:

BASIC INFORMATION

| |DEBTOR | |JOINT DEBTOR |

| | | | |

|Name (first, middle, last) /or Company | | | |

|Name: | | | |

| | | | |

|All Other Names/DBAs Used: | | | |

| | | | |

|Social Security No/Tax ID #: | | | |

| | | | |

|Street Address: | | | |

| | | | |

|City, State, Zip Code: | | | |

| | | | |

|County of Residence: | | | |

| | | | |

|Marital Status: | | | |

| | | | |

|Age/Company Start Date: | | | |

| | | | |

|Home Phone: | | | |

| | | | |

|Work Phone: | | | |

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|Cell Phone/Email: | | | |

| | | | |

|Mailing Address (if diff): | | | |

DEPENDANTS LIVING WITH YOU

|Name | |Age | |Relationship |

| | | | | |

| | | | | |

| | | | | |

| | | | | |

PRIOR BANKRUPTCY CASES

List ALL prior bankruptcy cases you have filed in any jurisdiction.

| | | | | |

|Where Filed: | | |Date Filed: | |

| | | | | |

|Case Number: | | |Judge: | |

List all pending bankruptcy cases filed by any Spouse, Partner, or Affiliate.

| | | | | |

|Name of Debtor: | | |Relationship: | |

| | | | | |

|Where Filed: | | |Date Filed: | |

| | | | | |

|Case Number: | | |Judge: | |

CREDIT COUNSELING REQUIREMENTS

Within the 180 days before the filing of your bankruptcy case, you must receive a briefing from a credit counseling agency approved by the United States trustee or bankruptcy administrator that outlined the opportunities for available credit counseling and assisted you in performing a related budget analysis. You must have a copy of the certificate and a copy of any debt repayment plan developed through the agency before filing.

PERSONAL FINANCIAL MANAGEMENT COURSE

You are required to complete an instructional course in personal financial management by an approved personal financial management provider. Deadlines: In a chapter 7 case, file within 45 days of the first date set for the meeting of creditors. In a chapter 13 case, file no later than the last payment made by the debtor as required by the plan.

SCHEDULE A – REAL PROPERTY

|Description and | |Owner | |Nature of | |Current Value | |Amount Of |

|Location | | | |Interest | | | |Liens |

| | | | | | | | | |

| | | | | | | | | |

| | | | | | |

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|Cash on Hand | | | | | |

| | | | | | |

|Bank Accounts | | | | | |

| | | | | | |

|Security Deposits | | | | | |

| | | | | | |

|Household Goods and Furnishings | | | | | |

| | | | | | |

|Books, Pictures, and other Collectibles | | | | | |

| | | | | | |

|Wearing apparel | | | | | |

| | | | | | |

|Furs and Jewelry | | | | | |

| | | | | | |

|Firearms, Sports, and other Equipment | | | | | |

| | | | | | |

|Interest in Insurance Policies | | | | | |

| | | | | | |

|Annuities | | | | | |

| | | | | | |

|Interest in Education IRA; Pension or Profit Sharing | | | | | |

|Plans | | | | | |

| | | | | | |

|Stock and Business Interest | | | | | |

| | | | | | |

|Government or Corporate Bonds | | | | | |

| | | | | | |

|Account Receivable | | | | | |

| | | | | | |

|Alimony, Maintenance, Support, etc. | | | | | |

| | | | | | |

|Other Liquidated Debts | | | | | |

| | | | | | |

|Equitable or Future Interests | | | | | |

| | | | | | |

|Interests in Estate of a Decedent | | | | | |

| | | | | | |

|Patents, Copyrights, etc. | | | | | |

| | | | | | |

|Customer Lists | | | | | |

| | | | | | |

|Automobiles, Trailers, etc. | | | | | |

| | | | | | |

|Boats, Motors, Aircraft, etc. | | | | | |

| | | | | | |

|Office Equipment, Furnishings, Supplies | | | | | |

| | | | | | |

|Business Machinery, Fixtures, etc. | | | | | |

| | | | | | |

|Inventory | | | | | |

| | | | | | |

|Animals and Crops, | | | | | |

| | | | | | |

|Farming Equipment, Supplies, etc. | | | | | |

| | | | | | |

|Other Personal Property Not Listed | | | | | |

SCHEDULE D ~ CREDITORS HOLDING SECURED CLAIMS

mortgages, auto loans, furniture, appliance, computer, property taxes, etc.

|Creditor | |Detailed | |Account |

|Name and Address | |Description/ | |No. |

| | |Address/Car & Yr | | |

| | | | | |

| | | | | |

SCHEDULE H – CODEBTORS

Co-borrowers and guarantors, sureties or co-signors of any kind.

|Name and Address of Codebtor | |Name and Address of Creditor |

| | | |

| | | |

| | | |

| | | |

SCHEDULE I – CURRENT MONTHLY INCOME

you must submit all pay stubs for the 6 months prior to filing

| |DEBTOR | |JOINT DEBTOR |

| | | | |

|Occupation: | | | |

| | | | |

|Length of employment | | | |

| | | | |

|Employer’s Name: | | | |

| | | | |

|Employer’s Address: | | | |

| | | | |

|Employer’s City, State, Zip | | | |

| | | | |

|How often paid: | | | |

| |DEBTOR | |JOINT DEBTOR |

| | | | |

|Gross Wages, Salary, Commissions | | | |

| | | | |

|Estimated Overtime | | | |

| | | | |

|Regular Income From Business, Profession, Or| | | |

|Farm | | | |

| | | | |

|Income From Real Property | | | |

| | | | |

|Monthly Interest And Dividends | | | |

| | | | |

|Monthly Alimony, Maintenance, Or Support | | | |

|Payments | | | |

| | | | |

|Social Security Or Government Assistance | | | |

| | | | |

|Pension Or Retirement | | | |

| | | | |

|Other Monthly Income | | | |

| | | | |

|Describe any increase or decrease of more | | | |

|than 10% in any previous category | | | |

|anticipated to occur in the year following | | | |

|filing. | | | |

SCHEDULE J – CURRENT EXPENDITURES

Estimate the average or projected monthly expenses of the debtor and the debtor’s family.

| | |

|Rent Or Home Mortgage Payment |$ |

| | |

|Property Taxes (if not included in mortgage payment) |$ |

| | |

|Property Insurance (if not included in mortgage payment) |$ |

| | |

|Electricity And Heating Fuel |$ |

| | |

|Water And Sewer |$ |

| | |

|Telephone / Cell Phone |$ |

| | |

|Garbage |$ |

| | |

|Cable |$ |

| | |

|Other Utilities |$ |

| | |

|Home Maintenance (Repairs And Upkeep) |$ |

| | |

|Food |$ |

| | |

|Clothing |$ |

| | |

|Laundry And Dry Cleaning |$ |

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|Medical And Dental Expense (co-payments, prescriptions, etc.) |$ |

| | |

|Transportation (not including car payments) |$ |

| | |

|Recreation, Clubs And Entertainment, Newspapers, Magazines, etc. |$ |

| | |

|Charitable Contributions |$ |

| | |

|Homeowner’s Or Renter’s Insurance |$ |

| | |

|Life Insurance |$ |

| | |

|Health Insurance |$ |

| | |

|Auto Insurance |$ |

| | |

|Other Insurance – specify |$ |

| | |

|Installment Payments: Auto, Other (details) |$ |

| | |

|Alimony, Maintenance, And Support Paid To Others |$ |

| | |

|Payments For Support Of Additional Dependents Not Living At Your Home |$ |

| | |

|Regular Expenses From Operation Expenses Of Business, Profession, Or Farm |$ |

| | |

|Other Expenses |$ |

| | |

|Describe any increase or decrease in expenditures reasonably anticipate to occur within the year following the filing of this |$ |

|document | |

STATEMENT OF FINANCIAL AFFAIRS

1. Gross Income from employment or operation of business; enter each income source for the past two years.

|Source | |Amount | |Fiscal Period |

|(name and address) | | | | |

| | | | | |

| | | | | |

2. Gross Income other than from employment or operation of business; enter each income source for the past two years.

|Source | |Amount | |Fiscal Period |

|(name and address) | | | | |

| | | | | |

| | | | | |

3. List payments made to any creditor during the last 90 days.

|Creditor | |Dates of | |Amount paid | |Amount |

|(name and address) | |payments | | | |still owing |

| | | | | | | |

| | | | | | | |

| | | | | | | |

| | | | | |

| | | | | |

| | | | | |

5. List any repossessions, foreclosures, and voluntary returns during the last year.

|Name and Address for | |Date of | |Description and value |

|Whose Benefit Property was Seized | |Seizure | |of Property |

| | | | | |

| | | | | |

6a. Describe any assignment of property for the benefit of creditors made within the last 120 days.

|Name and Address | |Date of | |Terms of Assignment |

|of Assignee | |Assignment | |or Settlement |

| | | | | |

| | | | | |

6b. List all property which has been in the hands of a custodian, receiver, etc. during the past year.

|Name and Address | |Court Case Title | |Date of | |Description and Value of Property |

|Of Custodian | |and Case Number | |Order | | |

| | | | | | | |

| | | | | | | |

| | | | | | | |

| | | | | |

| | | | | |

| | | | | |

9. List all payments made or property transferred related to debt counseling or bankruptcy.

|Name and Address | |Date of | |Amount paid |

|of Payee | |Payment | |or value of property transferred |

| | | | | |

| | | | | |

10a. List all property, other than property transferred in the ordinary course of the business or financial affairs of the debtor, transferred either absolutely or as security during the past two years to creditor or family member

|Name and Address of Transferee | |Date | |Describe Property | |Value Received |

|and Relationship to Debtor | | | |Transferred | | |

| | | | | | | |

| | | | | | | |

| | | | | | | |

| | | | | | | |

| | | | | | | |

| | | | | | | |

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| | | | | |

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| | | | | |

14. List all property owned by another person or entity that you and your spouse holds or controls.

|Owner | |Description And Value | |Location |

|(Name And Address) | |Of Property | |Of Property |

| | | | | |

| | | | | |

15. List all premises occupied and vacated during the past three years.

|Address | |Name Used | |Dates Of Occupancy |

| | | | | |

| | | | | |

16. Identify the name of spouse or former spouse who resided with you in a community property state (AK, AZ, CA, ID, LA, NV, NM, PR, TX, WA, or WI) in the eight years.

|Name | |Address |

| | | |

| | | |

17a. List the name and address for which your corporation has received notice in writing by a governmental unit that the corporation may be liable or potentially liable under or in violation for an Environmental Law.

|Site Name And Address | |Name And Address Of Governmental Unit | |Date | |Environmental |

| | | | |Of Notice | |Law |

| | | | | | | |

| | | | | | | |

| | | | | | | |

| | | | | |

| | | | | |

| | | | | |

18. List all businesses in which you were an officer, director, partner, or managing executive of a corporation, partnership, sole proprietorship, or were a self-employed professional within the last six years, or in which your owned 5 percent or more of the voting or equity securities within the last six years.

|Name | |Last four digits of Soc. | |Address | |Nature of business | |Beginning and ending |

| | |Sec. No. / Completed EIN or | | | | | |dates |

| | |other taxpayer I.D. No. | | | | | | |

| | | | | | | | | |

| |

| |

| |

| |

| |

|With respect to each parcel of real property or item of personal property identified in question 1, describe the nature and location of the dangerous condition, |

|whether environmental or otherwise, that poses or is alleged to pose a threat of imminent and identifiable harm to the public health or safety. |

| |

| |

| |

STATEMENT OF MILITARY SERVICE

|Are you or your spouse a disabled veteran whose indebtedness occurred primarily during a period in which you were on active duty or while I was performing a |

|homeland defense activity. |

| | | | |

|Yes: | |No: | |

| | | |

|Identification of Service Member: | | |

| | | |

|Type of Military Service: | | |

| | | |

|Active Service Since: | | |

| | | |

|Inductee – Order to Report On: | | |

| | | |

|Retired / Discharged: | | |

| | | |

|Service Member Deployed Overseas On: | | |

| | | |

|Anticipated Completion of Overseas Tour-of-Duty: | | |

BUSINESS INCOME AND MONTHLY EXPENSES

| | | |

|Gross Business Income for past 12 months: | |$ |

| | | |

|Gross Average Monthly Income: | |$ |

| | | |

|Net Employee Payroll: | |$ |

| | | |

|Payroll Taxes: | |$ |

| | | |

|Unemployment Taxes: | |$ |

| | | |

|Worker’s Compensation: | |$ |

| | | |

|Other Taxes: | |$ |

| | | |

|Inventory Purchases: | |$ |

| | | |

|Purchases of Feed/Fertilizer/Seed/Spray: | |$ |

| | | |

|Rent: | |$ |

| | | |

|Utilities: | |$ |

| | | |

|Office Expenses and Supplies: | |$ |

| | | |

|Repairs and Maintenance: | |$ |

| | | |

|Vehicle Expenses: | |$ |

| | | |

|Travel and Entertainment: | |$ |

| | | |

|Equipment Rental and Leases: | |$ |

| | | |

|Legal/Accounting/Other Professional Fees: | |$ |

| | | |

|Insurance: | |$ |

| | | |

|Employee Benefits (e.g. pension, medical, etc.): | |$ |

| | | |

|Payments to Be Made Directly by Debtor to Secured Creditors | |$ |

|Specify: | | |

| | | |

|Other: | |$ |

|Specify: | | |

All information provided in your bankruptcy filing is provided under oath and is subject to the laws of perjury. It is a crime to knowingly submit false information in conjunction with your bankruptcy filing. I/WE CERTIFY THAT THE ALL INFORMATION PROVIDED IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE.

_______________________________ _____________________________________

Debtor Spouse

-----------------------

Chapter 7 [ ] Joint [ ]

or

Chapter 13 [ ]

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