LAW OFFICE OF

MICHAEL BAUMER

Chase Bank Tower

**** ****** ****

Suite 530

Austin, Texas 78757

512-***-****

DATE: / /

NAME: (last) (first) (middle) SPOUSE: (last) (first) (middle) ADDRESS: CITY: STATE: ZIP: COUNTY: CELL PHONE: spouse: work: work: (spouse) EMAIL: (spouse) EMPLOYER: (spouse) Are you a member of Texas Legal Protection Plan (TLPP)? How did you find us? Our website Google Yahoo Citysearch Avvo YP Other: Referred by Client Referred by Attorney Have you previously filed bankruptcy? If yes: Chapter date filed Date of birth: / / Date of birth: (spouse) / / Social Security number: - - Social Security number (spouse): - - Marital status:

Number of dependent children: ages: Do you owe any taxes? IRS: $ sales: $ property: $ Do you pay or receive child support? monthly amount: $ Has anyone co-signed with you? relationship: Vehicles: year make pmt. $ bal. $

(include paid off year make pmt. $ bal. $ vehicles) tear make pmt. $ bal. $ Real Estate:

1st Mortgage bal. $ pmt. $ value $ 2nd Mortgage bal. $ pmt. $ value $ Timeshare bal. $ pmt. $ value $ Other secured debts (furniture, appliances, etc.) $ Student loans $

Total unsecured debt (credit cards, medical, signature loans) $ CURRENT INCOME AND EXPENDITURES

Give estimated average future income for each spouse unless separated. 1. Debtor's monthly take-home pay $

2. Spouses monthly take-home pay $ 3. Other monthly income (specify)

(bonuses, second job, child support, social security, etc.) TOTAL

$

Estimated average future monthly family expenses:

1. Rent or home mortgage payment $

(include lot rental for trailer)

2. Utilities: Elec. $ Heat $ Cable $ Water $ Phone $ Internet $ $ 3. Food 4. Clothing 5. Laundry and cleaning 6. Books, newspapers and periodicals 7. Medical, dental, and prescription drugs 8. Insurance (not deducted from wages)

a) Auto b) Other (specify) 9. Transportation $ 10. Auto payments 11. Recreation 12. Club and union dues (not deducted from wages) 13. Taxes (not deducted from wages) 14. Alimony or support payments (not deducted from wages) 15. Other support payments for dependents not living at home 16. Miscellaneous (specify): TOTAL $

Have you taken any credit card cash advances or made significant charges within the last 90 days?

Have you repaid any relatives in the last year? THIS INFORMATION IS BEING SUPPLIED FOR US TO EVALUATE THE OPTIONS AVAILABLE TO YOU. THIS DOES NOT CONSTITUTE AN AGREEMENT TO REPRESENT YOU. NO SUCH REPRESENTATION WILL EXIST UNTIL AN ENGAGEMENT LETTER HAS BEEN EXECUTED BY BOTH THE FIRM AND THE CLIENT.

THE FEE THAT WE QUOTE YOU TODAY IS GOOD FOR 6 MONTHS. IF YOUR CASE IS NOT FILED WITHIN 6 MONTHS, YOU ARE SUBJECT TO ANY FEE INCREASES THAT OCCUR. FOR OFFICE USE ONLY

Quote Fees: $ Chapter 7 13 Attorney: Retainer: $

DOCUMENTS TO PROVIDE PRIOR TO CONSULTATION:

1. Last paystub (please let us know if you are receiving unemployment benefits or social security benefits) 2. Last income tax return.

3. Credit Report: Please visit www.annualcreditreport.com to get the Transunion credit report for free. Do not save or email the link as we will not be able to access the report. You must download and save the pdf file.