1
General Information
2
Real Property Information
3
Personal Property Information
4
Vehicle Information
5
Monthly Household Expenses
General Information
Filing Type & Marital Status
Filing Type
Marital Status
Primary Debtor
Co-Debtor (if applicable)
Contact & Address
Prior Bankruptcies
Have you filed for bankruptcy before?
Prior Bankruptcy #1
Prior Bankruptcy #2
Dependents
Do you have or claim anyone as a dependent?
Occupation
Occupation of Debtor
Employment Status
Pay Frequency
Occupation of Co-Debtor
Employment Status
Pay Frequency
Real Property Information
Real Property (Home)
Ownership
Are you behind on your payments?
Do you wish to keep this property?
Is there a 2nd Mortgage?
Mortgage Details
Is there an Association?
Are you behind on the Association?
Real Property (2nd Home)
Ownership
Are you behind on your payments?
Do you wish to keep this property?
Is there a 2nd Mortgage?
Mortgage Details
Is there an Association?
Are you behind on the Association?
Cemetery Plot & Time-Share
Cemetery Plot
Do you own a cemetery plot?
Time-Share
Do you have a time-share?
Personal Property Information
Bank Accounts
Account 1
Account 2
Account 3
Account 4
Account 5
Account 6
Closed Bank Accounts
Did you close a bank account in the past 12 months?
Legal Proceedings
Are you currently being sued? (Pending)
Are you currently suing anyone in court?
Do you currently have representation for these cases?
Vehicle Information
Cars, trucks, ATVs, RVs, boats, and any other vehicles you own.
Vehicle 1
Ownership Type
Will You Retain the Vehicle?
Are you behind on your payments?
Vehicle 2
Ownership Type
Will You Retain the Vehicle?
Are you behind on your payments?
Other Vehicles
Do you own any other vehicles? (ATVs, RVs, Boats, etc.)
Other Vehicle 1
Ownership Type
Will you retain the vehicle?
Are you behind on your payments?
Other Vehicle 2
Ownership Type
Will You Retain the Vehicle?
Are you behind on your payments?
Expenses, Business & IRS
Monthly household expenses, business information, and IRS obligations.
Monthly Household Expenses
Business Information
Do you own or operate your own business?
Internal Revenue Service (IRS)
Do you owe money to the IRS?
Questionnaire Submitted!
Thank you for completing the DASA Law Individual Questionnaire Form. Our team will review your information and reach out to schedule your consultation.
Call Us: (888) 343-DASA (3272)14100 Palmetto Frontage Road, Suite 370, Miami Lakes, FL 33016
