Client Intake Form Step 1 of 5 20% Please fill out this form as complete as possible so we can be prepared for your consultation:Reason For Consultation Consultation Goals and Expectations Describe what your goals and expectations are from your consultation with us:Name Husband First Last Name Wife First Last Physical Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Mailing Address (If Different) Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code County In Which You LiveHusband PhoneHusband Email Enter Email Confirm Email Wife PhoneWife Email Enter Email Confirm Email Best Time To Call : HH MM AM PM Husband Social Security NumberHusband Date Of Birth Husband Gross Annual IncomeWife Social Security NumberWife Date Of Birth Wife Gross Annual IncomeNumber Of DependantsPlease enter a value greater than or equal to 0.Age(s) of Dependants Own/Rent House Own Rent If Own, Current "Realistic" Fair Market ValueIf Own, Balance Owed on 1st MortgageIf Own, Balance Owed on 2nd MortgageHow Long Have You Lived At Your Current ResidencePlease provide similar info if you have multiple properties Prior Addresses If you have not lived at your current address for the past 2 years, provide all prior addresses in this time frame, and whether you owned or rented for all prior property addresses. If any prior properties were owned in the last 2 years, provide detail as to what you sold the property for, when you sold it, and the net amount you received from the sale.Previous Bankruptcy Have you filed bankruptcy within the past 8 years? If yes, please advise the chapter of bankruptcy you filed (Chapter 7, Chapter 13, Chapter 11), where it was filed (City/State), when it was filed, whether the case was dismissed or discharged, and the applicable case number.Unfiled Tax Returns Have you filed all income tax returns? If not, explain in detail the returns not filed, whether you have all of your income and deduction information for preparation of those returns, or whether you have the returns prepared and just have not filed them with the Internal Revenue Service. (Include all relevant income and business tax returns that have not been filed.)Owed Taxes If you owe tax debts, answer: (a) what years; (b) are they filed; (c) how much with penalties and interest; and (d) what about state income tax returns.Liens Is there a Federal and/or State Tax Lien filed against you anywhere? If so, provide detailLast 4 years tax returnsYesNoDo you have copies of your last four (4) income tax returns in their entirety? Provide the following information relative to your secured debts:IRS or DOR NameHave you had contact with the IRS or DOR? If so please fill in the contact name above and Office ans Summary below.IRS or DOR OfficeIRS or DOR Result Summary IRS LetterYesNoHave you received any IRS letters regarding liens, levies or outstanding balances? (**If yes, Please send a copy of the notice to the Law Group with this intake form)**Substitute For Return - SFRYesNoDid IRS “prepare” returns or make assessments for any year before they filed a return for that year(s) (known as “substitute for return” or SFR)?Est Value of CarsBalance of Cars LoansHow Are Cars Titled? Party To A LawsuitYesNoAre you a party to a lawsuit or do you have the right to sue someone but haven’t yet?Does anyone owe you money?YesNoIf yes above, how much?Other Assets Please list all assets not described above (include IRA’s, 401k’s, life insurance, etc.), how much you think each is worth; how they are titled (e.g. H only, H&W jointly); whether there are liens or mortgages attached to theses assets, and the amounts owed, if any (feel free to lump some together such as “furniture”, but do not lump special items like antiques, collections, etc.):Credit Card Debt - HusbandCredit Card Debt - WifeStudent Load Debt - HusbandStudent Load Debt - WifeAlimonyChild Support Owed - HusbandChild Support Owed - WifeOther Tell us anything else you believe is relevant to your financial situation, your debts, and/or your assets.