BANKRUPTCY WORKSHEET

    PLEASE READ AND COMPLETE FRONT AND BACK PAGE    

The following information is needed to prevent any potential and/or actual conflicts of interest.

Providing this information DOES NOT mean you or your current, separated or former spouse is filing Bankruptcy.

(PLEASE PRINT)

Full Name(s) of you and your CURRENT spouse (including complete middle or maiden name).

If you have been divorced within the past six years, are currently separated, and/or have joint debts with a former or separated spouse, please include his or her name.

Contact Numbers