Exit Form Have you ever owned a house, co-op condo, land or time share, whether in your name for your benefit or for the benefit of another person in this country or outside this country?*YesNoUntitledDo you have a personal injury lawsuit, disability claim, or worker's comp case or auto insurance claim pending?*YesNoUntitledDo you currently have any other type of lawsuit, legal claim or insurance claim? If yes, has there been talk of a recent settlement, or will there be an upcoming trial on this? If you do have a lawsuit or claim, provide status of your case.*YesNoUntitledHas anyone died or is likely to die within the next 6 months that entitled you to an inheritance? The deceased may have died with a will or without a will.*YesNoUntitledAre you expecting life insurance proceeds as a result of an actual death that has occurred?*YesNoUntitledAre you involved in a divorce where there will be a property settlement or a change in marital status?*YesNoUntitledWhat do you project your tax refund to be for next year?Have you made any purchases, cash advances, or incurred any other debt since first coming into our office?*YesNoUntitledHave you made any transfers to friends or family members or payments to creditors since first coming into our office?*YesNoUntitledHave you previously filed bankruptcy & when?*YesNoUntitledDid you anticipate an increase in your salary or any other change in your financial circumstance during the next 12 months?*YesNoUntitledDo you have or have you had any involvement or ownership interest formally or informally in any business in this country or outside of this country?*YesNoUntitledDo you or did you change or expect to change your marital status? Marriage, divorce or separation?*YesNoUntitledIf you are a homeowner, any post-bankruptcy loan modification will affect your bankruptcy discharge status. Thus, do not sign any loan modification agreement without consulting our office.I HAVE READ THIS FINAL QUESTIONNAIRE AND MY ANSWERS ABOVE ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF.Signature First Last
