Name Spouse’s Name Address Home Phone City in Northern Ohio Work Phone ZIP eMail
Yes No
Name and address of current Employer. Name Address City State Zip Pay Period select oneevery weekevery other week15th and end of monthonce per month
select one1 year or less2 years3 years4 years5 – 10 years10 years or more If you have been at your current job less than one (1) year, describe your previous position.
select one1 year or less2 years3 years4 years5 – 10 years10 years or more If your spouse has been at their current job less than one (1) year, describe their previous position and length they were employed.
Please provide estimates of your debt for each of the below categories. You will be asked to provide more specific information after your initial consultation; therefore, it is understood that the figures you provide today may change prior to completing your legal documents. Credit Card Debt Medical Bills Repossession Debt Wage Garnishment Personal Loans Student Loans Other
Balance Payment Arrearage (Amount you owe for back payments.) Name of Mortgage Company
To find out what homes have recently sold for in your neighborhood go to www.bankofamerica.com
Yes No If YES, provide date: monthJanFebMarAprMayJunJulAugSepOctNovDec / year201320122011201020092008
List the sex and ages of all children whom you declare as dependents on your taxes:
Do you have a vehicle(s)? If YES, complete the following:
Mr. Brewer will not divulge any information submitted here to any third party for any reason.
