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Seymour and Associates, P.C.

706-595-1980
101-B Rossmore Place, Augusta, GA (Main) � 654 Main Street, Thomson GA 30824

Free Online Financial Evaluation

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Please complete the following questionnaire so that we may better answer your inquiry.

Have you ever filed bankruptcy before? * If so, when and what type?		Employer

Your Monthly Income * Income after taxes and insurance only:		Other Income * (Disability, rental, etc.)

Spouse's Monthly Income * Income after taxes and insurance only:		Spouse's Other Income * (Disability, rental, etc.)

Tax Value of Home * From your property tax bill:		Home Titled to * From your property tax bill or deed:

Real Estate

First mortgage balance: *		Payment amount: *		Months behind: *

Second mortgage balance:		Payment amount:		Months behind:

Third mortgage balance:		Payment amount:		Months behind:

Other real estate
List value(s) from tax bill, mortgage balance, payment amount and months behind:

Vehicles

First Vehicle * List year, make, model, loan balance, monthly payment, months behind, name on title:		Second Vehicle * List year, make, model, loan balance, monthly payment, months behind, name on title:

Other Debt

Total unsecured debt * (Medical bills, credit cards, etc.)		Finance company debt:		Balance of student loans:

Taxes and Miscellaneous

Federal taxes due List years for which taxes are due, amounts:		State taxes due List years for which taxes are due, amounts:

Returns current? Have all prior year tax returns been filed?		Number of dependents: *

Child support and alimony * Amount of child support and alimony paid monthly; amount behind:		Judgments Describe judgments against you; amount of judgment; balance:

Garnishments		Lawsuits Do you have any lawsuits pending against you?

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Seymour and Associates, P.C.
Phone: 706-868-1968
101-B Rossmore Place, Augusta, GA (Main) � 654 Main Street, Thomson GA 30824
706-595-1980
Mailing Address: P.O. Box 211003, Augusta, Georgia 30917-1003

The information in this site is provided for you to help you understand how you can best determine a course of action. This site is not intended to serve as legal advice or is in any way offering counsel with regard to any legal situation. You should not act or rely upon the information in this site without seeking the advice of an attorney. No attorney-client relationship exists until all parties to any attorney-client relationship have agreed upon a contract.