Assisted Person Analysis Form

After reading through this website and the links in our Bankruptcy Information Center, fill out the Assisted Person Analysis Form and get it to the firm.

After reading through this website and the links in our Bankruptcy Information Center, fill out the Assisted Person Analysis Form and get it to the firm.

After you have read through this website and the links found on our Bankruptcy Information Center and Web Resources pages, you should fill out the following Assisted Person Analysis Form (the “APA”) and get it to the firm. You can email it or fax it to the firm (303-850-7115) – remember that email is not secure and there is a small chance that the information you send could be viewed by another.

NOTE: The use of the Internet or this email link for communications with the firm or any individual member of the firm does not establish an attorney-client relationship. Confidential or time-sensitive information should not be sent through this email link. If your situation is urgent, please call 303-688-3189. If Mr. Clarke is available he will take your call. If not, briefly explain the urgency of your situation to his receptionist or legal assistant, or you may leave a voice mail. Thereafter, please complete the below APA and fax or email it to the firm.

DISCLAIMER: The information you have obtained from this website is not, nor is it intended to be, what is commonly called “legal advice”. Pursuant to the 2005 Act, this firm must determine your status as a business or consumer debtor and provide certain disclosures and notices before it can give an Assisted Person meaningful, personalized “legal advice” about any individual’s own unique situation.

*Name of prospective client:

The prospective client is: (check one)

individualsole proprietorgeneral partnershiplimited partnershiplimited liability companyS corporationC corporationOther
Describe "other":

Real Property Owner?

type
residence2nd residenceoffice bldgindustrial bldgraw land

combined current market value(s): $

combined 1st mortgage amount(s): $

combined 2nd mortgage amount(s): $

other tax, HOA, judgment lien $

combined amount(s):

Renter?

type: residenceofficestore

monthly rent amount: $

months left on the lease:

Business Personal Property

(use current liquidation value)

a. furniture, fixtures,
equipment, inventory value: $

ff&e purchase money
loan balance(s): $

seller-carried loan balance: $

bank/SBA loan balance: $

b. business vehicle(s) value: $

purchase money loan balance(s): $

vehicle lease payoff amounts: $

Consumer Personal Property

(use current replacement/retail value)

value of all vehicle(s): $

furniture, equipment value: $

consumer all-vehicle loan/lease
payoff total: $

furniture/equipment loan/lease
payoff total: $

Priority Debt Balances:

Employee Wages: $

Consumer Deposits: $

Payroll Taxes: $

Sales & Unemployment Taxes: $

Income Taxes: $

Last year for which an income tax return was filed:

Unsecured Debt Balances:

Credit Cards - consumer use: $

Credit Cards - business use: $

Other Consumer (medical, student loan)
Debt: $

Trade Creditors (business vendors): $

Name of Person to Contact?:

How should we contact you?

(more than one can be checked)

By email at the sender's address:

At home telephone:

At work telephone:

On a cell phone:

Best time to contact you:

Why do you need our help?