Steven L. Lefkovitz - Attorney At Law

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Steven L. Lefkovitz - Attorney At Law
Steven L. Lefkovitz - Attorney At Law
Steven L. Lefkovitz - Attorney At Law

 

 

 

Before your first visit, please print and fill out the following questionaire
as completely as possible.

Name:_________________________________________________________
SSN:__________________________________________________________
DOB:__________________________________________________________
SPOUSE:_______________________________________________________
SSN:__________________________________________________________
DOB:__________________________________________________________
ADDRESS:______________________________________________________
Other names used in last 6 years:______________________________
First Telephone Number:______________________________
Second Telephone Number:______________________________
Alimony or Support:_______ Paid:____________ Rec'd_______________
Gross Earnings:$________________ Per____________________________
Gross Earnings:$________________ Per ___________________________
Net Earnings$__________________ Per ___________________________
Net Earnings$__________________ Per ___________________________
Other Income:$________________ Per ___________________________
Other Income:$________________ Per ___________________________
Source:______________________________
Source:______________________________
Gross income last year:______________________________
Gross income last year:______________________________
Have you ever filed a chapter 7 bankruptcy petition:__________________
How many times/dates:______________________________
Have you ever filed a chapter 13 bankruptcy petition
( debtor's court )_______________
How many times/dates:______________________________
Motor Vehicles: Own__________________Buying____________________
Home or mobile home: Own_____________Buying____________________
Year and Model (1)______________________________
Payments (1st Mtg)______________________________
Interest Rate: $______________________________
(2)_____________________________2nd Mtg________________________
(3) Interest Rate: ___________________________________________________
Payments (1)_____________________Per____________________________
Prin. Bal.: 1st Mtg:______________________________
(2)__________________________________Per___________________________
2nd Mtg.______________________________
To Whom: (1) _____________________________________________________
To Whom: 1st Mtg:______________________________
(2)______________________________Per______________________________
2nd Mtg:______________________________
Pay off Balance: $______________________________
Original Cost: $_________________________(2)$_________________________
Approx. Date of Purchase:______________________________
Interest: (1)$______________________________
Estimated Current Market Value:$______________________________
Rate (2)$______________________________
Rent:$______________________________Per Month


I Attest The Foregoing To Be True And Correct On This The_____Day
of_____________________________.

Steven L. Lefkovitz
618 Church Street • Suite 410
Nashville, TN 37219

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