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Assisted Person Analysis Form

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 720-279-9475 or 866-916-3950 (Toll Free). 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.

An asterisk (*) indicates REQUIRED information.

*Name of prospective client:   
 
The prospective client is: (check one)
individual
sole proprietor
general partnership
limited partnership
    limited liability company
S corporation
C corporation
Other
Describe "other":
   
 
Real Property Owner?

 type:
residence  2nd residence 
office bldg industrial bldg raw 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:
residence  office  store
 
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?
 
 
 
     
Contemplating Bankruptcy?
  1. Get your questions answered, using the information provided via this site.
  2. To discuss your situation with Jon Clarke, fill out and submit the Business or Consumer Debtor Analysis Form.
  3. We will endeavor to contact you within 3 business days of receipt of your Business or Consumer Debtor Analysis Form.
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Bankruptcy Lawyer serving Colorado
www.jonbclarke.com
5290 DTC Parkway, Suite 150
Greenwood Village, Colorado 80111-2764
Phone: (720) 279-9475
Toll-Free: (866) 916-3950
Fax: (303) 850-7115
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