APPLICATION FOR CLASSIFICATION AS EXTREME HARDSHIP CASE
|
|
|
- Camilla Eaton
- 5 years ago
- Views:
Transcription
1 APPLICATION FOR CLASSIFICATION AS EXTREME HARDSHIP CASE I. TRUST CLAIMANT INFORMATION Trust Claimant: Address: POC#: Attorney Name: Law Firm: Address: Phone#: Injury Alleged: Date of Diagnosis: If you have updated medicals, please attach them to the application. II. STATEMENT FROM CLAIMANT To qualify for Hardship status, a Manville Trust claimant must demonstrate extreme financial hardship. Attach a narrative statement from the claimant (or surviving spouse/dependents) explaining the nature and extent of the financial hardship and how it is the direct result of an asbestos-related injury. III. FINANCIAL HARDSHIP For the Trust to evaluate a claimant's financial hardship, you must complete the financial statement below and attach documentation where requested. In the absence of this financial information your request for hardship status will not be reviewed. 7/15/2003 Form: Hardship Case Version 1
2 Dependents List all dependents, their relationship to the claimant, and their ages. Name Relationship Age Settlements/Verdicts/Judgments List the amounts of settlements/verdicts/judgments received from each co-defendant, and the date(s) they were received on the next page. In the event that there are settlements negotiated but not yet received, also record them. Codefendant Amount Date Life Insurance Proceeds List the amount of any life insurance proceeds received with respect to the claimant. If the claimant is living, list the face value of any policies currently in force. Amount(s) Dates(s) Federal Tax Returns Attach a copy of the claimant's (or surviving spouse's) Federal tax return for each of the last two years for which returns were filed. Specify years: 2
3 Statement of Monthly Expenses On the table below, list all monthly expenses incurred. Extraordinarily high expenses must be supported by explanation and/or copy (ies) of a monthly billing statement. HOUSEHOLD EXPENSES: Cleaning and laundry Clothing Groceries Household furniture/furnishings Household help Maintenance and repairs Mortgage/rent HOUSEHOLD UTILITIES: Gas and electric/oil Telephone Water and sewage TRANSPORTATION: Car payment Carpool Gasoline and Oil Maintenance and repairs Parking/tolls Public transportation/taxi Title and tags INSURANCE PREMIUMS: Automobile insurance Homeowners/renters Life insurance Medical insurance SCHOOL: (if college, name school) Activities Books, supplies, uniforms Lunch money Room and board Transportation Tuition AMOUNT OTHER EXPENSES: 3
4 Allowance/spending money Child care/babysitters Entertainment Gifts (Christmas/Hanukkah/birthday) Hairdresser and/or barber Personal care/toiletries Recreation/lessons/hobbies Subscriptions/newspapers/books Taxes Vacation MEDICAL AND DENTAL: Dental Doctor Drug store items Prescription drugs Non-prescription drugs Other medical expenses: Describe on separate sheet. TOTAL MONTHLY EXPENSES: 4
5 Statement of Monthly Income List all sources and amounts of monthly income. If the spouse or any other members of the household are employed or receive any benefits, these amounts must be included. SOURCE Wages: Amount: Pension: If spouse is not working, please explain why on the back of this page. Worker's Compensation: Social Security (list benefits): If none, explain why: (annuities, investment income, etc.) 5
6 TOTAL MONTHLY INCOME: Statement of Financial Liabilities List all large outstanding liabilities (e.g., mortgage, medical bills, loans). If any of these are in arrears, attach supporting documents. Charge Accounts: Monthly Payments Total Amount Due Mortgage Payments: Monthly Payments Total Amount Due Automobile Payments: Monthly Payments Total Amount Due Outstanding Medical/ Dental Bills: Monthly Payments Total Amount Due Other Outstanding Debts: Monthly Payments Total Amount Due 6
7 TOTAL LIABILITIES: Statement of Financial Assets List all available assets (e.g., savings/checking accounts, stocks, bonds, face value of life insurance policies, etc.) Copies of bank statements will serve to support the amounts listed. Liquid Assets: Checking/Savings, etc. account(s) Institution Balance Account No. Real Property: Address: Purchase Price Mortgage Balance Pension/Profit-Sharing Plan: Employer Value/Expected Date of Benefit Commencement Personal Property: Vehicles (automobiles, boats, campers, etc.) Year/Make/Model Owner Lien 7
8 Other Assets: Please send your hardship request and supporting documents to the address below. Upon receipt of a request for Extreme Hardship consideration and the items of documentation listed above, your case will be reviewed. Clarification or further explanation of certain items or facts may be required as each case has its own unique set of circumstances. S:\CRMC Word Web Doc\HSAPPL.DOC 3120 Fairview Park Drive Suite 200 Falls Church, VA Phone: Fax: Inquiry@claimsres.com 8
DOMESTIC RELATIONS FINANCIAL AFFIDAVIT - DIVORCE. Date of Separation:
IN THE SUPERIOR COURT OF COUNTY Plaintiff, vs. Defendant. Civil Action No. DOMESTIC RELATIONS FINANCIAL AFFIDAVIT - DIVORCE 1. AFFIANT'S NAME: Spouse s Name: Age: Age: Date of Marriage: Date of Separation:
Gaining and Maintaining Financial Stability Financial Documents and Workbook
Gaining and Maintaining Financial Stability Financial Documents and Workbook Actual Monthly Spending 1. Income Income #1 Income #2 2. Giving 10% Church 3. Saving 10% Emergency Retirement College 4. Taxes
DOMESTIC RELATIONS FINANCIAL AFFIDAVIT. 1. AFFIANT S NAME: Age Spouse s Name: Dates of Marriage: Date of Separation:
In the Superior Court of County, Georgia, Plaintiff vs. Civil Action No., Defendant DOMESTIC RELATIONS FINANCIAL AFFIDAVIT 1. AFFIANT S NAME: Age Spouse s Name: Age Dates of Marriage: Date of Separation:
IN THE SUPERIOR COURT OF CHEROKEE COUNTY STATE OF GEORGIA DOMESTIC RELATIONS FINANCIAL AFFIDAVIT
IN THE SUPERIOR COURT OF CHEROKEE COUNTY STATE OF GEORGIA, ) ) Plaintiff, ) ) CIVIL ACTION FILE NO. vs. ) ), ) ) Defendant. ) DOMESTIC RELATIONS FINANCIAL AFFIDAVIT 1. AFFIANT S NAME Age Spouse s Name
PRIMARY APPLICATION ACT 91 MORTGAGE ASSISTANCE
PRIMARY APPLICATION ACT 91 MORTGAGE ASSISTANCE Applicant (Last) (First) Social Security Number Co-Applicant (Last) (First) Social Security Number Primary Address Property being foreclosed on (if different
DOMESTIC RELATIONS FINANCIAL AFFIDAVIT
IN THE SUPERIOR COURT OF CLAYTON COUNTY STATE OF GEORGIA vs. Plaintiff,,, Defendant. Civil Action Case Number DOMESTIC RELATIONS FINANCIAL AFFIDAVIT (1) Your Name: Your Age: Spouse s Name: Spouse s Age:
IN THE SUPERIOR COURT OF HOUSTON COUNTY, GEORGIA DOMESTIC RELATIONS FINANCIAL AFFIDAVIT OF PLAINTIFF. 1. AFFIANT S NAME: Age.
IN THE SUPERIOR COURT OF HOUSTON COUNTY, GEORGIA, Plaintiff vs. Civil Action No., Defendant DOMESTIC RELATIONS FINANCIAL AFFIDAVIT OF PLAINTIFF 1. AFFIANT S NAME: Age Spouse s Name: Age Date of Marriage:
IN THE SUPERIOR COURT OF FLOYD COUNTY, STATE OF GEORGIA
IN THE SUPERIOR COURT OF FLOYD COUNTY, STATE OF GEORGIA _, ) Plaintiff / Petitioner, ) ) CIVIL ACTION FILE v. ) ) No., ) Defendant / Respondent. ) ) DOMESTIC RELATIONS FINANCIAL AFFIDAVIT 1. AFFIANT S
In the Superior Court of County, Georgia. In re (Child(ren)): ) ) ), Petitioner ) ) vs. ) Civil Action No. ), Respondent ) )
In the Superior Court of County, Georgia In re (Child(ren:, Petitioner vs. Civil Action No., Respondent DOMESTIC RELATIONS FINANCIAL AFFIDAVIT 1. AFFIANT S NAME (your name: Age Opposing Party s Name: _
COUNTY SUPERIOR COURT STATE OF GEORGIA DOMESTIC RELATIONS FINANCIAL AFFIDAVIT
COUNTY SUPERIOR COURT STATE OF GEORGIA vs. Plaintiff, Defendant.,, Civil Action Case Number DOMESTIC RELATIONS FINANCIAL AFFIDAVIT (1) Your Name: Your Age: Spouse s Name: Spouse s Age: Date of Marriage:
IN THE SUPERIOR COURT OF STATE OF GEORGIA., Plaintiff, v., CIVIL ACTION Defendant. FILE NO. DOMESTIC RELATIONS FINANCIAL AFFIDAVIT
IN THE SUPERIOR COURT OF STATE OF GEORGIA COUNTY, Plaintiff, v., CIVIL ACTION Defendant. FILE NO. DOMESTIC RELATIONS FINANCIAL AFFIDAVIT 1. AFFIANT S NAME: Ag e Spouse s Name: Ag e Date of Marriage: Date
UNIFORM SUPERIOR COURT RULE 24.2 DOMESTIC RELATIONS FINANCIAL AFFIDAVIT
UNIFORM SUPERIOR COURT RULE 24.2 DOMESTIC RELATIONS FINANCIAL AFFIDAVIT Except as noted below, at the time of filing any action for temporary or permanent child support, alimony, equitable division of
In the Superior Court of County, Georgia. ), Petitioner ) ) vs. ) Civil Action No. ), Respondent ) ) DOMESTIC RELATIONS FINANCIAL AFFIDAVIT
In the Superior Court of County, Georgia, Petitioner vs. Civil Action No., Respondent DOMESTIC RELATIONS FINANCIAL AFFIDAVIT 1. AFFIANT S NAME (your name: Age Spouse s Name: _ Age Date of Marriage: Date
DOMESTIC RELATIONS FINANCIAL AFFIDAVIT
DOMESTIC RELATIONS FINANCIAL AFFIDAVIT At the time of filing any action for temporary or permanent child support, alimony, equitable division of property, modification of child support or alimony or attorneys
State of Georgia., Plaintiff., Defendant AFFIDAVIT AND MOTION TO PROCEED IN FORMA PAUPERIS
In the Superior Court of State of Georgia County, Georgia vs., Plaintiff, Defendant Civil Action File No. AFFIDAVIT AND MOTION TO PROCEED IN FORMA PAUPERIS I,, the undersigned, having been duly sworn,
Part 1: Retirement Income Estimation Worksheet:
Retirement Cash Flow Worksheet and Budget Date: Name: Part 1: Retirement Income Estimation Worksheet: Annual Income $ CPI Indexed? Continued Employment of Spouse... (Until Age: ) Part Time Employment...
In the Superior Court of County, Georgia. 1. AFFIANT S NAME: Age. Spouse s Name:
In the Superior Court of County, Georgia, Plaintiff vs. Civil Action No., Defendant TIC FINANCIAL RELATIONS AFFIDAVIT FINANCIAL AFFIDAVIT 1. AFFIANT S NAME: Age Spouse s Name: Age Names and birth dates
Figure 1 Figure 2 Assets and Liabilities Inventory CAsh Cash on hand Checking account balance Savings account balance Certificates of deposit Money market account balance Credit union account balance Money
24.2. Financial data required; scheduling and notice of temporary hearing.
24.2. Financial data required; scheduling and notice of temporary hearing. At the time of filing any action for temporary or permanent child support, alimony, equitable division of property, modification
DOMESTIC RELATIONS FINANCIAL AFFIDAVIT
IN THE SUPERIOR COURT OF COUNTY STATE OF GEORGIA vs. Plaintiff, CIVIL ACTION FILE NO. Defendant. DOMESTIC RELATIONS FINANCIAL AFFIDAVIT You are required to make to the Court, under oath, a FULL DISCLOSURE
STATE OF MAINE. v. PLAINTIFF S DEFENDANT S FINANCIAL STATEMENT [M.R. CIV P. 80 (c)], Defendant
![STATE OF MAINE. v. PLAINTIFF S DEFENDANT S FINANCIAL STATEMENT [M.R. CIV P. 80 (c)], Defendant](/thumbs/85/91941724.jpg "STATE OF MAINE. v. PLAINTIFF S DEFENDANT S FINANCIAL STATEMENT [M.R. CIV P. 80 (c)], Defendant")
STATE OF MAINE SUPERIOR COURT county, ss. CV- DISTRICT COURT DIVISION OF LOCATION DOCKET NO., Plaintiff v. PLAINTIFF S DEFENDANT S FINANCIAL STATEMENT [M.R. CIV P. 80 (c)], Defendant INSTRUCTIONS This
STATE OF ILLINOIS UNITED STATES OF AMERICA COUNTY OF DUPAGE COUNTY IN THE CIRCUIT COURT OF THE EIGHTEENTH JUDICIAL CIRCUIT
IN RE THE MARRIAGE OF: ) ) Harold J Jones ) CASE NUMBER PETITIONER ) -VS- ) 44-32323 ) Marianne P Jones ) RESPONDENT ) COMPREHENSIVE FINANCIAL STATEMENT PURSUANT TO LOCAL COURT RULE 15.01.3 INSTRUCTIONS
IN THE CHANCERY COURT OF COUNTY, MISSISSIPPI PLAINTIFF CAUSE NO. DEFENDANT FINANCIAL DECLARATION OF NAME: ADDRESS: DATE OF BIRTH:
IN THE CHANCERY COURT OF COUNTY, MISSISSIPPI _, PLAINTIFF VS. _, CAUSE NO. DEFENDANT _ FINANCIAL DECLARATION OF I. GENERAL INFORMATION: NAME: ADDRESS: DATE OF BIRTH: SOCIAL SECURITY NUMBER: OCCUPATION:
Dear Customer: Time is critical and an immediate response is your first step toward finding a solution.
Dear Customer: We understand that you may be experiencing financial problems that could result in the foreclosure and loss of your home. We also understand that the temporary or longterm difficulties that
EBRI Databook on Employee Benefits. Chapter 11. Trends in Household Income and Expenditure for Older Americans
EBRI Databook on Employee Benefits Chapter 11 Trends in Household Income and Expenditure for Older Americans Description of Expenditure Components for figure 11.1 Home-related expenses include mortgage,
FINANCIAL AFFIDAVIT 11.02
IN THE CIRCUIT COURT OF THE NINETEENTH JUDICIAL CIRCUIT LAKE COUNTY, ILLINOIS IN RE: The Marriage of: Custody of: Support of: ) ) ) Harold J Jones ) Petitioner ) and ) No. 44-32323 ) Marianne P Jones )
IN THE COMMON PLEAS COURT OF SUMMIT COUNTY, OHIO DIVISION OF DOMESTIC RELATIONS
IN THE COMMON PLEAS COURT OF SUMMIT COUNTY, OHIO DIVISION OF DOMESTIC RELATIONS Plaintiff Address CASE NO. SETS NO. Marital Residence Attorney Yes No Phone: JUDGE MAGISTRATE Atty Address Atty Phone vs.
SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF X Plaintiff,
SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF ---------------------------------------------------------------------X Plaintiff, - against - STATEMENT OF NET WORTH DATED: Index No. Date Action Commenced:
FINANCIAL. 1. My information. Name of the person completing this Form (First Middle Last): Date this Form was completed (YYYY/MM/DD):
FINANCIAL INFORMATION Form I 1. My information Name of the person completing this Form (First Middle Last): Date this Form was completed : My financial circumstances My total annual income (before tax
CHRISTOPHER J. TAMMS 5 West Main Street Westerville, Ohio Phone: (614) Fax: (614)
CHRISTOPHER J. TAMMS 5 West Main Street Westerville, Ohio 43081 Phone: (614) 859-9529 Fax: (614) 567-0031 chris.tamms@gmail.com www.tammslaw.com CLIENT INFORMATION- Full Legal Addresses where you lived
FAMILY LAW FINANCIAL AFFIDAVIT
IN THE CIRCUIT COURT OF THE IN AND FOR JUDICIAL CIRCUIT, COUNTY, FLORIDA, Petitioner, Case No.: Division: and, Respondent. FAMILY LAW FINANCIAL AFFIDAVIT ($50,000 or more Individual Gross Annual Income)
Financial Disclosure Statement of Plaintiff Defendant
TYPE or PRINT in ink STATE OF MICHIGAN, 44th CIRCUIT COURT Note: File with FOC only! For Official Use Enter the name of the plaintiff. Plaintiff: First name Middle name Last name Enter the name of the
Date of Dissolution of Marriage if applicable): Children of this Marriage: Birth date residing with Birth date residing with Birth date residing with
STATE OF ILLINOIS } } ss COUNTY OF DuPAGE } IN THE CIRCUIT COURT OF THE EIGHTEENTH JUDICIAL CIRCUIT DuPAGE COUNTY, ILLINOIS IN RE THE MARRIAGE OF: } } } Plaintiff, } vs. } Case No. } } Defendant. } COMPREHENSIVE
Monthly Expenses Worksheet
Monthly Expenses Worksheet Education Rent or mortgage $ Tuition $ Heating (gas or oil) $ Books, papers and supplies $ Electricity $ Newspapers and magazines $ Water or sewage $ Lessons (sports, dance,
FAMILY LAW FINANCIAL AFFIDAVIT (LONG FORM)
IN THE CIRCUIT COURT OF THE IN AND FOR JUDICIAL CIRCUIT, COUNTY, FLORIDA, Petitioner, Case No.: Division: and, Respondent. FAMILY LAW FINANCIAL AFFIDAVIT (LONG FORM) ($50,000 or more Individual Gross Annual
, ) ) AFFIDAVIT OF FINANCIAL STANDING ) OF VS. ) (Name) ), ) Defendant. )
STATE OF NORTH CAROLINA COUNTY OF IREDELL IN THE GENERAL COURT OF JUSTICE DISTRICT COURT DIVISION FILE NO.:, ) Plaintiff, ) AFFIDAVIT OF FINANCIAL STANDING ) OF VS. ) (Name) ), ) Defendant. ) The Affiant,
Social Security Card(s) or Numbers for all family members listed on return.
Social Security Card(s) or Numbers for all family members listed on return. If you have your Social Security card, bring it with you to the appointment. If you have changed your name (due to marriage,
A.1: FORECLOSURE PREVENTION INTAKE FORM
A.1: FORECLOSURE PREVENTION INTAKE FORM I. CLIENT INFORMATION Date: Name(s) Address Home Phone Work Phone Best Times to Reach Marital Status Spouse (if any) Children (names and ages) Others in Household:
LEVY, LEVY AND NELSON
LEVY, LEVY AND NELSON A PROFESSIONAL ACCOUNTANCY CORPORATION 23801 CALABASAS ROAD, SUITE 2012 CALABASAS, CA 91302 PHONE:(818)346-8034 FAX:(818)346-6409 EMAIL:APPOINTMENTS@LEVYNELSON.COM TAX RETURN YEAR
DISCLOSURE STATEMENT (Pursuant to Rule )
IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS COUNTY DEPARTMENT - DOMESTIC RELATIONS DIVISION IN RE The Marriage Custody Parentage Support of: [ ] Petitioner / [ ] Counter-Respondent, -vs- [ ] Respondent
Financial Data Entry Sheet for Net Worth Statement
Financial Data Entry Sheet for Net Worth Statement Your name: Spouse s name: I. FAMILY DATA Your birth date: Spouse s birth date: Spouse s place of birth: Spouse s Social Security number: Date married:
JOYNER, KIRKHAM, KEEL & ROBERTSON, P.C INDIVIDUAL TAX ORGANIZER
Please provide a copy of your 2013 federal and state tax returns, and complete pages 1 through 3. Other pages: complete only those sections that apply to you. Your Name SS# Occupation Birth Date Spouse
SUPREME COURT OF YUKON FINANCIAL STATEMENT. FINANCIAL STATEMENT OF (Plaintiff/Defendant) I,, of the of,
Form 94 (Rule 63A (1) ) S.C. NO: SUPREME COURT OF YUKON Between: Plaintiff and Defendant FINANCIAL STATEMENT FINANCIAL STATEMENT OF _ (Plaintiff/Defendant) I,, of the of, in Yukon, SWEAR (or AFFIRM) THAT:
Tax Return Questionnaire Tax Year
Tax Return Questionnaire - 2015 Tax Year - Page 1 of 9..Fold here-then flip pages up Tax Return Questionnaire - 2015 Tax Year Name and Address: Taxpayer: Address: Social Security Number: Occupation Spouse:
PERSONAL INFORMATION YOUR INFORMATION CHURCH INFORMATION LEADER INFORMATION. Date: Please Print
PERSONAL INFORMATION YOUR INFORMATION Date: Please Print I AM A: STUDENT CO-LEADER LEADER BUSINESS TITLE/OCCUPATION YOUR TITLE: MR MRS MISS DR REV YOUR FIRST NAME YOUR LAST NAME SPOUSE IS A: STUDENT CO-LEADER
# 17 ASSETS: Severance Pay, RRSP and RIF 8-2 # 18 NET WORTH CALCULATION 8-4 # 19 MONTHLY RETIREMENT INCOME 8-6 # 20 MONTHLY RETIREMENT EXPENSES 8-7
What re you doing after work? Finance D, 8-1 Finance D WORKSHEETS HANDOUTS # 17 ASSETS: Severance Pay, RRSP and RIF 8-2 # 18 NET WORTH CALCULATION 8-4 # 19 MONTHLY RETIREMENT INCOME 8-6 # 20 MONTHLY RETIREMENT
and Financial Disclosure Statement of:
PRINT in BLACK ink Enter the name of the county in which this case is filed. STATE OF WISCONSIN, CIRCUIT COURT, COUNTY For Official Use Enter the name of the petitioner. If joint petitioners, enter the
Itemized Deductions. Pub 4012 Tab F Pub 4491 Lessons 20 & 21
Itemized Deductions Pub 4012 Tab F Pub 4491 Lessons 20 & 21 Deductions May claim larger of Standard deduction Increased if at least 65 or blind OR Itemized deductions If itemized deductions are entered,
INSTRUCTIONS FOR FLORIDA FAMILY LAW RULE OF PROCEDURE FORM (c), FAMILY LAW FINANCIAL AFFIDAVIT (LONG FORM)(09/12) Instructions
INSTRUCTIONS FOR FLORIDA FAMILY LAW RULE OF PROCEDURE FORM 12.902(c), FAMILY LAW FINANCIAL AFFIDAVIT (LONG FORM)(09/12) Instructions YOU DO NOT NEED TO FILL OUT THIS FORM IF YOU WORK WITH DIVORCE AND MEDIATION
FINANCIAL DISCLOSURE AFFIDAVIT, 2015
FINANCIAL DISCLOSURE AFFIDAVIT OF, 2015 1 STATE OF NEW YORK SUPREME COURT : COUNTY OF ERIE, vs., Plaintiff, Defendant. FINANCIAL DISCLOSURE AFFIDAVIT (DRL Section 236) Index No: SF, the Plaintiff/Defendant
FINANCIAL INFORMATION CHECK LIST o Real estate information: Address, purchase price and date purchased (Final HUD settlement form) Copies of Final HUD
Client Data Organizer Celia Griffin, CPA, CDFA Celia Griffin, CPA, PLLC 19125 North Creek Parkway, Suite 120, Bothell, WA 98011 Phone (425) 954-8500 Fax (425) 954-8500 Email: celia@celiagriffincpa.com
BUBDGET COUNSELING WORKSHEET INSTRUCTIONS
BUBDGET COUNSELING WORKSHEET INSTRUCTIONS 1) Please enter the financial information requested under the CURRENT Column of the Budget Counseling Worksheets. 2) Next, bring in a LES and any other information
Form 13.1: Financial Statement (Property and Support Claims) sworn/affirmed
ONTARIO Court File Number at (Name of court) (Court office address) Form 13.1: Financial Statement (Property and sworn/affirmed Applicant(s) Full legal name & address for service street & number, municipality,
DRESSLER & DRESSLER Attorneys at Law 110 Dixie Lane Cocoa Beach, FL (321)
DRESSLER & DRESSLER Attorneys at Law 110 Dixie Lane Cocoa Beach, FL 3231 (321) 783-2714 INSTRUCTIONS FOR FLORIDA FAMILY LAW FINANCIAL AFFIDAVIT FAMILY LAW RULES OF PROCEDURE FORM 12.02(c) (LONG FORM -
Income Tax Guide and Organizer for 2017
Income Tax Guide and Organizer for 2017 Email: rwa@blueriver.net Web site: www.rwataxservice.com phone: 812.586.0420 Before doing the booklet, please print out or read the informational sheet as it has
Financial Needs Analysis Questionnaire (the involvement of ALL decision makers are required for an accurate assessment) Date: Time:
Primary: D.O.B. Spouse / Partner: D.O.B. Address Primary s Cell phone: Home Phone: Spouse / Partner Cell phone: Primary s e-mail Spouse / Partner s e-mail Height Weight Any form of tobacco use? Height
Smart Money I A TOOL FOR PLANNING YOUR PERSONAL BUDGET
Smart Money I A TOOL FOR PLANNING YOUR PERSONAL BUDGET Table of Contents How Do You Manage Your Money? 1 Your Money Management Guidelines 2 Choosing Your Financial Goals 3 Charting Your Money 4 The Money
Client Questionnaire For Non-Business Debtor. Section 1 Basic Information
Client Questionnaire For Non-Business Debtor Section 1 Basic Information Part A. Name and Address Name: Last First Middle Telephone Number Home: Work: Cell: Other: Fax: Email: Social Security Number: -
Income (Monthly) Current Projected Totals Amount Projected Inc % Inc % Total Outgoing $ - $ - Total Current Projected Surplus/Deficit $ - $ -
Income (Monthly) Current Projected Totals Amount Projected Inc % Inc % Base pay Deductions 0% 0% BAS Housing 0% 0% BAH Food 0% 0% OHA Clothing 0% 0% COLA Transportation 0% 0% Special Pay Personal Needs
PLEASE PROVIDE A COPY OF THE FOLLOWING ITEMS: LAST YEAR'S TAX RETURNS (ONLY IF YOU ARE A NEW CLIENT) ALL FORMS W-2, 1098, 1099, 1099-SSA, ETC
81 Makawao Avenue, Suite 202, Makawao HI 96768; 808/572-6454; Fax: 808/572-1788 TAX ORGANIZER FOR YEAR: READ THIS FIRST: This tax organizer is designed to help you maximize your deductions and minimize
PLEASE PROVIDE A COPY OF THE FOLLOWING ITEMS: LAST YEAR'S TAX RETURNS (ONLY IF YOU ARE A NEW CLIENT) ALL FORMS W-2, 1098, 1099, 1099-SSA, ETC
81 Makawao Avenue, Suite 202, Makawao HI 96768; 808/572-6454; Fax: 808/572-1788 TAX ORGANIZER FOR YEAR: READ THIS FT: This tax organizer is designed to help you maximize your deductions and minimize problems
IN THE SUPERIOR COURT OF COBB COUNTY STATE OF GEORGIA DOMESTIC RELATIONS FINANCIAL AFFIDAVIT. (1) Your Name: Your Age:
IN THE SUPERIOR COURT OF COBB COUNTY STATE OF GEORGIA Petitioner: and Civil Action File No.: Respondent: DOMESTIC RELATIONS FINANCIAL AFFIDAVIT (1) Your Name: Your Age: Spouse s Name: Spouse s Age: Date
The Lee Accountancy Group, Inc th Street Oakland, CA
January 22, 2016 The Lee Accountancy Group, Inc. 369 13th Street Oakland, CA 94612-2636 Client, Dear : The Tax Organizer will assist you in collecting and reporting information necessary for us to properly
SCHOLARSHIP APPLICATION
EDUCATIONAL SCHOLARSHIPS FOR CHILDREN OF VIRGINIA S SERIOUSLY INJURED WORKERS Kids Chance of Virginia 12701 Marblestone Drive, Suite 250, Woodbridge, VA 22192 Telephone: 703.586.6300 1. Student s Name:
Evans & Woulfe Accounting, Inc.
Your Income: Wages on W-2 forms and Form 1095A (Health Insurance Marketplace Statement) and proof of Health Insurance coverage or applicable 1095B or 1095C. Interest Income Statements on Form 1099-INT
JOYNER, KIRKHAM, KEEL & ROBERTSON, P.C INDIVIDUAL TAX ORGANIZER
Please provide a copy of your 2017 federal and state tax returns, and complete pages 1 through 3. Other pages: complete only those sections that apply to you. Taxpayer Name SS# Occupation Birth Date Spouse
Budgets and Cash Flows
Select Portfolio Management, Inc 26800 Aliso Viejo Parkway Suite 150 Aliso Viejo, CA 92656 949-975-7900 800-445-9822 info@selectportfolio.com www.selectportfolio.com Budgets and Cash Flows Page 1 of 9,
Name: Date of birth: Social Security #: Relationship: Months lived in home:
Peter Morales Tax Service Tax Organizer Tax Organizer Form This form will help you to organize your tax information. Please print it out, complete as much of it as you can and bring it with you when you
Steps to Complete your 2013 Tax Return: Step 1:
Steps to Complete your 2013 Tax Return: Step 1: Step 2: Compile all business related income and expenses for 2013. Please list cash expenses on page 6 unless you already gave us ALL cash expense records
The Wise Wealth Planning Workshop Questionnaire
The Wise Wealth Planning Workshop Questionnaire The Wise Wealth Planning Program Instructions After completion of form, click the submit button to e-mail data to Savant or print off a copy and mail it
ALL COUNTS CONFERENCE INCOME AND EXPENSE STATEMENT. You must provide your recent tax return and W-2 form at the time of your All Counts Conference.
ALL COUNTS CONFERENCE INCOME AND EXPENSE STATEMENT You must provide your recent tax return and W-2 form at the time of your All Counts Conference. Name Address Telephone Date Social Security Income Employer
«Current_Date_Plus_1» «Mailing_Address_1» «Mailing_Address_2» «Mailing_Address_3» «Mailing_Address_4» «Mailing_Address_5» «Mailing_Address_6»
«Mailing_Address_1» «Mailing_Address_2» «Mailing_Address_3» «Mailing_Address_4» «Mailing_Address_5» «Mailing_Address_6» «Current_Date_Plus_1» RE: People s United Bank, N.A. Loan «Account_Number_2» Dear
DETAILED FINANCIAL DISCLOSURE FORM INSTRUCTIONS SHEET. v. Case Number
DETAILED FINANCIAL DISCLOSURE FORM INSTRUCTIONS SHEET v. Case Number Pages through 4, 5 through 6 and 7 through 0 are mandatory. Please fill out the number of pages used, if any, for the remaining supplemental
Steps to Successful Money Management
Steps to Successful Money Management How you spend your money today determines what you have 6 months from now, a year from now, 5 years from now, or in your lifetime. You control your financial destiny.
Case Information Statement - Client Intake Form.
Case Information ment - If you have a question about this form, please contact your attorney's office. PART A - CASE INFORMATION Your Attorney s Information Attorney's Name Address DeTorres & DeGeorge,
Form 13.1: Financial Statement (Property and Support Claims) sworn/affirmed
ONTARIO Court File Number at (Name of court) (Court office address) Form 13.1: Financial Statement (Property and sworn/affirmed Applicant(s) Full legal name & address for service street & number, municipality,
CUSTOMER AUTHORIZATION TO DISCLOSE ACCOUNT INFORMATION
CUSTOMER AUTHORIZATION TO DISCLOSE ACCOUNT INFORMATION The undersigned hereby authorizes the following individual to obtain, review and/or discuss the undersigned s financial account information with First
In the District Court of County, Utah. Court Address
My Name This is a private record. Address City, State, Zip Phone Email I am the In the District Court of County, Utah Court Address Financial Declaration v. Case Number Judge Commissioner Instructions:
SUPERIOR COURT OF ARIZONA MOHAVE COUNTY
FOR CLERK S USE ONLY Name of Person Filing: Mailing Address: City, State, Zip Code: Daytime Phone Number: Evening Phone Number: ATLAS Number (if applicable): Attorney Bar Number (if applicable): Representing:
Spectrum Financial Resources Inc. FINANCIAL Ventura Boulevard # T RESOURCES Sherman Oaks, CA
SPECTRUM Spectrum Financial Resources Inc. FINANCIAL 15021 Ventura Boulevard #341 310.963.4322 T RESOURCES Sherman Oaks, CA 91403 805.267.4134 F www.spectrum-cpa.com Tax Return Questionnaire - 2018 Tax
INSTRUCTIONS PART I: INCOME
at ONTARIO Superior Court of Justice Family Court Branch (Name of court) (Court office address) Court File Number Form 13.1: Financial Statement (Property and sworn/affirmed Applicant(s) Full legal name
Form 13: Financial Statement (Support Claims) sworn/affirmed
ONTARIO Court File Number at (Name of Court) Court office address Form : Financial Statement sworn/affirmed Applicant(s) Full legal name & address for service street & number, municipality, postal code,
Client Questionnaire Section 1 - Basic Information
Client Questionnaire Section 1 - Basic Information Part A. Name and Address Name: Have you used any other names in the past eight years? No Yes If yes, please list other names used: Telephone Numbers\Email
TAX ORGANIZER Page 3
TAX ORGANIZER Page Basic Taxpayer Information Taxpayer Spouse Taxpayer Spouse First Name Initial Last Name Social Security No. Check if Date of Occupation Dependent Presidential Birth Disabled Blind of
Brangham & Associates, Inc. Certified Public Accountant Accounting Taxes Consulting QuickBooks Training and Consulting
Brangham & Associates, Inc. Certified Public Accountant Accounting Taxes Consulting QuickBooks Training and Consulting 2017 Tax Document Checklist for Individuals We strongly encourage you to review and
nb Navigator Your Guide to Financial Success
nb Navigator Your Guide to Financial Success National Best is proud to deliver innovative concepts and strategies to our valued clients through referrals to our Network of licensed, qualified Insurance
NEWARK-FREMONT LEGAL CENTER BANKRUPTCY WORKSHEET
NEWARK-FREMONT LEGAL CENTER BANKRUPTCY WORKSHEET Complete the form below and then call our office for an appointment. 794-LAWS Please Print Clearly! DEBTOR JOINT DEBTOR Full Name Street Address Mailing
Evaluating Jobs Based on Wage
Evaluating Jobs Based on Wage Objectives In this lesson you will: learn how to evaluate a job based on wages learn about income, expenses, and net cash flow calculate your acceptable wage range based on
DISTRICT COURT FAMILY DIVISION CLARK COUNTY, NEVADA. Plaintiff, ) CASE NO. xxxxx PLAINTIFF S FIRST REQUEST FOR PRODUCTION OF DOCUMENTS
0 0 RFP Plaintiff name Address Phone Plaintiff in Proper Person DISTRICT COURT FAMILY DIVISION CLARK COUNTY, NEVADA xxxxx, ) Plaintiff, ) CASE NO. xxxxx Vs. ) DEPT.NO. x xxxxx, ) Defendant ) PLAINTIFF
Uniform Support Affidavit Instructions for Form 6F
Uniform Support Affidavit Instructions for Form 6F The Uniform Support Affidavit must be completed when the payment of child support is an issue. It provides basic information about expenses and ability
INDIVIDUAL TAX ORGANIZER LETTER (FORM 1040)
INDIVIDUAL TAX LETTER If we did not prepare your prior year returns, provide a copy of federal and state returns for the three previous years. Complete pages 1 through 4 and all applicable sections. Taxpayer
Understanding Actively Managed Exchange Traded Funds
Understanding Actively Managed Exchange Traded Funds With so many investors and their advisors questioning traditional market thinking about indexbased investing, exchange traded funds (ETFs) are starting
Financial Fitness Planner
Financial Fitness Planner The Financial Fitness Planner is a guide to help you take control of your finances. It will help you to monitor your cash flow. A sound spending and savings plan is the foundation
Form 72J APPENDIX OF FORMS FORM 72J FINANCIAL STATEMENT (FORM 72J) (Court, Court File Number, Style of Proceeding) FINANCIAL STATEMENT (FORM 72J)
APPENDIX OF FORMS FORM 72J FINANCIAL STATEMENT (FORM 72J) (Court, Court File Number, Style of Proceeding) FINANCIAL STATEMENT (FORM 72J) Financial statement of: I hereby make oath (or solemn affirmation)
What Does It Mean To File For Personal Bankruptcy?
Thank you for contacting our office to ask about personal bankruptcy. The following are some answers to many of the questions people have about the process of bankruptcy. Bankruptcy is complex and the
Short Sale Required Documents
Short Sale Required Documents Letter of Authorization Hardship Letter Tax records for previous 2 years 2 months current bank statement for all accounts 2 most recent pay stubs Financial Worksheet Authorization
P. J. FRANKLIN ATTORNEY AT LAW
P. J. FRANKLIN ATTORNEY AT LAW 7322 S. W. FREEWAY STE. 700 HOUSTON, TX 77074 Telephone: (713) 414-3066 Fax: (713) 414-3067 E-Mail: pjf@pjfranklin.com Website:www.pjfranklin.com BANKRUPTCY QUESTIONAIRE
What are your three most important financial goals? What are your three most important personal goals? GOALS
GOALS What are your three most important financial goals? Client: Spouse: A. A. B. B. C. C. What are your three most important personal goals? Client: Spouse: A. A. B. B. C. C. What would you like for
IN THE CIRCUIT COURT FOR THE SECOND JUDICIAL CIRCUIT COUNTY, ILLINOIS. Pre-Judgment Post-Judgment I. INTRODUCTION
IN THE CIRCUIT COURT FOR THE SECOND JUDICIAL CIRCUIT COUNTY, ILLINOIS IN RE THE MARRIAGE OF: ) ), ) ) Petitioner, ) and ) No. ), ) ) Respondent. ) FINANCIAL AFFIDAVIT Pre-Judgment Post-Judgment I. INTRODUCTION
Personal Legal Plans Client Organizer 2018
TAXPAYER NAME SOCIAL SECURITY NUMBER OCCUPATION DATE OF BIRTH EMAIL ADDRESS CELL PHONE SPOUSE Address: Home Phone: City: State: Zip: County: DEPENDENT CHILDREN & OTHER DEPENDENTS NAME SOCIAL SECURITY NUMBER