Office: 407 E Main St, Suite 1, Port Jefferson, NY 11777 | Email:
Michael E Walter, ESQ.
Call Us Today for a Free Consultation

Qualification for Bankruptcy in Suffolk County and Surrounding Areas

Before making an appointment, please fill out and submit this form and we will call you within 24 hours. Thank you!
Bankruptcy Telephone Interview
To Determine if Caller Qualifies for Bankruptcy:
1. Full Name:
Referred By:
Phone #:
2. Number of people living with and supported by Debtor:
3. Is Debtor married:
 Yes  No 
a) If yes, is spouse also filing:
 Yes  No 
4. Income:
Exclude all Social Security Income
Choose family size and the approximate annual income
1 person
 less than 49,086  less than 59,000  more than 59,000 
2 people
 less than 62,451  less than 72,000  more than 72,000 
3 people
 less than 72,074  less than 82,000  more than 82,000 
4 people
 less than 88,747  less than 99,000  more than 99,000 
5 people
 less than 91,000  less than 101,000  more than 101,00 
5. Do you get pay stubs or pay checks?
 Yes  No 
Does debtor's spouse get pay stubs?
 Yes  No 
IF Yes - we will need to see all pay stubs or pay checks for the 2 calendar months prior to the filing month for each person filing and the last pay stub for the month prior to filing for a non filing spouse.
6. Does Debtor have a Social Security card?
 Yes  No 
7. Does Debtor have a driver's license?
 Yes  No 
8. Has debtor filed tax returns for the last four years?
 Yes  No 
9. Does Debtor own a home?
 Yes  No 
10. What is the value of the home(s)?
11. What is the total amount owed on the mortgages combined including home equity loans?
12. Vehicle 1 (Year
Value $
Amount owed
Vehicle 2 (Year
Value $
Amount owed
13. Unsecured Debt
Total credit card debt $
Medical debt $
Personal loans $
Student loans $
(non dischargeable)
Utilities (outstanding) $
Judgments $