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May 18th 2012

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Type of Injury

Who is the injured party?
What is the extent of vehicle damage?

Name of Employer
Job Title
Was the injury reported?
Have you received medical treatment?

Total Monthly Expenses?

Why are you considering bankruptcy?

Garnishment

Creditor Harassment

Repossession

Foreclosure

Lawsuit

Illness/Disability

License Suspension

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What are your monthly bills?

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Who is the accused party?

Have charges been pressed?
What are the accusations / charges?
Can you Afford Legal Fees?

Do you have any prior DUI/DWI\'s?
Are you wanting to challenge your license suspension?
Reason you need your license?
Can you afford legal fees?

Type of Injury?
Who is the injured party?

What was the cause of the injury?

Are you attempting to reconcile?
Can you Afford Legal Fees?

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What is your spouses annual income?

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