Name
Name of Spouse
Address
Length at address
How long have you lived in Nevada?
Do you own your home?	No Yes
Are you in foreclosure?	No Yes
Contact Information
Cell Phone
Home
Work
E-Mail address
Marital Status	Married Single	Seperated Divorced
Income and Employment.  NOTE: IF YOU ARE MARRIED, YOU MUST ENTER YOUR SPOUSE'S INFORMATION ALSO, REGARDLESS OF WHETHER OR NOT THEY ARE FILING.
Employer
Spouse
Occupation
Spouse
Dates of Employment
Spouse
How much do you earn per hour?
Spouse?
How many hours do you work per week?
Spouse?
How many hours of overtime per week?
Spouse?
Overtime rate? (ex. time and a half)
Spouse?
Average estimate of tips per shift.
Spouse?
Average shifts per week?
Spouse?
Average monthly commission (if applicable).
Spouse?
Annual Salary (if on salary)
Spouse?
Social Security Income
Spouse?
Pension Income
Spouse?
Child Support Income
Spouse?
Spousal Support Income
Spouse?
Disability Income
Spouse?
Year to date income
Year to date income (spouse)
TOTAL OF ALL YEARLY INCOME
Do you own a business?		No Yes
If yes, what are the MONTHLY gross receipts of the business before any deductions?
What are the approximate total MONTHLY business expenses?
Have you paid a family member any money in the past year (excluding support)?		No Yes
Have you made any credit card purchases over $200 on any credit card in the past three months?		No Yes
Have you taken any cash advances in the past three months?		No Yes
Have you made any balance transfers on any credit card in the past 3 months?		No Yes
Have you set up a trust in the past 10 years?		No Yes
Do you owe any past STATE income taxes?		No Yes
Do you receive any income from a trust or annuity?		No Yes
Have you filed bankruptcy in the past 8 years?		No Yes
	If yes,what chapter?
How many people are in your household?		1 2 3 4 5+
Do you own a timeshare or other investment property?		No Yes
Do you have any stocks or bonds that aren't part of a retirement plan?		No Yes
Please tell us how much debt you have in each of the following categories.
	Credit Cards
	Medical Bills
	Reposessions
	Payday Loans
	Foreclosures
	Student Loans
	IRS (please include year)
Please tell us your monthly average that you owe on the following living expenses.
Rent/Mortgage
Child Care
Child Support/Alimony
Homeowner Association Dues
Vehicle # 1 Payment
Vehicle # 1 Insurance
Vehicle # 1 Gas
Vehicle # 2 Payment
Vehicle # 2 Insurance
Vehicle # 2 Gas
Electricity
Gas
Water
Phone
Trash
Sewer
Cell Phone
Cable
Internet
Home Security
Charity (church, etc.)
Is there anything else you think your attorneys should be made aware of?
Thank you! This will greatly reduce your wait time in the future.