OTC OFFICE (MAIN) NORTH OFFICE

6635 S. Dayton St. 11178 Huron St.

Suite 320 Suite 7
Greenwood Village, CO 80111 Northglenn, CO 80234

Phone 303-759-0728
Fax 888-475-3044
matt@mccunelegal.com
www.mccunelegal.com

We look forward to assisting you in moving past these difficult financial times. Our
federal bankruptcy laws allow for a "FRESH START" and it is our goal to help you
achieve that "FRESH STARr with a minimal amount of stress. Please feel free to call
or email with questions as you work through this packet but it is very important you have
completed the packet and we have all required items when you turn in your paperwork.
It is extremely important that all information that you provide is complete,
accurate and truthful! We appreciate your business!

Page 2 of this packet is a list of all required documentation to be turned in with your
completed packet.

I recommend you scan and email all of the required documents and the completed
worksheet. If you are unable to scan, mailing the packet is the preferred method. You
can always drop your packet at one of our office during normal business hours.

Processing paperwork usually takes 1 - 2 weeks. We will then schedule an

appointment (phone, video or in person) to meet with you and review all your paperwork
so we can get your case filed and get you moving forward with your "FRESH START!"

Again, please feel free to call with questions. We are here to assist you in this process!

Matt McCune
Attorney at Law

1
 Paperwork to Turn in With Application

1. ALL pay stubs or proof of other income (Social Security/pension/etc) for the.past
en
7 months you are self-employed we will need a "profit and loss statement for

each month).

2. Copies of your federal and state tax returns for the past 2 years.

3. Most recent statements/bills/notices/etc. for ALL outstanding debts you have (this
includes mortgages, HOA, cars, student loans, etc.).

4. Any letters you have from attorneys / debt collection companies.

5. A certificate of counseling for "pre-bankruptcy counseling." Available online at

www.cricketdebt.com or call 866-719-0400. (Use Attorney Code 449858)
*YOU ARE NOT ELIGIBLE TO FILE BANKRUPTCY WITHOUT THIS*

6. The required upfront fees must be paid before your case can be filed.

7. Copies of your most recent bank statements (two months).

8. Most recent statement for any account, such as 401k, IRA, CD's, Pension,
Investment account, Education, Health Savings Account, Life Insurance with a
Cash Surrender Value, etc.

9. Copy of the title for any vehicle you own free of any lien.

10. For every Car, Motorcycle, ATV, boat, snow mobile, or any major asset, we need
a valuation. For cars, you can go to www.KBB .com and print out, but for other
things you will want to detail how you arrived at the value.

11.Any Court Paperwork, Divorce Decree(s), Permanent Orders, Writs of

Garnishments, Foreclosure, Personal Injury, whether filed against you or by you.
(If you are being garnished provide contact info (name/phone/email/fax) for your
Human Resources Dept. so we can stop garnishment upon filing.)

12.Copy of most recent real estate tax assessment valuation for any home you own.

13.Copy of Driver's License AND Social Security Card (or W2)

I
Other names you have been known by in the past 8 years

Date of birth O\ / L\ / \ C\7

ci C\ ~\ W · L o t : ) ~ \ · \?s:p\:: ·
Street Address

CityLi\\\£' TO\'\ State 00 Zip Code ?:() \ 0

County t:\:C CLy=?OS'\O-e__
Social Security Numberb 7 \ -5 -'L\.C\S \
Email address \\-=::, 0- 0 \ ~L\~0\7 @ ~ \ \ • CDN':':)
loDd'\') C\c;B-C\~C\lo
Phone number (C) (H) _ _ _ _ _ _ __

MARITAL STATUS: \ >--DN:::)OJT\ e_d

0

SPOUSE NAME (if filing a joint bankruptcy):

Full legal name _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

Other names you have been known by in the past 8 years

Date of birth
---
/
- - / ___
Street Address
--------------------
City _ _ _ _ _ _ _ State _ _ _ _ _ _ Zip Code
-----
County _ _ _ _ __

Social Security Number - - -

Email address
-------------------
Phone number (C) _ _ _ _ _ _ _ _ _(H) _ _ _ _ _ _ _ __

3
MAILING ADDRESS (if different from street address):

HAVE YOU LIVED AT ANY OTHER ADDRESSES IN THE LAST 3 YEARS? uO

Address._ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Dates I--

Address._ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Dates I--

HAVE YOU EVER FILED FOR BANKRUPTCY BEFORE? ® NO

When was case filed? \ ) DV • D\ °'

Chapter? I State?_G
= -.:o"""'--- - - - - D , ~ \'\)\ s ~ e o\
HOW LONG HAVE YOU LIVED IN COLORADO? ½ " IC
DEPENDENTS:

NAME AGE RELATIONSHIP

occuPAT10N: S':i::) o(" \-- ~9),e 2'n <ie f"\ 0r,-\-{:__,r

< \

Name of employer'\=", D 0.D~e,_, o.Q ~""~ C.~ how long 3 )\ t=::?

EmployerStreetAddress 3CU \0R\n ~ Re) .g\c\~ 5

City HDCDbQS:{)State PB Zip Code \C\OLB

Approx annual GROSS income (before taxes/deductions) $ (?fv I CX)()/ per year
Any other sources of income (give amount)._,\.;)
'--"""'-D
""--"<-- - - - - - - - - - -

SPOUSE OCCUPATION (if married):. _ _ _ _ _ _ _ _ _ _ _ _ __

Name of employer _ _ _ _ _ _ _ _ _ _ _for how long,_ _ _ _ __

4
Employer Street Address;_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

City _ _ _ _ _ _ _ _ State _ _ _ _ _ _ _ Zip Code _ _ _ _ _ __

Approx annual GROSS income (before taxes/deductions) $_ _ _ _ _--'/ per year

Any other sources of income (give amount)_ _ _ _ _ _ _ _ _ _ _ _ _ __

Have you (or your spouse) been in business by yourself in the last 4 years?

If yes, give dates, nature of business, name of business, address and EIN:

ARE YOU BUYING A HOME? (YES @

Address: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

Date of purchase_ _ _ _ _ _ Approx CURRENT market value $._ _ _ _ __

1st Mortgage _ _ _ _ _ _ _ _ _ _TOTAL OWED$._ _ _ _ _ _ __

_ _ _ _%
MONTHLY PAYMENT$_ _ _ _ __ INTEREST RATE

2nd Mortgage _ _ _ _ _ _ _ _ _ _TOTAL OWED$._ _ _ _ _ _ __

INTEREST RATE
_ _ _ _%
MONTHLY PAYMENT$_ _ _ _ _ __

Are you behind on your home? _ _ _ If yes, how many months? _ _

Do you want to keep your home? _ _ _ _ _ _ _ _ _ _ __

Is there a Scheduled Foreclosure Sale Date? If Yes, When ---------

Do you have an HOA on this property (Yes/ No)

If you do owe an HOA on your home, how much per month? $

(please include a payment coupon for HOA) ------

5
DO YOU OWN ANY OTHER REAL PROPERTY? ( YES
(Examples of other REAL PROPERTY would include homes,~. land, rental
property, timeshares)

HOW MANY VEHICLES DO YOU OWN?

------------
(List all automobiles, trucks, trailers, mobile homes, RV's, campers, motorcycles, ATV's,
snowmobiles, boats, etc.)

1. YEAR ~Q\<t$ MAKE ~ MODEL \$ c:x:)

MILES 5lo , DOU
LENDER (if financed)} i ('v:\\:t,y e s\1pfuRcHASE DATE----

TOTAL OWED 2£\.'t:>\-\'O MONTHLY PAYMENT

I
/

INTEREST RATE% \::d ,'5 °lo

ARE YOU BEHIND ON PAYMENTS? @Y NO

Estimated Blue Book Value $_ _ _ __

Do you want to keep this vehicle? YES / NO

2. YEAR @o \7. MAKE Coo- ClD::) MODEL ti:\ O.\J erfc,.,,\::_

MILES
--- ~ - -\.A)
- {:,<c,-\- ~ ~Q
LENDER (if financed) ('IT\ ,\ AD\c::'.f::\ PURCHASE DATE _ _ __

TOTAL OWED 'a, C\ ~L\ S

I
MONTHLY PAYMENT
- - - - -

INTEREST RATE%._ _ _ _ _ __

ARE YOU BEHIND ON PAYMENTS?G ) NO

6
 Estimated Blue Book Value $_ _ _ __

Do you want to keep this vehicle? YES / NO

_ _ _MAKE_ _ _ _ _ _ _MODEL'--_ _ _ __
3. d) YEAR_

~ e < MILES

LENDER (if financed),_°N

.i..;::::.)+ -'-
f .\..l....-_ _ _PURCHASE DATE _ _ __

TOTAL OWED_ _ _ __ MONTHLY PAYMENT_ _ _ __

INTEREST RATE%_ _ _ _ _ __

ARE YOU BEHIND ON PAYMENTS? YES / NO

Estimated Blue Book Value $_ _ _ __

Do you want to keep this vehicle? YES / NO

4. YEAR 8 oo MAKE CDD -t\-m MODEL f f i O . v e s fc__,'(__

MILES
~we_o-\--
LENDER (if financed) fe OR@ C'JJ PURCHASE DATE _ _ __

TOTAL OWED -9~ i MONTHLY PAYMENT_ _ _ __

INTEREST RATE% _ _ _ _ _ __

ARE YOU BEHIND ON PAYMENTS? ~ NO

Estimated Blue Book Value $_ _ _ __

Do you want to keep this vehicle? YES / NO

DO YOU HAVE ANY OPEN FINANCIAL ACCOUNTS, @/ NO

(Checking accounts, savings accounts, credit union accounts, brokerage accounts, etc.)

7
1. BankName \ } . J f \ y b Y Q ~ Q C'k:Aj ·
Type of account

~.
Balance $ _ _ _ _ _ Do you owe this institution any money? e_y . . o '-..J...U L;\

2. Bank Name _ _ _ _ _ _ _ _ _ _ _ Type of account _ _ _ __

Balance $ _ _ _ _ _ Do you owe this institution any money? YES / NO

3. Bank Name _ _ _ _ _ _ _ _ _ _ _ Type of account _ _ _ __

Balance $ _ _ _ _ _ Do you owe this institution any money? YES / NO

4. Bank Name _ _ _ _ _ _ _ _ _ _ _ Type of account _ _ _ __

Balance $ _ _ _ _ _ Do you owe this institution any money? YES / NO

DO YOU HAVE ANY SECURITY DEPOSIT WITH A LANDLORD? YES/ NO

""1)~e,\¼:_ n r- -
Name 'S:2s::ili1 D Amount being held $ o'-- W CD
DO YOU HAVE A LIFE INSURANCE POLICY? ~ / NO ~n:::U..J~:i', lc()r'C...--
1. Name'ov\D\.=,&-e- Typeofpolicy _ _ _ __

If WHOLE LIFE INSURANCE POLICY, Cash Surrender Value: $_ _ _ __

2. Name _ _ _ _ _ _ _ _ _ _ _ _ _ Type of policy _ _ _ _ __

If WHOLE LIFE INSURANCE POLICY, Cash Surrender Value: $- - - - -

DO YOU HAVE ANY ANNUITIES? YES 1(8)

Name of Insurer: _ _ _ _ _ _ _ _ _ _ _ _ _ Value:$_ _ __

DO YOU HAVE A RETIREMENT ACCOUNe lRA/403b/Pension)? NO

1. Account holder: Ex:'f'iy> O u...):R., C Value $ 7 \0 7 "C\ \

8
 2. Account holder: _ _ _ _ _ _ _ _ _ _ _ Value$ _ _ _ _ __

3. Account holder: _ _ _ _ _ _ _ _ _ _ _ Value$ _ _ _ _ __

Are there any loans against your retirement account? YEs @

DO YOU HAVE ANY OTHER STOCKS, BONDS or MUTUAL FUNDS? YES @ )

Name of stock/bond/fund:
- - - - - - - -Value$- - - - - -
DO YOU HAVE ANY OTHER INTEREST IN A BUSINESS OR CORPORATION? Y

Name of business:
---------- Value $
·------

Beginning and ending dates

---------------
DOES ANYONE OWE YOU ANY MONEY? YES 1@
Name:
- - - - - - - - - - - - - Amount owed $ - - - -
Address
---------------------
DO YOU RECEIVE ANY CHILD SUPPORT/ALIMONY/SUPPORT? YES ®

Name: - - - - - - - - - - - - - Amount $ - - - - -/month

ARE YOU EXPECTING A TAX REFUND? YES ®

Date expected to receive:

- - - - - - - Amount $ - - - - -
DO YOU HAVE ANY LEGAL CLAIMS AGAINST ANYONE? YES ®
(such as personal injury, worker's compensation, harassment, etc.)

Provide details on claim _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

*FAILURE TO LIST ANY POTENTIAL LEGAL CLAIM AS AN ASSET ON YOUR

BANKRUPTCY WILL RESULT IN YOU LOSING THE RIGHT TO ASSERT IT.*

9
ARE YOU EXPECTING (or have you received} AN INHERITANCE? VES S

Provide details on inheritance

------------------

DO YOU HAVE ANY PATENTS/COPYRIGHTS/LICENSES? YES @

Provide details
---------------------
DO YOU HAVE ANY OF THE FOLLOWING?
(If yes, CIRCLE and provide details/value)

BOATs, AIRCRAFT _w
~
. -=----=o= - - - - - - - - - - - - - - - - -
OFFICE EQUIPMENT/SUPPLIES _;C
L......!..----=--
T)\ ....:: V:::::...._Q_,,
=--· _ _ _ _ _ _ _ _ __

TOOLS/MACHINERY USED IN BUSINESS -----=-

~.. .:"\
: :~Q
=-- - - - - - - - -

ANIMALS OR CROPS._
3_,_,~) .O
...:;__(ts
-+-_,,..__- - - - - - - - - - - - -

FARM EQUIPMENT/SUPPLIES _D
l-=-....,.,0""--- - - - - - - - - - - -
SEASON TICKETS_....1
D-=-O~ ---------------

HOUSEHOLD GOODS: Please indicate the value of the following items in your
possession by estimating the value as if it were to be sold at a garage sale:
ITEM VALUE

Bedroom set ~S-cc:>

Furniture ~SOC)
Dining set/ Table service/ Pots and pans ~'DCC)
Washer/ Dryer <&~
Stereo I Electronics

Computer, Phone -~ L\CYJ

10
 Vacuum
~8-..0
Refrigerator I Freezer

Dishwasher

Stove I Microwave

Art objects

Books, Music library, Video library

TV(s)
E$>soo
Bicycle(s)

Sporting goods

Clothing
~600
Jewelry

Guns

Camera equipment

Other household goods

DO YOU OWN ANY OTHER ASSET THAT WAS NOT LISTED? YES ®

(If yes, please give description and values on separate paper at end of this worksheet.)

DEBTS

PLEASE PROVIDE THE MOST RECENT STATEMENT FOR ALL BILLS

ARE YOU FINANCING ANY OF THE ABOVE HOUSEHOLD ITEMS? YES/ NO

(This is typically Furniture Row/American Furniture Warehouse/Dell/Conns)

---------- Personal Item -----------

Creditor

HOW MUCH IN TOTAL CREDIT CARD DEBT DO YOU OWE?$ 5 (Q L\7 °1

1

Date last used: _ _ _ _ _ _ Total charged in last 90 days:

I
0
11
HOW MUCH IN TOTAL MEDICAUDENTAUHOSPITAL BILLS?$ 7 \L\_
HOW MUCH IN TOTAL PAYDAY LOANS?$ \ Date Last Taken :_ _

HOW MUCH IN PERSONAUSIGNATURE/OVERDRAFT LOANS?----1N~ \.. 1,.i.

,.H_i...__

Last Use?_ __

HOW MUCH IN STUDENT LOANS? 6;\, (:t, dl Q '.K

DO YOU OWE ANY TAXES?~ O

Years _ _ _ _ _ _ _ _ Amount _ _ __ _ _ __ _ ~ r Colorado

Years _ _ _ _ _ _ _ _ Amount _ __ __ __ _ _ IRS or Colorado

DO YOU OWE ANYONE WAGES OR SALARY? YES @

If yes, provide details _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ __

DO YOU OWE ANY DOMESTIC SUPPORT OB~TION (ALIMONY,

MAINTENANCE OR CHILD SUPPORT)? YES ~

If yes, provide the last known name and address of the holder of the support obligation:
Name

Address

Telephone No.

Is there an agency governing collection of the domestic support obligation? Yes/ No

If yes, give name and address:

ANY CO-SIGNERS OR CO-DEBTORS ON ANY OF YOUR DEBTS? ~ / NO

12
If yes, which debt is this person listed on? ~ \ J l uC?5:::::>-\ Fe (\p_f~
Name of person Y:?c-e f::sY 'S::f:\Q('\\S=()D
Address _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ __

City _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ State W Zip _ __

What is your relationship to this person? \:')C2L'lE' Of\\~ \o\\~es-

ARE AT LEAST½ ~ OUR DEBTS RELATED TO THE OPERATION OF A
BUSINESS? YES/~

ARE THERE ANY OTHER DEBTS NOT LISTED ABOVE? YES @

If yes, provide details:._ _ _ _ _ _ _ _ _ _ __ _ _ _ _ __ _

FINANCIAL AFFAIRS

IN THE PAST ~ YS HAVE YOU PAID ANY ONE CREDITOR MORE THAN $600
TOTAL? YESZ:V

Creditor _ _ _ _ _ Monthly payment$._ _ _ _ Total paid in 90 days $ _ _

Creditor _ _ _ _ _ Monthly payment$_ _ _ _ Total paid in 90 days $ _ _

IN THE PAST YEAR HAVE YOU PAID ANY MONE~ FAMILY, FRIENDS,
RELATIVES OR BUSINESS ASSOCIATES? YES I ~

Name _ _ _ _ _ _ _ _ _ Relation _ _ _ __

Address _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

Amount paid$ _ _ _ _ _ Date of last payment _ _ __

IN THE PAST YEAR HAVE YOU BEEN SUED OR INVOLVED IN A LAWSUIT OR

°'\
ARE YOU BEING SUED NOW? YES / NO
~e.. - s ~~~\c\ 13

s D..,,\_ cs
ff yes, be sure to provide the attorney with copies of the legal paperwork ("summons" or
compfainr)

IN THE PAST YEAR HAVEA U BEEN GARNISHED OR ARE YOU BEING

GARNISHED NOW? YES ~

Creditor _ _ _ _ _ _ Dates and amounts of garnishment _ _ _ _ _ __

*** Provide a copy of the "Writ of Garnishment" and contact information for your Human
Resources Department (phone/fax/email)***

IN THE PAST YEAR HAVE YOU HAD ANY PROPERTY REPOSSESSED BY A

CREDITOR, SOLD AT A FORECLOSURE SALE, TRANSFERRED THR<JU~H A
DEED IN LIEU OF FORECLOSURE OR RETURNED TO A CREDITOR~ / NO
ff yes, provide details (date/copies of paperwork) c'.2C};D S?-o.ro \
S:::U.C L ·-

yS::0\2S c\ e c:\ \?a,,1?£ n 1,)0t\c

IN THE PAST YEAR HAVE YOU HAD OR DO YOU CURRENTLY HAVE ANY
PROPERTY UNDER CONTROL OF A C~DIAN, RECEIVER OR
COURT-APPOINTED OFFICIAL? YES ~
ff yes, provide details _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _

LIST ALL GIFTS OR CHARITABLE CONTRIBUTIONS YOU HAVE MADE IN THE

PAST ONE YEAR: (provide name/address)_ _ _ _ _ _ _ _ _ _ _ __

HAVE YOU HAD ANY LOSSES FROM F ~ THEFT, GAMBLING OR OTHER

CASUAL TY IN THE PAST YEAR? YES NO
If yes, provide details (date/ value of asset

HAVE YOU CONSULTED WITH ANY DEBT COUNSELING AGENCY OR ~ R

LEGAL OFFICE CONCERNING YOUR DEBT IN THE PAST YEAR? YES /~
Name _ _ _ _ _ _ _ _ _ _ _ _ _ _ Amount paid$_ _ _ __

14
LIST ALL PROPERTY THAT YOU HAVE TRANSFERRED EITHER ABSOLUTELY
OR AS SECURITY IN THE PAST TWO YEARS (Ex: cars, household items, etc.):
(provide dates and value received) _ _ _ _ _ _ _ _ _ _ _ _ __

LIST ALL FINANCIAL ACCOUNTS THAT HAVE BEEN CLOSED, SOLD OR

TRANSFERRED IN THE PAST YEAR: (list date closed and amount account at closing)

HAVE YOU HAD A SAFE DEPOSIT BOX IN THE PAST YEAR? YES ®
If yes, provide details _ _ _ _ __ __ _ __ _ _ _ _ _ __ _

HAVE ANY CREDITORS TAKEN ANY MONEY OUT OF YOUR BANK ACCOUNT IN
THE PAST 90 DAYS? YES/ NO
If yes, provide details (dates/amount/paperwork) _ _ _ _ _ _ __ _ __

LIST ALL PROPERTY OWNED BY SOMEONE ELSE THAT YOU HOLD OR

CONTROL:

DO YOU HAVE OR CONTROL ANY HAZARDOUS MATERIALS, TOXIC

SUBSTANCES OR OTHER SUCH POLLUTANTS? YES/~

HAVE YOU RECEIVED A RENTAL OR LEASE DEPOSIT FROM SO~ NE WHO 15

RENTING FROM YOU WHICH YOU HAVE NOT RETURNED? YES/~
If yes, provide details _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

ARE YOU PARTY TO ANY UNEXPIRED LEASE ON REAL OR PERSONAL

PROPERTY? YES / NO
OS'\\ ,_ ReD-\o..>. Le o,.,_se
If yes, provide details
J
HAVE YOU BEEN INVOLVED IN ANY CAR ACCIDENTS RECENTLY? YES @
If yes, provide details (dates/details) _ _ _ _ _ _ _ _ _ _ _ _ _ __

HAVE YOU EVER BEEN CONVICTED OF A FELONY? YES @

If yes, provide details (dates/details) _ _ _ _ _ _ _ _ _ _ __ __ _

15
ARE THERE PEND~ PROCEEDINGS WHERE YOU COULD BE CONVICTED OF
A FELONY? YES/ ~
If yes, provide details (dates/details) _ _ _ _ _ _ _ _ _ _ _ _ __

AVERAGE MONTHLY EXPENSES

TAKE EXTRA TIME ON THIS SECTION!
WE NEED TO KNOW ABOUT ALL EXPENSE CATEGORIES

RENT $ ~~CJ.-)
FIRST MORTGAGE $
SECOND MORTGAGE $
THIRD MORTGAGE $
HOA $
LOT RENT $
ELECTRICITY / HEATING FUEL $ d--00
WATER $
CELL PHONES $ \\S
HOME PHONE $
INTERNET $ \00
TELEVISION $ \CSO
'V~o~o\ (wi,~(~\e)
-
$ L\DO

~\JeX \'cxrl $ 7~
FOOD $ 70D
CLOTHING $ ot:cJ
-{'\\ ~Groc.e__n e.s $ ?::,DQ
MEDICAL (OUT OF POCKET) $ , 895
DENTAL (OUT OF POCKET) $
TRANSPORTATION $ {QCO ·-\- \ CD \'(\C\\\'\-\- .
16
(GAS/MAINTENANCE/TOLLS)

CAR PAYMENT f7?;'d

CAR PAYMENT $
AUTO INSURANCE $ 8CSlo
RECREATION/ ENTERTAINMENT $ 3'50
LIFE INSURANCE $
HEALTH INSURANCE (NOT ALREADY $
DEDUCTED FROM WAGES)

OTHERINSURANCE $ 50
OTHER PAYMENTS $
ALIMONY, CHILD SUPPORT $
DAYCARE / BABYSITTER $
TUITION CHILDREN $
EDUCATION CHILDREN $
CHURCH $
CHARITY $
TAX PAYMENTS (NOT ALREADY $
DEDUCTED FROM WAGES)

GYM $

PET CARE $ L\C\

OTHER $

OTHER $

17
 COMPLETE THIS SHEET FOR ANY CREDITOR THAT YOU DO NOT HAVE A
RECENT BILL FOR (make copies if needed). IF YOU HAVE PROVIDED US A
RECENT BILL YOU DO NOT NEED TO COMPLETE A CREDITOR SHEET FOR
THAT CREDITOR.

*You must list every debt of any nature, even if this is an oral agreement with no written
contract, for property you wish to keep, or for a non-dischargeable debt. Don't leave
any debts out for any reason, no matter how small or even if you want to repay the debt.
We must have a complete mailing address to properly list the debt.*

CREDITOR SHEET

NAME ON ACCOUNT _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

CREDITOR NAME _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

CREDITOR ADDRESS _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

WHAT IS THE NATURE OF THIS DEBT? _ _ _ _ _ _ _ _ _ _ _ __

HOW MUCH DO YOU OWE? _ _ _ _ ACCOUNT NO. _ _ _ _ _ _ __

IF CREDIT CARD, DATE LAST USED (MONTH/YEAR) _ _ _ _ _ _ __

IF NOT A CREDIT CARD, WHEN DID THIS DEBT BEGIN? _ _ _ _ _ __

IF A SECURED DEBT, DESCRIBE COLLATERAL _ _ _ _ _ _ _ _ __

18
 USE THIS SPACE TO WRITE DOWN ANY ADDITIONAL INFORMATION YOU
WOULD LIKE THE ATTORNEY TO KNOW ABOUT REGARDING YOUR CASE:

ill\:) c\o__u_ ~ r : D bd T a9e__~a\ecl o.

b\ >- s,Qes s - ~e _coos ~\e ,o ~er
bD A) e0£§"' T- , w o___2 0, S\ ~t\e r " \0 e..,,
hC\d DD Q~lf £ID€bT 10\ Q C'Db§Clcicr
1Dbc2 C'\\c\d -\-- ~ ½\\ 'ti~ cb\\~@CX') ~
\_\€_ \';::, 'i::) CLO E Q \2f a..[

~C-ec,,:\::E-'D\D':) --\D ¼~ US-\ e>

C:D,,, x::::t• I l,t'.)Q.D-\- ·=s::o \\'\(\t\ 1- df> m\

u()S)~e 0 ~e e___,o,g-;y C'.'ON:>-E:
a~:±:es= b~e \ a::k:er .L drn:t :m,DL
t:'R 'I- \µQ__~ Cb\, j Q
C_f),D 9:2\f'\Cx
'vS~cer bu::k \:-x:\\-ec s o&-e___ ---\\~ eD
~ \\vo

19
 FEE AGREEMENT FOR LEGAL SERVICES

THIS AGREEMENT, dated c:Jid\8 between McCune Legal, and:

\':z?()_ j::5, 't:{:'\ ~'c>O\"')

Debtor

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (If joint filing)

Co-Debtor

Filing expenses incurred and included in the fee are as follows:

Credit Report: $ 35 - 55 0oint)

Bankruptcy Court Filing Fee: $ 335 (7)- $310 (13)
Ownership & Encumbrance Report (If real property owned): $5
Credit Counseling & Financial Management (pre and post) $44
Attorneys fee: AS QUOTED

The objective of the representation is to prepare and file either a Chapter 7 or Chapter
13 bankruptcy (additional fees for Chapter 13 to be paid through plan pursuant to US
Bankruptcy Court District of Colorado, Local Bankruptcy Rule 2016-3 - current
presumptive reasonable fee is $4,100).

Client may cancel representation at any time, at which time the firm will prepare a bill for
which client may be entitled to a refund, or have a balance to pay (attorney time to be
billed at $250/hour).

A $250 fee is added for any missed appointments, such as to sign your paperwork or for
your 341 Meeting of Creditors, in order to reschedule a new time. Amendments to
schedules and/or additional mailings, (i.e. addition of creditors), are not included in the
above stated attorneys fees. A minimum fee of $100.00 will be charged for amending a
petition. Chapter 7 Motions to Avoid Liens are not included in the above stated
attorney's fees. If Debtor(s) needs such motions filed, there is a fee of $200.00 for each
Transcript of Judgment needing an avoided.

Adversary proceedings and contested matters are not included in this agreement. If
Debtor(s) requires representation in an adversary proceeding and/or contested matter,
arrangements must be made with this office and a new fee agreement will need to be
executed.

20
Attorney may withdraw if client isn't truthful, is not complying with requests of this office
and/or the Court, is verbally abusive to any member of the staff or as allowed under the
Colorado Rules of Professional Conduct.

Failure to keep this office aware of contact information, phone and mailing address and
email address can result in an inability to represent you prompting a withdrawal of
representation.

This office may consult with another attorney on this case, to discuss case itself, as well
as for the possibility of having an attorney attend your 341 hearing if unavailable on that
date. Office may also hire outside counsel to assist in certain matters related to your
case.

In the event of a dispute, both parties agree to settle through binding arbitration.

All Firm Files Get Shredded Two Years after Bankruptcy Discharge.

CLIENT HEREBY CONSENTS TO THE FOLLOWING:

I understand the Bankruptcy Petition cannot be filed until all fees have been paid, until
ALL of the requested documents that are applicable to my case have been turned in
(notwithstanding the fact that I may have a pending garnishment, home foreclosure,
repossession, levy, etc.) and attorney must also be given sufficient time to analyze the
documents in order to prepare a bankruptcy.

I realize I will not get out of the following debts: student loans, child support / alimony
(including related costs and attorney fees), certain tax debts, criminal fines & restitution
(including criminal charges relating to bounced checks), debts for personal injury or
property damage done while driving intoxicated, debts incurred via fraud, HOA dues
owed after a bankruptcy filing in Chapter 7.

I understand that a bankruptcy stays on my credit report for ten years (Chapter 7) or
seven years (Chapter 13), negatively affecting my credit and that the debt is listed as
discharged in bankruptcy on my credit report and is not deleted from it. The bankruptcy
may also interfere with my ability to refinance any mortgage loan I have, even after the
Discharge. Credit repair after bankruptcy is completely unrelated to attorney's
requirements to represent me in my bankruptcy case.

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I understand that any and all information and documentation provided by me to Attorney
may be discoverable and might be examined by the Trustee in my case, the United
States Trustee, the Bankruptcy Court and potentially my creditors. This information may
be audited and failure to comply with said object can result in case dismissal or
sanctions (including criminal sanctions).

I understand that I must provide complete, accurate, and truthful information and
documentation. A person who knowingly and fraudulently conceals assets or makes
false oath or statement under penalty of perjury in connection with a case under Title 11
shall be subject to fine, imprisonment or both. I understand I must list all my assets and
all my debts on the bankruptcy schedules.

I understand this agreement does not include representation of me in filing a

reaffirmation agreement as attorney does not believe it is in my best interest to sign
such agreements.

I understand that I must not communicate important or material documentation or

information orally to Attorney. I understand that with the important nature and
consequences involved with a bankruptcy, that all legal questions or informing this office
of important things must be submitted in writing, either by mail or email to ensure
important issues are addressed.

I consent to receive all communications from my attorney via email. I will take all
necessary measures to ensure that my attorney's email communication do not end up in
my junk/spam folder (such as "whitelisting" the email address and adding email address
to my contacts). I consent to all secure electronic storage of my documents.

I consent to the immediate destruction of all physical files of mine attorney may possess
as I'm aware of attorney's electronic document storage policy.

I have received the "Important Information About Bankruptcy" that is included in the
Addendum to Fee Agreement (next page).

Isl Matt McCune

Attorney at Law

Signature: _ _ _ _ _ _ _ __
Co-Debtor (If joint filing)

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 ADDENDUM TO FEE AGREEMENT

The US Bankruptcy Code requires that my office provide the following information:

IMPORTANT INFORMATION ABOUT BANKRUPTCY ASSISTANCE SERVICES FROM AN

ATTORNEY OR BANKRUPTCY PETITION PREPARER.

If you decide to seek bankruptcy relief, you can represent yourself, you can hire an attorney to
represent you, or you can get help in some localities from a bankruptcy petition preparer who is
not an attorney. THE LAW REQUIRES AN ATTORNEY OR BANKRUPTCY PETITION
PREPARER TO GIVE YOU A WRITTEN CONTRACT SPECIFYING WHAT THE ATTORNEY
OR BANKRUPTCY PETITION PREPARER WILL DO FOR YOU AND HOW MUCH IT WILL
COST. Ask to see the contract before you hire anyone.

The following information helps you understand what must be done in a routine bankruptcy case
to help you evaluate how much service you need. Although bankruptcy can be complex, many
cases are routine.

Before filing a bankruptcy case, either you or your attorney should analyze your eligibility for
different forms of debt relief available under the Bankruptcy Code and which form of relief is
most likely to be beneficial for you. Be sure you understand the relief you can obtain and its
limitations. To file a bankruptcy case, documents called a Petition, Schedules, and Statement of
Financial Affairs, and in some cases a Statement of Intention, need to be prepared correctly and
filed with the bankruptcy court. You will have to pay a filing fee to the bankruptcy court. Once
your case starts, you will have to attend the required first meeting of creditors where you may be
questioned by a court official called a 'trustee' and by creditors.

If you choose to file a chapter 7 case, you may be asked by a creditor to reaffirm a debt. You
may want help deciding whether to do so. A creditor is not permitted to coerce you into
reaffirming your debts.

If you choose to file a chapter 13 case in which you repay your creditors what you can afford
over 3 to 5 years, you may also want help with preparing your chapter 13 plan and with the
confirmation hearing on your plan which will be before a bankruptcy judge.

If you select another type of relief under the Bankruptcy Code other than chapter 7 or chapter
13, you will want to find out what should be done from someone familiar with that type of relief.

Your bankruptcy case may also involve litigation. You are generally permitted to represent
yourself in litigation in bankruptcy court, but only attorneys, not bankruptcy petition preparers,
can give you legal advice.

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