Personal Financial Statement

Our goal is to work with you to create a manageable payment plan that fits your current financial situation. To do this effectively, we need to gather detailed information about your financial status. Here's why:

Why We Ask for Financial Information

Tailored Payment Plans: By understanding your income, expenses, and overall financial health, we can design a payment plan that is realistic and achievable for you. This helps ensure that you can meet your obligations without undue hardship.
Fair Assessment: Collecting comprehensive financial information allows us to fairly assess your ability to pay. This ensures that the payment plan is equitable and considers all aspects of your financial situation.
Transparency and Trust: Providing detailed financial information fosters transparency and trust between us. It helps us understand your circumstances better and work together towards a solution that benefits both parties.
Avoiding Future Issues: A well-structured payment plan based on accurate financial information can help prevent future financial problems. It ensures that payments are manageable and sustainable over time.

What Information We Need

To create a payment plan that works for you, we ask for details such as:

Your income sources and amounts
Your monthly expenses
Any debts or financial obligations
Assets and property you own

How We Use This Information

Rest assured, the information you provide is used solely for the purpose of assessing and creating your payment plan. We handle all data with the utmost confidentiality and in accordance with privacy laws.

Please complete the form below and submit your answers and allow up to 3 business days for a response from our office.

THIS FORM MAY TAKE AN HOUR OR MORE TO COMPLETE!

PLEASE ANSWER ALL QUESTIONS COMPLETELY AND TO THE BEST OF YOUR KNOWLEDGE

What is your full legal name?

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

How long have you lived at this address?

Phone

(###)

###

####

Where do you work?

What is your position/title at your job?

What is your employer's address?

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

How often are you paid?

If other, please describe how you are paid.

How do you earn money?

If other, please explain

If hourly / salary, please list your hourly rate or your monthly salary

Are you self-employed or do you own any businesses? If yes, what is the business name and type?

Do you have any other sources of income (e.g., rental income, investments, pensions, side jobs)?

Are you expecting any large sums of money, such as bonuses, inheritances, or settlements? (if yes, describe)

Where do you maintain bank accounts (checking, savings, or otherwise)?

What are the balances of those accounts?

Are there any accounts held jointly with another person?

Do you have any safe deposit boxes? If yes, where and what do they contain?

Do you own any real estate? If yes, where is it located?

Are there any mortgages on these properties? What are the balances owed?

Do you rent out any property you own? If so, how much do you receive in rental income?

Do you own or lease any vehicles? If so, what make, model, and year?

Are there any loans or liens on these vehicles?

Do you own any recreational vehicles, boats, or motorcycles? (if yes, please describe and list how much each are worth).

What debts or obligations do you currently have (e.g., credit cards, loans, child support)?

Are you involved in any lawsuits, either as a plaintiff or defendant?

Do you owe money to anyone or any business?

Do you own any valuable personal property such as jewelry, antiques, artwork, or collectibles?

If yes, please describe

Do you have any stocks, bonds, or mutual funds?

If yes, please describe

Do you have any retirement accounts (e.g., 401(k), IRA, pension plans)?

If yes, please describe

Do you have any life insurance policies with cash value?

If yes, please describe

Have you sold, transferred, or gifted any assets in the last 12 months?

If yes, please describe

Have you closed any bank accounts in the last year?

If yes, please describe

Have you taken out any loans recently or received any lines of credit?

If yes, please describe

Do you have an ownership interest in any corporations, partnerships, or LLCs?

If yes, please describe

Are you a beneficiary of any trusts?

If yes, please describe

Have you received or are you expecting any distributions from a business?

If yes, please describe

Are you holding any assets for someone else?

If yes, please describe

Are there any other assets, accounts, or income sources not yet disclosed?

If yes, please describe

Are there any other individuals or entities that owe you money?

If yes, please describe

What is your proposal for monthly payments toward your debt owed to the state of Ohio?

statement

Personal Financial Statement

Why We Ask for Financial Information

What Information We Need

How We Use This Information

Please complete the form below and submit your answers and allow up to 3 business days for a response from our office.

THIS FORM MAY TAKE AN HOUR OR MORE TO COMPLETE!

PLEASE ANSWER ALL QUESTIONS COMPLETELY AND TO THE BEST OF YOUR KNOWLEDGE

Special Counsel Andy Bowers