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Personal Information

Your Name
Address
City, State, Zip
County
E-Mail
Home Phone
Work Phone
   
Date of Birth
   
Marital Status

Own A House


Yes No
*If So What Is The Equity Value
*Equity is the value of your house minus the amount you owe on your loan.
 
Income Information

Gross income for 2007
Gross income for 2006
Other income* for 2007
Other income* for 2006
*Other income – unemployment, social security, disability payments, non W-2 wages, stock dividends, certificates of deposit interest
   
How often are you paid
 
 
Monthly Expense Information

House Payment/Rent
Car Payment
Combined Utilities
Food/Dining
Personal Expenses
 
 
Additional Comments

Please feel free to give us additional information to help us serve you better.
 
   
 
   

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Lamey & Pacyga, P.A.
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