Application For Appointment Of Attorney (Pro Bono) (New Haven) | Pdf Fpdf Doc Docx | Connecticut

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Application For Appointment Of Attorney (Pro Bono) (New Haven) | Pdf Fpdf Doc Docx | Connecticut

Application For Appointment Of Attorney (Pro Bono) (New Haven)

This is a Connecticut form that can be used for Bankruptcy Court within Federal.

Alternate TextLast updated: 4/13/2015

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UNITED STATES BANKRUPTCY COURT DISTRICT OF CONNECTICUT APPLICATION FOR APPOINTMENT OF ATTORNEY ATTORNEYS ARE APPOINTED UNDER THIS COURT'S PRO BONO PROGRAM TO REPRESENT INDIVIDUAL DEBTORS IN CHAPTER 7 AND CHAPTER 13 CASES. IF YOUR APPLICATION FOR THE APPOINTMENT OF AN ATTORNEY IS GRANTED AND IF THE ATTORNEY ASSIGNED TO REPRESENT YOU DETERMINES THAT IT IS IN YOUR BEST INTEREST TO FILE A PETITION UNDER CHAPTER 13 AND A CHAPTER 13 PLAN IS FILED, YOUR ATTORNEY MAY REQUEST THE COURT TO ALLOW A REASONABLE FEE AND REIMBURSEMENT FOR ACTUAL, NECESSARY EXPENSES TO BE PAID OUT OF THAT PLAN. INSTRUCTIONS 1. If this is a joint application (filed by a husband and wife), each must provide all requested information. Please indicate by (H) and (W) if an answer to a particular question only applies to the husband or to the wife. 2. Attach additional sheets of paper if necessary. 3. Return this motion to: Clerk, United States Bankruptcy Court 157 Church Street 18th Floor New Haven, CT 06510 I. Personal/Financial Data A. State your full name, present mailing address, and a telephone number: _____________________________________________________________________________ _____________________________________________________________________________ B. Do you presently have a pending bankruptcy case? _________________________________ If the answer is yes, state the location of the court _____________________________________ and the bankruptcy case number ___________________________________________________ C. Are you presently employed? __________________________________________________ If the answer is yes, state: (a) the kind of job(s) you have: ______________________________________________ _______________________________________________________________________ (b) the name, address, and telephone number of your employer: _______________________________________________________________________ _______________________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com (c) the amount of your usual weekly wages or salary: gross $ _______________; take home pay $___________________ D. Are you self employed? ______________________________________________________ If the answer is yes, state: (a) the kind of work you do: ________________________________________________ (b) the name, address, and telephone number of your business: _____________________ _______________________________________________________________________ _______________________________________________________________________ (c) the amount of your ususal weekly income: gross $________________; take home pay $ ___________________ E. If you are not presently employed or self employed state: (a) the name and address of your last employer: ________________________________ _______________________________________________________________________ _______________________________________________________________________ (b) when you last worked: _________________________________________________ (c) the amount of your last weekly wages, salary, or income: gross $ ________________; take home pay $ ___________________ F. Approximately how much money have you received in the past twelve months from: (a) salary, wages, commissions, and other income: $_____________________________ (b) interest, rent, and investments of any kind: $ ________________________________ (c) gifts, inheritance, and the sale of any property of any kind: (attach itemized list) $ __________________________________ G. Do you have any money in any checking, savings, credit union, or similar accounts? _____________________________________________________________________________ If the answer is yes, state: (a) the name and address of the depository (bank, credit union, etc): _______________________________________________________________________ _______________________________________________________________________ (b) your account number(s): ________________________________________________ (c) the amount of money in each account: $ ____________________________________ H. Is any person, company, or governmental agency holding any money or property which you have a right to demand or receive? _________________________________________________ If the answer is yes, state: (a) the name and address of the person, company, or agency: ______________________ _______________________________________________________________________ (b) the basis for your claim: _______________________________________________ (c) the amount of money and/or a description of the property: _____________________ ______________________________________________________________________ I. Do you own any real estate or other property, excluding household items and clothing: ____________________________________________________________________________ If the answer is yes, describe the property: ____________________________________ ______________________________________________________________________ and state: (a) its location: __________________________________________________________ (b) the approximate present value of each such item of property after deducting the American LegalNet, Inc. www.FormsWorkFlow.com current balance of all mortgages and other liens on that property: __________________ ______________________________________________________________________ J. List each person who depends upon you for support and state your relationship to that person: _____________________________________________________________________________ _____________________________________________________________________________ K. Are there any persons regularly residing in your household who are over the age of eighteen and regularly employed? ________________________________________________________ If the answer is yes, state as to each person: (a) name: ______________________________________________________________ ______________________________________________________________________ (b) relationship to you: ___________________________________________________ ______________________________________________________________________ (c) name and address of employer: __________________________________________ ______________________________________________________________________ L. Itemize all household and living expense per month: (a) rent/mortgage payments: $ __________________ (b) food: $ __________________ (c) utilities: $ __________________ (d) transportation: $ __________________ (e) insu

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