Norton, OH Office: 4071 S. Cleveland-Massillon Road | P.O. Box 1080 Norton, Ohio, 44203 | 330-825-2477 | Fax: 330-825-2029

Bankruptcy Evaluation Form

This questionnaire is intended for the sole purpose of helping us make a preliminary determination as to whether you qualify to file for Bankruptcy protection. The information you provide will be evaluated by one of our attorneys to decide if you are eligible to file. More information may be required before a final determination can be made. The answers you provide will not be used for any other purpose and will not be disclosed to any third parties. After your questionnaire is submitted, an associate at Kennedy & Associates, Co. L.P.A. will contact you within two business days to discuss this matter further. We will not charge you a fee for reviewing and responding to your questionnaire.