Law Office of Erin H. Winkles P.S.

1424 16th Avenue
Longview, WA 98632

(360) 578-1392

Thank you so much for contacting our law office! Please read the privacy policy below, and then fill out this form in its entirety prior to our consultation.

Privacy Policy

All information received from a client is strictly confidential. Our firm takes every step possible to protect your privacy! The data submitted via this form is encrypted and secured using industry-standard 128-bit SSL encryption.

Your Social Security Number and other personal information will only be used in the event you hire the firm to represent you in your legal matter, and then only when necessary in limited use for the duration of your case.

Social Security Numbers are most often used to positively identify parties. Most courts require Social Security Numbers of all parties in a case. Some other examples of how this information may be used include:

Initial service
In court orders
In required reports or other documents filed with the State

Please fill out the following intake form. It's important that you provide an answer for each question but if not applicable please leave blank. Some questions are mandatory and contain an * next to them!

If you have any questions, please do not hesitate to contact our law office (360-578-1392). We look forward to working with you!

CLIENT GENERAL INFORMATION

Contact information: General Contact Information

Prefix

First name *

Middle name

Last name *

Date of birth

Company

Emails

Email Address *

Type

Upon submission, a copy of this form will be sent to the primary email.

Add email

Addresses

Street address

Country

City

State/Region

Zip/Postal code

Address type

Add address

Phone numbers

Phone number

Type

Add phone number

Your FULL Name

Your Preferred Name:

(please leave blank if not necessary)

Case Number:

Your Social Security Number

County Name:

Do you or the other party require an interpreter?

Yes

SELLER INFORMATION

In the section below please provide required information that pertains to the seller of the property.

Seller's Name

Seller's Address

Seller's Home Phone Number:

Seller's Work Phone Number:

Seller's Social Security Number:

Is title held in a trust?

Yes

BUYER INFORMATION

In the section below please provide required information that pertains to the buyer of the property.

Buyer's Name

Buyer's Address

Buyer's Home Phone Number:

Buyer's Work Phone Number:

Buyer's Social Security Number:

Is title to be deeded in a trust?

Yes

REAL ESTATE AGENT INFORMATION

Listing Office:

Listing Agent Name:

Listing Agent Address:

Listing Agent Phone Number:

Selling Office:

Selling Agent Name:

Selling Agent Address:

Selling Agent Phone Number:

Commission Terms:

Description of Property

Property Address

Legal Description:

SELLER'S EXISTING MORTGAGE INFORMATION

Loan Number:

Mortgage Approximate Balance ($):

Insurance Escrow Approximate Balance ($):

Loan Servicer:

Tax & Insurance Escrow Info:

Is This A VA (U.S. Department of Veterans Affairs) or FHA (Federal Housing Administration) Loan?

Yes

BUYER'S PROPOSED MORTGAGE

Lender's Name:

Lender's Address:

Contact Person:

Proposed Mortgage Amount:

Lender's required endorsement:

PERSONAL PROPERTY

The following items of personal property are included in the sale:

POSSESSION

Date possession to be delivered

Daily Rental For Post-Closing Possession:

Who Pays Utilities?

Buyer

Seller

Who Pays Condo Assessments?

Buyer

Seller

Possession Escrow Amount ($):

Possession Escrow Escrowed ($):

CONDO ASSOCIATION

Name of Contact Person:

Condo Association Address:

Condo Association Phone Number:

Monthly Assessments:

Special Assessments:

Master Insurance Policy Agent:

Master Insurance Policy Phone Number:

REAL ESTATE DISCLOSURE FORM

Date Completed By Seller:

Date Received By Buyer:

Lead Paint Disclosure:

Was the property built prior to 1978? (If No, please skip question below)

Yes

Has the Lead Paint Disclosure Requirement Been Met?

Yes

REAL ESTATE TAXES

Amount of Last Tax Bill?

Date of Last Tax Bill:

Existing Exemption:

Homestead

Senior

Farmland

Forest

Is Property Currently Assessed As 'Improved'

Yes

PREMISES INSPECTION

Contract contingency terms:

Termite inspection requirements:

Pre-closing Inspection Terms

Flood Zone Information

Well & Septic Inspection Requirements:

Municipal Inspection Requirements:

MONTHLY EXPENSES

Please list below what your monthly expenses are (approximate value is ok). Please enter $0.00 for any that do not apply to you.

(Housing Expenses) = Rent/Mortgage/Lot Rent

(Housing Expenses) = Property Tax:

If included in the mortgage please enter $0.00

(Housing Expenses) = Homeowner's or Rental Insurance:

If included in the mortgage please enter $0.00

(Housing Expenses) = Other mortgage, contract or debt payments based on equity in your home (please specify):

(Housing Expenses) = Homeowner's Association dues or fees

(Transportation Expenses) = Automobile Payment (loan or lease)

(Transportation Expenses) = Auto Insurance, License, Registration

(Transportation Expenses) = Gas & Auto Maintenance

(Transportation Expenses) = Parking, Tolls & Public Transportation

(Transportation Expenses) = Other Transportation Expenses

(Utilities Expenses) = Electricity & Heating (Gas & Oil)

(Utilities Expenses) = Water, Sewer & Garbage

(Utilities Expenses) = Telephone(s)/Cell phone(s)

(Utilities Expenses) = Cable/Internet

(Utilities Expenses) = Other Utilities - please specify

Personal Expenses (Not Children) = Clothing/Laundry/Dry-Cleaning

Personal Expenses (Not Children) = Hair & Personal Care

Personal Expenses (Not Children) = Recreation, Clubs, Gifts

Personal Expenses (Not Children) = Education, Books, Magazines

Personal Expenses (Not Children) = Other Personal Expenses

(Food & Household Expenses) = Groceries (do not include alcohol and tobacco)

(Food & Household Expenses) = Alcohol & Tobacco

(Food & Household Expenses) = Household Supplies Such As Cleaning Products, Paper, Pets etc

(Food & Household Expenses) = Eating Out

(Food & Household Expenses) = Other, Please Specify

(Children's Expenses) = Childcare, Baby-Sitting

(Children's Expenses) = Clothes, Diapers

(Children's Expenses) = Tuition, After School Programs & Lessons

(Children's Expenses) = Other Expenses - Please Specify

(HealthCare Expenses) = Insurance Premium (Health, Vision. Dental)

(HealthCare Expenses) = Health, Vision, Dental, Orthodontia, Mental Health or Other Health Expense Not Covered By Insurance

(HealthCare Expenses) = Life Insurance That Is Not Deducted From Pay

Debts Included In Monthly Expenses (Such as Credit Cards)

Explanation of Expenses or debts (If applicable)

EVICTION INTERVIEW - Defendant/Tenant Information

Please complete all relevant fields.

Name of Defendant:

Name of Tenant:

Full Address of Property:

Name of Employer:

Name of Employer's Address:

EVICTION INTERVIEW - Property Information

Owner of Property:

Address of Owner (if different than Plaintiff's)

Address of Property (if different than Plaintiff's)

Legal Description of Property:

Type of Lease:

Oral?

Written?

Rent Agreement:

Please include how much $ per week/month/year

Date Rent Is Due?

Security Deposit:

How Much is it?

Are Attorney's Fees Recoverable?

Yes

EVICTION INTERVIEW - Eviction Information

Eviction Information

Reason For Eviction

Has notice been served?

Yes

Length of Notice:

5 Day

10 day

30 day

Is there A Demand For Immediate Possession

Yes

Process To Be Served At Following Address:

FORECLOSURE INTAKE CHECKLIST

Please provide answers to as many questions as possible.

Full Address Of Property Being Foreclosed:

Description of Property (select one):

House

Mobile Home

Vacant Lot

Is your name on the deed?

Yes

Is Any One Else On The Deed With You?

Yes

Do You Live On The Property?

Yes

When Did You Purchase The Property?

How Much Did You Pay For The Property?

What Is The Current Value Of The Property?

Leave blank if unknown

Name of Mortgage Company?

Monthly Payment Amount?

What Is The Current Loan Balance?

Leave blank if unknown.

Number of Payments Past Due?

When Was The Last Payment Made?

Have Your Payments Ever Been Refused?

Yes

Term Of Mortgage (In Months)?

What Is The Interest Rate?

Is The Mortgage Fixed or Adjustable?

Please select one

Fixed

Adjustable

Does the Mortgage include escrow for Taxes & Insurance

Yes

Is this a re-finance?

Yes

Do you have a second mortgage?

Yes

Please list all names on the mortgage/s

What is the name of the person/company threatening to sue you?

Have you been served with legal papers?

Yes

If you answered 'yes' to the above question, what date did you receive them?

If served, what date is the answer due?

Is the first time you have been served on this property?

Yes

N/A

Why are your payments behind?

Is this the first time you have been behind on your payments?

Yes

Has your lender ever accepted late or partial payments?

Yes

Do you disagree with amount claimed to be owed?

Yes

Have you tried to resolve the situation with the Mortgage company?

Do you want to keep the property?

Yes

How soon will you be able to begin making regular payments?

I'm ready and able to start now

I will be ready to begin making regular payments soon

I won't be able to for a while

Is your mortgage insured by any of the following?

If 'yes', please select the one/s that are applicable

HUD (Department of Housing and Urban Development)FHA (Federal Housing Administration)VA (Veterans Affairs)None

Do you have a copy of all your mortgage documents?

Yes

Do you have any additional outstanding debts?

Yes

Have you been sued by a creditor before?

Yes

Do you have any judgments against you?

Yes

Have you ever filed for bankruptcy?

Yes

ATTORNEY FEES

List your total attorney fees and costs for this case as of today in the appropriate sections below.

Attorney Name:

Attorney Address:

Attorney Phone:

Amount Paid (To Date)

Amount Still Owed

Source Of The Money You Used To Pay These Fees & Costs (for example 'loan')

Describe your agreement with your attorney to pay your fees and costs

Financial Records - You must provide financial records as required by the statute and state and local court rules. These records may include Personal Income Tax Returns, Pay Stubs, Partnership or Corporate Income Tax Returns or Other Financial Records.

Add attachment

ACKNOWLEDGEMENT & ACCEPTANCE

Please note that by submitting this form you hereby acknowledge that you have read and accept the above privacy policy regarding use of your personal information.

THANK YOU

Thank you so much for completing this intake questionnaire. This information will be extremely helpful in evaluating your case.

Please click the SUBMIT button below when you have finished answering all questions.