Case 15-21233

Doc 1

Filed 07/13/15
Document

B1 (Official Form 1)(04/13)

Entered 07/13/15 09:39:38
Page 1 of 5

United States Bankruptcy Court

Desc Main

Voluntary Petition

District of Connecticut
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Name of Joint Debtor (Spouse) (Last, First, Middle):

Name of Debtor (if individual, enter Last, First, Middle):

Jackson, Curtis James III
All Other Names used by the Debtor in the last 8 years
(include married, maiden, and trade names):

All Other Names used by the Joint Debtor in the last 8 years
(include married, maiden, and trade names):

Last four digits of Soc. Sec. or Individual-Taxpayer I.D. (ITIN)/Complete EIN

Last four digits of Soc. Sec. or Individual-Taxpayer I.D. (ITIN) No./Complete EIN
(if more than one, state all)

(if more than one, state all)

xxx-xx-0616
Street Address of Joint Debtor (No. and Street, City, and State):

Street Address of Debtor (No. and Street, City, and State):

50 Poplar Hill Drive
Farmington, CT
ZIP Code

ZIP Code

06032
County of Residence or of the Principal Place of Business:

County of Residence or of the Principal Place of Business:

Hartford
Mailing Address of Joint Debtor (if different from street address):

Mailing Address of Debtor (if different from street address):

ZIP Code

ZIP Code

Location of Principal Assets of Business Debtor
(if different from street address above):

Type of Debtor

Nature of Business

(Form of Organization) (Check one box)

(Check one box)

Individual (includes Joint Debtors)

Chapter of Bankruptcy Code Under Which
the Petition is Filed (Check one box)

Health Care Business
Single Asset Real Estate as defined
in 11 U.S.C. § 101 (51B)
Railroad
Stockbroker
Commodity Broker
Clearing Bank
Other

See Exhibit D on page 2 of this form.

Corporation (includes LLC and LLP)
Partnership
Other (If debtor is not one of the above entities,
check this box and state type of entity below.)

Chapter 15 Debtors

Tax-Exempt Entity

Country of debtor's center of main interests:

(Check box, if applicable)
Debtor is a tax-exempt organization
under Title 26 of the United States
Code (the Internal Revenue Code).

Each country in which a foreign proceeding
by, regarding, or against debtor is pending:

Filing Fee (Check one box)
Full Filing Fee attached
Filing Fee to be paid in installments (applicable to individuals only). Must
attach signed application for the court's consideration certifying that the
debtor is unable to pay fee except in installments. Rule 1006(b). See Official
Form 3A.
Filing Fee waiver requested (applicable to chapter 7 individuals only). Must
attach signed application for the court's consideration. See Official Form 3B.

Chapter 7
Chapter 9
Chapter 11
Chapter 12
Chapter 13

(Check one box)
Debts are primarily consumer debts,
defined in 11 U.S.C. § 101(8) as
"incurred by an individual primarily for
a personal, family, or household purpose."

Check all applicable boxes:
A plan is being filed with this petition.
Acceptances of the plan were solicited prepetition from one or more classes of creditors,
in accordance with 11 U.S.C. § 1126(b).
THIS SPACE IS FOR COURT USE ONLY

100199

200999

1,0005,000

5,00110,000

10,00125,000

25,00150,000

50,001100,000

OVER
100,000

$100,001 to
$500,000

$500,001
to $1
million

$1,000,001
to $10
million

$10,000,001
to $50
million

$50,000,001
to $100
million

$100,000,001 $500,000,001 More than
to $500
to $1 billion $1 billion
million

$100,001 to
$500,000

$500,001
to $1
million

$1,000,001
to $10
million

$10,000,001
to $50
million

$50,000,001
to $100
million

$100,000,001 $500,000,001 More than
to $500
to $1 billion $1 billion
million

Estimated Assets
$0 to
$50,000

$50,001 to
$100,000

Estimated Liabilities
$0 to
$50,000

$50,001 to
$100,000

Debts are primarily
business debts.

Chapter 11 Debtors
Check one box:
Debtor is a small business debtor as defined in 11 U.S.C. § 101(51D).
Debtor is not a small business debtor as defined in 11 U.S.C. § 101(51D).
Check if:
Debtor’s aggregate noncontingent liquidated debts (excluding debts owed to insiders or affiliates)
are less than $2,490,925 (amount subject to adjustment on 4/01/16 and every three years thereafter).

Estimated Number of Creditors
5099

Chapter 15 Petition for Recognition
of a Foreign Nonmain Proceeding
Nature of Debts

Statistical/Administrative Information
Debtor estimates that funds will be available for distribution to unsecured creditors.
Debtor estimates that, after any exempt property is excluded and administrative expenses paid,
there will be no funds available for distribution to unsecured creditors.

149

Chapter 15 Petition for Recognition
of a Foreign Main Proceeding

 Case 15-21233

Doc 1

B1 (Official Form 1)(04/13)

Filed 07/13/15
Document

Entered 07/13/15 09:39:38
Page 2 of 5

Desc Main
Page 2

Name of Debtor(s):
Jackson, Curtis James III

Voluntary Petition
(This page must be completed and filed in every case)
Location
Where Filed: - None -

All Prior Bankruptcy Cases Filed Within Last 8 Years (If more than two, attach additional sheet)
Case Number:
Date Filed:

Location
Where Filed:

Case Number:

Date Filed:

Pending Bankruptcy Case Filed by any Spouse, Partner, or Affiliate of this Debtor (If more than one, attach additional sheet)
Name of Debtor:
Case Number:
Date Filed:
- None District:

Relationship:

Judge:
Exhibit B

Exhibit A

(To be completed if debtor is an individual whose debts are primarily consumer debts.)

(To be completed if debtor is required to file periodic reports (e.g.,
forms 10K and 10Q) with the Securities and Exchange Commission
pursuant to Section 13 or 15(d) of the Securities Exchange Act of 1934
and is requesting relief under chapter 11.)

I, the attorney for the petitioner named in the foregoing petition, declare that I
have informed the petitioner that [he or she] may proceed under chapter 7, 11,
12, or 13 of title 11, United States Code, and have explained the relief available
under each such chapter. I further certify that I delivered to the debtor the notice
required by 11 U.S.C. §342(b).

X

Exhibit A is attached and made a part of this petition.

/s/ James Berman
Signature of Attorney for Debtor(s)

July 13, 2015
(Date)

James Berman ct06027
Exhibit C
Does the debtor own or have possession of any property that poses or is alleged to pose a threat of imminent and identifiable harm to public health or safety?
Yes, and Exhibit C is attached and made a part of this petition.
No.

Exhibit D
(To be completed by every individual debtor. If a joint petition is filed, each spouse must complete and attach a separate Exhibit D.)
Exhibit D completed and signed by the debtor is attached and made a part of this petition.
If this is a joint petition:
Exhibit D also completed and signed by the joint debtor is attached and made a part of this petition.
Information Regarding the Debtor - Venue
(Check any applicable box)
Debtor has been domiciled or has had a residence, principal place of business, or principal assets in this District for 180
days immediately preceding the date of this petition or for a longer part of such 180 days than in any other District.
There is a bankruptcy case concerning debtor's affiliate, general partner, or partnership pending in this District.
Debtor is a debtor in a foreign proceeding and has its principal place of business or principal assets in the United States in
this District, or has no principal place of business or assets in the United States but is a defendant in an action or
proceeding [in a federal or state court] in this District, or the interests of the parties will be served in regard to the relief
sought in this District.
Certification by a Debtor Who Resides as a Tenant of Residential Property
(Check all applicable boxes)
Landlord has a judgment against the debtor for possession of debtor's residence. (If box checked, complete the following.)
(Name of landlord that obtained judgment)

(Address of landlord)

Debtor claims that under applicable nonbankruptcy law, there are circumstances under which the debtor would be permitted to cure
the entire monetary default that gave rise to the judgment for possession, after the judgment for possession was entered, and
Debtor has included with this petition the deposit with the court of any rent that would become due during the 30-day period
after the filing of the petition.
Debtor certifies that he/she has served the Landlord with this certification. (11 U.S.C. § 362(l)).

 Case 15-21233

Doc 1

B1 (Official Form 1)(04/13)

Filed 07/13/15
Document

Entered 07/13/15 09:39:38
Page 3 of 5

Desc Main
Page 3

Name of Debtor(s):
Jackson, Curtis James III

Voluntary Petition
(This page must be completed and filed in every case)

Signatures
Signature(s) of Debtor(s) (Individual/Joint)

Signature of a Foreign Representative

I declare under penalty of perjury that the information provided in this
petition is true and correct.
[If petitioner is an individual whose debts are primarily consumer debts and
has chosen to file under chapter 7] I am aware that I may proceed under
chapter 7, 11, 12, or 13 of title 11, United States Code, understand the relief
available under each such chapter, and choose to proceed under chapter 7.
[If no attorney represents me and no bankruptcy petition preparer signs the
petition] I have obtained and read the notice required by 11 U.S.C. §342(b).

I declare under penalty of perjury that the information provided in this petition
is true and correct, that I am the foreign representative of a debtor in a foreign
proceeding, and that I am authorized to file this petition.
(Check only one box.)

I request relief in accordance with chapter 15 of title 11. United States Code.
Certified copies of the documents required by 11 U.S.C. §1515 are attached.
Pursuant to 11 U.S.C. §1511, I request relief in accordance with the chapter
of title 11 specified in this petition. A certified copy of the order granting
recognition of the foreign main proceeding is attached.

I request relief in accordance with the chapter of title 11, United States Code,
specified in this petition.

X

/s/ Curtis James Jackson, III
Signature of Debtor Curtis James Jackson, III

X
Signature of Foreign Representative

X

Printed Name of Foreign Representative
Signature of Joint Debtor
Date
Telephone Number (If not represented by attorney)

Signature of Non-Attorney Bankruptcy Petition Preparer

July 13, 2015
Date

I declare under penalty of perjury that: (1) I am a bankruptcy petition
preparer as defined in 11 U.S.C. § 110; (2) I prepared this document for
compensation and have provided the debtor with a copy of this document
and the notices and information required under 11 U.S.C. §§ 110(b),
110(h), and 342(b); and, (3) if rules or guidelines have been promulgated
pursuant to 11 U.S.C. § 110(h) setting a maximum fee for services
chargeable by bankruptcy petition preparers, I have given the debtor notice
of the maximum amount before preparing any document for filing for a
debtor or accepting any fee from the debtor, as required in that section.
Official Form 19 is attached.

Signature of Attorney*

X

/s/ James Berman
Signature of Attorney for Debtor(s)
James Berman ct06027
Printed Name of Attorney for Debtor(s)
Zeisler & Zeisler, P.C.
Firm Name
10 Middle Street, 15th Floor
P.O. Box 1220
Bridgeport, CT 06604

Printed Name and title, if any, of Bankruptcy Petition Preparer
Social-Security number (If the bankrutpcy petition preparer is not
an individual, state the Social Security number of the officer,
principal, responsible person or partner of the bankruptcy petition
preparer.)(Required by 11 U.S.C. § 110.)

Address

(203) 368-4234 Fax: (203) 367-9678
Telephone Number
July 13, 2015
Date
*In a case in which § 707(b)(4)(D) applies, this signature also constitutes a
certification that the attorney has no knowledge after an inquiry that the
information in the schedules is incorrect.

Signature of Debtor (Corporation/Partnership)
I declare under penalty of perjury that the information provided in this
petition is true and correct, and that I have been authorized to file this petition
on behalf of the debtor.
The debtor requests relief in accordance with the chapter of title 11, United
States Code, specified in this petition.

Address

X
Date
Signature of bankruptcy petition preparer or officer, principal, responsible
person,or partner whose Social Security number is provided above.
Names and Social-Security numbers of all other individuals who prepared or
assisted in preparing this document unless the bankruptcy petition preparer is
not an individual:

X
Signature of Authorized Individual
Printed Name of Authorized Individual
Title of Authorized Individual
Date

If more than one person prepared this document, attach additional sheets
conforming to the appropriate official form for each person.
A bankruptcy petition preparer’s failure to comply with the provisions of
title 11 and the Federal Rules of Bankruptcy Procedure may result in
fines or imprisonment or both. 11 U.S.C. §110; 18 U.S.C. §156.

 Case 15-21233

Doc 1

Filed 07/13/15
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Entered 07/13/15 09:39:38
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B 1D (Official Form 1, Exhibit D) (12/09)

United States Bankruptcy Court
District of Connecticut
In re

Curtis James Jackson, III
Debtor(s)

Case No.
Chapter

11

EXHIBIT D - INDIVIDUAL DEBTOR'S STATEMENT OF COMPLIANCE WITH
CREDIT COUNSELING REQUIREMENT
Warning: You must be able to check truthfully one of the five statements regarding credit
counseling listed below. If you cannot do so, you are not eligible to file a bankruptcy case, and the court
can dismiss any case you do file. If that happens, you will lose whatever filing fee you paid, and your
creditors will be able to resume collection activities against you. If your case is dismissed and you file
another bankruptcy case later, you may be required to pay a second filing fee and you may have to take
extra steps to stop creditors' collection activities.
Every individual debtor must file this Exhibit D. If a joint petition is filed, each spouse must complete
and file a separate Exhibit D. Check one of the five statements below and attach any documents as directed.
1. Within the 180 days before the filing of my bankruptcy case, I received a briefing from a credit
counseling agency approved by the United States trustee or bankruptcy administrator that outlined the
opportunities for available credit counseling and assisted me in performing a related budget analysis, and I have
a certificate from the agency describing the services provided to me. Attach a copy of the certificate and a copy
of any debt repayment plan developed through the agency.
2. Within the 180 days before the filing of my bankruptcy case, I received a briefing from a credit
counseling agency approved by the United States trustee or bankruptcy administrator that outlined the
opportunities for available credit counseling and assisted me in performing a related budget analysis, but I do
not have a certificate from the agency describing the services provided to me. You must file a copy of a
certificate from the agency describing the services provided to you and a copy of any debt repayment plan
developed through the agency no later than 14 days after your bankruptcy case is filed.
3. I certify that I requested credit counseling services from an approved agency but was unable to
obtain the services during the seven days from the time I made my request, and the following exigent
circumstances merit a temporary waiver of the credit counseling requirement so I can file my bankruptcy case
now. [Summarize exigent circumstances here.]
If your certification is satisfactory to the court, you must still obtain the credit counseling briefing
within the first 30 days after you file your bankruptcy petition and promptly file a certificate from the
agency that provided the counseling, together with a copy of any debt management plan developed
through the agency. Failure to fulfill these requirements may result in dismissal of your case. Any
extension of the 30-day deadline can be granted only for cause and is limited to a maximum of 15 days.
Your case may also be dismissed if the court is not satisfied with your reasons for filing your bankruptcy
case without first receiving a credit counseling briefing.
4. I am not required to receive a credit counseling briefing because of: [Check the applicable
statement.] [Must be accompanied by a motion for determination by the court.]
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 Case 15-21233

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Filed 07/13/15
Document

Entered 07/13/15 09:39:38
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Desc Main

B 1D (Official Form 1, Exhibit D) (12/09) - Cont.

Page 2

Incapacity. (Defined in 11 U.S.C. § 109(h)(4) as impaired by reason of mental illness or mental
deficiency so as to be incapable of realizing and making rational decisions with respect to financial
responsibilities.);
Disability. (Defined in 11 U.S.C. § 109(h)(4) as physically impaired to the extent of being
unable, after reasonable effort, to participate in a credit counseling briefing in person, by telephone, or
through the Internet.);
Active military duty in a military combat zone.
5. The United States trustee or bankruptcy administrator has determined that the credit counseling
requirement of 11 U.S.C. § 109(h) does not apply in this district.
I certify under penalty of perjury that the information provided above is true and correct.
Signature of Debtor:
Date:

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/s/ Curtis James Jackson, III
Curtis James Jackson, III

July 13, 2015

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