Case Doc 1 Filed 08/08/16 Page 1 of 37 Fill in this information to identify your case: United States Bankruptcy Court for the: Middle District of Florida Case number (lfknown): FILED Chapter you are ?ling under: Chapter? CI Chapter 11 Chapter 12 Chapter Check if this is an amended ?ling Of?cial Form 101 Voluntary Petition for Individuals Filing for Bankruptcy WW CLE EK.U.S. BANKRUPTCY COURT LE answer or TAMPA 12115 The bankruptcy forms use you and Debtor 1 to refer to a debtor ?ling alone. A married couple may ?le a bankruptcy case together?called a joint case?and in joint cases, these forms use you to ask for information from both debtors. For example, if a form asks, ?Do you own a car," the answer would be yes if either debtor owns a car. When information is needed about the spouses separately, the form uses Debtor 1 and Debtor2 to distinguish between them. In joint cases, one of the spouses must report information as Debtor 1 and the other as Debtor 2. The same person must be Debtor 1 in all of the forms. Be as complete and accurate as possible. If two married people are ?ling together, both are equally responsible for supplying correct information. if more space is needed, attach a separate sheet to this form. On the top of any additional pages, write your name and case number (if known). Answer every question. ?dentin Yourself About Debtor 1: About Debtor 2 (Spouse Only in a Joint Case): 1. Your full name Write the name that is on your - . government-issued picture lusa Qra'g identi?cation (for example, F'rsf name Fm name your driver's license or Dianne passport). Middle name Middle name Bring your picture BytheWOOd Bythewood Last name Last name identi?cation to your meeting with the trustee. Suf?x Jr.. II, 2. All other names you Suf?x II. have used in the last 8 First name First name years include your married or Middle name Middle name maiden names. Last name Last name First name First name Middle name Middle name Last name Last name 3. Only the last 4 digits of your Social Security number or federal OR OR Individual Taxpayer Identi?cation number 9 xx xx 9 XX xx Of?cial Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 1 Case Doc 1 Filed 08/08/16 Page 2 of 37 Craig First Name Debtor 1 Middle Name Bythewood Last Name Case number (ifknown) 4. Any business names and Employer Identi?cation Numbers (EIN) you have used in the last 8 years Include trade names and doing business as names About Debtor 1: have not used any business names or Ele. VHU Express Inc Business name Vertical Holdings Unlimited LLC Business name 413577113 EEZ About Debtor 2 (Spouse Only in a Joint Case): I have not used any business names or EINs. VHU Express Inc Business name Vertical Holdings Unlimited LLC Business name 47-3577438 EIN EIN - 5. Where you live 9621 R_oya Fertn Court Number Street Tampa FL 33647 City State ZIP Code Hillsborough County If your mailing address is different from the one above, ?ll it in here. Note that the court will send any notices to you at this mailing address. 7853 Gunn Highway #181 If Debtor 2 lives at a different address: Number Street City State ZIP Code County If Debtor 2's mailing address is different from yours, ?ll it in here. Note that the court will send any notices to this mailing address. Number Street Number Street PO. Box PO. Box Tampa FL 33626 City State ZIP Code City State ZIP Code 6. Why you are choosing Check one: Check one: this district to ?le for bankruptcy 2] Over the last 180 days before ?ling this petition, I have lived in this district longer than in any other district. I have another reason. Explain. (See 28 U.S.C. 1408.) Over the last 180 days before ?ling this petition, I have lived in this district longer than in any other district. CI I have another reason. Explain. (See 28 U.S.C. 1408.) Of?cial Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 2 Case Doc 1 Filed 08/08/16 Page 3 of 37 Debtor 1 Grain Case number (ifknown) First Name Middle Name Last Name Tell the Court About Your Bankruptcy Case 7. The chapter of the Check one. (For a brief description of each, see Notice Required by 11 U. S. C. 342(b) for Individuals Filing Bankruptcy Code you for Bankruptcy (Form 2010)). Also, go to the top of page 1 and check the appropnate box. are choosing to file CI Chapter 7 under 13 Chapter 11 Cl Chapter 12 El Chapter 13 >+>nil41r ?mt Us 4 a . mm,? . Mariano.? . wwimtvm A- swam? a? a. How you will pay the fee Cl I will pay the entire fee when I file my petition. Please check with the clerk?s of?ce in your local court for more details about how you may pay. Typically, if you are paying the fee yourself, you may pay with cash, cashier's check, or money order. If your attorney is submitting your payment on your behalf, your attorney may pay with a credit card or check with a pre-printed address. a I need to pay the fee in installments. If you choose this option. sign and attach the Application for individuals to Pay The Filing Fee in lnstaiiments (Of?cial Form 103A). Cl I request that my fee be waived (You may request this option only if you are ?ling for Chapter 7. By law, a judge may, but is not required to, waive your fee, and may do so only if your income is less than 150% of the of?cial poverty line that applies to your family size and you are unable to pay the fee in installments). If you choose this option, you must ?ll out the Application to Have the Chapter 7 Filing Fee Waived (Of?cial Form 103B) and ?le it with your petition. maumm?c ?Mamas ,t ?Hummus . _I??m~Ali m: mm?? 1? ?abdi'H?r?w . ?:74 i 9. Have you filed for a No bankruptcy within the last 8 years? Yes- District When Case number MM DD District When Case number MM DD District When Case number MM DD I 10. Are any bankruptcy No cases pending or being ?'ed by a spouse who is Yes. DEbtor RelationShip to you "Ot caise WIth District When Case number, if known you, or by a busmess MM I DD partner, or by an af?liate? Debtor Relationship to you District When Case number, if known MM DD 11- Do you rent your 0 No. Go to line 12. reSIdence? EZI Yes. Has your landlord obtained an eviction judgment against you and do you want to stay in your residence? El No. Go to line 12. El Yes. Fill out initial Statement About an Eviction Judgment Against You (Form 101A) and ?le it with this bankruptcy petition. Of?cial Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 3 Case 8: Debtor 1 raig First Name Middle Name Doc 1 Filed 08/08/16 Page 4 of 37 Bythewood Case number (ifknown) Last Name ?Report About Any Businesses You Own as a Sole Proprietor 12. Are you a sole proprietor of any full- or part-time business? A sole proprietorship is a business you operate as an individual, and is not a separate legal entity such as a corporation, partnership. or LLC. If you have more than one sole proprietorship, use a separate sheet and attach it to this petition. 13. Are you ?ling under Chapter 11 of the Bankruptcy Code and are you a small business debtor? For a de?nition of small business debtor, see 11 U.S.C. a No. Go to Part 4. Yes. Name and location of business Name of business, if any Number Street City State ZIP Code Check the appropriate box to describe your business: El Health Care Business (as de?ned in 11 U.S.C. Single Asset Real Estate (as de?ned in 11 U.S.C. Stockbroker (as de?ned in 11 U.S.C. Commodity Broker (as de?ned in 11 U.S.C. 101(6)) None of the above if you are ?ling under Chapter 11, the court must know whether you are a small business debtor so that it can set appropriate deadlines. if you indicate that you are a small business debtor, you must attach your most recent balance sheet. statement of operations, cash-?ow statement, and federal income tax return or if any of these documents do not exist, follow the procedure in 11 U.S.C. it No. I am not ?ling under Chapter 11. No. I am ?ling under Chapter 11, but am NOT a small business debtor according to the de?nition in the Bankruptcy Code. Yes. I am ?ling under Chapter 11 and I am a small business debtor according to the de?nition in the Bankruptcy Code, ?Report if You Own or Have Any Hazardous Property or Any Property That Needs Immediate Attention 14. Do you own or have any property that poses or is alleged to pose a threat of imminent and identi?able hazard to public health or safety? Or do you own any property that needs immediate attention? For example, do you own perishable goods, or livestock that must be fed, or a building that needs urgent repairs? Of?cial Form 101 a No CI Yes. What is the hazard? If immediate attention is needed, why is it needed? Where is the property? Number Street City State ZIP Code Voluntary Petition for Individuals Filing for Bankruptcy page 4 Case Doc 1 Filed 08/08/16 Page 5 of 37 Debtor 1 Craig Case number (if known) First Name Middle Name Last Name ?Explain Your Efforts to Receive a Briefing About Credit Counseling 1: 15. Tell the court whether About Debtor you have received a brie?ng about credit You must check one. counseling. I received a brie?ng from an approved credit counseling agency within the 180 days before I The law requires that YOU ?led this bankruptcy petition, and I received a receive a brie?ng about credit certi?cate of completion. counseling before you ?le for Attach a copy of the certi?cate and the payment the plan, if any, that you developed with the agency. following ?h?i?es' If you I received a briefing from an approved credit cannot do you are counseling agency within the 180 days before I eligible t0 ?le. ?led this bankruptcy petition, but I do not have a certi?cate of completion. If youh?le'anyway, the court Within 14 days after you ?le this bankruptcy petition, can dismiss your case, you you MUST ?le a copy of the certi?cate and payment will lose whatever ?ling fee you paid, and your creditors can-begin collection activrties I certify that I asked for credit counseling 393'? services from an approved agency, but was unable to obtain those services during the 7 days after I made my request, and exigent circumstances merit a 30-day temporary waiver of the requirement. plan, if any. To ask for a 30-day temporary waiver of the requirement. attach a separate sheet explaining what efforts you made to obtain the brie?ng, why you were unable to obtain it before you ?led for bankruptcy, and what exigent circumstances required you to ?le this case. Your case may be dismissed if the court is dissatis?ed with your reasons for not receiving a brie?ng before you ?led for bankruptcy. If the court is satis?ed with your reasons, you must still receive a brie?ng within 30 days after you ?le. You must ?le a certi?cate from the approved agency, along with a copy of the payment plan you developed, if any. If you do not do so, your case may be dismissed. Any extension of the 30-day deadline is granted only for cause and is limited to a maximum of 15 days. I am not required to receive a brie?ng about credit counseling because of: Cl Incapacity. I have a mental illness or a mental de?ciency that makes me incapable of realizing or making rational decisions about ?nances. Disability. My physical disability causes me to be unable to participate in a brie?ng in person, by phone, or through the internet, even after I reasonably tried to do so. El Active duty. I am currently on active military duty in a military combat zone. If you believe you are not required to receive a brie?ng about credit counseling, you must ?ie a motion for waiver of credit counseling with the court. About Debtor 2 (Spouse Only in a Joint Case): You must check one: I received a briefing from an approved credit counseling agency within the 180 days before I ?led this bankruptcy petition, and i received a certi?cate of completion. Attach a copy of the certi?cate and the payment plan, if any, that you developed with the agency. I received a brie?ng from an approved credit counseling agency within the 180 days before i ?led this bankruptcy petition, but I do not have a certi?cate of completion. Within 14 days after you ?le this bankruptcy petition, you MUST ?le a copy of the certi?cate and payment plan, if any. I certify that I asked for credit counseling services from an approved agency, but was unable to obtain those services during the 7 days after I made my request, and exigent circumstances merit a 30-day temporary waiver of the requirement. To ask for a 30-day temporary waiver of the requirement, attach a separate sheet explaining what efforts you made to obtain the brie?ng, why you were unable to obtain it before you ?led for bankruptcy, and what exigent circumstances required you to ?le this case. Your case may be dismissed if the court is dissatis?ed with your reasons for not receiving a brie?ng before you ?led for bankruptcy. If the court is satis?ed with your reasons, you must still receive a brie?ng within 30 days after you ?le. You must ?le a certi?cate from the approved agency, along with a copy of the payment plan you developed, if any. If you do not do so, your case may be dismissed. Any extension of the 30-day deadline is granted only for cause and is limited to a maximum of 15 days. I am not required to receive a brie?ng about credit counseling because of: Incapacity. have a mental illness or a mental de?ciency that makes me incapable of realizing or making rational decisions about ?nances. El Disability. My physical disability causes me to be unable to participate in a brie?ng in person, by phone, or through the internet, even after I reasonably tried to do so. CI Active duty. I am currently on active military duty in a military combat zone. If you believe you are not required to receive a brie?ng about credit counseling, you must ?le a motion for waiver of credit counseling with the court. Of?cial Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 5 Case Doc 1 Filed 08/08/16 Page 6 of 37 Case number (ifknowrl) thhewood Last Name Craiq First Name Waller These Questions for Reporting Purposes Debtor 1 Middle Name 16a Are your debts primarily consumer debts? Consumer debts are de?ned' in? 11 U. S. C. 101(8) 16. What kind of debts do you have? as ?incurred by an individual primarily for a personal family, or household purpose.? El No. Go to line 16b. a Yes. Go to line 17. 16b. Are your debts primarily business debts? Business debts are debts that you incurred to obtain money for a business or investment or through the operation of the business or investment. No. Go to line 160. El Yes. Go to line 17. 16c. State the type of debts you owe that are not consumer debts or business debts. 17. Are you ?ling under Chapter 7? Do you estimate that after any exempt property is a No. I am not ?ling under Chapter 7. Go to line 18. CI Yes. I am ?ling under Chapter 7. Do you estimate that after any exempt property is excluded and administrative expenses are paid that funds will be available to distribute to unsecured creditors? excluded and No administrative expenses are paid that funds will be '3 Yes available for distribution to unsecured creditors? 18. How many creditors do a 149 CI 1,000?5,000 CI 25,001-50,000 YOU estimate that you CI 50-99 El 50001-100900 Cl 100-199 El mom-25,000 CI More than 100,000 Cl 200-999 19. How much do you El Cl $1,000,001-s1o million CI billion estimate your assets to be worth? El El million El million million CI million El billion CI billion More than $50 billion 20. How much do you estimate your liabilities to be? We" Below CI El a El million El million El million El million El $100,000,001-ssoo million billion El billion CI billion More than $50 billion I have examined this petition, and I declare under penalty of perjury that the information provided is true and For you correct. If I have chosen to ?le under Chapter 7, I am aware that I may proceed, if eligible, under Chapter 7, 11,12, or 13 of title 11, United States Code. I understand the relief available under each chapter, and I choose to proceed under Chapter 7. If no attorney represents agree to pay someone who is not an attorney to help me ?ll out this document, I have obtained and read the notice required by 11 U.S.C. 342(b). request relief in accordance with the chapter of title 11, United States Code, speci?ed in this petition. I understand making a false statement concealing property, or obtaining money or property by fraud in connection with a bankr tcy cas- can result' In ?nes up to $250 000, or imprisonment for up to 20 years, or both. I 06 7.0 I MM IDD Executed on . xecutedon 09 (08312010 DD Voluntary Petition for Individuals Filing for Bankruptcy Of?cial Form 101 page 6 Case Doc 1 Filed 08/08/16 Page 7 of 37 Craig First Name Debtor 1 For you if you are filing this bankruptcy without an attorney If you are represented by an attorney. you do not need to file this page. Of?cial Form 101 Middle Name Bythewood Last Name Case number (rfknown~wsm The law allows you, as an individual, to represent yourself in bankruptcy court, but you should understand that many people find it extremely dif?cult to represent themselves successfully. Because bankruptcy has long-term ?nancial and legal consequences, you are strongly urged to hire a qualified attorney. To be successful, you must correctly ?le and handle your bankruptcy case. The rules are very technical, and a mistake or inaction may affect your rights. For example, your case may be dismissed because you did not ?le a required document, pay a fee on time, attend a meeting or hearing, or cooperate with the court, case trustee, U.S. trustee, bankruptcy administrator, or audit ?rm if your case is selected for audit. If that happens, you could lose your right to ?le another case, or you may lose protections, including the bene?t of the automatic stay. You must list all your property and debts in the schedules that you are required to ?le with the court. Even if you plan to pay a particular debt outside of your bankruptcy, you must list that debt in your schedules. If you do not list a debt, the debt may not be discharged. if you do not list property or properly claim it as exempt, you may not be able to keep the property. The judge can also deny you a discharge of all your debts if you do something dishonest in your bankruptcy case, such as destroying or hiding property, falsifying records, or lying. Individual bankruptcy cases are randomly audited to determine if debtors have been accurate, truthful, and complete. Bankruptcy fraud is a serious crime; you could be fined and imprisoned. if you decide to ?le without an attorney, the court expects you to follow the rules as if you had hired an attorney. The court will not treat you differently because you are ?ling for yourself. To be successful, you must be familiar with the United States Bankruptcy Code, the Federal Rules of Bankruptcy Procedure, and the local rules of the court in which your case is ?led. You must also be familiar with any state exemption laws that apply. Are you aware that ?ling for bankruptcy is a serious action with long-tenn ?nancial and legal consequences? No El Yes Are you aware that bankruptcy fraud is a serious crime and that if your bankruptcy forms are inaccurate or incomplete, you could be ?ned or imprisonedagree to pay someone who is not an attorney to help you ?ll out your bankruptcy forms? mNo CI Yes. Name of Person Attach Bankruptcy Petition Preparer?s Notice, Declaration, and Signature (Of?cial Form 119). By signing here, I acknowledge that I understand the risks involved in ?ling without an attorney. I have read and understood this notice, and i am aware that ?ling a bankruptcy case without an tor 1 xSignatLg/e Mr 2 V5703 LP Date 2 DDI Contact phone 8 'bqiw 8:5 613' 534% MMIDD Contact phone a (E 1? 8 (3y tic)?? 09 4 0 Cell phone Cell phone Email address Voluntary Petition for Individuals Filing for Bankruptcy Case Doc 1 Filed 08/08/16 Page 8 of 37 Fiil in this information to identify your case and this filing: Delorj: ale deb?ale. La??aie Dejorzj :EbCBezlff?lingD Firstil a' e. Middlel?. al el Lasm a- :nited :tates no j?br??le: Middle District of Florida . El a? ended f?ling Of?cial Schedule AIB: Property 12:15 In each category, separately list and describe items. List an asset only once. If an asset ?ts in more than one category, list the asset in the category where you think it ?ts best. Be as complete and accurate as possible. If two married people are ?ling together, both are equally responsible for supplying correct information. If more space is needed, attach a separate sheet to this form. On the top of any additional pages, write your name and case number (if known). Answer every question. ?Describe Each Residence, Building, Land, or Other Real Estate You Own or Have an Interest In 1. Do you own or have any legal or equitable interest in any residence, building, land, or similar property? 21 :o.D:oIoJEart2. What is the Chew?mattjy' Domotnedltsecjedelaijsprerea CI Din leCiaIZIil ho:e theaaomtmfanyseca-edmaijsnn Schedule D: 9 . . 1.1. Cttijhitiijlding OWNS Who Have Claims Secured by Pinned)!- jtreetaddressjfalila . C?"d?e ??95 Miami-?awe Current value of the Current value of the Man [factEred brmojlehoze entire property? portion you own? CI Land jnanjjmaizajm :3 ?nest: entED?ojerty eShare Describe the nature of your ownership aea. a egg at ?g g? Interest (such as fee tenancy by ?her mm 31er33 WT 4433 the entireties, ora life estate), if known. Who has an interest in the property71l3hecj?neDori] only: 4441433 44;:77 :7777.li]]aa77777 003W DeZtorZConly: Cl Denorj Check if this is community property See instrictionsj Other information you wish to add about this item, such as local property identi?cation number: C?fyojbwn ErhaZeTJ] ore ?than What is the property? Checglmamjy' :lions 1133 ilyjho? thefajommfanyaecjedllaijsmn Schedule D: 1.2. - - - Creditors Who Have Claims by Properti- a Condo- "?35 ?rmware"? Current value of the Current value of the Maanactj?edI'lrIJojlei?oEe entire property? portion you own? Land EC CI 3.3 eshare Describe the nature of your ownership City_ Zitateu -a Coded El interest (such as fee simple, tenancy by the entireties, or a life estate), if known. Who has an interest in the property?IL?hechne_ DeEtorZ'i DnlyE 44? Dejor2Dnly: CI 3m! Delor??nly Cl Check if this is community property Seemstr?ction? Other information you wish to add about this item, such as local property identi?cation number: Ef?cialilior: 3065/3 Schedule AIB: Property age 1 3 i Delor] Filed First?! a; e: Middleil a: Lastci ar What is the :tions.:u:tj ?in letfai iI mo? theamomtfofanyaecjed?lai?sm Schedule D: 1.3. ?4 Creditors Who Have Claims Secured by Property. :tionj DjCle Dim Dtimitmtildmg - - Current value of the Current value of the oEeratIEe . condSL imam term entire property? portion you own? 33* 233:3332 Man actjedmrio Land have A as- as mLestEentECro :erty CI joeshare Describe the nature of your ownership C'ty? interest (such as fee simple, tenancy by El the entiretieS? or a life estate), if known. . 7 31:? 1?interest In the property713hecjbneji ?33 j: :13 44 333 3333 j] CI Begum C0 :nty De De 30m Check if this is community property Etleastmne Cof?heile Dorsiand another $865115" ltions: Other information you wish to add about this item, such as local pr0perty identi?cation number: 2, Add the dollar value of the portion you own for all of your entries from Part 1, including any entries for pages you have attached for Part 1. Write that number here; 3 ?Describe Your Vehicles Do you own, lease, or have legal or equitable interest in any vehicles, whether they are registered or not? yoaxiwn IhatBoi: eone?lseiilri?es. :?wo ?chedule G: Executory Contracts and Unexpired Leases. 3. Cars, vans, trucks, tractors, sport utility vehicles, :0 El Des 31, Male: Wh? has an interest in the Bhecjbne- 1ions.:Dth a a meal Schedule D: Modem EME313273 a De Creditors Who Have Claims Secured by Property. 2031*; DeEtorQIanyE Deana we Jae?4333? CI De:tor:1 3ndDe jammy Current value of the Current value of the a .. this, entire ro ortion ou own? CajoanteiLi El Enother rty thethforZ ation I CI Check if this is community property See instrEctionsD :?jyoniwn ?rmialem ore Ihan BneDIlescriEehereE: 32 Who has an interest in the property?iChecIone.: Dommedmmjed?amsmagj 10,1833] . the} :3 oj'itlfanyiseched Idai :i ston Schedule D: Model? a De only; Creditors Who Have Claims Secured by Property. Delor2 only: Ueaf?? ggj?ge?l?l CI eEtorj and Belem Dnly Current value of the Current value of the ateUD ileage $4433: iZl Canother entlre property? portlon you own? Dtherinfor? ation: W7 Check if this is community property See mam??g? mmjm?::? instrErztions Of?cial Form 106MB Schedule NB: Property Cage 2 i I :erElr De :torj e? Middlei! a. at Last: at 3 3 jggimerj?: Who has an interest in the property? Ehecjmnej 30,1531] I a I the}: omtiefcanyaec?'edllaijsmn Schedule D: Model: M: De V4 Creditors Who Have Claims Secured by Property. 293:5 Bear: 44 43:33 Current value of the Current value of the De [torn and [De :tor[2 manly entire property? a ortion ou own? 5303 2 ate 3 ileage @9323: ll Etherinfor: ation Check if this is community property Bee 3 Ma}: Who has an interest in the property713hecj?nej Domot?edmmjedmainsbrag? '4 meaaomtwanyeecjedmaijsmn Schedule D: Model: 945%: De Storm Dnlyu Creditors Who Have Claims Secured by Property. 203% A 39am 444 3333:? Current value of the Current value of the El DeitorEI and entire property? ?m?j?ggiggj Um?oCiE ate I ileage portion you own? therihfor: ation I i ., CI Check if this is community property 3ee a Watercraft, aircraft, motor homes, ATVs and other recreational vehicles, other vehicles, and accessories Examples::Boats :?'ailers?m dresselsEBnow: ojlesE El :0 :es Model Ea :133133333133311: Dearim 2:333:33: Etherihfor: ationE 1301mm ore Ihan Kine DIlstIIere: 32 Ma 3313 Model Cl: 3:133:333333333: [rear]: 22313133331: :therEnfor: ation: Of?cial Form 106MB Who has an interest in the 10,1533: DeCtorj Dnly: DeCtorEZImlyE Delorj 3nd?De10ri2I>nly CI Check if this is community property Bee Who has an interest in the De?or] Itnly: Dettor-IZDnIyE Deitorj 3nd?3e30r?23nly El Check if this is community property See instertionsE 5. Add the dollar value of the portion you own for all of your entries from Part 2, including any entries for pages you have attached for Part 2. Write that number here 9 Schedule NB: Property BlaiZIsEon Schedule D: Creditors Who Have Claims Secured by Property. Current value of the Current value of the entire property? portion you own? Domotiledictsecjediclaij spa}: :tions. 313:] the}: mail Schedule D: Creditors Who Have Claims Secured by Property. Current value of the Current value of the entire property? portion you own? large 3 a a 3' i e= Middleal a? el Lastl] a! Deloril ?Describe Your Personal and Household Items Filed 08/ Do you own or have any legal or equitable Interest in any of the following items? 6. Household goods and furnishings :DCliances and fjnitCre 7. Electronics Current value of the portion you own? Dohot?edibtaecjeditlaij s] 03:19:] :tions. Examples'jele?sionsandTadios [la Edio [Unideo :Btereo [land fligital BEE D: entZBoD [liters DYLJ'inters Scanners SHED [sic Ehones??a erasIm edia?ayersIgaC es? Cl :0 Zes-meSC?iDB-j Delejsionsim: D?ersDDintersEcannersicell :hones :Dacmjajo?m 8. Collectibles of value Examplesi?ntiDEesmnd mmtherart?i?cts? sta e: ora?lia?hollecti :les? El :0 Cl jesmescriie. 9. Equipment for sports and hobbies I EQDDEZJDDECJDCECZJEC Examples? j?hotogra Ehicl?EerciseEnd Itherho 3: mool Ia Jes :golfml 3:519 :isUItanoes andiiayaCSCEarEentryEfoolsEm Esicalihstrilj :o WW .. WW . 10. Firearms Examples: Eistols :?i?es 3hotg :nsJE: Enition [and melatediemi CG ent in :o El 25:13: 11.Clothes Cl :0 a Des?mescriEE-Jn-m Eeyday clothes and accessories 12. Jewelry I Eles?E?EErydayE?welryIEost?C e?welryj?ngageE entEEingsl?vedding Iings meirloo: fewelryiwatchesige: 33 gold :siIEr CI jes. :DescriZe. a wedding :and 13. Non-farm animals El :0 WW. El 13:52:31.5:ij - 1 .Any other personal and household items you did not already list, including any health aids you did not list 330 CI :es. CiEBlSCeci?c inforC ation. I 15. Add the dollar value of all of your entries from Part 3, including any entries for pages you have attached for Part 3. Write that number here Of?cial Form 106MB Schedule NB: Property 9 :age 4 Case 8:1 - 6784-R Deilorji] :4 41231313:431131:213 Hmura.e' Humane e1 ale ?Describe Your Financial Assets 3333134333 4: Filed 08/ Do you own or have any legal or equitable interest in any of the following? 16. Cash Q0 Ermalletmh 190311110: eEIniaBafe lie Qo Elle yojtetition 121:0 :es: 17. Deposits of money Cash 111 3 Examples: Checjng [tormtheri?nancial mcoomts Cherti?cates ?f?ezbsit?hares in mreditEEnions [EroL?ErageZhoLsesD and [other 3i ilarinstititions. 3130 :iha 3 Elti :le Ecco :hts mvith Ihe jhstitEtion :?st?ach. [3:0 17.1. Chec?ngaccomtmj 17.2. Chec?ng Eccojnt?l?i 17.3. :a?ngs?ccocnti?m 17.: :ajngs?ccomt?m 17.5. Certi?catesE?fIieEbsit: 17.6. :therjinancial?ccomt?? 17.7. :therj?nancial?ccoEntIEE 17.8. :theri?nancialaccoihtim 17.9. :ther?nancial?ccothtim 18. Bonds, mutual funds, or publicly traded stocks listitZIion 11Tl?11 DEJSD HIM Examples: Bond fest: [his Evith Etro Darage ?rm 5 oney ar?tacco Current value of the portion you own? Do?otIdedibtzseCCredBiai] 5:1 eaten fiions. 33135333533555335: EDEECJZEDZEJEDEZZJI :0 :es: =111411 117? 1111411711111 111 ?li; 17144 111 1H ?11 1UJ1 W711 ?11 jgg::jg1j?:jgj::jjgj 1111 111? 111 17:1: JJ 111? 19. Non-publicly traded stock and interests in incorporated and unincorporated businesses, including an interest in an LLC, partnership, and joint venture 30 13a:e:?fentity1?u ?f?wnershi?: gesJuE-BBEem1:1 InforC ation a that 1 1 1 11441 :1qu 1144: . 1 1 1 1771 1: Of?cial Form Schedule AIB: Property :13 :age 5 De Jorj MmmyIa a Hmmaia La?HaIe 20. Government and corporate bonds and other negotiable and non-negotiable instruments Negotiable instruments incl EdeIersonal [checis mashiersl?hectsmoc issorymotes [Landau oneyforders. Non?negotiable instruments are nose $10 Emannotm'ansferito 30E eone CEyBignIng Dri?eh :ienng Ihe . a :o :Ies?jiZBECeci?c inforD ation?tp?i them EsEerIIaCef: . I 1J4217 '43] I I i i77721. Retirement or pension accounts Examples??terests ?h I 3 E?ieogh m3 DrEEro?tBharing [Mans :0 CI :es. [List?ach acco EntSemrately. :Iy?e?f?cco :ntm] listitjion Eta e13 331:1]w3i3ilarjan: 777 I I use; I 77777 I I I I - I :ensionjan?7177 7773:: :11jetireientaccojntP7777 :Ieoghjl Edditional 3000 :ntE jdditional?ccojwt: HI JII 22. Security deposits and prepayments UoJBhare Ila Dosits ade BoIhatjo DJ: ay?ontin :eBerjce Wise Era: 3330: Ceny mications co: :0 CI jes: InstitEtion ebrihdijd :iaIE Electricjli I II II II II 73:: :as: jeatingDiII Mg Filed O8/Q?glgj ZEDDCEZDEDCIJDBEZJHC DEUCEZUHCDZIZD ZZIJE HIDDEIZDDICZCEC 23D: 4* jreiidi?ent: UH I I?ll I 777:: :elej?lone: Iili: 1777 :ater: I?Ijj: HEWI?rrenw?w.? IIJJI ing? I133: Tw?l??liwwjr?u? :ther: 23. Annuities Eiontractifora Eeriodicliayj entbf?: oneyitojio ??either?orjife mrmranij :emfyears: 21:0 Des: Of?cial Form 106NB Schedule NB: Property [age 6 De :tor :1 1 i I ?shiale? MMdh?a.ei La?haie 2: Interests in an education lRACin an account in a quali?ed ABLE program [Dr under a quali?ed state tuition program. 26110573330331: 3 91:0 CI 585]] 3 ?stitEtionizta: e?nd Ilescri 1 D1. @521 CUE: i 25.Trusts, equitable or future interests in property (other than anything listed in line 1), and rights or powers exercisable for your bene?t El El :0 :es. i323 Cecilio inforE ationaio?ithe: 26. Patents, copyrights, trademarks, trade secrets, and other intellectual property ExamplesSiDternetEdoE ain Ila: es me 3ites Eoceeds Ciro: royalties {and licensing Egree ents 23:0 CI inforE ationiaio?ithe: 27. Licenses, franchises, and other general intangibles ExamplesiBEilding ?ner: :siDejicenses moo :erati :e?ssociation [Defessional [licenses Cl :0 :esEiEBEeci?c infor: ationEZOEtIhej .3. Money or property owed to you? 28.Tax refunds owed to you Ell :0 jes. :iE?Ebci?cEnforE ation azomhe: ede'a' yo Dalready [?led [the TetErns State] and IheIa?earsL Local 29. Family support Examples: East? 39mm D3 :3 [Elli 3353mm aintenancei?iforce Bettlem entmoEertysettieE ent :o :es.EiEESZeci?cjnforDa?onJ 7 i :H:ony: Maintenancem :zjjort: DijorceBettlejentZU :rojerty Bettiejentll: 30. Other amounts someone owes you Examples-Entaid mages??isa Ulityinszrancelay: entsmisatilityl?ene?ts Tsicj?aymcation maymortersmo: insationm Docial mec Erity?Eene?tsUEh :aid loans adelfoSo: eonejelse El 30 :tstanding owed Dy cistozer Of?cial Form 106MB Schedule AIB: Property ICES: CEDZEIEDCZLUC IUEECJIGDIIZEUCCIJIC - IDUZCEDZ 33755:]: Current value of the portion you own? Do?otiledtblisec??edj claij small lions. ZEDUEEZIJDEZJZEDC: ZJIDDCIIEDZZIUDZI: 4w Sage 7 11.3% (36139811 Filed w: First11 a1 a. Middle11a: e1 Last11'al Deltorj 3 31. Interests in insurance policies Examples: :ealth misa?lity, or?ife [ins :rance :health 3a Cingsiacco Ehredittmo eownerl Eoriienters?hs :rance 21:0 :es?la: eEtheIhsD'anceBo: Cany Co: Bene?ciaryDE #4331334333317 1111 111. ~111 1! 11 11111 11111 133: :771 . 111 11113777 JEDDZEZDUECZDEEZZJU: T711 1113:1173- 1111-1-1111111111111 ?111 1113::311 32. Any interest in property that is due you from someone who has died Erojerty?ieca [Be 30D eonemas?ied. :o . El jest: iEBEeci?clIhforD ation.3 31 wag?vs 33. Claims against third parties, whether or not you have ?led a lawsuit or made a demand for payment Examples: Iccidents?e: :loyE entlisJCIesEInsCrance Blai s?br?ghtsIDBDe :0 ?hkw 3:0" En j'd 'n :Olces 3: Other contingent and unliquidated claims of every nature, including counterclaims of the debtor and rights to set off claims a :o -- CI Jes.DescriC53ach BlaiE .: .. ., . 35. Any ?nancial assets you did not already list a :0 .--WWH . - Mm.? .. . -.. :es. :ijleBZeci?cTnforDation 36. Add the dollar value of all of your entries from Part 4, including any entries for pages you have attached for Part 4. Write that number here 9 Describe Any Business-Related Property You Own or Have an Interest In. List any real estate in Part 1. 37. Do you own or have any legal or equitable interest in any business-related property? a Current value of the portion you own? Donot?edECtBecjednlaijsj or?te? :tions. 38.Accounts receivable or commissions you already earned a :0 jes. Descrig1m? A 7 A A - 39. Of?ce equipment, furnishings, and supplies ExamplessBISinessjelated 110 ?emmoftware: ode: smintersjto jersjla: achines :lces :o a Ses.Descri:e: coi DZters Djinters Eco jermf?ce fjnitje Of?cial Form 106MB Schedule NB: Property Sage 8 062:0er - ?QZIgjg-EWBTg?hngl Filed jerEIQoggj I I FirstII a! e. MiddleII a. at Last! ai I). Machinery, ?xtures, equipment, supplies you use in business, and tools of your trade 53:0 :1.lnventory :0 .- Cl Interests in partnerships orjoint ventures :o :es.IDescriZe2 :aCIeDfEntity:2312223: is j??32nnTr?Tj?ri?m?r 2C I II 2:33:22]: Customer lists, mailing lists, or other compilations :o CI your lists include personally identi?able information Easjle?nedinjes. Descrije. :3 Any business-related property you did not already list :0 Cl Des. menaci?c . . 117772771332II: HII IIMI: I -.II 35. Add thedollarvalue ofall of ourentriesfrom Part 5, includin an entriesfor a es ou haveattach . 9 9 ed EDEZUJDEQM for Part 5. Write that number here :9 Describe Any Farm- and Commercial Fishing-Related Property You Own or Have an Interest In. If you own or have an interest in farmland, list it in Part 1. 13. Do you own or have any legal or equitable interest in any farm- or commercial ?shing-related property? LE jo?oIbEIEartj. jesiolb?lne??i'. Current value of the portion you own? Donot?edmtsecjednlaijsj oriiej :tions. jr. Farm animals Examplesjlli EestocEmIID ?tryEfarj Raised [fish :o "wwm22m?2mm-mm? Of?cial Form 1061MB Schedule AIB: Property Rage 9 Ligammg?j??a??}: 1 Firsm a e: Middlell a ei Lastli al a Delorj 3. Crops?either growing or harvested :o i inform ationj g. - .. - W: 3. Farm and ?shing equipment, implements, machinery, ?xtures, and tools of trade :0 Wt :es: 50. Farm and ?shing supplies, chemicals, and feed a :o - - - :es: '7 A .. 51.Any farm- and commercial ?shing-related property you did not already list a :0 Les. :iJeBEeci?c inforEation: 52. Add the dollar value of all of your entries from Part 6, including any entries for pages you have attached for Part 6. Write that number here 9 Mesquite All Property You Own or Have an Interest in That You Did Not List Above 53. Do you have other property of any kind you did not already list? Examples: Season Iicjetslo :ntry El :14: :ershi i Ie TT?l:es. :iCeBCeci?c inforC ation. 5: Add the dollar value of all of your entries from Part 7. Write that number here 1 9 UBCEDDCICUDCUI Part 8: List the Totals of Each Part of this Form 55. Part 1: Total real estate, line 21 -) 0'00 55. Part 2: Total vehicles, line 5 57. Part 3: Total personal and household items, line 15 58. Part 4: Total ?nancial assets, line 36 59. Part 5: Total business-related property, line 45 60. Part 6: Total farm- and ?shing-related property, line 52 61. Part 7: Total other property not listed, line 54 62. Total personal property. Dddjines?elhrogh gsmz??EQQ?Qc :zaammjj?mamg?gg: 63. Total of all property on Schedule AIB. Edd Of?cial Form 106MB Schedule NB: Property eCoDymersonalmoCertontai? cu? Sage 10 Case Doc 1 Filed 08/08/16 Page 18 of 37 Fill in this information to identify your case: Deitorlil First?: a: e' MiddleII'af e: LastII a DeZtornj Fil'S1li'aI e: Middlell a: Lastll.a Middle District of Florida i3! 8 I I?lIllI . ET ww UCheckIfthISIsan amended ?ling Of?cial Schedule D: Creditors Who Have Claims Secured by Property 12:15 Be as complete and accurate as possible. If two married people are ?ling together, both are equally responsible for supplying correct information. If more space is needed, copy the Additional Page, ?ll it out. number the entries, and attach it to this form. On the top of any additional pages. write your name and case number (if known). 1. Do any creditors have claims secured by your property? :o?ihecDIhis?o?andBEl?: itmtisiorlj IbIheiojtmrith El jes?Fillihallbf?heInfor: ationE-"elow. List All Secured Claims Calm A 3 . Column 8 Cohrmn 2. List all secured claims. ma Ireditormas?? oreifhan [DneIBecD-ed [claim mismhe mreditor?seljarately mm of claim yam. of ooitaterai 0mm forIach Wail] Milli] orelthan Dodid?ed?d?n?'v? mg supports this portion Dem] Cchl?st?bssi?emistt?temlaiij s?hBlEha e. claim - . I..- Describe the property that secures the claimInna CreditorBEIEaZeD Dtreet: As of the date you ?le, the claim Contingent Cityj :?tateC DisIled Who owes the debt?IBhec33neI: Nature of Iien.3:hecjalljhata:jy. 0830?] hnly: Dejor2bnly: carlbanj Delorj CI El El :Edg:ent]1enrro: 319??th jiing 3 TightID offset CI Check if this claim relates to a community debt Date debt was incurred (38/26/0201 Last 4 digits of account number DEEMEDEJEJEDEJ: I_l2.2 wwj?iW-mm?mw Describe the property that secures the claimCreditorEEiDaZeD meetthe date you ?le, the claim Contingent 3""33dated City: State: :mmode Who owes the debtmhecmne- Nature of lien. checjaIImatajjy. a jn?gree: entyo ade332h as: ortgageDrBecjed: CI carIoanE jtatIloryJIen :3 33h 3513 echanichienI Idg: entJIen 3 :ding Bright Delorj El Check if this claim relates to a community debt Date debt was incurred 05/05/0201 Last 4 digits of account number Add the dollar value of your entries in Column A on this page. Write that number here: 33113313123311 Of?cialfor: 3060 Schedule D: Creditors Who Have Claims Secured by Property 33er NUDE: .. Case Doc 1 Filed 08/08/16 Page 19 of 37 Dejor1 Case hum jar IE known Firstl ame Middlel ame Lastl ame Additional Page . Amount of claim 7 Value of collateral Unsecund After listing any entries on this page, number them begInnIng 2.3, followed ?Wm portion by 2.4, and so forth. mug arm, claim . Many 3333 Describe the property that secures the claim: CreditorE Same i Dum:er 3treet J33 As of the date ?le, the claim is: Check all that a33y. W33T37313232gi3gal1lg?jj C?ntingent City 3tate 3n? Code 3n i31idated El Dis :uted Wh? owes the debt? Check one. Nature of lien. Check all that a::ly. Dejor 1 only El An agreement you made Such as mortgage or secured De10r2 only car loan: Dejor 1 and Dejor 2 only 3tatutory lien Such as tax lien, mechanicE lien3 At least one of the de Jors and another ll 3.Id9ment lien from a lawsuit Cl Other including a right to offsethII CI Check if this claim relates to a community debt Date debt was incurred Last 4 digits of account number 33: 333 333 . W?j?m33333333333w333 Describe the property that secures the claim: 3W CreditorE Dame I 3333 EumEBr Dtreet Wintar As of the date you ?le, the claim is: Check all that ajjy. - El Contingent 3nli31idated City 3tate Code Disllted Who owes the debt? Check one. a Delor1 only Nature of lien. Check all that ajjy. a An agreement you made Such as mortgage or secured a Dejor2 only car loan3 a De :tor 1 and De :tor 2 only El jtatutory lien Such as tax lien, mechanicS lien: At least one of the de:tors and another mdgment lien from a lawsuit Cl Other Including a right to CI Check if this claim relates to a community debt Date debt was incurred Last 4 digits of account number 33: 333I :33 Imeu?wst?l?B?Q?-Qtal?Tsm?ms?w Describe the property that secures the claim: ?3333?35339ng I I I I I - 3333 I Il I CreditorE E:ame ., I, ll 3treet As of the date you ?le, the claim is: Check all that a33y. I- Contingent City mm 33? Code CI 3nlimidated Cl Dismted Who owes the debt? Check one. Nature of lien. Check all that a33y. De:tor 1 only An agreement you made Buch as mortgage or secured De:tor 2 only car loan3 Dejor 1 and Dejor 2 only :ltatutory lien Such as tax lien. mechanic} lien3 At least one of the dejors and another mdgment lien from a lawsuit Other including a right to offset:2333333Z3333I33333: Check if this claim relates to a community debt Date debt was incurred Last 4 digits of account number I33 33C :33 333 Add the dollar value of your entries in Column A on this page. Write that number here: If this is the last page of your form, add the dollar value totals from all pages. Writs thatnumber. here: Of?cial Form 106D Additional Page of Schedule D: Creditors Who Have Claims Secured by Property Ege 33: of CD Case 8:1 -bk- 6784-RCT Doc 1 Filed 08/08/16 Page 20 of 37 DeDor1 L?j?mliwliilmw .iann?mwuj?l?g?h?waad- liil 3:371 .im mm Firsti ame Middlei arne Last! ame f3 List Others to Be Noti?ed for a Debt That You Already Listed Use this page only if you have others to be noti?ed about your bankruptcy for a debt that you already listed in Part 1. For example, if a collection - agency is trying to collect from you for a debt you owe to someone else. list the creditor in Part 1, and then list the collection agency here. Similarly, if - you have more than one creditor for any of the debts that you listed in Part 1, list the additional creditors here. If you do not have additional persons to be noti?ed for any debts in Part 1, do not fill out or submit this page. On which line in Part 1 did you enter the creditor? BEDS: Ii 1. Wm. :ame Last 4 digits of account number DC: EDI: EDD :um:er :treel !1u_ City jtate Code my? 4 .t ,w 7 . ?mum? On which line in Part 1 did you enter the creditor? 35:3: ii li?'lii :ame Last 4 digits of account number DH: Elm ?iiliui-ili mil :um:er jtreet iilii imm ilii-_Llii wiw 1?1] lime City jtate :PCode On which line in Part 1 did you enter the creditor? 32E: luv, :ame Last 4 digits of account number C: DE: E3: TWTiMIHJJiIi?Iii"iinirili?ili' ilii-Jiiw-ili? am Jim :umEr :treet V-rliimirwi rm in? City :tate :PCode On which line in Part 1 did you enter the creditor? ICE: niliiuiliirmimii: :ame Last 4 digits of account number DC: 3 mm: :umjer :treet ?iliil:'i? Eli :"vww: On which line in Part 1 did you enter the creditor? DUDE: 1 li?ilii :ame Last4digits ofaccount number Di C3: .Iiili?liilii'zili'iili "ii! ilii? ili :um:er :treet ?iliililii. ii' ii .lii iil 1H iili ?iliil i?L Ii liil Jil ii? a I On which line in Part 1 did you enter the creditor:ame Last 4 digits of account number ?Iiil ii um i] .ii :um:er jtreet 3 imI 1m mummy mm Mme?mu 1m: JIM-mil: Iilii mm ilii mumm? City jtate :PCode Of?cial Form 106D Part 2 of Schedule D: Creditors Who Have Claims Secured by Property :age of Case Doc 1 Filed 08/08/16 Page 21 of 37 Fill in this information to identify your case: Deitori .in First ame Middle' ame Last1 ame Deaorz Cram 1 - if?ling: First: ame Middle: ame Last ame Snited States Bankru :tcy Court for the: Middle District of Florida CasenumEBr CI Check if this is an amended ?ling Official Form 106D Schedule H: Your Codebtors 12:15 Codebtors are people or entities who are also liable for any debts you may have. Be as complete and accurate as possible. If two married people are ?ling together, both are equally responsible for supplying correct information. If more space is needed, copy the Additional Page, ?ll It out, and number the entries in the boxes on the left. Attach the Additional Page to this page. On the top of any Additional Pages, write your name and case number (if known). Answer every question. 1. Do you have any codebtors? [HEyou are ?ling a bint case, do not list either sSouse as a codeEtor.S [0 CI Des 2. Within the last 8 years, have you lived in a community property state or territory? [Community property states and territories include Arizona, California, Elaho, Louisiana, Sefada, :ew Mexico, Puerto :ico, Dexas, Washington. and Wisconsin: [30. So to line 3. lSes. Did your sEouse. former sinuse, or legal eSJiSalent Ii} with you at the time: Ed :0 CI See. II which community state or territory did you lie: Fill in the name and current address of that :erson. Same of your sinuse. former sEbuse, or legal eEtiiEalent Sumter Street City State Sjl?Code 3. ln Column 1, list all of your codebtors. Do not include your spouse as a codebtor if your spouse is ?ling with you. List the person shown in line 2 again as a codebtor only if that person is a guarantor or cosigner. Make sure you have listed the creditor on Schedule (Official Form 106D), Schedule HP (Of?cial Form 106EIF), or Schedule (Of?cial Form 1066). Use Schedule D, Schedule or Schedule to ?ll out Column 2. Column 1: Your codebtor Column 2: The creditor to whom you owe the debt Check all schedules that 3.1 i ., Schedule D, line Same El Schedule line 3m}: Jtreet El Schedule line :35: . .bF?li'i?F? lli illi? l?l?l ii 3 City .. . State. . . ?PCosie. 3.2 [3 ScheduleD line 4 Same ga i . SS gChedUIeJF?llneSJJEh??S Sumsr meet El Schedule line ESSDUE Gilt .K ., late, .131? 00d? 3.3 - ll ll llE Schedule D, line Same 1 ?rm :lChedUIe lme ijLU? Sum :er Street BUD Schedule C, line 32mm City . ?ats- . . 3? Code Of?cial Form 106E Schedule H: Your Codebtors :age 1 of ED: Case 8: 16- _bk- 06784- RCT Doc 1 Filed 08/08/16 Page 22 of 37 Better 1 1 Case numkr I?kmwn'f?lf?m?mm??m First ame Middle1 ame Lash ame - Additional Page to List More Codebtors Column 1: Your codebtor Column 2: The creditor to whom you owe the debt Check all schedules that 3.3 El 1cheduleD,llne333I~E Same El Schedule DIF, line IDES-C arm; 11111111111111 11111 11113113551333: 1. 1 332%,- :1treet El Jchedule 1, line ., . ?gate . . .1 .1 Coda. a IcheduleDJineDjij: :ame Cl Schedule line 3353: ?ag, meet CI Jchedule D, lune UUJEDD City . . . .1 Date 139? Code 9? E1 Schedule D, line DEZDUE :chedule line SUEDE: Same 11111111111 :uml-r Street DUB Schedule E, line SEEDS City mate 3D DChedUleD line?jj??' :ame El jchedule :jF, line SEEDS: jumfer jtreet _?ChedUIe L, llne 11111 1 4 ,1 State 55?00?? 711111111111111111111 CI icheduleD line jame ga CI Schedule CIF, line . :umCer :treet a UCheduleC,llne LQJDUE City .1 :tate 1. my Code Dam-1111 11 1 1111 11 1111 1 1 11111111 1 Du llne Schedule line ZED: WW: 1?1111 WUFWWEH jum?er urea 13 Schedule C, IIne City?. . ., State . CF Code, I - Schedule D, line 1ame Schedule HF, line SUEDE: Sumter :treet CIEJD Schedule E, line 233113: City . Dtare. _EPCode Dame El Schedule :lF, line 33mm: . meet CI uchedule llne DIED: City State Of?cial Form 1061-1 Schedule H: Your Codebtors ?age of Cut-.5 ~55? Case Doc 1 Filed 08/08/16 Page 23 of 37 Fill in this information to identify your case: Dejor 1 First ame Middlel ame Last ame Delor2 fiatFIZZ: i?fl'Iling: FirstI ame MiddIeI ame Last ame jnited jtates Bankrujcy Court for the: Middle District of Florida Case numier . I I 31 knownD Check if this is? An amended ?ling Of?cial Form 106D Schedule I: Your Income CI A suCDement showing :ostEetition chatter 13 income as of the following date:I MM I 12/15 Be as complete and accurate as possible. if two married people are ?ling together (Debtor 1 and Debtor 2), both are equally responsible for supplying correct information. If you are married and not ?ling jointly, and your spouse is living with you, include information about your spouse. If you are separated and your spouse is not ?ling with you, do not include information about your spouse. If more space is needed, attach a separate sheet to this form. On the top of any additional pages, write your name and case number (if known). Answer every question. Mescribe Employment 1. Fill in your employment Debtor 2 or non-?ling spouse information. Debtor 1 ha} more than one attach a seElarate :age with information amut additional Employment status joyed em Eloyers, CI Cot em :loyed Itclude :Iartmime, seasonal, or selemjoyed work. Em Zloyed Dot em ?ayed Occupation OccuCation may include student or homemaker, if it aDjies. Employer?s name jI: Employer's address jg, :umier jtreet jumIBr :treet ill l-ll' ll-llJaaI'I iljtj:: IlIllI Ill dill ?-Ill ?1 ill Isa-City State Code City :tate Code How long employed there? 2 years 2 years Give Details About Income Estimate income as of the date you ?le this form. I you ha} nothing to reEbrt for any line, write CD in the s:Iace. Include your non ?ling smuse unless you are seDarated. I you or your nonjling sDouse haCe more than one em :loyer, comljne the information for all em :loyers for that Isrson on the lines Elow. I you need more stace, attach a seErate sheet to this form. 2. List gross wages, salary, and commissions Iefore all Eyroll deductionsEI i not [aid calculate what the wage would De. 2. 3. Estimate and list overtime pay. 3. For Debtor 1 For Debtor 2 or non-?ling spouse 4. Calculate gross income. Add line 2 line 3. 4. Dij?i??i?f) Of?cial Form 106C Schedule I: Your Income Cage 1 Case Doc 1 FirstI ame Midan ame LastI ame De Her 1 Copy line 4 here 9 4. 5. List all payroll deductions: 5a. Tax, Medicare, and Social Security deductions 5: Mandatory contributions for retirement plans 5c. Voluntary contributions for retirement plans 5d. Required repayments of retirement fund loans 5e. Insurance 5f. Domestic support obligations 59. Union dues 5h. Other deductionsAdd the payroll deductions. Add lines Calculate total take-home pay. :u [tract line 6 from line 4. 8. List all other income regularly received: 8a. Net income from rental property and from operating a business, profession, or farm Attach a statement for each Erojarty and msiness showing gross receiCts, ordinary and necessary msiness exienses, and the total net income. 8:1 Interest and dividends 5a8c. Family support payments that you. a non-?ling spouse, or a dependent regularly receive Iclude alimony, smusal su mm, child su?iort, maintenance, diiorce settlement, and :roDerty settlement. 8d. Unemployment compensation Be. Social Security at. Other government assistance that you regularly receive 8c. 8d. 8e. Iclude cash assistance and the Elue if known that any non mash assistance that you receiCe, such as food stamS Ilene?ts under the :u Djemental :Iutrition Assistance Programjor housing su :sidies. Cliecify? 89. Pension or retirement income 8h. Other income. jEBcifyI Add all other income. Add lines :89 8h. 10. Calculate income. Add line 7 I: line EL Add the entries in line 10 for Better 1 and DeEtor 2 or non ?ling sEbuse. 11. State all other regular contributions to the expenses that you list in Schedule J. 8f. 89. 8h. 10. Case numZer IrknownIJJsassJ For Debtor 1 DZDEEDCEQEQQ: Djajm?mm iazjamat?? Dianam?dd?: ai?aml?? BUZZDUDEZZDEIZ Filed 08/08/16 Page 24 of 37 For Debtor 2 or Immz?jaad?lm: ZJUDEJDDEEDUDU jj??mll?i?i 3D:M?jd?c amjjmam??ft Jamjj??i??j :Dzjamig?g?? El El ch?gmmg?g?? hclude contriCUtions from an unmarried Eartner, memEers of your household, your deEEndents, your roommates, and other friends or relatiies. Do not include any amounts already included in lines 21:10 or amounts that are not a:aila ?le to thy eernses listed in Schedule 12. Add the amount in the last column of line 10 to the amount in line 11. the result is the comEined income. Write that amount on the Summary of YourAssets and Liabilities and Certain Statistical Information, if it ajjies 13. Do you expect an increase or decrease within the year after you file this form? Do. 12. . majmaajja: Combined income Des. Dx?ain? Business Zack UZand resumed Of?cial Form 106i Schedule I: Your Income Sage 2 :a Case Doc 1 Filed 08/08/16 Page 25 of 37 Fill in this information to identify your case: pager 1 Firsti ame Middle ame LastI ame Deitor 2 Emuse. if?lingD FirstI ame Middle: ame LastI ame :nited jtates Bankru :tcy Court for the: Middle District of Florida Case num :Br 315 known El Check if this is an amended ?ling Of?cial Form 106Dec Declaration About an Individual Debtor?s Schedules 12,15 If two married people are ?ling together, both are equally responsible for supplying correct infomation. You must ?le this form whenever you ?le bankruptcy schedules or amended schedules. Making a false statement, concealing property, or obtaining money or property by fraud in connection with a bankruptcy case can result in ?nes up to $250,000, or imprisonment for up to 20 years, or both. 18 use 152, 1341, 1519, and 3571. Did you pay or agree to pay someone who is NOT an attorney to help you ?ll out bankruptcy forms? Des. :ame Attach Bankruptcy Petition Preparers Notice, Declaration, and Signature Df?cial Form 11:: Under penalty of perjury, dectare that have read the summary and schedules ?led with this declaration and that they are true and correct. 4? v] of Deitor1 jignaf?? De or Date Date 4133313213113: MMI DO I 30:: DDI IUD Meanwhaww V. madame.? ?steamsmw wage?: .- ?Amman >3 2433:1292 .V rum-mu "mum smasaw 1:224 Of?cial Form 106Dec Declaration About an Individual Debtor?s Schedules Case Doc 1 Filed 08/08/16 Page 26 of 37 Fill in this information to identify your case: Debtor 1 Lisa Dianne Bythewood First Name Middle Name Last Name Debtor 2 Craig Bythewood (Spouse, if ?ling) First Name Middle Name Last Name United States Bankruptcy Court for the: Middle District of Florida Case number (If known) Official Form 107 Statement of Financial Affairs for Individuals Filing for Bankruptcy Cl Check if this is an amended ?ling 04116 Be as complete and accurate as possible. If two married people are ?ling together, both are equally responsible for supplying correct information. If more space is needed, attach a separate sheet to this form. On the top of any additional pages, write your name and case number (if known). Answer every question. ?Give Details About Your Marital Status and Where You Lived Before 1. What is your current marital status? Married Not married 2. During the last 3 years, have you lived anywhere other than where you live now? El Yes. List all of the places you lived in the last 3 years. Do not include where you live now. Debtor 1: Dates Debtor 1 lived there 11205 Sunny Delight Court Number Street From 08114/2016 To 03/15/2016 Tampa FL 33556 City State ZIP Code From Number Street To City State ZIP Code Debtor 2: Same as Debtor 1 Dates Debtor 2 lived there Ed Same as Debtor 1 From Number Street To City Same as Debtor 1 State ZIP Code El Same as Debtor 1 From Number Street To City State ZIP Code 3. Within the last 8 years, did you ever live with a spouse or legal equivalent in a community property state or territory? (Community property states and territories include Arizona, California, Idaho, Louisiana, Nevada, New Mexico, Puerto Rico, Texas, Washington, and Wisconsin.) ENC CI Yes. Make sure you ?ll out Schedule H: Your Codebtors (Of?cial Form ?Explain the Sources of Your Income Of?cial Form 107 106H). Statement of Financial Affairs for Individuals Filing for Bankruptcy page 1 Case Doc 1 Filed 08/08/16 Page 27 of 37 Debtor 1 Lisa Dianne BytheWOOd Case number (ifknown) First Name Middle Name Last Name 4. Did you have any income from employment or from operating a business during this year or the two previous calendar years? Fill in the total amount of income you received from all jobs and all businesses, including part-time activities. if you are ?ling a joint case and you have income that you receive together, list it only once under Debtor 1. No Yes. Fill in the details. Sources of income Gross income Sources of income Gross income Check all that apply. (before deductions and Check all that apply. (before deductions and exclusions) exclusions) From January 1 of cun?ent year until Eva-(533' cimmissms' 3; 13,000.00 :vages? 6?.mmi55ions' the date you ?led for bankruptcy: onuses' 'ps onuses, 'ps Operating a business Operating a business For last calendar year' Wages, commissions, El Wages. commissions, bonuses. tips 3; 42,000.00 bonuses, tips 5 53,000.00 (January 1 to December 31.2015_._) Operating a business Operating a business For the calendar year before that: Ed Wages, commissions, Wages, commissions, bonuses, tips bonuses, tips 108,000.00 120,000.00 (January 1 to December Operating a business Operating a business 5. Did you receive any other income during this year or the two previous calendar years? Include income regardless of whether that income is taxable. Examples of other income are alimony; child support; Social Security, unemployment, and other public bene?t payments; pensions; rental income; interest; dividends; money collected from lawsuits; royalties; and gambling and lottery winnings. If you are ?ling a joint case and you have income that you received together, list it only once under Debtor 1. List each source and the gross income from each source separately. Do not include income that you listed in line 4. UNO Cl Yes. Fill in the details. Sources of income Gross income from Sources of income Gross income from Describe below. each some Describe below. each source (before deductions and (before deductions and exclusions) exclusions) From January 1 of current year until i the date you ?led for bankruptcy: For last calendar year: (January 1 to December 31 ,201 5 For the calendar year before that: (January 1 to December 31,2014 Of?cial Form 107 Statement of Financial Affairs for individuals Filing for Bankruptcy page 2 Case Doc 1 Filed 08/08/16 Page 28 of 37 Debtor 1 Lisa Dianne BytheWOOd Case number (i'fknown) First Name Middle Name Last Name List Certain Payments You Made Before You Filed for Bankruptcy 6. Are either Debtor 1?s or Debtor 2's debts primarily consumer debts? No. Neither Debtor 1 nor Debtor 2 has primarily consumer debts. Consumer debts are de?ned in 11 U.S.C. 101(8) as ?incurred by an individual primarily for a personal, family, or household purpose.? During the 90 days before you ?led for bankruptcy, did you pay any creditor a total of $6,429" or more? El No. Go to line 7. El Yes. List below each creditor to whom you paid a total of $6,425* or more in one or more payments and the total amount you paid that creditor. Do not include payments for domestic support obligations, such as child support and alimony. Also, do not include payments to an attorney for this bankruptcy case. Subject to adjustment on 4/01/19 and every 3 years after that for cases ?led on or after the date of adjustment. Yes. Debtor1 or Debtor 2 or both have primarily consumer debts. During the 90 days before you ?led for bankruptcy, did you pay any creditor a total of $600 or more? El No. Go to line 7. El Yes. List below each creditor to whom you paid a total of $600 or more and the total amount you paid that creditor. Do not include payments for domestic support obligations, such as child support and alimony. Also, do not include payments to an attorney for this bankruptcy caseDates of Total amount paid Amount you still owe Was this payment payment 3: Creditors Name a Mmgage Car Number Street Credit card Loan repayment Suppliers or vendors City State ZIP Code Other - Mortgage Creditor?s Name Car Number Street Credit card Loan repayment El Suppliers or vendors City State ZIP Code Other Creditor?s Name Mmgage Car Number Street Credit card Loan repayment Suppliers or vendors City State ZIP Code Other Of?cial Form 107 Statement of Financial Affairs for Individuals Filing for Bankruptcy page 3 Case Doc 1 Filed 08/08/16 Page 29 of 37 Debtor 1 Lisa Dianne BytheWOOd Case number (ifknown) First Name Middle Name Last Name 7. Within 1 year before you ?led for bankruptcy, did you make a payment on a debt you owed anyone who was an insider? Insiders include your relatives; any general partners; relatives of any general partners; partnerships of which you are a general partner; corporations of which you are an of?cer, director. person in control, or owner of 20% or more of their voting securities; and any managing agent, including one for a business you operate as a sole proprietor. 11 U.S.C. 101. Include payments for domestic support obligations, such as child support and alimony. MNO Yes. List all payments to an insider. Dates of Total amount Amount you still Reason for this payment payment paid owe insider?s Name Number Street City State ZIP Code Insider?s Name Number Street City State ZIP Code 8. Within 1 year before you ?led for bankruptcy, did you make any payments or transfer any property on account of a debt that bene?ted an insider? Include payments on debts guaranteed or cosigned by an insider. aNo CI Yes. List all payments that bene?ted an insider. Dates of Total amount Amount you still Reason for this payment payment paid owe ., lncludecreditorfs name Insider's Name Number Street City State ZIP Code Insider's Name Number Street City State ZIP Code Of?cial Form 107 Statement of Financial Affairs for Individuals Filing for Bankruptcy page 4 Case Doc 1 Filed 08/08/16 Page 30 of 37 Debtor 1 Lisa Dianne BytheWOOd Case number (ifknown) First Name Middle Name Last Name Identify Legal Actions, Repossessions, and Foreclosures 9. Within 1 year before you ?led for bankruptcy, were you a party in any lawsuit, court action, or administrative proceeding? List all such matters, including personal injury cases, small claims actions. divorces, collection suits, paternity actions, support or custody modi?cations, and contract disputes. No Yes. Fill in the details. Nature of the case Court or agency Status of the case Child Support a Case title Court Name Pendmg On appeal Number Street Concluded Case number City State ZIP Code 3 Case title Court Name Pending On appeal Number Street Concluded Case number City State ZIP Code 10. Within 1 year before you ?led for bankruptcy, was any of your property repossessed, foreclosed, garnished, attached, seized, or levied? Check all that apply and ?ll in the details below. No. Gotoline11. [2 Yes. Fill in the information below. Describe the property Date Value of the property McKenzie Capital 3; 300.00 :3 Creditor?s Name Number Street Explain what happened Property was repossessed. El Property was foreclosed. El Property was garnished. City State ZIP Code Property was attached, seized, or levied. Describe the property Date Value of the property C430 Mercedes Mercedes Benz Financiai 03/050016 40,000.00 Creditor?s Name .3 Number Street 3, Explain what happened Property was repossessed. Property was foreclosed. Pro City State Zip Code petty as garnished DUDE Property was attached, seized, or levied. Of?cial Form 107 Statement of Financial Affairs for Individuals Filing for Bankruptcy page 5 Case Doc 1 Filed 08/08/16 Page 31 of 37 Debtor 1 Lisa Dian ne Case number (ifknown) First Name Middle Name Last Name 11. Within 90 days before you ?led for bankruptcy, did any creditor, including a bank or financial institution, set off any amounts from your accounts or refuse to make a payment because you owed a debt? ?No Yes. Fill in the details. Describe the action the creditor took Date action Amount was taken Creditor's Name Number Street City State ZIP Code Last 4 digits of account number: 12. Within 1 year before you ?led for bankruptcy, was any of your property in the possession of an assignee for the bene?t of creditors, a court-appointed receiver, a custodian, or another of?cial? it No Yes List Certain Gifts and Contributions 13. Within 2 years before you ?led for bankruptcy, did you give any gifts with a total value of more than $600 per person? wNo El Yes. Fill in the details for each gift. Gift: with a totai value of more than $600 Describe the gifts Dates you gave Value per person the gifts Person to Whom You Gave the Gift Number Street City State ZIP Code Person?s relationship to you Gifts with a total value of more than $600 Describe the gifts Dates you gave Value per person the gifts Person to Whom You Gave the Gift Number Street City State ZIP Code Person's relationship to you Of?cial Form 107 Statement of Financial Affairs for Individuals Filing for Bankruptcy page 6 Case Doc 1 Filed 08/08/16 Page 32 of 37 Debtor 1 Lisa Dianne Bythewood Case number tirknown) First Name Middle Name Last Name 14. Within 2 years before you ?led for bankruptcy, did you give any gifts or contributions with a total value of more than $600 to any charity? a Yes. Fill in the details for each gift or contribution. Gifts or contributions to charities Describe what you contributed Date you Value that total more than $600 contributed 100 Bikes to disadvantaged children 12/15/2015 5,000.00 Charity?s Name Number Street City State ZIP Code List Certain Losses 15. Within 1 year before you ?led for bankruptcy or since you ?led for bankruptcy, did you lose anything because of theft, ?re, other disaster, or gambling? mm [It Yes. Fill in the details. Describe the property you lost and Describe any insurance coverage for the loss Date of your Value of prOperty how the loss occurred loss lost Include the amount that Insurance has pald. Insurance claims on line 33 of Schedule Property. List Certain Payments or Transfers 16. Within 1 year before you ?led for bankruptcy, did you or anyone else acting on your behalf pay or transfer any property to anyone you consulted about seeking bankruptcy or preparing a bankruptcy petition? Include any attorneys, bankruptcy petition preparers, or credit counseling agencies for services required in your bankruptcy. mNo El Yes. Fill in the details. Description and value of any property transferred Date payment or Amount of payment transfer was Person Who Was Paid . . . . made Number Street City State ZIP Code Email or website address Person Who Made the Payment. if Not You Of?cial Form 107 Statement of Financial Affairs for Individuals Filing for Bankruptcy page 7 Case Doc 1 Filed 08/08/16 Page 33 of 37 Debtor 1 Lisa Dianne BytheWOOd Case number (ifknown) First Name Middle Name Last Name Description and value of any property transferred Date payment or Amount of transfer was made payment Person Who Was Paid Number Street City State ZIP Code Email or website address Person Who Made the Payment. if Not You 17. Within 1 year before you ?led for bankruptcy, did you or anyone else acting on your behalf pay or transfer any property to anyone who promised to help you deal with your creditors or to make payments to your creditors? Do not include any payment or transfer that you listed on line 16. El Yes. Fill in the details. Description and value of any property transferred Date payment or Amount of payment transfer was made Person Who Was Paid Number Street City State ZIP Code 18. Within 2 years before you ?led for bankruptcy, did you sell, trade, or otherwise transfer any property to anyone, other than property transferred in the ordinary course of your business or ?nancial affairs? Include both outright transfers and transfers made as security (such as the granting of a security interest or mortgage on your property). Do not include gifts and transfers that you have already listed on this statement. II No Yes. Fill in the details. Description and value of property Describe any property or payments received Date transfer transferred or debts paid in exchange was made Person Who Received Transfer Number Street City State ZIP Code Person's relationship to you Person Who Received Transfer Number Street City State ZIP Code Person's relationship to you Of?cial Form 107 Statement of Financial Affairs for Individuals Filing for Bankruptcy page 8 Case Doc 1 Filed 08/08/16 Page 34 of 37 Debtor 1 Lisa Dianne BytheWOOd Case number (ifknown) First Name Middle Name Last Name 19.Within 10 years before you ?led for bankruptcy, did you transfer any property to a self-settled trust or similar device of which you are a bene?ciary? (These are often called asset-protection devices.) QNC El Yes. Fill in the details. Description and veins of the property transferred Data transfer was made Name of trust -Llst Cortaln Flnanclal Accounts, Instruments, Safe Deposlt Boxes, and Storage Units 20. Within 1 year before you ?led for bankruptcy, were any ?nancial accounts or instruments held in your name, or for your bene?t, closed, sold, moved, or transferred? Include checking, savings, money market, or other ?nancial accounts; certi?cates of deposit; shares in banks, credit unions, brokerage houses, pension funds, cooperatives, associations, and other ?nancial institutions. El No Yes. Fill in the details. Last 4 digits of account number Type of account or Date account was Last balance before instrument closed, sold, moved, closing or transfer 5 or transferred Name of Financial Institution CI Checking 3 Number Street Savings Money market Brokerage City State ZIP Code Other 5 Checking 5 Name of Financial Institution 4: Savings Number Street El Money market Brokerage Other City State ZIP Code 21. Do you now have, or did you have within 1 year before you ?led for bankruptcy, any safe deposit box or other depository for securities, cash, or other valuables? No Yes. Fill in the details. Who else had access to it? Describe the contents Do you still have it? I No i Name of Financial Institution Name Yes Number Street Number Street City State ZIP Code City State ZIP Code i, Of?cial Form 107 Statement of Financial Affairs for Individuals Filing for Bankruptcy page 9 Case Doc 1 Filed 08/08/16 Page 35 of 37 Debtor 1 Lisa Dian ne Case number (ffknown) First Name Middle Name Last Name 22. Have you stored property in a storage unit or place other than your home within 1 year before you ?led for bankruptcy? No Yes. Fill in the details. i Who else has or had access to it? Describe the contents Do you still have it? CI No Name of Storage Facility Name Yes Number Street Number Street CityStete ZIP Code City State ZIP Code Matty Property You Hold or Control tor Someone Else 23. Do you hold or control any property that someone else owns? Include any property you borrowed from, are storing for, or hold in trust for someone. No El Yes. Fill in the details. Where is the property? Describe the property Value Owner?s Name 5 Number Street Number Street City State ZIP Code City State ZIP Code Mm Details About Envlronmental Informatlon For the purpose of Part 10, the following de?nitions apply: i 2 I Environmental law means any federal, state, or local statute or regulation concerning pollution, contamination, releases of hazardous or toxic substances, wastes, or material into the air, land, soil, surface water, groundwater, or other medium, including statutes or regulations controlling the cleanup of these substances, wastes, or material. I Site means any location, facility, or property as defined under any environmental law, whether you now own, operate, or utilize it or used to own, operate, or utilize it, including disposal sites. I Hazardous material means anything an environmental law de?nes as a hazardous waste, hazardous substance, toxic substance, hazardous material, pollutant, contaminant, or similar term. Report all notices, releases, and proceedings that you know about, regardless of when they occurred. 24. Has any governmental unit noti?ed you that you may be liable or potentially liable under or in violation of an environmental law? mNo Cl Yes. Fill in the details. Governmental unit Environmental law, if you know it Date of notice Name of site Governmental unit Number Street Number Street City State ZIP Code City State ZIP Code Of?cial Form 107 Statement of Financial Affairs for Individuals Filing for Bankruptcy page 10 Case Doc 1 Filed 08/08/16 Page 36 of 37 Debtor 1 Lisa Dianne BytheWOOd Case number (ifltnown) At Firsl Name Middle Name Last Name 25. Have you noti?ed any governmental unit of any release of hazardous material? ENO El Yes. Fill in the details. Governmental unit Environmental law, If you know it Date of notice . . . . 2 Name of site Governmental unit 3 Number Street Number Street i i 3 City State ZIP Code City State ZIP Code 26. Have you been a party in any judicial or administrative proceeding under any environmental law? Include settlements and orders. mNo El Yes. Fill in the details. -. Court or agency Nature of the case Status Of the . case 5? Case title Court Name Pending On appeal Number Street Concluded Case number City State ZIP Code lee Detalls About Your Buslness or Connections to Any Buslnoss 27. Within 4 years before you ?led for bankruptcy, did you own a business or have any of the following connections to any business? El A sole proprietor or self-employed in a trade, profession, or other activity, either full-time or part-time El A member of a limited liability company (LLC) or limited liability partnership (LLP) '3 A partner in a partnership An officer, director, or managing executive of a corporation An owner of at least 5% of the voting or equity securities of a corporation No. None of the above applies. Go to Part 12. Yes. Check all that apply above and ?ll in the details below for each business. Describe the nature of the business Employer Identi?cation number Do not include Social Security number or ITIN. . VHU Express Inc Business Name . . 7853 Gunn Highway #181 cour'er and mom.11 Number Street Name of accountant or bookkeeper Dates business existed Tampa FL 33626 C'a'g Bythewoo From 03/31/201510 08/05/2016 City State ZIP Code . . . . . Describe the nature of the business Employer Identi?cation number Vertical Holdings Unlimited LLC Do not include Social Security number or ITIN. Number Street Name of accountant or bookkeeper Dates business existed From To i City State ZIP Code Of?cial Form 107 Statement of Financial Affairs for Individuals Filing for Bankruptcy page 11 ?lac Case Doc 1 Filed 08/08/16 Page 37 of 37 Debtor 1 Lisa Dianne BytheWOOd Case number (ifknown) First Name Middle Name Last Name Employer Identi?cation number Do not include Social Security number or Describe the nature of the business Business Name -EIN: Name of accountant or bookkeeper Dates business existed From To City State ZIP Code 28. Within 2 years before you ?led for bankruptcy, did you give a ?nancial statement to anyone about your business? Include all ?nancial institutions, creditors, or other parties. El No El Yes. Fill in the details below. Date issued Name mmooiww Number Street City State Code mm" have read the answers on this Statement of Financial Affairs and any attachments, and I declare under penalty of perjury that the answers are true and correct. I understand that making a false statement, concealing property, or obtaining money or property by fraud in connection with a bankruptcy case can result in ?nes up to $250,000, or imprisonment for up to 20 years, or both. 18 ,r.1341, 1519, and 3571. guy/e ?36th ?rm, Did you attach additional pages to Your Statement of Financial Affairs for Individuals Filing for Bankruptcy (Of?cial Form 107agree to pay someone who is not an attorney to help you fill out bankruptcy forms? a No El Yes. Name of person . Attach the Petition Preparer?s Notice, Declaration, and Signature (Of?cial Form 119). Of?cial Form 107 Statement of Financial Affairs for Individuals Filing for Bankruptcy page 12