}bk1{form 1. Voluntary Petition}bk{ B1 (fficial Form 1)(12/11) ame of ebtor (if individual, enter Last, First, Middle): Khawam, atalie ase 8:12bk05664KRM oc 1 Filed 04/14/12 Page 1 of 53 nited States Bankruptcy ourt Middle istrict of Florida ame of Joint ebtor (Spouse) (Last, First, Middle): Voluntary Petition All ther ames used by the ebtor in the last 8 years (include married, maiden, and trade names): All ther ames used by the Joint ebtor in the last 8 years (include married, maiden, and trade names): Last four digits of Soc. Sec. or ndividualaxpayer.. () o./omplete (if more than one, state all) xxxxx0958 Street Address of ebtor (o. and Street, ity, and State): 1005 Bayshore Blvd. ampa, FL ZP ode 33606 ounty of Residence or of the Principal Place of Business: Hillsborough Mailing Address of ebtor (if different from street address): Last four digits of Soc. Sec. or ndividualaxpayer.. () o./omplete (if more than one, state all) Street Address of Joint ebtor (o. and Street, ity, and State): ounty of Residence or of the Principal Place of Business: Mailing Address of Joint ebtor (if different from street address): ZP ode ZP ode ZP ode Location of Principal Assets of Business ebtor (if different from street address above): ype of ebtor (Form of rganization) (heck one box) ndividual (includes Joint ebtors) See xhibit on page 2 of this form. orporation (includes LL and LLP) Partnership ther (f debtor is not one of the above entities, check this box and state type of entity below.) hapter 15 ebtors ountry of debtor's center of main interests: ach country in which a foreign proceeding by, regarding, or against debtor is pending: Full Filing Fee attached Filing Fee (heck one box) ature of Business (heck one box) Health are Business Single Asset Real state as defined in 11.S.. 101 (51B) Railroad Stockbroker ommodity Broker learing Bank ther axxempt ntity (heck box, if applicable) ebtor is a taxexempt organization under itle 26 of the nited States ode (the nternal Revenue ode). 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 fficial Form 3A. Filing Fee waiver requested (applicable to chapter 7 individuals only). Must attach signed application for the court's consideration. See fficial Form 3B. Statistical/Administrative nformation ebtor estimates that funds will be available for distribution to unsecured creditors. ebtor estimates that, after any exempt property is excluded and administrative expenses paid, there will be no funds available for distribution to unsecured creditors. stimated umber of reditors hapter 7 hapter 9 hapter 11 hapter 12 hapter 13 1 50 100 200 1,000 5,001 10,001 25,001 50,001 VR 49 99 199 999 5,000 10,000 25,000 50,000 100,000 100,000 stimated Assets $0 to $50,001 to $100,001 to $500,001 $1,000,001 $10,000,001 $50,000,001 $100,000,001 $500,000,001 More than $50,000 $100,000 $500,000 to $1 to $10 to $50 to $100 to $500 to $1 billion $1 billion million million million million million stimated Liabilities $0 to $50,001 to $100,001 to $500,001 $1,000,001 $10,000,001 $50,000,001 $100,000,001 $500,000,001 More than $50,000 $100,000 $500,000 to $1 to $10 to $50 to $100 to $500 to $1 billion $1 billion million million million million million hapter of Bankruptcy ode nder Which the Petition is Filed (heck one box) ature of ebts (heck one box) ebts are primarily consumer debts, defined in 11.S.. 101(8) as "incurred by an individual primarily for a personal, family, or household purpose." hapter 15 Petition for Recognition of a Foreign Main Proceeding hapter 15 Petition for Recognition of a Foreign onmain Proceeding ebts are primarily business debts. heck one box: hapter 11 ebtors ebtor is a small business debtor as defined in 11.S.. 101(51). ebtor is not a small business debtor as defined in 11.S.. 101(51). heck if: ebtor s aggregate noncontingent liquidated debts (excluding debts owed to insiders or affiliates) are less than $2,343,300 (amount subject to adjustment on 4/01/13 and every three years thereafter). heck 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.S.. 1126(b). HS SPA S FR R S LY
ase 8:12bk05664KRM oc 1 Filed 04/14/12 Page 2 of 53 B1 (fficial Form 1)(12/11) Page 2 ame of ebtor(s): Voluntary Petition Khawam, atalie (his page must be completed and filed in every case) All Prior Bankruptcy ases Filed Within Last 8 Years (f more than two, attach additional sheet) Location ase umber: ate Filed: Where Filed: one Location ase umber: ate Filed: Where Filed: Pending Bankruptcy ase Filed by any Spouse, Partner, or Affiliate of this ebtor (f more than one, attach additional sheet) ame of ebtor: ase umber: ate Filed: one istrict: Relationship: Judge: xhibit A (o be completed if debtor is required to file periodic reports (e.g., forms 10K and 10Q) with the Securities and xchange ommission pursuant to Section 13 or 15(d) of the Securities xchange Act of 1934 and is requesting relief under chapter 11.) xhibit A is attached and made a part of this petition. xhibit B (o be completed if debtor is an individual whose debts are primarily consumer debts.), the attorney for the petitioner named in the foregoing petition, declare that have informed the petitioner that [he or she] may proceed under chapter 7, 11, 12, or 13 of title 11, nited States ode, and have explained the relief available under each such chapter. further certify that delivered to the debtor the notice required by 11.S.. 342(b). /s/ Jacob L. Bair Signature of Attorney for ebtor(s) Jacob L. Bair 71437 April 14, 2012 (ate) xhibit oes 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 xhibit is attached and made a part of this petition. o. xhibit (o be completed by every individual debtor. f a joint petition is filed, each spouse must complete and attach a separate xhibit.) xhibit completed and signed by the debtor is attached and made a part of this petition. f this is a joint petition: xhibit also completed and signed by the joint debtor is attached and made a part of this petition. nformation Regarding the ebtor Venue (heck any applicable box) ebtor has been domiciled or has had a residence, principal place of business, or principal assets in this istrict for 180 days immediately preceding the date of this petition or for a longer part of such 180 days than in any other istrict. here is a bankruptcy case concerning debtor's affiliate, general partner, or partnership pending in this istrict. ebtor is a debtor in a foreign proceeding and has its principal place of business or principal assets in the nited States in this istrict, or has no principal place of business or assets in the nited States but is a defendant in an action or proceeding [in a federal or state court] in this istrict, or the interests of the parties will be served in regard to the relief sought in this istrict. ertification by a ebtor Who Resides as a enant of Residential Property (heck all applicable boxes) Landlord has a judgment against the debtor for possession of debtor's residence. (f box checked, complete the following.) (ame of landlord that obtained judgment) (Address of landlord) ebtor 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 ebtor has included in this petition the deposit with the court of any rent that would become due during the 30day period after the filing of the petition. ebtor certifies that he/she has served the Landlord with this certification. (11.S.. 362(l)).
B1 (fficial Form 1)(12/11) Page 3 ame of ebtor(s): Voluntary Petition Khawam, atalie (his page must be completed and filed in every case) Signatures Signature(s) of ebtor(s) (ndividual/joint) Signature of a Foreign Representative declare under penalty of perjury that the information provided in this petition is true and correct. [f petitioner is an individual whose debts are primarily consumer debts and has chosen to file under chapter 7] am aware that may proceed under chapter 7, 11, 12, or 13 of title 11, nited States ode, understand the relief available under each such chapter, and choose to proceed under chapter 7. [f no attorney represents me and no bankruptcy petition preparer signs the petition] have obtained and read the notice required by 11.S.. 342(b). request relief in accordance with the chapter of title 11, nited States ode, specified in this petition. /s/ atalie Khawam Signature of ebtor atalie Khawam Signature of Joint ebtor elephone umber (f not represented by attorney) April 14, 2012 ate Signature of Attorney* /s/ Jacob L. Bair Signature of Attorney for ebtor(s) Jacob L. Bair 71437 Printed ame of Attorney for ebtor(s) Kelley M. Petry, PA Firm ame P Box 7866 ampa, FL 33673 Address ase 8:12bk05664KRM oc 1 Filed 04/14/12 Page 3 of 53 declare under penalty of perjury that the information provided in this petition is true and correct, that am the foreign representative of a debtor in a foreign proceeding, and that am authorized to file this petition. (heck only one box.) request relief in accordance with chapter 15 of title 11. nited States ode. ertified copies of the documents required by 11.S.. 1515 are attached. Pursuant to 11.S.. 1511, 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. Signature of Foreign Representative Printed ame of Foreign Representative ate Signature of onattorney Bankruptcy Petition Preparer declare under penalty of perjury that: (1) am a bankruptcy petition preparer as defined in 11.S.. 110; (2) prepared this document for compensation and have provided the debtor with a copy of this document and the notices and information required under 11.S.. 110(b), 110(h), and 342(b); and, (3) if rules or guidelines have been promulgated pursuant to 11.S.. 110(h) setting a maximum fee for services chargeable by bankruptcy petition preparers, 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. fficial Form 19 is attached. Printed ame and title, if any, of Bankruptcy Petition Preparer SocialSecurity number (f 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.S.. 110.) mail: kmpetrypa@aol.com (813) 8730713 Fax: (813) 8730715 elephone umber April 14, 2012 ate *n a case in which 707(b)(4)() 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 ebtor (orporation/partnership) declare under penalty of perjury that the information provided in this petition is true and correct, and that have been authorized to file this petition on behalf of the debtor. he debtor requests relief in accordance with the chapter of title 11, nited States ode, specified in this petition. Signature of Authorized ndividual Printed ame of Authorized ndividual itle of Authorized ndividual Address ate Signature of bankruptcy petition preparer or officer, principal, responsible person,or partner whose Social Security number is provided above. ames and SocialSecurity numbers of all other individuals who prepared or assisted in preparing this document unless the bankruptcy petition preparer is not an individual: f 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.S.. 110; 18.S.. 156. ate
ase 8:12bk05664KRM oc 1 Filed 04/14/12 Page 4 of 53 B 1 (fficial Form 1, xhibit ) (12/09) nited States Bankruptcy ourt Middle istrict of Florida n re atalie Khawam ase o. ebtor(s) hapter 7 HB VAL BR'S SAM F MPLA WH R SLG RQRM Warning: You must be able to check truthfully one of the five statements regarding credit counseling listed below. f you cannot do so, you are not eligible to file a bankruptcy case, and the court can dismiss any case you do file. f that happens, you will lose whatever filing fee you paid, and your creditors will be able to resume collection activities against you. f 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. very individual debtor must file this xhibit. f a joint petition is filed, each spouse must complete and file a separate xhibit. heck one of the five statements below and attach any documents as directed. 1. Within the 180 days before the filing of my bankruptcy case, received a briefing from a credit counseling agency approved by the nited States trustee or bankruptcy administrator that outlined the opportunities for available credit counseling and assisted me in performing a related budget analysis, and 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, received a briefing from a credit counseling agency approved by the nited States trustee or bankruptcy administrator that outlined the opportunities for available credit counseling and assisted me in performing a related budget analysis, but 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. certify that requested credit counseling services from an approved agency but was unable to obtain the services during the seven days from the time made my request, and the following exigent circumstances merit a temporary waiver of the credit counseling requirement so can file my bankruptcy case now. [Summarize exigent circumstances here.] f 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 30day 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. am not required to receive a credit counseling briefing because of: [heck the applicable statement.] [Must be accompanied by a motion for determination by the court.] Software opyright (c) 19962012 H RPRA www.bestcase.com
ase 8:12bk05664KRM oc 1 Filed 04/14/12 Page 5 of 53 B 1 (fficial Form 1, xhibit ) (12/09) ont. Page 2 ncapacity. (efined in 11.S.. 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.); isability. (efined in 11.S.. 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 nternet.); Active military duty in a military combat zone. 5. he nited States trustee or bankruptcy administrator has determined that the credit counseling requirement of 11.S.. 109(h) does not apply in this district. certify under penalty of perjury that the information provided above is true and correct. Signature of ebtor: ate: April 14, 2012 /s/ atalie Khawam atalie Khawam Software opyright (c) 19962012 H RPRA www.bestcase.com
}bk1{form 6. Sumary of Schedules}bk{ B6 Summary (fficial Form 6 Summary) (12/07) ase 8:12bk05664KRM oc 1 Filed 04/14/12 Page 6 of 53 nited States Bankruptcy ourt Middle istrict of Florida n re atalie Khawam ebtor, ase o. hapter 7 SMMARY F SHLS ndicate as to each schedule whether that schedule is attached and state the number of pages in each. Report the totals from Schedules A, B,,, F,, and J in the boxes provided. Add the amounts from Schedules A and B to determine the total amount of the debtor s assets. Add the amounts of all claims from Schedules,, and F to determine the total amount of the debtor s liabilities. ndividual debtors must also complete the "Statistical Summary of ertain Liabilities and Related ata" if they file a case under chapter 7, 11, or 13. AM F SHL AAH. F ASSS LABLS HR (YS/) SHS A Real Property Yes 1 344,000.00 B Personal Property Yes 3 5,994.00 Property laimed as xempt Yes 1 reditors Holding Secured laims Yes 1 367,487.00 reditors Holding nsecured Priority laims (otal of laims on Schedule ) Yes 3 58,892.00 F reditors Holding nsecured onpriority laims Yes 7 3,183,013.00 G xecutory ontracts and nexpired Leases Yes 1 H odebtors Yes 1 urrent ncome of ndividual ebtor(s) J urrent xpenditures of ndividual ebtor(s) otal umber of Sheets of ALL Schedules Yes Yes 1 0.00 1 4,687.00 20 otal Assets 349,994.00 otal Liabilities 3,609,392.00 Software opyright (c) 19962012 H RPRA www.bestcase.com
}bk1{form 6. Statistical Sumary of ertain Liabilities and Related ata}bk{ ase 8:12bk05664KRM oc 1 Filed 04/14/12 Page 7 of 53 Form 6 Statistical Summary (12/07) nited States Bankruptcy ourt Middle istrict of Florida n re atalie Khawam ebtor, ase o. hapter 7 SASAL SMMARY F RA LABLS A RLA AA (28.S.. 159) f you are an individual debtor whose debts are primarily consumer debts, as defined in 101(8) of the Bankruptcy ode (11.S.. 101(8)), filing a case under chapter 7, 11 or 13, you must report all information requested below. heck this box if you are an individual debtor whose debts are primarily consumer debts. You are not required to report any information here. his information is for statistical purposes only under 28.S.. 159. Summarize the following types of liabilities, as reported in the Schedules, and total them. ype of Liability Amount omestic Support bligations (from Schedule ) axes and ertain ther ebts wed to Governmental nits (from Schedule ) laims for eath or Personal njury While ebtor Was ntoxicated (from Schedule ) (whether disputed or undisputed) Student Loan bligations (from Schedule F) omestic Support, Separation Agreement, and ivorce ecree bligations ot Reported on Schedule bligations to Pension or ProfitSharing, and ther Similar bligations (from Schedule F) AL 5,892.00 53,000.00 0.00 0.00 0.00 0.00 58,892.00 State the following: Average ncome (from Schedule, Line 16) 0.00 Average xpenses (from Schedule J, Line 18) urrent Monthly ncome (from Form 22A Line 12; R, Form 22B Line 11; R, Form 22 Line 20 ) 4,687.00 4,834.13 State the following: 1. otal from Schedule, "SR PR, F AY" column 23,487.00 2. otal from Schedule, "AM L PRRY" column 58,892.00 3. otal from Schedule, "AM L PRRY, F AY" column 4. otal from Schedule F 0.00 3,183,013.00 5. otal of nonpriority unsecured debt (sum of 1, 3, and 4) 3,206,500.00 Software opyright (c) 19962012 H RPRA www.bestcase.com
}bk1{schedule A Real Property}bk{ ase 8:12bk05664KRM oc 1 Filed 04/14/12 Page 8 of 53 B6A (fficial Form 6A) (12/07) n re atalie Khawam ebtor, ase o. SHL A RAL PRPRY xcept as directed below, list all real property in which the debtor has any legal, equitable, or future interest, including all property owned as a cotenant, community property, or in which the debtor has a life estate. nclude any property in which the debtor holds rights and powers exercisable for the debtor's own benefit. f the debtor is married, state whether husband, wife, both, or the marital community own the property by placing an "H," "W," "J," or "" in the column labeled "Husband, Wife, Joint, or ommunity." f the debtor holds no interest in real property, write "one" under "escription and Location of Property." o not include interests in executory contracts and unexpired leases on this schedule. List them in Schedule G xecutory ontracts and nexpired Leases. f an entity claims to have a lien or hold a secured interest in any property, state the amount of the secured claim. See Schedule. f no entity claims to hold a secured interest in the property, write "one" in the column labeled "Amount of Secured laim." f the debtor is an individual or if a joint petition is filed, state the amount of any exemption claimed in the property only in Schedule Property laimed as xempt. escription and Location of Property ature of ebtor's nterest in Property Husband, Wife, Joint, or ommunity urrent Value of ebtor's nterest in Property, without educting any Secured laim or xemption Amount of Secured laim onhomestead: 701 P AV W AP 1202, WASHG, 20004 Fee Simple 344,000.00 367,487.00 Subotal > 344,000.00 (otal of this page) 0 continuation sheets attached to the Schedule of Real Property otal > 344,000.00 (Report also on Summary of Schedules) Software opyright (c) 19962012 H RPRA www.bestcase.com
}bk1{schedule B Personal Property}bk{ ase 8:12bk05664KRM oc 1 Filed 04/14/12 Page 9 of 53 B6B (fficial Form 6B) (12/07) n re atalie Khawam ebtor, ase o. xcept as directed below, list all personal property of the debtor of whatever kind. f the debtor has no property in one or more of the categories, place an "x" in the appropriate position in the column labeled "one." f additional space is needed in any category, attach a separate sheet properly identified with the case name, case number, and the number of the category. f the debtor is married, state whether husband, wife, both, or the marital community own the property by placing an "H," "W," "J," or "" in the column labeled "Husband, Wife, Joint, or ommunity." f the debtor is an individual or a joint petition is filed, state the amount of any exemptions claimed only in Schedule Property laimed as xempt. o not list interests in executory contracts and unexpired leases on this schedule. List them in Schedule G xecutory ontracts and nexpired Leases. f the property is being held for the debtor by someone else, state that person's name and address under "escription and Location of Property." f the property is being held for a minor child, simply state the child's initials and the name and address of the child's parent or guardian, such as "A.B., a minor child, by John oe, guardian." o not disclose the child's name. See, 11.S.. 112 and Fed. R. Bankr. P. 1007(m). ype of Property 1. ash on hand SHL B PRSAL PRPRY escription and Location of Property Husband, Wife, Joint, or ommunity urrent Value of ebtor's nterest in Property, without educting any Secured laim or xemption 2. hecking, savings or other financial accounts, certificates of deposit, or shares in banks, savings and loan, thrift, building and loan, and homestead associations, or credit unions, brokerage houses, or cooperatives. Bank of America Money Market Savings 36.00 Bank of America hecking 658.00 3. Security deposits with public utilities, telephone companies, landlords, and others. 4. Household goods and furnishings, including audio, video, and computer equipment. o personal furnishings rooms with sister and brotherinlaw. 0.00 5. Books, pictures and other art objects, antiques, stamp, coin, record, tape, compact disc, and other collections or collectibles. 6. Wearing apparel. Apparel 800.00 7. Furs and jewelry. Jewelry 1,000.00 8. Firearms and sports, photographic, and other hobby equipment. 9. nterests in insurance policies. ame insurance company of each policy and itemize surrender or refund value of each. 10. Annuities. temize and name each issuer. Subotal > (otal of this page) 2,494.00 2 continuation sheets attached to the Schedule of Personal Property Software opyright (c) 19962012 H RPRA www.bestcase.com
B6B (fficial Form 6B) (12/07) ont. ase 8:12bk05664KRM oc 1 Filed 04/14/12 Page 10 of 53 n re atalie Khawam ebtor, ase o. SHL B PRSAL PRPRY (ontinuation Sheet) ype of Property escription and Location of Property Husband, Wife, Joint, or ommunity urrent Value of ebtor's nterest in Property, without educting any Secured laim or xemption 11. nterests in an education RA as defined in 26.S.. 530(b)(1) or under a qualified State tuition plan as defined in 26.S.. 529(b)(1). Give particulars. (File separately the record(s) of any such interest(s). 11.S.. 521(c).) 12. nterests in RA, RSA, Keogh, or other pension or profit sharing plans. Give particulars. 13. Stock and interests in incorporated and unincorporated businesses. temize. 14. nterests in partnerships or joint ventures. temize. 15. Government and corporate bonds and other negotiable and nonnegotiable instruments. 16. Accounts receivable. 17. Alimony, maintenance, support, and property settlements to which the debtor is or may be entitled. Give particulars. 18. ther liquidated debts owed to debtor including tax refunds. Give particulars. 19. quitable or future interests, life estates, and rights or powers exercisable for the benefit of the debtor other than those listed in Schedule A Real Property. 20. ontingent and noncontingent interests in estate of a decedent, death benefit plan, life insurance policy, or trust. 21. ther contingent and unliquidated claims of every nature, including tax refunds, counterclaims of the debtor, and rights to setoff claims. Give estimated value of each. Potential Harassment/ontract Violation Suit against Peter Meros and Meros, Smith, Lazzara, & lney P.A. nknown Subotal > (otal of this page) 0.00 Sheet 1 of 2 continuation sheets attached to the Schedule of Personal Property Software opyright (c) 19962012 H RPRA www.bestcase.com
B6B (fficial Form 6B) (12/07) ont. ase 8:12bk05664KRM oc 1 Filed 04/14/12 Page 11 of 53 n re atalie Khawam ebtor, ase o. SHL B PRSAL PRPRY (ontinuation Sheet) ype of Property escription and Location of Property Husband, Wife, Joint, or ommunity urrent Value of ebtor's nterest in Property, without educting any Secured laim or xemption 22. Patents, copyrights, and other intellectual property. Give particulars. 23. Licenses, franchises, and other general intangibles. Give particulars. 24. ustomer lists or other compilations containing personally identifiable information (as defined in 11.S.. 101(41A)) provided to the debtor by individuals in connection with obtaining a product or service from the debtor primarily for personal, family, or household purposes. 25. Automobiles, trucks, trailers, and other vehicles and accessories. 2000 Volvo S80 3,500.00 26. Boats, motors, and accessories. 27. Aircraft and accessories. 28. ffice equipment, furnishings, and supplies. 29. Machinery, fixtures, equipment, and supplies used in business. 30. nventory. 31. Animals. 32. rops growing or harvested. Give particulars. 33. Farming equipment and implements. 34. Farm supplies, chemicals, and feed. 35. ther personal property of any kind not already listed. temize. Sheet 2 of 2 continuation sheets attached to the Schedule of Personal Property Software opyright (c) 19962012 H RPRA www.bestcase.com Subotal > 3,500.00 (otal of this page) otal > 5,994.00 (Report also on Summary of Schedules)
}bk1{schedule Property laimed as xempt}bk{ ase 8:12bk05664KRM oc 1 Filed 04/14/12 Page 12 of 53 B6 (fficial Form 6) (4/10) n re atalie Khawam ebtor, ase o. ebtor claims the exemptions to which debtor is entitled under: (heck one box) 11.S.. 522(b)(2) 11.S.. 522(b)(3) escription of Property SHL PRPRY LAM AS MP Specify Law Providing ach xemption heck if debtor claims a homestead exemption that exceeds $146,450. (Amount subject to adjustment on 4/1/13, and every three years thereafter with respect to cases commenced on or after the date of adjustment.) Value of laimed xemption urrent Value of Property Without educting xemption hecking, Savings, or ther Financial Accounts, ertificates of eposit Bank of America Money Market Savings Fla. onst. art., 4(a)(2) 36.00 36.00 Bank of America hecking Fla. onst. art., 4(a)(2) 658.00 658.00 Wearing Apparel Apparel Fla. Stat. Ann. 222.25(4) 500.00 800.00 Furs and Jewelry Jewelry Fla. Stat. Ann. 222.25(4) 1,000.00 1,000.00 Automobiles, rucks, railers, and ther Vehicles 2000 Volvo S80 Fla. Stat. Ann. 222.25(1) 1,000.00 3,500.00 Fla. Stat. Ann. 222.25(4) 2,500.00 0 continuation sheets attached to Schedule of Property laimed as xempt Software opyright (c) 19962012 H RPRA www.bestcase.com otal: 5,694.00 5,994.00
}bk1{schedule reditors Holding Secured laims}bk{ ase 8:12bk05664KRM oc 1 Filed 04/14/12 Page 13 of 53 B6 (fficial Form 6) (12/07) n re atalie Khawam ebtor, ase o. SHL RRS HLG SR LAMS State the name, mailing address, including zip code, and last four digits of any account number of all entities holding claims secured by property of the debtor as of the date of filing of the petition. he complete account number of any account the debtor has with the creditor is useful to the trustee and the creditor and may be provided if the debtor chooses to do so. List creditors holding all types of secured interests such as judgment liens, garnishments, statutory liens, mortgages, deeds of trust, and other security interests. List creditors in alphabetical order to the extent practicable. f a minor child is a creditor, the child's initials and the name and address of the child's parent or guardian, such as "A.B., a minor child, by John oe, guardian." o not disclose the child's name. See, 11.S.. 112 and Fed. R. Bankr. P. 1007(m). f all secured creditors will not fit on this page, use the continuation sheet provided. f any entity other than a spouse in a joint case may be jointly liable on a claim, place an "" in the column labeled "odebtor",include the entity on the appropriate schedule of creditors, and complete Schedule H odebtors. f a joint petition is filed, state whether the husband, wife, both of them, or the marital community may be liable on each claim by placing an "H", "W", "J", or "" in the column labeled "Husband, Wife, Joint, or ommunity". f the claim is contingent, place an "" in the column labeled "ontingent". f the claim is unliquidated, place an "" in the column labeled "nliquidated". f the claim is disputed, place an "" in the column labeled "isputed". (You may need to place an "" in more than one of these three columns.) otal the columns labeled "Amount of laim Without educting Value of ollateral" and "nsecured Portion, if Any" in the boxes labeled "otal(s)" on the last sheet of the completed schedule. Report the total from the column labeled "Amount of laim" also on the Summary of Schedules and, if the debtor is an individual with primarily consumer debts, report the total from the column labeled "nsecured Portion" on the Statistical Summary of ertain Liabilities and Related ata. heck this box if debtor has no creditors holding secured claims to report on this Schedule. RR'S AM A MALG ARSS LG ZP, A A MBR (See instructions above.) Account o. xxxxx 1/1/08 Bank of America,.A. 450 American St. Simi Valley, A 93065 B R Husband, Wife, Joint, or ommunity H W J A LAM WAS RR, AR F L, A SRP A VAL F PRPRY SBJ L Second Mortgage onhomestead: 701 P AV W AP 1202, WASHG, 20004 G L Q A S P AM F LAM WH G VAL F LLARAL SR PR, F AY Value $ Account o. xxxxx 1/1/2008 344,000.00 73,288.00 23,487.00 Bank of America,.A. 450 American St. Simi Valley, A 93065 First Mortgage onhomestead: 701 P AV W AP 1202, WASHG, 20004 Value $ 344,000.00 294,199.00 0.00 Account o. Value $ Account o. Value $ 0 continuation sheets attached Subtotal (otal of this page) 367,487.00 23,487.00 otal (Report on Summary of Schedules) 367,487.00 23,487.00 Software opyright (c) 19962012 H RPRA www.bestcase.com
}bk1{schedule reditors Holding nsecured Priority laims}bk{ ase 8:12bk05664KRM oc 1 Filed 04/14/12 Page 14 of 53 B6 (fficial Form 6) (4/10) n re atalie Khawam ebtor, ase o. SHL RRS HLG SR PRRY LAMS A complete list of claims entitled to priority, listed separately by type of priority, is to be set forth on the sheets provided. nly holders of unsecured claims entitled to priority should be listed in this schedule. n the boxes provided on the attached sheets, state the name, mailing address, including zip code, and last four digits of the account number, if any, of all entities holding priority claims against the debtor or the property of the debtor, as of the date of the filing of the petition. se a separate continuation sheet for each type of priority and label each with the type of priority. he complete account number of any account the debtor has with the creditor is useful to the trustee and the creditor and may be provided if the debtor chooses to do so. f a minor child is a creditor, state the child's initials and the name and address of the child's parent or guardian, such as "A.B., a minor child, by John oe, guardian." o not disclose the child's name. See, 11.S.. 112 and Fed. R. Bankr. P. 1007(m). f any entity other than a spouse in a joint case may be jointly liable on a claim, place an "" in the column labeled "odebtor," include the entity on the appropriate schedule of creditors, and complete Schedule Hodebtors. f a joint petition is filed, state whether the husband, wife, both of them, or the marital community may be liable on each claim by placing an "H," "W," "J," or "" in the column labeled "Husband, Wife, Joint, or ommunity." f the claim is contingent, place an "" in the column labeled "ontingent." f the claim is unliquidated, place an "" in the column labeled "nliquidated." f the claim is disputed, place an "" in the column labeled "isputed." (You may need to place an "" in more than one of these three columns.) Report the total of claims listed on each sheet in the box labeled "Subtotals" on each sheet. Report the total of all claims listed on this Schedule in the box labeled "otal" on the last sheet of the completed schedule. Report this total also on the Summary of Schedules. Report the total of amounts entitled to priority listed on each sheet in the box labeled "Subtotals" on each sheet. Report the total of all amounts entitled to priority listed on this Schedule in the box labeled "otals" on the last sheet of the completed schedule. ndividual debtors with primarily consumer debts report this total also on the Statistical Summary of ertain Liabilities and Related ata. Report the total of amounts not entitled to priority listed on each sheet in the box labeled "Subtotals" on each sheet. Report the total of all amounts not entitled to priority listed on this Schedule in the box labeled "otals" on the last sheet of the completed schedule. ndividual debtors with primarily consumer debts report this total also on the Statistical Summary of ertain Liabilities and Related ata. heck this box if debtor has no creditors holding unsecured priority claims to report on this Schedule. YPS F PRRY LAMS (heck the appropriate box(es) below if claims in that category are listed on the attached sheets) omestic support obligations laims for domestic support that are owed to or recoverable by a spouse, former spouse, or child of the debtor, or the parent, legal guardian, or responsible relative of such a child, or a governmental unit to whom such a domestic support claim has been assigned to the extent provided in 11.S.. 507(a)(1). xtensions of credit in an involuntary case laims arising in the ordinary course of the debtor's business or financial affairs after the commencement of the case but before the earlier of the appointment of a trustee or the order for relief. 11.S.. 507(a)(3). Wages, salaries, and commissions Wages, salaries, and commissions, including vacation, severance, and sick leave pay owing to employees and commissions owing to qualifying independent sales representatives up to $11,725* per person earned within 180 days immediately preceding the filing of the original petition, or the cessation of business, whichever occurred first, to the extent provided in 11.S.. 507(a)(4). ontributions to employee benefit plans Money owed to employee benefit plans for services rendered within 180 days immediately preceding the filing of the original petition, or the cessation of business, whichever occurred first, to the extent provided in 11.S.. 507(a)(5). ertain farmers and fishermen laims of certain farmers and fishermen, up to $5,775* per farmer or fisherman, against the debtor, as provided in 11.S.. 507(a)(6). eposits by individuals laims of individuals up to $2,600* for deposits for the purchase, lease, or rental of property or services for personal, family, or household use, that were not delivered or provided. 11.S.. 507(a)(7). axes and certain other debts owed to governmental units axes, customs duties, and penalties owing to federal, state, and local governmental units as set forth in 11.S.. 507(a)(8). ommitments to maintain the capital of an insured depository institution laims based on commitments to the F, R, irector of the ffice of hrift Supervision, omptroller of the urrency, or Board of Governors of the Federal Reserve System, or their predecessors or successors, to maintain the capital of an insured depository institution. 11.S.. 507 (a)(9). laims for death or personal injury while debtor was intoxicated laims for death or personal injury resulting from the operation of a motor vehicle or vessel while the debtor was intoxicated from using alcohol, a drug, or another substance. 11.S.. 507(a)(10). * Amount subject to adjustment on 4/01/13, and every three years thereafter with respect to cases commenced on or after the date of adjustment. 2 continuation sheets attached Software opyright (c) 19962012 H RPRA www.bestcase.com
B6 (fficial Form 6) (4/10) ont. ase 8:12bk05664KRM oc 1 Filed 04/14/12 Page 15 of 53 n re atalie Khawam ebtor, ase o. SHL RRS HLG SR PRRY LAMS (ontinuation Sheet) omestic Support bligations YP F PRRY Account o. RR'S AM, A MALG ARSS LG ZP, A A MBR (See instructions.) B R Husband, Wife, Joint, or ommunity H W J A LAM WAS RR A SRA FR LAM Retroactive hild Support G L Q A S P AM F LAM AM L PRRY, F AY AM L PRRY Grayson P. Wolfe c/o hild Support learinghouse P Box 37715 Washington, 20013 0.00 5,892.00 5,892.00 Account o. Account o. Account o. Account o. Sheet 1 of 2 continuation sheets attached to Schedule of reditors Holding nsecured Priority laims Subtotal (otal of this page) 0.00 5,892.00 5,892.00 Software opyright (c) 19962012 H RPRA www.bestcase.com
B6 (fficial Form 6) (4/10) ont. ase 8:12bk05664KRM oc 1 Filed 04/14/12 Page 16 of 53 n re atalie Khawam ebtor, ase o. SHL RRS HLG SR PRRY LAMS (ontinuation Sheet) axes and ertain ther ebts wed to Governmental nits YP F PRRY Account o. RR'S AM, A MALG ARSS LG ZP, A A MBR (See instructions.) nternal Revenue Service ept. of the reasury Philadelphia, PA 19154 B R Husband, Wife, Joint, or ommunity H W J A LAM WAS RR A SRA FR LAM 2010, 2011 ncome axes G L Q A S P AM F LAM AM L PRRY, F AY 0.00 AM L PRRY Account o. 53,000.00 53,000.00 Account o. Account o. Account o. Sheet 2 of 2 continuation sheets attached to Schedule of reditors Holding nsecured Priority laims Subtotal (otal of this page) otal (Report on Summary of Schedules) 0.00 53,000.00 53,000.00 0.00 58,892.00 58,892.00 Software opyright (c) 19962012 H RPRA www.bestcase.com
}bk1{schedule F reditors Holding nsecured onpriority laims}bk{ ase 8:12bk05664KRM oc 1 Filed 04/14/12 Page 17 of 53 B6F (fficial Form 6F) (12/07) n re atalie Khawam ebtor, ase o. SHL F RRS HLG SR PRRY LAMS State the name, mailing address, including zip code, and last four digits of any account number, of all entities holding unsecured claims without priority against the debtor or the property of the debtor, as of the date of filing of the petition. he complete account number of any account the debtor has with the creditor is useful to the trustee and the creditor and may be provided if the debtor chooses to do so. f a minor child is a creditor, state the child's initials and the name and address of the child's parent or guardian, such as "A.B., a minor child, by John oe, guardian." o not disclose the child's name. See, 11.S.. 112 and Fed. R. Bankr. P. 1007(m). o not include claims listed in Schedules and. f all creditors will not fit on this page, use the continuation sheet provided. f any entity other than a spouse in a joint case may be jointly liable on a claim, place an "" in the column labeled "odebtor," include the entity on the appropriate schedule of creditors, and complete Schedule H odebtors. f a joint petition is filed, state whether the husband, wife, both of them, or the marital community may be liable on each claim by placing an "H," "W," "J," or "" in the column labeled "Husband, Wife, Joint, or ommunity." f the claim is contingent, place an "" in the column labeled "ontingent." f the claim is unliquidated, place an "" in the column labeled "nliquidated." f the claim is disputed, place an "" in the column labeled "isputed." (You may need to place an "" in more than one of these three columns.) Report the total of all claims listed on this schedule in the box labeled "otal" on the last sheet of the completed schedule. Report this total also on the Summary of Schedules and, if the debtor is an individual with primarily consumer debts, report this total also on the Statistical Summary of ertain Liabilities and Related ata. heck this box if debtor has no creditors holding unsecured claims to report on this Schedule F. RR'S AM, MALG ARSS LG ZP, A A MBR (See instructions above.) Account o. xxxxxx B R Husband, Wife, Joint, or ommunity H W J A LAM WAS RR A SRA FR LAM. F LAM S SBJ SFF, S SA. ollection G L Q A S P AM F LAM Aargon Agency nc. 8668 Spring Mountain Rd. Las Vegas, V 89117 100.00 Account o. xxxx Student Loan Access Group nc 5500 Brandywine Pkwy Wilmington, 19803 13,004.00 Account o. Access Group, nc 5500 Brandywine Pkwy Wilmington, 19803 xxxx 12/2004 Student Loan 34,335.00 Account o. xxxxxxxxxxxx Student Loan AS//ational ollegiate 1200 7th St Harrisburg, PA 17102 6 continuation sheets attached Subtotal (otal of this page) 33,149.00 80,588.00 Software opyright (c) 19962012 H RPRA www.bestcase.com S/:32064120329
ase 8:12bk05664KRM oc 1 Filed 04/14/12 Page 18 of 53 B6F (fficial Form 6F) (12/07) ont. n re atalie Khawam ebtor, ase o. SHL F RRS HLG SR PRRY LAMS (ontinuation Sheet) RR'S AM, MALG ARSS LG ZP, A A MBR (See instructions above.) Account o. xxxxxxxx6pa0 B R Husband, Wife, Joint, or ommunity H W J A LAM WAS RR A SRA FR LAM. F LAM S SBJ SFF, S SA. Student Loan G L Q A S P AM F LAM AS//ational ollegiate 1200 7th St Harrisburg, PA 17102 33,519.00 Account o. xxxxxxxxxxxx Revolving Account AM P B 297871 FR LARAL, FL 333297871 3,048.00 Account o. xxxxxxxxxxxx Revolving Account AM P B 297871 FR LARAL, FL 333297871 18,039.00 Account o. xxxxx ollection Asset Acceptance, LL P Box 1630 Warren, M 48090 19,409.00 Account o. xxxxxx Revolving Account Barclay's Bank elware 125 S. West Street Wilmington, 19801 24,399.00 Sheet no. 1 of 6 sheets attached to Schedule of reditors Holding nsecured onpriority laims Subtotal (otal of this page) 98,414.00 Software opyright (c) 19962012 H RPRA www.bestcase.com
ase 8:12bk05664KRM oc 1 Filed 04/14/12 Page 19 of 53 B6F (fficial Form 6F) (12/07) ont. n re atalie Khawam ebtor, ase o. SHL F RRS HLG SR PRRY LAMS (ontinuation Sheet) Account o. RR'S AM, MALG ARSS LG ZP, A A MBR (See instructions above.) B R Husband, Wife, Joint, or ommunity H W J A LAM WAS RR A SRA FR LAM. F LAM S SBJ SFF, S SA. Services G L Q A S P AM F LAM Brannock & Humphries 100 South Ashley r. Suite 1130 ampa, FL 33602 65,000.00 Account o. Services Brodsky, Renehan, Pearlstein Lastra & Bouquet, hartered 16061 omprint ircle Gaithersburg, M 20877 99,000.00 Account o. xxxxxx ollection redit Protection Assoc. 13355 oel Rd Ste 2100 allas, 75240 1,030.00 Account o. Services Feldesman, ucker, Leifer, Fidell, LLP 1129 20th St. W 4th Floor Washington, 20036 70,000.00 Account o. Services Fredrique B. Boire, PA 1211 orth Westshore Blvd. Suite 511 ampa, FL 33607 10,000.00 Sheet no. 2 of 6 sheets attached to Schedule of reditors Holding nsecured onpriority laims Subtotal (otal of this page) 245,030.00 Software opyright (c) 19962012 H RPRA www.bestcase.com
ase 8:12bk05664KRM oc 1 Filed 04/14/12 Page 20 of 53 B6F (fficial Form 6F) (12/07) ont. n re atalie Khawam ebtor, ase o. SHL F RRS HLG SR PRRY LAMS (ontinuation Sheet) Account o. RR'S AM, MALG ARSS LG ZP, A A MBR (See instructions above.) B R Husband, Wife, Joint, or ommunity H W J A LAM WAS RR A SRA FR LAM. F LAM S SBJ SFF, S SA. Personal Loan G L Q A S P AM F LAM Gerald Harrington 260 W. xchange St. Providence, R 02903 300,000.00 Account o. xxxxxx Student Loan GLLS/First Star 2401 nternational Lane Madison, W 53704 141,749.00 Account o. xxxxx Student Loan Glelsi/Star Bank, A 2401 nternational Ln Madison, W 53704 32,812.00 Account o. Personal Loan Jill and Scott Kelley 1005 Bayshore Ave. ampa, FL 33606 800,000.00 Account o. xxxxxxxxxx Student Loan Keystone Rewards 25 High Street Waynesburg, PA 15370 nknown Sheet no. 3 of 6 sheets attached to Schedule of reditors Holding nsecured onpriority laims Subtotal (otal of this page) 1,274,561.00 Software opyright (c) 19962012 H RPRA www.bestcase.com
ase 8:12bk05664KRM oc 1 Filed 04/14/12 Page 21 of 53 B6F (fficial Form 6F) (12/07) ont. n re atalie Khawam ebtor, ase o. SHL F RRS HLG SR PRRY LAMS (ontinuation Sheet) Account o. RR'S AM, MALG ARSS LG ZP, A A MBR (See instructions above.) B R Husband, Wife, Joint, or ommunity H W J A LAM WAS RR A SRA FR LAM. F LAM S SBJ SFF, S SA. Home wner Association ues G L Q A S P AM F LAM Legum & orman 3130 Fairview Park r. Suite 200 Falls hurch, VA 22042 6,000.00 Account o. Services Levine, Hirsch, Segall, MacKenzie & Friedsman, PA 100 S. Ashley r. Suite 1600 ampa, FL 33602 440,000.00 Account o. Services Liotta, ranitzke & ngel 1666 onneticut Ave W Suite 250 Washington, 20009 65,000.00 Account o. Personal Loan Lisa Krowne 777 7th St. W #1134 Washington, 20004 250,000.00 Account o. Services Maney, amsker, Jones & Khulman, PA 606 Madison St. #1 ampa, FL 33602 20,000.00 Sheet no. 4 of 6 sheets attached to Schedule of reditors Holding nsecured onpriority laims Subtotal (otal of this page) 781,000.00 Software opyright (c) 19962012 H RPRA www.bestcase.com
ase 8:12bk05664KRM oc 1 Filed 04/14/12 Page 22 of 53 B6F (fficial Form 6F) (12/07) ont. n re atalie Khawam ebtor, ase o. SHL F RRS HLG SR PRRY LAMS (ontinuation Sheet) RR'S AM, MALG ARSS LG ZP, A A MBR (See instructions above.) Account o. xxxxxx B R Husband, Wife, Joint, or ommunity H W J A LAM WAS RR A SRA FR LAM. F LAM S SBJ SFF, S SA. ollection G L Q A S P AM F LAM MBR 1920 Greenspring r Suite 200 Lutherville imonium, M 21093 521.00 Account o. Personal Loan Michael Boone 522 Pinellas Bay Way nit 211 Saint Petersburg, FL 33715 600,000.00 Account o. xxx ollection MRS BP, LL 1930 lney Ave herry Hill, J 08003 35,352.00 Account o. xxx ollection MRS BP, LL 1930 lney Ave herry Hill, J 08003 37,590.00 Account o. xxxx ollection Financial P Box 13574 Philadelphia, PA 19101 2,857.00 Sheet no. 5 of 6 sheets attached to Schedule of reditors Holding nsecured onpriority laims Subtotal (otal of this page) 676,320.00 Software opyright (c) 19962012 H RPRA www.bestcase.com
ase 8:12bk05664KRM oc 1 Filed 04/14/12 Page 23 of 53 B6F (fficial Form 6F) (12/07) ont. n re atalie Khawam ebtor, ase o. SHL F RRS HLG SR PRRY LAMS (ontinuation Sheet) Account o. xxxx RR'S AM, MALG ARSS LG ZP, A A MBR (See instructions above.) B R Husband, Wife, Joint, or ommunity H W J A LAM WAS RR A SRA FR LAM. F LAM S SBJ SFF, S SA. ollection G L Q A S P AM F LAM Professional Account Mngmnt 633 W. Wisconsin Ave Milwaukee, W 53203 100.00 Account o. Services omislav Loncar Reilly, Fisher & Solomon, PA 4950 W. Kennedy Blvd Suite 610 ampa, FL 33609 12,000.00 Account o. Services Wendy H. Schwartz & Assoc. 818 onneticut Ave. W Suite 315 Washington, 20006 15,000.00 Account o. Account o. Sheet no. 6 of 6 sheets attached to Schedule of reditors Holding nsecured onpriority laims Subtotal (otal of this page) otal (Report on Summary of Schedules) 27,100.00 3,183,013.00 Software opyright (c) 19962012 H RPRA www.bestcase.com
}bk1{schedule G xecutory ontracts and nexpired Leases}bk{ ase 8:12bk05664KRM oc 1 Filed 04/14/12 Page 24 of 53 B6G (fficial Form 6G) (12/07) n re atalie Khawam ebtor, ase o. SHL G RY RAS A PR LASS escribe all executory contracts of any nature and all unexpired leases of real or personal property. nclude any timeshare interests. State nature of debtor's interest in contract, i.e., "Purchaser", "Agent", etc. State whether debtor is the lessor or lessee of a lease. Provide the names and complete mailing addresses of all other parties to each lease or contract described. f a minor child is a party to one of the leases or contracts, state the child's initials and the name and address of the child's parent or guardian, such as "A.B., a minor child, by John oe, guardian." o not disclose the child's name. See, 11.S.. 112 and Fed. R. Bankr. P. 1007(m). heck this box if debtor has no executory contracts or unexpired leases. ame and Mailing Address, ncluding Zip ode, of ther Parties to Lease or ontract escription of ontract or Lease and ature of ebtor's nterest. State whether lease is for nonresidential real property. State contract number of any government contract. 0 continuation sheets attached to Schedule of xecutory ontracts and nexpired Leases Software opyright (c) 19962012 H RPRA www.bestcase.com