Case 11-54098-jrs Doc 20 Filed 03/15/11 Entered 03/15/11 13:24:19 Desc Main Document Page 1 of 22



Similar documents
SCHEDULE D - CREDITORS HOLDING SECURED CLAIMS

Case Doc 1 Filed 05/04/12 Entered 05/04/12 10:08:54 Desc Main Document Page 1 of 10

Case JKC-11 Doc 1 Filed 10/30/12 EOD 10/30/12 08:36:49 Pg 1 of 12

Case 2:10-bk ER Doc 11 Filed 07/14/10 Entered 07/14/10 21:09:13 Desc Main Document Page 1 of 50

Case lbr Doc 1 Entered 07/31/12 12:40:21 Page 1 of 43

Case 8:12-bk KRM Doc 1 Filed 04/14/12 Page 2 of 53. B1 (Official Form 1)(12/11) Page 2 Name of Debtor(s):

Case 6:10-bk SC Doc 13 Filed 08/24/10 Entered 08/24/10 16:27:19 Desc Main Document Page 1 of 234

Case Doc 1 Filed 04/16/10 Entered 04/16/10 10:11:28 Desc Main Document Page 1 of Fescue Lane Memphis, TN

Case Doc 1 Filed 12/28/10 Entered 12/28/10 16:56:01 Desc Main Document Page 1 of 40. Health Care Business Single Asset Real Estate as defined

Debtors SCHEDULE A. REAL PROPERTY

Case 1:12-bk VK Doc 1 Filed 03/21/12 Entered 03/21/12 15:47:22 Desc Main Document Page 1 of 51

Health Care Business Single Asset Real Estate as defined

Case Doc 1 Filed 05/07/10 Entered 05/07/10 16:36:09 Desc Main Document Page 1 of 57. Health Care Business Single Asset Real Estate as defined

Case Doc 1 Filed 12/13/11 Entered 12/13/11 16:51:04 Desc Main Document Page 1 of 64

Case MM7 Filed 02/23/15 Entered 02/23/15 16:50:46 Doc 1 Pg. 1 of 63

Case DHS Doc 1 Filed 01/02/15 Entered 01/02/15 12:24:24 Desc Main Document Page 1 of 50

United States Bankruptcy Court District of Arizona. Voluntary Petition

Case 8:13-bk Doc 1 Filed 01/25/13 Page 1 of 60

Case JKC-11 Doc 1 Filed 09/07/12 EOD 09/07/12 15:30:45 Pg 1 of 133

Case Doc 1 Filed 08/17/12 Entered 08/17/12 12:32:19 Desc Main Document Page 1 of 42

Case Doc 1 Filed 10/15/13 Entered 10/15/13 16:44:01 Desc Main Document Page 1 of 99

FIRST TN BANK PO BOX 1545 MEMPHIS TN FIRST TN BANK C/O JOHN H. ROWLAND 211 COMMERCE ST, STE 1000 NASHVILLE TN 37201

SCHEDULE A - REAL PROPERTY

Case 8:14-bk Doc 1 Filed 03/13/14 Page 1 of 96

United States Bankruptcy Court Southern District of Florida SUMMARY OF SCHEDULES - AMENDED

thejasminebrand.com thejasminebrand.com thejasminebrand.com

United States Bankruptcy Court Northern District of Texas Dallas Division SUMMARY OF SCHEDULES - AMENDED & RESTATED

United States Bankruptcy Court New Jersey SUMMARY OF SCHEDULES

United States Bankruptcy Court Western District of Louisiana SUMMARY OF SCHEDULES

SCHEDULE A - REAL PROPERTY

Case: MER Doc#:1 Filed:09/04/12 Entered:09/04/12 14:47:23 Page1 of 61

SCHEDULE A - REAL PROPERTY

United States Bankruptcy Court Middle District of Florida SUMMARY OF SCHEDULES

Case 8:14-bk Doc 1 Filed 08/26/14 Page 1 of 22. Nature of Business (Check one box)

Case EPK Doc 1 Filed 12/23/09 Page 1 of 37. Health Care Business Single Asset Real Estate as defined

B1 (Official Form 1)(1/08) Page 2 Name of Debtor(s):

United States Bankruptcy Court Eastern District of Wisconsin. Voluntary Petition. Case pp Doc 1 Filed 12/06/13 Page 1 of 54

Bankruptcy Petition Preparation

UNITED STATES BANKRUPTCY COURT

Health Care Business Single Asset Real Estate as defined

Health Care Business Single Asset Real Estate as defined

Case PGH Doc 1 Filed 07/10/14 Page 1 of 34

Case DHS Doc 42 Filed 02/17/10 Entered 02/17/10 16:22:16 Desc Main Document Page 1 of 74 SUMMARY OF SCHEDULES

Case DOT Doc 1 Filed 11/25/09 Entered 11/25/09 10:58:52 Desc Main Document Page 1 of 29. Mechanicsville, VA 23116

Health Care Business Single Asset Real Estate as defined

United States Bankruptcy Court Western District of Washington SUMMARY OF SCHEDULES

United States Bankruptcy Court District of Utah

Chapter 13: Repayment of All or Part of the Debts of an Individual with Regular Income ($235 filing fee, $39 administrative fee: Total fee $274)

Case elp11 Doc 1 Filed 02/17/ Health Care Business Single Asset Real Estate as defined

Case abl Doc 33 Entered 07/18/14 18:04:56 Page 1 of 34. Case No.: ABL Chapter 11

rg Doc 237 Filed 05/22/14 Entered 05/22/14 22:40:17 Main Document Pg 1 of 7

INSTRUCTIONS FOR COMPLETING OFFICIAL FORM 10, PROOF OF CLAIM I. INTRODUCTION

United States Bankruptcy Court District of Connecticut SUMMARY OF SCHEDULES

LIST OF CREDITORS HOLDING 20 LARGEST UNSECURED CLAIMS

Case Filed 05/27/11 Doc 1 Pg. 1 of 40. Health Care Business Single Asset Real Estate as defined

IMPORTANT INFORMATION ABOUT BANKRUPTCY ASSISTANCE SERVICES FROM AN ATTORNEY 1

UNITED STATES BANKRUPTCY COURT EASTERN DISTRICT OF MISSOURI EASTERN DIVISION

UNITED STATES BANKRUPTCY COURT NORTHERN DISTRICT OF ALABAMA SOUTHERN DIVISION

IMPORTANT INFORMATION ABOUT BANKRUPTCY ASSISTANCE SERVICES FROM AN ATTORNEY OR BANKRUPTCY PETITION PREPARER.

Instructions Bankruptcy Forms for Individuals

than one, state all): Nature of Business (Check one box.) Health Care Business

DEBT RELIEF AGENCY CONTRACT

UNITED STATES BANKRUPTCY COURT DISTRICT OF MINNESOTA. NOTICE TO CONSUMER DEBTOR(S) UNDER 342(b) OF THE BANKRUPTCY CODE

United States Bankruptcy Court Central District of California. Voluntary Petition. B1 (Official Form 1) (1/08)

United States Bankruptcy Court Eastern District of Michigan. Voluntary Petition

Case can11 Doc 1 Filed 06/16/15 Entered 06/16/15 09:00:53 Desc Main Document Page 1 of 75

230 West Monroe Suite 240 Chicago, IL

BANKRUPTCY INFORMATION SHEET

INSTRUCTIONS FOR COMPLETING OFFICIAL FORM 1, VOLUNTARY PETITION I. INTRODUCTION

NOTICE TO CONSUMER DEBTOR(S) UNDER 342(b) OF THE BANKRUPTCY CODE

UNITED STATES BANKRUPTCY COURT WESTERN DISTRICT OF MICHIGAN. NOTICE TO CONSUMER DEBTOR(S) UNDER 342(b) OF THE BANKRUPTCY CODE

INSTRUCTIONS FOR COMPLETING OFFICIAL FORM 7. STATEMENT OF FINANCIAL AFFAIRS (Revised 2/01) I. INTRODUCTION

Case RG Doc 1 Filed 10/15/14 Entered 10/15/14 17:46:18 Desc Main Document Page 2 of 138

Case LMI Doc 76 Filed 04/22/15 Page 1 of 6 UNITED STATES BANKRUPTCY COURT SOUTHERN DISTRICT OF FLORIDA

VOLUNTARY PETITION I. APPLICABLE LAW AND RULES

Chapter 7 Liquidation Under the Bankruptcy Code

Case RBR Doc 14 Filed 03/02/15 Page 1 of 38 LIST OF CREDITORS HOLDING 20 LARGEST UNSECURED CLAIMS

United States Bankruptcy Court Eastern District of Virginia

United States Bankruptcy Court Northern District of Ohio SUMMARY OF SCHEDULES

Name of Joint Debtor. (if more than one, state all): West Valley NY ZIPCODE ZIPCODE. Chapter 7. Chapter 12. Check one box:

Case Doc 1 Filed 05/26/09 Entered 05/26/09 16:20:31 Desc Main Document Page 1 of 9. Health Care Business Single Asset Real Estate as defined

UNITED STATES BANKRUPTCY COURT EASTERN DISTRICT OF CALIFORNIA. GUIDELINES FOR PAYMENT OF ATTORNEYS' FEES IN CHAPTER 13 CASES (Effective July 1, 2003)

Case Doc 1 Filed 10/09/13 Entered 10/09/13 16:20:22 Desc Main Document Page 1 of 10

Name of Joint Debtor (Spouse) (Last, First, Middle): ZIP CODE ZIP CODE

Case rld11 Doc 1 Filed 12/11/ NE Captain Michael Smith Way

CURRENT MONTHLY INCOME

Notice to Individual Consumer Debtor Under Section 342(b) and 527(a) of the Bankruptcy Code

Tax returns or a driver s license are not acceptable proof of your social security number.

Creditors must stop attempting to collect on unpaid bills the debtor was released from.

Notice Required by 11 U.S.C. 342(b) and 527(a)

STANLEY J. KARTCHNER, CHAPTER 7 TRUSTEE

Case LMI Doc 1 Filed 12/01/10 Page 1 of 9. Health Care Business Single Asset Real Estate as defined

Chapter 13 Bankruptcy

Chapter 13 - Bankruptcy Basics. Background. Advantages of Chapter 13

United States Bankruptcy Court District of Arizona. Voluntary Petition

CASE NO. I (We) hereby certify under penalty of perjury with regard to all secured consumer debts.

rbk Doc#1 Filed 08/28/09 Entered 08/28/09 16:21:04 Main Document Pg 1 of 8

INITIAL CONSULTATION AGREEMENT AND ACKNOWLEDGMENT OF RECEIPT OF DISCLOSURES

Case Doc 1 Filed 04/23/14 Entered 04/23/14 15:34:02 Desc Main Document Page 1 of 8

United States Bankruptcy Court Western District of Arkansas SUMMARY OF SCHEDULES - AMENDED

Transcription:

ase 11-54098-jrs oc 20 Filed 03/15/11 ntered 03/15/11 13:24:19 esc Main ocument Page 1 of 22 H SAS BAKRPY R RHR SR F GRGA ALAA VS R: ) ) HAPR 7 RAFAL ARA ) ) AS. 11-54098-JRS ebtor. ) AMM SHLS and F SMMARY F SHLS A RR MARX MS W Rafael ardona the ebtor in the above-styled hapter 7 Bankruptcy ase ( ebtor ) and files this Amendment and respectfully show the ourt as follows: (1) Schedules and F: he ebtor hereby substitutes the Schedules and F which are attached hereto in lieu of any such Schedules and F previously filed. (2) Summary of Schedules. he ebtor hereby substitutes the Summary of Schedules which is attached hereto in lieu of any such Summary of Schedules previously filed. (3) reditor Matrix. he ebtor hereby amends the reditor Matrix to include the creditors listed below: Georgia epartment of Banking and Finance 2990 Brandywine Rd. Suite 200 Atlanta GA 30341 Gano xcel SA nc. 4828 Fourth St. rwindale A 91706 Raymond Berrones Jr. 4553 Rivercliff r. Lilburn GA 30047 Melaleuca nc. 3910 S. Yellowstone Hwy. daho Falls. 83402 Smoke Rise ountry lub 4900 hedworth r. Stone Mountain GA 30087

ase 11-54098-jrs oc 20 Filed 03/15/11 ntered 03/15/11 13:24:19 esc Main ocument Page 2 of 22 (4) All other Schedules remain the same. RSPFLLY SBM HS 15 th AY F MARH 2011. JS & WAL LL /s/ oel J. Bartels oel J. Bartles Georgia Bar o. 823714 Attorney for ebtor 21 ighth Street Atlanta Georgia 30309 (404) 564-9300 nbartles@joneswalden.com

ase 11-54098-jrs oc 20 Filed 03/15/11 ntered 03/15/11 13:24:19 esc Main ocument Page 3 of 22 H SAS BAKRPY R RHR SR F GRGA ALAA VS R: ) ) HAPR 7 RAFAL ARA ) ) AS. 11-54098-JRS ebtor. ) LARA R PALY F PRJRY BY VAL BR declare under penalty of perjury that have read the foregoing Amendment and that the same is true and correct to the best of my knowledge information and belief. ate: March 15 2011 /s/ Rafael ardona Rafael ardona

}bk1{schedule-reditorsholdingnsecuredprioritylaims}bk{ ase 11-54098-jrs oc 20 Filed 03/15/11 ntered 03/15/11 13:24:19 esc Main ocument Page 4 of 22 B6 (fficial Form 6) (4/10) n re Rafael Agustin ardona ebtor ase o. 11-54098 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 "X" 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 "X" in the column labeled "ontingent." f the claim is unliquidated place an "X" in the column labeled "nliquidated." f the claim is disputed place an "X" in the column labeled "isputed." (You may need to place an "X" 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 $11725* 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 $5775* per farmer or fisherman against the debtor as provided in 11.S.. 507(a)(6). eposits by individuals laims of individuals up to $2600* 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. 1 continuation sheets attached Software opyright (c) 1996-2011 - H RPRA - www.bestcase.com Best ase Bankruptcy

ase 11-54098-jrs oc 20 Filed 03/15/11 ntered 03/15/11 13:24:19 esc Main ocument Page 5 of 22 B6 (fficial Form 6) (4/10) - ont. n re Rafael Agustin ardona ebtor ase o. 11-54098 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.) GA ept of Banking & Finance 2990 Brandywine Road Suite 200 Atlanta GA 30341 B R Husband Wife Joint or ommunity H W J - A LAM WAS RR AM F LAM G L S P A SRA FR LAM Audit Fine and Assessment Q A AM L PRRY F AY 0.00 AM L PRRY Account o. 9955.00 9955.00 Account o. Account o. Account o. Sheet 1 of 1 continuation sheets attached to Schedule of reditors Holding nsecured Priority laims Subtotal (otal of this page) otal (Report on Summary of Schedules) 0.00 9955.00 9955.00 0.00 9955.00 9955.00 Software opyright (c) 1996-2011 - H RPRA - www.bestcase.com Best ase Bankruptcy

}bk1{schedulef-reditorsholdingnsecuredonprioritylaims}bk{ ase 11-54098-jrs oc 20 Filed 03/15/11 ntered 03/15/11 13:24:19 esc Main ocument Page 6 of 22 B6F (fficial Form 6F) (12/07) n re Rafael Agustin ardona ebtor ase o. 11-54098 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 "X" 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 "X" in the column labeled "ontingent." f the claim is unliquidated place an "X" in the column labeled "nliquidated." f the claim is disputed place an "X" in the column labeled "isputed." (You may need to place an "X" 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. xxxx-xxxx-xxxx-9240 Aeromexico Visa 800 icollet Mall Minneapolis M 55402 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. redit ard G L Q A S P AM F LAM 10000.00 Account o. xxxx-xxxx-xxxx-3840 redit ard Amazon hase Visa P.. Box 15299 Wilmington 19850-7000.00 Account o. xxxx-xxxx-xxxx-4490 redit ard Assoc redit nion Visa 6251 rooked reed Rd orcross GA 30092-9048.00 Account o. xxxxxxxxxxx0218 Business ebt A& Business Phone Service P.. Box 105262 Atlanta GA 30348 360.00 7 continuation sheets attached Subtotal (otal of this page) 26408.00 Software opyright (c) 1996-2011 - H RPRA - www.bestcase.com S/:35745-110218 Best ase Bankruptcy

ase 11-54098-jrs oc 20 Filed 03/15/11 ntered 03/15/11 13:24:19 esc Main ocument Page 7 of 22 B6F (fficial Form 6F) (12/07) - ont. n re Rafael Agustin ardona ebtor ase o. 11-54098 SHL F - RRS HLG SR PRRY LAMS (ontinuation Sheet) RR'S AM MALG ARSS LG ZP A A MBR (See instructions above.) Account o. xxxxxxxxx0-001 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. Business ebt G L Q A S P AM F LAM A& Business Phone Service P.. Box 105262 Atlanta GA 30348 375.00 Account o. Judgment - Business ebt entro P ortheast Plaza LL 800 Kennesaw Ave Ste 400 Marietta GA 30060 43000.00 Account o. Business ebt hamblee Retail Holdings LL 2498 hamblee ucker Rd Atlanta GA 30341 108000.00 Account o. 3390 Business ebt rime Free Alarm Service 5825 Live ak Pkwy Ste A orcross GA 30093 100.00 Account o. xx2978 Business ebt rime Free Alarm Service 5825 Live ak Pkwy Ste A orcross GA 30093 Sheet no. 1 of 7 sheets attached to Schedule of reditors Holding nsecured onpriority laims Subtotal (otal of this page) 100.00 151575.00 Software opyright (c) 1996-2011 - H RPRA - www.bestcase.com Best ase Bankruptcy

ase 11-54098-jrs oc 20 Filed 03/15/11 ntered 03/15/11 13:24:19 esc Main ocument Page 8 of 22 B6F (fficial Form 6F) (12/07) - ont. n re Rafael Agustin ardona ebtor ase o. 11-54098 SHL F - RRS HLG SR PRRY LAMS (ontinuation Sheet) Account o. xxx3365 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. Business ebt G L Q A S P AM F LAM ekalb ounty Water 1300 ommerce r ecatur GA 500.00 Account o. Business ebt ennis Matthews 2934 Mabry Lane acula GA 30019 55000.00 Account o. Business ebt inex 188 Bering r Ste 420 Houston X 77057 50000.00 Account o. Business debt Gano xcel SA nc. 4828 Fourth St. Baldwin Park A 91706-210.00 Account o. xxxxx-x4049 Business ebt Georgia Power 1841 mablee ucker Rd Atlanta GA 30341 1000.00 Sheet no. 2 of 7 sheets attached to Schedule of reditors Holding nsecured onpriority laims Subtotal (otal of this page) 106710.00 Software opyright (c) 1996-2011 - H RPRA - www.bestcase.com Best ase Bankruptcy

ase 11-54098-jrs oc 20 Filed 03/15/11 ntered 03/15/11 13:24:19 esc Main ocument Page 9 of 22 B6F (fficial Form 6F) (12/07) - ont. n re Rafael Agustin ardona ebtor ase o. 11-54098 SHL F - RRS HLG SR PRRY LAMS (ontinuation Sheet) RR'S AM MALG ARSS LG ZP A A MBR (See instructions above.) Account o. xxxxx-x4058 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. Business ebt G L Q A S P AM F LAM Georgia Power 1841 mablee ucker Rd Atlanta GA 30341 500.00 Account o. Business ebt Halpern Business 5269 Buford Hwy Ste A Atlanta GA 30340 11480.00 Account o. Business ebt nsight 600 Beacon Pkwy West Ste 901 Birmingham AL 35209 785.00 Account o. Business ebt PP Bill Payment 330 Passiac Ave Fairfield J 07004 250.00 Account o. Business ebt transfer-empo Financial LL 7995 Prentice Ave Ste 103 nglewood 80111 90000.00 Sheet no. 3 of 7 sheets attached to Schedule of reditors Holding nsecured onpriority laims Subtotal (otal of this page) 103015.00 Software opyright (c) 1996-2011 - H RPRA - www.bestcase.com Best ase Bankruptcy

ase 11-54098-jrs oc 20 Filed 03/15/11 ntered 03/15/11 13:24:19 esc Main ocument Page 10 of 22 B6F (fficial Form 6F) (12/07) - ont. n re Rafael Agustin ardona ebtor ase o. 11-54098 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. Business ebt G L Q A S P AM F LAM transfer-empo Financial LL 7995 Prentice Ave Ste 103 nglewood 80111 34295.00 Account o. Business ebt Lawrence Buckles 9330 ailey ir Alpharetta GA 30022 55000.00 Account o. Payment owed Melaleuca nc. 3910 S. Yellowstone Hwy daho Falls 83402-185.13 Account o. Business ebt Money Gram 1550 tica Ave South Minneapolis M 55416 28651.00 Account o. Business ebt Money Gram Money rders 1550 tica Ave South Minneapolis M 55416 309876.00 Sheet no. 4 of 7 sheets attached to Schedule of reditors Holding nsecured onpriority laims Subtotal (otal of this page) 428007.13 Software opyright (c) 1996-2011 - H RPRA - www.bestcase.com Best ase Bankruptcy

ase 11-54098-jrs oc 20 Filed 03/15/11 ntered 03/15/11 13:24:19 esc Main ocument Page 11 of 22 B6F (fficial Form 6F) (12/07) - ont. n re Rafael Agustin ardona ebtor ase o. 11-54098 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. For otice nly G L Q A S P AM F LAM ew Plan Realty 3440 Preston Ridge Rd Alpharetta GA 30005-0.00 Account o. Business ebt rlandi Valuta 1301 nternational Pkwy 4th Fl Fort Lauderdale FL 33323 4872.00 Account o. Business ebt Prepaidworx - Page Plus ellul 11121 Hwy 70 Ste 202 Arlington 38002 804.00 Account o. Personal Loan Raymond Berrones Jr. 4553 Rivercliff r. Lilburn GA 30047-25000.00 Account o. Business ebt Ria Financial 13828 erritos orp r Ste erritos A 90703 100000.00 Sheet no. 5 of 7 sheets attached to Schedule of reditors Holding nsecured onpriority laims Subtotal (otal of this page) 130676.00 Software opyright (c) 1996-2011 - H RPRA - www.bestcase.com Best ase Bankruptcy

ase 11-54098-jrs oc 20 Filed 03/15/11 ntered 03/15/11 13:24:19 esc Main ocument Page 12 of 22 B6F (fficial Form 6F) (12/07) - ont. n re Rafael Agustin ardona ebtor ase o. 11-54098 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. Business ebt G L Q A S P AM F LAM Ria Financial 13828 erritos orp r Ste erritos A 90703 30000.00 Account o. Business ebt Sigue 13291 Ralston Ave Sylmar A 91342 2586.00 Account o. Membership ues Smoke Rise ounty lub 4900 hedworth rive Stone Mountain GA 30087-537.00 Account o. Business ebt South xchange 80 SW 8th St Ste 120 Miami FL 33130 20000.00 Account o. xxxxx7384 Business ebt -Mobile P.. Box 742596 incinnati H 45274-2596 500.00 Sheet no. 6 of 7 sheets attached to Schedule of reditors Holding nsecured onpriority laims Subtotal (otal of this page) 53623.00 Software opyright (c) 1996-2011 - H RPRA - www.bestcase.com Best ase Bankruptcy

ase 11-54098-jrs oc 20 Filed 03/15/11 ntered 03/15/11 13:24:19 esc Main ocument Page 13 of 22 B6F (fficial Form 6F) (12/07) - ont. n re Rafael Agustin ardona ebtor ase o. 11-54098 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. Business ebt G L Q A S P AM F LAM ranspayment Services 3721 Kings Rd hattanooga 37416 20749.00 Account o. Business ebt nidos Money ransfers 1250 Broadway Ave ew York Y 10001 10651.00 Account o. Business ebt Vigo 1301 nternational Pkwy 4th Fl Fort Lauderdale FL 33323 50000.00 Account o. Business ebt Vigo 1301 nternational Pkwy 4th Fl Fort Lauderdale FL 33323 43823.00 Account o. Sheet no. 7 of 7 sheets attached to Schedule of reditors Holding nsecured onpriority laims Subtotal (otal of this page) otal (Report on Summary of Schedules) 125223.00 1125237.13 Software opyright (c) 1996-2011 - H RPRA - www.bestcase.com Best ase Bankruptcy

}bk1{form6.sumaryofschedules}bk{ ase 11-54098-jrs oc 20 Filed 03/15/11 ntered 03/15/11 13:24:19 esc Main ocument Page 14 of 22 B6 Summary (fficial Form 6 - Summary) (12/07) nited States Bankruptcy ourt orthern istrict of Georgia n re Rafael Agustin ardona ebtor ase o. hapter 11-54098 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 340000.00 B - Personal Property Yes 3 21023.50 - Property laimed as xempt Yes 1 - reditors Holding Secured laims Yes 1 440464.00 - reditors Holding nsecured Priority laims (otal of laims on Schedule ) Yes 2 9955.00 F - reditors Holding nsecured onpriority laims Yes 8 1125237.13 G - xecutory ontracts and nexpired Leases Yes 1 H - odebtors Yes 3 - urrent ncome of ndividual ebtor(s) J - urrent xpenditures of ndividual ebtor(s) otal umber of Sheets of ALL Schedules Yes Yes 1 1068.17 1 9489.00 22 otal Assets 361023.50 otal Liabilities 1575656.13 Software opyright (c) 1996-2011 - H RPRA - www.bestcase.com Best ase Bankruptcy

}bk1{form6.statisticalsumaryofertainliabilitiesandrelatedata}bk{ ase 11-54098-jrs oc 20 Filed 03/15/11 ntered 03/15/11 13:24:19 esc Main ocument Page 15 of 22 Form 6 - Statistical Summary (12/07) nited States Bankruptcy ourt orthern istrict of Georgia n re Rafael Agustin ardona ebtor ase o. hapter 11-54098 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 Profit-Sharing and ther Similar bligations (from Schedule F) AL State the following: Average ncome (from Schedule Line 16) 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 ) State the following: 1. otal from Schedule "SR PR F AY" column 2. otal from Schedule "AM L PRRY" column 3. otal from Schedule "AM L PRRY F AY" column 4. otal from Schedule F 5. otal of non-priority unsecured debt (sum of 1 3 and 4) Software opyright (c) 1996-2011 - H RPRA - www.bestcase.com Best ase Bankruptcy

}bk1{reditoradresmatrix}bk{ ase 11-54098-jrs oc 20 Filed 03/15/11 ntered 03/15/11 13:24:19 esc Main ocument Page 16 of 22 Aeromexico Visa 800 icollet Mall Minneapolis M 55402 Amazon hase Visa P.. Box 15299 Wilmington 19850 Assoc redit nion Visa 6251 rooked reed Rd orcross GA 30092 Associated redit nion 6251 rooked reek Rd A& Business Phone Service P.. Box 105262 Atlanta GA 30348 entro P ortheast Plaza LL 800 Kennesaw Ave Ste 400 Marietta GA 30060 hamblee Retail Holdings LL 9925 Haynes Bridge Rd Ste 200 Alpharetta GA 30022 hamblee Retail Holdings LL 2498 hamblee ucker Rd Atlanta GA 30341 rime Free Alarm Service 5825 Live ak Pkwy Ste A orcross GA 30093

ase 11-54098-jrs oc 20 Filed 03/15/11 ntered 03/15/11 13:24:19 esc Main ocument Page 17 of 22 ekalb ounty Water 1300 ommerce r ecatur GA ennis Matthews 2934 Mabry Lane acula GA 30019 inex 188 Bering r Ste 420 Houston X 77057 GA ept of Banking & Finance 2990 Brandywine Road Suite 200 Atlanta GA 30341 Gano xcel SA nc. 4828 Fourth St. Baldwin Park A 91706 Georgia Power 1841 mablee ucker Rd Atlanta GA 30341 Halpern Business 5269 Buford Hwy Ste A Atlanta GA 30340 nsight 600 Beacon Pkwy West Ste 901 Birmingham AL 35209 PP Bill Payment 330 Passiac Ave Fairfield J 07004

ase 11-54098-jrs oc 20 Filed 03/15/11 ntered 03/15/11 13:24:19 esc Main ocument Page 18 of 22 transfer-empo Financial LL 7995 Prentice Ave Ste 103 nglewood 80111 Ladden Group LL 2498 hamblee unwody Rd. Atlanta GA 30341 Lawrence Buckles 9330 ailey ir Alpharetta GA 30022 Melaleuca nc. 3910 S. Yellowstone Hwy daho Falls 83402 Money Gram 1550 tica Ave South Minneapolis M 55416 Money Gram Money rders 1550 tica Ave South Minneapolis M 55416 ationstar Mortgage 350 Highland r Lewisville X 75067 ew Plan Realty 3440 Preston Ridge Rd Alpharetta GA 30005 rlandi Valuta 1301 nternational Pkwy 4th Fl Fort Lauderdale FL 33323

ase 11-54098-jrs oc 20 Filed 03/15/11 ntered 03/15/11 13:24:19 esc Main ocument Page 19 of 22 Prepaidworx - Page Plus ellul 11121 Hwy 70 Ste 202 Arlington 38002 Raymond Berrones Jr. 4553 Rivercliff r. Lilburn GA 30047 Ria Financial 13828 erritos orp r Ste erritos A 90703 Sigue 13291 Ralston Ave Sylmar A 91342 Smoke Rise ounty lub 4900 hedworth rive Stone Mountain GA 30087 South xchange 80 SW 8th St Ste 120 Miami FL 33130 -Mobile P.. Box 742596 incinnati H 45274-2596 ranspayment Services 3721 Kings Rd hattanooga 37416 nidos Money ransfers 1250 Broadway Ave ew York Y 10001

ase 11-54098-jrs oc 20 Filed 03/15/11 ntered 03/15/11 13:24:19 esc Main ocument Page 20 of 22 nited Americas Bank/StateBank 3789 Roswell Rd Atlanta GA 30342 Vigo 1301 nternational Pkwy 4th Fl Fort Lauderdale FL 33323

ase 11-54098-jrs oc 20 Filed 03/15/11 ntered 03/15/11 13:24:19 esc Main ocument Page 21 of 22 reditors Added to Mailing Matrix: Georgia epartment of Banking and Finance 2990 Brandywine Rd. Suite 200 Atlanta GA 30341 Smoke Rise ountry lub 4900 hedworth r. Stone Mountain Ga 30087 Melaleuca nc. 3910 S. Yellowstone Hwy. daho Falls. 83402 Gano xcel SA nc. 4828 Fourth St. rwindale A 91706 Raymond Berrones Jr. 4553 Rivercliff r. Lilburn GA 30047

ase 11-54098-jrs oc 20 Filed 03/15/11 ntered 03/15/11 13:24:19 esc Main ocument Page 22 of 22 H SAS BAKRPY R RHR SR F GRGA ALAA VS R: ) ) HAPR 7 RAFAL ARA ) ) AS. 11-54098-JRS ebtor. ) RFA F SRV hereby certify that have served a copy of the AMM SHLS A RR MARX on all parties referenced below by depositing a copy of same in the nited States Mail postage prepaid to the following: Georgia epartment of Banking and Finance 2990 Brandywine Rd. Suite 200 Atlanta GA 30341 Gano xcel SA nc. 4828 Fourth St. rwindale A 91706 Smoke Rise ountry lub 4900 hedworth r. Stone Mountain GA 30087 Melaleuca nc. 3910 S. Yellowstone Hwy. daho Falls. 83402 Rafael ardona 2869 Briarlake Road Atlanta GA 30345 amara Miles gier llenberg gier Rothschild & Rosenfeld 170 Mitchell St. S.W. Atlanta GA 30303 Raymond Berrones Jr. 4553 Rivercliff r. Lilburn GA 30047 his 15 th day of March 2011. JS & WAL LL /s/ oel J. Bartels oel J. Bartles Georgia Bar o. 823714 Attorney for ebtor 21 ighth Street Atlanta Georgia 30309 (404) 564-9300 nbartles@joneswalden.com