Chapter 7 Bankruptcy Forms for Filing Without an Attorney

Chapter 7 Bankruptcy Form for Filing Without an Attorney Addre: United State Bankruptcy Court 126 U.S. Courthoue 517 Eat Wiconin Avenue Milwaukee, Wiconin 53202-4581 Office Hour: 8:30a.m. to 4:30p.m., M-F Main Office Phone Number: (414) 297-3291 Bankruptcy Help Dek: Staffed by volunteer attorney on Thurday morning from 9:00 a.m. to 10:30 a.m. The Help Dek I in Room 153 at the above courthoue addre. Diclaimer: Thi packet of form and related Information ha been put togetherto oit individual who ore conidering filing ban/1ruptcy without an attorney. The Bankruptcy Court doe not guarantee that thi pocket contain all the form or information you need to file bankruptcy. The information In thi packet hould not be a ubtitute for the advice of competent legal counel. The taff of the Bankruptcy Court cannot provide /ego/ advice. Such advice may be obtoinedfram a competent attorney.----

z TO: ALL PERSONS FILING BANKRUPTCY A tmtee will be aigned in every Chapter 7 and 13 cae. The name and addre of the trutee will be given in the Notice of Banlauptcy Cae Filing (alo called the 341 Notice). That Notice will alo give the date, time, and place of the "Section341 Meeting of Creditor." Attendance at thi meeting i required of all debtor. The N.otice will be ent to the Debtor and all creditor lited on the mailing matrix within 7 to 1 0 buine day. A. No later than 7 dav before the Section 34 I Meeting of Creditor. vou are required to provide the trutee with copie of the following reguired document (do not end original. malce a copy for the tmtee): 1. Title to all vehicle; 2. Recorded deed and land contract for all real etate; 3. Recorded mortgage for all renl etate; 4. The mot recent real etate tax bill for nil real etate; 5. The preceding two (2) year igned federal and tate income tax return and all chedule or trancript of the return. 6. Payment advice (e.g. pay tub) or other evidence of payment received by the debtor from any employer within 60 day befure filing the petition. 7. The name, addre and telephone number of each holder of a Dometic Support Obligation; and, 8. Any other document requeted by the trutee. 9. Tax return and payment advice or other evidence of payment provided to the trutee under paragraph (a)(5) and (a)(6) above, hall not be filed with the court unle otherwie ordered, B. At the Meeting of Creditor. you mut produce the following: 1. Pictnre identification iued by a govemmental unlt (driver' licene, county id card or the like), howing your name and picture identification. 2. Social Security card orrecent W-2 or 1099 howing your Social Security number. C. In addition. you mut provide to the trutee any additional document the Trutee requet at leat even (7) dav before the meeting of Creditor: If any of thee document are not provided a requeted, the cae may have to be adjourned from the initial meeting date. lf any of thee matter are not applicable, pleae o indicate in your repone. If you have any quetion regarding the requet, pleae contact the Trutee,

Warning Regarding Petition Prepnrer Only an attorney i autl10rized to give you legal advice regarding a bankruptcy cae or proceeding. So-called "petition preparer" are not autl1orized to give debtor legal advice, Their role i trictly that of a typing ervice trancribing for a minimal fee tl1e information a client provide, For example, they cannot: Malee uggetion regarding what paper are legally appropriate Advie you regarding what i legally required when a form elicit infmmation :from you Explain the meaning of a particular tatutory proviion or rule Provide advice on the bet procedure to accomplih a particular goal Explain tlie reult oftaldng or not taldng action in a cae Explain who hould receive proper notice or ervice Mot of tl1e required form in a bankruptcy cae are available for free, and mot are in pdffillable form o that they can be completed uing a keyboard. If you do not have a computer, check at the Clerk' intake couoter regarding tbe availability of a computer you may ue, free of charge, for the purpoe of filling out the reqtrired form. Given!he availability on the internet of pdf-fill able form, there i little or no reaon for a debtor to pay a non-attorney "petition preparer" to obtain the form. Properly completing thoe form, however, may require advice ofcompetent legal coune~ a petition preparer may not give you uch legal advice. Waming to Petition Preparer: Section]] 0 of the Bankruptcy Code provide civil penaltie for peron, other than an allorney or an employee ofan.attomey, who negligently orfi audzilent/y prepare bankruptcy petition or any other document for filing by a debtor in connection with a banlrr:uptcy cae. All petition preparer hall comply with the requitement of 11 U.S. C. II 0. Failure to comply with II 0 may reult in civil enforcement action by the United State Trutee or ubject the preparer to criminal proecution under I8 U.S. C. 156,

Farm 200 (Chaptl!r7, Individual! What form do I need to file bankruptcy?* A. To open a Chapter 7 bankruptcy cae, you need to file thee form and deal with the filing fee today, If you are o buine/corporation and want to file Chapter 7, you mut hove on attorney. D Voluntary Petition B 1 D Creditor Mailing Matrix 0 Exhibit D B 1D D Credit Couneling Certificate Don't have your credit couneling certificate? D I took a credit couneling coure, but do not have the certificate. (You have 14 day to ubmit it.) D I requeted, but could not obtain the couneling, and I have an emergency and need to file banltruptcy before I can take the coure. (The judge may allow a 30 or45-day extenion, depending on the explanation you provide.) D I am not required to get credit couneling. {See intruction in Exhibit D) D Statement of Social Security Number Lccal Form 21 D 299 filingfee, or Can'_t affa~d the filing fee? d You may be able to pay in intalirnemt B 3A D You maybe able to have your fee waived B 38 D Did a petition preparer help you? If o, you will need to file: D Notice to Debtor by Bankruptcy Petition Preparer B 19 D Dicloure of Compenation for a Bankruptcy Petition Preparer B 280 B. The following form are alo needed in your cae. They are due in 14 day. If you do not ubmit them within 45 day, your cae will be dimied. D D D Schedule D Schedule A- Real Property D Schedule B- Peronal Property D Schedule C- Property Claimed a Exempt D Schedule D- Creditor Holding Secured Claim D Schedule E- Creditor Holding Unecured Priority Claim D Schedule F- Creditor Holding Unecured Non priority Claim D Schedule G- Executory Contract and Unexpired Leae D Schedule H-Co-debtor D Schedule 1- current Income D Schedule J -current Expenditure of individual Debtor() with Statement of Monthly Net Income Statement of Financial Affair Statement of Current Monthly Income and Mean Tet Calculation B 6A B 6B B 6C 8 6D 86E 8 6F 866 86H 8 61 8 6J B7 822A.C. Thee form alo need to be ubmitted within 14 day, D ummary of Schedule D Statitical Summary B 6, page 1 B 6, page 2 * STOP! Have you filed Chapter 7 in the lat8 year and received a dicharge? If o, you mut wait to file unti/8 year and 1 day after your lat petition wa filed. 4

m com 1 F IC!n arm n C41JOJ 1upe:! Vohmtnry Petition Nume of DebloJ(): (nli paf!e m11.rt be cump/t!idri and filed flll!i'iu1' c:nt!,) AIIJ'rlnr llnnltnmlc\' Cne lilletl WIUtht l..ltl B Vcnr.> (If more limn nvo. nttoch utlditionnl.heet.) Lncnt!an Cuc Number: DnteFiled: Where Filed: J..acutlon C115e Number. DuteFiled; Where Filed: l'cmlln 1 Dnnltrllpt~ Cuc Fll~d h~ nny S 1nuc, l'nrtuer, ur Mfillnll! nflhi!i Debtot Ofmnrellum nne, nllm::h nddilionul heet.) Nnme ofoehtor. Cme Number: Dote Fllctl: DiSirict Relntionhip: Jttdgc; E:rhlbll A [fo bu complcle:tl Jftlubtor i required to file periodic rcpon (c.c., fmm IOK ond IOQ) \\1Ut the Sucurilie und Exclmnge Commiion puruant to SecJ.ion 13 or l5(d} of the Securitii!S 8tchnnge Act or 19J4 und i requi!sting relief under ehnpter II,) Exhlhh n {To bo completed If debtor i on individual wltne debt nro primllri]y con.umer debt,) 1, lhl! nuamcy for lhe petilloner nnmed in the foregoing petition, duclnrc that I hove infonned!he pethloner lim\ [he or he] mny proceed undi!r chnplor7, II, 12, or 13 ortltle II, United Stute Code, and hove expln\ned Ute rclicfomllnble under encb uch thnpter. 1 further certify thnt I hove dalivorcd to the debtor the notice required hl' II U.S.C. 342(b). 0 Eli.hlbit A i nltncber.l und 111nde n part ofthl petilion. X Signature of Attorney for Dcbtor() {Dote) Exhibit c Doe.'i the debtor own or hnve poeion of nny property tlun poe or I alleged to poen thrco\ of lmmln~:nt nnr.lltlentifioblll hnrm lo public henllh or nfety'} 0 Ye, and ExhlbitC i aunched ond mude n pnrtofthi pethion, 0 No. Exblbll D ffo be tompi!!u!d b)' CVCI)' individual debtor. Ifnjoint petition i nlcd, ench pouie mut complete nnd ntlnth nepnrnte Exhibit D.) 0 E x.hiblt 0 completed nnd igned by the debtor i nunc bed nnd mntle n pnrt of liti petition. If thi I a joint pc.tllion: 0 Exhibit D alo completed nnd igned by the joint debtor i ntmchcd nnd mndc. n port ofthi petiliorl 0 Infnnnnllnn Rcgnrdlng lhll Debtor- Vcuuc (Check nny nppticable bd:t.} Debtor hn been domlnlh~d or hn had o ll!sirlencc, prlncipnl place ofbtuim:, or principal net In thi Ditrict for lbo day immcdlntcl} pre~:eding the tlnle of lbi petition or for n longer port nfueh 180 dny thou in nny othllr Ditrict. 0 Them i 11 bankruptcy CllSC concaming: debtor' nffilintll, gnncrnl pnrtner, or pnrtm:rhip pending iil thi Ditrict. 0 Dlilitor i n dl!blor In o foreign proceeding ond hll!i it princlpnl pluce of buine or pdncipnl net in the Unllllti Stole in thi Ditrict, or l1n no prlnclpnl place ofbuirit:s or nl!t in the Unlt~:d Stnle but i n dert:ndnnt innn action or procectlinn [in o fcdcml or tntc court] In thi Di!rlct. or!he Interet oflh.c pnrlie will be crvl!d In rcgortlto Uu~ n:licfoughi in thir. Ditrict, Ccrtlfi~!nlion b)' II Dei.Jtor Who Rchlcit 11 Tenon I urreldenllnl i'rnpcrty (Chct:i; u\1 ilpplicnblc bo:te.) 0 Lnmllord hn njutlgm~:nt ognhlttbe debtor for pd.seiun of debtor' reidcn~ (lfbox chile ked, complete the following.) {Nome or Jnndlord tltnl obtnincdjudgmcnt) (Addre oflundlord) 0 Debtor cluims thnl under npplicnble nonbnnl;rup!cy Jnw, them n~ circumetnnce under which the debtor\vould be permitted to cure Ute entire monetnry defuuh thnt gnvc rise to the judgment forpct!iion. ofier the judgment forpoi!ssion wn entered, nnd 0 Debtor hd5 included wlll1lhi p!!lllion the depoit wltlt the court ofnny rent liml would become due dtiring the 30-dny pcriod nflcr the filing ofu c pelitiun. 0 Debtor ccnlfie Lbnl he/he hll!l erved tltu Lnrn1Jord with thi c:rtlficotion. (II U.S.C. Jli2(1)), 5

B I (Offitiul Fom1) I {4/1 0) Voluntni'Y }lctitlon (f/ti;r puxv 1111t.~l he compici/t!d a/ltl.!ift!d ijii!i'l!/j' ccuu.} Slgnnture() ofucblur{} (lndlviduni/,joinl) Slgnnture Numl! of Dcbtor(}: Slguntnru or11 Furclgn Rtprt!.!il!lttnlh c Pnge.J I dl!clnrc undl!r pnnnlty of peljury thnt the inrormntion prnvldi!ll in thi pnlithm i true I detlnre under pcnnll}' or pnrjmy lhnlthll informntion provided In thi pctilion l5 nud correcl true and cdrrcct, thnt I nm the fo~ign repreentutive of u debtor in n foreign fif petitioner i nn lndividuui whoe debt nrc primarily conumer debt and hn pmt:~:eding, nnd thnt I om uuthoriwd 111 11Je thi petition. choen to file under chnptcr 7J I om D\YllTC thnt 1 mil}' procm:d undru chnpter 7, II, I:! or 13 oflitll! II, United Stntc Code, undcrtnnd d1ll rcliefnvullnblc under cnclt uclt {Chtck only unu box.) chnpter,nnd clmoc to proceed under chupter 7. D I requet relief in uccordnnce with chapter \5 oft!tlc II, United Stole Code. [If no ouonh!)' repreent me nntlno bankruptcy petition prepnrer ign tlte polltion} I CllrtUicd copie of the document required b)' II U.S.C. 1515 nru nunched. hnvu obtninetlnnd rend the notice required b.y II U.S. C..342{b}. D Purlliln\to 11 U,S,C. 1511,1 requet relief in occordnnce with the I requet relief in nccordrmcu with lite clmptcr of title II, United Stnte Code, clmptcroftlllc II pecllied in thi petition. A cenitiecl copy orthc peclrietl in thi petition. order grnnling rucognition of the foreign mnin proceeding i~ ounched. X Sigmuuro ofdcbtor X (Sigmuure of Foreign Reprer:ntntive} X Signature of Joint Debtor (Printed Nome of Foreign Rcpr!CI11Dllvc} Telephone Number {if not repreented by nllomey) Dote Slgunture or Attnn1el'"' Dote Slunnlure ofnou-aitorney Bnnltnlptcy Petitlnu Prepnrer X Slnntureuf Allomcy for DebiDr() Printed Nnme of Allomc~ for Oebtor{) Finn Nome Addre Telephone Number I dl!l:lnrc under penni!.} or pejjuty thnt: (I} l om n bnnliruptcy pelition prcpnrer u defined in 11 U,S,C, 110; (2) I prepared lhl document for compcnntlon nnd hove provided the debtor with n copy of thi document nnd 1he notice and infommuon required under II U.S.C, JIO[b), II OQ1), nnd 342(b); and, (3) If rule or guideline hove bean promulgnted purunnt to II U.S.C.!i 11 O{h) etting o maximum fee. for ervice chnrg~oble by bankruptcy petition prepnn:r, I hove given the debtor notice of the mnximum nmount before preparing llnl' dm:ument for filing for n debtor or nct!!!pung ony fcc from the debtor, n required in lhnl ection. Official Fonn 19l nunched. Printed Nnme nnd tille, ifnn), ofbnnkruptcy Petition Prepnn:r Dote Social-Security number {If the bnnltruptt:y pctillnn prcpnrcr I not nn individual, tole the Socini Sccurity number or the officer, principal. 'In n ctl5c in which jj 7D7{b)(<I)(D) nppll~, thi ignntw-t: alo contitult: u ICSpoll!ilble peron or punnar of tln.! bnnkruptcy pt:tllian prcpnrer.) (Required cenificnticn thntlhe nuomey hn no btowlcdc nficr nn lnquhy lhntthcinfonnntion by 11 u..c. 110.) in the. chedule i im:orrc:cl Signature of Debtor (Corponlllonll'nrlncrhlp) I declare underpcnnlty ofpeljul}' lhot the information provided In thi petition l true nod correct, ond llmt. I have bean oul11orized to filn thi petition on behalf or the debtor. X Addre The debtor requet the rellr:r in uccortlom:c-wlth the. choptcr of title II, United Stute Code, pecified in thi pl!lltion. X Signature or Authortzerllndlvitlunl Printed Nnme Of AulhoriU.!d lndlvldunl Tille omuthnrized lndlviduol Dntc Dall: Signoture of bnnltruptcy. petition prcpnn:r or officer, princlpnl, reponible peron, or partner WhD!!u Soclni Set:urhy number i provided ubovc. Nnme nod Boclnl Sccurlly number of oil other indlvidunl who prepnrcd or nitt:d in propnrlng thili docuintnl unle!l!llhe bllnkruplcl' petllion prupnrur i not nn Jndlviduol, If mere thnh one per_on prepnrctl llii document, Dttnch odd!uonnl heet conforming to the npproprlntc off' mini fonn fer cnch ptr.;on. A bt111atilplcy.pctftfon prepa~' jaifllre to -complj will _ihe provi.foll of Iiiii.! J J a11p tile Federal Rule af Bonkillptcy Procedure Jllttl' rc.nlt in]llit!s or lmpriotlllu!lll or bath. 1 I.u.. c. JJfJ: 111 U.S.C.9 l:i6.

Jmwt L, Mrullut. li Clerk nfctjlij't 126 U.S. Cuul'thoue 517 E. Wi~ c:umiin rjve...ll:lilwnulir!e 1 WI 53202-4581 414-297-3291 www. wieb.ucourt.gov Uni/l!d State Bankruptcy Court Eatem Dltrict of Wicun;u Offi" nf /he Clerk REQUIREMENTS FOR FILING A LIST OF CREDITORS, CREDITOR MATRIX, OR MASTER LIST (MATRIX) In order to proce matrice more efficiently, the Clerk requet that matrice are filed electronically either by uing the File Your Creditor Matrix application which i available on the court' webite, www.wieb.ucourt.gov or on the terminal in the public area of the Banlcruptcy Clerk' Office, or bye-mail atwieb matrice(alwieb.ucourt.gov. Only in extenuating circumtance will a paper matrix be accepted for filing. It i not neceary to file a verification of the creditor matrix in thi ditrict. I. Uing the File Your Creditor Matrix application (www.wieb.ucourt.gov) a. Type the name and addree of all creditor. For example: AT&T P 0Box575 Murray, UT 83557 ADT Security Service P 0 Box3490 Pittburgh, PA 15450-7490 Sear, Roebuck & Company POBox3671 De Moine, 1A 50322 b. Wlmtlfinihed typing each creditor, click on Add Creditor. c. Wllen finihed adding all creditor, click on Submit Lit button. d. You have an opportunity to review the lit at the next window. e. Click on either Back button to edit the lit or the Submit button to accept the lit. i. Clicking on Submit will 'Send your matrix to a deputy clerk. 1

B ID {Offil:iul Form 1, Exhibit D}(l2/09) UNITED STATES BANKRUPTCY COURT In re ---~-,------- Debtor Cae No.. _-:-::--:-::---:- (iflmown) EXHIBIT D- INDIVIDUAL DEBTOR'S STATEMENT OF COMPLIANCE 'WITH CREDIT COUNSELING REQUIREMENT Warning: You mut be able to check truthfully one of the five tatement regarding credit couneling lited below. If you cannot do o, you are not eligible to file a bankruptcy cae, and the court can dimi any cae you do file. If that happen, you will loe wbatevcr filing fee you paid, and your creditor will be able to reume collection activitie againt you. If your cae i dimied and you file anotber bankruptcy cae Inter, you rnny be required to pay a econd filing fcc and you rnny have to take extra tep to top creditor' collection activitie. Eve!J' individual debtor mut file thi Exhibit D. If a joint petition i filed, eaclz poue mut complete and file a eparate Exhibit D. Check one ofthefrve tatement below and allach any document a directed. 0 1. Within the 180 day before tbc filing of my bankruptcy cae, I received n briefing from a credit couneling agency approved by the United State trutee or bnnlcruptcy adminitrator that outlined the opportunitie for available credit couneling and aited me in performing a related budget analyi, and I have a certificate from the agency decribing the ervice provided to me. Attaci1 a copy of the certificate and a copy of any debt repcijqnent plan developed tln ough the agency. 0 2. Within the 180 day bef01 e the filing of my bankruptcy cae, I received a briefing from a credit couneling agency approved by the United State trutee or banlcruptcy adminiti'btor that outlined the opportunitie for available credit couneling and aited me in performing a related budget analyi, but I do not have a certificate from the agency decribing the ervice provided to me. J'oumutfile a capy of a certificate from the agency decribing the en ice pmvided to you and a copy of anydebt repcijmrent plan developed through the agency no later than 14 dcij's after your ban/a11ptcy cae i filed

BID (Officilll Fcnn I, Elih. 0)(12/09)-Cunt. Pngc:! 0 3. 1 certify that I requeted credit couneling ervice from an approved agency but wa unable to obtain tl1e ervice during the even day from UJe time 1 made my requet, and the following exigent circumtance merit a temporary waiver of the credit couneling requirement o J can file my bankruptcy cae now. [Summarize e..r:igenl ch cum/ance here.] If your certilication i atifactory to the coort, you mut till obtain the credit couneling briefing within the firt 30 day after you file your bankruptcy petition and prompt!)' file a certificate from the agency that proyided the couneling, together with a copy of any debt m:magement plan developed through the agency. Failure to fulfill thee requirement mny reult in dimial of your cae. Any extenion of the 30-day deadline can be granted only for en ue nnd i limited ton maximum of 15 day. Your cae may alo be dimied if the court i not atified with your reaon for filing your bankruptcy cae 'vithout firt receiving n credit couneling briefing. 0 4. I am not required to receive a credit couneling briefing becaue of: [Check ihe applicable tatement.] [Mut be accompanied by a motion for determination by the courl] 0 Incapacity. (Defined in 1 I U.S.C. 109[h)[4) a impaired by reaon of mental illne or mental deficiency o a to be.incapable of realizing and making rational deciion with repect to financial reponibilitie.); 0 Diability. (Defined in J1 U.S.C. 109(h)(4) a phyically impaired to the extent of being unable, after reaonable effort, to participate in a credit couneling briefing in peron, by telephone, or tlu ough the Internet.); 0 Active military duty in a military combat zone. 0 5. The United State trutee or banlcruptcy adminitrator ha determined that the credit couneling reqtjirement of 11 U.S.C. I 09(h) doe not apply in thi ditrict. I certify under pennlty of perjury that the information provided nbove i true nud correct. Signature ofdebtor: ----------- Date:------- q

Locnl Fnmt11 Ue\': 1212007 UNITED STATES BANKRUPTCY COURT FOR THE EASTERN DISTRICT 01' WISCONSIN lnre. Dubtor Cae No.------------------- Chnplllr STATEMENT OF SOCIAL SECURITY NUMIIER(S) I. Name of Debtor (Lat, Fir~ Middle):----------------------------- 1 Debtor hn a Sociul Security Number and ll i I Debtor doe not have a Social Security Number but hn un lndividuul Taxpayer-ldentificalion Number (!TIN), and it i:---------------------- 1 Debtor doe not have either n Social Security Number or an Individual Tnxpayer-ldenlification Number (!TIN). 2. Name of Joint Debtor (La~ Firt, Middle]:, I Joint Debtor ha a Social Security Number and it i I.JolnlDebtor doe not have a Social Security Number but ha an lndividunl Taxpayer-Identification Number (!TIN), and it i: ----------------------- LJoint Debtor doe not have either a Social Security Number or an Individual Tm:payer-ldentilication Number (!TIN]. 3. Name of Spoi!Se if not n Joint Debtor (LDS~ Firt, Middle]:------------------------------- Addre!:Spoue ha a Social Security Number and it i f:'ispoue doc not hnve n Socinl Security Number but hn an Individual Tnxpayer-Jdentificatian Number (!TIN], and ll i:----------------------- I poue doc not hnve either a Social Security Number or an lndivlduul Taxpayer-Identificntion Number (!TIN). I deolnre under penally of perjury that the foregoing i true and correct X--~~~~~~-----~~ Signnture ofdebtor Dnte x-~~~~~~~~--- Signnture of Join! Debtor Dnte *Check the appropriate boxe abot'e and pl'dl'ide the raqrtired informal! an. *Debtor mut.pravide in[armatian[or non-filing poue. "'[f Debtor, Jdlnt Debtor or Non-Filing Spoue ha mare than one. Socia( Securib' Nrmiber, late all. Penalu'far making a fale /alemenl: Fine of up /o 250,000 or11p los yeat\r in!priaumenl or both. 18 U.S. C. /52 and 3571. /0

B JA {Dmclnl FonnJA) {12/07) UNITED STATES BANKRUPTCY COURT In re ---------;:--;-,..--------' Dcblol' Coc No,------- Chnpler APPLICATION TO PAY FILING FEE IN INSTALLMENTS I. In uccordlljlce with Fed. R. Bunkr. fl. IDOfi, I opply for Jlcnniicn to pll)' the filing fcc nmounting toc ln lnlnllment. 2 I nm unnbh: to pny llu: filing fcc except in lntn\lmcnt. J. Until Ute liung fee i pnld in full, 1 will not mnkc nny uddllionnl p11}'111ciil or tmnfer nny oddillcnni)uo(lcrt)' to nn unorney or nny other peron fnr ervice in connection with thi Cll5C. 4. l pmpoe lh~: following teml5 for the payment ofthe Filing Fee. Check one D With the filing cflhc petition, or D On or before au or before on or before on or before The number oflntnllmcnt propocdhnll not exceed four {4), nnd tl1e linn! inmllmcnthn\1 be pnyrtblc notlnlcr lljun 120 doy after filing the petition. For cuuc hown, I he court mny extend Ute time of llll)' intnlhncnl, provided the In\ irulnllment i pnid not inter thnn I 80 d11y nli.er filing U1e petition. Fed. R. Bnnkr. P. I006(b)(2). 5. I undertood lhalifl fall to pay uny inulllment when due, my bankruptt:y cae mn)' be dimied and 1 rna}' not receive a d[chnrge of my tlebt. Sigmttnrc of Attorney Dote Signature of Debtor Dnu: (In a joint cue, bou1 poue mut ign.) Name of Attamey Signature of Joint Deb lor (if nny) Date DECLARATION AND SIGNATURE DFNDN ATIDRNEY DANIGlUPTCV PETITION l'reparer (Soo II U.S,C. llo) I dco\nre under pennlly ofpcijut)' lhnc (1) I om n bankruptcy petition prcpnrer a defined in J I U.S.C. 110; (2) 1 prepllfcd tld document for compcnotlon and hnvc. provided tltc dcbtorwllh n copy of thi document ond lite notice and infcnnntion required under II U.S.C, IIO{b), IID(h), and342(ll}; (~)if ntle or guideline luwe been promulgntcd purunnt.to II U.S.C. J I D(h} ettirig n maximum fee for ervice olmrgcnb\1! by bnnkruptcy pelltion prcpnrcr, 1 It ave given the debtor notice oflho mnximum amount before preparing nny document for filing for n debtor or accepting nny fcc Trom the deb lor, n required und~r that ection~ and (4) I will not.dcccpt any additional money or outerpropcrt)ifrom lhe dehlor before the filing fee i pnld in full. PrinLcd or Typed Nnmc nnd TlUc, ifnny, ofbnnkruptcj' Petition Prepnrer.Sooini~Security No. (Required by II U.S.C. f1 0,) ljtha ba11kruptcy patltirmpraparo.r i not an Jndillldual,.rtate 1/lf! name, IIIla (ifnnj~, addre, and acial-ecut Uy nmnberojjhc officer, prlualpal, reptlltible. prtrjan, or partner who ign the dacjtmrmt: Addre ~~~~~~~~~-------------- Signature ofbunkruplc}' Petition Prcpnrcr Dille Nnme tmd SDt:inJ-Sccurity number of nll outer individunis \Yho prepnred or nitt:tl in prcpurlng thi document, unle the bunkruptcy pclitlnn prepnrcr i no! nn individual: lfmore than r:meprwon prepanul thi document, auuchaddltiana/ igned hee.t carifomring tcnhe appropriate OffiCial Form for each peron. A hankntptc:y perilion pre.parel' ' folilwc Ia comply with the pt ovi/dijs riftille I 1 and the Ferleral Rille{]/ Bankruptr:J' Procedwe :may reu/titrflne ur imprfammmt or hath. 11 U.S.C, 1 IOi IB U,S.C; 156, \(

D JB (Omcinl FnnnJB)(I2/07) APPLICATION FOR WAIVER OFTiill CHAPTER 7 FILING FEE FOR INDIVIDUALS WHO CANNOT PAY THE FILING FEE IN FULL OR IN INSTALLMENTS The court fee for filing a cae under chapter 7 ofthe Bankruptcy Code i 299. lfyou cannot afford to pay the full fee at the time of filing, you may apply to pay the fee in intallment. A form, which i available li"din the bankruptcy clerk' office, mut be completed to make tlmt application. If your application to pay in intallment i approved, you will be permitted to file your petition, generally completing payment of the fee over the coure of four to ix month. If you cannot afford to pay the fee either in full at the time of filing or in intallment, you may requet a waiver of the :filing fee by completing thi application and :filing it with the Clerk of Court. A judge will decide whether you have to pay tl1e fee. By law, the judge may waive the fee onlv if your income i le than 150 percent of the official poverty line applicable to your family ize and you are unable to pay the fee in intallment. You may obtain information about the pove~ty guideline at www.ucourt.uov or in the banlo uptcy clerk' office. Required information. Complete all item in the application, and attach requeted chedule. Then ign the application on the lat page. If you and your poue are filing a joint bankruptcy petition, you botl1 mut provide information a requeted and ign the application. /2-

D 38 (Qfficild Form JB) (12107) - ConL UNITED STATES BANKRUPTCY COURT In J'e: Deblor() Cae No. (if7k-no-l-vn"") APPLICATJON FOR WAIVER OF THE CHAPTER 7 FILING FEE FOR INDIVIDUALS WHO CANNOT PAY THE FlLING FEE TN FULL OR ln INSTALLMENTS Pnrt A. Fmnlly Size nnd Income I. Including yourelf, your pouo, and dependenl you hnve Jiled orwllllit on Schedule 1 (Current Income of lndlvlduul Debtor[)), how mllily people ure in your family? (Do not include your poue if you are epnrnted AND nre not filing a joint petition.) 2. Retate the following information that you provided, or will provide, on Line 16 of Schedule I. Altnch a completed copy of Schedule 1, if it i available. Totnl Combined Montltl)' Income (Line 16 of Schedule 1]: ----- 3. State the monthly net income, if any, of dependent included In Quetion 1 above. Do not Include any Income nlrendy reported in Item 2. If none, enter 0.. 4. Add Ute "Tolal Combined Monthly Income" reported in Quetion 2 to your dependent' monthly net income from Quetion 3. '~'---------- 5. Do you expect the amount in Quetion 4 to Increae or decreae by more than 10% during the next 6 month? Ye No If ye, explain. Pnrt B. Monthly Expene 6. EITHER (u] nttach u eomplclud copy of Schedule J [Schedule ofmontilly Expene), and tate your total monthly expene reported on Line 18 of!hnt Schedule, DR (b) if you hove notyel completed Schedule JJ provide an etimnte of your tot11l monthly expene.. 7. Do you expecl the amount in Quetion 6 to increne or decreae by more than 10% during tlm next 6 month? Ye No lfye, explnin-.- Pnrt C. Renl nnd l 1 eronnl Property EITHER (1) attnch completed.copie of Schedule A (Reul Property) and Schedule B (Peronal Property], OR (2] if you have not yet completed thoe chedule, anwer the following quetion. 8. State the amount of cnil you hnve on hnnd. 9, State below any money you hnve In aving, chccldng, or' other account in a bank or other financlni intitution. Bonk ar Other Financial Jnlhutiun: Typo cf AccautiL5Uclt 11!i fidylng, chccklnfl CD: Amount.. /3

B 38 (Official Fonn3B)(I2/07) -Com I 0. Stat~ below lhe net owned by you. Do not lil ordinary houehold ru1 nihing nnd clothing. Home Addre: Vnhu::S Amount owed on mongngl nnd lhm: S ------- Dt.ber tcnll!stnu: Ar.ltlre: Vnluc: Amount owed on mortgage and lhm: ------- Molar vchich: ModclfYCllr. Vnlu!!!S Amottnl ower.j:s Motor vehicle Mndui/Vcnr. Vnluc; Amount owed: Otlt!!t Dccriptinuc Vnluc: Amount owed: S ------- 11. Stnte below any peron,. buine, organization, or governmental unit that owe you money nnd the nmount thai i owed. Nome or Peron, Bwlni!SS, or Orpnlzntion thnlowe Ynu Manny Amount Owed Pnrt D. Additionnl lnformn!lou. 12. Hnve you puid nn attorney nny money for ervice in connection with thi cae, including the completion of thi form, the bankruptcy petition, or chedule? Ye_ No_ If ye, how much have you paid? 13. Have you promied to pay or do you anticipate poying nn attorney in connection with your bnnluuptcy cd.sc? Ye_No_ If ye, how much have you promied to pny or do you nnticlpnte paying? --------- 14. Have you pnld nnyone other t1111n nn nt!orney (uch a a bnnlcruptcy petition prepnrer, paralegal, Lyplng ervice, or nnotller peron) nny money "for ervice In connection witl1 Uti cne, includijlgthe completion of thi iorm, the banlrruptcy petition, or chedule? Ye _No_ Jfye, how much hove you paid? -------- 15. Hnve you promied to pay or do you anliclpnte paying nnyonc. otlu~r thnn nil nttornc.y.(uoh a a bllrlkruplcy petition prepnrer, pnrnlegal, typing ervice, or nnotherperon) any money for ervice in connection wiu1 thi coo, including tho oomplclion of thi form, the bankruptcy petition, or chedule? Ye No lf ye, how much hove you promied to pay or do you anticipate pay lng? --------- 16. Hn anyone paid an attorney or other-peron or ervice. in connection with ilii elie, on your behalf? Ye No lfye, explain. 14

B 3B (Officinl Fonn JB) (12107) -Cont. 17. Have you previouly filed for bankruptcy relief during the pat eight year? Ye_No_ Cne Number (if known] Yenr filed Location of filing Did you obtain a dicharge? [lflmown) Ye No Don't know Ye No Don 1 1 know I H. Pleae provide any other lnfonnatlon tl1at help to explnin why you are unable to pay the filing fee in intallmenl. I 9. I (we) declnre under penalty ofpeljury thnt I (we) cannot currently afford to pny the filing fee in full or in intollmenl nnd Umt the foregoing information i true and carn:ml Executed on: Dale Date Signature ofdebtor Signature of Codebtor DECLARATION AND SIGNATURE OJ' DANICRUPTC\' l'etitidn PREI'ARER!Soe 11 U.S.C. 110) I dcclnreundcrpenully ofpctiu!j' tim!; (I) I nm n bnnkruptcy petition prcpnrc.rn defined in I I U.S.C. 110; {2) I prcpnrcd thi documenl for compcn.:ntion nnd luwe provldcu the dcblor wiu1 n copy oftl1i document nnd the notice nnd infonnnlion required under I l U.S.C. H II O(b}, J I 001}. nnd 342(b); nnd (3) If rule or guideline hnvc been promulgated purunnlto II U.S. C. I I O{h) euing n mrudmum fcc for ervice ~:ltnrgenble by bnnkrupt~:y petition prepnrer, I have given the debtor nctice.cflhll mnx.imum nmount before prcpnring nny documcnj for filing for n debtor or neccpting Wl}' fee from the debtor, n required under thnt ection. Printed or Typed Nwne nnd Title, If nny, of Bankruptcy Petition Prcpnrer Socini Sccurity No. (Rcqulrod b) II U,S,C. I to.) if tho banlmtplr:)' pelf/ion pro parer I nat an indmdjtal, tate the name, title fl( anj~, addre, and oc:ial.iet:ttrfo number of the officer, prfnclpa/, repanlble peron or partuer wit a fgnr the. dacumam. Addre X S~ig= n=n=w=re~o~f~b~nn~~==p~lcy~p~el~il"io=n P~re=p=ruo==r------------- Dale Nnme ond Sooini~Sc~:urity number of nil outer lmlividuol who.prcporcd or nitcd Jn propitrlng thi document, unlt!s the bunlcruptcy pt:.tllinn prcpnrer i not on individual: /[mare than one prwon prepared thi document, at/ar:/1 addiliana/.igned heet cat!farming to the appropriale Official Fot mfot aach pl!l<on. A brmkrupicj' pelftlon preparnl' 'jall11re Ia comply with tim pravliou of lit/a 11 artd rlw Federal Rt~le of Bankl'llplcy Procedw c llltd' reult in fine or imprlanmrmt or both. ll U.S. C. I JO: 18 U.S. C. 156. IS

BIY {Dfficlnll'orm 19)(12101) United State Bankruptcy Comt lnr --------------~~------~ Debtor Cae No. ------------- Chapter DECLARATION AND SIGNATURE OF NON-ATTORNEY BANKRUPTCY PETITION PREPARER (See 11 U.S.C. 110) I declare under penalty of perjury that: (1) I am a bankruptcy petition preparer a defined in II U.S.C. I I 0; (2) I prepared the accompanying document() lited below for compenation and have provided the debtor with a copy of the document() and the attached notice a required by 11 U.S.C. IIO(b), l!o(h), and 342(b); and (3) if rule or guideline have been promulgated puruant to 11 U.S.C. II O(h) etting a maximum fee for ervice chargeable by bankruptcy petition preparer, I have given the debtor notice of the mnximum amount before preparing any document for filing for a debtor or accepting any fee from the debtor, a required by that ection. Accompanying document: Printed or Typed Name and Title, if any, of Bankruptcy Petition Prepnrer: Social-Security No. of Bankruptcy Petition Preparer (Required by I I U.S.C. 11 0): If the banlc11rptcy petition preparer i not an individual, tate the name, Iitle (if any), addre, and ocial-ecurity numbe1 of the officer, principal, reponible peron, m pal'tner who ign thi document. Addre X Sig;;;n"'a"'ru'"r"'e"o"'r"B:r.a"n"'lcr"'t"'lp"'t"'cy""'P""et"'lr"'Jo"'n,...I"''I"' e"'p'"ar""er '"D"'a"'te,------------ Name and ocial-ecurity number of all otiter individual who prepared or aited in preparing thi document, unle the bankruptcy petition preparer i not an individual: Q'more.than one peron prepared.thi dormment, attach add/tiona/igned heet cm!formingto the appropriate Offiriial Form for each peron. A bn il<ruptcy petition prcpn c ' failure to comply with tlw proviion of title 11 und the Fcdcr:il Rule ol'bnnl<ruptcy Procedure mny reult in fine or imprionment or both. 11 U.S.C. 110; 18 u..c. 156. lb

819 (Ofiiclnl Fnnn 19) {1"1/07)- Cnnt. 2 NOTICE TO DEBTOR BY NON-ATTORNEY BANKRUPTCY PETJTION PREP ARER [Mut be filed with any dacument() prupared by a banlauptcy petition preparer.] Jam a bankruptcy petition preparer. I am not an attorney and may not practice law or give legal advice, Before preparing any document for filing a defined in 11 D(a)(2) of the Bankruptcy Code or accepting any fee, I am required by law to provide you with thi notice concerning bankruptcy petition preparer. Under the law, 110 ofthebanktuptcy Code (11 U.S.C. I 10), I am forbidden to offer you any legal advice, including advice about any of the following: whether to file a petition under the Bankruptcy Code (11 U.S.C. 101 et eq.); whether commencing a cae under chapter 7, 11, 12, or l3 i appropriate; wheu1er your debt will be eliminated or dicharged in a cae under the Bankruptcy Code; whether you will be able to retain your horne, car, or otl1er property after commencing a cae under the Bankruptcy Code; the tax conequence of a cae brought underthe Bankruptcy Code; the dichargeabilily of1llx claim; whether you may or hould promie to repay debt to a creditor or enter into a reaffirmation agreement with a creditor to reaffirm a debt; how to characterize the natore of your Interet in property or your debt; or bank-ruptcy procedure and right. [The notice may pra11ide additional example of legal advice that a bankruptcy petition preparer i not authorized to give.] In addition, under 11 U.S.C. l!o(h), the Supreme Court or the Judicial Conference of the United State may promulgate rule or guideline etting a majtimurn allowable fee chargeable by a bankruptcy petition preparer. A required by law, I have notified you of thi maximum allowable fee, if any, before preparing any document for filing or accepting any fee from you. Signature of Debtor Date Joint Debtor (ifany) Dale [h1 a joint cae, bath poue mut ign.] 11

B2BO (Fonn 280) (10/05) United State Bankruptcy Court Ditrict Of Jnre ~~~------- Dcblor c.. c No,-------- Chapler DISCLOSURE OF COMPENSATION OF BANKRUPTCY PETITION PREFARER [l'lli.rform mils/ be filed with tim pelillan if a bankr11ptcy petit/on preparer prepare tile petition. 11 U.S. C. 11 0(11)(2).]!. Under II U.S.C. 11 O(h), 1 dcc!nrc under penally ofpetiury Utall am not an allomcy or employee ofnn allomey, that! prepared or coued to be prepared one or more document for filing by Lhcnbove-nnmcd clebtor() in connection with thi bankntptcy coe, nnd thnt cornpemllltlon pnld to me within one year before the filing of the bnnltruplcy petition, or agreed to be pu\d to me, for ervice rendered on behalf of the dcbtor() in contemplntion of or In connection with the bankruptcy cne i tis follow: For document pl'cpnration ervice I have agreed to accepl... c _ Prior to the filing of thi tntement I hove receh,cd... Bnlnnce Due... '------------ 2, I have prepared or caued to be prepnred the following document (Itemize): and provided the following ervice (Itemize): 3. The ource of the compensation paid to me wa: D Debtor D Othet (pecify) 4. The ource of compenation to be pnid to me i: D Deblor D Other (pecil)') 5. The foregoing I a complete. tntcmcnt ofnny agreement or arrangement for payment ld me for preparation of.lhc petition iiled by the debtor() In!hi bankrupltly cne, 6. To my knowledge no other peron ha prepared for comperiation a document fol' ftjing In connection wiu1 thi batiltruptcy cne except a lited below: NAME SOClAL SECURITY NUMBER Signature Printed nnmennd Litle, ll'nny, of Bankruptcy Petition Jlrcporer Addre:. Social Security number ofbnnkrupltly petition prepnrcr (lflhe bankruptcy petition prcpnrer 1 not an Jndivldunl, tate the Social Security number oft.he officer 1 principnl, reponible peron or partner oflhc bankruptcy petition prepnrer.) (Required by lj U;S.C. I 10.) Date A ba/1/a'ujj/cji pe.lition pre.parel"'faihwe to comply with the praviidjr of title 11 -t;jnd.the.fedi!rdl Rille qjbankruptcypracedw ejjlojlreuft in fine or imprionment or both. 11 U.S. C. IJD; 18 U.S, C. 156. 19'

D6 Cm cr (l'nrm 6 Cover) (12/07) FORM 6. SCHEDULES Summary of Schedule Statitical Summary of Certain Liabilitie and Related Data (28 U.S.C. 159) Schedule A- Real Property Schedule B- Peronal Property Schedule C- Property Claimed a Exempt ScheduleD - Creditor Holding Secured Claim Schedule E- Creditor Holding Unecured Priority Claim Schedule F- Creditor Holding Unecured Nonpriority Claim Schedule G -Executory Contract and Unexpired Leae Schedule H - Codebtor Schedule I -Current Income oflndividual Debtor() Schedule J- Current Expenditure of Individual Debtor() Unworn Declaration Under Penalty ofperjury GENERAL INSTRUCTIONS: The firt page of the debtor' chedule and the firt page of any amendment thereto mut contain a caption a InForm 16B. Subequent page hould be identified with the debtor' name and cae number. If UJe chedule are filed with the petition, the cae number hould be left blank. Schedule D, E, and F have been deigned for the liting of each claim only once. Even when a claim.i ecured only in pnrt or entitled to priority only in pnr~ it till bould be lited only once. A claim Which i ecured in whole or in part hould he lited on ScheduleD only, and a claim which i entitled to priority in whole or in part hould be lited on Schedule E only, Do not lit the ame claim twice. If a credftor ha more than one claim, uch a claim ariing from eparate tranaction, each claim hould be cheduled eparately, Review the pecific in!juction for each chedule before completing the chedule. 1'1

06A (Officinl Fonn 6A) (12J07J ln~--------~~~------------------ D~:btut Cm;~: Nu. ------...,o:-:-----c---------- (lflmo\\'11} SCHEDULE A- REAL PROPERTY ENcept u directed below, lit nil renl pmp!!rty in which the d!!btor huuny Jcgnl, cquituble, or fmure interet, including n!j property owned un cull!nnnl, community property, or in which the debtor hn n life etntc. Include nny property in which the debtor bold right and power exorcianble for ~1c debtor' own bcm:fil lftln: dt!btor i married, tate whether the huband, wife, both, or the mnrilul community own tl1e property by plncing nn "H," "W," "1," or ucn In lhc column lubeled "Huband, Wife, Joint, or Community.'' If the dabtor hold no Interet in renl property, write 01 Nonc" under "Dt!Scription nod Locniion ofprop~:rty." Do nol hlchu1e intei'csl In CJil.!cutoJ y contrnct nnd 1lllt!.'tpircd lene on lid chedule. Lillhem in SclJoi.lulc G- Executory Cnnti'OclSund Unexpired Lc.nc. 1 r nn entity clnirn to have nlil:n or hold o ecured interet in nny propcrt)' 1 tnte lhc amount nflht! t.-cured cluim. Sec Schedule D. I fno enllty claim to hold n ecured Interet in the property, wrile "None" in the column lnbeletl "Amount of Secured C\uim." If the dcbjor i lul lndh idunl or Jr n ju lnt petition i Jiied, lnle the nmounl of nny eliemplion c.jnimed in the property only in Schcdull! C - Property Clnimed n Exempt. DESCIUI'TION AND LOCATION OF PROPERT\' NATURE DJi DEBTOR'S INTEREST IN PROPERTY CtJltRENTVALUE OFDEDTOR'S INTEREST IN PROPERTY, WJIDOUT OEDUCI'ING AN\' SECURED CLAIM OR EXEMPTION AMOUNT OF SECURED CLAIM zo

U fib {Official Fom161l) (12107} In ru -;,--,-,-------------- Dubtur Cue No.---=::----:---;--- (Ifltnnwn) SCHEDULE B- PERSONAL PROPERTY E;;ccpt n directed bclaw,lilnll peronnl property oftlu: dcblorofwhntcvcr kind. Iflhc debtor ho no property in one or more oru~t: cmegorie, pidcc nn "x" in thu nppt oprlote poition in the column Jnbclcd "None.." Ifoddilionul pace i needed in nny cntegory, nunch 11 epnrutc heet properly idcntl ried whh the cne nome, cue number, nnd the number oftln: category. lflhe debtor i married, tole whether thchubnnr.l, wife, bolh~ or the muritnl communily awn the property bj' plncing an "H," "W,""J," or "C" in the calumnlnbeled uhubnnd, Wife, Joint, or Communlt:y.~' IfU1e dcbtor i un Jndlvidunl oro joint petition i filed, tntc the Dmou.nt of nny axcmplian claimed only in Sclu:dule C- Properly Clnimcd n Exempl. Do not lit Interet in executory contn~ct nnd uncxpircl1l1!u5cs on thi chedule. Lit them In Sdtl!dnlc G Exccutnt'Y Ctmlrn~t nnd Unexpired Lene. lflhc propcrty I being hold fonhc debtor by omeone ele., idle that peron' nama and nddrc~ under "Decription and Location ofprnpcrly." If the property i being held for u minor child, impl)' tale the child' iniliol and the nome nnd addre ofr..hc child' pnrenlor gunrdinn, uch n "A.B., n minor child, by John Do~ gunrdinn." Do not dicloe the child' nome. See, II U.S.C. I 12nnd Fed. R.. Bnnkr. P. 1007(m}. T\'PE OF PROPEfiTI' N 0 N E DESCRll'TION AND LOCATION OFPROPERTI' CURRENT VALUE OF DEBTOR'S INTEREST IN PROPERTY, WJTH~ OUT DEDUCTING AN\' SECURED CLAJ?oi'l OREzXEM1 1 TION I. Cnh on.ltnnd. 2. Checking, aving or other finnncinl nceount, ccrtllicrlle of depoit or hare In bunk,nving nnd lonn, thrift. building nnd lonn, nnd hometead n9ocintiou, or c:rcd\l union, brcla:rage houe, or eoopemtivc. 3. Securi~y doponlt with public util Itie, telephone companie, lnndlord, nnd oth~r. 4. Houehold nood nnd furnihing, includmg nudlo, video, nnd complllcr cquipmcnl S. Bon~:; ph:lun: nnd at11er nrt object; nmique; LUmp; coin, record.lnpe, t!ompncl dic, nod other collection orcollctliblc. 6, Wearing oppnrcl. 7. Fur ond jcwchy. S. Fln:nrmnnd port, photo graphic, nnd other hobby equipment. 9. lnu:nml!i in lnurom:e policie. Nome lnnrnncc company ofcnch policy nnd hnmlw liutrend~:r or refund vuluc ofcnch. 10. Annuilil!i. llcmize nnd nome ench i.~:u~r. 11. lnterct in on edm:nuonira u defined in 26 U.S.C. 530(b)(l) c.rundor n qunlificd Sinte tuition pion u delinetlln 2fi U.S.C. 529(b)[l), Give pnrticulnr. (File epnrntely the rccord() arnny nucl1 intc~l(a~ 11 U.S. C.!i 2--/

B 6B {Dfficinl Form 6D} (12107)- CnnL lnr --------~~~--------------------' DcUtnr CIISL! No.-------,=--.,----- (lrltnown) SCHEDULEB-PERSONALPROPERTY (Continuation Sheet) T\'JlE OF PROPER'n' N 0 N E DESCRII'TION 1\ND LOCATION OF PRO PERT\' CUilRENTVALUEOF DEDTDR 1 S INTEREST IN PltDPEfiT\ 1, WITII OUT DEDUCTING AN\' SECURED CLAlM on EXEMI'TION 12.lnterot In UtA, EiUSA,Kc:ngh, or other penion or profit horing pion. Gh e pnrllculnr:;. IJ. Stock und interet in inr:orporull:d nnd unincorpomtcd buinee, Itemize. 14. Interet in pnnncrhlp or joint Vt:JJture. Itemize. 15. Government ll11d corpornte bond nnd other ncgotinblc nud nonmgotloble intntmcnt. 1 fi. Account rcceivnble, '.,.. _;:..-: -~; 17.Aiimon)', mninlt!nnm:e, upport, nod propcr1y elllemcnt tn wljicl11he debtor i or TTlllY be enlilled. Give pnr11culor. 1 B. OU1cr liquiddted debt owed ld debtor including tnx refund. Give pnrticulor. 19. Equitable or fuwn: lntcr~t, life. ctnte, nnd right or power cxc:n::lnblo rortllc hcncrit.oflhe debtor ottu:r limn thoclitedinschetlulca- Real Propeny. 20. Conlingentoml noncontingcnt lntnretln clnle oro dcccdnnt, de nth lrenent plnn, lire lnumnee policy, or lnt!il 21, Olhcrconllngent nnd unliquideted clnlm ofevl!fy nature, Including ln.'i. rer1md, I:Ollntnrclnimn oflhe dcblor,and rinht to cjoffclnhn. Oivt: ctimaled valu~areuull... : :. >- :- '..' ' ~.-,.. :.. ; 2Z

B fib (Official Fonn GB) (12/07)- Cont. lnn ~~~------------------------- Debtor SCHEDULEB-PERSONALPROPERTY (Conlinunlian Shtl!l) Cno Nn, ------=;----;--- (HluiUwn} T\'PE OF PRDPERT\' N 0 N E DESCRIPTION AND LOCATION OF PROFERT\' CUIUtENTVALUEOF D~BTOR'S INTEREST IN PRDI'ERT\', WI'I'II OUT DEDUCTING ANY SECURED CLAIM OR EXEMPTION 22. l'nu:nt, copyrlg]m, nnd otlu:r inulllcctunl propcny, Give panlculur. 2.3. Licene, frnnchle, nnd outer geneml lntnngiblc. Give pnrtlculn1'5. 24. Cutomer lim or outer compllntion containing peronally ldentifioble Information (n Ucfiner.l in II U.S.C. 101 (41A)) pro vi dell to I he deb Lor by inrllvldunl in connection wltlt obwinlng n product orncrvice from the debtor primarily forptronnl, family, or houehold purpoe, 25. Automobile, tttlck, trnller, and otheneidcle nnd necearie. ': :-~"'..--,:.. -~-. :. :,..::. 26. Boat, motor, nnd necearie.. -.. ' 27. Aircrnfi nnd acceorie. 28. Office equipment, furnihing, nnd upplie... :.-.. 29, Machine!)', rtxtu~, equipment, nnd upplie ued in liuine. 30.1nvcntory. 3J.Anlmnl. 32. 'crop- growing or hnrvei.cd. Give particulnr. 33. Funning equipment and ltnplcment. 34. Form upplie, clu:micul, nnd feed. 35. Dtl11~rpc!Snnnl pmperty ofony lcind not nlrendy lil!!d. lteinlzc. ------'cominuulion lrect-nllnchcd TnlOI>- (Include amount rrum nn.y ctmununtion ht!ct nttnched, Repon totnl nln.on Summary pfschcdulc.} L.:-------------------'

B 60 {Offitiul Fonn fio) (12107) In"------;;--;-:---------' Debtor Cnc No --------,=--,------ (lfltnown) SCHEDULE.D- CREDITORS HOLDING SECURED CLAIMS Slntc the nnme, mnillng uddre, including zip code, nnd In! four digit of nil)' nccounl number of nil cntitic..'i holding claim ecured by property ofu1e debtor n oflhe dote of filing ofthe pelilion. The complete necourll number ofnn)' ncc:ount the debtor hn with the. credilllr i ueful lo the lnttce nnd the crcdilornnd mny be provided If U1c deblor chooe Ia do o. Lit creditor holding nll type of ecured interet uch n judgmenl lien, gnmlhmcnt, lntutory lien, mortguge, deed oflnll, nnd other ccurill' interet. Lit creditor in nlplmbctlcnl onler to the c);:tent prnctlcnble. Ifu minor child i the creditor, tnte the child' initinl nnd lhe nome nnd uddre ofu1e child'purcnt or gunrdinn, uch ils "A.B., n minor child, by John DoeJ gunrdinn.'' Do not dicloe the ch.lld' nome, See, 11 U.S.C. 112 nnd Fed. IL Bonkr. P. 1007(m}. Irnllccurcd creditor will not fit on Ibi page. ue l11c continuation \u:et provided. If nny entity ouuw tlmn a poue in a joint cae mny be jointly linblc on n clnim, pluce on "X" in the columnlobeled "Codebtor," include Ute enlity on the npproprinlc chedule ofcredilor, ond complete Schedule H- Codebtor. IfnjoinL petition I filed, tntc whcutcr lht! hubnncl, wire, bout of them, or tlu:: mnritnl community moy be linblo on nuch claim by plnclng nn "H," "W,'"uJ," or "C'' in the column lnbulcd "Hubnnd, Wife, Joint, or Community." If the clnim i contingent, plnce ntl "A"' in the column lnbeled "ContingenL" JfU1e clnim i unliqulclnted, plnce nn "X" in Lhc co lumn lob~:led "Unllquidntcd." lflh~: claim i diput~:d, ploce an''x''in lhe colunu1 Jnbelcd "Diputed." {You mny need to place nn "X" in more U1nn onr; of Lln~c Llm:c column.) Total Lhc column labeled "Amount ofcinim WiU1oUt Deducting Value ofcollnl.ernl" nod "Unecured Portion, If Any~ in U1e boxe labeled '"Tollll()~ on the lat heet ofu1c completed chedule. Report the tolnl from lbe column Jabeletl"AmounlofCinim WiUJoul Deducting Vnlue or Collnternl" nlo on the Summary of Schedule nnd, iflhc debtor i nn indlvldunj with primnrily conumer debt, report the totnl from the column lnbeled "Unecured Portion, If Any 11 on the Slntilicnl Summnry of Certain Linbililic nnd Relnted Onto. D Check lhi box if debtor hils no creditor holding ecured clnim to report on thi Schedule D. CREDITOR'S NAME AND 1\>IA!LING ADD!lESS ~ 1:: " 0 :<o "' - ~ t:!;; "'!i5 z ~ INCLUDING ZIP CODE AND AN ACCOUNT NUMilER (See Jnlruct/an.r Abava) "' Q <- 0 o:o-" u oo"'=o Cl u ACCOUNT NO. = DATE CLAIM WAS INCURRED, NATU!lE OF LIEN, AND DESCRIPTION AND VALliE OF PllOPERTI' SUBJECT TO LIEN!<: "' Cl "' ':;: Cl "' ;:,.,. 0' (.!> z e 5 ~ "' Q 0 u ~ Ali'IOUNT OF CLAIM WITHOUT DEDUCTING VALUE OF COLLATERAL UNSECURED PORTION, IF AN\' VALUE ACCOUNT NO. ACCOUNT NO, VALUES contlnuntion heet --EIIIII~hcd VALUE Sub1ntnl,.. (Total orthi pngc) Tntnl ~ (Ue orli)' on lot pogc} (Report nln on Sunnmuy or ScheduleS.) (Irnppllonblc. report olo nn Stntilh:nl Summary arcennin Linbilltie nnd ne:lntcd Dnln.J z_4-

B 60 (Dffit:inl Form CiD) {I:U07)-ConL 2!nrc ~~~--------------~ DobtuJ Cne No.----------;=---,,--------- (iflmown) SCHEDULED - CREDITORS HOLDING SECURED CLAil\1S (Continuation Sheel) CREDn'OR'S NAME AND MAlLJNG ADDRESS INCLUDING ZIP CODE AND AN ACCOUNT NUMBER (See Ju.rtnrt!ltan lfholle.} ACCOUNT NO,.,; DA.1'E CLAIM WAS c AMOUNT OF CLAIM 0:!=.:i': INCURRED, NATUilE ~ "' c WITUOUT 0 ~oi;; OFLIEN,AND "' '< ci' -~ " DEDUCTING VALUE., DESCRIPTION AND 10 ~ OF COLLATERAL "' z!<.,.. ~ VALUE OF PROPERTI' " \;; Cl 0!!! "O"' ::; u,~o SUDJECf'fO LIEN 0 c 5 u u UNSECURED PORTION, IF i\n\' ACCOUNT NO, VALUES ACCOUNT NO, VALUES ACCOUNT NO. VALUES ACCOUNT NO. VALUES VALUES Sheet no. of euntinunlion Subtntnl (j~ heet nunc.lu!d to Scbcthilc or (Totnl(li:) ofthlpnge) Cn:diloG Holding Secured Claim 'fotnl() ~ (Uc only on In\ pnge) {Report nlo on (lfnppllcnbl!!, Summnl}' or Si:hedU]c,) rcporl!d]so on Stnli:ticnl Somm111y ofcertnln Linbllitrenntl ;.RcJntl!ll Dnln.)

B 6E (Omcinl Fonn DE) {0<111 U) lore ~~----------------~ Debtor Cnc No ------=----:--- (!1 lmdll'll) SCHEDULE E- CREDITORS HOLDING UNSECURED PRIORITY CLAIMS A complete Jit of claim entitled to priority, lited SCJUU1Jtely by type. of priority, i to be et foru1 on Ute l1eel'i provided. Only holdm of unecured claim.cntilled to priority hould be lited in thi chedule. In the boxe provided on Ute ounchctl lu:ct, tole tl1c nnmc, moiling. nddre, including zip code. und Jut four digit of the account number, ifuny, ofuu t:~~title holding priority claim ngninl tltc debtor or the property ofthe debtor, ru; DfUtc date of the filing of Ute pcthion. Uc n eparate continuntion heet for cnch type of priority nnd Iobel ench Witll Ute type of priority. The c.omplclc oceount number ofnny nccount the debtor hn wltb Ute crcdilor i ueful to the lnllee nnd the creditor nnd mny be providcrl if lhe deblor chooe to do o, lfn minor child i 11 creditor. tole the. child' initinl nnd the nnmc nnd nddre of the child' pnrcnt or gunrditm, uch n 11 A.B.. n minor child, by John Doe, gunnlinn. 11 Do not dicloe Ute child' nome. Sea, I I U.S.C. 112 nod Fed. R. Bnnkr. P. 1007{m). Jfnny entity other than n poue in njoinl cae moy be jointly 1\nllle on n claim, pluce on "X" in lhe column lnbcled "Codebtor," include. the entity on tl!c upproprhlle chedule of creditor, oml complete Schedule H-Codebtor. If njolnt petition I filed, tntc wheuu:r the huband, wife, both oflhcm, or the mnrltnl communil)' mny be liable on cuch clnim by placing 1m ''H," ''v. 1," "J, 11 or "C" in the column lnbeled "Huband, Win; Joinl. or Community." If the claim i conlingcnt, pi nee un "X" in!he colwnn labeled "ContingenL 11 If Ute clnim i unliqujdnled, plnce tm "X" in the column lnbcled 11 Unllquidmcd." lfu1e cluim i diputed, plncc on "X" in the column labeled "Dipuled. 11 (You mny need to p!nce on "X" in more thnn one ofu1ec three column.) Report the total of claim lited on ench heet in the box labeled 11 Subtotnl" on ench heel Report 1l1e totnl of all claim lited on U1i Schedule E in the bolo" lnbeled "Tolol,.. on the lot heet of the completed chedule. Report thi toto! ulo on the Summnry of Schedule. Report lhe total of nmounl entitled Ia priority lited on tmch heet in lhe box lnbeled 11 Subtotnl 11 on cnch heel Report the totnl of nil amount enuued to priority lited on thi Schedule E in the box labeled "Tolnl" on U1e lat heet oflhe completed chedule. Indh idunl deblor with primnn1y conumer debt report thi Lollll alo on the Slntilicnl Summmy of Certain Liabilitie nnd Related Dntn. Report the toto! of amount not entitled to priority ti led on each heet in the box Jnbelcd "Sublotnl" on ench heel Report rhe totnl of ull nrnount not entilled to priority lited on thi Schedule E In the box Jnbclcd '"Totnt~, on the lnl heet ofthe completed ehedule. lndividun! dcblor with primorily conumer debt report thi tclnl alo on the StoUtlcol Surnmnry of Certain Linbilltlc and Related Dntu. D Check thi box if debtor hn no creditor.holding unecured priority claim to rcporl on thi Schedule. E. TYPES OF PRJ ORITY CLAIMS (Chec)l the npproprinle box(e) below 1r clnim in thnl cnlegcry ore lited an Ute nuncllcd h~is.) 0 Dometic. Support Obligntion Clnim for dometic upport U10L nre owed to orrcoovcrnble by.n poue, former poue, tlr"chlld oflho debtor. or lhe pnren!., legol gunitllnn, or reponible relntlve of uch n child, or n govemmentnl unll to whom uch n dometic upport clnlm ho been olgned to the extent provided in 1l u.. c. 507(a)(l). D Extl!n.&lon of ercditln nn lovolunlnry cne Clnim ariing in the ordinary coure ofll1e debtor' buine or financial affair nfier the commcncomcnt of the cae but before lhe curlier oflhe appoinll110nl orn trutee or the order rorreller. II u:.c. 507(n)(3). 0 Wngc, njnric, nnd commiion Wngc, nloi'ie, nnd commiion, Including vnontion~ evcrancr.:, ond ick leuve poy owing lo cmployecii nnd commiion owing to qualifying indeptmdent ole repreeotnuvc.up to 1 1",725"' per peron cnmed within I 80 tlny.irnmei:lintely preceding "the filing-ofthe orlginnl petition, or Ute ccntion of bi!sinc,. whichever occurred fir~ to the extent provided ln n U.S.C, 9 507(Ii)( 4). 0 Conlribution to employee benelil plnn "Money owed to employee benefit pion for erviceu rl!flderctl within- 180 dny immediately preceding the filing ofun: originnl peuuon, or the ct!snlion ofb.uine, whichever occumid firt, to the extent provided in lj U.S.C, 507{n)(5). -.~o AmoJUJl ubject Ia adjirtme.nt on41dl/j3, and avery' lhreejrear lhereajle.i'with repect to cae conmrem::ed on or aficr the datc.afac!jrls/mr.mt.

B 6E (Ofliciul Fnnn 6E) (OM! 0)- Com In r ---------:::-:--------- Dcblor Cn!iC N -----,.,--:--- (IJ known) D Ccrtnin fnrmer nnd ftbcrnum Cluim ofcerlnin former nnd flhemlcn, up to 5,775 per fnm1er or flshcnnnn, nguint the debtor, n provjded in 1 I U.S.C, 507(n}(6}. D Depoit by indivitlunl Claim ofindividunl up to 2,600* for depoit for the purchae, lcuc, ornmtnl of prop crt)' or ervice for peronal, fnmlly, or houehold uc, U1al were nol delivered or provlded. l l U,S,C. 507(n)(7). D Taxe nod Certain OUtct Debt Owed tu Go\ emntcntnl Unit Tm:e, cu10m dutie, nnd penaltie owing to fcdcrnl, lnlc. nnd local govemmcnlnl unit n el forth in I I U.S.C..507{n)(B). D Commitment to Mninlnin the Cnpitnl ofnn lnurcr.l Depoitor')' Intitution Clnim bued on commitment to U1c FDJC, RTC. Director ofu1e Office ofthrifl Supcrvilon, Comptroller of the Currency, or Bonrd of Governor oflhe Federal Reen e Sytem, or their predeceor or ucceor5, to muintnin the cupitnl of nn inured depoitory int.illlucn. 11 U.S.C. 507 (n)(9). 0 Cluim for Dl!lltb or Puronnllnjur) While Debtor Wa lnloxlcnled Clnim for deauj or peronal Injury reulting from lhe. cperut.ion -of u molor vehicle or veel willie the debtor wn intoxlcnted from uing nlcohol, n drug, or nnotl1cr ublonce. II U.S.C. 9 507(n)( I 0), "' Amount are ubjecllo adjlllme.nt on 4101113, mrd eveij' t!wee. year thercaflen! ilh repect to cae comtmmced an or afier the dale af adj11lment. continunlion Sheet attncher.l 21

B 6E (Omcinl Fomt 6E) (0~/1 0}-ConL In t c ------::-:-.,---------- Debtor Cne No ----=:----:------ (iflmown) SCHEDULE E- CREDITORS HOLDING UNSECURED PRIORITY CLAIMS {Continuntion Sheel) TJ pe of Priority ror Clnim Lited on Thi Sheet CRIJ11TOR'S NAME., MAILING ADDIIESS INCLUDING ZIP CODE, AND ACCOUNT NUMBER (Sec lmumrt/011 rtlot e.} DATE CLAIM WAS INCURRED AND CONSIDERATION FOR CLAIM AMOUNT OF CLAIJ\'I AMOUNT ENTITLED 1'0 PIUORIT\' AMOUNT NOT ENTITLED TO PIUORIT\' 1 IF ANY Account No. Account No. Account No. AccoUllt No, Sh~t no._ nr _ cmi~nuntio11 la:eu Dllnr.hcd to Sclrcdul~ ora~tlilnnr llnldi11g Priurhy Clnin~S Subtmnl>fl'otnl oftlti pnge) S Totnl> {Ue only on lll!llpngeoflhe complotcrl Schedule E. Report nlo on thc SummnrY ofschctlulc.) Totnl> (Ue only on lnt poge oftlic complet!!d Schedule E. If npplienblc, rep on Iii o on the Stntiticnl Summary ofcennln Llnbilltic nrul Relntcd Dntn.) 2-5

D 6F (Omcinl Fam1 UF) {12/07) Jn re n::=:::--------' Debtor Cnc No.-----.,.-==;;,----- (iflulown) SCHEDULE F- CREDITORS HOLDING UNSECURED NONPRIORITY CLAllVIS Stntc the nmne, moiling uddre, including zip cod~:, nnd lot fourdigit ofnny nccountnumbcr, ofull entitle holding unecured clnimwithout priority ngnint the debtor or the property of the debtor, n of the dote ofliling oflhe petition. The eumplcte nccount numberofuny uceount the debtor hn with the creditor i U!icfulto the trutee nnd the crctlhor nnd mny be provided iflhc debtor chooe lo do o. lfu minor child i a crcdilor, tnle the child' initinl nnd the nnme nnd nddre oflhc thfld' purenl or gunrdinn. uch n 11 A.B., n minor child, by John Dm; gunrdiun." Do notdicloc the child' nome. See, 11 U.S.C. 112 nod Fed. R. Bnnkr. P. 1007(m). Do not include clnim lited in Schedule D und E. Irnll creditor will nat fit an Uti pnge, uc U1e continuation heet provided. Ifnny entity ou1er thnn a poue In njolnt cue mny be jointly liable on n clnim, place nn ":h"' In the column Jnbcled "Codebtor~,, include the. cntily on the npproprinlt! chedule of creditor, nnd compieie Schedule H ~ Codeblor. Ifn joint petition i filed, tate wheuu~r tl1c huband, wlie, both of them, or the marital community may be liable on ench clnim by plnclng nn "H,""W." "J," or''c"in the column lnbeled "flubnnd, Wifu, Joint, or Community."' If the clnhn I contlngcnl, pluce on 11 X" in the column labeled 01 ContingenL" lfllu!clnim i unliquidntcd, place nn 'X'' in the column lnbeled "Unliquidated," If the clnlm i diputed, plncc nn "X'' in the column labeled "Diputed." (You mny n~:cd to place nn 11 X" in more tbnn one of thee. three column.) Report the totnl of nil clnim lited on thi oh~:dule in the bo1-! labeled "Tolnl" on the ID.!It heet of the completed chedule. Reporl thi totnl nln on the Summary ofschctluh.: nnd, If the debtor i no incllvldunl with primnrily conumerdcblf report lhi 1otul nlo on the Stnlillcnl Summnry of Certain Linbililie nnd Rclulcd Dotn.. 0 C h cck tl' 115 box ffdcbtor hn no creditor holding unecured cloim to rc.parton thi Schedule F. CREDITOR'S NAME, "' ~ ui DATE CLAIM WAS '< Q Q "' OJO~ 5 UJ~o Q.o Q (- CONS!DERA T!DN FOR ffi ~~~ ~ Q AMOUNT OF MAU..!NO ADDRESS ~.. ~~ INCURRED AND "' CLAlM INCLUDING ZIP CODE, ANDACCDUNTNUMBER "' CLAIM. ~ tsee lntrut:jfan.r aboi'l'.} (- IF CLAlM IS SUBJECT TO 0' 0. 0 ;:J u z UJ u SETOFF, SO STATE. 0 ::; :I; u i5 5 Q ACCOUNT NO. ACCOUNT NO. ACCOUNT NO. ACCOUNT NO. conlinuntinn hecl5 nunched Subtntnl>- Tntnl>- (Uc only on int pngc.ofiho cnmpleted.schcdulc F.) {Reportnln on Summary cfschedujc nnd,1fopplicnble, on the Stnlitlcnl Swnmnl)' ofcertnin LTn'bilitie-ntid Rclnlcd Doll!,)

B fif (Officlul Funn 6PJ ( 12/07}- Con!, lnr -------------=~----------------~ Debtor CncNu. ~~----~----------- (lflrnown) SCHEDULE F- CREDITORS HOLDING UNSECURED NONPRIORITY CLAIMS (Contlnuntian Shet!t) uf CREDITOR'S NAME, ~!::: DATE CLAIM WAS 1-0 AMOUNT OF MAILING ADDRESS 0 "".6 ~ INCURRED AND 0 m ~ CLAIM 1- INCLUDING ZIP CODE, ~C:- CONSIDERA TIGN FOR t:j < "' 0!:i AND ACCGUNTNUMBER "' 0..,;~d: CLAIM. p. OJO.a ;3 (Sec intruction nbcve.} 0.,~o IF CLAIM IS SUBJECT TO Cl u ~ 5 "' j u SETOFF, SO STATE. u ::J ACCOUNT NO. 5 ACCOUNT NO. ACCOUNT NO. ACCOUNT NO. ACCOUNT NO. Sh~ct no. of ccntlnuntlon hcct nllnched Subtotnl>- to Schedule of Creditor Holding Unecured Nonprlorizy Cloim Total>- (U~ only cliln.t pnge orthc cumplu\cd Schedule F.) CRcpon nino on Summary ofschcdule. und.lfnppliclible onlhc Slll.tlticnl SummnJY ofccrtnin L!nbtll~lc nnd llelnted Onlll..)

B 5F (Dffit:iul Fom1 fif) {12107)- Cont. In J'c --:;---;--:--------- Dcbtor Cnc No.-------:;::-:----:------ (iflmuwn) SCHEDULE F- CREDITORS HOLDING UNSECURED NONPRIORITY CLAIMS (ConLinuntion Shc.t.:t) "' ui CREDITOR'S NAME,!!:"'j':: DATE CLAIM WAS f.- " z ~ INCLUDING ZIP CODE, Ill ~ r-: ::I CONSIDERATION FDR 0 < 0 AMOUNT OF MAJLING ADDRESS 0 "'-o- INCURRED AND ~ g CLAIM Ul <~::;( ~ 0 AND ACCOUNT NUMBER CLAIM. c. 5 (See lntrw:tlon ubovc.j 0 Jll0:;: rn~o u IF CLAIM IS SUBJECT TO ~ 0' "' ::I u 0 :::; Ci :c SETOFF, SO STATE, u ACCOUNT "NO. ~ ACCOUNT NO. ACCOUNT NO. ACCOUNT NO. ACCOUNT NO. Sheet no. or continuntion heet nttuthcd SubiO!ol>- to Schedule orcredilor Holding Unecured Nonpriority Claim Totnl)o- (Uc only on lnt puge orthc completed Schetlule F.) {Report alo on Summnry orsclu:dulcr. nnd,_ifnpptlenble.oli U1cStntltlcnl Sommmy ofccrtnln LioblliUc n11d RC!ntet.l Dntn.) 31

B 6F(Officin1 Form UF) {12/07)- Coni. lnrc ~~------------------ Debtor Cnc No.--------=-----,----------- (if!uiown) SCHEDULE F- CREDITORS HOLDING UNSECURED NONPRIORITY CLAIMS (Cantinunticn Sheel) u.f CREDITOR'S NAME, rt:!::rt:i: DATE CLAIM WAS 1- MAILING ADDRESS 0 ;l::o- rncurred AND Gi " til 1- INCLUDrNG ZIP CODE, o~ 5 "' - CONSIDERATION I' DR t:l '< til ~ AND ACCOUNT NUMBER ~IS~ CLAIM. 0.. " 0 :::> ~ "!Sf!'.: intruction nbo\'e.) u ~~0 IF CLAIM IS SUBJECT TO Cl "' :::> u 0 ::; 5 :!: SETOFF, SO STATE. u ACCOUNT NO. 5 AMOUNT OF CLAIM ACCOUNT NO. ACCOUNT NO. ACCOUNT NO. ACCOUNT NO. Sheet no. or conlinuntlon lumis ouocbed Sublolol~ to Schcdulc.ofCredllor Holding Unecured Nonpriorll)' Clnim Tolnl> (U!!e only on ln!il puge oflhc complcu:d Schedule F.) (Report alo on SummnT}' of SchedUle nnd, lfnpp.llcnble on thcslntilieiil Summazy ofccrtnfn Uribililie ond neloted Datn.)

B 6F {Official Fnm1 fif) (12/07)- Com, lnr ------------~~----------------- Dcbtor CneNo. ~~----~----------- (lfltnown) SCHEDULE F- CREDITORS HOLDING UNSECURED NONPRlORlTY CLAIMS (CanlinuoLion Sheet) CREDlTOR'SNAME, MAILING ADDRESS INCLUDING ZIP CODE, AND ACCOUNT NUMBER (Sec lnlruclion!l nlmve.} DATE CLAIM WAS INCURRED AND CONSIDERATION FOR CLAIM. IF CLAIM IS SUBJECT TO SETOFF, SO STATE, AMOUNT OF CLAIM ACCOUNT NO. ACCOUNT NO. ACCOUNT NO. ACCOUNT NO. ACCOUNT NO. Shecl no. of cantlnunlinn heeu; oltnohed to Schedule orcrcdilot!i Holding Un::;ecurcd Nonprioricy Claim Subtotal>- 5i Total> (Ue only on hml pngc or the cumphucd Schedule F.) {Report nlan nn5ummnry or:schl!dulc nnd, lr oppllcnble Ill\ the Stntiticnl SummiU}' DrCcnnin LinbfliLieS ii!id Related Dolo,} '-------' 37

U 60 (Officinl Form 6G) (1 '1107) lnr --------~~------------------ Del:Jtor CncNo.. (Irlmown) SCHEDULE G -EXECUTORY CONTRACTS AND UNEXPillED LEASES Decribe nil f!1;ecutcry contrnct ornny noture und ull unc11:pircd lcnc.c; ofrcnl or pcr.;onnl property. Include ony timehure. lnl011!sl. Stntc nuturc or debtor' interet in contnlcl, i.e~ "Purchnert'' 11 Agtmt,Y' etc. Stull! whether debtor i the leor or leee ofn tene, Provide the nnmc nnd complete mailing nddrue..<t a roll other partie to cuch lcnc orcontmct decribed. Jr u miner child i D pnrty to one ofl11c lene or contmct, tnle lhe child'lnitinl nnd the nnmc nnd uddre of the child' purcnt or guunllnn, uch n 11 A.B.l 11 minor child, by John Doc, gunrdiun. 11 Do not dicloe the child' nnmc. See. I 1 U.S.C. 1 12 nnd Fed. R. Bonkr. P. 1007(m). D Check thi box if debtor hnno [!Xeoutor,y conlrncl!i or unexpired le115c, NAME AND MAILING ADDRESS, INCLUDING Zll' CODE, OF OTI!ER I'ARTIES TO LEASE OR CONTRACT. DESCRIPTION OF CONTRACT OR LEASE 1\ND NATURE OF DEBTOR'S INTEREST. STATE WHETHER LEASE IS FOR NONIIESIDENTIAL REAL PROPERTI'. STATE CONTRACT NUMBER OF ANl' GOVERNnoJENT CONTRACT.

B fih [Omclnl Fann 6H) (12107) Iu rc --::--,----------- Debtor Cno No.-----:::;:----;---- (iflrnown) SCHEDULE H- CODEBTORS Provitle the infommlion t"t!qucted concerning nny peron or entity, other lhnn n poue in njoinl cnl!, thnt i nlo linblc on nuy debt lil.l!d by tim debtor in Ou:clu:dule of creditor. Include nil guurnntor nml co--igner. If Ute debtor reide or reided inn community property tnte, commonwcnlth, or territory (including Alnkn, Arizonn, Cnlifontln, ldnho. Louiiana, Ncvudn, New McKico, Puerto Rico, Tcxn, Wnhington, m Wiconin) within the cight..ycnrpcriod immediately preceding U1c commcnmmumt ofthc cue, identify U1c nome orthc debtor' poue und ofnn)' fom1cr poue who reide or reided wllh the debtor in the cmnmunily propert:) tntc, commonwcnllb, or llmilol)'. Include nil nnme ued by lht: nonclebtor poua during Uu~ eight yenr immcdintel}' preceding the commcncelnt:nl ofu1i cne. If n minor child i u codebtor or u creditor, tole Lhc chllcl' initial und lhe nnmc ond udclrc ofthe child' pnrent or gunrdinn, uch n!i "A.B., o minor child, b)' John Dot:., guurdinn." Do not dicloe the child' name. Soo, II U.S.C. jill nnd Fcd.IL Bnnkr. P.l007[m). D Check thi box if debtor ha no codebtor. NAME AND ADDRESS OF CODEBTOR NAME AND ADDRESS OF CREDITOR :.. : : '...,.... c

BGI (Officlnl Fo m 61) (12/07) lnre =-~------------------- Dehlor Cnc No. --------::c;.,----:--- (ifltnnwn) SCHEDULE I- CURRENT INCOME OF INDIVIDUAL DEBTOR(S) n1e column lnbeled "Spoue" mut be comph:led In n\1 cne Jiled by joint debtor ond by every mnrriml debtor, whether or not n joint pclilion I Oled, unle the pouu nn: epnrnted nnd ujoinl petition I not filed. Do not tole the nnme ofnny minor child. The nvernge monu1ly income culculn!ed on thi fonn mny dlffur from the cumml month!) income culculnted on Fonn 22A, 21B, or 22C. Debior' Mnrhnl Stnlu: RELATIONSH!P(S)! DEPENDENTS OF DEBTOR AND SPOUSE AGE(S): EmJ!loyment: Occupntion Nome 01 employer """ '""" Addre of Employer DEBTOR SPOUSE INCOME: (E!itimnte ofovernge or pmjected monthly income nt time CDSC filed) 1. Monthly gro wnge, nlory, nnd commiion (PrornLe if not pnid monthly) 2 Ellmnle mcnlhly ovnrt.imc DEBTOR SPOUSE 3. SUBTOTAL 4. LESS PAYROLL DEDUCTIONS n. Pnymll toxe nnd ocial ecurit)' b. Inumnce c. Union due d. Other (Specify)!--------------- 5. SUBTOTAL OF PAYROLL DEDUCTIONS 6. TOTALNETMONTHLYTAKEHOMEPAY 7. Regulor income from opernlion ofbuine or profeion or fnnn {AUnCh detniled lntcmenf) H. lnccme from renj property 9. lnterel-nnd dj, ldcnd!i 10. Alimony. moinumnnce or upport pnymcnt pnynblc tn the debtor for lhe debtor's U!IC or tl'!nt of dependent lflcd nbove 11. Socinl ccu1ily or govemmenl uitnncc (Spet:il'y):.-::---:-:----------- 12. 'Penion or retirement income 13. Othermonlhl)' income (Spcclli') '-------------- 14. SUBTOTALOFLINES7THROUGH 13 I : 15. AVERAGEMONTHLYJNCOME(Addnmounl5online6nnd14) ~======---~=====:...-------J 16. COME!NED AVERAGE MONTHLY INCOME: (Combine column total from line 15) I : {Rcpnrtuhm on Sumituuy ofschcdultis ondj ifupplicnble, on StnUtionl Summary ofccrtnin Linbllftle nnd Related Dutn) 17. Decribe any increae or dccrene in incbmc n:nonnbly nnlicipnted to occur within lhe yent following the filing of lhl dooumenl:

BGJ (Officinl Form 6.1) (12/07) In r --------------- Delltur Cne Nn -----,=------- (lfknown) SCHEDULE J- CURRENT EXPENDITURES OF INDIVIDUAL DEBTOR(S) Complete thi chedule by t!sthnntint: tlu: O\'l!rnfil!otpmjectetl month!} e>:punt!s of the lleblornn~ the debtor' family at time cue nh:d. Prornte nny pnyment mode bi~ \\'l!tkl}, quurterly, omi-nnnunll~. orumnmll}' to how monthly rote. The nvcrngc monthly expene cnlculntcd on thi fonn mu~ differ from the deduction from income olio wed on Fnnn22A or22c. 0 Check thi bol:'if n joint pctitiou i Iilctl ond debtor' poue mni!jinln u epurute houehold. Complete n cpnrntc chedule of!pipcnditure lnbclcd "Spoue," J. Rent ar home mongngc puymcnl {include lotronu:tl for mobile home) n. An!rcnl etate tul:c incjuded7 Ye No b. I property inumnce included? Ye No 2. Utllitie: n. Electricity nnd heating rue! b. Water nnd ewer c. Tc\cplu:mc d.oiher J. Home malntcllnm:e (n:pnlrn nnd upl;ccp) 4. Fond 5. Clothing 6. Lnundo nnd dry clenning 7. Medit.nl nnd dentnlcxpc.ne E. Tnmpartntinn {not including cnr pnymeot) 9. Rccrcntlnn, club nod entcnninmcot, nuwpnper, mngnzinc, etc. IO.Ciuuitnble contribution ll.lnumm:c (not deducted from wogi!s or Included in home morlgog.e pnymant) u. Homeowner' cr renter' b. Life c.henl!h d. Auto ~olli~ ----------------------------------- 1:!. Tuxe (not deducted from wnga or includoo in home mongngc payment} (Spocl~ )l 13. ln!ltalhncnt payment: (ln chnpler 11, 12, nod 13 cll!i~s, do net llt pnyment LD be included in the plan) n.auto b. Other c. Other 14. Albnnny, mnintcnnnc:c, nnd upport pnidto clher 15. Payment for uppcrt of oddilionnl dependent not living nt your homn I 6. Regular c~pernu: from cpcmtion nfbwlni!s, profe:don, or fann (nttnch dwjiled LDicmimt} 17.ather lb. AVERAGE MONTHLY EXPENSES (Tolnllinc 1-17. Rcpon alo on Summnzy cfsohcdlilc nnd, ifnppiicdble, on the Slntllicnl Summnt}' orccnuin Liabilitie ond Rclntcd Onto.) 19. Decn'be nny increae or dccren.u In c:ipuntiiwrt:!l renonnbly nnticipntcd 10 occur within the ycnr.following the filing of! hi dccumcnl: 5 2U. STATEMENT OF MONTHLY NET INCOME n. A~cJ1!ge monutij.incomc from Lina IS ofschcdlllc I b. Average monthly expene rrom Line IB nbo vc c. Monthly net income (n. minu b.)

B6 Dl:clarntinn (Offidnl Form r, Dc:tlnmlion) (12/07) In re --,;:;:c::c------- Uehlnr Cnlt! No. ------ooc----,--- {lf ltnuwn) DECLARATION CONCERNING DEBTOR'S SCHEDULES DECLARATION UND~R.PENALTY OF P~IUURY BY INDIVIDUAL. DEBTOR 1 declare umh:r penalty ofpcrjury lhall hove rcnd I he furegoing ummary nntl c\tcdulc, coniting nf 5hccl5, und lhnt thuy ure true nnd cnrreclto th!! bi!st or Ill}' knowledge, info011n1lon, nnd lmllcf. Dote DDie Signnturc: =:--------- Dchlnr Slgnnlurc: ---.===:-;,=,-------- (Joint Otblnr, if11ny) [lfjoln\l:ll!ie, b11\h p1111.51!5 mut ign.) DECLARATION AND SIGNATURE OF' NON ATI'ORNE'i' DANJffiUJITC).' PETmON PREPARER {Sci! 11 U.S.C. 110) 1 tleclnre under penni!}' ofpudury thnt: (I) I nm u lumktuptcy petition prtlpnn:r n dclil!fll in II U.S. C. 110; (2) 1 pn:pd.red thi dm:umenl fnr enmpcnnlinn nnd hove povlded tin: deh!or with n copy of thi dncumt:nt nnd the nulicc nrul fnformnlinn required under I I U.S.C. IIO(b}, IIO(h) nnd 342(b); nrul, (3) If rule or guhlcline hnve. llcen pmmulgutl!tl pummnllo II U.S. C.!i l!o(h) etting n maa'imum fee fnrcrvice clllllyet~bh: b) bnnbup1c}'pelillnn preporcr, lltnve!liven the debtor nctieeofthe maximum omount befcn: preparing nny document fcrfiuug for n debtor or accepting nny fee from the de.btnr. n requlre.tllly thn1 =:tlon. Prinu:r.l ort}'jierl Nnmconr.l Title, ifniij', ofbnnluuptcy Petition Pn:pnrer Socinl SI:Cutil}' Nn. (Required bj I 1 U.S, C. 1 10.) ([tin: bmtkntpii!j' plllilirm prvpurrwt.f lltll au 1/lrliv/duuL.l/Die I hi! numc, lllfn (if uuj'), adtln!.~ nllti.rm:iu/,n:cur/lj numberafllle a,d/f!tli prlllt!lpnl, ~mldblu per.~rm, nr p.llrmur 1tfltJ.rig/IS //1/:r dtlc/111/j!(i/, Addre " S;;lf!!U'::::~Iu=m~o~riia;;n=n;::l:ru:::;pl=ny~.;;P,~I;;Iti;:o=n-;;P~.c= pn=r=n=r -------- Dntc Nnm~ nnd Sotinl Securit)' number arujj ctlu:rinr.li\'idunl who pn:pnn:tl orni!iis\cd In preparing \hi document, tmlt!s the hnnkrupley pctltion 11rcpnrer i not nn indivldtint: lj'mure 1/run Ill II! p!!t:rtm.proparod lhldar:umelll, u//m:/1 mldu/mruf tyned lmvt cot!{tmlllllg In the upproprlme Offir:Ja/ Fnn11Jur cmch paron. A bnnlmtp/r::j'prlllllutl prrpu~r'.tfnlfu/11-tn cmupij 1r/tll /ll~prurhlu/u of/it/ I! l'lotlll t/rr: Fcrkrrl/ nulc.rq{uankruplt:ji Prm:edrm~ ll~ n!sitlt llljine.r rwrmprl.!umur.n/ wbul/1. J 1 U.S.C,.f IJU: 18 u..c. f JJ(i. DECLIIllATION UNDER PENALTY OF PERJUIU' ON BEHALF OF A COIU'OllATION OR PARTNERSH!l' 1, the!the. preident or other officer or on nuthmitl:d ugcnt of the coljlornllon oro tnember or on nulhorizcd ngcntnfllu: pnnnorhlp j orthc [ccrporntlon or pnnnerhlp] nnmr::d n dnbtor ln thi eae, dcclnre tmdr::r pr::nnlty of pr::rjury thnt I hny~t rwd the forr::golng unumu)' nndcbcdule_ cnnillng of.!llu:ct (7'Dtal.r/Jamt otr S/111111/ttiJ' page pfu 1). and thnt thny ore true nnd correct tn ibc bet nf rriy l:rtowlcdgc, lnfonjlllllon, ontl belief..dote Signnturc: [Aft indll'idua/.iigrlfl1g on bahu!fofo partnerjftljt or r:arporatinll mut lndle!lltl! po:r/r/rm or r!!ltttlr:mhfp to dab tor.] JPrlnt nr type nnme nflnrliv1dunl lgnlng on behnlror debtor.] Pr!llult}'}ormaltillg afa/c.jta/lmrtml arcrmun/ingpropl!rly: Flnc. of up to 500,000 or imprionment for up to 5 ycnr or both. IU U.S. C. 152 nnd 3571.

E 7 (Omcinl Fonn 7) (04110) UNITED STATES BANICRUPTCY COURT 1n re: D~:btnr CncNo...,.,==-------- (1fhnmvl1) STATEMENTOFFINANCIALAFFAIRS Thi tntemcntl to be completed by evety debtor. Spoue filing njoint petition mny file n ingle tntemcnt on which the infonnntion for both poue i com~lned. If the coe i filed under chapter 12 or chnpler 13, n married debtor mut furnih infonnnlion for both poue whether arnot a joint petition i filed: unle Ute poue nre eparnted and ujoint petition i no! filed, An indlviduei} debtorengnged in buine n n ol!! proprietor, partner. fnmll)' former, or elf-employed profeional, hould provide Lim infannntion requeted on tltbi tnlemcnl concerning nil uch activitie n well n U1e individuuj' peronul nffnir. To indicntepoymcnl, lrnnfer nnd the like lc minor cbildrc:n, lutc the child' initinl and the nnmc w1d addre ofu1e child' parent or gunrdinn, uch n "A.B., n minor chil~ by John Doe, guurdhm." Do not dicloe the child' nome. Set; 11 U.S.C, I 12nnd Fcd.R. Bunkr. P.I007(m). Qut!Slicn 1-18 nrc to be completed by nil debtor. Debtor thnlnre or hove been in buine, u defined below, nlo mut complete Quetion 19-25. If the nnwc.r to nn npp1icnble quetion I ' 1 Nonc, 11 mnrlt the bol: lnbc.lcd 11 Nonc.. 11 lf ndditionnl pace i needed for the anwer to on)' quetion. ue and nllnch n epnmte heet proper!)' jdtmtiiied witltlhe coe nnme. cne number (lflcnown), nnd the number of the quetion. DEFINITIONS "in buine." A debtor i "in buin~:ss" for the pui'jloe ofthi form if t11e debtor i 11 corpornuon or partnerhip. An indivldunl debtor i "in buine" for the purpoe of thi form if the debtor'i or hn been, within h:. year immediutei}' preceding.the filing oflbi bankruptcy cne, any of the following: nn officer, director, mnnnglng cxecuuve. or owner of 5 percent or more of the voting or equity ee.urilie of n corporntion; n partner, other than n limited partner, of a purtncrhip; n ol!: pmprie.lor or elf-employed full~limc orpnrt-limc. An Individual debler Dlo mny be "in buinet' for the purpoe of thi form lflhe debtor engage in u Lrndc, buine, or otln:r uclivit), other thun n nn c.lnployee. 10 upplement income from the debtor? primdry employmenl "Inide/'." The term ''inider" include but i not Iimiled to: relative of the debtor. genernl partner of the debtor llnd lheirrelauve; corporation of which the debtor I nn officer, dlre.ctnr, or peron in conlrol; officer. direclor,nnd uny owner of 5 percent or more of the voting or eqully ccurilie of o corpornle debtor i:md their relative; nmllatc of the debtor and inider of uch nffilinl.e; nny mnnnging ugent or the debtor. 11 U.S. C.li 101. 1. Income from employment or opernllon ofbu!oine Nune: D State the gronmount of income the debtor hu received from employment, trade, or profeion, or.from opernllon of lhe debtor' buine, including parlmlime activitie either n on employee or in indepcndei\ltrnde orbuinllss, fmm the beginning of thi a~lendur year to the dole thi cae 'WDS commenced. SLO\e.olo the; gros ilmotml received during the two ycnr lmmedintcly preceding thi cnhmtluryear. [A dcbtor.thut mnintain, or hn maintnine~ finnnciul record on Un: bni of 11 ficnl mlhcr Lhnn 11 culendnrycnr may report ficni ycnr Income. ldentify the beginning nnd i:ndlng tlnte of the debtor.' iionl yeur,) 1fnjolnlpetilion.i filed, tnla Income for ench poue cpamtcly. (Married debtor Jiling under chllptcr 12 or ohnpwr 13 mut tntc income of both poue \Vhe.lhcr or uot u joint palition i Iiled, unle the poue nre cpnmtcthmd njoint petition i nol'filed,) AMOUNT SOURCE

2 2. Income outer tlum from employment or O(ll!l'l\linn of buini!s!i Nnllll D Stntc the nmounl of income received by Uu~ debtor othcrlltnn from cmploymcn~ lrodc, profeion, opcrntion of the debtor' buine during the two ycnt immediotcly preceding the commencement of thi cnc. Give purliculnr. lfn joint petition i filed, toh: Income for coch poue cpamtcly. (Murriod debtor filing under chnplcr 12 or ahopter l3 mut tole income forench SJmuc whc!hcr or not njoinl petition i filed, unle tlte poue ore eporuted nnd o joint pelilion i not fijt!rl.) AMOUNT SOURCE 3. Pn) ment to crcdilor Complete a. or b., a npproprlata, am/ c. D n. individual or jai11t deblor{) wilh prlmarib conumer debt: Lit nil pnyment on loon, inulljmenl purchae of. good or ervice, Wld ether dcbis to nny creditor mode wiu1in 90 dti)'s immedinu:ly preceding the commencemenl of thi cne unli!ss the nggrcgnte vnlue of nil property thnl contitute ori nitccted by uch tranfer i le Ulan 600,!ndicnte wiu1 nn aterik ( ) nny payment Lhnt were mode to D credilor on account of n dometic upport cbligntion or n pnrl ofnn nlu:mnlive repayment chedule under n pion by nn nppmwd nonprofit budgeting nod credit couneling agency, (Mnrried debtor filing undar chnplar 12 or chapter 13 mut include pnyment. b}' either or both poue whether arnot njolnt petition i filed, unle the poue nrc epnrnt.ed nod njoint pcthion i not liled.) NAME AND ADDRESS OF CREDITOR DATES OF PAYMENTS AMOUNT PAID AMOUNT STILL OWING Nam: 0 b. Debtor whoe de.bt:r ore nat primarily cansjtl/11!1' debt: Lit ead1 payment or otflel' Iran:rfor to any c:redilor made \vi thin 90 dny immediately preceding the commcncem~mt of the cae unle!be aggregate value of nil property thnl contitute or i nftected by uch trnnfor i le thnn 5,850', If Uu: dcbtori nn individual, indicnte with"nn nlerilt { ) nny pnymcnt thnt wei'!! mode-to a creditor on nccounl of n domi!slic upport oblignlion or n parl of nn li ltemntive repnymcntclu~dule under o plnn by nn approved nonprofit budgeting nod credit couneling agency. (Married dcblor filing under clu~pter 12 or chapter 13 mut include pnyrncnt nnd other trnnfer by either or both poue whether or nnl njoint petition i filed~ unle the poue nrc cpnrnlcd nnd njolnt peliuoni nol filed.) NAME AND ADDRESS OF CI1.ED1TOR OATES OF PAYMENTS/ T11.ANSFEI1.S AMOUNT :PAID 011. VALUE OF TI1.ANSFEI1.S AMOUNT STILL OWING Amount ubject to udjulmf!llt on 4101113, Cl/ld evcij' tlweeyuw.r Jhereujlerwllh re.!phci ta cae cammf!lice.d an or qfier lhe dale afut!futment.

3 Nm~ D c. 1'111 dctblol': Lit nll pnyment mode within one ycnr immedintcl)' preceding the commcncemunt of Liti cae to or for lhe benefil of creditor who ore or were. inider. (Married debtor filing under chapter IJ or chapter 13 mut include payment by either or bath poue whetller or not ujolnt pelilion i filed, unle llu~ poue ure epnmlcd und njoinl pcthion I not fil!!t.l.) NAME AND ADDRESS OF CREDITOR AND RELA T1 ONSHII' TO DEBTOR DATE OF PAYMENT AMOUNT PAID AMOUNT STILL OWING 4. Suit mul udmlnitrnth c proccetllng, execution, gnrnilmumt nnd nttnehment Ncne n. Lit all uit nnd ndminilrntive proceeding lo which U1c debtor i or wa o pony within one yenr immcdlolely 0 precoding the filing of thi bnnkruptcy cne. (Mnnicd debtor filing under chapter 12 or choplcr 13 mut include Jnfonnntion eonccmiog either or botb poue whelher or not n joint petition i filed. unle the poue nre epnruled nnd a joint pelition i not filed.) CAPTION OF SUIT AND CASE NUMBER NATURE OFPROCEEDING COURT OR AGENCY AND LOCATION STATUS OR DISPOSITION Nan:: b. Decribe nil property H111t hn been nttnched, garnihed or eized under any legnl or equltoble proce wilhin one 0 yenr immedintely preceding Lhc commencement ofutl cae. (Married debtor filing under chapter 11 or chapter 13 mulinolude infonnntion concerning property of either or both poue whether or not njoint pelllian i filed, uri le lhe poue nrc cpnmlcd end njainl peliuon i not filed.) NAME AND ADDRESS OF PERSON FOR WHOSE BENEFIT PROPERTY WAS SEIZED DATE OF SEIZURE DESCRIPTION AND VALUE OF PROPERTY 5. Repoeion, forct:lourc nlid rritum Nan:: Lit nil pfopcrtj thnl hn bmm repoeed by n credhor, old nt n forecloure ale, tnmfetred Utrough o deed in lieu 0 of forecloure: or returned tn the eller, wilhin one enr immedlntely preceding.u1e commencemenl oflhi cne. (Mnrried debtor filing under chapter 12 or cbnptt!r 13 mut inelud6lnfannnlion concerning prop6rty afelther or both poue wbeu1eror not I! joint petition i, filed, unle the poue nrc eparated nnd njoint petitlon i not nt~;d.} NAME AND ADDRESS OF CREDITOR OR.SELLER DATE OF REPOSSESSION, FORECLOSURE SALE, mansper OR RETURN DESCRIPTION AND VALUE OF PROPERTY 4/

4 G. Aignll!cnt nntl rccch cj hij15 Nouc D u. Dt!liaribt: uny oignment ofprcpcrl)' for the benefit ofcrctlilor mode within 120 dny immcdintc\y precetlitlg the commcnccmcnl oftbi cnc. (Mnrrictl debtor filing under clmpter 12 or chnpter 13 mut inclutlt: uny nignmcnt by cilhar or both poue whether or notnjoinl pclition i filed, unle the poue nrc cpnrntetl nnd njoint petition i not filed.) NAME AND ADDRESS OF ASSIGNEE DATE OF ASSIGNMENT TERMS OF ASSIGNMENT OR SETTLEMENT Nunc D b. Lit nil property which hu been in Ute hnm:l ofn culotllnn, rcueivcr, or court-nppolnt.ed officlul within one yeur immcdintely pre~tling U1c commcncemenl or Ll!l ane. (Mnrricd deblor filing. under chnpter 12 or chnplcr 13 mut include infonnntion concerning property of cllher or both poue whether or not njoint petition I med, uolc the poue nrc cpnrntcd nnd njcinl petition i not Iilcd.) NAME AND ADDRESS OF CUSTODIAN NAME AND LOCATION OF COURT CASE TlTLE & NUMBER DATE OF ORDER DESCnJPTION AND VALUE Of PROPERTY 7. Gift Na~e Lit nil gift or chnrltnblc. contribulion mode within one )'cur immediately preceding the commencement of lhi CllSC 0 t:hccpt orclinnry nnrl uual gin to fnmill' member nggregnting Je llmn S20D in value per Individual family memb~:r nnd chnritnble ctln1ribution nggrcgnting le than 100 per recipient. (Monied debtcr filing under chapter 12 or chapter 13 mut include gift or conlribulion by either or bout pa u~ whether arnot njaintpculion i filed, unle U11: poue nrc cpnrnted and njoint petition i nol filed,) NAME AND ADDRESS OF PERSON OR ORGANIZATION RELATIONSillP TO DEBTOR, IF ANY DATE OF GIFT DESCRIPTION AND VALUE OF GIFT B. LOS!ii!S Non: D Lit ullloe from firc, then, other onunlty or gambling within one yenr hnmediotely preceding the commencement orthi cne or ince the. c.omn.umccmcnt ofuti cne, (Married debtor filil1gundcr chnpter 12 or chdpler 13 mul.include.loe by either or both poue whf!uu:r or nol njoinl pctltlon i filed, unle the poue ore epnrntcd nnd n joinl pclilion i not filed.) DESCIUPTION AND VALUE OF PROPnRTY DESCnJPTION OF CIRCUMSTANCES AND, IF LOSS WAS COVERED IN WHOLE OR IN PART BY INSURANCE, GIVE PARTICULARS DATE DFLOSS

5!1. Puynuml rclnlcd to debt couneling or lmnlcruptcy None D Lit nil paymcnl mode or property lrnnfcrred by or on bchnlf or the debtor to uny peron, including nltorney. for conultolion concerning debt conolidntion, relief under U1e bnnkruptcy low or prepnmtion ofn peulion in bnnlmlplcy within une ycnr immcdintcly preceding the commcncemcnl oflhi onc. NAME AND ADDRESS OFFAYEE DATEOFI'AYMENT, NAME OF PAYER IF OTI-IER THAN DEBTOR AMOUNT OF MONEY OR DESCRJPTION AND VALUE OF PROPERTY Ncn~ 10. Other u nnfcrli 0 n, Lit oll other property, olher lhnn properly Lrnnferred in the ordinnry coure oflhe buine or finnncinl uffnir5 of the tlcbtcr, tmnnmcd e1u1er nbolutel) or D5 ecurity within hvo ycnr immedintnly preceding tl1e commencement of thi cae. (M'unied debtor filing under chapter 12 or chapter 13 mut includ~: trnnfcr by ciuu~r or both poue whether or nol njoinl petition i filed, unle the poue nm epornl.cd nnd njoinl petition i not filed.} NAME AND ADDRESS OF TRANSFEREE, RELATIONSHIP TO DEBTOR DATE DESCRJBE PROPERTY TRANSFERRED AND VALUE RECEIVED Nlllle: D b. Lit nil property tronferred by tit!!. debtor within ten ycur immedinlely preceding the commencement of thi cae lo n!inlf ellh.:d trut or imilnr device of which the debtor i n bencficiury. NAME OF TRUST OR OTHER DEVICE DATE(S) OF TRANSFER(S) AMOUNT OF MONEY DR DESCRJPTION AND VALUE OF PROPERTY OR DEBTOR'S INTEREST IN PROPERTY 11, Cloe!] finunclnl nccount None: Lit nil fimmciul account mtd intrument held in the nnme of the debtor or for Ute benefit of llu: debtor whic.h were 0 cloed, old, or othenvlc tmnferrcd within one ycnr immcdinlcly preceding the commenccnn:nt of Lhi ana. Include chcclcing, nvlng, or outer finnncinl nee aunt, cerlificnte of dcpol~.or other.intrumcnl!i; hare nnd hare account held in bunk, credil union, penion fund, coopcrolive, aooiolion, bm1tcrnge houe nnd outer finnnclal lnlilullon, (Monied debtor lillng under chapter 11 or chnpler j3 mut include lnfcnnntlon concemirig account or Intrument held by or for either or both poue whether or nolnjolnt pclition j filed, un"je the poue nre cpnrnh:d nnd njolnl pelition I not filed.) NAME AND ADDRESS 01' INSTITUTJON TYPE OF ACCOUNT, LAST FOUR DIGITS OF ACCOUNTNUMBE!l, AND AMOUNT OF FINAL BALANCE.AMOUNT AND DATE OF SALE OR CLOSING 43

6 12. Snfc dcpo\1 buxi!s None. Lit each ufc depoit or other box or depoilor:\' in which U1e dabtor bn or hurl ecuritie, cnh, or other vn\uable 0 wilhin one ycur immctliolcly preceding the commencomenl ofthl clist!, {Monied debtor filing under chnpter 12 or chapter 13 mut include boxe or depoitorie ofeilher or bolh poue whe~ll!r or not njoinl petition i filed, unle the poue ore t:pnmted nod ojoint petition I not riled.) NAME AND ADDRESS OF BANK Oil OTHER DEPOSITORY NAMES AND ADDRESSES OF THOSE WlTI-1 ACCESS TO BOX OR DEPOSITORY DESCIUPTIDN OF CONTENTS DATE OF TRANSFER DR SURRENDER, IF ANY 13. Sctofr Nam: Lit nil etoff mod~: by nny credhor, including 11 bnnk, ngninl n debt or depo!.'il of lhe debtor within 90 du3's preceding 0 the commencement ofuji cae. (Milllicd debtor li1ing under chapter 12 or chnptcr 13 mut include infonnnlion concerning eiuu:ror both poue whelber or not njoinl petition i filed, unle the poue are ~:pnrnled and a joint petition i not filed.) NAME AND ADDRESS OF CREDITOR DATE OF SETOFF AMOUNT OF SETOFF 14. ]'ropcrty held for nnotluw peron Nnnt D Lit nil property owned by nnotller peron that the debtor hold or control. NAME AND ADDRESS OF OWNER DESCRIPTION AND VALUE OF PROPERTY LOCATION OF PROPERTY 15.P1 Ior nddri!ss of debtor Ncnt D If debtor ha moved wiuiin U1rcc yt!llr lmmcdinlely preceding the commcm:c:menl oflhi cne, lit nll premie which tha debtor occupll!d during that period and vtcnlcd prior Lo Uta commcnccmcnlofthi cae. lfnjoint petilion i. nlod, report nlo nny epurntc addre of eilhcr-poue. ADDRESS.NAME USED DATES OF OCCUPANCY

7 Hi, Spoue nnll Former SpoU!ii!S 0 I r the debtor reide or reided in u commnnily properl)' lut~; commonwcn1th, or territory (including Alnlm, Arizonn, Cnllfomlu, lduho, Loulinnn, Nevndn, New Mexico, Puerto Rico, Tc>:n, Wuhlngton, or Wiconin} within eight ycnr immcdiutcly preceding the commencement orthc cnc, identify lhc nnmc of the debtor' poue ond of 1111)' fanner poue who rc.ld!!s or reided with Uu! debtor in the community property tole. NAME 17, En, irunmcuhll JnfnrmnUon. For the purpoe of thi que.lion, the following dofinilion apply: "En\ ironmentnl Low'' mean nny fcdernl, tale, or locnl tatute or regulntion rcgulnling pollution, contnminnlion, rcleu.'ic ofhuznrdou or toxic ubumcc, wnte ormdicrlnllnto the oir, land, oil, urface water, groundwntcr, or other medium, including, but not limited to, tatute or regulation regulating the cleanup oflhee ubtnncc, wntc. ormntcrlnl. 1 'Shc 11 mcon nny locouon, facility, or property n defined under nny Environmental Lnw, whether or not preently or fonnerly owned or opcn:n.ed by!be debldr, including, but nolllmlted to, dipoal he. 11 Hnznrdou Mntcrialn mean anything d~:fined un hazardou WllSI1:, hnznrdou ubtance toxic ubtance, hnznrdou mnterinl, pouutnnt.. or contnminnnl or imi! or term under nn Em ironmenlnl Luw. Ncnc n. Lit!he nmne nnd addre of every ite for which the debtor hn received notice in writing by n govemmentnl 0 unit UuiLiLmn)' be liable orpotentinjjy liublc under or in vlolntion ofnn Environmentul Low. Indicate the govemmentul unil, the dale of ll1e nolice, nnd, if1mown, the Environmental Law: SITE NAME AND ADDRESS NAME AND ADDRESS OF GOVERNMENTAL UNIT DATE OF NOTICE ENVIRONMENTAL LAW N1111C" b. Litlhe name nnd addre ofevcrj ite Jbr which U1c deblorprovided nolice ton governmcntnl unil of.n relellsc 0 ofhnznrdou Mnterlnl. lndicnte-uje governmentul unit to which the notioo WllS cnl nntl the clntn of the notice, SITE NAME ANDADORESS NAME AND ADDRESS OF GOVERNMENTAL UNIT DATE OF NOTICE ENVIRONMENTAL LAW Nc11ll D c. Lit all judicial or ndmlnlt.rnlivc procm~ding, including etllement or order, under-any Environme11laiLnw with rcpectlo which the debtor i or wa npnrl)' lndlcnte the name und nddre of the governmental unit thnl i or wn u parl)' to the procl!eding,.and the doclmt n_umbcr. NAMEANO ADDRESS OF GOVERNMENTAL UNiT DOCKET NUMBER STATUS.OR DISFOSITION 18, Nnture, lncntion.nnd nnmc of buine NonJ: D n, Qt/Je debtor I an lndividrmf, lit-the nnme, nddrce, lnxpayer-.:idtmtiiicntion number, nature of Ute buinee, nod beginning nnd ending clnte of nil buineo in which the debtorwn nn a nicer, director 2 partner: or.mnnaging

8 executive of n corpomtlon, pnrl.uer inn pnrtmmhip, olu proprietor, or wn elf-employed in u lllldt; profeion, or other uclivily eiu1cr full- or port-lime within ix ycm immodinlely prccecllng tl1e commencemcnl of thi cne, or in which the debtor owned 5 percent or more of the voting. or equity ecuritie wilhin.:;ix yl!lar bnmedinteh preceding the commencomenl oflhi cae. lftlta dcbror i o panncr!jip, lit the m1mc, addree, toxpnyer-identlfh:ntlon number, nature of the buinee, und beginning nnd ending dutc ofnll buinee in which the dnbtor wu u pnrlm:r or owned 5 p~:rcent or more of U1e voting or equity ecurilie, wiudn ix yeur immedintely preceding the commencement of thi cae. lfthe dcbtm i o corporal fall, lit tho name, addree, LDXpuyer ldcnlificntion number, nnturc oflhe buinei!s, nnd beginning nnd ending date of nil buim:.c in which the debtor wa n pnrlncr or owned 5 percent or more of Ute voting or equity ecuritie wilbin lx yenr immediately preceding tlte commencement of thi en e. NAME LAST FOUR DIGITS OF SOCJAL-SECURJ1Y OR OTHER INDIVIDUAL TAXPAYER-J.D. NO. (!TIN)/ COMPLETE EIN BEGINNING AND ADDRESS NATURE OF BUSINESS ENDING DATES Nom: b. ldentif) nny buine lited in repone to ubdiviion n., above, Lhnt i "ingle nelronl ctnte" lls 0 defined in II U.S.C. I D I. NAME ADDRESS The following quetion nre to be completed by ever)' debtor thnt i u corpornllon or partnerhip ond by nny indlvidunl debtor who. i or ha been, within ix l'l!nr immedln.lely preceding Ute commencement of thi cae, nny oftlu: following: 11n officer, director, mnnn.glng axeculive: or owner of more tlt11i15 percent orthe voting or equity ecuritie ofn corporntion: n partner, ouu:r thnn n limited pnrtner, ofn partnerhip, n ole proprietor~ or t:lf-employcd inn t.rddc, profeion 1 orolher activi1) 1 either full- cr pnrt-timc. (An indhtfdual ar job!/ t:kbtorhonld complete.thlporlilm of the tatemrml ou~r if the debtor i CJI' ha:r bmm in buine, a defined abqve, within ix year immedlale/y preceding Jhe.comnrencenreltl afthi cae. tl debtorll'ho ha nat been in buine within thoe i:r JleOI'S hould go directly ta the ignature page.) 19. Boolt 1 record nnd finnncinj lnlcment Non!!. D a. LlL nll boolckeepern tmd nccountnnt who wiutin two ycnr immcdinlcly preceding the filing ofthi bunlauplcy Cnc kcpl or upervied lhe!tee ping of book of account and record of the debtor. NAME AND ADDRESS DAT.ES SERVICES RENDERED Naut b. Lil nil firm or indivldunl who within two J'CDr immedinlcl) preceding lhc fillng oflhi bnnlcruptcy 0 cne hove audited Uu~ book of nccounl nntl record, or pre pored n finnncinl tnlcm~.utt of the deblor. NAME ADDRESS DATES SERVICES RENDERED 4-b

9 Nnn.: c. Lit oil Jinn or individuol who ol the time of Ute commencement of liti cne were in poeion of the 0 boolt of nccounl nntf record of the debtor. lfnny oflhc book ofnccounlnntl rei!ord ure not nvnilnble, c"plnin. NAME ADD!tESS Nnn~ d. Lit ull finnnclnllnthution, orcditnr nnd other pnrtie, including mel'cnntilc nnd trnde ngencic, Lo whom u 0 finnncinllntcmenl wn iued by lhe debtor within two ycor immediately preceding tltc cammcnccmcnl of Ibi co c. NAME AND ADDRESS DATE ISSUED 20. Inventorie Nam: n. Lit the dote oflhc lnl two inventorie lnl>en of your property, the nmm: oftlu: peron who upervied!he 0 tnking of ca.ch invenlth)', und the dollnr amount nnd bai of ench invcnldij', DATE OF INVENTORY INVENTORY SUPERVISOR DOLLAR AMOUNT OF INVENTORY {Specify col, mnrkcl or outer bni) None b. Lit the name and oddre of the peron having poe.'iion of the record ofench of the in\ enlorie reported 0 in n., oboye, DATE OF INVENTORY NAME AND ADDRESSES OF CUSTODIAN OF INVENTORY RECORDS 21. Current Pnrtncr, Officer, Director and Shnrcholdcr Nnnr. D n. If the deblor i n pnrtnerltip~ llll11e nnture ond percentnge of partnerhip interet nf ench member oftlte pnrlnornhip. NAME AND ADDRESS NATURE OF INTEREST PERCENTAGE OF INTEREST Nann b. lrtltc debtor i n corporution,lit nil officer ond di.rec\or oftl11~ corpomtion, nnd cooh tockholder who 0 dirccul' or indirectly awn, Control, or hold 5 percent or more of the voti~g or equ.lty ecuritie of the corpomuon. NATU!tE ANQ PERCENTAGE NAME AND ADDRESS TITLE OF STOCK OWNERSHIP 41

10 22. Former purlner, nfficcr, dircctur mul lmrchnldcr Nanc a, If the deblor i n partnerhip, Jil each member who wilhclrew from lhe pnrtncrhip will lin tme ycur intmedintcly 0 preceding the commencement of lhi Clli!C., NAME ADDRESS DATE OFWJTHDilAWAL. Na11c b. lflhe d~:btor i o corpornlion, lll all omcer or director who~: rclutlonhip wllh the corpomllon lenninntcd D wllhln one )'CDr lmmedintcly preceding the commcnc~:menl of thi cne. NAME AND ADDRESS TITLE DATE OF TERMINATION 23. Witlulnnml frnm n partnerhip or ditribu1ion by n corporntion Nanc D If the debtor i n pnrtnerhip or corporulion,lil all wil11drnwal or ditribution credited or given to nn inider, including compenation in ony form, bonue,!onu, tock redemption, oplion t:xen:ied and nny other perquiite during one yenr hnmediotcly preceding tha commem:emenl of thi crum. NAME & ADDRESS OF RECIPIENT, RELATIONSHIP TO DEBTOR DATE AND purpose 0 F \\~THORA WAL AMOUNT OF MONEY OR DESCIUPTION AND VALUE OF PROPERTY 24, Tnx Conolldlltion G1 oup. None D lf the debtor i n corporollon, lit lhc nome. and foderollw:pnycr-idenlificntion number ofth~ parent corporntion of nny conolidated group fo1 Lnx purpoe of which lh~: debtor hn been n member nl any tim a within ix yenr immcdlotely preceding the commencement ofu11: ctl!ic, NAME OF PARENT CORPOilATION TAXPAYER-IDENTIFICATION NUMBER (E!N) 25, Penion Fund. None D If Ute dcbtori nol on individllnt, lit the nnmc nnd fcdcmllnxpnyerwidcmllficnllon number ofnn.y penion.fund to which the debtor, n an employer. hn been reponible for contributing nl nny:limc wiutln ixyenr immediolely preceding ~lc commencement of Ute cll!lc, NAME OFPENS!ON FUND TAXI' AYER-IDENT!FICA TION NUMBER (EIN)..,..... "...

II [If r:amp/eted by llll imlil iductl or JndMdtlo/ and pa1te] I declare undcrpennll)' nfpc~ury Umt1 hove rend Ute nnwern oonlnlncd in the foregoing tatement of flnnnciul uffnir nnd nny tltlnchmcnt thereto nnd thnt they ore true nnd corrccl Dote Dole Signnture of Debtor SignaLUre of Joint Debtor (ifnny) {/fcnmpluf~l 011 Jn~lmlft!fu purmnr.rlnp ur cnrporttl/an] I dcelnre undcr pennlly orpeljmy lhntl hnve. ~lithe nnwara canloincd in the foregoing tntcmenl offinoncfnlnitnlr ond ony nunchmcnt!i lhtn:lo IUid tim! th~ nrc true nnd cnnectto tin: b=.t ofm}' knowledge, informntlon nud belief. Dole --------------------- Signntuu: Prinl Nnmenml Tille [An individunl igning on bclmtrorn pnollc!:!ihlp or co~pomtlan mut lndlcntc poition or rdntinnhip to dchtor.j _tontinuution hccl!i nttnchoo ~1mf{J'.[ur nmkiiij: nfobelalrmumt: Fine rzi11p tu SJ(JIJ,UOO or llllprl.lanm:ru.(ornp fr.i.s.}'i!il'r.t, or hull. 18 U.S.C f IJ2 Ullll3S1J DECLARATION AND SIGNATURE OF NON~ATTORNEY DANiffiUPTC\' PETITION"I'REPAnER (See t I U.S.C. lid) I d~:~~lnrc under pllllnhy ofpeljury Llmt: (I) I run n bnnkruptcy p~lition prepnn:r n. dclincd in 11 U.S.t. 110; (2} I pn:pnrcd lhi ducntllcnt for com]ttnntlon nnd lmvc provided the debtor with 11 cop of thi document nnd the notice nnd lnfonnntlon required under II U,S.C. II O(b), 11 D(h), nnd J~J(b}; nnd, (3) ifrult..!l or_gufdc\lne hove b!:!!n prumil\glllcd pur.;unnt Jo II U.S.C. llo(h) elllngn milximum fcc forerviw chmycnblc bs lmnl..-ruptcy petition prcpnrur.;, I hnve giv!=fl the debtor nnlicc of the mrudmum nmount before prcpntina nny rlocum~ml forfilinu fnrn dcbtorornc~cpt\ng on}' fee frum!he debtor, o: requircd by-tlmtettiun. Prin!ed or Typed Nome nud Tlt\c,lfuny, ofbilllkrup1cy Pttilfon Preplltcr Soclni.Sccurlty 'No. (Rcqulrful hy II U.S. C. f 110.}!film bunkruplcj' pt!f/llwr pr11pnrc.r iltnl em Jnd/vldtiU/, lnlt! lire nwmt, If/It! (f{unj~, addf'j!ss, rmrladul~.fl!ctinu'iiij/1/bl!r eft he ajfil:er, prmclpul, n::rpnnd/jie per:uur, nr purtttl!l' w/lo lgllo~ t/li,\' tlnt:uiiicitl. J\ddtl!ll 5ib'11Diun: or.bnnl.ruptcy Pclllton 1 n:porer Dnte Nnm~ nnd Socini SI!Cllrfty num!jer ofnll other Jndlvldunl who pn:pnral ornited In ptllpnring llli document un\t:ll lhc bnnl;mptcy pt:lltlou pre)tllrcr[9 not un inillvldunl: If marc dum one: penon propnn:d thi dncuincnt, nllnch.nddhlannl 11igncd hecl confonnlnglo 1l1e npprnprinlc Officlnl Ftmn fol'cmch puron A bnjjiotllplcj' petition prepnriy''fullure to compb1 wfllt t/je prot ldatj n[jf/11! J J mul/lre Fetlunl Rule o[dnlllcntplt:,t PrnceEllire illllj' ri!srifr ir1 jiflt!'i or Jmptlortml!nt or bnrlt, JB US. c. /56. 41

B l:!a (Offidnl Fonn22A} (Chnpter7} (12/1(]} lnre ~~~~--------- Dcbtor() Cae Number.--=;--,--;-- (If known) According to the information required to be entered on thi tatement (chec!t one box n directed in Port I, III, or VI of thi tatement): 0TJtc preumption nriu. 0Tbc preumption doc not nrie. 0Thc preumption i tempornrily innppllcnblc. CHAPTER 7 STATEMENT OF CURRENT MONTHLY INCOME AND MEANS-TEST CALCULATION In nddition to Schedule I and J, thi tatement mut be completed by every lndividuni chapter 7 debtor. If none oftl1e excluion in Part I opp!ic,joint debtor may complete one tatement only. lfnny oftl1e exc!nion in Port I applie, joint debtor hould complete eparate tatement If they believe thi i required by 707(b)(2J(C). Part I. MILITARY AND NON-CONSUMER DEBTORS - la 18 Dlnbled Vete nn.ifyou are a diabled veteran decribed in tl1e Deciorntion in thi Part la, (I) cheek tl1c box at tl1e beginning of the Declnrntion, (2) check the box for "The preumption doe not arie,. at the top of thi tntement 3 and (3) complete the verification in Part Vll[. Do not complete any of the remaining part of thi tatement. 0 Declnratlon of Dinbled Veternn. By checking thi box, I dcclnre under penalty of pedury that I om n diabled veternn (a defined in 38 U.S.C. 374 I (I)) whoe indebtedne occurred primarily during n period in which I wn on active duty (a defined in 10 U.S.C. IOI(d)(1)) or while I wa performing o homeland defene activity (a defined in 32 U.S.C. 901(1)). Non~conumcr Dabtor, Jfyour debt are not primarily conumer debt, check the box below nnd complete the verification in Part VIU. Do not complete nny of the remaining part of thi tatement 0 Declnrntion ofnonmconumcr debt. By checldng thi box, I declare that my debt are not primarily conumer debt. : Reervit nod Nntionnl Gunrd Member; nctivc duty or homehmd defene activity. Member of a reerve component of the Armed Force and member oflhe Notional Guard who were called to nctive duty (a defined in 10 U.S. C. IOl{d)(l)) ofter September I I, 2001, fur a period of at leat 90 day, or who have perfurmed homeland defene activity (a defined in 32. U.S.C. 901 (I)) for a period ofntleot 90 day, are excluded from all form ofmenn teting during the time of active duty or homeland defene activity and for 540 day thereafter (the "e<cluion period'1. If you quality for ' ; thi tempomry excluion, (1) check the ~ppropriate boxe nnd complete nny required information in 1he Declnrntion of.. _: Reervit and Notional Gunrd Member below, (2) check the box for "The prenmption i temporarily lnapplicnble" at the top ofthi tatement. and (3) complele the verification in Pnrt VIJL During your excluion period you nrc not required to complete. the bnlnnce of thi form) but you mut complete the fonn no Intel" thnn 1.4 dny after the date on which... your cxc.luion period cndl unl~ the time for filing a motion I"aiingthe mcnn tet preumption expire in your " rc ~ : c.nc before your excluion period end. 0 Dcclrtrntion of Reervit.nnd Nntionnl GunrdMcmber. By cbecldng thi box nnd mnking the npproprlnte entrie below,l declare tltatl am eligible for a tcmporary excluion from mean teting becaue, n n member ofn reerve component of the Armed Force or the National Guard -... ' ' '-" -:;;i' - IL 0 I wa called to nctive duty after September.1 i, 2001, fur n period ofnt leat 90 day and 0 1 remain on active duty /or/ 0 I wa releaed from active duty on. which i le than 540 daybeforo thi bankruptcy cne wa filed; OR.'.,;...., h. I am performing homeland defene nctivity fur a period of ntleat 90.dny/or/ 0 l performed boraelnnd defene activity for a period of ot ient90 day, terminating on which i le than 540 day before thi bnnlcruptcy cae wa filed.

B l2a (Officlnl Fonn22A) {Cimnlcr7J (12/10) 2 Part II. CALCULATION OF MONTHLY INCOME FOR 707(b)(7) EXCLUSION Mnritnl/filing tnh1. Check the box that applie and complete the bnlnnce of thi pnrt of thi tatement n directed. n. D Unmarried. Complete only Column A (udcbtor' Incomcn) for Line 3 11. b. 0 Marri~:cl, not filingjointly 2 with declarntlon ofepnrnte houehold, By checking lhi box., debtor declare under penalty ofpejjury: "My poue nod J are legnlly eparntod under npplicable non-bnnlcruptcy lnw or my poue nod I 2 nre living apart other thnn for the purpoe of evading the requirement of 707(b)(2)[A) oftl1e Bnnlcruptcy Code." Complete only Column A (udebtor' lncomc 11 ) ror Line 3-11. c. 0 Married, not lilingjoin!ly, without tl1e declaration ofepnmte houehold etout in Line 2.b above. Complete bath. Column A ("Debtor' Income") nnd Column B ("Spoue' Income") for Line 3 11. d. D Married, filingjointly, Complete both Column A ("Debtor'lncomen) nnd Column B ("Spoue' Income") for Line 3-11. All figure mut reflect' overage monthly income received from all ource. derived during ColumnA Column B the lxcnlendnr month prior to filing the banlrruptcy cae, ending on the lnl day of tl1e Debtor' Spoue' month before the filing. ffthe amount of monthly income varied during the ix month, you Income Income mut divide the ix-montl1 total by ix, nnd enter the reult on the appropriate line. 3 Gro wage, aidij', tip, bonui!s, overtime, commiion. Income from the operation of n buine, proreiou or fnnn. Sublrnct Line b from Linen and enter the difference in lhe appropriate colurnn() ofline 4. If you operate more than one buine~ profeion or form, enter aggregate number nod provide detail on an nttnchrnent.. Do not enter n number le than zero. Do not include nny pnrt of the Puint!.! expene 4 entered on Line b n n deduction in PnrtV. a. Gro receipt.. b. Ordinary and neceary buine expene..,. C, Buine income Subtract Line b from Line a Rent nnd otber renl property income. Subtract Line b from Line a nod enter the difference in the appropriate column() of Line 5. Do not enter a number le thnn zero. Do not include nny pm't of llle operating ex:pcnl!!l lntcred on Line b n n d lduction in Pnrt V. ' a. Gro receipt b. Ordinary and neceary operatlng expene c. Rent W1d other real property income Subtmct Line b from Line a. t; :', lnterett dividend and royaltie. '.7. : Penion nnd retirement" income. ~~~,it. :,\ " Any mnount paid by nnother peron or entity, on n regular bni~ "ror tile houehold expene of tl1c debtor or the debtor' dependent, including child upport paid for Utnt purpoe. Do not include alimony or eparate maintenance payment or nmount.pnid by your poue if Column B i completed..each regular payment hould be reportod in only one column; if a payment I lited in Column A, do not reportthatpnyment in Column B, Unemployment compenntlon. Enter the nmount in the appropriate column() ofline 9. HoweVer~ If you contend that unemployment compenation received by you or your poue wa a benefit under the Social Security Act, do not lit the amount of uch oornp~:~nation in Column.A orb, but intead tate the nmount in the pace below: Unemployment compenntion claimed to I be a benefit under the Socinl Security Act Debtor I Spoue 61

13 ""'A (Officilll Fonn 22A) {Chllntcr7} (1:!/10) 10 ll Jncomc from nil other om cc. Specify ource and nmount. If neceary~ litndditionnl.ource on n eparate pnge, Do not include nllmony or cpnrntc mninteunnce puyment pnid by you I' poue if Column B i completed, but include nil ou1c1' pnymcnt of nlimony or cpnmte mnintennnec. Do not include any benefit received under the Social Security Act or payment received n n victim of a wnr crime, crime againt humanity. or n n victim of intemntional or dometic terrorim. I :: I I : I Total and enter on Line I 0 Subtotal of Current Monthly Income for 707(~)(7). Add Line 3 Lhru 10 In Column A, and, if Column B I completed, add Line 3 U1rough 10 in Column B. Enter the lotnl(). Totnl Current Monthly Income for 707(b)(7). If Column B hn been completed, add 12 Line 1l, Column A to Line 11, Column B, and enter Lhe total. If Column B ha not been completed, enter the amount from Line 11, Column A. u 14... ' '.. : Partm. APPLI(CATION OF 7o7(b)(7{EXbLQSIQJ'oTc ' >' ; ''........ '. Annunlized Current MonU1ly Income fo1 707(b)(7). Multiply the amount from Line 12 by U1e number 12 and enter the reult. Applicn~lc median fnmily income. Enter the median fnmily income for the applicable tate and houehold ize. (Thi information i available by family ize nt www.udol.gov/uu or :from the clerk of the bankruptcy court.) n. Enter debtor tate of reidence: b. Enter debtor' houehold ize: Applicntion of Section 707(b)(7). Check the applicable box and proceed a directed. 15 0 The nmount on Line 13 i le thnn or cqunl to the nmount on Line 14. Check the box for "Tile preumption doe not arie" at thctop ofpnge 1 oflhi tatement, nnd complete PartVJII; do notcomplctepnrt IV, V, VI or VII. 0 The nmount on Line 13 i more tlmn the amount on Line 14. Coniplele the rem11iriingpart ofthi tatement. Complete Part IV, V, VI, nnd VII of thi tatement only if required. (Sec Line 15.) l ~ : ik:..: Enter the.. nmount from Line 12.,.:..,<~ Mnritnl adjutment. If you checkedtl10 box at Line 2.c, enter on Line 17 the total of any income lited in. <.i Line II, ColumnB that wa NOT paid on n regular bai for the houehold expene of!he.debtorortl1e '.. ;.: ; debtor' dependenl. Specliy in the line below!he bai for excluding the Column B Income (uch a. j.. f' ::<J payment tiftbe poue' tnx llablllty.or the poue' upport of peron other than the debtor or.the debtor'. '.. dependent}nnd the amount of income devoted to ench purpoe, lfneceal)', lit additional adjutment on " n cparnte page. If you did not check box at Line 2.c, enter zero..: I!: I I : I : '..\i:\ Total and enter online 17.. '~-.,. tis : ; Current monthly income for 707(b)(2). Subtract Line 17 from Llne 16 and enter. U1e reult

B "J"JA COfficiul Form ""::A) rchnpler 7) ( 12/10) 4 Part V. CALCULATION OF DEDUCTIONS FROM INCOME Subpart A: Deduction under Standard of the Internal Revenue Service (IRS) Nntionnl Stnndnrd: food, cjothiug nnd other item. Enter in Line 19A ihe 11 Totnl" amount from IRS National Stnndard. far Food, Clothing and Other llem fortlte applicable number of peron. [Thi 19A infonnation i avnilnble nt www.udoi.gov/u!l or from the clerk of the bunkruph:y court.) The applicable number of peron i the number that would currently be aiiowed n exemption on your federnllncome tnx return, plu the number of any additional dependenl5 whom you upport. Nnllonnl Standard: henlth care. Enter in Lineal below the amount from IRS National Standard for Outof-Pocket Health Care for peron under 65 year ofnge, and in Line n2 theirs Nationnl Standnrd. fur Out of-poclcet Henlth Cnre for peron 65 yenr of ngc or older. (Thi information i available at www.udoi.aovlutl or from tlte clerk of the bankmptcy courl) Enter in Line bl the applicable number of peron who nrc under65 year ofnge. and enter In Line b2 the npplicnble number of peron who arc 65 year of age or older. {The applicable number of peron in each age calegory i the number in that category that would currently be allowed a exemption on your federal income tax: return, plu the number ofnny additional dependent whom you upport) Multiply Lineal by Line bl to obtain a total amount for peron 19B under 65, and enter the reult in Line cl. Multiply Line a2 by Line b2 to obtain n total amount for peron 65 and older, and enter the reult in Line c2. Add Line cl and c2 to obtain a total health care amount, and enter the reult in Line 198. Peron under 65 ycnr of nge Peron 65 ycnr of ngc or older a!. Allowance per peron n2. Allowance per peron bi. Number of peron b2. Number of peron cl. Subtotal c2. Subtotal Locnl Stnndnrd: houing nod utllltle; nonwmortgngc expcni!s, Enterihe amount of the IRS Houing and Utilitie Standard; non-mortgage expene for the applicable county and family ize. {Thi Information i 2DA available at www.udoi.nov/utl or from the clerk of the bankruptcy court). The applicable family ize... conit of the number that would currently be nllowed a exemption on your federal income tax return, plu the number ofnny ndditiomll dependent whom you upport '. ' : <2tiJ3'' ',' I id b. Locnl Stondnrd: houing nod utilitie; mortgngefl'ent expene. Enter, in Line a below, the nmount of the IRS Houing and Utilitie Standard; mortgage/rent expene for your county and family ize {thi Information i nvallable atwww.udoj.gov/ut/ or from the clerk oftlte bankruptcy court) (the applicable family ize conit ofthe number that would currently be allowed a exc~ption on your federal income tax return, plu tho number of ~ny additional dependenl5 whom you upport); enter.on Line b the total ofthe A vcrnge Monthly Payment for any debt ecured by your home, a tated In Line 42; ub!met Line b from Line a and enter the reult in Line 20B. Do not enter nn nmountlc thnn zero. a. IRS Houing and Utilitie Standard; mortgage/rental expene Average Monthly Payment for any debt ecured by your home, If nny, o tated in Line 42 c. Net mortgage/rental expene Subtract Line b from Line a. I;;;) Local Stnndnrd: bouing and utilitie; adjutment If you contend that the proce et out in Line 20A und 20B doe not nccumtely compute the allowance to which you nre entitled under the TRS Houing and I : Utilitie Standard, enter any additional amount to which you contend you nre entitled, and tnte tlte bliis'for :: your contention in the pace below: :,

rd~2=la~forffi~ic~io~i~f~orm~'='~a~lf~c=h~ddnl~l''~r~7l~f~i2~/~io~j--------------------------------------------------~----,---------, 5 Local Stnndurd: trnuportntion.; vehicle opcrntion/public trnnportntion expene. You nrc entitled to nn expene nllownncc In thi c:ntegory regardle of whether you pny the expene of operating n vehicle and regardle of whether you uc public trnnportntion. Check the number of vehicle for which you pny the operating ekpene or for which lhe operating expene are included a n contribution to your houehold expene in Line 8. 22A D 0 D I 02armare. lfyou checked 0, enter on Line 22A the "Public Trnnportntionn amount fi om IRS Local StllJldnrd: Trnnportntion. If you chet:ked 1 or 2 or more, enter online 22A the uopernting Cot" amount from IRS Lacnl Stnndnrd: Trnnpartntian far the npplicnble nwnber of vehicle in the npplicnble Metrapnlitnn Statitlcnl Area or Cenu Region. (Thee amount are nvnilnble at www.udoleov/utl or from the clerk of the bnnlcruptcy court.) Locnl Stnndnrd: trnnportntion; ndditionol public trnnportntion expene. If you pay the operating expene for a vehicle and nlo ue public tronportatlon, nnd you contend tho.t'you nrc entitled to nn 228 additional deduction for your public trnnportntion expene, enter on Line 21B the "Public Tranportation" amount from IRS Local Standnrd: Trnnportntion. (Thi amount i nvnilnble ol www.udoltmv/utl or from tl1e cleric of the bnnkruptcy court) Locnl Stnndnrd: trnnportntion ownerhipnenc expene; Vehicle 1. Check U1e number of vehicle for which you clolm an ownerhip/iene expene. (You may not claim nn ownerhip/leae e}l.-pene for more thnn : twa vehicle.) D I D 2 or mare. Enter, In Line a below, the "Ownerhip Cotfl for "One Cnr" from the IRS Locnl Standard: Tmnpcrtation (nvnilnble ntwww.udal.oav/ulf or from the clerk afthe bnnltruptcy court); enter in Line b the tatnl of!he 23 Average Monthly Payment far any debt ecured by Vehicle 1, n tntcd in Line 42; ubtract Line b from. Line n nnd enter the reult In Line 23. Do not enter nn nmount le thnn zero. n. IRS Tranpartntian Stnndnrd, Ownerhip Cot b. Avernge Monthly Pnyment far nny debt ecured by Vehicle I, n tated in Line 42.c. Net awncrhip/lene expene far Vehicle I SublrnctLine b from Line a. :-.~ Locnl Stnndnl'd: tranportation ownerbip/lenc expene; Vehicle 2. Complete twline only if you :_: :..: checked the 11 2 or more" Box in Line 23. -. >) Enter. In Line a below. the "Ownerhip Cotu for 11 0ne CW' 11 from the IRS Locnl Standard: Tranportation (nvallnble atwww.udaj.gov/uu or from the clerk of the bankruptcy court); enter in Line b the tatnl af1he, : " Average Monthly Pnyment far nny debt ecured byvehlole 2, n tated in Line 42; ublrnotliae b from _;_~24'.,~-~ Line a and enter the reult in Line 24. Do not enter nn nmount.le thnit zc1 o. : { i-"---+l_r_s_t_r_a_n_,_p_a_rt_nu_ a_n t..:.n..:.nd..:.n..:.r..:.d::...:.d_w... n_e... r_h_,lp_c a_t --11-----------------------l b. Average Mantl1ly Pnyment far nny debt ecured by Vehicle 2, '.. :: l---+n...,t_n... te_d..:.i..:.n_l..:.in..:.c_4_2 +--------------------l :: i. ' c. Net ownerhip/leae "''pene far V chicle 2 Sublract Line b from Line n. ' -: Other Neceary Expene: tnxc. Enter the total average monthly exp~ne thatyou nctunlly incur.for rill. js_: ~.! federal, tnte11ild.locnl taxe, ether them real etate nnd ale taxe, uch a income tnxe, elf-employment :: taxe, ocial-ecurity tnxe~ nod Medicare tnxe.do not include real etnte or nlc tnxc. Other Neceary Expene: involuntary deduction for employment Enter the tolti.l avernge monthly payroll deduction that ore n:guired for your employment, uch a retirement contribution, union due, and : ;: uniform cot. Do not include dicretionary amount, ucb.n voluntnry 401(h:) contribution. ";,ji,[cj 0. ther Neceary Expene: life inurance.- Enter total average monthly premium that you nctunlly pay for teon life inurance for yourelf.. Do not include premium foi inurance on your dependent, for whole I,.::: I life or ror nnv other fonn.ofinurnncc..: :~t:);~:~~ O~cr Ncccnry Expene: court-ordered payment. Enter the total monthly amount that you are 28_:::;: tequired to 'pay puruantto the order of a court or adminitrative ngency 1 uch n poual or child upport : ~--.;::;:. payment. Do not include payment on pnt due obligation included in Line 44.

29 30.3!. 32 Other Neceary Expene: cducntion for employment or ror n phyicnlly or mentnlly challenged chiltl, Enter lhe totnl overage monthly amount thnt- you actunlly expend far education that i n condition of employment and for education thnt i required for a phyically or mentally challenged dependent child for whom no public education providing imilar ervice i nvoilabte. Other Neceary Expcn!!S: childcnrc. Enter the lata! nvernge monthly amount thnt you octunlly expend on childcare---uch n baby~itting, dny c:nre, nurery and precl10ol. Do not include other cducntionnl pnyment. Other Nceenry Expene: health enre. Enter the total average monthly amount lhatyou actunlly expend on health care Umt i required for the health and welfare of yourelf or your dependent, thnt i not reimbured by inurance or pnid by n health aving nccounf1 and that i in exce of the amount entered in Line l9b. Do not include pnymcnt for hcnlth inurnncc or ltenlth nving account lited 1n LJnc 34. Other Neceary Expene: tclccommunicntion cnricc. Enter the total average monthly amount thnt you actunlly pny for telecammunicntion ervice ather than your baic home telephone nnd cell phone erviceuch n pnger, call waiting, cnller id, pecial long ditance, or Internet ervice--to the el\ient neceary for henlth and welfare or that Do not include nny deducted. 33 Totnl Expene AUowed under IRS Subpn:rt.B::. Addililmal Liy:ing E:{pene D'edm:tion Note: Do not incl~de any expene_ tliat you.h ""'" Holn.nn T Henlth lnurnncc, Diability luurnnec, nnd Henlth Saving Account Expene. Lit the monthly expene in the categorie et out in line a-o below that ore renonobly necenry for yourel~ your poue, or your dependent. 34 Account Tolnl and enter on Line 34 If you do noi"nctunlly expend thi totnl amount, tate your actual total avemge monthly expenditure in the pnce below: Continued contribution to the enre ofijouehold or fnmlly member. Enter the total average actual monthly expene that you will continue to pay for the reaonable and neceary care and upport Of lin elderly, chronically il~ or diabled member of your houehold or member of your immediate fumily who i unable to for uch Protection ngnint fnmily violence. Enter the total average reaonably neceary monthly expene that you actually incurred to mnlntaln tl1e afety of your family under the Family Violence Prevention nnd Service Act or otl1er applicable federollnw. The nature of thee expene i required to be lcept confidentlnl by the court. energy cot. Enter tlu~ total average monthly amoun~ in exce Ofthe nllowance pecified by lrs Standard for Houing and Utilitie. that you nctuolly expend for home energy cot. You mut provide your cne trutee with documentntion of your nc.tun] expene, nnd )'ou mut demontrate thnt tl1e ndditionnl nmount clnhncd i rcn~onnble nnd neceary. Education expene for dcpcndciit children le thnn 18. Enter the totnl avemge monthly expene that you actually incur, not to exceed 147.92* per child, for atlendance-nt.a private or public elementary or econdary chool by your dependent children le than 18 year QfQge. You mut provide your cne trutee with documentntion Of your nc.tunl nnd mut explnin \Yby U1e nmount.elnimed i rcnonnblc nnd nod for in the IRS Stnndnrd. *Am aunt ubject ta ac!/utmenl 01r4101113, and eveljt//rreeyear tllej't!aj}i!rwltlr repect.1a ca:re commenced on.ar.aflor the date afacfjutmrml. '

B n/\ (Offi u:m ' IF tmn,"la){ci mn t c.r 7)(1"'/10) - 7 Addltionnl rood nnd clothing expene. Enter the totnl average monthly nmounl by which your food nnd clothing expene exceed the combined nllowance for food and clothing (apparel and ervice) in tl1e IRS 39 National Standard, not to exceed 5% of thoe combined nllownnce. (Thi inforiuntion i nvallablc at www.udoi-l!ov/utl or from the clerk of the bnnlcruptcy court) You mut demontrate thnt the ndditionnl amount clnimed i renonnblc nud nccenry. 40 Continued chnritnble contribution. Enter the amount thnt you will continue to contribute in the form of cah or financial intrument to a chorltnble organization u defined in 26 U.S.C. 170(c)(l)-(2). 41 Totnl Additional Expene Deduction under 707(b). Enter the total of Line 34 tlll'ough 40 Subpart C: Deduction for Del:itPiiym~nt;. ' >-.. ~... Future payment on ecured c.lnim. For each of your debt that i ecured by nn interet in property that you own, lit the name of tl1e creditor, identicy the property ecuring the debt, tate the Average Monthly Pnyment, and check whether the payment include taxe or inurnncc. The Average Monthly Payment i U1e totnl o[nll amount cheduled a contractually due to ench Secured Creditorln the 60 month following the filing of the bankruptcy cae, divided by 60. Ifnecenry, lit ndditlonal entrie on n epornte page. Enter the total of the Avernge Monthly Payment on Line 42. Name of Property Securing the Debt Average Doe payment '.42 Creditor Monthly include taxe Payment or inumnce?. ';-:.. ~3.. n. Dye Dno b. Dye D no c. Dye Dno Totnl: Add Line a, b nnd c. Other pnyment on ecured clnlm.lf.nny of debt lited in Line 42 are ecured by your primary. reidence, n motor vehicle. or other property neceary for your upport or the upport of your dependent. you may include in your deduction 1/60ti1 of any amount (the "cureamounr') that you mut poy the creditor. In nddlticn to the payment lited in Line 42. in crderto maintain poeion of the properly. The cure : nmount would include any um in default that.mut be paid in order to avoid repoeion or foreclo urc. : Lit nnd totnl any uch amount in the following chart. If neceary, lit addltionnl entrie on a eparate age. Name of Property Securing the Debt l/60th of the Cure Amount Credilor n,.. i ' b. c... < Total: Add Line a. b and.o. 0/ Pnymcot on prepetition priority claim. Enter the total amoun~ divided by 60, of all priority claim, uch a priority tax, chnd upport nnd nlimony claim, fur which you were liable at the time of your banlcrupic)' :;. filing. Do ncit include C.UI1'cnt.obligntlonJ uch n thoe et out in I.;inc 28,

8.,,A (Official Fonn '11,\) (Chanter?) (12/IOl 45 Chapter 13 ndminitrntivc expene. If you nre eligible to file n c115e underchnpter 13, complele the following chart, multiply the amount in line n by the amount in line b, and enter the reulting ndminitrallve expene... b. c. Projected average monu1ly chapter 13 plnn payment. Current multiplier for your ditrict a detennined unde1 chedule iued by the Executive Office for Uniled State Trutee. (Thi informntlon i nvnilnble at www.udoj.oov/ul/ or from tbe cle k ofthe bankruptcy courl) Average monthly adminitrative expene of chapter 13 cae 46 Total Deduction for Debt Pnyment. Enter tl1e totnl of Line 42 through 45. Subpart D: Total Deduction from Iricome 47 Totnl of nil deduction nllowcd under 707(b)(2). Enter tbe total of Line 33, 41, and 46. x Total: Multiply Line nand b... :: 1 48 Enter the amount from Line 18 (Current monthly income for 707(b)(2)).49. Enter the nmount from Line 47 (Totnl of nil deduction nllowed under 707(b)(2)) 50 Monthly diponble income under 707(b)(2). Subtract Line 49 from Line 48 and eater the reult 51 _ 60-month dlponblc income under 707(b)(2). Multiply the amount In Line 50 by the number 60 nnd enter the reult Tnitinl pre.!lumption detenninntion. Check the applicable box and proceed n directed. - D Tbc nmount on Llne 51 i le tlmn 7,025. Check the box for"the preumption doe not nrie" ntthe top ofpoge 1 of thi tntement! and complete the verification in Part Vlll. Do not complete the remainder of Part VI. D The nmount et forth on Line 51 i more thnn 11,725*. Check the box for 11 The preumption Brie" at the top of page 1 of thi tatement! nnd complete the verification in Part VITI, You may alo complete Part VII. Do not complete the remainder ofpnrt VI. 0 The nmount on Line 51 i at lcnt 7~025*, but not more tbnn 11,725*. Complcle the remainder ofpnrtvj (Line 53 through 55), '53_.. :., : ::,: Enter tbc nmount of your totnl non~priority unecured debt '54_;,:' Threhold debt payment amount. Multiply the amount in Line 53 by the number 0.25 and enter tlm retill. 1 \ >(':-' Secondary preumption determination. Check the applicable box and proceed a directed. 1:J}): } 0 The amount on Line 51 i le than the amount on Line 54. Check tho bo>:for "The preumption doe not arie" nt.c :: J::< ihetop of page I of thi tntemen~ nnd complete tl1e verification in Part Vlll. 1'!,~'- ~',,: 0 Tltc nmount on Line: 51 i cqunl to or greater thnn the omount on Line 54. Checkthe box for "The preumption aricfl at the top of page 1 of lhi taiement! and complete the verification in Part Vlfl. You.mny alo complete Part VII. 'L:~~~:L) :;.Other Expene. Lit nnd decnde any monthly expene, not otherwie tated in thi form, that ate required for1he health -'>'>::;; and welfare of you and your family and thnt you contend hould be an addltiooal deduction from your current monthly :;;;:.\~:-::; income. under 707(b)(2)(A)(ii)(I), If neceary, lit additional ource-on a cporate_page. All figure hould reflect your -'~ :t }-_~ average monthly expene for each item. Total-the expene, '<f<i a. Expene Decription b. c. Monthly Amount Total: Add Line a, b and c * Aniounl!. ore cubjer:l.lo acfjuunent an 4/0J/13, and every tltreeyear llummflerwithrepec:l Jo cac commenced on or qfler Jlle rfate ofacfjutment.

B 21A (Dfliclnl Form!2A) (Cilnptcr7) (12110} 9 Part VITI: VERIFICATION 1 decjnre under penalty of petjury thnt the informntlon provided in thi tatement i true nnd com~ct. (!fthi I a joint cae, both debtm" IIIIlS/ lg/1.) 57 Date: Date: Signature: Signature: (DI!btar) (Joint Debtor, If am~ SB

B6 SmnmDiy (Offidnl Fonn U- SumnWI)') (12/07) United State Banhuptcy Comt Jnre ~~~---------- Deblor Coe No.------------- Chapter SUMMARY OF SCHEDULES lmlicnte n to euoh chedule whelber that chedule i nllached and late the number ofpogc in cnch. Report the totul from Schedule A, B, D, E, F. I, und J in Ute boxe provided, Add Ute amount from Schedule A untl B to dctennino the totnlnmount oftltc debtor' uel. Add lh!! nmount of nil claim from Schedule D, E, nnd F to determine tlte Lotnl nmount of the debtor'liobilitic. Indlvlduul debtor ulo mut complete the "SlnliUcnl Summary ofccrtuin Liobillti~:S nml Rclnted Dnln" if they file. n cne under ohnpter 7. II, or 1.3. NAME OF SCHEDULE A- Renl Prop~:ny ATTACHED [l'es/no) NO. OF SltEETS B- Pcronni'Prnpcrt.y C- Property Clnim&l n Bct:mpt D- Creditor Holding Secured Clnim E- Creditor Holding Unecured Priority ClniJTl!i {Tclnl orc:tnim on F- Creditor Holding Unecured Nonpriority Clnim G- Executory Conlmcl nnd Unexpired Leae H- Cod~blor 1- Current Income or lndividunl Dcbtor(} TOTAL

D 6 Summnn {Official Fom16 Summnr;, } (12/07} United State Banlauptcy Comt In rc -------::,-;----- Debtor Cne No. Chnpler STATISTICAL SUMMARY OF CERTAIN LIABILITIES AND RELATED DATA [28 U.S. C. 159) I fyou arc on individual debtor whoe debt ore primarily conumer debt, n defined in 101 (B) cf U1c Bnnkruplcy Code {II U.S.C. 101 (8)), filing n cuc undt!rchaptcr 7. II or 13, you mut rep on nil infonnnlion requcted below. tj Check U1i box if you nrc un individual debtor whoc debt oro NOT primarily conumer debt. You nrc. not required to report nny infonnution hen:. Thi Information i for tntiticnl purpoe only nnder 28 U.S. C. 159. Sununnrize the following ll'pcs of linbilltic, n rcportcu in the Scbcdulc, nnd lotnl them. Type cflinbllity Dometic Support Obligation (from Schedule E) ToKe ond Ccrtnin Other Debt Owed to Go\ emmentnl Unit (from Schedule E) Claim for Death or Peronal Injury While Debtor Wn Intoxicated (from Schedule E) (wheun:r diputed or undiputed) Stud~:nt Loon Obiigntion {from Sc:Jn:t.lule F) Dometic Supper~ Seporulion Agreement, nnd Divorce Decree Obligation Nol Reported on Schcduh E Obligulion lo Penion or Profit-Shming, nntl Other Similitr Oblignllon (from Schedule F) Stnte the fullowlnf!: Avernge lncomc (from Schedule 1, Line I 6} Av<:rngc Expene (from Schedule J, Line 18) TOTAL Current Monthly Income {from Fonn 22A Line 12; OR, Form 228 Line 11; OR, Fonn 22C Line 20 ) Amount I. Toiol from ScheduleD, "UNSECURED PDRT!ON,IF ANY" column 2 Toinl from Schedule E. "AMOUNT ENTITLED TO PlUDRITY'' column. 3, Tninllrom Schedule E, "AMOUNTNDT ENTITLED TO PIUOIUTY, If ANY" column lj. Totnl from Schedule F 5. Total ofnon-prlorll)' unecured debl (um of l, 3, and 4)