Fill in this information to identify your case:

United States Bankruptcy Court for the:

EASTERN DISTRICT OF VIRGINIA

Case number (if known) Chapter you are filing under:

 Chapter 7

 Chapter 11

 Chapter 12

 Chapter 13  Check if this an

amended filing

Official Form 101

Voluntary Petition for Individuals Filing for Bankruptcy 12/15

The bankruptcy forms use you and Debtor 1 to refer to a debtor filing alone. A married couple may file a bankruptcy case together—called a joint

case—and in joint cases, these forms use you to ask for information from both debtors. For example, if a form asks, “Do you own a car,” the answer

would be yes if either debtor owns a car. When information is needed about the spouses separately, the form uses Debtor 1 and Debtor 2 to

distinguish between them. In joint cases, one of the spouses must report information as Debtor 1 and the other as Debtor 2. The same person must be

Debtor 1 in all of the forms.

Be as complete and accurate as possible. If two married people are filing together, both are equally responsible for supplying correct information. If

more space is needed, attach a separate sheet to this form. On the top of any additional pages, write your name and case number (if known). Answer

every question.

Part 1: Identify Yourself

About Debtor 1: About Debtor 2 (Spouse Only in a Joint Case):

1. Your full name

Write the name that is on

your government-issued

picture identification (for

example, your driver's

license or passport).

Bring your picture

identification to your

meeting with the trustee.

Keith Gina

First name First name

Blake G

Middle name Middle name

Hensley Hensley

Last name and Suffix (Sr., Jr., II, III) Last name and Suffix (Sr., Jr., II, III)

2. All other names you have

used in the last 8 years

Include your married or

maiden names.

3. Only the last 4 digits of

your Social Security

number or federal

Individual Taxpayer

Identification number

(ITIN)

xxx-xx-8821 xxx-xx-4118

Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 1

Case 16-30045-KRH Doc 1 Filed 01/05/16 Entered 01/05/16 18:09:09 Desc Main

 Document Page 1 of 14
Debtor 1

Debtor 2

Keith Blake Hensley

Gina G Hensley Case number (if known)

About Debtor 1: About Debtor 2 (Spouse Only in a Joint Case):

4. Any business names and

Employer Identification

Numbers (EIN) you have

used in the last 8 years

 I have not used any business name or EINs.  I have not used any business name or EINs.

Include trade names and

doing business as names

Business name(s) Business name(s)

EINs EINs

5. Where you live If Debtor 2 lives at a different address:

7967 Vaughan Drive

Mechanicsville, VA 23111

Number, Street, City, State & ZIP Code Number, Street, City, State & ZIP Code

Hanover

County County

If your mailing address is different from the one

above, fill it in here. Note that the court will send any

notices to you at this mailing address.

If Debtor 2's mailing address is different from yours, fill it

in here. Note that the court will send any notices to this

mailing address.

PO Box 422

Mechanicsville, VA 23111

Number, P.O. Box, Street, City, State & ZIP Code Number, P.O. Box, Street, City, State & ZIP Code

6. Why you are choosing

this district to file for

bankruptcy

Check one:

 Over the last 180 days before filing this

petition, I have lived in this district longer than

in any other district.

 I have another reason.

Explain. (See 28 U.S.C. § 1408.)

Check one:

 Over the last 180 days before filing this petition, I

have lived in this district longer than in any other

district.

 I have another reason.

Explain. (See 28 U.S.C. § 1408.)

Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 2

Case 16-30045-KRH Doc 1 Filed 01/05/16 Entered 01/05/16 18:09:09 Desc Main

 Document Page 2 of 14
Debtor 1

Debtor 2

Keith Blake Hensley

Gina G Hensley Case number (if known)

Part 2: Tell the Court About Your Bankruptcy Case

7. The chapter of the

Bankruptcy Code you are

choosing to file under

Check one. (For a brief description of each, see Notice Required by 11 U.S.C. § 342(b) for Individuals Filing for Bankruptcy

(Form 2010)). Also, go to the top of page 1 and check the appropriate box.

 Chapter 7

 Chapter 11

 Chapter 12

 Chapter 13

8. How you will pay the fee  I will pay the entire fee when I file my petition. Please check with the clerk’s office in your local court for more details

about how you may pay. Typically, if you are paying the fee yourself, you may pay with cash, cashier’s check, or money

order. If your attorney is submitting your payment on your behalf, your attorney may pay with a credit card or check with

a pre-printed address.

 I need to pay the fee in installments. If you choose this option, sign and attach the Application for Individuals to Pay

The Filing Fee in Installments (Official Form 103A).

 I request that my fee be waived (You may request this option only if you are filing for Chapter 7. By law, a judge may,

but is not required to, waive your fee, and may do so only if your income is less than 150% of the official poverty line

that applies to your family size and you are unable to pay the fee in installments). If you choose this option, you must fill

out the Application to Have the Chapter 7 Filing Fee Waived (Official Form 103B) and file it with your petition.

9. Have you filed for

bankruptcy within the

last 8 years?

 No.

 Yes.

District

ch13/dismissed

3/5/2015 When 12/15/14 Case number 14-36648-KLP

District

Debtor discharged:

01/25/2012 When 1/14/10 Case number 10-30238-DOT

District See Attachment When Case number

10. Are any bankruptcy

cases pending or being

filed by a spouse who is

not filing this case with

you, or by a business

partner, or by an

affiliate?

 No

 Yes.

Debtor Relationship to you

District When Case number, if known

Debtor Relationship to you

District When Case number, if known

11. Do you rent your

residence?

 No. Go to line 12.

 Yes. Has your landlord obtained an eviction judgment against you and do you want to stay in your residence?

 No. Go to line 12.

 Yes. Fill out Initial Statement About an Eviction Judgment Against You (Form 101A) and file it with this

bankruptcy petition.

Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 3

Case 16-30045-KRH Doc 1 Filed 01/05/16 Entered 01/05/16 18:09:09 Desc Main

 Document Page 3 of 14
Debtor 1

Debtor 2

Keith Blake Hensley

Gina G Hensley Case number (if known)

Part 3: Report About Any Businesses You Own as a Sole Proprietor

12. Are you a sole proprietor

of any full- or part-time

business?

 No. Go to Part 4.

 Yes. Name and location of business

A sole proprietorship is a

business you operate as

an individual, and is not a

separate legal entity such

as a corporation,

partnership, or LLC.

Name of business, if any

If you have more than one

sole proprietorship, use a

separate sheet and attach

it to this petition.

Number, Street, City, State & ZIP Code

Check the appropriate box to describe your business:

 Health Care Business (as defined in 11 U.S.C. § 101(27A))

 Single Asset Real Estate (as defined in 11 U.S.C. § 101(51B))

 Stockbroker (as defined in 11 U.S.C. § 101(53A))

 Commodity Broker (as defined in 11 U.S.C. § 101(6))

 None of the above

13. Are you filing under

Chapter 11 of the

Bankruptcy Code and are

you a small business

debtor?

If you are filing under Chapter 11, the court must know whether you are a small business debtor so that it can set appropriate

deadlines. If you indicate that you are a small business debtor, you must attach your most recent balance sheet, statement of

operations, cash-flow statement, and federal income tax return or if any of these documents do not exist, follow the procedure

in 11 U.S.C. 1116(1)(B).

For a definition of small

business debtor, see 11

U.S.C. § 101(51D).

 No. I am not filing under Chapter 11.

 No. I am filing under Chapter 11, but I am NOT a small business debtor according to the definition in the Bankruptcy

Code.

 Yes. I am filing under Chapter 11 and I am a small business debtor according to the definition in the Bankruptcy Code.

Part 4: Report if You Own or Have Any Hazardous Property or Any Property That Needs Immediate Attention

14. Do you own or have any

property that poses or is

alleged to pose a threat

of imminent and

identifiable hazard to

public health or safety?

Or do you own any

property that needs

immediate attention?

 No.

 Yes.

What is the hazard?

If immediate attention is

needed, why is it needed?

For example, do you own

perishable goods, or

livestock that must be fed,

or a building that needs

urgent repairs?

Where is the property?

Number, Street, City, State & Zip Code

Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 4

Case 16-30045-KRH Doc 1 Filed 01/05/16 Entered 01/05/16 18:09:09 Desc Main

 Document Page 4 of 14
Debtor 1

Debtor 2

Keith Blake Hensley

Gina G Hensley Case number (if known)

Part 5: Explain Your Efforts to Receive a Briefing About Credit Counseling

About Debtor 1: About Debtor 2 (Spouse Only in a Joint Case):

15. Tell the court whether

you have received a

briefing about credit

counseling.

The law requires that you

receive a briefing about

credit counseling before

you file for bankruptcy.

You must truthfully check

one of the following

choices. If you cannot do

so, you are not eligible to

file.

If you file anyway, the court

can dismiss your case, you

will lose whatever filing fee

you paid, and your

creditors can begin

collection activities again.

You must check one: You must check one:

 I received a briefing from an approved credit

counseling agency within the 180 days before I

filed this bankruptcy petition, and I received a

certificate of completion.

Attach a copy of the certificate and the payment

plan, if any, that you developed with the agency.

 I received a briefing from an approved credit

counseling agency within the 180 days before I filed

this bankruptcy petition, and I received a certificate of

completion.

Attach a copy of the certificate and the payment plan, if

any, that you developed with the agency.

 I received a briefing from an approved credit

counseling agency within the 180 days before I

filed this bankruptcy petition, but I do not have

a certificate of completion.

Within 14 days after you file this bankruptcy

petition, you MUST file a copy of the certificate and

payment plan, if any.

 I received a briefing from an approved credit

counseling agency within the 180 days before I filed

this bankruptcy petition, but I do not have a

certificate of completion.

Within 14 days after you file this bankruptcy petition, you

MUST file a copy of the certificate and payment plan, if

any.

 I certify that I asked for credit counseling

services from an approved agency, but was

unable to obtain those services during the 7

days after I made my request, and exigent

circumstances merit a 30-day temporary waiver

of the requirement.

To ask for a 30-day temporary waiver of the

requirement, attach a separate sheet explaining

what efforts you made to obtain the briefing, why

you were unable to obtain it before you filed for

bankruptcy, and what exigent circumstances

required you to file this case.

Your case may be dismissed if the court is

dissatisfied with your reasons for not receiving a

briefing before you filed for bankruptcy.

If the court is satisfied with your reasons, you must

still receive a briefing within 30 days after you file.

You must file a certificate from the approved

agency, along with a copy of the payment plan you

developed, if any. If you do not do so, your case

may be dismissed.

Any extension of the 30-day deadline is granted

only for cause and is limited to a maximum of 15

days.

 I certify that I asked for credit counseling services

from an approved agency, but was unable to obtain

those services during the 7 days after I made my

request, and exigent circumstances merit a 30-day

temporary waiver of the requirement.

To ask for a 30-day temporary waiver of the requirement,

attach a separate sheet explaining what efforts you made

to obtain the briefing, why you were unable to obtain it

before you filed for bankruptcy, and what exigent

circumstances required you to file this case.

Your case may be dismissed if the court is dissatisfied

with your reasons for not receiving a briefing before you

filed for bankruptcy.

If the court is satisfied with your reasons, you must still

receive a briefing within 30 days after you file. You must

file a certificate from the approved agency, along with a

copy of the payment plan you developed, if any. If you do

not do so, your case may be dismissed.

Any extension of the 30-day deadline is granted only for

cause and is limited to a maximum of 15 days.

 I am not required to receive a briefing about

credit counseling because of:

 I am not required to receive a briefing about credit

counseling because of:

 Incapacity. I have a mental illness or a

mental deficiency that makes

me incapable of realizing or

making rational decisions

about finances.

 Incapacity. I have a mental illness or a mental

deficiency that makes me incapable

of realizing or making rational

decisions about finances.

 Disability. My physical disability causes

me to be unable to participate

in a briefing in person, by

phone, or through the

internet, even after I

reasonably tried to do so.

 Disability. My physical disability causes me to

be unable to participate in a briefing

in person, by phone, or through the

internet, even after I reasonably tried

to do so.

 Active duty. I am currently on active

military duty in a military

combat zone.

 Active duty. I am currently on active military duty

in a military combat zone.

If you believe you are not required to receive a

briefing about credit counseling, you must file a

motion for waiver of credit counseling with the

court.

If you believe you are not required to receive a briefing

about credit counseling, you must file a motion for waiver

of credit counseling with the court.

Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 5

Case 16-30045-KRH Doc 1 Filed 01/05/16 Entered 01/05/16 18:09:09 Desc Main

 Document Page 5 of 14
Debtor 1

Debtor 2

Keith Blake Hensley

Gina G Hensley Case number (if known)

Part 6: Answer These Questions for Reporting Purposes

16. What kind of debts do

you have?

16a. Are your debts primarily consumer debts? Consumer debts are defined in 11 U.S.C. § 101(8) as “incurred by an

individual primarily for a personal, family, or household purpose.”

 No. Go to line 16b.

 Yes. Go to line 17.

16b. Are your debts primarily business debts? Business debts are debts that you incurred to obtain

money for a business or investment or through the operation of the business or investment.

 No. Go to line 16c.

 Yes. Go to line 17.

16c. State the type of debts you owe that are not consumer debts or business debts

17. Are you filing under

Chapter 7?

 No. I am not filing under Chapter 7. Go to line 18.

Do you estimate that

after any exempt

property is excluded and

administrative expenses

are paid that funds will

be available for

distribution to unsecured

creditors?

 Yes. I am filing under Chapter 7. Do you estimate that after any exempt property is excluded and administrative

expenses are paid that funds will be available to distribute to unsecured creditors?

 No

 Yes

18. How many Creditors do

you estimate that you

owe?

 1-49

 50-99

 100-199

 200-999

 1,000-5,000

 5001-10,000

 10,001-25,000

 25,001-50,000

 50,001-100,000

 More than100,000

19. How much do you

estimate your assets to

be worth?

 $0 - $50,000

 $50,001 - $100,000

 $100,001 - $500,000

 $500,001 - $1 million

 $1,000,001 - $10 million

 $10,000,001 - $50 million

 $50,000,001 - $100 million

 $100,000,001 - $500 million

 $500,000,001 - $1 billion

 $1,000,000,001 - $10 billion

 $10,000,000,001 - $50 billion

 More than $50 billion

20. How much do you

estimate your liabilities

to be?

 $0 - $50,000

 $50,001 - $100,000

 $100,001 - $500,000

 $500,001 - $1 million

 $1,000,001 - $10 million

 $10,000,001 - $50 million

 $50,000,001 - $100 million

 $100,000,001 - $500 million

 $500,000,001 - $1 billion

 $1,000,000,001 - $10 billion

 $10,000,000,001 - $50 billion

 More than $50 billion

Part 7: Sign Below

For you I have examined this petition, and I declare under penalty of perjury that the information provided is true and correct.

If I have chosen to file under Chapter 7, I am aware that I may proceed, if eligible, under Chapter 7, 11,12, or 13 of title 11,

United States Code. I understand the relief available under each chapter, and I choose to proceed under Chapter 7.

If no attorney represents me and I did not pay or agree to pay someone who is not an attorney to help me fill out this

document, I have obtained and read the notice required by 11 U.S.C. § 342(b).

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

I understand making a false statement, concealing property, or obtaining money or property by fraud in connection with a

bankruptcy case can result in fines up to $250,000, or imprisonment for up to 20 years, or both. 18 U.S.C. §§ 152, 1341,

1519, and 3571.

/s/ Keith Blake Hensley /s/ Gina G Hensley

Keith Blake Hensley Gina G Hensley

Signature of Debtor 1 Signature of Debtor 2

Executed on January 5, 2016 Executed on January 5, 2016

MM / DD / YYYY MM / DD / YYYY

Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 6

Case 16-30045-KRH Doc 1 Filed 01/05/16 Entered 01/05/16 18:09:09 Desc Main

 Document Page 6 of 14
Debtor 1

Debtor 2

Keith Blake Hensley

Gina G Hensley Case number (if known)

For your attorney, if you are

represented by one

If you are not represented by

an attorney, you do not need

to file this page.

I, the attorney for the debtor(s) named in this petition, declare that I have informed the debtor(s) about eligibility to proceed

under Chapter 7, 11, 12, or 13 of title 11, United States Code, and have explained the relief available under each chapter

for which the person is eligible. I also certify that I have delivered to the debtor(s) the notice required by 11 U.S.C. §

342(b) and, in a case in which § 707(b)(4)(D) applies, certify that I have no knowledge after an inquiry that the information

in the schedules filed with the petition is incorrect.

/s/ Nupa Agarwal Date January 5, 2016

Signature of Attorney for Debtor MM / DD / YYYY

Nupa Agarwal

Printed name

Nupa Agarwal Attorney at Law

Firm name

PO Box 17275

Richmond, VA 23226

Number, Street, City, State & ZIP Code

Contact phone (804) 691-2655 Email address noopaa@yahoo.com

42545

Bar number & State

Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 7

Case 16-30045-KRH Doc 1 Filed 01/05/16 Entered 01/05/16 18:09:09 Desc Main

 Document Page 7 of 14
Debtor 1

Debtor 2

Keith Blake Hensley

Gina G Hensley Case number (if known)

Fill in this information to identify your case:

Debtor 1 Keith Blake Hensley

First Name Middle Name Last Name

Debtor 2 Gina G Hensley

(Spouse if, filing) First Name Middle Name Last Name

United States Bankruptcy Court for the: EASTERN DISTRICT OF VIRGINIA

Case number

(if known)  Check if this is an

amended filing

FORM 101. VOLUNTARY PETITION

Prior Bankruptcy Cases Filed Attachment

District Case Number Date Filed

ch13/dismissed 3/5/2015 14-36648-KLP 12/15/14

Debtor discharged: 01/25/2012 10-30238-DOT 1/14/10

 Date discharged: 06/13/2008 06-33534-KRH 12/05/06

 ch 13/Date discharged: 06/23/2004 01-33234-DOT 5/25/01

ch13 dismissed/5/25/2001 00-35648-DOT 10/20/00

Date discharged: 06/22/1996 96-31202-BNS 3/12/96

Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 8

Case 16-30045-KRH Doc 1 Filed 01/05/16 Entered 01/05/16 18:09:09 Desc Main

 Document Page 8 of 14
}bk1{Credito AresMatix}bk{

Acceptance Now

Customer Service

501 Headquarters Dr

Plano, TX 75024

Advance America

7119 Staples Mill Road

Henrico, VA 23228-4110

Bon Secours

Richmond Health System

PO Box 28538

Henrico, VA 23228

Calvary Portfolio Services

500 Summit Lake Dr

Ste 400

Valhalla, NY 10595

Capital One Auto Finance

7933 Preston Rd

Plano, TX 75024

Cci

Contract Callers I

Augusta, GA 30901

Central Furniture Company, Inc

3700 Mechanicsville Pike

Richmond, VA 23223

Checksmart

6785 Bobcat Way, Suite 200

Dublin, OH 43016-1443

Chexsystems

7805 Hudson Rd., Suite 100

Saint Paul, MN 55125-1703

Citibank/The Home Depot

Citicorp Credit Srvs/Centralized Bankrup

Po Box 790040

Saint Louis, MO 63179

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City Leasing And Sales

3006 Chamberlayne Ave.

Richmond, VA

Comcast

Attention Bankruptcy

PO Box 3012

Commonwealth of VA-Tax

PO Box 2156

Richmond, VA 23218

County of Hanover Public Utili

PO Box 91736

Richmond, VA 23291-1736

Credit Collections

PO Box 9134

Needham Heights, MA 02494

Direct General Insurance, Co

1281 Murfreesboro Rd

Nashville, TN 37217-2437

Direct TV/ ATTN: Bankruptcy

P.o. Box 6550

Englewood, CO 80155

Dishnetwork Main Office

9601 S. Meridican Blvd

Englewood, CO 80112

Dominion Behavoral Health

2305 North Parham Rd.

Suite 3

Henrico, VA 23229

Dominion Customer Credit SERV*

P.O. Box 2000000

10Th Floor, ATTN: Bankruptcy

Richmond, VA 23261

Dominion Virginia Power

PO Box 26543

Richmond, VA 23290

Case 16-30045-KRH Doc 1 Filed 01/05/16 Entered 01/05/16 18:09:09 Desc Main

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Elephant Auto Insurance

PO Box 5005

Glen Allen, VA 23058-5005

Firts Premier Bank

601 S Minneapolis Ave

Sioux Falls, SD 57104

GEICO

One GEICO Plaza

Bethesda, MD 20811

Hanover Green Veterinary Clini

7273 Hanover Green Drive

Mechanicsville, VA 23111-1797

Henrico Doctors Hospital

PO Box 13620

Richmond, VA 23225

Herff Jones

2020 New Dorset RD.

Powhatan, VA 23139-7540

Herff Jones Inc.

3 Easton Oval Ste 210

Columbus, OH 43219-6011

Household Finance

c/o PRA Receivables

PO Box 12914

Norfolk, VA 23541

Hunters Wood, LLC

7438 Tack Room Drive

Mechanicsville, VA 23111-1952

IC Systems, Inc

444 Highway 96 East

Po Box 64378

St Paul, MN 55164

Case 16-30045-KRH Doc 1 Filed 01/05/16 Entered 01/05/16 18:09:09 Desc Main

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Internal Revenue Service

Insolvency Unit

Post Office Box 21126

Philadelphia, PA 19114

Jefferson Capital Systems, LLC

16 Mcleland Rd

Saint Cloud, MN 56303

Lab. Corp

PO Box 2240

Burlington, NC 27216

Memorial Regional Medical Cent

PO Box 409601

Atlanta, GA 30384-9601

Mid America Bank & Tru

5109 S Broadband Ln

Sioux Falls, SD 57108

Midwest Collections

MediCredit Corp.

Po Box 411187

St. Louis, MO 63141

Ntelos

P.O. Box 1990

Waynesboro, VA 22980

Payliance

3 Eastern Oval, Suite 210

Columbus, OH 43219-6011

Prestige Financial Svc

Attn: Bankruptcy Department

Po Box 26707

Salt Lake City, UT 84126

Progressive Insurance

PO Box 31260

Tampa, FL 33631

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Receivable Management

7206 Hull Street Rd Ste

North Chesterfield, VA 23235

Richmond Emergency Physcians

5801 Bremo Road

Richmond, VA 23226-1907

Richmond General District Ct

John Marshall Courts Building

400 N. 9th Street, Room 203

Richmond, VA 23219

Sam Parrish

Parrish Automotive Sales

2757 Davis Mill Road

Goochland, VA 23063

Southwest Credit Systems

4120 International Parkway

Suite 1100

Carrollton, TX 75007

Spinella Owings and Shaia

8550 Mayland Dr

Henrico, VA 23294

Sprint

PO Box 660075

Dallas, TX 75266-0075

Stellar Recovery Inc

1327 Hwy 2 W

Suite 100

Kalispell, MT 59901

Stephen F. Relyea

Boleman Law Firm

PO Box 11588

Richmond, VA 23230-1588

T-Mobile

PO Box 742596

Cincinnati, OH 45274

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Verizon

500 Technology Dr

Suite 500

Weldon Spring, MO 63304

Vonage

23 Main Street

Holmdel, NJ 07733

Wells Fargo

Attn: Bankruptcy

1 Home Campus X2303-01a

Des Moines, IA 50328

West Coast Adjusters

PO Box 12070

Montpelier, VT 05601

Westcoastadj

Po Box 569

Lynnwood, WA 98046

Woodforest National Bank

PO Box 7889

Spring, TX 77387-7889

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