}bk1{Form .Vluntary Peiton}bk{

B1 (Official Form 1)(04/13)

United States Bankruptcy Court Voluntary Petition

Name of Debtor (if individual, enter Last, First, Middle):

All Other Names used by the Debtor in the last 8 years

(include married, maiden, and trade names):

Last four digits of Soc. Sec. or Individual-Taxpayer I.D. (ITIN)/Complete EIN

(if more than one, state all)

Street Address of Debtor (No. and Street, City, and State):

County of Residence or of the Principal Place of Business:

Mailing Address of Debtor (if different from street address):

Location of Principal Assets of Business Debtor

(if different from street address above):

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

All Other Names used by the Joint Debtor in the last 8 years

(include married, maiden, and trade names):

Last four digits of Soc. Sec. or Individual-Taxpayer I.D. (ITIN) No./Complete EIN

(if more than one, state all)

Street Address of Joint Debtor (No. and Street, City, and State):

County of Residence or of the Principal Place of Business:

Mailing Address of Joint Debtor (if different from street address):

ZIP Code ZIP Code

ZIP Code ZIP Code

Type of Debtor

(Form of Organization) (Check one box)

Individual (includes Joint Debtors)

See Exhibit D on page 2 of this form.

Corporation (includes LLC and LLP)

Partnership

Other (If debtor is not one of the above entities,

check this box and state type of entity below.)

Chapter 15 Debtors

Country of debtor's center of main interests:

Each country in which a foreign proceeding

by, regarding, or against debtor is pending:

Filing Fee (Check one box)

Full Filing Fee attached

Filing Fee to be paid in installments (applicable to individuals only). Must

attach signed application for the court's consideration certifying that the

debtor is unable to pay fee except in installments. Rule 1006(b). See Official

Form 3A.

Filing Fee waiver requested (applicable to chapter 7 individuals only). Must

attach signed application for the court's consideration. See Official Form 3B.

Nature of Business

(Check one box)

Health Care Business

Single Asset Real Estate as defined

in 11 U.S.C. § 101 (51B)

Railroad

Stockbroker

Commodity Broker

Clearing Bank

Other

Tax-Exempt Entity

(Check box, if applicable)

Debtor is a tax-exempt organization

under Title 26 of the United States

Code (the Internal Revenue Code).

Chapter of Bankruptcy Code Under Which

the Petition is Filed (Check one box)

Chapter 7

Chapter 9

Chapter 11

Chapter 12

Chapter 13

Chapter 15 Petition for Recognition

of a Foreign Main Proceeding

Chapter 15 Petition for Recognition

of a Foreign Nonmain Proceeding

Nature of Debts

(Check one box)

Debts are primarily consumer debts, Debts are primarily

defined in 11 U.S.C. § 101(8) as business debts.

"incurred by an individual primarily for

a personal, family, or household purpose."

Check Chapter 11 Debtors one box:

Debtor is a small business debtor as defined in 11 U.S.C. § 101(51D).

Debtor is not a small business debtor as defined in 11 U.S.C. § 101(51D).

Check if:

Debtor’s aggregate noncontingent liquidated debts (excluding debts owed to insiders or affiliates)

are less than $2,490,925 (amount subject to adjustment on 4/01/16 and every three years thereafter).

Check all applicable boxes:

A plan is being filed with this petition.

Acceptances of the plan were solicited prepetition from one or more classes of creditors,

in accordance with 11 U.S.C. § 1126(b).

Statistical/Administrative Information THIS SPACE IS FOR COURT USE ONLY

Debtor estimates that funds will be available for distribution to unsecured creditors.

Debtor estimates that, after any exempt property is excluded and administrative expenses paid, 

there will be no funds available for distribution to unsecured creditors.

Estimated Number of Creditors

1- 50- 100- 200- 1,000- 5,001- 10,001- 25,001- 50,001- OVER

49 99 199 999 5,000 10,000 25,000 50,000 100,000 100,000

Estimated Assets

$0 to $50,001 to $100,001 to $500,001 $1,000,001 $10,000,001 $50,000,001 $100,000,001 $500,000,001 More than

$50,000 $100,000 $500,000 to $1 to $10 to $50 to $100 to $500 to $1 billion $1 billion

million million million million million

Estimated Liabilities

$0 to $50,001 to $100,001 to $500,001 $1,000,001 $10,000,001 $50,000,001 $100,000,001 $500,000,001 More than

$50,000 $100,000 $500,000 to $1 to $10 to $50 to $100 to $500 to $1 billion $1 billion

million million million million million

Eastern District of Virginia

Khatun, Mossammat R.

xxx-xx-5955

5220 Fillmore Ave.,

Alexandria, VA

Alexandria City

22311

Case 15-13148-BFK Doc 1 Filed 09/10/15 Entered 09/10/15 15:33:36 Desc Main

 Document Page 1 of 14
B1 (Official Form 1)(04/13) Page 2

Voluntary Petition

(This page must be completed and filed in every case)

Name of Debtor(s):

All Prior Bankruptcy Cases Filed Within Last 8 Years (If more than two, attach additional sheet)

Location Case Number: Date Filed:

Where Filed:

Location Case Number: Date Filed:

Where Filed:

Pending Bankruptcy Case Filed by any Spouse, Partner, or Affiliate of this Debtor (If more than one, attach additional sheet)

Name of Debtor: Case Number: Date Filed:

District: Relationship: Judge:

Exhibit A

(To be completed if debtor is required to file periodic reports (e.g.,

forms 10K and 10Q) with the Securities and Exchange Commission

pursuant to Section 13 or 15(d) of the Securities Exchange Act of 1934

and is requesting relief under chapter 11.)

Exhibit A is attached and made a part of this petition.

Exhibit C

Does the debtor own or have possession of any property that poses or is alleged to pose a threat of imminent and identifiable harm to public health or safety?

Yes, and Exhibit C is attached and made a part of this petition.

No.

Exhibit D

(To be completed by every individual debtor. If a joint petition is filed, each spouse must complete and attach a separate Exhibit D.)

Exhibit D completed and signed by the debtor is attached and made a part of this petition.

If this is a joint petition:

Exhibit D also completed and signed by the joint debtor is attached and made a part of this petition.

Information Regarding the Debtor - Venue

(Check any applicable box)

Debtor has been domiciled or has had a residence, principal place of business, or principal assets in this District for 180

days immediately preceding the date of this petition or for a longer part of such 180 days than in any other District.

There is a bankruptcy case concerning debtor's affiliate, general partner, or partnership pending in this District.

Debtor is a debtor in a foreign proceeding and has its principal place of business or principal assets in the United States in

this District, or has no principal place of business or assets in the United States but is a defendant in an action or

proceeding [in a federal or state court] in this District, or the interests of the parties will be served in regard to the relief

sought in this District.

Certification by a Debtor Who Resides as a Tenant of Residential Property

(Check all applicable boxes)

Landlord has a judgment against the debtor for possession of debtor's residence. (If box checked, complete the following.)

(Name of landlord that obtained judgment)

(Address of landlord)

Debtor claims that under applicable nonbankruptcy law, there are circumstances under which the debtor would be permitted to cure

the entire monetary default that gave rise to the judgment for possession, after the judgment for possession was entered, and 

Debtor has included with this petition the deposit with the court of any rent that would become due during the 30-day period

after the filing of the petition.

Debtor certifies that he/she has served the Landlord with this certification. (11 U.S.C. § 362(l)).

Exhibit B

(To be completed if debtor is an individual whose debts are primarily consumer debts.)

I, the attorney for the petitioner named in the foregoing petition, declare that I

have informed the petitioner that [he or she] may proceed under chapter 7, 11,

12, or 13 of title 11, United States Code, and have explained the relief available

under each such chapter. I further certify that I delivered to the debtor the notice

required by 11 U.S.C. §342(b).

X

Signature of Attorney for Debtor(s) (Date)

Khatun, Mossammat R.

Alexandria, VA 11-12486 4/05/11

- None -

/s/ Januario G. Azarcon September 10, 2015

Januario G. Azarcon 22810

Case 15-13148-BFK Doc 1 Filed 09/10/15 Entered 09/10/15 15:33:36 Desc Main

 Document Page 2 of 14
B1 (Official Form 1)(04/13) Page 3

Voluntary Petition

(This page must be completed and filed in every case)

Name of Debtor(s):

Signatures

Signature(s) of Debtor(s) (Individual/Joint)

I declare under penalty of perjury that the information provided in this

petition is true and correct.

[If petitioner is an individual whose debts are primarily consumer debts and

has chosen to file under chapter 7] I am aware that I may proceed under

chapter 7, 11, 12, or 13 of title 11, United States Code, understand the relief

available under each such chapter, and choose to proceed under chapter 7.

[If no attorney represents me and no bankruptcy petition preparer signs the

petition] 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.

X

Signature of Debtor

X

Signature of Joint Debtor

Telephone Number (If not represented by attorney)

Date

Signature of Attorney*

X

Signature of Attorney for Debtor(s)

Printed Name of Attorney for Debtor(s)

Firm Name

Address

Telephone Number

Date

*In a case in which § 707(b)(4)(D) applies, this signature also constitutes a

certification that the attorney has no knowledge after an inquiry that the

information in the schedules is incorrect.

Signature of Debtor (Corporation/Partnership)

I declare under penalty of perjury that the information provided in this

petition is true and correct, and that I have been authorized to file this petition

on behalf of the debtor.

The debtor requests relief in accordance with the chapter of title 11, United

States Code, specified in this petition.

X

Signature of Authorized Individual

Printed Name of Authorized Individual

Title of Authorized Individual

Date

Signature of a Foreign Representative

I declare under penalty of perjury that the information provided in this petition

is true and correct, that I am the foreign representative of a debtor in a foreign

proceeding, and that I am authorized to file this petition.

(Check only one box.)

I request relief in accordance with chapter 15 of title 11. United States Code.

Certified copies of the documents required by 11 U.S.C. §1515 are attached.

Pursuant to 11 U.S.C. §1511, I request relief in accordance with the chapter

of title 11 specified in this petition. A certified copy of the order granting

recognition of the foreign main proceeding is attached.

X

Signature of Foreign Representative

Printed Name of Foreign Representative

Date

Signature of Non-Attorney Bankruptcy Petition Preparer

I declare under penalty of perjury that: (1) I am a bankruptcy petition

preparer as defined in 11 U.S.C. § 110; (2) I prepared this document for

compensation and have provided the debtor with a copy of this document

and the notices and information required under 11 U.S.C. §§ 110(b),

110(h), and 342(b); and, (3) if rules or guidelines have been promulgated

pursuant to 11 U.S.C. § 110(h) setting a maximum fee for services

chargeable by bankruptcy petition preparers, I have given the debtor notice

of the maximum amount before preparing any document for filing for a

debtor or accepting any fee from the debtor, as required in that section.

Official Form 19 is attached.

Printed Name and title, if any, of Bankruptcy Petition Preparer

Social-Security number (If the bankrutpcy petition preparer is not

an individual, state the Social Security number of the officer,

principal, responsible person or partner of the bankruptcy petition

preparer.)(Required by 11 U.S.C. § 110.)

Address

X

Date

Signature of bankruptcy petition preparer or officer, principal, responsible

person,or partner whose Social Security number is provided above.

Names and Social-Security numbers of all other individuals who prepared or

assisted in preparing this document unless the bankruptcy petition preparer is

not an individual:

If more than one person prepared this document, attach additional sheets

conforming to the appropriate official form for each person.

A bankruptcy petition preparer’s failure to comply with the provisions of

title 11 and the Federal Rules of Bankruptcy Procedure may result in

fines or imprisonment or both. 11 U.S.C. §110; 18 U.S.C. §156.

Khatun, Mossammat R.

/s/ Mossammat R. Khatun

Mossammat R. Khatun

September 10, 2015

/s/ Januario G. Azarcon

Januario G. Azarcon 22810

Sawyer & Azarcon, P.C.

10605 B2 Judicial Drive

Fairfax, VA 22030

Email: sa@sawyerazarcon.com

(703) 893 0760 Fax: (703) 273 9886

September 10, 2015

Case 15-13148-BFK Doc 1 Filed 09/10/15 Entered 09/10/15 15:33:36 Desc Main

 Document Page 3 of 14
B 1D (Official Form 1, Exhibit D) (12/09)

United States Bankruptcy Court

Eastern District of Virginia

In re Mossammat R. Khatun Case No.

Debtor(s) Chapter 13

EXHIBIT D - INDIVIDUAL DEBTOR'S STATEMENT OF COMPLIANCE WITH

CREDIT COUNSELING REQUIREMENT

Warning: You must be able to check truthfully one of the five statements regarding credit

counseling listed below. If you cannot do so, you are not eligible to file a bankruptcy case, and the court

can dismiss any case you do file. If that happens, you will lose whatever filing fee you paid, and your

creditors will be able to resume collection activities against you. If your case is dismissed and you file

another bankruptcy case later, you may be required to pay a second filing fee and you may have to take

extra steps to stop creditors' collection activities.

Every individual debtor must file this Exhibit D. If a joint petition is filed, each spouse must complete

and file a separate Exhibit D. Check one of the five statements below and attach any documents as directed.

 1. Within the 180 days before the filing of my bankruptcy case, I received a briefing from a credit

counseling agency approved by the United States trustee or bankruptcy administrator that outlined the

opportunities for available credit counseling and assisted me in performing a related budget analysis, and I have

a certificate from the agency describing the services provided to me. Attach a copy of the certificate and a copy

of any debt repayment plan developed through the agency.

 2. Within the 180 days before the filing of my bankruptcy case, I received a briefing from a credit

counseling agency approved by the United States trustee or bankruptcy administrator that outlined the

opportunities for available credit counseling and assisted me in performing a related budget analysis, but I do

not have a certificate from the agency describing the services provided to me. You must file a copy of a

certificate from the agency describing the services provided to you and a copy of any debt repayment plan

developed through the agency no later than 14 days after your bankruptcy case is filed.

 3. I certify that I requested credit counseling services from an approved agency but was unable to

obtain the services during the seven days from the time I made my request, and the following exigent

circumstances merit a temporary waiver of the credit counseling requirement so I can file my bankruptcy case

now. [Summarize exigent circumstances here.]

If your certification is satisfactory to the court, you must still obtain the credit counseling briefing

within the first 30 days after you file your bankruptcy petition and promptly file a certificate from the

agency that provided the counseling, together with a copy of any debt management plan developed

through the agency. Failure to fulfill these requirements may result in dismissal of your case. Any

extension of the 30-day deadline can be granted only for cause and is limited to a maximum of 15 days.

Your case may also be dismissed if the court is not satisfied with your reasons for filing your bankruptcy

case without first receiving a credit counseling briefing.

 4. I am not required to receive a credit counseling briefing because of: [Check the applicable

statement.] [Must be accompanied by a motion for determination by the court.]

Software Copyright (c) 1996-2014 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 15-13148-BFK Doc 1 Filed 09/10/15 Entered 09/10/15 15:33:36 Desc Main

 Document Page 4 of 14
B 1D (Official Form 1, Exhibit D) (12/09) - Cont. Page 2

 Incapacity. (Defined in 11 U.S.C. § 109(h)(4) as impaired by reason of mental illness or mental

deficiency so as to be incapable of realizing and making rational decisions with respect to financial

responsibilities.);

 Disability. (Defined in 11 U.S.C. § 109(h)(4) as physically impaired to the extent of being

unable, after reasonable effort, to participate in a credit counseling briefing in person, by telephone, or

through the Internet.);

 Active military duty in a military combat zone.

 5. The United States trustee or bankruptcy administrator has determined that the credit counseling

requirement of 11 U.S.C. § 109(h) does not apply in this district.

I certify under penalty of perjury that the information provided above is true and correct.

Signature of Debtor: /s/ Mossammat R. Khatun

Mossammat R. Khatun

Date: September 10, 2015

Software Copyright (c) 1996-2014 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 15-13148-BFK Doc 1 Filed 09/10/15 Entered 09/10/15 15:33:36 Desc Main

 Document Page 5 of 14
}bk1{Schedul D-Creditos HldingSecurd Claims}bk{

AMOUNT OF

CLAIM

WITHOUT

DEDUCTING

VALUE OF

COLLATERAL

DATE CLAIM WAS INCURRED,

NATURE OF LIEN, AND

DESCRIPTION AND VALUE

OF PROPERTY

SUBJECT TO LIEN

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Husband, Wife, Joint, or Community

H

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CREDITOR'S NAME 

AND MAILING ADDRESS

INCLUDING ZIP CODE,

AND ACCOUNT NUMBER

(See instructions above.)

Account No.

Value $

Account No.

Value $

Account No.

Value $

Account No.

Value $

Subtotal

_____ continuation sheets attached (Total of this page)

UNSECURED

PORTION, IF

ANY

B6D (Official Form 6D) (12/07)

State the name, mailing address, including zip code, and last four digits of any account number of all entities holding claims secured by property of the debtor as of

the date of filing of the petition. The complete account number of any account the debtor has with the creditor is useful to the trustee and the creditor and may be provided

if the debtor chooses to do so. List creditors holding all types of secured interests such as judgment liens, garnishments, statutory liens, mortgages, deeds of trust, and

other security interests.

List creditors in alphabetical order to the extent practicable. If a minor child is a creditor, the child's initials and the name and address of the child's parent or 

guardian, such as "A.B., a minor child, by John Doe, guardian." Do not disclose the child's name. See, 11 U.S.C. §112 and Fed. R. Bankr. P. 1007(m). If all secured 

creditors will not fit on this page, use the continuation sheet provided. 

If any entity other than a spouse in a joint case may be jointly liable on a claim, place an "X" in the column labeled "Codebtor" ,include the entity on the appropriate

schedule of creditors, and complete Schedule H - Codebtors. If a joint petition is filed, state whether the husband, wife, both of them, or the marital community may be

liable on each claim by placing an "H", "W", "J", or "C" in the column labeled "Husband, Wife, Joint, or Community".

If the claim is contingent, place an "X" in the column labeled "Contingent". If the claim is unliquidated, place an "X" in the column labeled "Unliquidated". If the

claim is disputed, place an "X" in the column labeled "Disputed". (You may need to place an "X" in more than one of these three columns.)

Total the columns labeled "Amount of Claim Without Deducting Value of Collateral" and "Unsecured Portion, if Any" in the boxes labeled "Total(s)" on the last

sheet of the completed schedule. Report the total from the column labeled "Amount of Claim" also on the Summary of Schedules and, if the debtor is an individual with

primarily consumer debts, report the total from the column labeled "Unsecured Portion" on the Statistical Summary of Certain Liabilities and Related Data.

Check this box if debtor has no creditors holding secured claims to report on this Schedule D.

SCHEDULE D - CREDITORS HOLDING SECURED CLAIMS

Software Copyright (c) 1996-2014 - Best Case, LLC - www.bestcase.com Best Case Bankruptcy

In re

,

Debtor

Mossammat R. Khatun Case No.

0

xxxxxxxxx1983 Opened 11/01/07 Last Active 3/01/11

First Mortgage

SFH at

5226 Fillmore Ave

Alexandria, VA 22311

Seterus Inc

14523 Sw Millikan Way St

Beaverton, OR 97005

-

305,000.00 397,000.00 92,000.00

397,000.00 92,000.00

Total 397,000.00 92,000.00

(Report on Summary of Schedules)

Case 15-13148-BFK Doc 1 Filed 09/10/15 Entered 09/10/15 15:33:36 Desc Main

 Document Page 6 of 14
}bk1{Schedul E-Creditos HldingUsecurd PiotyClams}bk{

B6E (Official Form 6E) (4/13)

A complete list of claims entitled to priority, listed separately by type of priority, is to be set forth on the sheets provided. Only holders of unsecured claims entitled

to priority should be listed in this schedule. In the boxes provided on the attached sheets, state the name, mailing address, including zip code, and last four digits of the

account number, if any, of all entities holding priority claims against the debtor or the property of the debtor, as of the date of the filing of the petition. Use a separate

continuation sheet for each type of priority and label each with the type of priority.

The complete account number of any account the debtor has with the creditor is useful to the trustee and the creditor and may be provided if the debtor chooses to do

so. If a minor child is a creditor, state the child's initials and the name and address of the child's parent or guardian, such as "A.B., a minor child, by John Doe, guardian." 

Do not disclose the child's name. See, 11 U.S.C. §112 and Fed. R. Bankr. P. 1007(m). 

If any entity other than a spouse in a joint case may be jointly liable on a claim, place an "X" in the column labeled "Codebtor," include the entity on the appropriate

schedule of creditors, and complete Schedule H-Codebtors. If a joint petition is filed, state whether the husband, wife, both of them, or the marital community may be

liable on each claim by placing an "H," "W," "J," or "C" in the column labeled "Husband, Wife, Joint, or Community." If the claim is contingent, place an "X" in the

column labeled "Contingent." If the claim is unliquidated, place an "X" in the column labeled "Unliquidated." If the claim is disputed, place an "X" in the column labeled

"Disputed." (You may need to place an "X" in more than one of these three columns.)

Report the total of claims listed on each sheet in the box labeled "Subtotals" on each sheet. Report the total of all claims listed on this Schedule E in the box labeled

"Total" on the last sheet of the completed schedule. Report this total also on the Summary of Schedules.

Report the total of amounts entitled to priority listed on each sheet in the box labeled "Subtotals" on each sheet. Report the total of all amounts entitled to priority

listed on this Schedule E in the box labeled "Totals" on the last sheet of the completed schedule. Individual debtors with primarily consumer debts report this total 

also on the Statistical Summary of Certain Liabilities and Related Data.

Report the total of amounts not entitled to priority listed on each sheet in the box labeled "Subtotals" on each sheet. Report the total of all amounts not entitled to

priority listed on this Schedule E in the box labeled "Totals" on the last sheet of the completed schedule. Individual debtors with primarily consumer debts report this 

total also on the Statistical Summary of Certain Liabilities and Related Data.

Check this box if debtor has no creditors holding unsecured priority claims to report on this Schedule E.

TYPES OF PRIORITY CLAIMS (Check the appropriate box(es) below if claims in that category are listed on the attached sheets)

Domestic support obligations

Claims for domestic support that are owed to or recoverable by a spouse, former spouse, or child of the debtor, or the parent, legal guardian, or responsible relative 

of such a child, or a governmental unit to whom such a domestic support claim has been assigned to the extent provided in 11 U.S.C. § 507(a)(1).

Extensions of credit in an involuntary case

Claims arising in the ordinary course of the debtor's business or financial affairs after the commencement of the case but before the earlier of the appointment of a 

trustee or the order for relief. 11 U.S.C. § 507(a)(3).

Wages, salaries, and commissions

Wages, salaries, and commissions, including vacation, severance, and sick leave pay owing to employees and commissions owing to qualifying independent sales

representatives up to $12,475* per person earned within 180 days immediately preceding the filing of the original petition, or the cessation of business, whichever

occurred first, to the extent provided in 11 U.S.C. § 507(a)(4).

Contributions to employee benefit plans

Money owed to employee benefit plans for services rendered within 180 days immediately preceding the filing of the original petition, or the cessation of business,

whichever occurred first, to the extent provided in 11 U.S.C. § 507(a)(5).

Certain farmers and fishermen

Claims of certain farmers and fishermen, up to $6,150* per farmer or fisherman, against the debtor, as provided in 11 U.S.C. § 507(a)(6).

Deposits by individuals

Claims of individuals up to $2,775* for deposits for the purchase, lease, or rental of property or services for personal, family, or household use, that were not 

delivered or provided. 11 U.S.C. § 507(a)(7).

Taxes and certain other debts owed to governmental units

Taxes, customs duties, and penalties owing to federal, state, and local governmental units as set forth in 11 U.S.C. § 507(a)(8).

Commitments to maintain the capital of an insured depository institution

Claims based on commitments to the FDIC, RTC, Director of the Office of Thrift Supervision, Comptroller of the Currency, or Board of Governors of the Federal

Reserve System, or their predecessors or successors, to maintain the capital of an insured depository institution. 11 U.S.C. § 507 (a)(9).

Claims for death or personal injury while debtor was intoxicated

Claims for death or personal injury resulting from the operation of a motor vehicle or vessel while the debtor was intoxicated from using alcohol, a drug, or 

another substance. 11 U.S.C. § 507(a)(10).

* Amount subject to adjustment on 4/01/16, and every three years thereafter with respect to cases commenced on or after the date of adjustment.

continuation sheets attached

SCHEDULE E - CREDITORS HOLDING UNSECURED PRIORITY CLAIMS

Software Copyright (c) 1996-2014 - Best Case, LLC - www.bestcase.com Best Case Bankruptcy

In re

,

Debtor

Mossammat R. Khatun Case No.

0

Case 15-13148-BFK Doc 1 Filed 09/10/15 Entered 09/10/15 15:33:36 Desc Main

 Document Page 7 of 14
}bk1{Schedul F-Creditos HldingUsecurd Nonpirty Claims}bk{

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Husband, Wife, Joint, or Community

H

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CREDITOR'S NAME,

MAILING ADDRESS

INCLUDING ZIP CODE,

AND ACCOUNT NUMBER

(See instructions above.)

Account No.

Account No.

Account No.

Account No.

Subtotal

_____ continuation sheets attached (Total of this page)

DATE CLAIM WAS INCURRED AND

CONSIDERATION FOR CLAIM. IF CLAIM

IS SUBJECT TO SETOFF, SO STATE. AMOUNT OF CLAIM

B6F (Official Form 6F) (12/07)

State the name, mailing address, including zip code, and last four digits of any account number, of all entities holding unsecured claims without priority against the

debtor or the property of the debtor, as of the date of filing of the petition. The complete account number of any account the debtor has with the creditor is useful to the

trustee and the creditor and may be provided if the debtor chooses to do so. If a minor child is a creditor, state the child's initials and the name and address of the child's 

parent or guardian, such as "A.B., a minor child, by John Doe, guardian." Do not disclose the child's name. See, 11 U.S.C. §112 and Fed. R. Bankr. P. 1007(m). Do not 

include claims listed in Schedules D and E. If all creditors will not fit on this page, use the continuation sheet provided. 

If any entity other than a spouse in a joint case may be jointly liable on a claim, place an "X" in the column labeled "Codebtor," include the entity on the appropriate

schedule of creditors, and complete Schedule H - Codebtors. If a joint petition is filed, state whether the husband, wife, both of them, or the marital community may be

liable on each claim by placing an "H," "W," "J," or "C" in the column labeled "Husband, Wife, Joint, or Community."

If the claim is contingent, place an "X" in the column labeled "Contingent." If the claim is unliquidated, place an "X" in the column labeled "Unliquidated." If the

claim is disputed, place an "X" in the column labeled "Disputed." (You may need to place an "X" in more than one of these three columns.)

Report the total of all claims listed on this schedule in the box labeled "Total" on the last sheet of the completed schedule. Report this total also on the Summary of

Schedules and, if the debtor is an individual with primarily consumer debts, report this total also on the Statistical Summary of Certain Liabilities and Related Data.

Check this box if debtor has no creditors holding unsecured claims to report on this Schedule F.

S/N:27480-150820

SCHEDULE F - CREDITORS HOLDING UNSECURED NONPRIORITY CLAIMS

Software Copyright (c) 1996-2014 - Best Case, LLC - www.bestcase.com Best Case Bankruptcy

In re

,

Debtor

Mossammat R. Khatun Case No.

1

xxxxxxx1974 Opened 8/01/12

Collection Attorney Association Of Alexandria

Radi

American Collections E

205 S Whiting St Ste 500

Alexandria, VA 22304

-

1,306.00

xxxxxxx2322 Opened 3/01/11

Collection Attorney Association Of Alexandria

Radi

American Collections E

205 S Whiting St Ste 500

Alexandria, VA 22304

-

256.00

xxxxxxx2278 Opened 4/01/13

Collection Attorney Association Of Alexandria

Radi

American Collections E

205 S Whiting St Ste 500

Alexandria, VA 22304

-

110.00

xxx8827 Medical

Oac

Po Box 500

Baraboo, WI 53913

-

512.00

2,184.00

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 Document Page 8 of 14
B6F (Official Form 6F) (12/07) - Cont.

C

O

D

E

B

T

O

R

C

O

N

T

I

N

G

E

N

T

U

N

L

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U

I

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D

Husband, Wife, Joint, or Community

H

W

J

C

CREDITOR'S NAME,

MAILING ADDRESS

INCLUDING ZIP CODE,

AND ACCOUNT NUMBER

(See instructions above.)

Account No.

Account No.

Account No.

Account No.

Account No.

Sheet no. _____ of _____ sheets attached to Schedule of Subtotal

Creditors Holding Unsecured Nonpriority Claims (Total of this page)

DATE CLAIM WAS INCURRED AND

CONSIDERATION FOR CLAIM. IF CLAIM

IS SUBJECT TO SETOFF, SO STATE. AMOUNT OF CLAIM

SCHEDULE F - CREDITORS HOLDING UNSECURED NONPRIORITY CLAIMS

(Continuation Sheet)

Software Copyright (c) 1996-2014 - Best Case, LLC - www.bestcase.com Best Case Bankruptcy

In re

,

Debtor

Mossammat R. Khatun Case No.

xxx9034 Medical

Oac

Po Box 500

Baraboo, WI 53913

-

192.00

xxx1804 Medical

Oac

Po Box 500

Baraboo, WI 53913

-

71.00

263.00

1 1

2,447.00

Total

(Report on Summary of Schedules)

Case 15-13148-BFK Doc 1 Filed 09/10/15 Entered 09/10/15 15:33:36 Desc Main

 Document Page 9 of 14
B6 Declaration (Official Form 6 - Declaration). (12/07)

United States Bankruptcy Court

Eastern District of Virginia

In re Mossammat R. Khatun Case No.

Debtor(s) Chapter 13

DECLARATION CONCERNING DEBTOR'S SCHEDULES

DECLARATION UNDER PENALTY OF PERJURY BY INDIVIDUAL DEBTOR

I declare under penalty of perjury that I have read the foregoing summary and schedules, consisting

of 17 sheets, and that they are true and correct to the best of my knowledge, information, and belief.

Date September 10, 2015 Signature /s/ Mossammat R. Khatun

Mossammat R. Khatun

Debtor

Penalty for making a false statement or concealing property: Fine of up to $500,000 or imprisonment for up to 5 years or both.

18 U.S.C. §§ 152 and 3571.

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 Document Page 10 of 14
B 201A (Form 201A) (6/14)

UNITED STATES BANKRUPTCY COURT

EASTERN DISTRICT OF VIRGINIA

NOTICE TO CONSUMER DEBTOR(S) UNDER § 342(b)

OF THE BANKRUPTCY CODE

In accordance with § 342(b) of the Bankruptcy Code, this notice to individuals with primarily consumer debts: (1) Describes

briefly the services available from credit counseling services; (2) Describes briefly the purposes, benefits and costs of the four types of

bankruptcy proceedings you may commence; and (3) Informs you about bankruptcy crimes and notifies you that the Attorney General

may examine all information you supply in connection with a bankruptcy case.

You are cautioned that bankruptcy law is complicated and not easily described. Thus, you may wish to seek the advice of an

attorney to learn of your rights and responsibilities should you decide to file a petition. Court employees cannot give you legal advice.

Notices from the bankruptcy court are sent to the mailing address you list on your bankruptcy petition. In order to ensure that

you receive information about events concerning your case, Bankruptcy Rule 4002 requires that you notify the court of any changes in

your address. If you are filing a joint case (a single bankruptcy case for two individuals married to each other), and each spouse lists

the same mailing address on the bankruptcy petition, you and your spouse will generally receive a single copy of each notice mailed

from the bankruptcy court in a jointly-addressed envelope, unless you file a statement with the court requesting that each spouse

receive a separate copy of all notices.

1. Services Available from Credit Counseling Agencies

With limited exceptions, § 109(h) of the Bankruptcy Code requires that all individual debtors who file for bankruptcy

relief on or after October 17, 2005, receive a briefing that outlines the available opportunities for credit counseling and

provides assistance in performing a budget analysis. The briefing must be given within 180 days before the bankruptcy filing. The

briefing may be provided individually or in a group (including briefings conducted by telephone or on the Internet) and must be

provided by a nonprofit budget and credit counseling agency approved by the United States trustee or bankruptcy administrator. The

clerk of the bankruptcy court has a list that you may consult of the approved budget and credit counseling agencies. Each debtor in a

joint case must complete the briefing.

In addition, after filing a bankruptcy case, an individual debtor generally must complete a financial management

instructional course before he or she can receive a discharge. The clerk also has a list of approved financial management

instructional courses. Each debtor in a joint case must complete the course.

2. The Four Chapters of the Bankruptcy Code Available to Individual Consumer Debtors

Chapter 7: Liquidation ($245 filing fee, $75 administrative fee, $15 trustee surcharge: Total Fee $335)

Chapter 7 is designed for debtors in financial difficulty who do not have the ability to pay their existing debts. Debtors whose

debts are primarily consumer debts are subject to a "means test" designed to determine whether the case should be permitted to

proceed under chapter 7. If your income is greater than the median income for your state of residence and family size, in some cases,

the United States trustee (or bankruptcy administrator), the trustee, or creditors have the right to file a motion requesting that the court

dismiss your case under § 707(b) of the Code. It is up to the court to decide whether the case should be dismissed.

Under chapter 7, you may claim certain of your property as exempt under governing law. A trustee may have the right to take

possession of and sell the remaining property that is not exempt and use the sale proceeds to pay your creditors.

The purpose of filing a chapter 7 case is to obtain a discharge of your existing debts. If, however, you are found to have

committed certain kinds of improper conduct described in the Bankruptcy Code, the court may deny your discharge and, if it does, the

purpose for which you filed the bankruptcy petition will be defeated.

Even if you receive a general discharge, some particular debts are not discharged under the law. Therefore, you may still be

responsible for most taxes and student loans; debts incurred to pay nondischargeable taxes; domestic support and property settlement

obligations; most fines, penalties, forfeitures, and criminal restitution obligations; certain debts which are not properly listed in your

bankruptcy papers; and debts for death or personal injury caused by operating a motor vehicle, vessel, or aircraft while intoxicated

from alcohol or drugs. Also, if a creditor can prove that a debt arose from fraud, breach of fiduciary duty, or theft, or from a willful and

malicious injury, the bankruptcy court may determine that the debt is not discharged.

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

$75 administrative fee: Total Fee $310)

Chapter 13 is designed for individuals with regular income who would like to pay all or part of their debts in installments over

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 Document Page 11 of 14
Form B 201A, Notice to Consumer Debtor(s) Page 2

a period of time. You are only eligible for chapter 13 if your debts do not exceed certain dollar amounts set forth in the Bankruptcy

Code.

Under chapter 13, you must file with the court a plan to repay your creditors all or part of the money that you owe them, using

your future earnings. The period allowed by the court to repay your debts may be three years or five years, depending upon your

income and other factors. The court must approve your plan before it can take effect.

After completing the payments under your plan, your debts are generally discharged except for domestic support obligations;

most student loans; certain taxes; most criminal fines and restitution obligations; certain debts which are not properly listed in your

bankruptcy papers; certain debts for acts that caused death or personal injury; and certain long term secured obligations.

Chapter 11: Reorganization ($1,167 filing fee, $550 administrative fee: Total Fee $1,717)

Chapter 11 is designed for the reorganization of a business but is also available to consumer debtors. Its provisions are quite

complicated, and any decision by an individual to file a chapter 11 petition should be reviewed with an attorney.

Chapter 12: Family Farmer or Fisherman ($200 filing fee, $75 administrative fee: Total Fee $275)

Chapter 12 is designed to permit family farmers and fishermen to repay their debts over a period of time from future earnings

and is similar to chapter 13. The eligibility requirements are restrictive, limiting its use to those whose income arises primarily from a

family-owned farm or commercial fishing operation.

3. Bankruptcy Crimes and Availability of Bankruptcy Papers to Law Enforcement Officials

A person who knowingly and fraudulently conceals assets or makes a false oath or statement under penalty of perjury, either

orally or in writing, in connection with a bankruptcy case is subject to a fine, imprisonment, or both. All information supplied by a

debtor in connection with a bankruptcy case is subject to examination by the Attorney General acting through the Office of the United

States Trustee, the Office of the United States Attorney, and other components and employees of the Department of Justice.

WARNING: Section 521(a)(1) of the Bankruptcy Code requires that you promptly file detailed information regarding your creditors,

assets, liabilities, income, expenses and general financial condition. Your bankruptcy case may be dismissed if this information is not

filed with the court within the time deadlines set by the Bankruptcy Code, the Bankruptcy Rules, and the local rules of the court. The

documents and the deadlines for filing them are listed on Form B200, which is posted at

http://www.uscourts.gov/bkforms/bankruptcy_forms.html#procedure.

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Case 15-13148-BFK Doc 1 Filed 09/10/15 Entered 09/10/15 15:33:36 Desc Main

 Document Page 12 of 14
B 201B (Form 201B) (12/09)

United States Bankruptcy Court

Eastern District of Virginia

In re Mossammat R. Khatun Case No.

Debtor(s) Chapter 13

CERTIFICATION OF NOTICE TO CONSUMER DEBTOR(S)

UNDER § 342(b) OF THE BANKRUPTCY CODE

Certification of Debtor

I (We), the debtor(s), affirm that I (we) have received and read the attached notice, as required by § 342(b) of the Bankruptcy

Code.

Mossammat R. Khatun X /s/ Mossammat R. Khatun

September 10,

2015

Printed Name(s) of Debtor(s) Signature of Debtor Date

Case No. (if known) X

Signature of Joint Debtor (if any) Date

Instructions: Attach a copy of Form B 201 A, Notice to Consumer Debtor(s) Under § 342(b) of the Bankruptcy Code.

Use this form to certify that the debtor has received the notice required by 11 U.S.C. § 342(b) only if the certification has NOT been made on the

Voluntary Petition, Official Form B1. Exhibit B on page 2 of Form B1 contains a certification by the debtor's attorney that the attorney has given the

notice to the debtor. The Declarations made by debtors and bankruptcy petition preparers on page 3 of Form B1 also include this certification.

Case 15-13148-BFK Doc 1 Filed 09/10/15 Entered 09/10/15 15:33:36 Desc Main

 Document Page 13 of 14
}bk1{Credito AresMatix}bk{

Mossammat R. Khatun

5220 Fillmore Ave.,

Alexandria, VA 22311

American Collections E

205 S Whiting St Ste 500

Alexandria, VA 22304

Oac

Po Box 500

Baraboo, WI 53913

Seterus Inc

14523 Sw Millikan Way St

Beaverton, OR 97005

Case 15-13148-BFK Doc 1 Filed 09/10/15 Entered 09/10/15 15:33:36 Desc Main

 Document Page 14 of 14