Fill in this information to identify the case:

Debtor name Aero-X Golf, Inc.

United States Bankruptcy Court for the: EASTERN DISTRICT OF VIRGINIA

Case number (if known) 17-14249

 Check if this is an

amended filing

Official Form 202

Declaration Under Penalty of Perjury for Non-Individual Debtors 12/15

An individual who is authorized to act on behalf of a non-individual debtor, such as a corporation or partnership, must sign and submit this

form for the schedules of assets and liabilities, any other document that requires a declaration that is not included in the document, and any

amendments of those documents. This form must state the individual’s position or relationship to the debtor, the identity of the document,

and the date. Bankruptcy Rules 1008 and 9011.

WARNING -- Bankruptcy fraud is a serious crime. 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 $500,000 or imprisonment for up to 20 years, or both. 18 U.S.C. §§ 152, 1341,

1519, and 3571.

Declaration and signature

I am the president, another officer, or an authorized agent of the corporation; a member or an authorized agent of the partnership; or another

individual serving as a representative of the debtor in this case.

I have examined the information in the documents checked below and I have a reasonable belief that the information is true and correct:

 Schedule A/B: Assets–Real and Personal Property (Official Form 206A/B)

 Schedule D: Creditors Who Have Claims Secured by Property (Official Form 206D)

 Schedule E/F: Creditors Who Have Unsecured Claims (Official Form 206E/F)

 Schedule G: Executory Contracts and Unexpired Leases (Official Form 206G)

 Schedule H: Codebtors (Official Form 206H)

 Summary of Assets and Liabilities for Non-Individuals (Official Form 206Sum)

 Amended Schedule E/F

 Chapter 11 or Chapter 9 Cases: List of Creditors Who Have the 20 Largest Unsecured Claims and Are Not Insiders (Official Form 204)

 Other document that requires a declaration

I declare under penalty of perjury that the foregoing is true and correct.

Executed on January 15, 2018 X /s/ Steven Lebischak

Signature of individual signing on behalf of debtor

Steven Lebischak

Printed name

Chief Executive

Position or relationship to debtor

Official Form 202 Declaration Under Penalty of Perjury for Non-Individual Debtors

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Case 17-14249-BFK Doc 24 Filed 01/16/18 Entered 01/16/18 10:19:08 Desc Main

Document Page 1 of 14
Fill in this information to identify the case:

Debtor name Aero-X Golf, Inc.

United States Bankruptcy Court for the: EASTERN DISTRICT OF VIRGINIA

Case number (if known) 17-14249

 Check if this is an

amended filing

Official Form 206Sum

Summary of Assets and Liabilities for Non-Individuals 12/15

Part 1: Summary of Assets

1. Schedule A/B: Assets-Real and Personal Property (Official Form 206A/B)

1a. Real property:

 Copy line 88 from Schedule A/B............................................................................................................................. $ 0.00

1b. Total personal property:

 Copy line 91A from Schedule A/B......................................................................................................................... $ 844,268.44

1c. Total of all property:

 Copy line 92 from Schedule A/B........................................................................................................................... $ 844,268.44

Part 2: Summary of Liabilities

2. Schedule D: Creditors Who Have Claims Secured by Property (Official Form 206D)

Copy the total dollar amount listed in Column A, Amount of claim, from line 3 of Schedule D.................................... $ 10,000.00

3. Schedule E/F: Creditors Who Have Unsecured Claims (Official Form 206E/F)

3a. Total claim amounts of priority unsecured claims:

 Copy the total claims from Part 1 from line 5a of Schedule E/F.......................................................................... $ 0.00

3b. Total amount of claims of nonpriority amount of unsecured claims:

 Copy the total of the amount of claims from Part 2 from line 5b of Schedule E/F................................................ +$ 5,722,678.56

4. Total liabilities .......................................................................................................................................................

Lines 2 + 3a + 3b $ 5,732,678.56

Official Form 206Sum Summary of Assets and Liabilities for Non-Individuals page 1

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Case 17-14249-BFK Doc 24 Filed 01/16/18 Entered 01/16/18 10:19:08 Desc Main

Document Page 2 of 14
Fill in this information to identify the case:

Debtor name Aero-X Golf, Inc.

United States Bankruptcy Court for the: EASTERN DISTRICT OF VIRGINIA

Case number (if known) 17-14249

 Check if this is an

amended filing

Official Form 206E/F

Schedule E/F: Creditors Who Have Unsecured Claims 12/15

Be as complete and accurate as possible. Use Part 1 for creditors with PRIORITY unsecured claims and Part 2 for creditors with NONPRIORITY unsecured claims.

List the other party to any executory contracts or unexpired leases that could result in a claim. Also list executory contracts on Schedule A/B: Assets - Real and

Personal Property (Official Form 206A/B) and on Schedule G: Executory Contracts and Unexpired Leases (Official Form 206G). Number the entries in Parts 1 and

2 in the boxes on the left. If more space is needed for Part 1 or Part 2, fill out and attach the Additional Page of that Part included in this form.

Part 1: List All Creditors with PRIORITY Unsecured Claims

1. Do any creditors have priority unsecured claims? (See 11 U.S.C. § 507).

 No. Go to Part 2.

 Yes. Go to line 2.

Part 2: List All Creditors with NONPRIORITY Unsecured Claims

3. List in alphabetical order all of the creditors with nonpriority unsecured claims. If the debtor has more than 6 creditors with nonpriority unsecured claims, fill

out and attach the Additional Page of Part 2.

Amount of claim

3.1 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $9,000.00

Action Media Inc

4665 Red Deer Trail

Broomfield, CO 80020

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 

Is the claim subject to offset?  No  Yes

3.2 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $528.00

AFCO Insurance Premium Finance

5600 N. River Road Ste 400

Des Plaines, IL 60018-5187

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 

Is the claim subject to offset?  No  Yes

3.3 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $1,269.00

Antonelli, Terry, Stout

1300 North Seventeenth Street

Suite 1800

Arlington, VA 22209

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 

Is the claim subject to offset?  No  Yes

3.4 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $18,279.66

Bellatrix PC

5405 Morehouse Dr., Suite 110

San Diego, CA 92121

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 

Is the claim subject to offset?  No  Yes

Official Form 206E/F Schedule E/F: Creditors Who Have Unsecured Claims page 1 of 12

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Case 17-14249-BFK Doc 24 Filed 01/16/18 Entered 01/16/18 10:19:08 Desc Main

Document Page 3 of 14
Debtor Aero-X Golf, Inc. Case number (if known) 17-14249

Name

3.5 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $50,000.00

Beverly Brito FBO Bud Misfelt

c/o Erwin J. Shustak, Esq.,

401 West “A” Street, Ste 2250

San Diego, CA 92101

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 12% mandatory convertible note - Claim amount 

includes principal only 

Is the claim subject to offset?  No  Yes

3.6 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $5,000.00

Bruce Pettibone Consulting

2633 Ocean St #2

Carlsbad, CA 92008

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 

Is the claim subject to offset?  No  Yes

3.7 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $111,842.00

Chris Holiday

12624 Carmel Country Road, #82

San Diego, CA 92130

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: Claim amount includes principal only 

Is the claim subject to offset?  No  Yes

3.8 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $1,700.00

Commonwealth of Virginia

State Corp Comm

PO Box 7607

Merrifield, VA 22116-7607

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 

Is the claim subject to offset?  No  Yes

3.9 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $30,000.00

Cora Vaden

22 West Washington St.

Carson City, NV 89703

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 12% mandatory convertible note - Claim amount 

includes principal only 

Is the claim subject to offset?  No  Yes

3.10 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $1,282,348.97

David Felker

20844 Wild Willow Hollow

Escondido, CA 92029

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: judgment 

Is the claim subject to offset?  No  Yes

3.11 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $2,000.00

deBary Partners

1012 Brentwood Lane

Brentwood, TN 37027

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 

Is the claim subject to offset?  No  Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 2 of 12

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Document Page 4 of 14
Debtor Aero-X Golf, Inc. Case number (if known) 17-14249

Name

3.12 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $76,342.00

Doug Winfield

1 Carriage Hill

Madison, AL 35758

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: Claim amount includes principal only 

Is the claim subject to offset?  No  Yes

3.13 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $419.25

DW Sports Group

310 South Nina Drive, Ste 1

Mesa, AZ 85210

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 

Is the claim subject to offset?  No  Yes

3.14 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $25,000.00

EGJ, LLC

c/o Erwin J. Shustak, Esq.

401 West “A” Street, Ste 2250

San Diego, CA 92101

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 8% new money subscription note - Claim amount 

includes principal only 

Is the claim subject to offset?  No  Yes

3.15 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $529.55

Executive Financial Enterprise

1626 N Wilcox AVE, Box 680

Los Angeles, CA 90028

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 

Is the claim subject to offset?  No  Yes

3.16 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $1,000,000.00

Foremost Golf Manufacturing

No. 5 Kegong 8th Rd

Touliu City, Yunlin County 640

Taiwan (R.O.C)

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 

Is the claim subject to offset?  No  Yes

3.17 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $800.00

Franchise Tax Board

PO Box 942857

Sacramento, CA 94257-0531

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 

Is the claim subject to offset?  No  Yes

3.18 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $100,000.00

Gertrude Bronner

12624 Carmel Country Road, #82

San Diego, CA 92130

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 8% new money subscription note - Claim amount 

includes principal only 

Is the claim subject to offset?  No  Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 3 of 12

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Case 17-14249-BFK Doc 24 Filed 01/16/18 Entered 01/16/18 10:19:08 Desc Main

Document Page 5 of 14
Debtor Aero-X Golf, Inc. Case number (if known) 17-14249

Name

3.19 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $597.00

Golf Talk Radio

900 Salida Del Sol Drive

Paso Robles, CA 93446

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 

Is the claim subject to offset?  No  Yes

3.20 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $7,027.28

Golfer's First Technologies

3444 Silverlake Ct.

Jamestown, NC 27282

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 

Is the claim subject to offset?  No  Yes

3.21 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $50,000.00

Grace McLain Capital Advisors

952 Golf House Rd, W. Suite I

PMB 127

Whitsett, NC 27377

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 12% mandatory convertible note - Claim amount 

includes principal only 

Is the claim subject to offset?  No  Yes

3.22 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $104,000.00

Grace McLain Capital Advisors

952 Golf House Rd, W. Suite I

PMB 127

Whitsett, NC 27377

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: Note - Claim amount includes principal only 

Is the claim subject to offset?  No  Yes

3.23 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $12,757.54

Grace McLain Capital Advisors

952 Golf House Rd, W. Suite I

PMB 127

Whitsett, NC 27377

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: Accrued interest note - Claim amount includes 

principal only 

Is the claim subject to offset?  No  Yes

3.24 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $40,000.00

Gravity Capital

Humberto Galleno

186 Collins Street

San Francisco, CA 94118

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 6% secured note - Claim amount includes principal 

only 

Is the claim subject to offset?  No  Yes

3.25 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $1,785.20

Hammacher Schlemmer INC

9307 N Milwaukee Ave

Saint Charles, IL 60174

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 

Is the claim subject to offset?  No  Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 4 of 12

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Document Page 6 of 14
Debtor Aero-X Golf, Inc. Case number (if known) 17-14249

Name

3.26 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $3,031.78

Hye Precision Products

745 Carroll Street

Perry, GA 31069

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 

Is the claim subject to offset?  No  Yes

3.27 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $2,329.00

IP Data

704 W Park Ave Suite C

Edgewater, FL 32132-1409

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 

Is the claim subject to offset?  No  Yes

3.28 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $33,719.55

Jason Davies

c/o RBC Private Wealth Mgmt

500 La Terraza Blvd #102

Escondido, CA 92025

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: Note-short term - Claim amount includes principal 

only 

Is the claim subject to offset?  No  Yes

3.29 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $28,750.00

Jeff Guzy

3130 19th Street

Arlington, VA 22201

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 12% mandatory convertible note - Claim amount 

includes principal only 

Is the claim subject to offset?  No  Yes

3.30 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $50,000.00

Jennifer Vaugh, Betsy R. 002

c/o Erwin J. Shustak, Esq.

401 West “A” Street, Suite 225

San Diego, CA 92101

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: Note-short term - Claim amount includes principal 

only 

Is the claim subject to offset?  No  Yes

3.31 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $25,000.00

John Chu

3444 Silverlake Ct.

Jamestown, NC 27282

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 12% mandatory convertible note - Claim amount 

includes principal only 

Is the claim subject to offset?  No  Yes

3.32 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $100,000.00

John Crawford

212 Arrowhead Way

Clinton, NY 13323

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: Note-short term - Claim amount includes principal 

only 

Is the claim subject to offset?  No  Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 5 of 12

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Document Page 7 of 14
Debtor Aero-X Golf, Inc. Case number (if known) 17-14249

Name

3.33 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $150,000.00

John McGinnis

4333 E. Hashknife Rd.

Phoenix, AZ 85050

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 6% secured note - Claim amount includes principal 

only 

Is the claim subject to offset?  No  Yes

3.34 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $275,000.00

John McGinnis

4333 E. Hashknife Rd.

Phoenix, AZ 85050

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 12% mandatory convertible note - Claim amount 

includes principal only 

Is the claim subject to offset?  No  Yes

3.35 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $7,208.34

Just Add Technology Solutions

PO Box 2092

Merrifield, VA 22116

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 

Is the claim subject to offset?  No  Yes

3.36 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $40,000.00

Karen Weseloh

6250 Mimulus

Rancho Santa Fe, CA 92067

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 5% 3 year note - Claim amount includes principal 

only 

Is the claim subject to offset?  No  Yes

3.37 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $130,000.00

Karen Weseloh

6250 Mimulus

Rancho Santa Fe, CA 92067

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 8% new money subscription - Claim amount includes 

principal only 

Is the claim subject to offset?  No  Yes

3.38 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $370,000.00

Karen Weseloh

6250 Mimulus

Rancho Santa Fe, CA 92067

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 12% mandatory convertible note - Claim amount 

includes principal only 

Is the claim subject to offset?  No  Yes

3.39 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $35,000.00

Karen Weseloh

6250 Mimulus

Rancho Santa Fe, CA 92067

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: Note-short term - Claim amount includes principal 

only 

Is the claim subject to offset?  No  Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 6 of 12

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Case 17-14249-BFK Doc 24 Filed 01/16/18 Entered 01/16/18 10:19:08 Desc Main

Document Page 8 of 14
Debtor Aero-X Golf, Inc. Case number (if known) 17-14249

Name

3.40 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $455.75

Liberty Mutual Insurance

P. O. Box 85834

San Diego, CA 92186-5834

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 

Is the claim subject to offset?  No  Yes

3.41 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $800.00

Life After 50

50 S. De Lacey Ave. Suite 200

Pasadena, CA 91105-3806

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 

Is the claim subject to offset?  No  Yes

3.42 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $1,500.00

Madavor Media LLC

25 Braintree Hill Office Park

Suite 404

Braintree, MA 02184

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 

Is the claim subject to offset?  No  Yes

3.43 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $5,762.77

McCarthy, Burgess, Wolff

26000 Cannon Road

Bedford, OH 44146

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 

Is the claim subject to offset?  No  Yes

3.44 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $665.02

Minuteman Press of Carlsbad

6353 El Camino Real #H

Carlsbad, CA 92009

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 

Is the claim subject to offset?  No  Yes

3.45 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $2,345.00

Miranda & Associates

1595 South Mission Road

Fallbrook, CA 92028

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 

Is the claim subject to offset?  No  Yes

3.46 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $101,162.50

Miranda CFO Services, Inc.

1595 South Mission Rd

Fallbrook, CA 92028

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 

Is the claim subject to offset?  No  Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 7 of 12

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Document Page 9 of 14
Debtor Aero-X Golf, Inc. Case number (if known) 17-14249

Name

3.47 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $21,061.62

MLG Automotive Law

2801 W. Coast Hiighway

Suite 370

Newport Beach, CA 92663

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 

Is the claim subject to offset?  No  Yes

3.48 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $822.95

Montana Department of Revenue

PO Box 6309

Helena, MT 59604-6309

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 

Is the claim subject to offset?  No  Yes

3.49 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $250,000.00

Mr. Cole Burr

Burrtec

9820 Cherry Avenue

Fontana, CA 92335

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 12% mandatory convertible note - Claim amount 

includes principal only 

Is the claim subject to offset?  No  Yes

3.50 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $528.00

New Jersey Commercial

Collection (AFCO)

PO Box 2212

Cherry Hill, NJ 08034

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 

Is the claim subject to offset?  No  Yes

3.51 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $96,043.52

Novus Media Inc.

PO Box 86

Minneapolis, MN 55486-0664

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 

Is the claim subject to offset?  No  Yes

3.52 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $6,173.75

Pijush Dewanjee

3746 Saddle Dr.

Carlsbad, CA 92010

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 

Is the claim subject to offset?  No  Yes

3.53 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $1,179.36

POP TV LLC

5069 Maureen Lane, Unit A

Moorpark, CA 93021

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 

Is the claim subject to offset?  No  Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 8 of 12

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Case 17-14249-BFK Doc 24 Filed 01/16/18 Entered 01/16/18 10:19:08 Desc Main

Document Page 10 of 14
Debtor Aero-X Golf, Inc. Case number (if known) 17-14249

Name

3.54 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $285,697.18

Procopio Law

525 B St Ste 2200

San Diego, CA 92101

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 12% mandatory convertible note - Claim amount 

includes principal only 

Is the claim subject to offset?  No  Yes

3.55 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $63,804.00

Procopio Law

525 B St Ste 2200

San Diego, CA 92101

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: Note - Claim amount includes principal only 

Is the claim subject to offset?  No  Yes

3.56 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $400,000.00

Procopio, Cory, Hargreaves

& Savitch LLP

12544 High Bluff Drive, #300

San Diego, CA 92130

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 

Is the claim subject to offset?  No  Yes

3.57 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $14,000.00

QSControl Corp

No.39, Jing 3 Rd, C.E.P.Z

Wuchi, 04

Taichung City, Taiwan 435

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 

Is the claim subject to offset?  No  Yes

3.58 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $90,000.00

RBC FBO D L Felker

500 La Terraza Blvd., Ste. 150

Escondido, CA 92025

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 12% mandatory convertible note - Claim amount 

includes principal only 

Is the claim subject to offset?  No  Yes

3.59 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $758.33

RBC Capital Markets

FBO David Felker

500 La Terraza Blvd, #102

Escondido, CA 92025

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 

Is the claim subject to offset?  No  Yes

3.60 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $30,000.00

Riley L Criss Family Trust

c/o Erwin J. Shustak, Esq.

401 West “A” Street, Ste 2250

San Diego, CA 92101

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 12% mandatory convertible note - Claim amount 

includes principal only 

Is the claim subject to offset?  No  Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 9 of 12

Software Copyright (c) 1996-2017 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 17-14249-BFK Doc 24 Filed 01/16/18 Entered 01/16/18 10:19:08 Desc Main

Document Page 11 of 14
Debtor Aero-X Golf, Inc. Case number (if known) 17-14249

Name

3.61 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $33,719.55

Riley L Criss Family Trust

c/o Erwin J. Shustak, Esq.

401 West “A” Street, Ste 2250

San Diego, CA 92101

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: Note-short term - Claim amount includes principal 

only 

Is the claim subject to offset?  No  Yes

3.62 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $25,000.00

Robert W Morris TTEE

c/o Erwin J. Shustak, Esq.

401 West “A” Street, Ste 2250

San Diego, CA 92101

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 8% new money subscription note - Claim amount 

includes principal only 

Is the claim subject to offset?  No  Yes

3.63 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $250.00

State of California

Franschise Tax Board

PO Box 942857

Sacramento, CA 94257-0511

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 

Is the claim subject to offset?  No  Yes

3.64 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $6,519.11

Steven Lebischak

PO Box 2092

Merrifield, VA 22116

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 

Is the claim subject to offset?  No  Yes

3.65 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $64,235.00

Steven Lebischak

PO Box 2092

Merrifield, VA 22116

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 12% manadatory convertible note - Claim amount 

includes principal only 

Is the claim subject to offset?  No  Yes

3.66 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $900.00

Steven Lebischak

PO Box 2092

Merrifield, VA 22116

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 2014 back interest note - Claim amount includes 

principal only 

Is the claim subject to offset?  No  Yes

3.67 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $17,610.00

Steven Lebischak

PO Box 2092

Merrifield, VA 22116

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 2014 back pay note - Claim amount includes principal 

only 

Is the claim subject to offset?  No  Yes

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 10 of 12

Software Copyright (c) 1996-2017 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

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Document Page 12 of 14
Debtor Aero-X Golf, Inc. Case number (if known) 17-14249

Name

3.68 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $3,083.35

The Golf Shop - James Love

2768 Loker Avenue

Suite 100

Carlsbad, CA 92010

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 

Is the claim subject to offset?  No  Yes

3.69 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $6,625.00

The McLean Group

7918 Jones Branch Dr #750

Mc Lean, VA 22102

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 

Is the claim subject to offset?  No  Yes

3.70 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $7,500.00

The Media Group

848 West Bartlett Road, #10E

Bartlett, IL 60103

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 

Is the claim subject to offset?  No  Yes

3.71 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $1,624.73

Travelers Insurance

PO Box 660317

Dallas, TX 75266-0317

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 

Is the claim subject to offset?  No  Yes

3.72 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $425.00

Turnstile Media Group

PO Box 951276

Dallas, TX 75395-1323

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 

Is the claim subject to offset?  No  Yes

3.73 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $766.95

Word's Court Reporting Service

Gidgette Nieves, CSR, Principa

1265 Carlsbad Village Dr. #210

Carlsbad, CA 92008

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 

Is the claim subject to offset?  No  Yes

3.74 Nonpriority creditor's name and mailing address As of the petition filing date, the claim is: Check all that apply. $396.00

Yellow Pages United

 PO Box 50038

Jacksonville Beach, FL 32240-0038

Date(s) debt was incurred 

Last 4 digits of account number 

 Contingent

 Unliquidated

 Disputed

Basis for the claim: 

Is the claim subject to offset?  No  Yes

Part 3: List Others to Be Notified About Unsecured Claims

4. List in alphabetical order any others who must be notified for claims listed in Parts 1 and 2. Examples of entities that may be listed are collection agencies,

assignees of claims listed above, and attorneys for unsecured creditors.

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 11 of 12

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Case 17-14249-BFK Doc 24 Filed 01/16/18 Entered 01/16/18 10:19:08 Desc Main

Document Page 13 of 14
Debtor Aero-X Golf, Inc. Case number (if known) 17-14249

Name

If no others need to be notified for the debts listed in Parts 1 and 2, do not fill out or submit this page. If additional pages are needed, copy the next page.

Name and mailing address On which line in Part1 or Part 2 is the

related creditor (if any) listed?

Last 4 digits of

account number, if

any

4.1 James P. Koch, Esq.

Law Offices of James P. Koch

1101 St. Paul Street

Baltimore, MD 21202

Line 3.10 

 Not listed. Explain 

Part 4: Total Amounts of the Priority and Nonpriority Unsecured Claims

5. Add the amounts of priority and nonpriority unsecured claims.

Total of claim amounts

5a. Total claims from Part 1 5a. $ 0.00

5b. Total claims from Part 2 5b. + $ 5,722,678.56

5c. Total of Parts 1 and 2

Lines 5a + 5b = 5c. 5c. $ 5,722,678.56

Official Form 206 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 12 of 12

Software Copyright (c) 1996-2017 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 17-14249-BFK Doc 24 Filed 01/16/18 Entered 01/16/18 10:19:08 Desc Main

Document Page 14 of 14