© 2016 CINgroup 1.866.218.1003 – CINcompass (www.cincompass.com)

United States Bankruptcy Court

IN RE: Case No. 

Debtor(s)

Chapter 

I hereby certify under penalty of perjury that the master mailing list of creditors submitted either on computer diskette or by

a typed hard copy in scannable format, with Request for Waiver attached, , correct, and complete listing to the best 

my knowledge.

I further acknowledge that (1) the accuracy and completeness in preparing the creditor listing are the shared responsibility of

the debtor and the debtor’s attorney, (2) the court will rely on the creditor listing for all mailings, and (3) that the various

schedules and statements required by the Bankruptcy Rules are not used for mailing purposes.

Master mailing list of creditors submitted via:

(a) computer diskette listing a total of creditors; or

(b) scannable hard copy, with Request for Waiver attached, consisting of pages 

listing a total of creditors

Debtor

Joint Debtor

Date: 

[Check if applicable] Creditor(s) with foreign addresses included on disk/hard copy.

is a true

of

[diskcs ver. R-1/2003]

Eastern District of Virginia, Alexandria Division

COVER SHEET FOR LIST OF CREDITORS

1:16-bk-13439-BFK

Adib, Kaveh 13

9 22

/s/ Kaveh Adib

November 8, 2016

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Amca

2269 S Saw Ml

Elmsford, NY 10523

Apple Federal Credit Union

4029 Ridge Top Rd

Fairfax, VA 22030-6090

Asset Acceptance LLC

PO Box 2036

Warren, MI 48090-2036

BANK OF AMERICA, N.A.

PO Box 982238

El Paso, TX 79998-2238

BETHESDA MRI

3202 Tower Oaks Blvd Ste 120

Rockville, MD 20852-4263

Center for Cranial & Spinal Surgery, PC

3016 Williams Dr

Fairfax, VA 22031-4616

COMCAST

676 Island Pond Rd

Manchester, NH 03109-5420

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District of Columbia Govt

DMV Adjudication Services

PO Box 2014

Washington, DC 20013-2014

Fidelity Information C

441 N Varney St

Burbank, CA 91502-1733

Glasser & Glasser, P.L.C.

PO Box 3400

Norfolk, VA 23514-3400

HOUSEHOLD FINANCE CORP II

Attn: Research

PO Box 1231

Brandon, FL 33509-1231

I C System Inc

PO Box 64378

Saint Paul, MN 55164-0378

Laboratory Corp of America

358 S Main St

Burlington, NC 27215-5837

Oac

PO Box 500

Baraboo, WI 53913-0500

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Orange County California

Attn: Treasurer-Tax Collector

PO Box 1438

Santa Ana, CA 92702-1438

PERRY & ASSOC

4085 Chain Bridge Rd # 300

Fairfax, VA 22030-4106

Profess Acct

633 W Wisconsin Ave

Milwaukee, WI 53203-1918

Psychiatric Institute of Washington

4228 Wisconsin Ave NW

Washington, DC 20016-2138

Southwest Credit Syste

4120 International Pkwy

Carrollton, TX 75007-1957

State of California

BANKRUPTCY SECTION FRANCHISE TAX BOARD

PO Box 2952

Sacramento, CA 95812-2952

THE ATRIUM, A CONDO UNIT OWNERS ASSN

1530 Key Blvd

Arlington, VA 22209-1531

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Trojan Professional SE

4410 Cerritos Ave

Los Alamitos, CA 90720-2549

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Fill in this information to identify your case and this filing: Debtor 1 Kaveh Adib

First Name Middle Name Last Name Debtor 2

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

United States Bankruptcy Court for the: EASTERN DISTRICT OF VIRGINIA, ALEXANDRIA DIVISION

Case number 1:16-bk-13439-BFK  Check if this is an

amended filing

Official Form 106A/B

Schedule A/B: Property 12/15

In each category, separately list and describe items. List an asset only once. If an asset fits in more than one category, list the asset in the category where you

think it fits best. 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: Describe Each Residence, Building, Land, or Other Real Estate You Own or Have an Interest In

1. Do you own or have any legal or equitable interest in any residence, building, land, or similar property?

 No. Go to Part 2.

 Yes. Where is the property?

Part 2: Describe Your Vehicles

Do you own, lease, or have legal or equitable interest in any vehicles, whether they are registered or not? Include any vehicles you own that someone else drives. If you lease a vehicle, also report it on Schedule G: Executory Contracts and Unexpired Leases.

3. Cars, vans, trucks, tractors, sport utility vehicles, motorcycles  No

Yes

3.1 Make: Ford Who has an interest in the property? Check one Do not deduct secured claims or exemptions. Put

the amount of any secured claims on Schedule D:

Model: Explorer  Debtor 1 only Creditors Who Have Claims Secured by Property . Year: 2016  Debtor 2 only Current value of the

entire property?

Current value of the

Approximate mileage: 3500  Debtor 1 and Debtor 2 only portion you own?

Other information:  At least one of the debtors and another

Check if this is community property $36,749.00 $36,749.00

 (see instructions)

4. Watercraft, aircraft, motor homes, ATVs and other recreational vehicles, other vehicles, and accessories Examples: Boats, trailers, motors, personal watercraft, fishing vessels, snowmobiles, motorcycle accessories  No

Yes

5

.Add the dollar value of the portion you own for all of your entries from Part 2, including any entries for pagesyou have attached for Part 2. Write that number here.............................................................................=> $36,749.00

Part 3: Describe Your Personal and Household Items

Do you own or have any legal or equitable interest in any of the following items? Current value of the portion you own?

Do not deduct secured

claims or exemptions.

6. Household goods and furnishings Examples: Major appliances, furniture, linens, china, kitchenware  No

Official Form 106A/B Schedule A/B: Property page 1

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Debtor 1 Adib, Kaveh Case number (if known) 1:16-bk-13439-BFK

Yes. Describe..... Love seat, coffee table, sofa, dining room set, bedroom set,

linens, kitchenware $2,700.00

7. Electronics Examples: Televisions and radios; audio, video, stereo, and digital equipment; computers, printers, scanners; music collections; electronic devices

including cell phones, cameras, media players, games

 No

Yes. Describe..... Samsung TV, iPad, iPhone, Apple TV, Laptop, xBox, Workstation $800.00

8. Collectibles of value Examples: Antiques and figurines; paintings, prints, or other artwork; books, pictures, or other art objects; stamp, coin, or baseball card collections; other collections, memorabilia, collectibles

 No

Yes. Describe.....

9. Equipment for sports and hobbies Examples: Sports, photographic, exercise, and other hobby equipment; bicycles, pool tables, golf clubs, skis; canoes and kayaks; carpentry tools; musical

instruments

 No

Yes. Describe..... Synthesizer Korg, electric guitar $1,100.00

10. Firearms Examples: Pistols, rifles, shotguns, ammunition, and related equipment

 No

Yes. Describe.....

11. Clothes Examples: Everyday clothes, furs, leather coats, designer wear, shoes, accessories  No

Yes. Describe.....

12. Jewelry

Examples: Everyday jewelry, costume jewelry, engagement rings, wedding rings, heirloom jewelry, watches, gems, gold, silver  No

Yes. Describe.....

13. Non-farm animals Examples: Dogs, cats, birds, horses  No

Yes. Describe.....

14. Any other personal and household items you did not already list, including any health aids you did not list

 No

Yes. Give specific information.....

15. Add the dollar value of all of your entries from Part 3, including any entries for pages you have attached for Part 3. Write that number here .............................................................................. $4,600.00

Part 4: Describe Your Financial Assets

Do you own or have any legal or equitable interest in any of the following? Current value of the portion you own?

Do not deduct secured

claims or exemptions.

16. Cash

Examples: Money you have in your wallet, in your home, in a safe deposit box, and on hand when you file your petition  No

Official Form 106A/B Schedule A/B: Property page 2

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Debtor 1 Adib, Kaveh Case number (if known) 1:16-bk-13439-BFK

 Yes................................................................................................................

17. Deposits of money

Examples: Checking, savings, or other financial accounts; certificates of deposit; shares in credit unions, brokerage houses, and other similar

institutions. If you have multiple accounts with the same institution, list each.

 No

Yes........................

Institution name:

17.1. Checking Account SunTrust acct #...4165 $2,062.06

17.2. Savings Account SunTrust acct # ...4300 $65.01

18. Bonds, mutual funds, or publicly traded stocks Examples: Bond funds, investment accounts with brokerage firms, money market accounts  No

Yes..................

Institution or issuer name:

19. Non-publicly traded stock and interests in incorporated and unincorporated businesses, including an interest in an LLC, partnership, and

joint venture  No

 Yes. Give specific information about them...................

Name of entity: % of ownership:

20. Government and corporate bonds and other negotiable and non-negotiable instruments Negotiable instruments include personal checks, cashiers’checks, promissory notes, and money orders. Non-negotiable instruments are those you cannot transfer to someone by signing or delivering them.  No

Yes. Give specific information about them

Issuer name:

21. Retirement or pension accounts Examples: Interests in IRA, ERISA, Keogh, 401(k), 403(b), thrift savings accounts, or other pension or profit-sharing plans

 No

Yes. List each account separately. Type of account: Institution name:

401(k) or Similar Plan TSP $40,000.00

22. Security deposits and prepayments Your share of all unused deposits you have made so that you may continue service or use from a company

Examples: Agreements with landlords, prepaid rent, public utilities (electric, gas, water), telecommunications companies, or others  No

Yes. .....................

Institution name or individual:

23. Annuities (A contract for a periodic payment of money to you, either for life or for a number of years)

 No

Yes.............

Issuer name and description.

24. Interests in an education IRA, in an account in a qualified ABLE program, or under a qualified state tuition program. 26 U.S.C. §§ 530(b)(1), 529A(b), and 529(b)(1).  No

Yes.............

Institution name and description. Separately file the records of any interests.11 U.S.C. § 521(c):

25. Trusts, equitable or future interests in property (other than anything listed in line 1), and rights or powers exercisable for your benefit

 No

 Yes. Give specific information about them...

26. Patents, copyrights, trademarks, trade secrets, and other intellectual property

Examples: Internet domain names, websites, proceeds from royalties and licensing agreements  No

 Yes. Give specific information about them...

Official Form 106A/B Schedule A/B: Property page 3

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Debtor 1 Adib, Kaveh Case number (if known) 1:16-bk-13439-BFK

27. Licenses, franchises, and other general intangibles Examples: Building permits, exclusive licenses, cooperative association holdings, liquor licenses, professional licenses  No

 Yes. Give specific information about them...

Money or property owed to you? Current value of the portion you own?

Do not deduct secured

claims or exemptions.

28. Tax refunds owed to you  No

Yes. Give specific information about them, including whether you already filed the returns and the tax years.......

29. Family support

Examples: Past due or lump sum alimony, spousal support, child support, maintenance, divorce settlement, property settlement

 No

Yes. Give specific information......

30. Other amounts someone owes you Examples: Unpaid wages, disability insurance payments, disability benefits, sick pay, vacation pay, workers’ compensation, Social Security benefits;

unpaid loans you made to someone else

 No

Yes. Give specific information.. Accrued compensation from Voice of America unknown

31. Interests in insurance policies Examples: Health, disability, or life insurance; health savings account (HSA); credit, homeowner’s, or renter’s insurance  No

Yes. Name the insurance company of each policy and list its value. Company name: Beneficiary: Surrender or refund

value: FEGLI $0.00

32. Any interest in property that is due you from someone who has died

If you are the beneficiary of a living trust, expect proceeds from a life insurance policy, or are currently entitled to receive property because someone has died.

 No

Yes. Give specific information..

33. Claims against third parties, whether or not you have filed a lawsuit or made a demand for payment

Examples: Accidents, employment disputes, insurance claims, or rights to sue

 No

 Yes. Describe each claim.........

34. Other contingent and unliquidated claims of every nature, including counterclaims of the debtor and rights to set off claims  No

 Yes. Describe each claim.........

35. Any financial assets you did not already list

 No

Yes. Give specific information..

36. Add the dollar value of all of your entries from Part 4, including any entries for pages you have attached for Part 4. Write that number here..................................................................................................................... $42,127.07

Part 5: Describe Any Business-Related Property You Own or Have an Interest In. List any real estate in Part 1.

37. Do you own or have any legal or equitable interest in any business-related property?

 No. Go to Part 6.

Official Form 106A/B Schedule A/B: Property page 4

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Debtor 1 Adib, Kaveh Case number (if known) 1:16-bk-13439-BFK

 Yes. Go to line 38.

Part 6: Describe Any Farm- and Commercial Fishing-Related Property You Own or Have an Interest In.

If you own or have an interest in farmland, list it in Part 1.

46. Do you own or have any legal or equitable interest in any farm- or commercial fishing-related property?

 No. Go to Part 7.

 Yes. Go to line 47.

Part 7: Describe All Property You Own or Have an Interest in That You Did Not List Above

53. Do you have other property of any kind you did not already list?

Examples: Season tickets, country club membership

 No

Yes. Give specific information.........

54. Add the dollar value of all of your entries from Part 7. Write that number here .................................... $0.00

Part 8: List the Totals of Each Part of this Form

55. Part 1: Total real estate, line 2 ...................................................................................................................... $0.00

56. Part 2: Total vehicles, line 5 $36,749.00

57. Part 3: Total personal and household items, line 15 $4,600.00

58. Part 4: Total financial assets, line 36 $42,127.07

59. Part 5: Total business-related property, line 45 $0.00

60. Part 6: Total farm- and fishing-related property, line 52 $0.00

61. Part 7: Total other property not listed, line 54 + $0.00

62. Total personal property. Add lines 56 through 61... $83,476.07 Copy personal property total $83,476.07

63. Total of all property on Schedule A/B. Add line 55 + line 62 $83,476.07

Official Form 106A/B Schedule A/B: Property page 5

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Fill in this information to identify your case: Debtor 1 Kaveh Adib

First Name Middle Name Last Name Debtor 2

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

United States Bankruptcy Court for the: EASTERN DISTRICT OF VIRGINIA, ALEXANDRIA DIVISION

Case number 1:16-bk-13439-BFK

(if known)  Check if this is an

amended filing

Official Form 106C

Schedule C: The Property You Claim as Exempt 4/16

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

property you listed on Schedule A/B: Property (Official Form 106A/B) as your source, list the property that you claim as exempt. If more space is needed, fill out and attach to this page as many copies of Part 2: Additional Page as necessary. On the top of any additional pages, write your name and case number (if

known).

For each item of property you claim as exempt, you must specify the amount of the exemption you claim. One way of doing so is to state a

specific dollar amount as exempt. Alternatively, you may claim the full fair market value of the property being exempted up to the amount of any

applicable statutory limit. Some exemptions—such as those for health aids, rights to receive certain benefits, and tax-exempt retirement

funds—may be unlimited in dollar amount. However, if you claim an exemption of 100% of fair market value under a law that limits the exemption

to a particular dollar amount and the value of the property is determined to exceed that amount, your exemption would be limited to the

applicable statutory amount. Part 1: Identify the Property You Claim as Exempt

1. Which set of exemptions are you claiming? Check one only, even if your spouse is filing with you. You are claiming state and federal nonbankruptcy exemptions. 11 U.S.C. § 522(b)(3)

You are claiming federal exemptions. 11 U.S.C. § 522(b)(2)

2. For any property you list on Schedule A/B that you claim as exempt, fill in the information below. Brief description of the property and line on

Schedule A/B that lists this property

Current value of the

portion you own

Copy the value from

Schedule A/B

Amount of the exemption you claim

Check only one box for each exemption.

Specific laws that allow exemption

Love seat, coffee table, sofa, dining

room set, bedroom set, linens,

kitchenware

Line from Schedule A/B: 6.1

$2,700.00  $2,700.00 Va. Code Ann. § 34-26(4a)

 100% of fair market value, up to

any applicable statutory limit

Samsung TV, iPad, iPhone, Apple

TV, Laptop, xBox, Workstation

Line from Schedule A/B: 7.1

$800.00  $800.00 Va. Code Ann. § 34-26(4a)

 100% of fair market value, up to

any applicable statutory limit

Synthesizer Korg, electric guitar

Line from Schedule A/B: 9.1

$1,100.00  $1,100.00 Va. Code Ann. § 34-4

 100% of fair market value, up to

any applicable statutory limit

SunTrust acct #...4165

Line from Schedule A/B: 17.1

$2,062.06  75% Va. Code Ann. § 34-29

 100% of fair market value, up to

any applicable statutory limit

SunTrust acct # ...4300

Line from Schedule A/B: 17.2

$65.01  75% Va. Code Ann. § 34-29

 100% of fair market value, up to

any applicable statutory limit

Official Form 106C Schedule C: The Property You Claim as Exempt page 1 of 2

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Brief description of the property and line on

Schedule A/B that lists this property

Current value of the

portion you own

Copy the value from

Schedule A/B

Amount of the exemption you claim

Check only one box for each exemption.

Specific laws that allow exemption

TSP

Line from Schedule A/B: 21.1

$40,000.00  Va. Code Ann. § 34-34

 100% of fair market value, up to

any applicable statutory limit

Accrued compensation from Voice

of America

Line from Schedule A/B: 30.1

Unknown  75% Va. Code Ann. § 34-29

 100% of fair market value, up to

any applicable statutory limit

3. Are you claiming a homestead exemption of more than $160,375?

(Subject to adjustment on 4/01/19 and every 3 years after that for cases filed on or after the date of adjustment.)

 No

 Yes. Did you acquire the property covered by the exemption within 1,215 days before you filed this case?

 No

 Yes

Official Form 106C Schedule C: The Property You Claim as Exempt page 2 of 2

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Fill in this information to identify your case: Debtor 1 Kaveh Adib

First Name Middle Name Last Name Debtor 2

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

United States Bankruptcy Court for the: EASTERN DISTRICT OF VIRGINIA, ALEXANDRIA DIVISION

Case number 1:16-bk-13439-BFK

(if known)  Check if this is an

amended filing

Official Form 106D

Schedule D: Creditors Who Have Claims Secured by Property 12/15

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, copy the Additional Page, fill it out, number the entries, and attach it to this form. On the top of any additional pages, write your name and case number (if

known).

1. Do any creditors have claims secured by your property?

No. Check this box and submit this form to the court with your other schedules. You have nothing else to report on this form. Yes. Fill in all of the information below. Part 1: List All Secured Claims

2. List all secured claims. If a creditor has more than one secured claim, list the creditor separately

for each claim. If more than one creditor has a particular claim, list the other creditors in Part 2. As

much as possible, list the claims in alphabetical order according to the creditor ’s name.

Column A

Amount of claim

Do not deduct the

value of collateral.

Column B

Value of collateral

that supports this

claim

Column C

Unsecured

portion

If any

2.1 Apple Federal Credit

Union Describe the property that secures the claim: $40,000.00 $36,749.00 $3,251.00

Creditor's Name 2016 Ford Explorer

4029 Ridge Top Rd

Fairfax, VA 22030-6090

As of the date you file, the claim is: Check all that apply.  Contingent Number, Street, City, State & Zip Code  Unliquidated

 Disputed

Who owes the debt? Check one. Nature of lien. Check all that apply.

 Debtor 1 only

 Debtor 2 only

 An agreement you made (such as mortgage or secured

car loan)

Debtor 1 and Debtor 2 only  Statutory lien (such as tax lien, mechanic's lien)

 At least one of the debtors and another  Judgment lien from a lawsuit

Check if this claim relates to a

community debt

 Other (including a right to offset)

Date debt was incurred 08/01/2016 Last 4 digits of account number

Add the dollar value of your entries in Column A on this page. Write that number here: $40,000.00

If this is the last page of your form, add the dollar value totals from all pages.

Write that number here: $40,000.00

Part 2: List Others to Be Notified for a Debt That You Already Listed

Use this page only if you have others to be notified about your bankruptcy for a debt that you already listed in Part 1. For example, if a collection agency is

trying to collect from you for a debt you owe to someone else, list the creditor in Part 1, and then list the collection agency here. Similarly, if you have more

than one creditor for any of the debts that you listed in Part 1, list the additional creditors here. If you do not have additional persons to be notified for any

debts in Part 1, do not fill out or submit this page.

Name, Number, Street, City, State & Zip Code

Hanieh Rahimi Tari

On which line in Part 1 did you enter the creditor? 2.1

Last 4 digits of account number 

Official Form 106D Schedule D: Creditors Who Have Claims Secured by Property page 1 of 1

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Fill in this information to identify your case: Debtor 1 Kaveh Adib

First Name Middle Name Last Name Debtor 2

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

United States Bankruptcy Court for the: EASTERN DISTRICT OF VIRGINIA, ALEXANDRIA DIVISION

Case number 1:16-bk-13439-BFK

(if known)  Check if this is an

amended filing

Official Form 106E/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 claims and Part 2 for creditors with NONPRIORITY 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: Property (Official Form 106A/B) and on

Schedule G: Executory Contracts and Unexpired Leases (Official Form 106G). Do not include any creditors with partially secured claims that are listed in Schedule

D: Creditors Who Have Claims Secured by Property. If more space is needed, copy the Part you need, fill it out, number the entries in the boxes on the left. Attach

the Continuation Page to this page. If you have no information to report in a Part, do not file that Part. On the top of any additional pages, write your name and

case number (if known).

Part 1: List All of Your PRIORITY Unsecured Claims

1. Do any creditors have priority unsecured claims against you?

 No. Go to Part 2.

Yes. 2. List all of your priority unsecured claims. If a creditor has more than one priority unsecured claim, list the creditor separately for each claim. For each claim listed,

identify what type of claim it is. If a claim has both priority and nonpriority amounts, list that claim here and show both priority and nonpriority amounts. As much as

possible, list the claims in alphabetical order according to the creditor ’s name. If you have more than two priority unsecured claims, fill out the Continuation Page of Part

1. If more than one creditor holds a particular claim, list the other creditors in Part 3.

(For an explanation of each type of claim, see the instructions for this form in the instruction booklet.)

Total claim Priority

amount

Nonpriority

amount

2.1 District of Columbia Govt Last 4 digits of account number 3667 $205.00 $205.00 $0.00

Priority Creditor's Name

DMV Adjudication Services

PO Box 2014

Washington, DC 20013-2014

When was the debt incurred? Unknown

Number Street City State ZIp Code As of the date you file, the claim is: Check all that apply

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

 No

Yes

 Contingent

 Unliquidated

 Disputed

Type of PRIORITY unsecured claim:

 Domestic support obligations

 Taxes and certain other debts you owe the government

 Claims for death or personal injury while you were intoxicated

Other. Specify

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 1 of 8

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Debtor 1 Adib, Kaveh Case number (if know) 1:16-bk-13439-BFK

2.2 Orange County California Last 4 digits of account number $12,346.00 $12,346.00 $0.00

Priority Creditor's Name

Attn: Treasurer-Tax Collector

PO Box 1438

Santa Ana, CA 92702-1438

When was the debt incurred?

Number Street City State ZIp Code As of the date you file, the claim is: Check all that apply

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

 No

Yes

 Contingent

 Unliquidated

 Disputed

Type of PRIORITY unsecured claim:

 Domestic support obligations

 Taxes and certain other debts you owe the government

 Claims for death or personal injury while you were intoxicated

Other. Specify

2.3 State of California Last 4 digits of account number 5917 $8,599.00 $8,599.00 $0.00

Priority Creditor's Name

BANKRUPTCY SECTION

FRANCHISE TAX BOARD

PO Box 2952

Sacramento, CA 95812-2952

When was the debt incurred?

Number Street City State ZIp Code As of the date you file, the claim is: Check all that apply

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

 No

Yes

 Contingent

 Unliquidated

 Disputed

Type of PRIORITY unsecured claim:

 Domestic support obligations

 Taxes and certain other debts you owe the government

 Claims for death or personal injury while you were intoxicated

Other. Specify

Part 2: List All of Your NONPRIORITY Unsecured Claims

3. Do any creditors have nonpriority unsecured claims against you?

 No. You have nothing to report in this part. Submit this form to the court with your other schedules.

Yes.

4. List all of your nonpriority unsecured claims in the alphabetical order of the creditor who holds each claim. If a creditor has more than one nonpriority

unsecured claim, list the creditor separately for each claim. For each claim listed, identify what type of claim it is. Do not list claims already included in Part 1. If more

than one creditor holds a particular claim, list the other creditors in Part 3.If you have more than three nonpriority unsecured claims fill out the Continuation Page of Part

2.

Total claim

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 2 of 8

Software Copyright (c) 1996-2016 CIN Group - www.cincompass.com

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Debtor 1 Adib, Kaveh Case number (if know) 1:16-bk-13439-BFK

4.1 ARCHSTONE Last 4 digits of account number 3764 $2,687.00

Nonpriority Creditor's Name

When was the debt incurred? 07/01/2011

Number Street City State ZIp Code As of the date you file, the claim is: Check all that apply

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

 Debts to pension or profit-sharing plans, and other similar debts

Yes Other. Specify

4.2 Asset Acceptance LLC Last 4 digits of account number 9300 $14,266.00

Nonpriority Creditor's Name

PO Box 2036

Warren, MI 48090-2036

When was the debt incurred?

Number Street City State ZIp Code As of the date you file, the claim is: Check all that apply

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

 Debts to pension or profit-sharing plans, and other similar debts

Yes Other. Specify

4.3 BANK OF AMERICA, N.A. Last 4 digits of account number 6400 $3,164.56

Nonpriority Creditor's Name

PO Box 982238

El Paso, TX 79998-2238

When was the debt incurred?

Number Street City State ZIp Code As of the date you file, the claim is: Check all that apply

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

 Debts to pension or profit-sharing plans, and other similar debts

Yes Other. Specify

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 3 of 8

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Debtor 1 Adib, Kaveh Case number (if know) 1:16-bk-13439-BFK

4.4 BETHESDA MRI Last 4 digits of account number 2112 $368.00

Nonpriority Creditor's Name

3202 Tower Oaks Blvd Ste 120

Rockville, MD 20852-4263

When was the debt incurred? Unknown

Number Street City State ZIp Code As of the date you file, the claim is: Check all that apply

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

 Debts to pension or profit-sharing plans, and other similar debts

Yes Other. Specify

4.5

Center for Cranial & Spinal

Surgery, PC Last 4 digits of account number 8000 $981.52

Nonpriority Creditor's Name

3016 Williams Dr

Fairfax, VA 22031-4616

When was the debt incurred?

Number Street City State ZIp Code As of the date you file, the claim is: Check all that apply

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

 Debts to pension or profit-sharing plans, and other similar debts

Yes Other. Specify

4.6 COMCAST Last 4 digits of account number 2266 $911.00

Nonpriority Creditor's Name

676 Island Pond Rd

Manchester, NH 03109-5420

When was the debt incurred? 05/01/2015

Number Street City State ZIp Code As of the date you file, the claim is: Check all that apply

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

 Debts to pension or profit-sharing plans, and other similar debts

Yes Other. Specify

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 4 of 8

Software Copyright (c) 1996-2016 CIN Group - www.cincompass.com

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Debtor 1 Adib, Kaveh Case number (if know) 1:16-bk-13439-BFK

4.7 CONOO I INC Last 4 digits of account number 3400 $3,430.94

Nonpriority Creditor's Name

When was the debt incurred? 12/18/2007

Number Street City State ZIp Code As of the date you file, the claim is: Check all that apply

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

 Debts to pension or profit-sharing plans, and other similar debts

Yes Other. Specify

4.8 GMAC, LLC Last 4 digits of account number 3900 $12,845.93

Nonpriority Creditor's Name

When was the debt incurred?

Number Street City State ZIp Code As of the date you file, the claim is: Check all that apply

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

 Debts to pension or profit-sharing plans, and other similar debts

Yes Other. Specify

4.9 HOUSEHOLD FINANCE CORP II Last 4 digits of account number 3900 $12,845.93

Nonpriority Creditor's Name

Attn: Research

PO Box 1231

Brandon, FL 33509-1231

When was the debt incurred?

Number Street City State ZIp Code As of the date you file, the claim is: Check all that apply

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

 Debts to pension or profit-sharing plans, and other similar debts

Yes Other. Specify

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 5 of 8

Software Copyright (c) 1996-2016 CIN Group - www.cincompass.com

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Debtor 1 Adib, Kaveh Case number (if know) 1:16-bk-13439-BFK

4.10 JAMES B LEE DDS Last 4 digits of account number 4379 $62.00

Nonpriority Creditor's Name

When was the debt incurred? 08/01/2012

Number Street City State ZIp Code As of the date you file, the claim is: Check all that apply

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

 Debts to pension or profit-sharing plans, and other similar debts

Yes Other. Specify

4.11 Laboratory Corp of America Last 4 digits of account number 4260 $151.00

Nonpriority Creditor's Name

358 S Main St

Burlington, NC 27215-5837

When was the debt incurred? Unknown

Number Street City State ZIp Code As of the date you file, the claim is: Check all that apply

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

 Debts to pension or profit-sharing plans, and other similar debts

Yes Other. Specify

4.12 Psychiatric Institute of Washington Last 4 digits of account number 5001 $250.00

Nonpriority Creditor's Name

4228 Wisconsin Ave NW

Washington, DC 20016-2138

When was the debt incurred? 03/01/2012

Number Street City State ZIp Code As of the date you file, the claim is: Check all that apply

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

 Debts to pension or profit-sharing plans, and other similar debts

Yes Other. Specify

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 6 of 8

Software Copyright (c) 1996-2016 CIN Group - www.cincompass.com

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Debtor 1 Adib, Kaveh Case number (if know) 1:16-bk-13439-BFK

4.13

THE ATRIUM, A CONDO UNIT

OWNERS ASSN Last 4 digits of account number 4400 $5,683.18

Nonpriority Creditor's Name

1530 Key Blvd

Arlington, VA 22209-1531

When was the debt incurred? 11/06/2008

Number Street City State ZIp Code As of the date you file, the claim is: Check all that apply

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

 Debts to pension or profit-sharing plans, and other similar debts

Yes Other. Specify

Part 3: List Others to Be Notified About a Debt That You Already Listed

5. Use this page only if you have others to be notified about your bankruptcy, for a debt that you already listed in Parts 1 or 2. For example, if a collection agency

is trying to collect from you for a debt you owe to someone else, list the original creditor in Parts 1 or 2, then list the collection agency here. Similarly, if you

have more than one creditor for any of the debts that you listed in Parts 1 or 2, list the additional creditors here. If you do not have additional persons to be

notified for any debts in Parts 1 or 2, do not fill out or submit this page.

Name and Address On which entry in Part 1 or Part 2 did you list the original creditor?

Amca

2269 S Saw Ml

Elmsford, NY 10523

Line 4.11 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 4260

Name and Address On which entry in Part 1 or Part 2 did you list the original creditor?

Fidelity Information C

441 N Varney St

Burbank, CA 91502-1733

Line 4.1 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 3764

Name and Address On which entry in Part 1 or Part 2 did you list the original creditor?

Glasser & Glasser, P.L.C.

PO Box 3400

Norfolk, VA 23514-3400

Line 4.9 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 3900

Name and Address On which entry in Part 1 or Part 2 did you list the original creditor?

I C System Inc

PO Box 64378

Saint Paul, MN 55164-0378

Line 4.12 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 5001

Name and Address On which entry in Part 1 or Part 2 did you list the original creditor?

Oac

PO Box 500

Baraboo, WI 53913-0500

Line 4.4 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 2112

Name and Address On which entry in Part 1 or Part 2 did you list the original creditor?

PERRY & ASSOC

4085 Chain Bridge Rd # 300

Fairfax, VA 22030-4106

Line 4.5 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 8000

Name and Address On which entry in Part 1 or Part 2 did you list the original creditor?

Profess Acct

633 W Wisconsin Ave

Milwaukee, WI 53203-1918

Line 2.1 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 3667

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 7 of 8

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Debtor 1 Adib, Kaveh Case number (if know) 1:16-bk-13439-BFK

Name and Address On which entry in Part 1 or Part 2 did you list the original creditor?

Southwest Credit Syste

4120 International Pkwy

Carrollton, TX 75007-1957

Line 4.6 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 2266

Name and Address On which entry in Part 1 or Part 2 did you list the original creditor?

Trojan Professional SE

4410 Cerritos Ave

Los Alamitos, CA 90720-2549

Line 4.10 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 4379

Part 4: Add the Amounts for Each Type of Unsecured Claim

6. Total the amounts of certain types of unsecured claims. This information is for statistical reporting purposes only. 28 U.S.C. §159. Add the amounts for each

type of unsecured claim.

Total Claim

6a. Domestic support obligations 6a. $ 0.00

Total claims

from Part 1 6b. Taxes and certain other debts you owe the government 6b. $ 21,150.00

6c. Claims for death or personal injury while you were intoxicated 6c. $ 0.00

6d. Other. Add all other priority unsecured claims. Write that amount here. 6d. $ 0.00

6e. Total Priority. Add lines 6a through 6d. 6e. $ 21,150.00

Total Claim

6f. Student loans 6f. $ 0.00

Total claims

from Part 2 6g. Obligations arising out of a separation agreement or divorce that

you did not report as priority claims 6g. $ 0.00

6h. Debts to pension or profit-sharing plans, and other similar debts 6h. $ 0.00

6i. Other. Add all other nonpriority unsecured claims. Write that amount

here.

6i.

$ 57,647.06

6j. Total Nonpriority. Add lines 6f through 6i. 6j. $ 57,647.06

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 8 of 8

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Fill in this information to identify your case: Debtor 1 Kaveh Adib

First Name Middle Name Last Name Debtor 2

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

United States Bankruptcy Court for the: EASTERN DISTRICT OF VIRGINIA, ALEXANDRIA DIVISION

Case number 1:16-bk-13439-BFK

(if known)  Check if this is an

amended filing

Official Form 106G

Schedule G: Executory Contracts and Unexpired Leases 12/15

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, copy the additional page, fill it out, number the entries, and attach it to this page. On the top of any

additional pages, write your name and case number (if known).

1. Do you have any executory contracts or unexpired leases?

No. Check this box and file this form with the court with your other schedules. You have nothing else to report on this form. Yes. Fill in all of the information below even if the contacts of leases are listed on Schedule A/B:Property (Official Form 106 A/B).

2. List separately each person or company with whom you have the contract or lease. Then state what each contract or lease is for (for example, rent, vehicle lease, cell phone). See the instructions for this form in the instruction booklet for more examples of executory contracts and

unexpired leases.

Person or company with whom you have the contract or lease

Name, Number, Street, City, State and ZIP Code State what the contract or lease is for

2.1

Name

Number Street

City State ZIP Code

2.2

Name

Number Street

City State ZIP Code

2.3

Name

Number Street

City State ZIP Code

2.4

Name

Number Street

City State ZIP Code

2.5

Name

Number Street

City State ZIP Code

Official Form 106G Schedule G: Executory Contracts and Unexpired Leases Page 1 of 1

Software Copyright (c) 1996-2016 CIN Group - www.cincompass.com

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Fill in this information to identify your case: Debtor 1 Kaveh Adib

First Name Middle Name Last Name Debtor 2

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

United States Bankruptcy Court for the: EASTERN DISTRICT OF VIRGINIA, ALEXANDRIA DIVISION

Case number 1:16-bk-13439-BFK

(if known)  Check if this is an

amended filing

Official Form 106H

Schedule H: Your Codebtors 12/15

Codebtors are people or entities who are also liable for any debts you may have. 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, copy the Additional Page, fill it out, and number the entries in the boxes on the left. Attach the Additional Page to this page. On the top of any Additional Pages, write your name and

case number (if known). Answer every question.

1. Do you have any codebtors? (If you are filing a joint case, do not list either spouse as a codebtor.  No

Yes

2. Within the last 8 years, have you lived in a community property state or territory? (Community property states and territories include Arizona, California, Idaho, Louisiana, Nevada, New Mexico, Puerto Rico, Texas, Washington, and Wisconsin.)

 No. Go to line 3.

Yes. Did your spouse, former spouse, or legal equivalent live with you at the time?

3. In Column 1, list all of your codebtors. Do not include your spouse as a codebtor if your spouse is filing with you. List the person shown in

line 2 again as a codebtor only if that person is a guarantor or cosigner. Make sure you have listed the creditor on Schedule D (Official Form

106D), Schedule E/F (Official Form 106E/F), or Schedule G (Official Form 106G). Use Schedule D, Schedule E/F, or Schedule G to fill out

Column 2.

Column 1: Your codebtor Name, Number, Street, City, State and ZIP Code Column 2: The creditor to whom you owe the debt

Check all schedules that apply:

3.1  Schedule D, line

Name  Schedule E/F, line

 Schedule G, line

Number Street

City State ZIP Code

3.2  Schedule D, line

Name  Schedule E/F, line

 Schedule G, line

Number Street

City State ZIP Code

Official Form 106H Schedule H: Your Codebtors Page 1 of 1

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Fill in this information to identify your case:

Debtor 1 Kaveh Adib

Debtor 2

(Spouse, if filing)

United States Bankruptcy Court for the: EASTERN DISTRICT OF VIRGINIA, ALEXANDRIA

DIVISION

Case number 1:16-bk-13439-BFK Check if this is:

(If known)  An amended filing

 A supplement showing postpetition chapter 13

income as of the following date: Official Form 106I MM / DD/ YYYY

Schedule I: Your Income 12/15

Be as complete and accurate as possible. If two married people are filing together (Debtor 1 and Debtor 2), both are equally responsible for supplying correct information. If you are married and not filing jointly, and your spouse is living with you, include information about your spouse. If you are separated and your spouse is not filing with you, do not include information about your spouse. 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: Describe Employment

1. Fill in your employment

information. Debtor 1 Debtor 2 or non-filing spouse

If you have more than one job, attach a separate page with

information about additional employers.

Include part-time, seasonal, or self-employed work. Occupation may include student or

homemaker, if it applies.

Employment status  Employed

 Not employed

 Employed

 Not employed

Occupation Producer

Employer's name Broadcasting Board of

Governors

Employer's address

How long employed there? 13 years

Part 2: Give Details About Monthly Income

Estimate monthly income as of the date you file this form. If you have nothing to report for any line, write $0 in the space. Include your non-filing spouse

unless you are separated.

If you or your non-filing spouse have more than one employer, combine the information for all employers for that person on the lines below. If you need more

space, attach a separate sheet to this form.

For Debtor 1 For Debtor 2 or non-filing spouse

2.

List monthly gross wages, salary, and commissions (before all payroll

deductions). If not paid monthly, calculate what the monthly wage would be. 2. $ 8,673.60 $ N/A

3. Estimate and list monthly overtime pay. 3. +$ 0.00 +$ N/A

4. Calculate gross Income. Add line 2 + line 3. 4. $ 8,673.60 $ N/A

Official Form 106I Schedule I: Your Income page 1

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Debtor 1 Adib, Kaveh Case number (if known) 1:16-bk-13439-BFK

For Debtor 1 For Debtor 2 or non-filing spouse Copy line 4 here 4. $ 8,673.60 $ N/A

5. List all payroll deductions: 5a. Tax, Medicare, and Social Security deductions 5a. $ 2,601.68 $ N/A

5b. Mandatory contributions for retirement plans 5b. $ 69.40 $ N/A

5c. Voluntary contributions for retirement plans 5c. $ 433.68 $ N/A

5d. Required repayments of retirement fund loans 5d. $ 0.00 $ N/A

5e. Insurance 5e. $ 455.56 $ N/A

5f. Domestic support obligations 5f. $ 0.00 $ N/A

5g. Union dues 5g. $ 0.00 $ N/A

5h. Other deductions. Specify: 5h.+ $ 0.00 + $ N/A

6. Add the payroll deductions. Add lines 5a+5b+5c+5d+5e+5f+5g+5h. 6. $ 3,560.32 $ N/A

7. Calculate total monthly take-home pay. Subtract line 6 from line 4. 7. $ 5,113.28 $ N/A

8. List all other income regularly received: 8a. Net income from rental property and from operating a business, profession, or farm

Attach a statement for each property and business showing gross

receipts, ordinary and necessary business expenses, and the total

monthly net income. 8a. $ 0.00 $ N/A

8b. Interest and dividends 8b. $ 0.00 $ N/A

8c. Family support payments that you, a non-filing spouse, or a dependent regularly receive

Include alimony, spousal support, child support, maintenance, divorce

settlement, and property settlement. 8c. $ 0.00 $ N/A

8d. Unemployment compensation 8d. $ 0.00 $ N/A

8e. Social Security 8e. $ 0.00 $ N/A

8f. Other government assistance that you regularly receive

Include cash assistance and the value (if known) of any non-cash assistance

that you receive, such as food stamps (benefits under the Supplemental

Nutrition Assistance Program) or housing subsidies.

Specify: 8f. $ 0.00 $ N/A

8g. Pension or retirement income 8g. $ 0.00 $ N/A

8h. Other monthly income. Specify: 8h.+ $ 0.00 + $ N/A

9. Add all other income. Add lines 8a+8b+8c+8d+8e+8f+8g+8h. 9. $ 0.00 $ N/A

10. Calculate monthly income. Add line 7 + line 9. 10. $ 5,113.28 + $ N/A = $ 5,113.28

Add the entries in line 10 for Debtor 1 and Debtor 2 or non-filing spouse.

11. State all other regular contributions to the expenses that you list in Schedule J.

Include contributions from an unmarried partner, members of your household, your dependents, your roommates, and

other friends or relatives. Do not include any amounts already included in lines 2-10 or amounts that are not available to pay expenses listed in Schedule J. Specify: 11. +$ 0.00

12. Add the amount in the last column of line 10 to the amount in line 11. The result is the combined monthly income.

Write that amount on the Summary of Schedules and Statistical Summary of Certain Liabilities and Related Data, if it applies 12. $ 5,113.28

Combined monthly income

13. Do you expect an increase or decrease within the year after you file this form?

 No.

 Yes. Explain:

Official Form 106I Schedule I: Your Income page 2

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Fill in this information to identify your case:

Debtor 1 Kaveh Adib Check if this is:

 An amended filing

Debtor 2  A supplement showing postpetition chapter 13

(Spouse, if filing) expenses as of the following date:

United States Bankruptcy Court for the: EASTERN DISTRICT OF VIRGINIA, ALEXANDRIA DIVISIONMM / DD / YYYY

Case number 1:16-bk-13439-BFK

(If known)

Official Form 106J

Schedule J: Your Expenses 12/15

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 another sheet to this form. On the top of any additional pages, write your name and case number

(if known). Answer every question.

Part 1: Describe Your Household

1. Is this a joint case?

 No. Go to line 2.

Yes. Does Debtor 2 live in a separate household?

 No

 Yes. Debtor 2 must file Official Form 106J-2, Expenses for Separate Householdof Debtor 2.

2. Do you have dependents?  No

Do not list Debtor 1 and

Debtor 2.

Yes. Fill out this information for

each dependent..............

Dependent’s relationship to

Debtor 1 or Debtor 2

Dependent’s

age

Does dependent

live with you?

Do not state the

dependents names.

 No

Yes  No

Yes  No

Yes  No

Yes 3. Do your expenses include

expenses of people other than

yourself and your dependents?

 No

Yes

Part 2: Estimate Your Ongoing Monthly Expenses Estimate your expenses as of your bankruptcy filing date unless you are using this form as a supplement in a Chapter 13 case to report expenses as of a date after the bankruptcy is filed. If this is a supplemental Schedule J, check the box at the top of the form and fill in the

applicable date.

Include expenses paid for with non-cash government assistance if you know the

value of such assistance and have included it on Schedule I: Your Income

(Official Form 106I.) Your expenses

4. The rental or home ownership expenses for your residence. Include first mortgage

payments and any rent for the ground or lot. 4. $ 1,400.00

If not included in line 4:

4a. Real estate taxes 4a. $ 0.00

4b. Property, homeowner’s, or renter’s insurance 4b. $ 0.00

4c. Home maintenance, repair, and upkeep expenses 4c. $ 0.00

4d. Homeowner’s association or condominium dues 4d. $ 0.00

5. Additional mortgage payments for your residence, such as home equity loans 5. $ 0.00

Official Form 106J Schedule J: Your Expenses page 1

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6. Utilities: 6a. Electricity, heat, natural gas 6a. $ 220.00

6b. Water, sewer, garbage collection 6b. $ 40.00

6c. Telephone, cell phone, Internet, satellite, and cable services 6c. $ 450.00

6d. Other. Specify: 6d. $ 0.00

7. Food and housekeeping supplies 7. $ 750.00

8. Childcare and children’s education costs 8. $ 0.00

9. Clothing, laundry, and dry cleaning 9. $ 144.00

10. Personal care products and services 10. $ 100.00

11. Medical and dental expenses 11. $ 250.00

12. Transportation. Include gas, maintenance, bus or train fare.

Do not include car payments. 12. $ 390.00

13. Entertainment, clubs, recreation, newspapers, magazines, and books 13. $ 240.00

14. Charitable contributions and religious donations 14. $ 0.00

15. Insurance. Do not include insurance deducted from your pay or included in lines 4 or 20.

15a. Life insurance 15a. $ 0.00

15b. Health insurance 15b. $ 0.00

15c. Vehicle insurance 15c. $ 70.00

15d. Other insurance. Specify: 15d. $ 0.00

16. Taxes. Do not include taxes deducted from your pay or included in lines 4 or 20. Specify: 16. $ 0.00

17. Installment or lease payments: 17a. Car payments for Vehicle 1 17a. $ 550.00

17b. Car payments for Vehicle 2 17b. $ 0.00

17c. Other. Specify: 17c. $ 0.00

17d. Other. Specify: 17d. $ 0.00

18. Your payments of alimony, maintenance, and support that you did not report as deducted from your pay on line 5, Schedule I, Your Income (Official Form 106I). 18. $ 0.00

19. Other payments you make to support others who do not live with you. $ 0.00

Specify: 19.

20. Other real property expenses not included in lines 4 or 5 of this form or on Schedule I: Your Income. 20a. Mortgages on other property 20a. $ 0.00

20b. Real estate taxes 20b. $ 0.00

20c. Property, homeowner’s, or renter’s insurance 20c. $ 0.00

20d. Maintenance, repair, and upkeep expenses 20d. $ 0.00

20e. Homeowner’s association or condominium dues 20e. $ 0.00

21. Other: Specify: 21. +$ 0.00

22. Calculate your monthly expenses

22a. Add lines 4 through 21. $ 4,604.00

22b. Copy line 22 (monthly expenses for Debtor 2), if any, from Official Form 106J-2 $

22c. Add line 22a and 22b. The result is your monthly expenses. $ 4,604.00

23. Calculate your monthly net income. 23a. Copy line 12(your combined monthly income) from Schedule I. 23a. $ 5,113.28

23b. Copy your monthly expenses from line 22c above. 23b. -$ 4,604.00

23c. Subtract your monthly expenses from your monthly income. The result is your monthly net income. 23c. $ 509.28

24. Do you expect an increase or decrease in your expenses within the year after you file this form?

For example, do you expect to finish paying for your car loan within the year or do you expect your mortgage payment to increase or decrease because of a

modification to the terms of your mortgage?

 No.

Yes. Explain here:

Official Form 106J Schedule J: Your Expenses page 2

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Fill in this information to identify your case: Debtor 1 Kaveh Adib

First Name Middle Name Last Name Debtor 2

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

United States Bankruptcy Court for the: EASTERN DISTRICT OF VIRGINIA, ALEXANDRIA DIVISION

Case number 1:16-bk-13439-BFK

(if known)  Check if this is an

amended filing

Official Form 106Dec

Declaration About an Individual Debtor's Schedules 12/15

If two married people are filing together, both are equally responsible for supplying correct information.

You must file this form whenever you file bankruptcy schedules or amended schedules. 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.

Sign Below

Did you pay or agree to pay someone who is NOT an attorney to help you fill out bankruptcy forms?

 No

 Yes. Name of person Attach Bankruptcy Petition Preparer’s Notice, Declaration, and Signature (Official Form 119)

Under penalty of perjury, I declare that I have read the summary and schedules filed with this declaration and

that they are true and correct.

X /s/ Kaveh Adib X

Kaveh Adib Signature of Debtor 2

Signature of Debtor 1

Date November 8, 2016 Date

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Fill in this information to identify your case: Debtor 1 Kaveh Adib

First Name Middle Name Last Name Debtor 2

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

United States Bankruptcy Court for the: EASTERN DISTRICT OF VIRGINIA, ALEXANDRIA DIVISION

Case number 1:16-bk-13439-BFK

(if known)  Check if this is an

amended filing

Official Form 106Sum

Summary of Your Assets and Liabilities and Certain Statistical Information 12/15

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

information. Fill out all of your schedules first; then complete the information on this form. If you are filing amended schedules after you file

your original forms, you must fill out a new Summary and check the box at the top of this page.

Part 1: Summarize Your Assets

Your assets Value of what you own

1. Schedule A/B: Property (Official Form 106A/B)

1a. Copy line 55, Total real estate, from Schedule A/B................................................................................................ $ 0.00

1b. Copy line 62, Total personal property, from Schedule A/B..................................................................................... $ 83,726.07

1c. Copy line 63, Total of all property on Schedule A/B............................................................................................... $ 83,726.07

Part 2: Summarize Your Liabilities

Your liabilities Amount you owe

2. Schedule D: Creditors Who Have Claims Secured by Property (Official Form 106D)

2a. Copy the total you listed in Column A, Amount of claim, at the bottom of the last page of Part 1 of Schedule D... $ 40,000.00

3. Schedule E/F: Creditors Who Have Unsecured Claims (Official Form 106E/F)

3a. Copy the total claims from Part 1 (priority unsecured claims) from line 6e of Schedule E/F................................. $ 21,150.00

3b. Copy the total claims from Part 2 (nonpriority unsecured claims) from line 6j of Schedule E/F............................ $ 57,647.06

Your total liabilities $ 118,797.06

Part 3: Summarize Your Income and Expenses

4. Schedule I: Your Income (Official Form 106I)

Copy your combined monthly income from line 12 of Schedule I................................................................................ $ 5,113.28

5. Schedule J: Your Expenses (Official Form 106J)

Copy your monthly expenses from line 22c of Schedule J.......................................................................... $ 4,604.00

Part 4: Answer These Questions for Administrative and Statistical Records

6. Are you filing for bankruptcy under Chapters 7, 11, or 13?

 No. You have nothing to report on this part of the form. Check this box and submit this form to the court with your other schedules.  Yes 7. What kind of debt do you have?

 Your debts are primarily consumer debts. Consumer debts are those “incurred by an individual primarily for a personal, family, or household

purpose.” 11 U.S.C. § 101(8). Fill out lines 8-9g for statistical purposes. 28 U.S.C. § 159.

 Your debts are not primarily consumer debts. You have nothing to report on this part of the form. Check this box and submit this form to the

court with your other schedules. Official Form 106Sum Summary of Your Assets and Liabilities and Certain Statistical Information page 1 of 2

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8. From the Statement of Your Current Monthly Income: Copy your total current monthly income from Official Form

122A-1 Line 11; OR, Form 122B Line 11; OR, Form 122C-1 Line 14. $ 8,873.76

9. Copy the following special categories of claims from Part 4, line 6 of Schedule E/F:

Total claim

From Part 4 on Schedule E/F, copy the following:

9a. Domestic support obligations (Copy line 6a.) $ 0.00

9b. Taxes and certain other debts you owe the government. (Copy line 6b.) $ 21,150.00

9c. Claims for death or personal injury while you were intoxicated. (Copy line 6c.) $ 0.00

9d. Student loans. (Copy line 6f.) $ 0.00

9e. Obligations arising out of a separation agreement or divorce that you did not report as priority claims. (Copy line 6g.) $ 0.00

9f. Debts to pension or profit-sharing plans, and other similar debts. (Copy line 6h.) +$ 0.00

9g. Total. Add lines 9a through 9f. $ 21,150.00

Official Form 106Sum Summary of Your Assets and Liabilities and Certain Statistical Information page 2 of 2

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Fill in this information to identify your case: Debtor 1 Kaveh Adib

First Name Middle Name Last Name Debtor 2

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

United States Bankruptcy Court for the: EASTERN DISTRICT OF VIRGINIA, ALEXANDRIA DIVISION

Case number 1:16-bk-13439-BFK

(if known)  Check if this is an

amended filing

Official Form 107

Statement of Financial Affairs for Individuals Filing for Bankruptcy 4/16

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: Give Details About Your Marital Status and Where You Lived Before

1. What is your current marital status?

 Married

 Not married

2. During the last 3 years, have you lived anywhere other than where you live now?

 No

 Yes. List all of the places you lived in the last 3 years. Do not include where you live now.

Debtor 1 Prior Address: Dates Debtor 1 lived

there Debtor 2 Prior Address: Dates Debtor 2lived there 5601 Seminary Rd Apt 1916N

Falls Church, VA 22041-5104

From-To:

Apr 2013 - Aug

2016

 Same as Debtor 1  Same as Debtor 1

From-To:

3. Within the last 8 years, did you ever live with a spouse or legal equivalent in a community property state or territory? (Community property

states and territories include Arizona, California, Idaho, Louisiana, Nevada, New Mexico, Puerto Rico, Texas, Washington and Wisconsin.)

 No

 Yes. Make sure you fill out Schedule H: Your Codebtors (Official Form 106H).

Part 2 Explain the Sources of Your Income

4. Did you have any income from employment or from operating a business during this year or the two previous calendar years?

Fill in the total amount of income you received from all jobs and all businesses, including part-time activities.

If you are filing a joint case and you have income that you receive together, list it only once under Debtor 1.  No

 Yes. Fill in the details.

Debtor 1 Debtor 2

Sources of income Check all that apply.Gross income

(before deductions and

exclusions)

Sources of income Check all that apply.Gross income

(before deductions and exclusions)

Official Form 107 Statement of Financial Affairs for Individuals Filing for Bankruptcy page 1

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Debtor 1 Adib, Kaveh Case number (if known) 1:16-bk-13439-BFK

5. Did you receive any other income during this year or the two previous calendar years?

Include income regardless of whether that income is taxable. Examples of other income are alimony; child support; Social Security, unemployment, and

other public benefit payments; pensions; rental income; interest; dividends; money collected from lawsuits; royalties; and gambling and lottery winnings. If

you are filing a joint case and you have income that you received together, list it only once under Debtor 1.

List each source and the gross income from each source separately. Do not include income that you listed in line 4.  No

 Yes. Fill in the details.

Debtor 1 Debtor 2

Sources of income Describe below. Gross income from

each source

(before deductions and

exclusions)

Sources of income Describe below. Gross income

(before deductions and exclusions)

Part 3: List Certain Payments You Made Before You Filed for Bankruptcy

6. Are either Debtor 1’s or Debtor 2’s debts primarily consumer debts?

 No. Neither Debtor 1 nor Debtor 2 has 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.”

During the 90 days before you filed for bankruptcy, did you pay any creditor a total of $6,425* or more?

 No. Go to line 7.

 Yes List below each creditor to whom you paid a total of $6,425* or more in one or more payments and the total amount you paid that

creditor. Do not include payments for domestic support obligations, such as child support and alimony. Also, do not include

payments to an attorney for this bankruptcy case. * Subject to adjustment on 4/01/19 and every 3 years after that for cases filed on or after the date of adjustment.  Yes. Debtor 1 or Debtor 2 or both have primarily consumer debts. During the 90 days before you filed for bankruptcy, did you pay any creditor a total of $600 or more?

No. Go to line 7.

 Yes List below each creditor to whom you paid a total of $600 or more and the total amount you paid that creditor. Do not include

payments for domestic support obligations, such as child support and alimony. Also, do not include payments to an attorney for

this bankruptcy case.

Creditor's Name and Address Dates of payment Total amount

paid

Amount you

still owe Was this payment for ...

7. Within 1 year before you filed for bankruptcy, did you make a payment on a debt you owed anyone who was an insider?

Insiders include your relatives; any general partners; relatives of any general partners; partnerships of which you are a general partner; corporations of which you are an officer, director, person in control, or owner of 20% or more of their voting securities; and any managing agent, including one for a

business you operate as a sole proprietor. 11 U.S.C. § 101. Include payments for domestic support obligations, such as child support and alimony.  No

 Yes. List all payments to an insider.

Insider's Name and Address Dates of payment Total amount

paid

Amount you

still owe Reason for this payment

8. Within 1 year before you filed for bankruptcy, did you make any payments or transfer any property on account of a debt that benefited an

insider?

Include payments on debts guaranteed or cosigned by an insider.  No

 Yes. List all payments to an insider

Insider's Name and Address Dates of payment Total amount

paid

Amount you

still owe Reason for this paymentInclude creditor's name

Part 4: Identify Legal Actions, Repossessions, and Foreclosures

9. Within 1 year before you filed for bankruptcy, were you a party in any lawsuit, court action, or administrative proceeding?

List all such matters, including personal injury cases, small claims actions, divorces, collection suits, paternity actions, support or custody modifications,

Official Form 107 Statement of Financial Affairs for Individuals Filing for Bankruptcy page 2

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and contract disputes.  No

 Yes. Fill in the details.

Case title Case number Nature of the case Court or agency Status of the case

Center for Cranial & Spinal

Surgery, PC v. Kaveh Adib

GV15028980-00

Warrant in Debt Fairfax County General

District Court

4110 Chain Bridge Rd

Fairfax, VA 22030-4020

 Pending

 On appeal

 Concluded

Default Judgment

Household Finance Corp II v.

Kaveh Adib

GV09000018-07

Garnishment Arlington General District

Court

1425 N Courthouse Rd #

2400

Arlington, VA 22201-2685

 Pending

 On appeal

 Concluded

Dismissed No Funds

10. Within 1 year before you filed for bankruptcy, was any of your property repossessed, foreclosed, garnished, attached, seized, or levied?

Check all that apply and fill in the details below.

 No. Go to line 11.

 Yes. Fill in the information below. Creditor Name and Address Describe the Property

Explain what happened

Date Value of the property

11. Within 90 days before you filed for bankruptcy, did any creditor, including a bank or financial institution, set off any amounts from your accounts or refuse to make a payment because you owed a debt?

 No

 Yes. Fill in the details.

Creditor Name and Address Describe the action the creditor took Date action was

taken Amount

12. Within 1 year before you filed for bankruptcy, was any of your property in the possession of an assignee for the benefit of creditors, a

court-appointed receiver, a custodian, or another official?

 No

 Yes

Part 5: List Certain Gifts and Contributions

13. Within 2 years before you filed for bankruptcy, did you give any gifts with a total value of more than $600 per person?

 No

 Yes. Fill in the details for each gift. Gifts with a total value of more than $600 per person

Person to Whom You Gave the Gift and

Address:

Describe the gifts Dates you gave

the gifts Value

14. Within 2 years before you filed for bankruptcy, did you give any gifts or contributions with a total value of more than $600 to any charity?

 No

 Yes. Fill in the details for each gift or contribution. Gifts or contributions to charities that total more than $600

Charity's Name Address (Number, Street, City, State and ZIP Code)

Describe what you contributed Dates you

contributed

Value

Part 6: List Certain Losses

15. Within 1 year before you filed for bankruptcy or since you filed for bankruptcy, did you lose anything because of theft, fire, other disaster, Official Form 107 Statement of Financial Affairs for Individuals Filing for Bankruptcy page 3

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or gambling?

 No

 Yes. Fill in the details.

Describe the property you lost and

how the loss occurred

Describe any insurance coverage for the loss

Include the amount that insurance has paid. List pending

insurance claims on line 33 of Schedule A/B: Property.

Date of your

loss Value of propertylost

Part 7: List Certain Payments or Transfers

16. Within 1 year before you filed for bankruptcy, did you or anyone else acting on your behalf pay or transfer any property to anyone you

consulted about seeking bankruptcy or preparing a bankruptcy petition?

Include any attorneys, bankruptcy petition preparers, or credit counseling agencies for services required in your bankruptcy.  No

 Yes. Fill in the details.

Person Who Was Paid

Address Email or website address Person Who Made the Payment, if Not You

Description and value of any property

transferred

Date payment or

transfer was made

Amount of

payment

Law Office of Sebastian A Hoeges,

PLLC

4000 Legato Rd Ste 1100

Fairfax, VA 22033-2893

hoegeslaw.com

8/1/2016 $155.00

17. Within 1 year before you filed for bankruptcy, did you or anyone else acting on your behalf pay or transfer any property to anyone who

promised to help you deal with your creditors or to make payments to your creditors?

Do not include any payment or transfer that you listed on line 16.  No

 Yes. Fill in the details.

Person Who Was Paid

Address Description and value of any propertytransferred

Date payment or

transfer was made

Amount of

payment

18. Within 2 years before you filed for bankruptcy, did you sell, trade, or otherwise transfer any property to anyone, other than property

transferred in the ordinary course of your business or financial affairs?

Include both outright transfers and transfers made as security (such as the granting of a security interest or mortgage on your property). Do not include

gifts and transfers that you have already listed on this statement.  No

 Yes. Fill in the details.

Person Who Received Transfer Address

Person's relationship to you

Description and value of

property transferred

Describe any property or payments received or debts paid in exchangeDate transfer was made

19. Within 10 years before you filed for bankruptcy, did you transfer any property to a self-settled trust or similar device of which you are a beneficiary? (These are often called asset-protection devices.)

 No

 Yes. Fill in the details.

Name of trust Description and value of the property transferred Date Transfer was made

Official Form 107 Statement of Financial Affairs for Individuals Filing for Bankruptcy page 4

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Part 8: List of Certain Financial Accounts, Instruments, Safe Deposit Boxes, and Storage Units

20. Within 1 year before you filed for bankruptcy, were any financial accounts or instruments held in your name, or for your benefit, closed, sold, moved, or transferred?

Include checking, savings, money market, or other financial accounts; certificates of deposit; shares in banks, credit unions, brokerage houses, pension funds, cooperatives, associations, and other financial institutions.  No

 Yes. Fill in the details. Name of Financial Institution and

Address (Number, Street, City, State and ZIP

Code)

Last 4 digits of account number Type of account or

instrument

Date account was

closed, sold, moved, or

transferred

Last balance before

closing or transfer

21. Do you now have, or did you have within 1 year before you filed for bankruptcy, any safe deposit box or other depository for securities, cash, or other valuables?

 No

 Yes. Fill in the details. Name of Financial Institution Address (Number, Street, City, State and ZIP Code)

Who else had access to it?

Address (Number, Street, City, State

and ZIP Code)

Describe the contents Do you still

have it?

22. Have you stored property in a storage unit or place other than your home within 1 year before you filed for bankruptcy?

 No

 Yes. Fill in the details. Name of Storage Facility

Address (Number, Street, City, State and ZIP Code)

Who else has or had access

to it?

Address (Number, Street, City, State

and ZIP Code)

Describe the contents Do you still

have it?

Part 9: Identify Property You Hold or Control for Someone Else

23. Do you hold or control any property that someone else owns? Include any property you borrowed from, are storing for, or hold in trust for someone.  No

 Yes. Fill in the details. Owner's Name Address (Number, Street, City, State and ZIP Code)

Where is the property?

(Number, Street, City, State and ZIP

Code)

Describe the property Value

Part 10: Give Details About Environmental Information

For the purpose of Part 10, the following definitions apply:  Environmental law means any federal, state, or local statute or regulation concerning pollution, contamination, releases of hazardous or

toxic substances, wastes, or material into the air, land, soil, surface water, groundwater, or other medium, including statutes or regulations

controlling the cleanup of these substances, wastes, or material.  Site means any location, facility, or property as defined under any environmental law, whether you now own, operate, or utilize it or used to

own, operate, or utilize it, including disposal sites.  Hazardous material means anything an environmental law defines as a hazardous waste, hazardous substance, toxic substance, hazardous material, pollutant, contaminant, or similar term.

Report all notices, releases, and proceedings that you know about, regardless of when they occurred.

24. Has any governmental unit notified you that you may be liable or potentially liable under or in violation of an environmental law?

 No

 Yes. Fill in the details. Name of site Address (Number, Street, City, State and ZIP Code)

Governmental unit

Address (Number, Street, City, State and

ZIP Code)

Environmental law, if you

know it

Date of notice

Official Form 107 Statement of Financial Affairs for Individuals Filing for Bankruptcy page 5

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25. Have you notified any governmental unit of any release of hazardous material?

 No

 Yes. Fill in the details. Name of site Address (Number, Street, City, State and ZIP Code)

Governmental unit

Address (Number, Street, City, State and

ZIP Code)

Environmental law, if you

know it

Date of notice

26. Have you been a party in any judicial or administrative proceeding under any environmental law? Include settlements and orders.  No

 Yes. Fill in the details. Case Title Case Number Court or agency

Name Address (Number, Street, City, State

and ZIP Code)

Nature of the case Status of the

case

Part 11: Give Details About Your Business or Connections to Any Business

27. Within 4 years before you filed for bankruptcy, did you own a business or have any of the following connections to any business?

A sole proprietor or self-employed in a trade, profession, or other activity, either full-time or part-time A member of a limited liability company (LLC) or limited liability partnership (LLP)

A partner in a partnership

An officer, director, or managing executive of a corporation An owner of at least 5% of the voting or equity securities of a corporation  No. None of the above applies. Go to Part 12.  Yes. Check all that apply above and fill in the details below for each business. Business Name Address

(Number, Street, City, State and ZIP Code)

Describe the nature of the business

Name of accountant or bookkeeper

Employer Identification number Do not include Social Security number or ITIN.

Dates business existed

28. Within 2 years before you filed for bankruptcy, did you give a financial statement to anyone about your business? Include all financial

institutions, creditors, or other parties.  No

 Yes. Fill in the details below. Name Address

(Number, Street, City, State and ZIP Code)

Date Issued

Part 12: Sign Below

I have read the answers on this Statement of Financial Affairs and any attachments, and I declare under penalty of perjury that the answers are

true and correct. I understand that 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/ Kaveh Adib

Kaveh Adib Signature of Debtor 2

Signature of Debtor 1

Date November 8, 2016 Date

Did you attach additional pages to Your Statement of Financial Affairs for Individuals Filing for Bankruptcy (Official Form 107)?

 No

Yes

Did you pay or agree to pay someone who is not an attorney to help you fill out bankruptcy forms?

 No

 Yes. Name of Person . Attach the Bankruptcy Petition Preparer's Notice, Declaration, and Signature (Official Form 119).

Official Form 107 Statement of Financial Affairs for Individuals Filing for Bankruptcy page 6

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Fill in this information to identify your case: Check as directed in lines 17 and 21:

According to the calculations required by this Statement:

 1. Disposable income is not determined under

11 U.S.C. § 1325(b)(3).  2. Disposable income is determined under 11

U.S.C. § 1325(b)(3).  3. The commitment period is 3 years.

 4. The commitment period is 5 years.

Debtor 1 Kaveh Adib

Debtor 2

(Spouse, if filing)

United States Bankruptcy Court for the:

Eastern District of Virginia, Alexandria

Division

Case number 1:16-bk-13439-BFK

(if known)

 Check if this is an amended filing

Official Form 122C-1

Chapter 13 Statement of Your Current Monthly Income

and Calculation of Commitment Period 12/15

Be as complete and accurate as possible. If two married people are filing together, both are equally responsible for being accurate. If more space

is needed, attach a separate sheet to this form. Include the line number to which the additional information applies. On the top of any additional

pages, write your name and case number (if known).

Part 1: Calculate Your Average Monthly Income

1. What is your marital and filing status? Check one only.

Not married. Fill out Column A, lines 2-11.

Married. Fill out both Columns A and B, lines 2-11.

Fill in the average monthly income that you received from all sources, derived during the 6 full months before you file this bankruptcy case. 11 U.S.C. §

101(10A). For example, if you are filing on September 15, the 6-month period would be March 1 through August 31. If the amount of your monthly income varied during the

6 months, add the income for all 6 months and divide the total by 6. Fill in the result. Do not include any income amount more than once. For example, if both spouses

own the same rental property, put the income from that property in one column only. If you have nothing to report for any line, write $0 in the space.

Column A

Debtor 1

Column B

Debtor 2 or non-filing spouse

2. Your gross wages, salary, tips, bonuses, overtime, and commissions (before all

payroll deductions). $ 8,873.76 $

3. Alimony and maintenance payments. Do not include payments from a spouse if

Column B is filled in. $ 0.00 $

4. All amounts from any source which are regularly paid for household expenses of you or your dependents, including child support. Include regular contributions

from an unmarried partner, members of your household, your dependents, parents, and

roommates. Include regular contributions from a spouse only if Column B is not filled in.

Do not include payments you listed on line 3. $ 0.00 $

5. Net income from operating a business, profession, or farm Debtor 1

Gross receipts (before all deductions) $ 0.00

Ordinary and necessary operating expenses -$ 0.00

Net monthly income from a business, profession, or farm $ 0.00 Copy here -> $ 0.00 $

6. Net income from rental and other real property Debtor 1

Gross receipts (before all deductions) $ 0.00

Ordinary and necessary operating expenses -$ 0.00

Net monthly income from rental or other real property $ 0.00 Copy here -> $ 0.00 $

Official Form 122C-1 Chapter 13 Statement of Your Current Monthly Income and Calculation of Commitment Period page 1

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Column A

Debtor 1

Column B

Debtor 2 or non-filing spouse

7. Interest, dividends, and royalties $ 0.00 $

8. Unemployment compensation $ 0.00 $

Do not enter the amount if you contend that the amount received was a benefit under the Social Security Act. Instead, list it here:

For you $ 0.00

For your spouse $

9. Pension or retirement income. Do not include any amount received that was a benefit under the Social Security Act. $ 0.00 $

10. Income from all other sources not listed above. Specify the source and amount. Do

not include any benefits received under the Social Security Act or payments received as a victim of a war crime, a crime against humanity, or international or domestic terrorism.

If necessary, list other sources on a separate page and put the total below. $ 0.00 $

$ 0.00 $

Total amounts from separate pages, if any. + $ 0.00 $

11. Calculate your total average monthly income. Add lines 2 through 10 for each column. Then add the total for Column A to the total for Column B. $ 8,873.76 + $ = $ 8,873.76

Total average

monthly income

Part 2: Determine How to Measure Your Deductions from Income

12. Copy your total average monthly income from line 11. $ 8,873.76

13. Calculate the marital adjustment. Check one:

 You are not married. Fill in 0 below.  You are married and your spouse is filing with you. Fill in 0 below.  You are married and your spouse is not filing with you. Fill in the amount of the income listed in line 11, Column B, that was NOT regularly paid for the household expenses of you or your dependents, such as payment of the spouse's tax liability or the spouse's support of someone other than you or your dependents. Below, specify the basis for excluding this income and the amount of income devoted to each purpose. If necessary, list additional adjustments on

a separate page.

If this adjustment does not apply, enter 0 below. $

$

+$

Total $ 0.00 Copy here=> - 0.00

14. Your current monthly income. Subtract line 13 from line 12. $ 8,873.76

15. Calculate your current monthly income for the year. Follow these steps:

15a. Copy line 14 here=> $ 8,873.76

Multiply line 15a by 12 (the number of months in a year). x 12

15b. The result is your current monthly income for the year for this part of the form. ........................................... $ 106,485.12

Official Form 122C-1 Chapter 13 Statement of Your Current Monthly Income and Calculation of Commitment Period page 2

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16. Calculate the median family income that applies to you. Follow these steps:

16a. Fill in the state in which you live. VA

16b. Fill in the number of people in your household. 1

16c. Fill in the median family income for your state and size of household. $ 55,055.00

To find a list of applicable median income amounts, go online using the link specified in the separate

instructions for this form. This list may also be available at the bankruptcy clerk's office. 17. How do the lines compare?

17a.  Line 15b is less than or equal to line 16c. On the top of page 1 of this form, check box 1, Disposable income is not determined under 11

U.S.C. § 1325(b)(3). Go to Part 3. Do NOT fill out Calculation of Your Disposable Income (Official Form 122C-2).

17b.  Line 15b is more than line 16c. On the top of page 1 of this form, check box 2, Disposable income is determined under 11 U.S.C. §

1325(b)(3). Go to Part 3 and fill out Calculation of Your Disposable Income (Official Form 122C-2). On line 39 of that form, copy

your current monthly income from line 14 above. Part 3: Calculate Your Commitment Period Under 11 U.S.C. § 1325(b)(4)

18. Copy your total average monthly income from line 11 . $ 8,873.76

19. Deduct the marital adjustment if it applies. If you are married, your spouse is not filing with you, and you contend

that calculating the commitment period under 11 U.S.C. § 1325(b)(4) allows you to deduct part of your spouse's

income, copy the amount from line 13.

19a. If the marital adjustment does not apply, fill in 0 on line 19a. -$ 0.00

19b. Subtract line 19a from line 18. $ 8,873.76

20. Calculate your current monthly income for the year. Follow these steps:

20a. Copy line 19b $ 8,873.76

Multiply by 12 (the number of months in a year). x 12

20b. The result is your current monthly income for the year for this part of the form $ 106,485.12

20c. Copy the median family income for your state and size of household from line 16c $ 55,055.00

21. How do the lines compare?

 Line 20b is less than line 20c. Unless otherwise ordered by the court, on the top of page 1 of this form, check box 3, The commitment period

is 3 years. Go to Part 4.

 Line 20b is more than or equal to line 20c. Unless otherwise ordered by the court, on the top of page 1 of this form, check box 4, The

commitment period is 5 years. Go to Part 4.

Part 4: Sign Below

By signing here, under penalty of perjury I declare that the information on this statement and in any attachments is true and correct. X /s/ Kaveh Adib

Kaveh Adib

Signature of Debtor 1

Date November 8, 2016

MM / DD / YYYY

If you checked 17a, do NOT fill out or file Form 122C-2.

If you checked 17b, fill out Form 122C-2 and file it with this form. On line 39 of that form, copy your current monthly income from line 14 above.

Official Form 122C-1 Chapter 13 Statement of Your Current Monthly Income and Calculation of Commitment Period page 3

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Fill in this information to identify your case:

Debtor 1 Kaveh Adib

 Check if this is an amended filing

Debtor 2

(Spouse, if filing)

United States Bankruptcy Court for the:

Eastern District of Virginia, Alexandria

Division

Case number 1:16-bk-13439-BFK

(if known)

Official Form 122C-2

Chapter 13 Calculation of Your Disposable Income 04/16

To fill out this form, you will need your completed copy of Chapter 13 Statement of Your Current Monthly Income and Calculation of

Commitment Period (Official Form 122C-1).

Be as complete and accurate as possible. If two married people are filing together, both are equally responsible for being accurate. If more space

is needed, attach a separate sheet to this form, Include the line number to which additional information applies. On the top any additional pages, write your name and case number (if known).

Part 1: Calculate Your Deductions from Your Income

The Internal Revenue Service (IRS) issues National and Local Standards for certain expense amounts. Use these amounts to answer the the questions in lines 6-15. To find the IRS standards, go online using the link specified in the separate instructions for this form. This

information may also be available at the bankruptcy clerk’s office.

Deduct the expense amounts set out in lines 6-15 regardless of your actual expense. In later parts of the form, you will use some of your actual expenses

if they are higher than the standards. Do not include any operating expenses that you subtracted from income in lines 5 and 6 of Form 122C–1, and do not

deduct any amounts that you subtracted from your spouse’s income in line 13 of Form 122C–1.

If your expenses differ from month to month, enter the average expense.

Note: Line numbers 1-4 are not used in this form. These numbers apply to information required by a similar form used in chapter 7 cases.

5. The number of people used in determining your deductions from income

Fill in the number of people who could be claimed as exemptions on your federal income tax return, plus the

number of any additional dependents whom you support. This number may be different from the number of

people in your household.

1 Living

0 Housing

National Standards You must use the IRS National Standards to answer the questions in lines 6-7.

6. Food, clothing, and other items: Using the number of people you entered in line 5 and the IRS National Standards,

fill in the dollar amount for food, clothing, and other items. $ 570.00

7. Out-of-pocket health care allowance: Using the number of people you entered in line 5 and the IRS National Standards, fill in

the dollar amount for out-of-pocket health care. The number of people is split into two categories--people who are under 65 and

people who are 65 or older--because older people have a higher IRS allowance for health car costs. If your actual expenses are

higher than this IRS amount, you may deduct the additional amount on line 22.

Official Form 122C-2 Chapter 13 Calculation of Your Disposable Income page 1

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People who are under 65 years of age

7a. Out-of-pocket health care allowance per person $ 54

7b. Number of people who are under 65 X 1

7c. Subtotal. Multiply line 7a by line 7b. $ 54.00 Copy here=> $ 54.00

People who are 65 years of age or older

7d. Out-of-pocket health care allowance per person $ 130

7e. Number of people who are 65 or older X 0

7f. Subtotal. Multiply line 7d by line 7e. $ 0.00 Copy here=> $ 0.00

7g. Total. Add line 7c and line 7f $ 54.00 Copy total here=> $ 54.00

Local Standards You must use the IRS Local Standards to answer the questions in lines 8-15.

Based on information from the IRS, the U.S. Trustee Program has divided the IRS Local Standard for housing for bankruptcy

purposes into two parts: Housing and utilities - Insurance and operating expenses Housing and utilities - Mortgage or rent expenses To answer the questions in lines 8-9, use the U.S. Trustee Program chart. To find the chart, go online using the link specified in the separate

instructions for this form. This chart may also be available at the bankruptcy clerk's office. 8. Housing and utilities - Insurance and operating expenses: Using the number of people you entered in line 5, fill in

the dollar amount listed for your county for insurance and operating expenses. $ 452.00

9. Housing and utilities - Mortgage or rent expenses:

9a. Using the number of people you entered in line 5, fill in the dollar amount

listed for your county for mortgage or rent expenses.

 $ 1,861.00

9b. Total average monthly payment for all mortgages and other debts secured by your home. To calculate the total average monthly payment, add all amounts that are

contractually due to each secured creditor in the 60 months after you file for bankruptcy. Next divide by 60. Name of the creditor Average monthly

payment

-NONE- $

9b. Total average monthly payment $ 0.00

Copy

here=> -$ 0.00 Repeat this amount

on line 33a.

9c. Net mortgage or rent expense.

Subtract line 9b (total average monthly payment) from line 9a (mortgage or

rent expense). If this number is less than $0, enter $0. $ 1,861.00

Copy

here=> $ 1,861.00

10. If you claim that the U.S. Trustee Program's division of the IRS Local Standard for housing is incorrect and

affects the calculation of your monthly expenses, fill in any additional amount you claim. $ 0.00

Explain why:

Official Form 122C-2 Chapter 13 Calculation of Your Disposable Income page 2

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11. Local transportation expenses: Check the number of vehicles for which you claim an ownership or operating expense.  0. Go to line 14.

 1. Go to line 12.

 2 or more. Go to line 12.

12. Vehicle operation expense: Using the IRS Local Standards and the number of vehicles for which you claim the operating

expenses, fill in the Operating Costs that apply for your Census region or metropolitan statistical area. $ 250.00

13. Vehicle ownership or lease expense: Using the IRS Local Standards, calculate the net ownership or lease expense for each vehicle below. You may not claim the expense if you do not make any loan or lease payments on the vehicle. In addition, you may not claim the expense for more than

two vehicles. Vehicle 1 Describe Vehicle 1:

,

13a. Ownership or leasing costs using IRS Local Standard.................................................. $ 471.00

13b. Average monthly payment for all debts secured by Vehicle 1. Do not include costs for leased vehicles.

To calculate the average monthly payment here and on line 13e, add all amounts that are

contractually due to each secured creditor in the 60 months after you file for bankruptcy. Then divide by 60.

Name of each creditor for Vehicle 1 Average monthly

payment

Apple Federal Credit Union $ 550.00

Total Average Monthly Payment $ 550.00

Copy

here => -$ 550.00

Repeat this amount on

line 33b.

13c. Net Vehicle 1 ownership or lease expense Subtract line 13b from line 13a. if the numbert is less than $0, enter $0. ...................

$ 0.00

Copy net

Vehicle 1

expense here => $ 0.00

Vehicle 2 Describe Vehicle 2:

13d. Ownership or leasing costs using IRS Local Standard.................................................. $ 0.00

13e. Average monthly payment for all debts secured by Vehicle 2. Do not include costs for

leased vehicles.

Name of each creditor for Vehicle 2 Average monthly

payment

$

Total average monthly payment $

Copy

here => -$ 0.00

Repeat this amount on line

33c.

13f. Net Vehicle 2 ownership or lease expense Subtract line 13e from line 13d. if this number is less than $0, enter $0. .....................

$ 0.00

Copy net

Vehicle 2

expense here => $ 0.00

14. Public transportation expense: If you claimed 0 vehicles in line 11, using the IRS Local Standards, fill in the Public Transportation expense allowance regardless of whether you use public transportation. $ 0.00

15. Additional public transportation expense: If you claimed 1 or more vehicles in line 11 and if you claim that you may also

deduct a public transportation expense, you may fill in what you believe is the appropriate expense, but you may not claim

more than the IRS Local Standard for Public Transportation. $ 0.00

Official Form 122C-2 Chapter 13 Calculation of Your Disposable Income page 3

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Other Necessary Expenses In addition to the expense deductions listed above, you are allowed your monthly expenses for

the following IRS categories.

16. Taxes: The total monthly amount that you will actually pay for federal, state and local taxes, such as income taxes, self-employment taxes, social security taxes, and Medicare taxes. You may include the monthly amount withheld from your pay for these taxes. However, if you expect to receive a tax refund, you must divide the expected refund by 12 and subtract

that number from the total monthly amount that is withheld to pay for taxes. Do not include real estate, sales, or use taxes. $ 2,684.55

17. Involuntary deductions: The total monthly payroll deductions that your job requires, such as retirement contributions, union dues, and uniform costs.

Do not include amounts that are not required by your job, such as voluntary 401(k) contributions or payroll savings. $ 690.43

18. Life Insurance: The total monthly premiums that you pay for your own term life insurance. If two married people are filing

together, include payments that you make for your spouse's term life insurance. Do not include premiums for life insurance on your dependents, for a non-filing spouse's life insurance, or for any form of

life insurance other than term. $ 0.00

19. Court-ordered payments: The total monthly amount that you pay as required by the order of a court or administrative

agency, such as spousal or child support payments. Do not include payments on past due obligations for spousal or child support. You will list these obligations in line 35. $ 0.00

20. Education: The total monthly amount that you pay for education that is either required: as a condition for your job, or for your physically or mentally challenged dependent child if no public education is available for similar services. $ 0.00

21. Childcare: The total monthly amount that you pay for childcare, such as babysitting, daycare, nursery, and preschool. Do not include payments for any elementary or secondary school education. $ 0.00

22. Additional health care expenses, excluding insurance costs: The monthly amount that you pay for health care that is

required for the health and welfare of you or your dependents and that is not reimbursed by insurance or paid by a health

savings account. Include only the amount that is more than the total entered in line 7.

Payments for health insurance or health savings accounts should be listed only in line 25. $ 0.00

23. Optional telephone and telephone services: The total monthly amount that you pay for telecommunication services for you and your dependents, such as pagers, call waiting, caller identification, special long distance, or business cell phone

service, to the extent necessary for your health and welfare or that of your dependents or for the production of income, if it

is not reimbursed by your employer. Do not include payments for basic home telephone, internet and cell phone service. Do not include self-employment expenses, such as those reported on line 5 of Official Form 122C-1, or any amount you previously deducted. +$ 0.00

24. Add all of the expenses allowed under the IRS expense allowances. $ 6,561.98

Add lines 6 through 23.

Additional Expense Deductions These are additional deductions allowed by the Means Test. Note: Do not include any expense allowances listed in lines 6-24.

25. Health insurance, disability insurance, and health savings account expenses. The monthly expenses for health

insurance, disability insurance, and health savings accounts that are reasonably necessary for yourself, your spouse, or your dependents. Health insurance $ 455.56

Disability insurance $ 0.00

Health savings account + $ 0.00

Total $ 455.56 Copy total here=> $ 455.56

Do you actually spend this total amount?

 No. How much do you actually spend?

 Yes $

26. Continued contributions to the care of household or family members. The actual monthly expenses that you will continue to pay for the reasonable and necessary care and support of an elderly, chronically ill, or disabled member of your household or member of your immediate family who is unable to pay for such expenses. These expenses may include

contributions to an account of a qualified ABLE program. 26 U.S.C. § 529A(b). $ 0.00

27. Protection against family violence. The reasonably necessary monthly expenses that you incur to maintain the safety of

you and your family under the Family Violence Prevention and Services Act or other federal laws that apply.

By law, the court must keep the nature of these expenses confidential. $ 0.00

Official Form 122C-2 Chapter 13 Calculation of Your Disposable Income page 4

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28. Additional home energy costs. Your home energy costs are included in your insurance and operating expenses on line 8.

If you believe that you have home energy costs that are more than the home energy costs included in expenses on line 8,

then fill in the excess amount of home energy costs. You must give your case trustee documentation of your actual expenses, and you must show that the additional amount claimed is reasonable and necessary. $ 0.00

29. Education expenses for dependent children who are younger than 18. The monthly expenses (not more than

$160.42* per child) that you pay for your dependent children who are younger than 18 years old to attend a private or public elementary or secondary school. You must give your case trustee documentation of your actual expenses, and you must explain why the amount claimed is

reasonable and necessary and not already accounted for in lines 6-23.

* Subject to adjustment on 4/01/19, and every 3 years after that for cases begun on or after the date of adjustment. $ 0.00

30. Additional food and clothing expense. The monthly amount by which your actual food and clothing expenses are higher

than the combined food and clothing allowances in the IRS National Standards. That amount cannot be more than 5% of

the food and clothing allowances in the IRS National Standards.

To find a chart showing the maximum additional allowance, go online using the link specified in the separate instructions for

this form. This chart may also be available at the bankruptcy clerk's office. You must show that the additional amount claimed is reasonable and necessary. $ 19.35

31. Continuing charitable contributions. The amount that you will continue to contribute in the form of cash or financial

instruments to a religious or charitable organization. 11 U.S.C. § 548(d)(3) and (4).

Do not include any amount more than 15% of your gross monthly income. $ 0.00

32. Add all of the additional expense deductions. $ 474.91

Add lines 25 through 31.

Deductions for Debt Payment

33. For debts that are secured by an interest in property that you own, including home mortgages, vehicle loans, and other secured debt, fill in lines 33a through 33e. To calculate the total average monthly payment, add all amounts that are contractually due to each secured creditor in

the 60 months after you file for bankruptcy. Then divide by 60. Mortgages on your home Average monthly

payment

33a. Copy line 9b here => $ 0.00

Loans on your first two vehicles

33b. Copy line 13b here => $ 550.00

33c. Copy line 13e here => $ 0.00

33d. List other secured debts Name of each creditor for other secured debt Identify property that secures the debt Does payment

include taxes or insurance?

-NONE-  No Yes $

 No

 Yes $

 No

 Yes + $

33e. Total average monthly payment. Add lines 33a through 33d $ 550.00

Copy

total

here=> $ 550.00

Official Form 122C-2 Chapter 13 Calculation of Your Disposable Income page 5

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34. Are any debts that you listed in line 33 secured by your primary residence, a vehicle, or other property necessary for your support or the support of your dependents?

No. Go to line 35.

 Yes. State any amount that you must pay to a creditor, in addition to the payments listed in

line 33, to keep possession of your property (called the cure amount). Next, divide by

60 and fill in the information below.

Name of the creditor Identify property that secures the debt Total cure amount Monthly cure

amount

-NONE- $ ÷ 60 = $

Total $ 0.00

Copy

total

here=> $ 0.00

35. Do you owe any priority claims - such as a priority tax, child support, or alimony - that are past due as of the filing date of your bankruptcy case? 11 U.S.C. § 507.  No. Go to line 36.

Yes. Fill in the total amount of all of these priority claims. Do not include current or ongoing

priority claims, such as those you listed in line 19.

Total amount of all past-due priority claims $ 21,150.60 ÷ 60 $ 352.51

36. Projected monthly Chapter 13 plan payment $ 934.37

Current multiplier for your district as stated on the list issued by the Administrative

Office of the United States Courts (for districts in Alabama and North Carolina) or by the

Executive Office for United States Trustees (for all other districts). X 7.00

To find a list of district multipliers that includes your district, go online using the link specified in the

separate instructions for this form. This list may also be available at the bankruptcy clerk's office.

Average monthly administrative expense $ 65.41

Copy total

here=> $ 65.41

37. Add all of the deductions for debt payment. $ 967.92

Add lines 33e through 36.

Total Deductions from Income

38. Add all of the allowed deductions. Copy line 24, All of the expenses allowed under IRS

expense allowances $ 6,561.98

Copy line 32, All of the additional expense deductions $ 474.91

Copy line 37, All of the deductions for debt payment +$ 967.92

Total deductions.................................................................. $ 8,004.81 Copy total here=> $ 8,004.81

Official Form 122C-2 Chapter 13 Calculation of Your Disposable Income page 6

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Debtor 1 Adib, Kaveh Case number (if known) 1:16-bk-13439-BFK

Part 2: Determine Your Disposable Income Under 11 U.S.C. § 1325(b)(2)

39. Copy your total current monthly income from line 14 of Form 122C-1, Chapter 13

Statement of Your Current Monthly Income and Calculation of Commitment Period. $ 8,873.76

40. Fill in any reasonably necessary income you receive for support for dependent children. The monthly average of any child support payments, foster care payments, or disability payments for a dependent child, reported in Part I of Form 122C-1, that you received

in accordance with applicable nonbankruptcy law to the extent reasonably necessary to be

expended for such child. $ 0.00

41. Fill in all qualified retirement deductions. The monthly total of all amounts that your employer withheld from wages as contributions for qualified retirement plans, as specified in 11

U.S.C. § 541(b)(7) plus all required repayments of loans from retirement plans, as specified in

11 U.S.C. § 362(b)(19). $ 0.00

42. Total of all deductions allowed under 11 U.S.C. § 707(b)(2)(A). Copy line 38 here => $ 8,004.81

43. Deduction for special circumstances. If special circumstances justify additional expenses and you have no reasonable alternative, describe the special circumstances and their expenses. You must give your case trustee a detailed explanation of the special circumstances and documentation for the expenses.

Describe the special circumstances Amount of expense

$

$

$

Total $ 0.00

Copy

here=> $ 0.00

44. Total adjustments. Add lines 40 through 43 => $ 8,004.81

Copy

here=> -$ 8,004.81

45. Calculate your monthly disposable income under § 1325(b)(2). Subtract line 44 from line 39. $ 868.95

Part 3: Change in Income or Expenses

46. Change in income or expenses. If the income in Form 122C-1 or the expenses you reported

in this form have changed or are virtually certain to change after the date you filed your bankruptcy petition and during the time your case will be open, fill in the information below. For example, if the wages reported increased after you filed your petition, check 122C-1 in the first column, enter line 2 in the second column, explain why the wages increased, fill in when the

increase occurred, and fill in the amount of the increase.

Form Line Reason for change Date of change Increase or

decrease?

Amount of change

 122C-1

 122C-2

 Increase

 Decrease $

 122C-1

 122C-2

 Increase

 Decrease $

 122C-1

 122C-2

 Increase

 Decrease $

 122C-1

 122C-2

 Increase

 Decrease $

Official Form 122C-2 Chapter 13 Calculation of Your Disposable Income page 7

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Debtor 1 Adib, Kaveh Case number (if known) 1:16-bk-13439-BFK

Part 4: Sign Below

By signing here, under penalty of perjury you declare that the information on this statement and in any attachments is true and correct.

X /s/ Kaveh Adib

Kaveh Adib

Signature of Debtor 1

Date November 8, 2016

MM / DD / YYYY

Official Form 122C-2 Chapter 13 Calculation of Your Disposable Income page 8

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© 2016 CINgroup 1.866.218.1003 – CINcompass (www.cincompass.com)

United States Bankruptcy Court

IN RE: Case No. 

Debtor(s)

Chapter 

1.

For legal services, I have agreed to accept . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 

Prior to the filing of this statement I have received . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 

Balance Due . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 

2. The source of the compensation paid to me was:

 Debtor Other (specify):

3. The source of compensation to be paid to me is:

 Debtor Other (specify):

4. I have not agreed to share the above-disclosed compensation with any other person unless they are members and associates of my

law firm.

 I have agreed to share the above-disclosed compensation with a person or persons who are not members or associates of my law

firm. A copy of the agreement, together with a list of the names of the people sharing in the compensation, is attached.

5. In return for the above-disclosed fee, I have agreed to render legal service for all aspects of the bankruptcy case, including:

a. Analysis of the debtor's financial situation, and rendering advice to the debtor in determining whether to file a petition in

bankruptcy;

b. Preparation and filing of any petition, schedules, statement of affairs and plan which may be required;

c. Representation of the debtor at the meeting of creditors and confirmation hearing, and any adjourned hearings thereof;

d. Representation of the debtor in adversary proceedings and other contested bankruptcy matters;

e. Other provisions as needed:

Pursuant to 11 U.S.C. § 329(a) and Bankruptcy Rule 2016(b), I certify that I am the attorney for the above-named debtor(s) and that

 compensation paid to me, for services rendered or to be rendered on behalf of the debtor(s) in contemplation of or in connection 

with the bankruptcy case is as follows:

Eastern District of Virginia, Alexandria Division

DISCLOSURE OF COMPENSATION OF ATTORNEY FOR DEBTOR

1:16-bk-13439-BFK

Adib, Kaveh 13

5,100.00

155.00

4,945.00

9

9

9

The Legal Services Agreement does not cover representation in case of a conversion to a Chapter 11 or Chapter 13

bankruptcy, representation in an Adversary Proceeding, appeals, or representation in matters outside of this bankruptcy

case.

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© 2016 CINgroup 1.866.218.1003 – CINcompass (www.cincompass.com)

6. By agreement with the debtor(s), the above disclosed fee does not include the following services:

CERTIFICATION

I certify that the foregoing is a complete statement of any agreement or arrangement for payment to me for representation of the debtor(s)

in this bankruptcy proceeding.

Date Signature of Attorney

Name of Law Firm

The filing fees for this case, a homestead deed filing fee (if required) and other out-of-pocket charges, such as (but not

limited to) other filing fees, deliveries, postage, transcripts, outside copying or document management, printing/copying

costs and related expenses.

November 8, 2016 /s/ Sebastian A. Hoeges

Law Office of Sebastian A Hoeges, PLLC

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