( $31.00 fee required if adding or deleting pre-petition creditors, changing amounts owed or classification of

UNITED STATES BANKRUPTCY COURT

EASTERN DISTRICT OF VIRGINIA

In re

Case No.

Chapter

AMENDMENT COVER SHEET

Amendment(s) to the following petition, list(s), schedule(s) or statement(s) are transmitted herewith:

___ Involuntary/Voluntary Petition [Specify reason for amendment:_________________________________________]

Check if applicable: ___ Soc. Sec. No. amended. [If applicable: An original, signed Official Form 121 was

mailed/hand-delivered to the Clerk’s Office on__________________.*]

___ Summary of Your Assets and Liabilities (and Certain Statistical Information - Individuals Only)

___ Declaration (Individuals - Form 106Dec) (Non-Individuals - Form 202)

___ Schedule A/B - Property

___ Schedule C - The Property You Claim as Exempt

___ Schedule D – Creditors Who Hold Claims Secured by Property (See LBR 1009-1)

___ Schedule E/F Creditors Who Have Unsecured Claims (See LBR 1009-1)

debt.) Check applicable statement(s):

___ Creditor(s) added ___ Creditor(s) deleted

___ Change in amounts owed or classification of debt

___ No pre-petition creditors added/deleted, or amounts owed or classification of debt

changed. [Docket: Amended Schedule(s) and/or Statement(s), List(s)-NO

FEE)

___ Post-petition creditors added (Schedule of Unpaid Debts)

REMINDER: Conversion of Chapter 13 to Chapter 7 – only file Schedule of Unpaid Debts.

___ Schedule G - Executory Contracts and Unexpired Leases

___ Schedule H – Your Codebtors

___ Schedule I – Your Income

___ Schedule J – Your Expenses

[NOTE: The form “NOTICE TO CREDITOR(S) (RE AMENDMENT)” is still required when adding or deleting creditors.

*Amendment of debtor(s) Social Security Number requires that this cover sheet together with a completed Official Form 121 –

Statement About Your Social Security Numbers be electronically filed or submitted to the Clerk’s Office for “restricted” entry

of the amended Social Security Number into the case record.]

___ Statement of Financial Affairs

___ Statement of Intention for Individuals Filing Under Chapter 7

___ Chapter 11 List of Equity Security Holders

___ Chapter 11: The List of Creditors Who Have the 20 Largest Unsecured Claims Against You Who Are Not Insiders

___ Attorney’s Disclosure of Compensation

___ Other: ______________________________________________________________________________________

NOTICE OF AMENDMENT(S) TO AFFECTED PARTIES

Pursuant to Federal Rule of Bankruptcy Procedure 1009(a) and Local Rule 1009-1, I certify that notice of the filing of the

amendment(s) checked above has been given this date to the United States Trustee, the trustee in this case, and to any and all entities

affected by the amendment as follows: __________________________________________________________________________

_________________________________________________________________________________________________________.

Date: _________________________

_____________________________________________

State Bar No.:

Mailing Address:

[amendcs ver. 12/15] Telephone No.:

Clint Allen Draper

Alexandria Division

18-13346

13

District of Columbia Govt., c/o Professional Account Management, LLC, P.O. Box 37038,

Washington, DC 20013; ADT Security Systems, Inc., 1501 Yamato Road, Boca Rotan, FL 33431

October 18, 2018

/s/ Robert B. Easterling

VSB #15552

2217 Princess Anne Street Suite 100-2

Fredericksburg, Virginia 22401

(540) 373-5030

X

X

X

Debtor

Attorney for Debtor

Case 18-13346-KHK Doc 14-1 Filed 10/18/18 Entered 10/18/18 14:21:54 Desc

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