Fill in this information to identify your case:

Debtor 1 LeMar Allen Bowers

Debtor 2

(Spouse, if filing)

United States Bankruptcy Court for the: EASTERN DISTRICT OF VIRGINIA

Case number 20-34139 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 Business Owner Vice President

Employer's name Civitas Health Services, Inc. Civitas Health Services, Inc.

Employer's address 5663 S Laburnum Ave

Henrico, VA 23231

5663 S Laburnum Ave

Henrico, VA 23231

How long employed there? 12 years 8 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. $ 12,500.00 $ 9,167.00

3. Estimate and list monthly overtime pay. 3. +$ 0.00 +$ 0.00

4. Calculate gross Income. Add line 2 + line 3. 4. $ 12,500.00 $ 9,167.00

Official Form 106I Schedule I: Your Income page 1

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D Page 1 of 4
Debtor 1 LeMar Allen Bowers Case number (if known) 20-34139

For Debtor 1 For Debtor 2 or

non-filing spouse

Copy line 4 here 4. $ 12,500.00 $ 9,167.00

5. List all payroll deductions:

5a. Tax, Medicare, and Social Security deductions 5a. $ 2,771.00 $ 2,284.00

5b. Mandatory contributions for retirement plans 5b. $ 0.00 $ 0.00

5c. Voluntary contributions for retirement plans 5c. $ 0.00 $ 0.00

5d. Required repayments of retirement fund loans 5d. $ 0.00 $ 0.00

5e. Insurance 5e. $ 2,019.00 $ 0.00

5f. Domestic support obligations 5f. $ 0.00 $ 0.00

5g. Union dues 5g. $ 0.00 $ 0.00

5h. Other deductions. Specify: 5h.+ $ 0.00 + $ 0.00

6. Add the payroll deductions. Add lines 5a+5b+5c+5d+5e+5f+5g+5h. 6. $ 4,790.00 $ 2,284.00

7. Calculate total monthly take-home pay. Subtract line 6 from line 4. 7. $ 7,710.00 $ 6,883.00

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 $ 0.00

8b. Interest and dividends 8b. $ 0.00 $ 0.00

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 $ 0.00

8d. Unemployment compensation 8d. $ 0.00 $ 0.00

8e. Social Security 8e. $ 0.00 $ 0.00

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 $ 0.00

8g. Pension or retirement income 8g. $ 0.00 $ 0.00

8h. Other monthly income. Specify: 8h.+ $ 0.00 + $ 0.00

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

10. Calculate monthly income. Add line 7 + line 9. 10. $ 7,710.00 + $ 6,883.00 = $ 14,593.00

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.

12. $ 14,593.00

Write that amount on the Summary of Schedules and Statistical Summary of Certain Liabilities and Related Data, if it

applies

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

Case 19-34993-KRH Doc 175-4 Filed 12/11/20 Entered 12/11/20 18:51:35 Desc Ex

D Page 2 of 4
Fill in this information to identify your case:

Debtor 1 LeMar Allen Bowers Check if this is:

 An amended filing

Debtor 2  A supplement showing postpetition chapter

(Spouse, if filing) 13 expenses as of the following date:

United States Bankruptcy Court for the: EASTERN DISTRICT OF VIRGINIA MM / DD / YYYY

Case number 20-34139

(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 Household of 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. Daughter 12

 No

 Yes

Son 18

 No

 Yes

Son 20

 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. $ 3,683.00

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. $ 200.00

4d. Homeowner’s association or condominium dues 4d. $ 42.00

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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Debtor 1 LeMar Allen Bowers Case number (if known) 20-34139

6. Utilities:

6a. Electricity, heat, natural gas 6a. $ 500.00

6b. Water, sewer, garbage collection 6b. $ 100.00

6c. Telephone, cell phone, Internet, satellite, and cable services 6c. $ 500.00

6d. Other. Specify: Cell phones 6d. $ 500.00

7. Food and housekeeping supplies 7. $ 1,250.00

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

9. Clothing, laundry, and dry cleaning 9. $ 250.00

10. Personal care products and services 10. $ 200.00

11. Medical and dental expenses 11. $ 100.00

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

Do not include car payments. 12. $ 450.00

13. Entertainment, clubs, recreation, newspapers, magazines, and books 13. $ 250.00

14. Charitable contributions and religious donations 14. $ 100.00

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. $ 600.00

15d. Other insurance. Specify: Pet Insurance 15d. $ 85.00

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

Specify: Personal Property Taxes 16. $ 125.00

17. Installment or lease payments:

17a. Car payments for Vehicle 1 17a. $ 0.00

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

17c. Other. Specify: Spouse's Chapter 13 Plan Payment 17c. $ 2,000.00

17d. Other. Specify: Travel and lodging for personal matters 17d. $ 500.00

College Tuition and Reimbursement (Son) $ 650.00

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: Emergency Fund for household and auto repairs 21. +$ 1,000.00

22. Calculate your monthly expenses

22a. Add lines 4 through 21. $ 13,085.00

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. $ 13,085.00

23. Calculate your monthly net income.

23a. Copy line 12 (your combined monthly income) from Schedule I. 23a. $ 14,593.00

23b. Copy your monthly expenses from line 22c above. 23b. -$ 13,085.00

23c. Subtract your monthly expenses from your monthly income.

The result is your monthly net income. 23c. $ 1,508.00

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: Spouse's Chapter 13 plan payment increases to $2,925.00 in October 2021.

Official Form 106J Schedule J: Your Expenses page 2

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