Fill in this information to identify your case:

United States Bankruptcy Court for the:

Eastern District of Virginia

Case number (If known): Chapter you are filing under:

Chapter 7

Chapter 11

Chapter 12

Chapter 13 Check if this is an

amended filing

Official Form 101

The bankruptcy forms use you and Debtor 1 to refer to a debtor filing alone. A married couple may file a bankruptcy case together—called a joint case—and in joint

cases, these forms use you to ask for information from both debtors. For example, if a form asks, “Do you own a car,” the answer would be yes if either debtor owns

a car. When information is needed about the spouses separately, the form uses Debtor 1 and Debtor 2 to distinguish between them. In joint cases, one of the

spouses must report information as Debtor 1 and the other as Debtor 2. The same person must be Debtor 1 in all of the forms.

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: Identify Yourself

1. Your full name

Write the name that is on your

government-issued picture

identification (for example, your

driver’s license or passport).

Bring your picture identification to

your meeting with the trustee.

About Debtor 1: About Debtor 2 (Spouse Only in a Joint Case):

Shikia

First name First name

Latasha

Middle name Middle name

Blair

Last name Last name

Suffix (Sr., Jr, II, III) Suffix (Sr., Jr, II, III)

2. All other names you have used

in the last 8 years

Include your married or maiden

names.

First name First name

Middle name Middle name

Last name Last name

First name First name

Middle name Middle name

Last name Last name

3. Only the last 4 digits of your

Social Security number or

federal Individual Taxpayer

Identification number

(ITIN)

xxx - xx - 1 7 4 1 xxx - xx -

OR OR

9xx - xx - 9xx - xx -

Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 1

❑✔

❑

❑

❑ ❑

Voluntary Petition for Individuals Filing for Bankruptcy 02/20

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 1 of 64
Debtor 1 Shikia Latasha Blair

First Name Middle Name Last Name

Case number (if known)

4. Any business names and

Employer Identification

Numbers (EIN) you have used

in the last 8 years

Include trade names and doing

business as names

About Debtor 1: About Debtor 2 (Spouse Only in a Joint Case):

I have not used any business names or EINs. I have not used any business names or EINs.

Business name Business name

Business name Business name

-

EIN

-

EIN

-

EIN

-

EIN

5. Where you live

If Debtor 2 lives at a different address:

2150 Sentry Falls Way #315

Number Street Number Street

Woodbridge, VA 22191

City State ZIP Code City State ZIP Code

Prince William

County County

If your mailing address is different from the one above, fill

it in here. Note that the court will send any notices to you at

this mailing address.

If Debtor 2's mailing address is different from yours, fill it

in here. Note that the court will send any notices to you at this

mailing address.

Number Street Number Street

P.O. Box P.O. Box

City State ZIP Code City State ZIP Code

6. Why you are choosing this

district to file for bankruptcy

Check one: Check one:

Over the last 180 days before filing this petition, I have

lived in this district longer than in any other district.

Over the last 180 days before filing this petition, I have

lived in this district longer than in any other district.

I have another reason. Explain.

(See 28 U.S.C. § 1408)

I have another reason. Explain.

(See 28 U.S.C. § 1408)

Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 2

❑✔ ❑

❑✔ ❑

❑ ❑

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 2 of 64
Debtor 1 Shikia Latasha Blair

First Name Middle Name Last Name

Case number (if known)

Part 2: Tell the Court About Your Bankruptcy Case

7. The chapter of the Bankruptcy

Code you are choosing to file

under

Check one. (For a brief description of each, see Notice Required by 11 U.S.C. § 342(b) for Individuals Filing for Bankruptcy

(Form 2010)). Also, go to the top of page 1 and check the appropriate box.

Chapter 7

Chapter 11

Chapter 12

Chapter 13

8. How you will pay the fee I will pay the entire fee when I file my petition. Please check with the clerk's office in your local court for more details

about how you may pay. Typically, if you are paying the fee yourself, you may pay with cash, cashier's check, or money

order. If your attorney is submitting your payment on your behalf, your attorney may pay with a credit card or check with

a pre-printed address.

I need to pay the fee in installments. If you choose this option, sign and attach the Application for Individuals to Pay

The Filing Fee in Installments (Official Form 103A).

I request that my fee be waived (You may request this option only if you are filing for Chapter 7. By law, a judge may,

but is not required to, waive your fee, and may do so only if your income is less than 150% of the official poverty line

that applies to your family size and you are unable to pay the fee in installments). If you choose this option, you must fill

out the Application to Have the Chapter 7 Filing Fee Waived (Official Form 103B) and file it with your petition.

9. Have you filed for bankruptcy

within the last 8 years?

No.

Yes. District When

MM / DD / YYYY

Case number

District When

MM / DD / YYYY

Case number

District When

MM / DD / YYYY

Case number

10. Are any bankruptcy cases

pending or being filed by a

spouse who is not filing this

case with you, or by a business

partner, or by an affiliate?

No.

Yes. Debtor Relationship to you

District When

MM / DD / YYYY

Case number, if known

Debtor Relationship to you

District When

MM / DD / YYYY

Case number, if known

11. Do you rent your residence?

No. Go to line 12.

Yes. Has your landlord obtained an eviction judgment against you?

No. Go to line 12.

Yes. Fill out Initial Statement About an Eviction Judgment Against You (Form 101A) and file it as part

of this bankruptcy petition.

Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 3

❑✔

❑

❑

❑

❑✔

❑

❑

❑✔

❑

❑✔

❑

❑

❑✔

❑✔

❑

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 3 of 64
Debtor 1 Shikia Latasha Blair

First Name Middle Name Last Name

Case number (if known)

Part 3: Report About Any Businesses You Own as a Sole Proprietor

12. Are you a sole proprietor of any

full- or part-time business?

A sole proprietorship is a business

you operate as an individual, and is

not a separate legal entity such as

a corporation, partnership, or LLC.

If you have more than one sole

proprietorship, use a separate

sheet and attach it to this petition.

No. Go to Part 4.

Yes. Name and location of business

Name of business, if any

Number Street

City State ZIP Code

Check the appropriate box to describe your business:

Health Care Business (as defined in 11 U.S.C. § 101(27A))

Single Asset Real Estate (as defined in 11 U.S.C. § 101(51B))

Stockbroker (as defined in 11 U.S.C. § 101(53A))

Commodity Broker (as defined in 11 U.S.C. § 101(6))

None of the above

13. Are you filing under Chapter 11

of the Bankruptcy Code and are

you a small business debtor?

For a definition of small business

debtor, see 11 U.S.C. § 101(51D).

If you are filing under Chapter 11, the court must know whether you are a small business debtor so that it can set appropriate

deadlines. If you indicate that you are a small business debtor, you must attach your most recent balance sheet, statement of

operations, cash-flow statement, and federal income tax return or if any of these documents do not exist, follow the procedure in

11 U.S.C. § 1116(1)(B).

No. I am not filing under Chapter 11.

No. I am filing under Chapter 11, but I am NOT a small business debtor according to the definition in the

Bankruptcy Code.

Yes. I am filing under Chapter 11, I am a small business debtor according to the definition in the Bankruptcy

Code, and I do not choose to proceed under Subchapter V of Chapter 11.

Yes. I am filing under Chapter 11, I am a small business debtor according to the definition in the Bankruptcy

Code, and I choose to proceed under Subchapter V of Chapter 11.

Part 4: Report if You Own or Have Any Hazardous Property or Any Property That Needs Immediate Attention

14. Do you own or have any

property that poses or is

alleged to pose a threat of

imminent and identifiable

hazard to public health or

safety? Or do you own any

property that needs immediate

attention?

For example, do you own

perishable goods, or livestock that

must be fed, or a building that

needs urgent repairs?

No.

Yes. What is the hazard?

If immediate attention is needed, why is it needed? 

Where is the property?

Number Street

City State ZIP Code

Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 4

❑✔

❑

❑

❑

❑

❑

❑

❑✔

❑

❑

❑

❑✔

❑

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 4 of 64
Debtor 1 Shikia Latasha Blair

First Name Middle Name Last Name

Case number (if known)

Part 5: Explain Your Efforts to Receive a Briefing About Credit Counseling

15. Tell the court whether you

have received a briefing

about credit counseling.

The law requires that you

receive a briefing about credit

counseling before you file for

bankruptcy. You must truthfully

check one of the following

choices. If you cannot do so, you

are not eligible to file.

If you file anyway, the court can

dismiss your case, you will lose

whatever filing fee you paid, and

your creditors can begin

collection activities again.

About Debtor 1: About Debtor 2 (Spouse Only in a Joint Case):

You must check one: You must check one:

I received a briefing from an approved credit counseling

agency within the 180 days before I filed this bankruptcy

petition, and I received a certificate of completion.

Attach a copy of the certificate and the payment plan, if

any, that you developed with the agency.

I received a briefing from an approved credit counseling

agency within the 180 days before I filed this bankruptcy

petition, and I received a certificate of completion.

Attach a copy of the certificate and the payment plan, if

any, that you developed with the agency.

I received a briefing from an approved credit counseling

agency within the 180 days before I filed this bankruptcy

petition, but I do not have a certificate of completion.

Within 14 days after you file this bankruptcy petition, you

MUST file a copy of the certificate and payment plan, if

any.

I received a briefing from an approved credit counseling

agency within the 180 days before I filed this bankruptcy

petition, but I do not have a certificate of completion.

Within 14 days after you file this bankruptcy petition, you

MUST file a copy of the certificate and payment plan, if

any.

I certify that I asked for credit counseling services from an

approved agency, but was unable to obtain those services

during the 7 days after I made my request, and exigent

circumstances merit a 30-day temporary waiver of the

requirement.

To ask for a 30-day temporary waiver of the requirement,

attach a separate sheet explaining what efforts you made

to obtain the briefing, why you were unable to obtain it

before you filed for bankruptcy, and what exigent

circumstances required you to file this case.

I certify that I asked for credit counseling services from an

approved agency, but was unable to obtain those services

during the 7 days after I made my request, and exigent

circumstances merit a 30-day temporary waiver of the

requirement.

To ask for a 30-day temporary waiver of the requirement,

attach a separate sheet explaining what efforts you made

to obtain the briefing, why you were unable to obtain it

before you filed for bankruptcy, and what exigent

circumstances required you to file this case.

Your case may be dismissed if the court is dissatisfied

with your reasons for not receiving a briefing before you

filed for bankruptcy.

Your case may be dismissed if the court is dissatisfied

with your reasons for not receiving a briefing before you

filed for bankruptcy.

If the court is satisfied with your reasons, you must still

receive a briefing within 30 days after you file.

You must file a certificate from the approved agency,

along with a copy of the payment plan you developed, if

any. If you do not do so, your case may be dismissed.

If the court is satisfied with your reasons, you must still

receive a briefing within 30 days after you file.

You must file a certificate from the approved agency,

along with a copy of the payment plan you developed, if

any. If you do not do so, your case may be dismissed.

Any extension of the 30-day deadline is granted only for

cause and is limited to a maximum of 15 days.

Any extension of the 30-day deadline is granted only for

cause and is limited to a maximum of 15 days.

I am not required to receive a briefing about credit

counseling because of:

Incapacity. I have a mental illness or a mental

deficiency that makes me incapable

of realizing or making rational

decisions about finances.

Disability. My physical disability causes me to

be unable to participate in a briefing

in person, by phone, or through the

internet, even after I reasonably tried

to do so.

Active duty. I am currently on active military duty in

a military combat zone.

I am not required to receive a briefing about credit

counseling because of:

Incapacity. I have a mental illness or a mental

deficiency that makes me incapable

of realizing or making rational

decisions about finances.

Disability. My physical disability causes me to

be unable to participate in a briefing

in person, by phone, or through the

internet, even after I reasonably tried

to do so.

Active duty. I am currently on active military duty in

a military combat zone.

If you believe you are not required to receive a briefing

about credit counseling, you must file a motion for waiver

of credit counseling with the court.

If you believe you are not required to receive a briefing

about credit counseling, you must file a motion for waiver

of credit counseling with the court.

Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 5

❑✔ ❑

❑ ❑

❑ ❑

❑

❑

❑

❑

❑

❑

❑

❑

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 5 of 64
Debtor 1 Shikia Latasha Blair

First Name Middle Name Last Name

Case number (if known)

Part 6: Answer These Questions for Reporting Purposes

16. What kind of debts do you

have?

16a. Are your debts 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.”

No. Go to line 16b.

Yes. Go to line 17.

16b. Are your debts primarily business debts? Business debts are debts that you incurred to obtain money for a

business or investment or through the operation of the business or investment.

No. Go to line 16c.

Yes. Go to line 17.

16c. State the type of debts you owe that are not consumer debts or business debts.

17. Are you filing under Chapter 7?

Do you estimate that after any

exempt property is excluded and

administrative expenses are paid

that funds will be available for

distribution to unsecured

creditors?

No. I am not filing under Chapter 7. Go to line 18.

Yes. I am filing under Chapter 7. Do you estimate that after any exempt property is excluded and administrative

expenses are paid that funds will be available to distribute to unsecured creditors?

No

Yes

18. How many creditors do you

estimate that you owe?

1-49

50-99

100-199

200-999

1,000-5,000

5,001-10,000

10,001-25,000

25,001-50,000 50,000-100,000 More than 100,000

19. How much do you estimate your

assets to be worth?

$0-$50,000

$50,001-$100,000

$100,001-$500,000

$500,001-$1 million

$1,000,001-$10 million

$10,000,001-$50 million

$50,000,001-$100 million

$100,000,001-$500 million

$500,000,001-$1 billion

$1,000,000,001-$10 billion

$10,000,000,001-$50 billion

More than $50 billion

20. How much do you estimate your

liabilities to be?

$0-$50,000

$50,001-$100,000

$100,001-$500,000

$500,001-$1 million

$1,000,001-$10 million

$10,000,001-$50 million

$50,000,001-$100 million

$100,000,001-$500 million

$500,000,001-$1 billion

$1,000,000,001-$10 billion

$10,000,000,001-$50 billion

More than $50 billion

Part 7: Sign Below

For you I have examined this petition, and I declare under penalty of perjury that the information provided is true and correct.

If I have chosen to file under Chapter 7, I am aware that I may proceed, if eligible, under Chapter 7, 11,12, or 13 of title 11, United States

Code. I understand the relief available under each chapter, and I choose to proceed under Chapter 7.

If no attorney represents me and I did not pay or agree to pay someone who is not an attorney to help me fill out this document, I have

obtained and read the notice required by 11 U.S.C. § 342(b).

I request relief in accordance with the chapter of title 11, United States Code, specified in this petition.

I understand 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/ Shikia Latasha Blair

Shikia Latasha Blair, Debtor 1

Executed on 03/09/2020

MM/ DD/ YYYY

Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 6

❑

❑✔

❑

❑

❑

❑✔

❑✔

❑

❑✔

❑

❑

❑

❑

❑

❑

❑ ❑ ❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑

❑

❑

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑

❑

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 6 of 64
Debtor 1 Shikia Latasha Blair

First Name Middle Name Last Name

Case number (if known)

For your attorney, if you are

represented by one

If you are not represented by an

attorney, you do not need to file this

page.

I, the attorney for the debtor(s) named in this petition, declare that I have informed the debtor(s) about eligibility to proceed

under Chapter 7, 11, 12, or 13 of title 11, United States Code, and have explained the relief available under each chapter for

which the person is eligible. I also certify that I have delivered to the debtor(s) the notice required by 11 U.S.C. § 342(b) and,

in a case in which § 707(b)(4)(D) applies, certify that I have no knowledge after an inquiry that the information in the schedules

filed with the petition is incorrect.

✘ /s/ Robert R. Weed

Robert R. Weed, Attorney

Date 03/09/2020

MM / DD / YYYY

Robert R. Weed

Printed name

Law Offices Of Robert Weed

Firm name

13800 Coppermine Rd # 183

Number Street

Herndon

City

VA

State

20171-6163

ZIP Code

Contact phone (703) 335-7793 Email address robertweed@robertweed.com

24646

Bar number

VA

State

Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 7

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 7 of 64
Street address, if available, or other

description

City State ZIP Code

County

Fill in this information to identify your case and this filing:

Debtor 1 Shikia Latasha Blair

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

Case number

Check if this is an

amended filing

Official Form 106A/B

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?

What is the property? Check all that apply.

Single-family home

Duplex or multi-unit building

Condominium or cooperative

Manufactured or mobile home

Land

Investment property

Timeshare

Other 

Who has an interest in the property? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Do not deduct secured claims or exemptions. Put the

amount of any secured claims on Schedule D:

Creditors Who Have Claims Secured by Property.

Current value of the

entire property?

Current value of the

portion you own?

Describe the nature of your ownership interest (such

as fee simple, tenancy by the entireties, or a life

estate), if known.

Check if this is community property

(see instructions)

2. Add the dollar value of the portion you own for all of your entries from Part 1, including any entries for pages

you have attached for Part 1. Write that number here......................................................................................................... ➜ $0.00

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

❑

Schedule A/B: Property 12/15

❑✔

❑

❑

❑

❑

❑

❑

❑

❑

❑

❑

❑

❑

❑

❑

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 8 of 64
3.1 Make:

Model:

Year:

Approximate mileage:

Kia

Optima

2018

30000

Other information:

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.

No

Yes. Describe........

Bunkbed, desks, dressers

No

Yes. Describe........

Electronics TV, computer, phone

No

Yes. Describe........

Debtor 1 Shikia Latasha Blair

First Name Middle Name Last Name

Case number (if known)

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

Who has an interest in the property? 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 is community property (see

instructions)

Do not deduct secured claims or exemptions. Put the

amount of any secured claims on Schedule D:

Creditors Who Have Claims Secured by Property.

Current value of the

entire property?

$9,270.00

Current value of the

portion you own?

$9,270.00

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 pages

you have attached for Part 2. Write that number here......................................................................................................... ➜ $9,270.00

Part 3: Describe Your Personal and Household Items

6. Household goods and furnishings

Examples: Major appliances, furniture, linens, china, kitchenware

$400.00

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

$850.00

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

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

❑

❑✔

❑✔

❑

❑

❑

❑

❑✔

❑

❑

❑✔

❑

❑✔

❑✔

❑

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 9 of 64
Debtor 1 Shikia Latasha Blair

First Name Middle Name Last Name

Case number (if known)

9.

No

Yes. Describe........

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

10.

No

Yes. Describe........

Firearms

Examples: Pistols, rifles, shotguns, ammunition, and related equipment

11.

No

Yes. Describe........

Clothes

Clothes

Examples: Everyday clothes, furs, leather coats, designer wear, shoes, accessories

$200.00

12.

No

Yes. Describe........

Jewelry

Jewelry

Examples: Everyday jewelry, costume jewelry, engagement rings, wedding rings, heirloom jewelry, watches, gems, gold, silver

$100.00

13.

No

Yes. Describe........

Non-farm animals

Examples: Dogs, cats, birds, horses

14.

No

Yes. Describe........

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

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........................................................................................................................................➜ $1,550.00

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

Yes........................................................................................................................................................ Cash.............. $5.00

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

❑✔

❑

❑✔

❑

❑

❑✔

❑

❑✔

❑✔

❑

❑✔

❑

❑

❑✔

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 10 of 64
Debtor 1 Shikia Latasha Blair

First Name Middle Name Last Name

Case number (if known)

17.

No

Yes..................

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.

Institution name:

17.1. Checking account: Meta Bank 2110 $200.00

17.2. Checking account: USAA 9358 $350.00

17.3. Savings account: USAA 9366 $14.61

17.4. Savings account:

17.5. Certificates of deposit:

17.6. Other financial account:

17.7. Other financial account:

17.8. Other financial account:

17.9. Other financial account:

18.

No

Yes..................

Bonds, mutual funds, or publicly traded stocks

Examples: Bond funds, investment accounts with brokerage firms, money market accounts

Institution or issuer name:

19.

No

Yes. Give specific

information about

them...................

Non-publicly traded stock and interests in incorporated and unincorporated businesses, including an interest in

an LLC, partnership, and joint venture

Name of entity: % of ownership:

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

❑

❑✔

❑✔

❑

❑✔

❑

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 11 of 64
Debtor 1 Shikia Latasha Blair

First Name Middle Name Last Name

Case number (if known)

20.

No

Yes. Give specific

information about

them...................

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.

Issuer name:

21.

No

Yes. List each account

separately.

Retirement or pension accounts

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

Type of account: Institution name:

401(k) or similar plan:

Pension plan:

IRA:

Retirement account:

Keogh:

Additional account:

22.

No

Yes.....................

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

Institution name or individual:

Electric:

Gas:

Heating oil:

Security deposit on rental unit: 

Prepaid rent:

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

❑✔

❑

❑✔

❑

❑✔

❑

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 12 of 64
Debtor 1 Shikia Latasha Blair

First Name Middle Name Last Name

Case number (if known)

Telephone:

Water:

Rented furniture:

Other:

23.

No

Yes.....................

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

Issuer name and description:

24.

No

Yes.....................

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).

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

25.

No

Yes. Give specific

information about them....

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

benefit

26.

No

Yes. Give specific

information about them....

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

Examples: Internet domain names, websites, proceeds from royalties and licensing agreements

27.

No

Yes. Give specific

information about them....

Licenses, franchises, and other general intangibles

Examples: Building permits, exclusive licenses, cooperative association holdings, liquor licenses,

professional licenses

Money or property owed to you? Current value of the

portion you own?

Do not deduct secured

claims or exemptions.

Official Form 106A/B Schedule A/B: Property page 6

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 13 of 64
Debtor 1 Shikia Latasha Blair

First Name Middle Name Last Name

Case number (if known)

28.

No

Yes. Give specific information about

them, including whether you

already filed the returns and the

tax years.......................

Federal:

State:

Local:

Tax refunds owed to you

2019 | Come and gone unknown

29. Family support

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

No

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

Alimony:

Maintenance:

Support:

Divorce settlement:

Property settlement:

Back child support $3,000.00

30.

No

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

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

31.

No

Yes. Name the insurance company

of each policy and list its value.... Company name: Beneficiary: Surrender or refund value:

term life through work $1.00

Interests in insurance policies

Examples: Health, disability, or life insurance; health savings account (HSA); credit, homeowner’s, or renter’s insurance

32.

No

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

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.

33.

No

Yes. Describe each claim................

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

Official Form 106A/B Schedule A/B: Property page 7

❑

❑✔

❑

❑✔

❑✔

❑

❑

❑✔

❑✔

❑

❑✔

❑

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 14 of 64
Debtor 1 Shikia Latasha Blair

First Name Middle Name Last Name

Case number (if known)

34.

No

Yes. Describe each claim................

Other contingent and unliquidated claims of every nature, including counterclaims of the debtor and rights

to set off claims

35.

No

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

Any financial assets you did not already list

36.

$3,570.61

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..................................................................................................................................➜

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.

 Yes. Go to line 38.

Current value of the

portion you own?

Do not deduct secured

claims or exemptions.

38.

No

Yes. Describe........

Accounts receivable or commissions you already earned

39. Office equipment, furnishings, and supplies

Examples: Business-related computers, software, modems, printers, copiers, fax machines, rugs, telephones, desks, chairs, electronic devices

No

Yes. Describe........

40.

No

Yes. Describe........

Machinery, fixtures, equipment, supplies you use in business, and tools of your trade

41.

No

Yes. Describe........

Inventory

42.

No

Yes. Describe........

Interests in partnerships or joint ventures

Name of entity: % of ownership:

Official Form 106A/B Schedule A/B: Property page 8

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 15 of 64
Debtor 1 Shikia Latasha Blair

First Name Middle Name Last Name

Case number (if known)

%

43.

No

Yes. Describe........

Customer lists, mailing lists, or other compilations

No

Yes. Do your lists include personally identifiable information (as defined in 11 U.S.C. § 101(41A))?

44.

No

Yes. Give specific

information.........

Any business-related property you did not already list

45.

$0.00

Add the dollar value of all of your entries from Part 5, including any entries for pages you have attached

for Part 5. Write that number here.................................................................................................................................➜

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.

Current value of the

portion you own?

Do not deduct secured

claims or exemptions.

47.

No

Yes.........................

Farm animals

Examples: Livestock, poultry, farm-raised fish

48.

No

Yes. Give specific

information.............

Crops—either growing or harvested

49.

No

Yes..........................

Farm and fishing equipment, implements, machinery, fixtures, and tools of trade

50.

No

Yes..........................

Farm and fishing supplies, chemicals, and feed

Official Form 106A/B Schedule A/B: Property page 9

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 16 of 64
Debtor 1 Shikia Latasha Blair

First Name Middle Name Last Name

Case number (if known)

51.

No

Yes. Give specific

information.............

Any farm- and commercial fishing-related property you did not already list

52.

$0.00

Add the dollar value of all of your entries from Part 6, including any entries for pages you have attached

for Part 6. Write that number here...................................................................................................................................➜

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

53.

No

Yes. Give specific

information.............

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

Examples: Season tickets, country club membership

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 $9,270.00

57. Part 3: Total personal and household items, line 15 $1,550.00

58. Part 4: Total financial assets, line 36 $3,570.61

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.............. $14,390.61 Copy personal property total➜ + $14,390.61

63. Total of all property on Schedule A/B. Add line 55 + line 62................................................................................................. $14,390.61

Official Form 106A/B Schedule A/B: Property page 10

❑✔

❑

❑✔

❑

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 17 of 64
$400.00

100% of fair market value, up to

any applicable statutory limit

Va. Code Ann. § 34-26(4a)

$850.00

100% of fair market value, up to

any applicable statutory limit

Va. Code Ann. § 34-26(4a)

Fill in this information to identify your case:

Debtor 1 Shikia Latasha Blair

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

Case number

(if known)

Check if this is an

amended filing

Official Form 106C

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

Brief description:

Bunkbed, desks, dressers

Line from

Schedule A/B: 6

$400.00

Brief description:

Electronics TV, computer, phone

Line from

Schedule A/B: 7

$850.00

3. Are you claiming a homestead exemption of more than $170,350?

(Subject to adjustment on 4/01/22 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 1 of 2

❑

Schedule C: The Property You Claim as Exempt 04/19

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑

❑

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 18 of 64
$200.00

100% of fair market value, up to

any applicable statutory limit

Va. Code Ann. § 34-26(4)

$100.00

100% of fair market value, up to

any applicable statutory limit

Va. Code Ann. § 34-26(1a)

$5.00

100% of fair market value, up to

any applicable statutory limit

Va. Code Ann. § 34-4

$200.00

100% of fair market value, up to

any applicable statutory limit

Va. Code Ann. § 34-4

$350.00

100% of fair market value, up to

any applicable statutory limit

Va. Code Ann. § 34-4

$14.61

100% of fair market value, up to

any applicable statutory limit

Va. Code Ann. § 34-4

$1.00

100% of fair market value, up to

any applicable statutory limit

Va. Code Ann. §§ 38.2-3339

Debtor 1 Shikia Latasha Blair

First Name Middle Name Last Name

Case number (if known)

Part 2: Additional Page

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

Brief description:

Clothes

Line from

Schedule A/B: 11

$200.00

Brief description:

Jewelry

Line from

Schedule A/B: 12

$100.00

Brief description:

Cash

Line from

Schedule A/B: 16

$5.00

Brief description:

Meta Bank 2110

Checking account

Line from

Schedule A/B: 17

$200.00

Brief description:

USAA 9358

Checking account

Line from

Schedule A/B: 17

$350.00

Brief description:

USAA 9366

Savings account

Line from

Schedule A/B: 17

$14.61

Brief description:

term life through work

Line from

Schedule A/B: 31

$1.00

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

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 19 of 64
Fill in this information to identify your case:

Debtor 1 Shikia Latasha Blair

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

Case number

(if known)

Check if this is an

amended filing

Official Form 106D

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 Virginia Credit Union

Creditor's Name

7500 Boulders View Drive

Number Street

Richmond, VA 23225

City State ZIP Code

Who owes 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 relates to a

community debt

Date debt was incurred

Describe the property that secures the claim:

2018 Kia Optima

As of the date you file, the claim is: Check all that apply.

Contingent

Unliquidated

Disputed

Nature of lien. Check all that apply.

An agreement you made (such as mortgage or

secured car loan)

Statutory lien (such as tax lien, mechanic's lien)

Judgment lien from a lawsuit

Other (including a right to offset)

Last 4 digits of account number

$27,386.00 $9,270.00 $18,116.00

Add the dollar value of your entries in Column A on this page. Write that number here: $27,386.00

Official Form 106D Schedule D: Creditors Who Have Claims Secured by Property page 1 of 2

❑

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

❑

❑✔

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

❑

❑

❑

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 20 of 64
Part 1:

Additional Page

After listing any entries on this page, number them beginning with

2.3, followed by 2.4, and so forth.

Debtor 1 Shikia Latasha Blair

First Name Middle Name Last Name

Case number (if known)

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

2.2

Creditor's Name

Number Street

City State ZIP Code

Who owes 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 relates to a

community debt

Date debt was incurred

Describe the property that secures the claim:

As of the date you file, the claim is: Check all that apply.

Contingent

Unliquidated

Disputed

Nature of lien. Check all that apply.

An agreement you made (such as mortgage or

secured car loan)

Statutory lien (such as tax lien, mechanic's lien)

Judgment lien from a lawsuit

Other (including a right to offset)

Last 4 digits of account number

Add the dollar value of your entries in Column A on this page. Write that number here: $0.00

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

here:

$27,386.00

Official Form 106D Additional Page of Schedule D: Creditors Who Have Claims Secured by Property page 2 of 2

❑

❑

❑

❑

❑

❑

❑

❑

❑

❑

❑

❑

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 21 of 64
Fill in this information to identify your case:

Debtor 1 Shikia Latasha Blair

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

Case number

(if known)

Check if this is an

amended filing

Official Form 106E/F

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 Hold 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. 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

Priority Creditor's Name

Number Street

City State ZIP Code

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

Last 4 digits of account number

When was the debt incurred?

As of the date you file, the claim is: Check all that

apply.

Contingent

Unliquidated

Disputed

Type of PRIORITY unsecured claim:

Domestic support obligations

Taxes and certain other debts you owe the

government

Claims for death or person injury while you were

intoxicated

Other. Specify

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 1 of 11

❑

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

❑✔

❑

❑

❑

❑

❑

❑

❑

❑

❑

❑

❑

❑

❑

❑

❑

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 22 of 64
Debtor 1 Shikia Latasha Blair

First Name Middle Name Last Name

Case number (if known)

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

4.1 Apple FCU

Nonpriority Creditor's Name

4097 Monument Corner Dr.

Number Street

Fairfax, VA 22030

City State ZIP Code

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

Remarks: barred by statute of limitations

Last 4 digits of account number

When was the debt incurred?

As of the date you file, the claim is: Check all that apply.

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

Other. Specify

Credit Card

$5,000.00

4.2 Autotrakk

Nonpriority Creditor's Name

1500 Sycamore Rd

Number Street

Montoursville, PA 17754-9303

City State ZIP Code

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

Remarks: Car lease deficiency

Last 4 digits of account number

When was the debt incurred?

As of the date you file, the claim is: Check all that apply.

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

Other. Specify

Misc

$8,851.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 2 of 11

❑

❑✔

❑✔

❑

❑

❑

❑

❑✔

❑

❑

❑

❑✔

❑

❑

❑

❑✔

❑✔

❑

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 23 of 64
Debtor 1 Shikia Latasha Blair

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

After listing any entries on this page, number them beginning with 4.5, followed by 4.6, and so forth. Total claim

4.3 Capital One

Nonpriority Creditor's Name

PO Box 30285

Number Street

Salt Lake City, UT 84130

City State ZIP Code

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

Remarks: Walmart Card

Last 4 digits of account number

When was the debt incurred?

As of the date you file, the claim is: Check all that apply.

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

Other. Specify

Credit Card

$180.00

4.4 CashnetUSA

Nonpriority Creditor's Name

175 West Jackson St 1000

Number Street

Chicago, IL 60604

City State ZIP Code

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

Remarks: charges illegal interest

Last 4 digits of account number

When was the debt incurred?

As of the date you file, the claim is: Check all that apply.

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

Other. Specify

Pay Day Loan

$960.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 3 of 11

❑✔

❑

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

❑✔

❑

❑

❑

❑

❑✔

❑

❑

❑

❑✔

❑

❑

❑

❑✔

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 24 of 64
Debtor 1 Shikia Latasha Blair

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

After listing any entries on this page, number them beginning with 4.5, followed by 4.6, and so forth. Total claim

4.5 Comenity Bank/Victorias Secret

Nonpriority Creditor's Name

PO Box 182273

Number Street

Columbus, OH 43218

City State ZIP Code

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

Last 4 digits of account number

When was the debt incurred?

As of the date you file, the claim is: Check all that apply.

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

Other. Specify

Credit Card

$317.00

4.6 Dept of Ed/Navient

Nonpriority Creditor's Name

PO Box 9635

Number Street

Wilkes Barre, PA 18773

City State ZIP Code

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

Last 4 digits of account number

When was the debt incurred?

As of the date you file, the claim is: Check all that apply.

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

Other. Specify

Student Loans

$4,543.00

4.7 Dept of Ed/Navient

Nonpriority Creditor's Name

123 Justison St 3rd Flr

Number Street

Wilmington, DE 19801

City State ZIP Code

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

Last 4 digits of account number

When was the debt incurred?

As of the date you file, the claim is: Check all that apply.

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

Other. Specify

Student Loans

$7,820.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 4 of 11

❑✔

❑

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

❑✔

❑

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

❑✔

❑

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 25 of 64
Debtor 1 Shikia Latasha Blair

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

After listing any entries on this page, number them beginning with 4.5, followed by 4.6, and so forth. Total claim

4.8 Dept of Ed/Navient

Nonpriority Creditor's Name

123 Justison St 3rd Flr

Number Street

Wilmington, DE 19801

City State ZIP Code

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

Remarks: total of 11 accounts

Last 4 digits of account number

When was the debt incurred?

As of the date you file, the claim is: Check all that apply.

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

Other. Specify

Student Loans

$45,803.00

4.9 GEICO Corporate Office

Nonpriority Creditor's Name

5260 Western Ave

Number Street

Chevy Chase, MD 20815

City State ZIP Code

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

Last 4 digits of account number

When was the debt incurred?

As of the date you file, the claim is: Check all that apply.

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

Other. Specify

Misc

$424.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 5 of 11

❑✔

❑

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

❑✔

❑

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 26 of 64
Debtor 1 Shikia Latasha Blair

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

After listing any entries on this page, number them beginning with 4.5, followed by 4.6, and so forth. Total claim

4.10 Grand Canyon University

Nonpriority Creditor's Name

3300 W Camelback Rd

Number Street

Phoenix, AZ 85017-3030

City State ZIP Code

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

Remarks: Barred by limitations

Last 4 digits of account number

When was the debt incurred?

As of the date you file, the claim is: Check all that apply.

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

Other. Specify

Misc

$1,126.00

4.11 Mary Washington Healthcare/Stafford Hosp

Nonpriority Creditor's Name

2300 Fall Hill Ave. 101

Number Street

Fredericksburg, VA 22401

City State ZIP Code

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

Last 4 digits of account number

When was the debt incurred?

As of the date you file, the claim is: Check all that apply.

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

Other. Specify

Medical

$1,164.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 6 of 11

❑✔

❑

❑

❑

❑

❑✔

❑

❑

❑

❑✔

❑

❑

❑

❑✔

❑✔

❑

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 27 of 64
Debtor 1 Shikia Latasha Blair

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

After listing any entries on this page, number them beginning with 4.5, followed by 4.6, and so forth. Total claim

4.12 Navy Federal Credit Union

Nonpriority Creditor's Name

c/o Mary McDuffie, President & CEO

820 Follin Lane

Number Street

Vienna, VA 22180

City State ZIP Code

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

Last 4 digits of account number

When was the debt incurred?

As of the date you file, the claim is: Check all that apply.

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

Other. Specify

$999.00

4.13 Pentagon FCU

Nonpriority Creditor's Name

PO Box 456

Number Street

Alexandria, VA 22313

City State ZIP Code

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

Last 4 digits of account number

When was the debt incurred?

As of the date you file, the claim is: Check all that apply.

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

Other. Specify

Credit Card

$5,628.00

4.14 Santander

Nonpriority Creditor's Name

PO Box 961245

Number Street

Fort Worth, TX 76161

City State ZIP Code

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

Last 4 digits of account number

When was the debt incurred?

As of the date you file, the claim is: Check all that apply.

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

Other. Specify

Loan

$8,903.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 7 of 11

❑✔

❑

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

❑✔

❑

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

❑✔

❑

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 28 of 64
Debtor 1 Shikia Latasha Blair

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

After listing any entries on this page, number them beginning with 4.5, followed by 4.6, and so forth. Total claim

4.15 The Bank of Missouri

Nonpriority Creditor's Name

Po Box 4499

Number Street

Beaverton , OR 97076

City State ZIP Code

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

Last 4 digits of account number

When was the debt incurred?

As of the date you file, the claim is: Check all that apply.

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

Other. Specify

Credit Card

$425.00

4.16 Virginia Credit Union

Nonpriority Creditor's Name

7500 Boulders View Drive

Number Street

Richmond, VA 23225

City State ZIP Code

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

Last 4 digits of account number

When was the debt incurred?

As of the date you file, the claim is: Check all that apply.

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

Other. Specify

Loan

$4,611.00

4.17 Webbank/Fingerhut

Nonpriority Creditor's Name

6250 Ridgewood Rd

Number Street

Saint Cloud, MN 56303-0820

City State ZIP Code

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

Last 4 digits of account number

When was the debt incurred?

As of the date you file, the claim is: Check all that apply.

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

Other. Specify

Credit Card

$388.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 8 of 11

❑✔

❑

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

❑✔

❑

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

❑✔

❑

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 29 of 64
Debtor 1 Shikia Latasha Blair

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

After listing any entries on this page, number them beginning with 4.5, followed by 4.6, and so forth. Total claim

4.18 Why not Lease

Nonpriority Creditor's Name

1750 Elm St

Number Street

Manchester, NH 03104-2907

City State ZIP Code

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

Remarks: Disputing illegal interest rate

Last 4 digits of account number

When was the debt incurred?

As of the date you file, the claim is: Check all that apply.

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

Other. Specify

Misc

$1,000.00

4.19 Zoca Loans

Nonpriority Creditor's Name

PO Box 1147

Number Street

Mission, SD 57555

City State ZIP Code

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

Remarks: charges illegal interest

Last 4 digits of account number

When was the debt incurred?

As of the date you file, the claim is: Check all that apply.

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

Other. Specify

Pay Day Loan

$1,123.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 9 of 11

❑✔

❑

❑

❑

❑

❑✔

❑

❑

❑

❑✔

❑

❑

❑

❑✔

❑✔

❑

❑

❑

❑

❑✔

❑

❑

❑

❑✔

❑

❑

❑

❑✔

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 30 of 64
Debtor 1 Shikia Latasha Blair

First Name Middle Name Last Name

Case number (if known)

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.

Jormandy LLC.

Name

6363 Center Drive Bldg 6, Suite 203

Number Street

Norfolk, VA 23502

City State ZIP Code

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

Line 4.18 of (Check one): Part 1: Creditors with Priority Unsecured Claims

Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number

Prince William GDC

Name

9311 Lee Ave

Number Street

Manassas, VA 20110-5555

City State ZIP Code

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

Line 4.18 of (Check one): Part 1: Creditors with Priority Unsecured Claims

Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number

R.A. Rogers

Name

PO Box 3302

Number Street

Crofton, MD 21114

City State ZIP Code

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

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

Name

Number Street

City State ZIP Code

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

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

Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 10 of 11

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 31 of 64
Debtor 1 Shikia Latasha Blair

First Name Middle Name Last Name

Case number (if known)

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

Total claims

from Part 1

6a. Domestic support obligations 6a. $0.00

6b. Taxes and certain other debts you owe the

government

6b. $0.00

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. Add lines 6a through 6d. 6e. $0.00

Total claim

Total claims

from Part 2

6f. Student loans 6f. $0.00

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. + $99,265.00

6j. Total. Add lines 6f through 6i. 6j. $99,265.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 11 of 11

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 32 of 64
Fill in this information to identify your case:

Debtor 1 Shikia Latasha Blair

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

Case number

(if known)

Check if this is an

amended filing

Official Form 106G

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 contracts or leases are listed on Schedule A/B: Property (Official Form 106A/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 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

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

❑

Schedule G: Executory Contracts and Unexpired Leases 12/15

❑✔

❑

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 33 of 64
Fill in this information to identify your case:

Debtor 1 Shikia Latasha Blair

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

Case number

(if known)

Check if this is an

amended filing

Official Form 106H

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?

 No

 Yes. In which community state or territory did you live? . Fill in the name and current address of that person.

Name

Number Street

City State ZIP Code

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 Column 2: The creditor to whom you owe the debt

Check all schedules that apply:

3.1

Name

Number Street

City State ZIP Code

 Schedule D, line 

 Schedule E/F, line 

 Schedule G, line 

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

❑

Schedule H: Your Codebtors 12/15

❑✔

❑

❑✔

❑

❑

❑

❑

❑

❑

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 34 of 64
Check if this is:

 An amended filing

A supplement showing postpetition

chapter 13 income as of the following date:

MM / DD / YYYY

Fill in this information to identify your case:

Debtor 1 Shikia Latasha Blair

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

Case number

(if known)

Official Form 106I

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

Occupation

Employer's name

Employer's address

Employed Not Employed

Processor

Dominion National

Number Street

City State Zip Code

Employed Not Employed

Number Street

City State Zip Code

How long employed there? 4 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. $4,559.60 $0.00

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

4. Calculate gross income. Add line 2 + line 3. 4. $4,559.60 $0.00

Official Form 106I Schedule I: Your Income page 1

❑

❑

Schedule I: Your Income 12/15

❑✔ ❑ ❑ ❑

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 35 of 64
Debtor 1 Shikia Latasha Blair

First Name Middle Name Last Name

Case number (if known)

For Debtor 1 For Debtor 2 or

non-filing spouse

Copy line 4 here....................................................................................➔ 4. $4,559.60 $0.00

5. List all payroll deductions:

5a. Tax, Medicare, and Social Security deductions

5b. Mandatory contributions for retirement plans

5c. Voluntary contributions for retirement plans

5d. Required repayments of retirement fund loans

5e. Insurance

5f. Domestic support obligations

5g. Union dues

5h. Other deductions. Specify: 

5a.

5b.

5c.

5d.

5e.

5f.

5g.

5h.

$535.34

$0.00

$0.00

$0.00

$111.96

$0.00

$0.00

+ $0.00

$0.00

$0.00

$0.00

$0.00

$0.00

$0.00

$0.00

+ $0.00

6. Add the payroll deductions. Add lines 5a + 5b + 5c + 5d + 5e +5f + 5g + 5h. 6. $647.30 $0.00

7. Calculate total monthly take-home pay. Subtract line 6 from line 4. 7. $3,912.30 $0.00

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. $400.00 $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. $400.00 $0.00

10. Calculate monthly income. Add line 7 + line 9.

Add the entries in line 10 for Debtor 1 and Debtor 2 or non-filing spouse 10. $4,312.30 + $0.00 = $4,312.30

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 Your Assets and Liabilities and Certain Statistical Information, if it applies 12. $4,312.30

Combined

monthly income

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

 No.

 Yes. Explain: 

Income hourly based tends to drop in spring; child support recently stopped.

Official Form 106I Schedule I: Your Income page 2

❑

❑✔

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 36 of 64
Check if this is:

 An amended filing

A supplement showing postpetition

chapter 13 income as of the following date:

MM / DD / YYYY

Do you have dependents?

Do not list Debtor 1 and

Debtor 2.

Do not state the dependents' names.

 No

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?

Child 20 No. Yes.

Child 11 No. Yes.

Child 7 No. Yes.

 No. Yes.

 No. Yes.

Fill in this information to identify your case:

Debtor 1 Shikia Latasha Blair

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

Case number

(if known)

Official Form 106J

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.

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.

If not included in line 4:

4a. Real estate taxes

4b. Property, homeowner's, or renter's insurance

4c. Home maintenance, repair, and upkeep expenses

4d. Homeowner's association or condominium dues

4.

4a.

4b.

4c.

4d.

$1,000.00

$0.00

$18.00

$0.00

$0.00

Official Form 106J Schedule J: Your Expenses page 1

❑

❑

Schedule J: Your Expenses 12/15

❑✔

❑

❑

❑

❑

❑✔

❑✔ ❑

❑ ❑✔

❑ ❑✔

❑ ❑

❑ ❑

❑✔

❑

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 37 of 64
Debtor 1 Shikia Latasha Blair

First Name Middle Name Last Name

Case number (if known)

Your expenses

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

6. Utilities:

6a. Electricity, heat, natural gas

6b. Water, sewer, garbage collection

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

6d. Other. Specify: 

6a.

6b.

6c.

6d.

$250.00

$36.00

$190.00

$0.00

7. Food and housekeeping supplies 7. $950.00

8. Childcare and children’s education costs 8. $200.00

9. Clothing, laundry, and dry cleaning 9. $150.00

10. Personal care products and services 10. $50.00

11. Medical and dental expenses 11. $220.00

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

Do not include car payments. 12. $225.00

13. Entertainment, clubs, recreation, newspapers, magazines, and books 13. $120.00

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

15b. Health insurance

15c. Vehicle insurance

15d. Other insurance. Specify: 

15a.

15b.

15c.

15d.

$0.00

$0.00

$115.00

$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

17b. Car payments for Vehicle 2

17c. Other. Specify: 

17d. Other. Specify: 

17a.

17b.

17c.

17d.

$531.00

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.

Specify: 19. $0.00

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

20b. Real estate taxes

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

20d. Maintenance, repair, and upkeep expenses

20e. Homeowner’s association or condominium dues

20a.

20b.

20c.

20d.

20e.

$0.00

$0.00

$0.00

$0.00

$0.00

Official Form 106J Schedule J: Your Expenses page 2

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 38 of 64
Debtor 1 Shikia Latasha Blair

First Name Middle Name Last Name

Case number (if known)

21. Other. Specify: 21. + $0.00

22. Calculate your monthly expenses.

22a. Add lines 4 through 21.

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.

22a.

22b.

22c.

$4,055.00

$0.00

$4,055.00

23. Calculate your monthly net income.

23a. Copy line 12 (your combined monthly income) from Schedule I.

23b. Copy your monthly expenses from line 22c above.

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

The result is your monthly net income.

23a.

23b.

23c.

$4,312.30

– $4,055.00

$257.30

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.

None

Official Form 106J Schedule J: Your Expenses page 3

❑✔

❑

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 39 of 64
Debtor 1 Shikia Latasha Blair

First Name Middle Name Last Name

Case number (if known)

Amount

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

cell phone $65.00

cable $125.00

Official Form 106J Schedule J: Your Expenses page 4

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 40 of 64
Fill in this information to identify your case:

Debtor 1 Shikia Latasha Blair

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

Case number

(if known)

Check if this is an

amended filing

Official Form 106Sum

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...........................................................................................................

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

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

$0.00

$14,390.61

$14,390.61

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.......

$27,386.00

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......................................

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

$0.00

+ $99,265.00

Your total liabilities $126,651.00

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..........................................................................................

$4,312.30

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

Copy your monthly expenses from line 22c of Schedule J.................................................................................. $4,055.00

Official Form 106Sum Summary of Your Assets and Liabilities and Certain Statistical Information page 1 of 2

❑

Summary of Your Assets and Liabilities and Certain Statistical

Information 12/15

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 41 of 64
Debtor 1 Shikia Latasha Blair

First Name Middle Name Last Name

Case number (if known)

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.

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. $5,146.00

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.) $0.00

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. $0.00

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

❑

❑✔

❑✔

❑

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 42 of 64
Fill in this information to identify your case:

Debtor 1 Shikia Latasha Blair

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

Case number

(if known)

Check if this is an

amended filing

Official Form 106Dec

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.

✘ /s/ Shikia Latasha Blair

Shikia Latasha Blair, Debtor 1

Date 03/09/2020

MM/ DD/ YYYY

✘

Date 

MM/ DD/ YYYY

Official Form 106Dec Declaration About an Individual Debtor's Schedules

❑

Declaration About an Individual Debtor's Schedules 12/15

❑✔

❑

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 43 of 64
Fill in this information to identify your case:

Debtor 1 Shikia Latasha Blair

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

Case number

(if known)

Check if this is an

amended filing

Official Form 107

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: Dates Debtor 1 lived

there

Debtor 2: Dates Debtor 2 lived

there

Number Street

City State ZIP Code

From 

To

Same as Debtor 1

Number Street

City State ZIP Code

Same as Debtor 1

From 

To

Number Street

City State ZIP Code

From 

To

Same as Debtor 1

Number Street

City State ZIP Code

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).

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

❑

Statement of Financial Affairs for Individuals Filing for Bankruptcy 04/19

❑

❑✔

❑✔

❑

❑ ❑

❑ ❑

❑✔

❑

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 44 of 64
Debtor 1 Shikia Latasha Blair

First Name Middle Name Last Name

Case number (if known)

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)

From January 1 of current year until the

date you filed for bankruptcy:

Wages, commissions,

bonuses, tips

 Operating a business

$8,673.00

Wages, commissions,

bonuses, tips

 Operating a business

For last calendar year:

(January 1 to December 31, 2019 )

YYYY

Wages, commissions,

bonuses, tips

 Operating a business

$51,676.00

Wages, commissions,

bonuses, tips

 Operating a business

For the calendar year before that:

(January 1 to December 31, 2018 )

YYYY

Wages, commissions,

bonuses, tips

 Operating a business

$40,571.00

Wages, commissions,

bonuses, tips

 Operating a business

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.

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 from each

source

(before deductions and

exclusions)

From January 1 of current year until the

date you filed for bankruptcy:

c hild support $0.00

For last calendar year:

(January 1 to December 31, 2019 )

YYYY

child support $2,800.00

For the calendar year before that:

(January 1 to December 31, 2018 )

YYYY

child support $5,000.00

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

❑

❑✔

❑✔

❑

❑

❑

❑✔

❑

❑

❑

❑✔

❑

❑

❑

❑

❑✔

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 45 of 64
Debtor 1 Shikia Latasha Blair

First Name Middle Name Last Name

Case number (if known)

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 $6,825* or more?

 No. Go to line 7.

 Yes. List below each creditor to whom you paid a total of $6,825* 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 4/01/22 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.

Dates of

payment

Total amount paid Amount you still owe Was this payment for...

Virginia Credit Union

Creditor's Name

7500 Boulders View Drive

Number Street

Richmond, VA 23225

City State ZIP Code

monthly $531.00 $27,000.00

 Mortgage

 Car

 Credit card

 Loan repayment

 Suppliers or vendors

 Other 

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.

Dates of

payment

Total amount paid Amount you still owe Reason for this payment

Insider's Name

Number Street

City State ZIP Code

Official Form 107 Statement of Financial Affairs for Individuals Filing for Bankruptcy page 3

❑

❑

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑

❑

❑

❑✔

❑

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 46 of 64
Debtor 1 Shikia Latasha Blair

First Name Middle Name Last Name

Case number (if known)

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 that benefited an insider.

Dates of

payment

Total amount paid Amount you still owe Reason for this payment

Include creditor’s name

Insider's Name

Number Street

City State ZIP Code

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, and contract

disputes.

 No

 Yes. Fill in the details.

Nature of the case Court or agency Status of the case

Case title Virginia Credit Union v

Blair

Case number 

warrant in debt, followed by attempted

garnishment Richmond General District Court

Court Name

400 N 9th St Room 203

Number Street

Richmond, VA 23219

City State ZIP Code

 Pending

 On appeal

 Concluded

Case title Jormandy v Blair

Case number 

w-i-d

Prince William GDC

Court Name

9311 Lee Ave

Number Street

Manassas, VA 20110-5555

City State ZIP Code

 Pending

 On appeal

 Concluded

Case title Blair v Abbas

Case number 

car accident w-i-d

Prince William GDC

Court Name

9311 Lee Ave

Number Street

Manassas, VA 20110-5555

City State ZIP Code

 Pending

 On appeal

 Concluded

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

❑✔

❑

❑

❑✔

❑

❑

❑✔

❑

❑

❑✔

❑

❑

❑✔

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 47 of 64
Debtor 1 Shikia Latasha Blair

First Name Middle Name Last Name

Case number (if known)

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’s Name

Number Street

City State ZIP Code

Describe the property

Explain what happened

 Property was repossessed.

 Property was foreclosed.

 Property was garnished.

 Property was attached, seized, or levied.

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’s Name

Number Street

City State ZIP Code

Describe the action the creditor took

Last 4 digits of account number: XXXX– 

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.

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

❑✔

❑

❑

❑

❑

❑

❑✔

❑

❑✔

❑

❑✔

❑

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 48 of 64
Debtor 1 Shikia Latasha Blair

First Name Middle Name Last Name

Case number (if known)

Gifts with a total value of more than $600 per

person

Person to Whom You Gave the Gift

Number Street

City State ZIP Code

Person’s relationship to you 

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

Number Street

City State ZIP Code

Describe what you contributed Date 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, 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 property lost

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

❑✔

❑

❑✔

❑

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 49 of 64
Debtor 1 Shikia Latasha Blair

First Name Middle Name Last Name

Case number (if known)

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

Number Street

City State ZIP Code

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

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

Number Street

City State ZIP Code

Description and value of any property transferred 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.

Official Form 107 Statement of Financial Affairs for Individuals Filing for Bankruptcy page 7

❑✔

❑

❑✔

❑

❑✔

❑

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 50 of 64
Debtor 1 Shikia Latasha Blair

First Name Middle Name Last Name

Case number (if known)

Description and value of property

transferred

Describe any property or payments received

or debts paid in exchange

Date transfer was

made

Person Who Received Transfer

Number Street

City State ZIP Code

Person's relationship to you 

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

Part 8: List 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.

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

Name of Financial Institution

Number Street

City State ZIP Code

XXXX– Checking

 Savings

 Money market

 Brokerage

 Other 

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.

Official Form 107 Statement of Financial Affairs for Individuals Filing for Bankruptcy page 8

❑✔

❑

❑✔

❑

❑

❑

❑

❑

❑

❑✔

❑

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 51 of 64
Debtor 1 Shikia Latasha Blair

First Name Middle Name Last Name

Case number (if known)

Who else had access to it? Describe the contents Do you still have

it?

Name of Financial Institution

Number Street

City State ZIP Code

Name

Number Street

City State ZIP Code

 No

 Yes

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.

Who else has or had access to it? Describe the contents Do you still have

it?

Name of Storage Facility

Number Street

City State ZIP Code

Name

Number Street

City State ZIP Code

 No

 Yes

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.

Where is the property? Describe the property Value

Owner's Name

Number Street

City State ZIP Code

Number Street

City State ZIP Code

Official Form 107 Statement of Financial Affairs for Individuals Filing for Bankruptcy page 9

❑

❑

❑✔

❑

❑

❑

❑✔

❑

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 52 of 64
Debtor 1 Shikia Latasha Blair

First Name Middle Name Last Name

Case number (if known)

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.

Governmental unit Environmental law, if you know it Date of notice

Name of site

Number Street

City State ZIP Code

Governmental unit

Number Street

City State ZIP Code

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

 No

 Yes. Fill in the details.

Governmental unit Environmental law, if you know it Date of notice

Name of site

Number Street

City State ZIP Code

Governmental unit

Number Street

City State ZIP Code

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.

Official Form 107 Statement of Financial Affairs for Individuals Filing for Bankruptcy page 10

❑✔

❑

❑✔

❑

❑✔

❑

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 53 of 64
Debtor 1 Shikia Latasha Blair

First Name Middle Name Last Name

Case number (if known)

Court or agency Nature of the case Status of the case

Case title

Case number

Court Name

Number Street

City State ZIP Code

 Pending

 On appeal

 Concluded

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.

Name

Number Street

City State ZIP Code

Describe the nature of the business

Name of accountant or bookkeeper

Employer Identification number

Do not include Social Security number or ITIN.

EIN: –

Dates business existed

From To 

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.

Date issued

Name

Number Street

City State ZIP Code

MM / DD / YYYY

Official Form 107 Statement of Financial Affairs for Individuals Filing for Bankruptcy page 11

❑

❑

❑

❑

❑

❑

❑

❑

❑✔

❑

❑✔

❑

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 54 of 64
Debtor 1 Shikia Latasha Blair

First Name Middle Name Last Name

Case number (if known)

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/ Shikia Latasha Blair

Signature of Shikia Latasha Blair, Debtor 1

Date 03/09/2020

✘

Signature of

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).

❑✔

❑

❑✔

❑

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 55 of 64
Fill in this information to identify your case:

Debtor 1 Shikia Latasha Blair

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

Case number

(if known)

Check if this is an

amended filing

Official Form 108

If you are an individual filing under chapter 7, you must fill out this form if:

■ creditors have claims secured by your property, or

■ you have leased personal property and the lease has not expired.

You must file this form with the court within 30 days after you file your bankruptcy petition or by the date set for the meeting of creditors, whichever is earlier, unless

the court extends the time for cause. You must also send copies to the creditors and lessors you list on the form.

If two married people are filing together in a joint case, both are equally responsible for supplying correct information. Both debtors must sign and date the form.

Be as complete and accurate as possible. 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).

Part 1: List Your Creditors Who Have Secured Claims

1. For any creditors that you listed in Part 1 of Schedule D: Creditors Who Have Claims Secured by Property (Official Form 106D), fill in the information below.

Identify the creditor and the property that is collateral What do you intend to do with the property that secures a

debt?

Did you claim the property as

exempt on Schedule C?

Creditor’s

name: Virginia Credit Union

Description of

property

securing debt:

2018 Kia Optima

Surrender the property.

Retain the property and redeem it.

Retain the property and enter into a

Reaffirmation Agreement.

Retain the property and [explain]:

pay

No

Yes

Official Form 108 Statement of Intention for Individuals Filing Under Chapter 7 page 1

❑

Statement of Intention for Individuals Filing Under Chapter 7 12/15

❑

❑

❑

❑✔

❑

❑✔

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 56 of 64
Debtor 1 Shikia Latasha Blair

First Name Middle Name Last Name

Case number (if known)

Part 2: List Your Unexpired Personal Property Leases

For any unexpired personal property lease that you listed in Schedule G: Executory Contracts and Unexpired Leases (Official Form 106G), fill in the information

below. Do not list real estate leases. Unexpired leases are leases that are still in effect; the lease period has not yet ended. You may assume an unexpired personal

property lease if the trustee does not assume it. 11 U.S.C. § 365(p)(2).

Describe your unexpired personal property leases Will the lease be assumed?

Lessor’s name:

Description of leased

property:

No

Yes

Lessor’s name:

Description of leased

property:

No

Yes

Lessor’s name:

Description of leased

property:

No

Yes

Lessor’s name:

Description of leased

property:

No

Yes

Lessor’s name:

Description of leased

property:

No

Yes

Lessor’s name:

Description of leased

property:

No

Yes

Lessor’s name:

Description of leased

property:

No

Yes

Part 3: Sign Below

Under penalty of perjury, I declare that I have indicated my intention about any property of my estate that secures a debt and any personal property that

is subject to an unexpired lease.

✘ /s/ Shikia Latasha Blair

Signature of Debtor 1

Date 03/09/2020

MM/ DD/ YYYY

✘

Signature of Debtor 2

Date 

MM/ DD/ YYYY

Official Form 108 Statement of Intention for Individuals Filing Under Chapter 7 page 2

❑

❑

❑

❑

❑

❑

❑

❑

❑

❑

❑

❑

❑

❑

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 57 of 64
B2030 (Form 2030)(12/15)

United States Bankruptcy Court

Eastern District of Virginia

In re

Blair, Shikia Latasha

Debtor(s)

Case No.

Chapter 7

DISCLOSURE OF COMPENSATION OF ATTORNEY FOR DEBTOR

1. Pursuant to 11 U .S.C. § 329(a) and Fed. Bankr. P. 2016(b), I certify that I am the attorney for the above named debtor(s) and that

compensation paid to me within one year before the filing of the petition in bankruptcy, or agreed to be 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:

For legal services, I have agreed to accept . . . . . . . . . . . . . . . . . . . . . . . . $2,085.00

Prior to the filing of this statement I have received . . . . . . . . . . . . . . . . . . $1,785.00

Balance Due . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $300.00

2. The source of the compensation to be 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 another 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, statements 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;

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.

03/09/2020

Date

/s/ Robert R. Weed

Signature of Attorney

Robert R. Weed

Bar Number: 24646

Law Offices Of Robert Weed

13800 Coppermine Rd # 183

Herndon, VA 20171-6163

Phone: (703) 335-7793

Law Offices Of Robert Weed

Name of law firm

❑✔ ❑

❑✔ ❑

❑✔

❑

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 58 of 64
Check one box only as directed in this form and in Form

122A-1Supp:

1. There is no presumption of abuse.

2. The calculation to determine if a presumption of

abuse applies will be made under Chapter 7 Means

Test Calculation (Official Form 122A-2).

3. The Means Test does not apply now because of

qualified military service but it could apply later.

Check if this is an amended filing

Fill in this information to identify your case:

Debtor 1 Shikia Latasha Blair

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

Case number

(if known)

Official Form 122A-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 the additional information applies. On the top of any additional pages, write your name and case

number (if known). If you believe that you are exempted from a presumption of abuse because you do not have primarily consumer debts or because of qualifying

military service, complete and file Statement of Exemption from Presumption of Abuse Under § 707(b)(2) (Official Form 122A-1Supp) with this form.

Part 1: Calculate Your Current Monthly Income

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

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

Married and your spouse is filing with you. Fill out both Columns A and B, lines 2-11.

Married and your spouse is NOT filing with you. You and your spouse are:

Living in the same household and are not legally separated. Fill out both Column A and B, lines 2-11.

Living separately or are legally separated. Fill out Column A, lines 2-11; do not fill out Column B. By checking this box, you declare under

penalty of perjury that you and your spouse are legally separated under nonbankruptcy law that applies or that you and your spouse are living

apart for reasons that do not include evading the Means Test requirements. 11 U.S.C. § 707(b)(7)(B).

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). $4,746.00

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. $400.00

5. Net income from operating a business, profession,

or farm Debtor 1 Debtor 2

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 Debtor 2

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

7. Interest, dividends, and royalties $0.00

Official Form 122A-1 Chapter 7 Statement of Your Current Monthly Income page 1

❑✔

❑

❑

❑

Chapter 7 Statement of Your Current Monthly Income 12/19

❑✔

❑

❑

❑

❑

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 59 of 64
For you.................................................................................... $0.00

For your spouse......................................................................

Copy line 11 here →

12b.

13.

Debtor 1 Shikia Latasha Blair

First Name Middle Name Last Name

Case number (if known)

Column A

Debtor 1

Column B

Debtor 2 or

non-filing spouse

Unemployment compensation

Do not enter the amount if you contend that the amount received was a benefit under

the Social Security Act. Instead, list it here: .................................................. ↓

8. $0.00

Pension or retirement income. Do not include any amount received that was a benefit

under the Social Security Act. Also, except as stated in the next sentence, do not include

any compensation, pension, pay, annuity, or allowance paid by the United States

Government in connection with a disability, combat-related injury or disability, or death of a

member of the uniformed services. If you received any retired pay paid under chapter 61 of

title 10, then include that pay only to the extent that it does not exceed the amount of retired

pay to which you would otherwise be entitled if retired under any provision of title 10 other

than chapter 61 of that title.

9. $0.00

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

not include any benefits received under the Social Security Act; payments received as a

victim of a war crime, a crime against humanity, or international or domestic terrorism;

or compensation, pension, pay, annuity, or allowance paid by the United States

Government in connection with a disability, combat-related injury or disability, or death of

a member of the uniformed services. If necessary, list other sources on a separate page

and put the total below.

10.

Total amounts from separate pages, if any. + +

Calculate your total current monthly income. Add lines 2 through 10 for each

column. Then add the total for Column A to the total for Column B.

11. $5,146.00 +

= $5,146.00

Total current

monthly income

Part 2: Determine Whether the Means Test Applies to You

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

12a. Copy your total current monthly income from line 11.................................................................................... $5,146.00

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

12b. The result is your annual income for this part of the form. $61,752.00

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

Fill in the state in which you live. Virginia

Fill in the number of people in your household. 3

Fill in the median family income for your state and size of household....................................................................................................

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.

$90,358.00

14. How do the lines compare?

14a. Line 12b is less than or equal to line 13. On the top of page 1, check box 1, There is no presumption of abuse.

Go to Part 3. Do NOT fill out or file Official Form 122A-2.

14b. Line 12b is more than line 13. On the top of page 1, check box 2, The presumption of abuse is determined by Form 122A-2. Go to Part

3 and fill out Form 122A–2.

Part 3: Sign Below

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

X /s/ Shikia Latasha Blair

Signature of Debtor 1

X

Signature of Debtor 2

Date 03/09/2020

MM/DD/YYYY

Date

MM/DD/YYYY

If you checked line 14a, do NOT fill out or file Form 122A–2.

If you checked line 14b, fill out Form 122A–2 and file it with this form.

Official Form 122A-1 Chapter 7 Statement of Your Current Monthly Income page 2

❑✔

❑

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 60 of 64
CASE NO

CHAPTER 7

IN THE UNITED STATES BANKRUPTCY COURT

EASTERN DISTRICT OF VIRGINIA

ALEXANDRIA DIVISION

IN RE: Blair, Shikia Latasha

VERIFICATION OF CREDITOR MATRIX

The above named Debtor hereby verifies that the attached list of creditors is true and correct to the best of his/her knowledge.

Date 03/09/2020 Signature /s/ Shikia Latasha Blair

Shikia Latasha Blair, Debtor

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 61 of 64
Apple FCU

4097 Monument Corner Dr.

Fairfax, VA 22030

Autotrakk

1500 Sycamore Rd

Montoursville, PA 17754-9303

Capital One

PO Box 30285

Salt Lake City, UT 84130

CashnetUSA

175 West Jackson St 1000

Chicago, IL 60604

Comenity Bank/Victorias

Secret

PO Box 182273

Columbus, OH 43218

Dept of Ed/Navient

PO Box 9635

Wilkes Barre, PA 18773

Dept of Ed/Navient

123 Justison St 3rd Flr

Wilmington, DE 19801

GEICO Corporate Office

5260 Western Ave

Chevy Chase, MD 20815

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 62 of 64
Grand Canyon University

3300 W Camelback Rd

Phoenix, AZ 85017-3030

Jormandy LLC.

6363 Center Drive Bldg 6, Suite 203

Norfolk, VA 23502

Mary Washington

Healthcare/Stafford Hosp

2300 Fall Hill Ave. 101

Fredericksburg, VA 22401

Navy Federal Credit Union

c/o Mary McDuffie, President & CEO

820 Follin Lane

Vienna, VA 22180

Pentagon FCU

PO Box 456

Alexandria, VA 22313

Prince William GDC

9311 Lee Ave

Manassas, VA 20110-5555

R.A. Rogers

PO Box 3302

Crofton, MD 21114

Santander

PO Box 961245

Fort Worth, TX 76161

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 63 of 64
The Bank of Missouri

Po Box 4499

Beaverton , OR 97076

Virginia Credit Union

7500 Boulders View Drive

Richmond, VA 23225

Webbank/Fingerhut

6250 Ridgewood Rd

Saint Cloud, MN 56303-0820

Why not Lease

1750 Elm St

Manchester, NH 03104-2907

Zoca Loans

PO Box 1147

Mission, SD 57555

Case 20-10784-KHK Doc 1 Filed 03/12/20 Entered 03/12/20 18:16:39 Desc Main

Document Page 64 of 64