1.1 47 Liberty Knolls Drive

Street address, if available, or other

description

Stafford, VA 22554

City State ZIP Code

County

1.2 6722 Spring Forest

Street address, if available, or other

description

San Antonio, TX 78249

City State ZIP Code

Bexar

County

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

Debtor 1 Jeffrey D. Pattock

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Nadine R. Pattock

First Name Middle Name Last Name

United States Bankruptcy Court for the: Eastern District of Virginia

Case number 18-12974

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?

$680,000.00

Current value of the

portion you own?

$680,000.00

Describe the nature of your ownership interest (such

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

estate), if known.

Tenancy By The Entirety

Check if this is community property

(see instructions)

Source of Value:

Comps from Agent

If you own or have more than one, list here:

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?

$120,000.00

Current value of the

portion you own?

$120,000.00

Describe the nature of your ownership interest (such

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

estate), if known.

Fee Simple

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......................................................................................................... ➜ $800,000.00

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

❑

Schedule A/B: Property 12/15

❑

❑✔

❑✔

❑

❑

❑

❑

❑

❑

❑

❑

❑

❑✔

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑

❑

❑✔

❑

❑

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 1 of 67
3.1 Make:

Model:

Year:

Approximate mileage:

Lincoln

MKX

2016

64471

Other information:

3.2 Make:

Model:

Year:

Approximate mileage:

Chrysler

200C

2015

23649

Other information:

3.3 Make:

Model:

Year:

Approximate mileage:

Chrysler

Pacifica

2017

28239

Other information:

Debtor 1

Debtor 2

Jeffrey D. Pattock

Nadine R. Pattock

First Name Middle Name Last Name

Case number (if known) 18-12974

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?

$22,896.00

Current value of the

portion you own?

$22,896.00

If you own or have more than one, list here:

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?

$13,048.00

Current value of the

portion you own?

$13,048.00

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?

$23,973.00

Current value of the

portion you own?

$23,973.00

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......................................................................................................... ➜ $59,917.00

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

❑

❑✔

❑✔

❑

❑

❑

❑

❑

❑✔

❑

❑

❑

❑✔

❑

❑

❑

❑

❑✔

❑

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 2 of 67
Debtor 1

Debtor 2

Jeffrey D. Pattock

Nadine R. Pattock

First Name Middle Name Last Name

Case number (if known) 18-12974

Part 3: Describe Your Personal and Household Items

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

portion you own?

Do not deduct secured

claims or exemptions.

6.

No

Yes. Describe........

See Attached.

Household goods and furnishings

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

$660.00

7.

No

Yes. Describe........

Electronics

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

$100.00

8.

No

Yes. Describe........

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

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

$150.00

12.

No

Yes. Describe........

See Attached.

Jewelry

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

$175.00

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

❑

❑✔

❑

❑✔

❑✔

❑

❑✔

❑

❑✔

❑

❑

❑✔

❑

❑✔

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 3 of 67
Debtor 1

Debtor 2

Jeffrey D. Pattock

Nadine R. Pattock

First Name Middle Name Last Name

Case number (if known) 18-12974

13.

No

Yes. Describe........

Non-farm animals

Examples: Dogs, cats, birds, horses

unknown

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........................................................................................................................................➜ $1,085.00

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.............. $1.00

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: NFCU *6571 $2,823.01

17.2. Checking account: USAA *6994 $1.43

17.3. Savings account: NFCU *8981 $7.89

17.4. Savings account: USAA *4269 $1.00

17.5. Certificates of deposit:

17.6. Other financial account:

17.7. Other financial account:

17.8. Other financial account:

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

❑✔

❑

❑✔

❑

❑

❑✔

❑

❑✔

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 4 of 67
Debtor 1

Debtor 2

Jeffrey D. Pattock

Nadine R. Pattock

First Name Middle Name Last Name

Case number (if known) 18-12974

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

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

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.

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:

IRA: USAA IRA $1,800.00

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

23.

No

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

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

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

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

❑✔

❑

❑✔

❑

❑✔

❑

❑

❑✔

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 5 of 67
Debtor 1

Debtor 2

Jeffrey D. Pattock

Nadine R. Pattock

First Name Middle Name Last Name

Case number (if known) 18-12974

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.

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

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:

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

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

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 6 of 67
Debtor 1

Debtor 2

Jeffrey D. Pattock

Nadine R. Pattock

First Name Middle Name Last Name

Case number (if known) 18-12974

31.

No

Yes. Name the insurance company

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

Surrender or refund

value:

Lincoln Financial Group Term

life through work

$1.00

Lincoln Financial Group Term

Life

$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.

Inchoate Inheritance

$2.00

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

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.

$4,801.05

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.

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

❑

❑✔

❑

❑✔

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 7 of 67
Debtor 1

Debtor 2

Jeffrey D. Pattock

Nadine R. Pattock

First Name Middle Name Last Name

Case number (if known) 18-12974

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

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.

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

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 8 of 67
Debtor 1

Debtor 2

Jeffrey D. Pattock

Nadine R. Pattock

First Name Middle Name Last Name

Case number (if known) 18-12974

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

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..........................................................................................................................................➜ $800,000.00

56. Part 2: Total vehicles, line 5 $59,917.00

57. Part 3: Total personal and household items, line 15 $1,085.00

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

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 9 of 67
Debtor 1

Debtor 2

Jeffrey D. Pattock

Nadine R. Pattock

First Name Middle Name Last Name

Case number (if known) 18-12974

58. Part 4: Total financial assets, line 36 $4,801.05

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.............. $65,803.05 Copy personal property total➜ + $65,803.05

63. Total of all property on Schedule A/B. Add line 55 + line 62................................................................................................. $865,803.05

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

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 10 of 67
Debtor 1

Debtor 2

Jeffrey D. Pattock

Nadine R. Pattock

First Name Middle Name Last Name

Case number (if known) 18-12974

SCHEDULE A/B: PROPERTY

Continuation Page

6. Household goods and furnishings

Bedroom Furniture $300.00

Kitchen Furniture & Appliances $15.00

Living Room & Family Room Furniture $300.00

Items in Garage $45.00

12. Jewelry

2 Watches $5.00

Wedding & Engagement Jewelry $150.00

Costume Jewelry $20.00

17. Deposits of money

Checking account: Bank of America *3791 $1.43

Checking account: Schwab *7559 $50.12

Savings account: Amex *9927 $53.58

Savings account: Barclays *1824 $52.59

Savings account: NFCU *4759 $5.00

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

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 11 of 67
$0.00

100% of fair market value, up to

any applicable statutory limit

11 U.S.C. § 522(b)(3)(B)

$1.00

100% of fair market value, up to

any applicable statutory limit

Va. Code Ann. § 34-26(8)

Fill in this information to identify your case:

Debtor 1 Jeffrey D. Pattock

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Nadine R. Pattock

First Name Middle Name Last Name

United States Bankruptcy Court for the: Eastern District of Virginia

Case number

(if known)

18-12974 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:

47 Liberty Knolls Drive Stafford, VA 22554

Line from

Schedule A/B: 1.1

$680,000.00

Brief description:

2016 Lincoln MKX

Line from

Schedule A/B: 3.1

$22,896.00

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

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

No

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

No

Yes

Official Form 106C Schedule C: The Property You Claim as Exempt page 1 of 4

❑

Schedule C: The Property You Claim as Exempt 04/16

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑

❑

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 12 of 67
$1.00

100% of fair market value, up to

any applicable statutory limit

Va. Code Ann. § 34-26(8)

$1.00

100% of fair market value, up to

any applicable statutory limit

Va. Code Ann. § 34-26(8)

$300.00

100% of fair market value, up to

any applicable statutory limit

Va. Code Ann. § 34-26(4a)

$15.00

100% of fair market value, up to

any applicable statutory limit

Va. Code Ann. § 34-26(4a)

$300.00

100% of fair market value, up to

any applicable statutory limit

Va. Code Ann. § 34-26(4a)

$45.00

100% of fair market value, up to

any applicable statutory limit

Va. Code Ann. § 34-26(4a)

$100.00

100% of fair market value, up to

any applicable statutory limit

Va. Code Ann. § 34-26(4a)

$150.00

100% of fair market value, up to

any applicable statutory limit

Va. Code Ann. § 34-26(4)

$5.00

100% of fair market value, up to

any applicable statutory limit

Va. Code Ann. § 34-4

Debtor 1

Debtor 2

Jeffrey D. Pattock

Nadine R. Pattock

First Name Middle Name Last Name

Case number (if known) 18-12974

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:

2015 Chrysler 200C

Line from

Schedule A/B: 3.2

$13,048.00

Brief description:

2017 Chrysler Pacifica

Line from

Schedule A/B: 3.3

$23,973.00

Brief description:

Bedroom Furniture

Line from

Schedule A/B: 6

$300.00

Brief description:

Kitchen Furniture & Appliances

Line from

Schedule A/B: 6

$15.00

Brief description:

Living Room & Family Room Furniture

Line from

Schedule A/B: 6

$300.00

Brief description:

Items in Garage

Line from

Schedule A/B: 6

$45.00

Brief description:

Electronics

Line from

Schedule A/B: 7

$100.00

Brief description:

Clothes

Line from

Schedule A/B: 11

$150.00

Brief description:

2 Watches

Line from

Schedule A/B: 12

$5.00

Official Form 106C Schedule C: The Property You Claim as Exempt page 2 of 4

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 13 of 67
$150.00

100% of fair market value, up to

any applicable statutory limit

Va. Code Ann. § 34-26(1a)

$20.00

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. § 34-4

$2,823.01

100% of fair market value, up to

any applicable statutory limit

Va. Code Ann. § 34-4

$1.43

100% of fair market value, up to

any applicable statutory limit

Va. Code Ann. § 34-4

$1.43

100% of fair market value, up to

any applicable statutory limit

Va. Code Ann. § 34-4

$7.89

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. § 34-4

Debtor 1

Debtor 2

Jeffrey D. Pattock

Nadine R. Pattock

First Name Middle Name Last Name

Case number (if known) 18-12974

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:

Wedding & Engagement Jewelry

Line from

Schedule A/B: 12

$150.00

Brief description:

Costume Jewelry

Line from

Schedule A/B: 12

$20.00

Brief description:

Cash

Line from

Schedule A/B: 16

$1.00

Brief description:

NFCU *6571

Checking account

Line from

Schedule A/B: 17

$2,823.01

Brief description:

USAA *6994

Checking account

Line from

Schedule A/B: 17

$1.43

Brief description:

Bank of America *3791

Checking account

Line from

Schedule A/B: 17

$1.43

Brief description:

NFCU *8981

Savings account

Line from

Schedule A/B: 17

$7.89

Brief description:

USAA *4269

Savings account

Line from

Schedule A/B: 17

$1.00

Official Form 106C Schedule C: The Property You Claim as Exempt page 3 of 4

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 14 of 67
$53.58

100% of fair market value, up to

any applicable statutory limit

Va. Code Ann. § 34-4

$52.59

100% of fair market value, up to

any applicable statutory limit

Va. Code Ann. § 34-4

$5.00

100% of fair market value, up to

any applicable statutory limit

Va. Code Ann. § 34-4

$50.12

100% of fair market value, up to

any applicable statutory limit

Va. Code Ann. § 34-4

$1,800.00

100% of fair market value, up to

any applicable statutory limit

Va. Code Ann. § 34-34

$1.00

100% of fair market value, up to

any applicable statutory limit

Va. Code Ann. §§ 38.2-3339

$1.00

100% of fair market value, up to

any applicable statutory limit

Va. Code Ann. §§ 38.2-3122, 3123

$2.00

100% of fair market value, up to

any applicable statutory limit

Va. Code Ann. § 34-4

Debtor 1

Debtor 2

Jeffrey D. Pattock

Nadine R. Pattock

First Name Middle Name Last Name

Case number (if known) 18-12974

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:

Amex *9927

Savings account

Line from

Schedule A/B: 17

$53.58

Brief description:

Barclays *1824

Savings account

Line from

Schedule A/B: 17

$52.59

Brief description:

NFCU *4759

Savings account

Line from

Schedule A/B: 17

$5.00

Brief description:

Schwab *7559

Checking account

Line from

Schedule A/B: 17

$50.12

Brief description:

USAA IRA

Line from

Schedule A/B: 21

$1,800.00

Brief description:

Lincoln Financial Group Term life through work

Line from

Schedule A/B: 31

$1.00

Brief description:

Lincoln Financial Group Term Life

Line from

Schedule A/B: 31

$1.00

Brief description:

Inchoate Inheritance

Line from

Schedule A/B: 32

$2.00

Official Form 106C Schedule C: The Property You Claim as Exempt page 4 of 4

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 15 of 67
Fill in this information to identify your case:

Debtor 1 Jeffrey D. Pattock

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Nadine R. Pattock

First Name Middle Name Last Name

United States Bankruptcy Court for the: Eastern District of Virginia

Case number

(if known)

18-12974 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 Chase Auto

Creditor's Name

PO Box 901003

Number Street

Fort Worth, TX 76101

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:

2016 Lincoln MKX

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

Contigent

Unlquidated

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 1 7 3 2

$36,430.96 $22,896.00 $13,534.96

Add the dollar value of your entries in Column A on this page. Write that number here: $36,430.96

Official Form 106D Schedule D: Creditors Who Have Claims Secured by Property page 1 of 3

❑

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

❑

❑✔

❑✔

❑

❑

❑

❑

❑

❑

❑

❑

❑

❑

❑

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 16 of 67
Debtor 1

Debtor 2

Jeffrey D. Pattock

Nadine R. Pattock

First Name Middle Name Last Name

Case number (if known) 18-12974

Part 1:

Additional Page

After listing any entries on this page, number them beginning

with 2.3, followed by 2.4, and so forth.

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 Citizen Auto Finance

Creditor's Name

480 Jefferson Blvd

Number Street

Warwick, RI 02886

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:

2015 Chrysler 200C

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

Contigent

Unlquidated

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 4 6 5 9

$18,066.23 $13,048.00 $5,018.23

2.3 Fidelity Bank

Creditor's Name

3 Corporate Sq NE Ste 110

Number Street

Atlanta, GA 30329

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:

2017 Chrysler Pacifica

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

Contigent

Unlquidated

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 1 4 6 3

$49,171.82 $23,973.00 $25,198.82

Add the dollar value of your entries in Column A on this page. Write that number here: $67,238.05

Official Form 106D Additional Page of Schedule D: Creditors Who Have Claims Secured by Property page 2 of 3

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑

❑

❑

❑

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 17 of 67
Debtor 1

Debtor 2

Jeffrey D. Pattock

Nadine R. Pattock

First Name Middle Name Last Name

Case number (if known) 18-12974

Part 1:

Additional Page

After listing any entries on this page, number them beginning

with 2.3, followed by 2.4, and so forth.

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

2.4 Nationstar Mortgage/Mr. Cooper

Creditor's Name

8950 Cypress Waters Blvd

Number Street

Coppell, TX 75019

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:

6722 Spring Forest San Antonio, TX 78249

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

Contigent

Unlquidated

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 5 3 2 0

$56,993.00 $120,000.00 $0.00

2.5 Pennymac Loan Svcs

Creditor's Name

PO Box 514387

Number Street

Los Angeles, CA 90051

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:

47 Liberty Knolls Drive Stafford, VA 22554

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

Contigent

Unlquidated

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 9 0 2 4

$685,263.44 $680,000.00 $5,263.44

Add the dollar value of your entries in Column A on this page. Write that number here: $742,256.44

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

here:

$845,925.45

Official Form 106D Additional Page of Schedule D: Creditors Who Have Claims Secured by Property page 3 of 3

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑

❑

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 18 of 67
Fill in this information to identify your case:

Debtor 1 Jeffrey D. Pattock

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Nadine R. Pattock

First Name Middle Name Last Name

United States Bankruptcy Court for the: Eastern District of Virginia

Case number

(if known)

18-12974 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

2.1 IRS Centralized Insolvency OP 1 of 3

Priority Creditor's Name

Po Box 7436

Number Street

Philadelphia, PA 19101-7436

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? 2015

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 personal injury while you were

intoxicated

Other. Specify

$2,500.00 $2,500.00 $0.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 1 of 18

❑

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

❑

❑✔

❑

❑

❑✔

❑

❑

❑✔

❑

❑

❑

❑

❑

❑✔

❑

❑

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 19 of 67
Debtor 1

Debtor 2

Jeffrey D. Pattock

Nadine R. Pattock

First Name Middle Name Last Name

Case number (if known) 18-12974

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 American Express

Nonpriority Creditor's Name

PO Box 981537

Number Street

El Paso, TX 79998

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 3793

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

$2,085.00

4.2 American Express

Nonpriority Creditor's Name

PO Box 981537

Number Street

El Paso, TX 79998

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 8873

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

$4,951.00

4.3 American Express

Nonpriority Creditor's Name

PO Box 981537

Number Street

El Paso, TX 79998

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 2143

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

$3,878.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 2 of 18

❑

❑✔

❑✔

❑

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

❑✔

❑

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

❑

❑✔

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 20 of 67
Debtor 1

Debtor 2

Jeffrey D. Pattock

Nadine R. Pattock

First Name Middle Name Last Name

Case number (if known) 18-12974

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

4.4 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

Last 4 digits of account number 6886

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

$20,256.00

4.5 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

Last 4 digits of account number 2405

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

$4,596.00

4.6 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

Last 4 digits of account number 9622

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

$20,791.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 3 of 18

❑✔

❑

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

❑✔

❑

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

❑

❑✔

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 21 of 67
Debtor 1

Debtor 2

Jeffrey D. Pattock

Nadine R. Pattock

First Name Middle Name Last Name

Case number (if known) 18-12974

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

4.7 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

Last 4 digits of account number 0435

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

$1,957.00

4.8 Chase Card

Nonpriority Creditor's Name

PO Box 15298

Number Street

Wilmington, DE 19850

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 6018

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

$16,036.00

4.9 Chase Card

Nonpriority Creditor's Name

PO Box 15298

Number Street

Wilmington, DE 19850

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 3664

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

$926.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 4 of 18

❑

❑✔

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

❑✔

❑

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

❑✔

❑

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 22 of 67
Debtor 1

Debtor 2

Jeffrey D. Pattock

Nadine R. Pattock

First Name Middle Name Last Name

Case number (if known) 18-12974

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 Chase Card

Nonpriority Creditor's Name

PO Box 15298

Number Street

Wilmington, DE 19850

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 4685

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

$16,553.00

4.11 Chase Card

Nonpriority Creditor's Name

PO Box 15298

Number Street

Wilmington, DE 19850

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 6547

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

$5,831.00

4.12 Chase Card

Nonpriority Creditor's Name

PO Box 15298

Number Street

Wilmington, DE 19850

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 4941

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

$16,370.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 5 of 18

❑✔

❑

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

❑

❑✔

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

❑

❑✔

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 23 of 67
Debtor 1

Debtor 2

Jeffrey D. Pattock

Nadine R. Pattock

First Name Middle Name Last Name

Case number (if known) 18-12974

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

4.13 Citi Cards/Citibank

Nonpriority Creditor's Name

PO Box 6241

Number Street

Sioux Falls, SD 57117

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 4511

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

$19,313.00

4.14 Citi Cards/Citibank

Nonpriority Creditor's Name

PO Box 6241

Number Street

Sioux Falls, SD 57117

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 4226

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

$20,476.00

4.15 Citi Cards/Citibank

Nonpriority Creditor's Name

PO Box 6241

Number Street

Sioux Falls, SD 57117

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 4885

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

$5,319.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 6 of 18

❑✔

❑

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

❑✔

❑

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

❑

❑✔

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 24 of 67
Debtor 1

Debtor 2

Jeffrey D. Pattock

Nadine R. Pattock

First Name Middle Name Last Name

Case number (if known) 18-12974

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

4.16 Dept of Veterans Affairs

Nonpriority Creditor's Name

PO Box 11930

Number Street

Saint Paul, MN 55111

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 8595

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

Collection

$391.00

4.17 Dept of Veterans Affairs

Nonpriority Creditor's Name

PO Box 11930

Number Street

Saint Paul, MN 55111

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 8595

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

Collection

$818.00

4.18 Discover Financial Services

Nonpriority Creditor's Name

PO Box 15316

Number Street

Wilmington, DE 19850

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 1132

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

$9,361.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 7 of 18

❑

❑✔

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

❑

❑✔

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

❑✔

❑

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 25 of 67
Debtor 1

Debtor 2

Jeffrey D. Pattock

Nadine R. Pattock

First Name Middle Name Last Name

Case number (if known) 18-12974

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

4.19 Discover Financial Services

Nonpriority Creditor's Name

PO Box 15316

Number Street

Wilmington, DE 19850

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 3651

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

$13,998.00

4.20 Fairfax Radiological Consultants PC

Nonpriority Creditor's Name

2722 Merrilee Dr. Ste 230

Number Street

Fairfax, VA 22031

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 0856

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

$293.46

4.21 Inova Dept of Medicine

Nonpriority Creditor's Name

3300 Gallows Rd.

Number Street

Falls Church, VA 22042

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 0889

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

$28.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 8 of 18

❑

❑✔

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

❑

❑

❑✔

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

❑

❑

❑✔

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 26 of 67
Debtor 1

Debtor 2

Jeffrey D. Pattock

Nadine R. Pattock

First Name Middle Name Last Name

Case number (if known) 18-12974

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

4.22 Inova Exec Health Sub Machine

Nonpriority Creditor's Name

3300 Gallows Rd.

Number Street

Falls Church, VA 22042

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 0889

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

$56.00

4.23 Inova Fairfax Hospital

Nonpriority Creditor's Name

3300 Gallows Rd.

Number Street

Falls Church, VA 22042

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 8889

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

$830.00

4.24 Inova Medcial Group Cardiology

Nonpriority Creditor's Name

3650 Joseph Siewick Dr Ste 204

Number Street

Fairfax, VA 22033

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 0889

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

$21.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 9 of 18

❑

❑

❑✔

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

❑

❑

❑✔

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

❑

❑

❑✔

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 27 of 67
Debtor 1

Debtor 2

Jeffrey D. Pattock

Nadine R. Pattock

First Name Middle Name Last Name

Case number (if known) 18-12974

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

4.25 Inova Traumatology & General Surgery

Nonpriority Creditor's Name

3300 Gallows Rd.

Number Street

Falls Church, VA 22042

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 0889

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

$28.00

4.26 Kohls/CapOne

Nonpriority Creditor's Name

PO Box 3115

Number Street

Milwaukee, WI 53201

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 0066

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

$347.00

4.27 Kohls/CapOne

Nonpriority Creditor's Name

PO Box 3115

Number Street

Milwaukee, WI 53201

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 0093

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

$575.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 10 of 18

❑

❑

❑✔

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

❑✔

❑

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

❑

❑✔

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 28 of 67
Debtor 1

Debtor 2

Jeffrey D. Pattock

Nadine R. Pattock

First Name Middle Name Last Name

Case number (if known) 18-12974

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

4.28 Maria Delgado

Nonpriority Creditor's Name

6722 Spring Forest St

Number Street

San Antonio, TX 78249

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

unknown

4.29 Mary Washington Healthcare

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 3998

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

$25.00

4.30 Mary Washington Hospital

Nonpriority Creditor's Name

1001 Sam Perry Blvd

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 9194

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

$673.86

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 11 of 18

❑

❑

❑✔

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

❑

❑

❑✔

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

❑

❑

❑✔

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 29 of 67
Debtor 1

Debtor 2

Jeffrey D. Pattock

Nadine R. Pattock

First Name Middle Name Last Name

Case number (if known) 18-12974

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

4.31 Mary Washington Hospital

Nonpriority Creditor's Name

1001 Sam Perry Blvd

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 7489

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

$60.00

4.32 Mary Washington Hospital

Nonpriority Creditor's Name

1001 Sam Perry Blvd

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 9577

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

$320.00

4.33 Moxie Pest Control

Nonpriority Creditor's Name

14301 Sullyfield Cir Ste G

Number Street

Chantilly, VA 20151

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

$300.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 12 of 18

❑

❑

❑✔

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

❑

❑

❑✔

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

❑

❑

❑✔

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 30 of 67
Debtor 1

Debtor 2

Jeffrey D. Pattock

Nadine R. Pattock

First Name Middle Name Last Name

Case number (if known) 18-12974

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

4.34 Navy Federal Credit Union

Nonpriority Creditor's Name

PO Box 3700

Number Street

Merrifield, VA 22119

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 9367

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

$4,976.00

4.35 Navy Federal Credit Union

Nonpriority Creditor's Name

PO Box 3700

Number Street

Merrifield, VA 22119

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 5018

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

$26,637.00

4.36 Patino, Rafael

Nonpriority Creditor's Name

6722 Spring Forest St

Number Street

San Antonio, TX 78249

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

unknown

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 13 of 18

❑

❑

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

❑

❑

❑✔

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

❑

❑

❑✔

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 31 of 67
Debtor 1

Debtor 2

Jeffrey D. Pattock

Nadine R. Pattock

First Name Middle Name Last Name

Case number (if known) 18-12974

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

4.37 Radiologic Associates of Fredericksburg

Nonpriority Creditor's Name

4718 Carr Dr

Number Street

Fredericksburg, VA 22408

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 2713

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

$87.44

4.38 Sunrise Credit Svcs/AT&T

Nonpriority Creditor's Name

234 Airport Plaza Blvd, Ste 4

Number Street

Farmingdale, NY 11735

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 6896

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

Collection

$1,743.00

4.39 Tajammul Ehsan MD

Nonpriority Creditor's Name

8622 Lee Hwy C

Number Street

Fairfax, VA 22031

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 7810

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

$221.89

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 14 of 18

❑

❑

❑✔

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

❑✔

❑

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

❑

❑

❑✔

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 32 of 67
Debtor 1

Debtor 2

Jeffrey D. Pattock

Nadine R. Pattock

First Name Middle Name Last Name

Case number (if known) 18-12974

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

4.40 Trinity Wiring & Monitoring

Nonpriority Creditor's Name

8610 Virginia Meadows Dr

Number Street

Manassas, VA 20109

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

$250.00

4.41 Trugreen

Nonpriority Creditor's Name

1790 Kirby Pkwy Ste 300

Number Street

Memphis, TN 38138-7411

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 8013

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

$532.67

4.42 Virginia Cardiovascular Consultants PC

Nonpriority Creditor's Name

1201 Sam Perry Blvd Ste 280

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 2861

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

$20.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 15 of 18

❑

❑

❑✔

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

❑

❑

❑✔

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

❑

❑

❑✔

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 33 of 67
Debtor 1

Debtor 2

Jeffrey D. Pattock

Nadine R. Pattock

First Name Middle Name Last Name

Case number (if known) 18-12974

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.

Diversified Consultants Inc

Name

PO Box 1391

Number Street

Southgate, MI 48195

City State ZIP Code

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

Line 4.38 of (Check one): Part 1: Creditors with Priority Unsecured Claims

Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number

Sunrise Credit Services

Name

PO Box 9100

Number Street

Farmingdale, NY 11735

City State ZIP Code

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

Line 4.38 of (Check one): Part 1: Creditors with Priority Unsecured Claims

Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number

AT&T

Name

PO Box 536216

Number Street

Atlanta, GA 30353

City State ZIP Code

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

Line 4.38 of (Check one): Part 1: Creditors with Priority Unsecured Claims

Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number

Alltran Financial Express Co

Name

PO Box 722929

Number Street

Houston, TX 77272

City State ZIP Code

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

Line 4.3 of (Check one): Part 1: Creditors with Priority Unsecured Claims

Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number

ODC Recovery/Mary Washington

Name

2300 Fall Hill Ave Ste 314

Number Street

Fredericksburg, VA 22401

City State ZIP Code

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

Line 4.32 of (Check one): Part 1: Creditors with Priority Unsecured Claims

Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number

Creditors Collection Service

Name

PO BOX 21504

Number Street

Roanoke, VA 24018

City State ZIP Code

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

Line 4.37 of (Check one): Part 1: Creditors with Priority Unsecured Claims

Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number

Transworld Systems

Name

9525 Sweet Valley Dr Bldg A

Number Street

Valley View, OH 44125

City State ZIP Code

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

Line 4.41 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 16 of 18

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 34 of 67
Debtor 1

Debtor 2

Jeffrey D. Pattock

Nadine R. Pattock

First Name Middle Name Last Name

Case number (if known) 18-12974

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

IRS c/o US Attorney 2 of 3

Name

2100 Jamieson Ave

Number Street

Alexandria, VA 22314-5702

City State ZIP Code

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

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

Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number

IRS Hon. Jeff Session 3 of 3

Name

10th St & Constitution Ave NW, Rm 6313

Number Street

Washington, DC 20530

City State ZIP Code

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

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

Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 17 of 18

❑✔

❑

❑✔

❑

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 35 of 67
Debtor 1

Debtor 2

Jeffrey D. Pattock

Nadine R. Pattock

First Name Middle Name Last Name

Case number (if known) 18-12974

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. $2,500.00

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. $2,500.00

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. + $221,931.32

6j. Total. Add lines 6f through 6i. 6j. $221,931.32

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 18 of 18

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 36 of 67
Fill in this information to identify your case:

Debtor 1 Jeffrey D. Pattock

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Nadine R. Pattock

First Name Middle Name Last Name

United States Bankruptcy Court for the: Eastern District of Virginia

Case number

(if known)

18-12974 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

2.5

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 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 37 of 67
Fill in this information to identify your case:

Debtor 1 Jeffrey D. Pattock

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Nadine R. Pattock

First Name Middle Name Last Name

United States Bankruptcy Court for the: Eastern District of Virginia

Case number

(if known)

18-12974 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 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 38 of 67
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 Jeffrey D. Pattock

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Nadine R. Pattock

First Name Middle Name Last Name

United States Bankruptcy Court for the: Eastern District of Virginia

Case number

(if known)

18-12974

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

Senior Anaylst

The Buffalo Group LLC

1851 Alexander Bell Drive Ste 300

Number Street

Reston, VA 20191

City State Zip Code

Employed Not Employed

Senior Payroll Account

Gryphon Technologies

80 M Street SE Ste 600

Number Street

Washington, DC 20003

City State Zip Code

How long employed there? 1 year 1 year

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. $6,938.46 $8,119.35

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

4. Calculate gross income. Add line 2 + line 3. 4. $6,938.46 $8,119.35

Official Form 106I Schedule I: Your Income page 1

❑

❑

Schedule I: Your Income 12/15

❑✔ ❑ ❑✔ ❑

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 39 of 67
Debtor 1

Debtor 2

Jeffrey D. Pattock

Nadine R. Pattock

First Name Middle Name Last Name

Case number (if known) 18-12974

For Debtor 1 For Debtor 2 or

non-filing spouse

Copy line 4 here....................................................................................➔ 4. $6,938.46 $8,119.35

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.

$1,432.54

$0.00

$0.00

$0.00

$0.00

$0.00

$0.00

+ $0.00

$1,401.23

$0.00

$0.00

$0.00

$96.07

$0.00

$0.00

+ $0.00

6. Add the payroll deductions. Add lines 5a + 5b + 5c + 5d + 5e +5f + 5g + 5h. 6. $1,432.54 $1,497.30

7. Calculate total monthly take-home pay. Subtract line 6 from line 4. 7. $5,505.92 $6,622.05

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.

8b. Interest and dividends

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.

8d. Unemployment compensation

8e. Social Security

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: 

8g. Pension or retirement income

8h. Other monthly income. Specify: 

8a.

8b.

8c.

8d.

8e.

8f.

8g.

8h.

$0.00

$0.00

$0.00

$0.00

$0.00

$0.00

$2,324.70

+ $0.00

$0.00

$0.00

$0.00

$0.00

$0.00

$0.00

$0.00

+ $0.00

9. Add all other income. Add lines 8a + 8b + 8c + 8d + 8e + 8f +8g + 8h. 9. $2,324.70 $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. $7,830.62 + $6,622.05 = $14,452.67

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. $14,452.67

Combined

monthly income

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

 No.

 Yes. Explain: 

Official Form 106I Schedule I: Your Income page 2

❑✔

❑

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 40 of 67
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 31

No. Yes.

Daughter-in-law 33

No. Yes.

Grandson 9

No. Yes.

 No

 Yes

 No

 Yes

Fill in this information to identify your case:

Debtor 1 Jeffrey D. Pattock

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Nadine R. Pattock

First Name Middle Name Last Name

United States Bankruptcy Court for the: Eastern District of Virginia

Case number

(if known)

18-12974

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.

$3,766.91

$0.00

$0.00

$200.00

$52.00

Official Form 106J Schedule J: Your Expenses page 1

❑

❑

Schedule J: Your Expenses 12/15

❑

❑✔

❑✔

❑

❑

❑✔

❑ ❑✔

❑ ❑✔

❑ ❑✔

❑

❑

❑

❑

❑✔

❑

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 41 of 67
Debtor 1

Debtor 2

Jeffrey D. Pattock

Nadine R. Pattock

First Name Middle Name Last Name

Case number (if known) 18-12974

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: Cell Phones

6a.

6b.

6c.

6d.

$480.00

$140.00

$370.00

$325.00

7. Food and housekeeping supplies 7. $1,300.00

8. Childcare and children’s education costs 8. $50.00

9. Clothing, laundry, and dry cleaning 9. $350.00

10. Personal care products and services 10. $145.00

11. Medical and dental expenses 11. $350.00

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

Do not include car payments. 12. $770.00

13. Entertainment, clubs, recreation, newspapers, magazines, and books 13. $100.00

14. Charitable contributions and religious donations 14. $20.00

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

$149.00

$310.00

$0.00

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

Specify: IRS $240 / Car Tax $198 16. $438.00

17. Installment or lease payments:

17a. Car payments for Vehicle 1

17b. Car payments for Vehicle 2

17c. Other. Specify: Car Payment for Vehicle 3

17d. Other. Specify: 

17a.

17b.

17c.

17d.

$787.56

$503.00

$799.00

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 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 42 of 67
Debtor 1

Debtor 2

Jeffrey D. Pattock

Nadine R. Pattock

First Name Middle Name Last Name

Case number (if known) 18-12974

21. Other. Specify: Home Security 21. + $50.00

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.

$11,455.47

$0.00

$11,455.47

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.

$14,452.67

– $11,455.47

$2,997.20

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 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 43 of 67
Fill in this information to identify your case:

Debtor 1 Jeffrey D. Pattock

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Nadine R. Pattock

First Name Middle Name Last Name

United States Bankruptcy Court for the: Eastern District of Virginia

Case number

(if known)

18-12974 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...........................................................................................................

$800,000.00

$65,803.05

$865,803.05

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.......

$845,925.45

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

$2,500.00

+ $221,931.32

Your total liabilities $1,070,356.77

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

$14,452.67

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

Copy your monthly expenses from line 22c of Schedule J.................................................................................. $11,455.47

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 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 44 of 67
Debtor 1

Debtor 2

Jeffrey D. Pattock

Nadine R. Pattock

First Name Middle Name Last Name

Case number (if known) 18-12974

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. $14,071.26

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.) $2,500.00

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. $2,500.00

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

❑

❑✔

❑✔

❑

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 45 of 67
Fill in this information to identify your case:

Debtor 1 Jeffrey D. Pattock

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Nadine R. Pattock

First Name Middle Name Last Name

United States Bankruptcy Court for the: Eastern District of Virginia

Case number

(if known)

18-12974 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 declaraion and that they are true and correct.

✘ /s/ Jeffrey D. Pattock

Jeffrey D. Pattock, Debtor 1, Debtor 1

Date 09/13/2018

MM/ DD/ YYYY

✘ /s/ Nadine R. Pattock

Nadine R. Pattock, Debtor 2

Date 09/13/2018

MM/ DD/ YYYY

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

❑

Declaration About an Individual Debtor's Schedules 12/15

❑✔

❑

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 46 of 67
Fill in this information to identify your case:

Debtor 1 Jeffrey D. Pattock

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Nadine R. Pattock

First Name Middle Name Last Name

United States Bankruptcy Court for the: Eastern District of Virginia

Case number

(if known)

18-12974 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

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

❑

Statement of Financial Affairs for Individuals Filing for Bankruptcy 04/16

❑✔

❑

❑✔

❑

❑ ❑

❑ ❑

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 47 of 67
Debtor 1

Debtor 2

Jeffrey D. Pattock

Nadine R. Pattock

First Name Middle Name Last Name

Case number (if known) 18-12974

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

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

No

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

Part 2: Explain the Sources of Your Income

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

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

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

No

Yes. Fill in the details.

Debtor 1 Debtor 2

Sources of income

Check all that apply.

Gross Income

(before deductions and

exclusions)

Sources of income

Check all that apply.

Gross Income

(before deductions and

exclusions)

From January 1 of current year until the

date you filed for bankruptcy:

Wages, commissions,

bonuses, tips

 Operating a business

$54,561.56

Wages, commissions,

bonuses, tips

 Operating a business

$59,107.95

For last calendar year:

(January 1 to December 31, 2017 )

YYYY

Wages, commissions,

bonuses, tips

 Operating a business

$66,820.81

Wages, commissions,

bonuses, tips

 Operating a business

$78,459.99

For the calendar year before that:

(January 1 to December 31, 2016 )

YYYY

Wages, commissions,

bonuses, tips

 Operating a business

$60,735.60

Wages, commissions,

bonuses, tips

 Operating a business

$41,569.62

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:

Military Retirement $22,666.00

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

❑✔

❑

❑

❑✔

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑

❑✔

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 48 of 67
Debtor 1

Debtor 2

Jeffrey D. Pattock

Nadine R. Pattock

First Name Middle Name Last Name

Case number (if known) 18-12974

For last calendar year:

(January 1 to December 31, 2017 )

YYYY

Military Retirement $34,000.00

For the calendar year before that:

(January 1 to December 31, 2016 )

YYYY

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

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

 No. Neither Debtor 1 nor Debtor 2 has primarily consumer debts. Consumer debts are defined in 11 U.S.C. § 101(8) as “incurred by an

individual primarily for a personal, family, or household purpose.”

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

 No. Go to line 7.

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

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

payments to an attorney for this bankruptcy case.

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

 Yes. Debtor 1 or Debtor 2 or both have primarily consumer debts.

During the 90 days before you filed for bankruptcy, did you pay any creditor a total of $600 or more?

 No. Go to line 7.

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

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

this bankruptcy case.

Dates of

payment

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

Pennymac Loan Svcs

Creditor's Name

PO Box 514387

Number Street

Los Angeles, CA 90051

City State ZIP Code

Monthly $11,300.73 $685,263.44

 Mortgage

 Car

 Credit card

 Loan repayment

 Suppliers or vendors

 Other 

Chase Auto

Creditor's Name

PO Box 901003

Number Street

Fort Worth, TX 76101

City State ZIP Code

Monthly $2,364.00 $36,430.96

 Mortgage

 Car

 Credit card

 Loan repayment

 Suppliers or vendors

 Other 

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

❑

❑

❑

❑✔

❑

❑✔

❑✔

❑

❑

❑

❑

❑

❑

❑✔

❑

❑

❑

❑

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 49 of 67
Debtor 1

Debtor 2

Jeffrey D. Pattock

Nadine R. Pattock

First Name Middle Name Last Name

Case number (if known) 18-12974

Dates of

payment

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

Citizen Auto Finance

Creditor's Name

480 Jefferson Blvd

Number Street

Warwick, RI 02886

City State ZIP Code

Monthly $1,509.00 $18,066.23

 Mortgage

 Car

 Credit card

 Loan repayment

 Suppliers or vendors

 Other 

Fidelity Bank

Creditor's Name

3 Corporate Sq NE Ste 110

Number Street

Atlanta, GA 30329

City State ZIP Code

Monthly $2,397.00 $49,171.82

 Mortgage

 Car

 Credit card

 Loan repayment

 Suppliers or vendors

 Other 

American Express

Creditor's Name

PO Box 981537

Number Street

El Paso, TX 79998

City State ZIP Code

Monthly $870.00 $0.00

 Mortgage

 Car

 Credit card

 Loan repayment

 Suppliers or vendors

 Other 

Chase Card

Creditor's Name

PO Box 15298

Number Street

Wilmington, DE 19850

City State ZIP Code

Monthly $854.00 $0.00

 Mortgage

 Car

 Credit card

 Loan repayment

 Suppliers or vendors

 Other 

Chase Card

Creditor's Name

PO Box 15298

Number Street

Wilmington, DE 19850

City State ZIP Code

Monthly $829.00 $0.00

 Mortgage

 Car

 Credit card

 Loan repayment

 Suppliers or vendors

 Other 

Chase Card

Creditor's Name

PO Box 15298

Number Street

Wilmington, DE 19850

City State ZIP Code

Monthly $857.00 $0.00

 Mortgage

 Car

 Credit card

 Loan repayment

 Suppliers or vendors

 Other 

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

❑

❑✔

❑

❑

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑✔

❑

❑

❑

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 50 of 67
Debtor 1

Debtor 2

Jeffrey D. Pattock

Nadine R. Pattock

First Name Middle Name Last Name

Case number (if known) 18-12974

Dates of

payment

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

Citi Cards/Citibank

Creditor's Name

PO Box 6241

Number Street

Sioux Falls, SD 57117

City State ZIP Code

Monthly $991.00 $0.00

 Mortgage

 Car

 Credit card

 Loan repayment

 Suppliers or vendors

 Other 

Citi Cards/Citibank

Creditor's Name

PO Box 6241

Number Street

Sioux Falls, SD 57117

City State ZIP Code

Monthly $853.00 $0.00

 Mortgage

 Car

 Credit card

 Loan repayment

 Suppliers or vendors

 Other 

Capital One

Creditor's Name

PO Box 30285

Number Street

Salt Lake City, UT 84130

City State ZIP Code

Monthly $1,108.00 $0.00

 Mortgage

 Car

 Credit card

 Loan repayment

 Suppliers or vendors

 Other 

Capital One

Creditor's Name

PO Box 30285

Number Street

Salt Lake City, UT 84130

City State ZIP Code

Monthly $1,093.00 $0.00

 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.

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

❑

❑

❑✔

❑

❑

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑✔

❑

❑

❑

❑✔

❑

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 51 of 67
Debtor 1

Debtor 2

Jeffrey D. Pattock

Nadine R. Pattock

First Name Middle Name Last Name

Case number (if known) 18-12974

Dates of

payment

Total amount paid Amount you still owe Reason for this payment

Insider's Name

Number Street

City State ZIP Code

Insider's Name

Number Street

City State ZIP Code

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

Insider's Name

Number Street

City State ZIP Code

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

❑✔

❑

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 52 of 67
Debtor 1

Debtor 2

Jeffrey D. Pattock

Nadine R. Pattock

First Name Middle Name Last Name

Case number (if known) 18-12974

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 

Case number 

Court Name

Number Street

City State ZIP Code

 Pending

 On appeal

 Concluded

Case title 

Case number 

Court Name

Number Street

City State ZIP Code

 Pending

 On appeal

 Concluded

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.

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

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

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

❑

❑✔

❑

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 53 of 67
Debtor 1

Debtor 2

Jeffrey D. Pattock

Nadine R. Pattock

First Name Middle Name Last Name

Case number (if known) 18-12974

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

receiver, a custodian, or another official?

 No

 Yes

Part 5: List Certain Gifts and Contributions

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

 No

 Yes. Fill in the details for each gift.

Gifts with a total value of more than $600 per

person

Person to Whom You Gave the Gift

Number Street

City State ZIP Code

Person’s relationship to you 

Describe the gifts Dates you gave

the gifts

Value

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.

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

❑✔

❑

❑✔

❑

❑✔

❑

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 54 of 67
Debtor 1

Debtor 2

Jeffrey D. Pattock

Nadine R. Pattock

First Name Middle Name Last Name

Case number (if known) 18-12974

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

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.

Law Offices Of Robert Weed

Person Who Was Paid

1376 Old Bridge Rd. Ste 101-4

Number Street

Woodbridge, VA 22192

City State ZIP Code

Email or website address

Person Who Made the Payment, if Not You

Description and value of any property transferred

Attorney’s Fee; Attorney's Fee

Date payment or

transfer was made

Sep 11, 2018

Aug 30, 2018

Amount of payment

$2,485.00

$1,700.00

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

❑✔

❑

❑

❑✔

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 55 of 67
Debtor 1

Debtor 2

Jeffrey D. Pattock

Nadine R. Pattock

First Name Middle Name Last Name

Case number (if known) 18-12974

Money Sharp

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

$10.00

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

deal with your creditors or to make payments to your creditors?

Do not include any payment or transfer that you listed on line 16.

 No

 Yes. Fill in the details.

Person Who Was Paid

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.

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 

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

❑✔

❑

❑✔

❑

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 56 of 67
Debtor 1

Debtor 2

Jeffrey D. Pattock

Nadine R. Pattock

First Name Middle Name Last Name

Case number (if known) 18-12974

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 

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

❑✔

❑

❑✔

❑

❑

❑

❑

❑

❑

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 57 of 67
Debtor 1

Debtor 2

Jeffrey D. Pattock

Nadine R. Pattock

First Name Middle Name Last Name

Case number (if known) 18-12974

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.

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

Official Form 107 Statement of Financial Affairs for Individuals Filing for Bankruptcy page 12

❑

❑

❑

❑

❑

❑✔

❑

❑

❑

❑✔

❑

❑

❑

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 58 of 67
Debtor 1

Debtor 2

Jeffrey D. Pattock

Nadine R. Pattock

First Name Middle Name Last Name

Case number (if known) 18-12974

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

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.

Official Form 107 Statement of Financial Affairs for Individuals Filing for Bankruptcy page 13

❑✔

❑

❑✔

❑

❑✔

❑

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 59 of 67
Debtor 1

Debtor 2

Jeffrey D. Pattock

Nadine R. Pattock

First Name Middle Name Last Name

Case number (if known) 18-12974

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.

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 

Official Form 107 Statement of Financial Affairs for Individuals Filing for Bankruptcy page 14

❑✔

❑

❑

❑

❑

❑

❑

❑

❑

❑

❑✔

❑

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 60 of 67
Debtor 1

Debtor 2

Jeffrey D. Pattock

Nadine R. Pattock

First Name Middle Name Last Name

Case number (if known) 18-12974

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 

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 15

❑✔

❑

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 61 of 67
Debtor 1

Debtor 2

Jeffrey D. Pattock

Nadine R. Pattock

First Name Middle Name Last Name

Case number (if known) 18-12974

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/ Jeffrey D. Pattock

Signature of Jeffrey D. Pattock, Debtor 1

Date 09/13/2018

✘ /s/ Nadine R. Pattock

Signature of Nadine R. Pattock, Debtor 2

Date 09/13/2018

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

 No

 Yes

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

 No

 Yes. Name of person 

Attach the Bankruptcy Petition Preparer’s Notice,

Declaration, and Signature (Official Form 119).

Official Form 107 Statement of Financial Affairs for Individuals Filing for Bankruptcy page 16

❑✔

❑

❑✔

❑

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 62 of 67
Fill in this information to identify your case:

Debtor 1 Jeffrey D. Pattock

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Nadine R. Pattock

First Name Middle Name Last Name

United States Bankruptcy Court for the: Eastern District of Virginia

Case number

(if known)

18-12974 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: Chase Auto

Description of

property

securing debt:

2016 Lincoln MKX

Surrender the property.

Retain the property and redeem it.

Retain the property and enter into a

Reaffirmation Agreement.

Retain the property and [explain]:

Debtor will continue making payments without

reaffirming.

No

Yes

Creditor’s

name: Fidelity Bank

Description of

property

securing debt:

2017 Chrysler Pacifica

Surrender the property.

Retain the property and redeem it.

Retain the property and enter into a

Reaffirmation Agreement.

Retain the property and [explain]:

Debtor will continue making payments without

reaffirming.

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 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 63 of 67
Debtor 1

Debtor 2

Jeffrey D. Pattock

Nadine R. Pattock

First Name Middle Name Last Name

Case number (if known) 18-12974

Additional Page for Part 1

Creditor’s

name: Nationstar Mortgage/Mr. Cooper

Description of

property

securing debt:

6722 Spring Forest San Antonio, TX

78249

Surrender the property.

Retain the property and redeem it.

Retain the property and enter into a

Reaffirmation Agreement.

Retain the property and [explain]:

No

Yes

Creditor’s

name: Pennymac Loan Svcs

Description of

property

securing debt:

47 Liberty Knolls Drive Stafford, VA

22554

Surrender the property.

Retain the property and redeem it.

Retain the property and enter into a

Reaffirmation Agreement.

Retain the property and [explain]:

Debtor will continue making payments without

reaffirming.

No

Yes

Creditor’s

name: Citizen Auto Finance

Description of

property

securing debt:

2015 Chrysler 200C

Surrender the property.

Retain the property and redeem it.

Retain the property and enter into a

Reaffirmation Agreement.

Retain the property and [explain]:

Debtor will continue making payments without

reaffirming.

No

Yes

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

❑✔

❑

❑

❑

❑

❑

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑✔

❑

❑

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 64 of 67
Debtor 1

Debtor 2

Jeffrey D. Pattock

Nadine R. Pattock

First Name Middle Name Last Name

Case number (if known) 18-12974

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/ Jeffrey D. Pattock

Signature of Debtor 1

Date 09/13/2018

MM/ DD/ YYYY

✘ /s/ Nadine R. Pattock

Signature of Debtor 2

Date 09/13/2018

MM/ DD/ YYYY

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

❑

❑

❑

❑

❑

❑

❑

❑

❑

❑

❑

❑

❑

❑

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 65 of 67
Check if this is an amended filing

Fill in this information to identify your case:

Debtor 1 Jeffrey D. Pattock

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Nadine R. Pattock

First Name Middle Name Last Name

United States Bankruptcy Court for the: Eastern District of Virginia

Case number

(if known)

18-12974

Statement for Pattock, Jeffrey D.

Official Form 122A-1Supp

File this supplement together with Chapter 7 Statement of Your Current Monthly Income (Official Form 122A-1), if you believe that you are exempted from a

presumption of abuse. Be as complete and accurate as possible. If two married people are filing together, and any of the exclusions in this statement applies to only

one of you, the other person should complete a separate Form 122A-1 if you believe that this is required by 11 U.S.C. § 707(b)(2)(C).

Part 1: Identify the Kind of Debts You Have

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." Make sure that your answer is consistent with the answer you gave at line 16 of the Voluntary Petition (Official Form 101).

No. Go to Form 122A-1; on the top of page 1 of that form, check box 1, There is no presumption of abuse, and sign Part 3. Then submit this

supplement with the signed Form 122A-1.

Yes. Go to Part 2.

1.

Part 2: Determine Whether Military Service Provisions Apply to You

Are you a disabled veteran (as defined in 38 U.S.C. § 3741(1))?

No. Go to line 3.

Yes. Did you incur debts mostly while you were on active duty or while you were performing a homeland defense activity?

10 U.S.C. § 101(d)(1)); 32 U.S.C. § 901(1).

No. Go to line 3.

Yes. Go to Form 122A-1; on the top of page 1 of that form, check box 1, There is no presumption of abuse, and sign Part 3. Then

submit this supplement with the signed Form 122A-1.

2.

Are you or have you been a Reservist or member of the National Guard?

No. Complete Form 122A-1. Do not submit this supplement.

Yes. Were you called to active duty or did you perform a homeland defense activity? 10 U.S.C. § 101(d)(1); 32 U.S.C. § 901(1)

No. Complete Form 122A-1. Do not submit this supplement.

Yes. Check any one of the following categories that applies:

3.

I was called to active duty after September 11, 2001, for at least 90 days and

remain on active duty.

I was called to active duty after September 11, 2001, for at least 90 days and was

released from active duty on 06/30/2017 , which is fewer than 540 days

before I file this bankruptcy case.

I am performing a homeland defense activity for at least 90 days.

I performed a homeland defense activity for at least 90 days, ending on

, which is fewer than 540 days before I file this bankruptcy

case.

If you checked one of the categories to the left, go to Form

122A-1. On the top of page 1 of Form 122A-1, check box 3,

The Means Test does not apply now, and sign Part 3. Then

submit this supplement with the signed Form 122A-1. You are

not required to fill out the rest of Official Form 122A-1 during

the exclusion period. The exclusion period means the time you

are on active duty or are performing a homeland defense

activity, and for 540 days afterward. 11 U.S.C. § 707(b)

(2)(D)(ii).

If your exclusion period ends before your case is closed, you

may have to file an amended form later

Official Form 122A-1Supp Statement of Exemption from Presumption of Abuse Under § 707(b)(2) page 1

❑

Statement of Exemption from Presumption of Abuse Under § 707(b)(2) 12/15

❑

❑✔

❑✔

❑

❑

❑

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 66 of 67
B2030 (Form 2030)(12/15)

United States Bankruptcy Court

Eastern District of Virginia

In re

Pattock, Jeffrey D.

Pattock, Nadine R.

Case No. 18-12974

Chapter 7

Debtor(s)

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 . . . . . . . . . . . . . . . . . . . . . . . . $4,485.00

Prior to the filing of this statement I have received . . . . . . . . . . . . . . . . . . $4,185.00

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.

09/13/2018

Date

/s/ Robert R. Weed

Signature of Attorney

Law Offices Of Robert Weed

Name of law firm

❑✔ ❑

❑✔ ❑

❑✔

❑

Case 18-12974-BFK Doc 21 Filed 09/17/18 Entered 09/17/18 11:52:45 Desc Main

 Document Page 67 of 67