Debtor 1 

Debtor 2 

(Spouse, if filing) 

Donna 

First Name 

First Name 

United States Bankruptcy Court for the: 

Case number 

Middle Name 

Middle Name 

Official Form 106A/B 

Schedule A/B: Property 

Darnley 

Last Name 

Last Name 

Eastern District of Virginia 

GZI Check if this is an 

amended filing 

12/15 

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

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

information. If more space is needed, attach a separate sheet to this form. On the top of any additional pages, write your name and case number (if known). 

Answer every question. 

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? 

D No. Go to Part 2. 

GZI Yes. Where is the property? 

1 .1 609 Todd Trail 

Street address, if available, or other 

description 

Newport News, VA 23602 

City State 

County 

ZIP Code 

What is the property? Check all that apply. 

D Single-family home 

D Duplex or multi-unit building 

!ill Condominium or cooperative 

D Manufactured or mobile home 

Oland 

D Investment property 

D Timeshare 

D Other __________ _ 

Who has an interest in the property? Check one. 

liZI Debtor 1 only 

0 Debtor 2 only 

D Debtor 1 and Debtor 2 only 

0 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? 

$140,000.00 

Current value of the 

portion you own? 

$140,000.00 

Describe the nature of your ownership interest 

(such as fee simple, tenancy by the entireties, or 

a life estate), if known. 

Fee Simple 

D 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 ➔ l----'-$_14_0"""',_oo_o_.o_o_ for Part 1. Write that number here ........................................................................................................ . 

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

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Document Page 1 of 18
Debtor 1 Donna Darnley Case number (if known) _________ _ 

First Name Middle Name Last Name 

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 

ONo 

QI Yes 

3.1 Make: Acura 

Model: 

Who has an interest in the property? Check one. 

QI Debtor 1 only 

D Debtor 2 only 

Do not deduct secured claims or exemptions. Put the 

amount of any secured claims on Schedule D: Creditors 

Who Have Claims Secured by Property. 

Year: 2011 D Debtor 1 and Debtor 2 only 

D At least one of the debtors and another 

Current value of the 

entire property? 

Approximate mileage: 

Other information: 

I 

70000 

D Check if this is community property 

(see instructions) 

4 . Watercraft, aircraft, motor homes, ATVs and other recreational vehicles, other vehicles, and accessories 

Examples: Boats, trailers, motors, personal watercraft, fishing vessels, snowmobiles, motorcycle accessories 

QI No 

OYes 

$5,725.00 

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

Describe Your Personal and Household Items 

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

6. Household goods and furnishings 

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

~ ~;s. Describe ....... . I lvng rm set, table & chairs, beds (2) 

7. Electronics 

Examples: Televisions and radios; audio, video, stereo, and digital equipment; computers, printers, scanners; music 

collections; electronic devices including cell phones, cameras, media players, games 

QI No 

D Yes. Describe ....... . 

8. Collectibles of value 

Examples: Antiques and figurines; paintings, prints, or other artwork; books, pictures, or other art objects; 

stamp, coin , or baseball card collections; other collections, memorabilia, collectibles 

QI No 

0 Yes. Describe ....... . 

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

Current value of the 

portion you own? 

$5 725.00 

➔ l----'-$5....:,_72_5_._oo_ 

Current value of the 

portion you own? 

Do not deduct secured 

claims or exemptions. 

$3,300.00 

page 2 

Case 21-50337-SCS Doc 27 Filed 05/22/21 Entered 05/22/21 16:46:43 Desc Main

Document Page 2 of 18
Debtor 1 Donna Darnley Case number (if known) ________ _ 

First Name Middle Name Last Name 

9. Equipment for sports and hobbies 

Examples: Sports, photographic, exercise, and other hobby equipment; bicycles, pool tables, golf clubs, skis; canoes 

and kayaks; carpentry tools; musical instruments 

6Zi No 

0 Yes. Describe ....... . 

10. Fireanns 

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

6Zi No 

0 Yes. Describe ...... . . 

11 . Clothes 

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

6Zi No 

0 Yes. Describe ....... . 

12. Jewelry 

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

gold, silver 

6Zi No 

0 Yes. Describe ....... . 

13. Non-fann animals 

Examples: Dogs, cats, birds, horses 

6Zi No 

0 Yes. Describe ........ 

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

6Zi No 

0 Yes. Describe ....... . 

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 ............... .... .................. .. .......... ........ ............................................................ .......... ......... ➔ 

Describe Your Financial Assets 

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

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 

6Zi No 

0 Yes ..... ...................... ... .......................................................................................................................... Cash ............. . 

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

$3,300.00 

Current value of the 

portion you own? 

Do not deduct secured 

claims or exemptions. 

page 3 

Case 21-50337-SCS Doc 27 Filed 05/22/21 Entered 05/22/21 16:46:43 Desc Main

Document Page 3 of 18
Debtor 1 Donna Darnley Case number (if known) _________ _ 

First Name Middle Name Last Name 

17. Deposits of money 

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

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

~~:s ............... .. . Institution name: 

17. 1. Checking account: Union Bank & Trust 

17.2. Checking account: 

17.3. Savings account: 

17.4. Savings account: 

17 .5. Certificates of deposit: 

17 .6. Other financial account: 

17. 7. 01her financial account: 

17.8. Other financial account: 

17.9. Other financial account: 

18. Bonds, mutual funds, or publicly traded stocks 

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

liZf No 

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

Institution or issuer name: 

$6,529.00 

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

an LLC, partnership, and joint venture 

5Zi No 

0 Yes. Give specific 

information about 

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

Name of entity: 

Official Form 106A/B 

% of ownership: 

Schedule A/8: Property page4 

Case 21-50337-SCS Doc 27 Filed 05/22/21 Entered 05/22/21 16:46:43 Desc Main

Document Page 4 of 18
Debtor 1 Donna Darnley Case number (if known) _________ _ 

First Name Middle Name Last Name 

20. Government and corporate bonds and other negotiable and non-negotiable instruments 

Negotiable instruments include personal checks, cashiers' checks, promissory notes, and money orders. 

Non-negotiable instruments are those you cannot transfer to someone by signing or delivering them. 

fi1 No 

D Yes. Give specific 

information about 

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

Issuer name: 

21 . Retirement or pension accounts 

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

fi1 No 

D Yes. List each 

account separately. 

Type of account: 

401 (k) or similar plan: 

Pension plan: 

IRA: 

Retirement account: 

Keogh: 

Additional account: 

Institution name: 

22. Security deposits and prepayments 

Your share of all unused deposits you have made so that you may continue service or use from a company 

Examples: Agreements with landlords, prepaid rent, public utilities (electric, gas, water), telecommunications 

companies, or others 

fi1 No 

DYes .................... . 

Institution name or individual: 

Electric: 

Gas: 

Heating oil: 

Security deposit on rental unit: 

Prepaid rent: 

Official Form 106A/B Schedule A/8: Property page 5 

Case 21-50337-SCS Doc 27 Filed 05/22/21 Entered 05/22/21 16:46:43 Desc Main

Document Page 5 of 18
Debtor 1 Donna Darnley Case number (if known) ________ _ 

First Name Middle Name Last Name 

Telephone: 

Water: 

Rented furniture: 

Other: 

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

5Zi No 

OYes .................... . 

Issuer name and description: 

24. Interests in an education IRA, in an account in a qualified ABLE program, or under a qualified state tuition program. 

26 U.S.C. §§ 530(b)(1 ), 529A(b), and 529(b)(1 ). 

~No 

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

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

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

for your benefit 

5Zi No 

0 Yes. Give specific 

information about them .... 

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

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

ill! No 

0 Yes. Give specific 

information about them .... 

27. Licenses, franchises, and other general intangibles 

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

professional licenses 

5Zi No 

0 Yes. Give specific 

information about them .... 

Money or property owed to you? 

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

Current value of the 

portion you own? 

Do not deduct secured 

claims or exemptions. 

page 6 

Case 21-50337-SCS Doc 27 Filed 05/22/21 Entered 05/22/21 16:46:43 Desc Main

Document Page 6 of 18
Debtor 1 Donna Darnley 

Last Name 

Case number (if known) ________ _ 

First Name Middle Name 

28. Tax refunds owed to you 

621 No 

D Yes. Give specific information 

about them, including whether 

you already filed the returns 

and the tax 

years ...................... . 

29. Family support 

I 

Federal: 

State: 

Local: .._ ____________________ __, 

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

621 No 

D Yes. Give specific 

information ......... . 

30. Other amounts someone owes you 

Alimony: 

Maintenance: 

Support: 

Divorce settlement 

Property settlement: 

Examples: Unpaid wages, disability insurance payments, disability benefits, sick pay, vacation pay, workers' 

compensation, Social Security benefits; unpaid loans you made to someone else 

621 No 

D Yes. Give specific 

information .... ..... . 

31. Interests in insurance policies 

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

621 No 

D Yes. Name the insurance company 

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

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

If you are the beneficiary of a living trust, expect proceeds from a life insurance policy, or are currently entitled to receive 

property because someone has died. 

621 No 

D Yes. Give specific 

information ......... . 

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

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

liZf No 

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

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

Case 21-50337-SCS Doc 27 Filed 05/22/21 Entered 05/22/21 16:46:43 Desc Main

Document Page 7 of 18
Debtor 1 Donna Darnley Case number (if known) _________ _ 

First Name Middle Name Last Name 

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

to set off claims 

621 No 

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

35. Any financial assets you did not already list 

621 No 

0 Yes. Give specific 

information ......... . 

36. Add the dollar value of all of your entries from Part 4, including any entries for pages you have attached 

for Part 4. Write that number here ............................................ ......... ............................................................... .............. ➔ $6,529.00 

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? 

621 No. Go to Part 6. 

0Yes. Go to line 38. 

38. Accounts receivable or commissions you already earned 

621 No 

0 Yes. Describe ...... .. 

39. Office equipment, furnishings, and supplies 

Current value of the 

portion you own? 

Do not deduct secured 

claims or exemptions. 

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

621 No 

0 Yes. Describe ....... . 

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

621 No 

0 Yes. Describe ....... . 

41 . Inventory 

621 No 

0 Yes. Describe ....... . 

42. Interests in partnerships or joint ventures 

621 No 

0 Yes. Describe ....... . 

Name of entity: 

Official Form 106A/B 

% of ownership: 

Schedule A/B: Property page 8 

Case 21-50337-SCS Doc 27 Filed 05/22/21 Entered 05/22/21 16:46:43 Desc Main

Document Page 8 of 18
Debtor 1 Donna Darnley Case number (if known) _________ _ 

First Name Middle Name 

43. Customer lists, mailing lists, or other compilations 

iiZI No 

Last Name 

______ % 

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

!iZl No 

0 Yes. Describe ....... . 

44. Any business-related property you did not already list 

iiZI No 

0 Yes. Give specific 

information ........ . 

45. 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 ............ ............... ...................................................................... ................................ ➔ 

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? 

iiZI No. Go to Part 7. 

OYes. Go to line 47. 

47. Farm animals 

Examples: Livestock, poultry, farm-raised fish 

iiZI No 

Ye s ........................ . 

48. Crops-either growing or harvested 

iit1 No 

0 Yes. Give specific 

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

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

iiZI No 

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

50. Farm and fishing supplies, chemicals, and feed 

bZl No 

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

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

$0.00 

Current value of the 

portion you own? 

Do not deduct secured 

claims or exemptions. 

page 9 

Case 21-50337-SCS Doc 27 Filed 05/22/21 Entered 05/22/21 16:46:43 Desc Main

Document Page 9 of 18
Debtor 1 Donna Darnley Case number (if known) _________ _ 

First Name Middle Name Last Name 

51 . Any fann- and commercial fishing-related property you did not already list 

621 No 

0 Yes. Give specific 

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

52. 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 .......................................................................................... ..................................... .... ➔ 

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

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

Examples: Season tickets, country club membership 

621 No 

0 Yes. Give specific 

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

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

List the Totals of Each Part of this Form 

55. Part 1: Total real estate, line 2 .......................................................................................................................................... ➔ 

56. Part 2: Total vehicles, line 5 $5,725.00 

57. Part 3: Total personal and household items, line 15 $3,300.00 

58. Part 4: Total financial assets, line 36 $6,529.00 

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

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

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

$0.00 

$0.00 

$140,000.00 

62. Total personal property. Add lines 56 through 61 ............. . $15,554.00 I Copy perso nal property total ➔ 1•-----'$_1_5-'--,5_5_4_.0_0_ 

63. Total of all property on Schedule A/8. Add line 55 + line 62 ............................................................................................... .. $155,554.00 

Official Form 106A/B Schedule A/8: Property page 10 

Case 21-50337-SCS Doc 27 Filed 05/22/21 Entered 05/22/21 16:46:43 Desc Main

Document Page 10 of 18
Debtor 1 

Debtor 2 

(Spouse, if filing) 

Donna 

First Name 

First Name 

United States Bankruptcy Court for the: 

Case number 

(if known) 

Official Form 106C 

Darnley 

Middle Name Last Name 

Middle Name Last Name 

Eastern District of Virginia 

Schedule C: The Property You Claim as Exempt 

5li Check if this is an 

amended filing 

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

property you listed on Schedule AIB: Property (Official Form 106A/B) as your source, list the property that you claim as exempt. If more space is ne 

out and attach to this page as many copies of Part Z: Additional Page as necessary. On the top of any additional pages, write your name and case n 

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 

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

Some exemptions-such as those for health aids, rights to receive certain benefits, and tax-exempt retirement funds-may be unlimited in dollar ar 

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 

property is determined to exceed that amount, your exemption would be limited to the applicable staMory amount. 

p 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. 

5li You are claiming state and federal nonbankruptcy exemptions. 11 U.S.C. § 522(b)(3) 

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

2. For any property you list on Schedule AIB 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 

Brief description: 

609 Todd Trail Newport News, VA 23602 

Line from 

Schedule AIB: 1. 1 

Brief description: 

2011 Acura 

Line from 

Schedule AIB: 3.1 

Current value of the 

portion you own 

Copy the value from 

Schedule AIB 

$140,000.00 

$5 725.00 

Amount of the exemption you claim 

Check only one box for each exemption. 

5li $20 000.00 

0 100% of fair market value, up 

to any applicable statutory limit 

5li $5,725.00 

0 100% of fair market value, up 

to any applicable statutory limit 

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

(Subject to adjustment on 4/01/22 and every 3 years after that for cases filed on or after the date of adjustment.) 

5li No 

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

0No 

Yes 

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

Specific laws that allow ex• 

Va. Code Ann. § 34-4 

Va. Code Ann. § 34-26(8) 

Case 21-50337-SCS Doc 27 Filed 05/22/21 Entered 05/22/21 16:46:43 Desc Main

Document Page 11 of 18
Debtor 1 Donna 

First Name Middle Name 

Additional Page 

Brief description of the property and line on 

Schedule A/8 that lists this property 

Brief description: 

lvng rm set, table & chairs, beds (2) 

Line from 

Schedule NB: 6 

Brief description: 

Union Bank & Trust 

Checking account 

Line from 

Schedule NB: 17 

Darnley 

Last Name 

Current value of the 

portion you own 

Copy the value from 

Schedule NB 

$3 300.00 

$6 529.00 

Case number (if known) _____ _ 

Amount of the exemption you claim Specific laws that allow ex, 

Check only one box for each exemption. 

~ $3 300.00 Va. Code Ann.§ 34-26(4a) 

0 100% of fair market value, up 

to any applicable statutory limit 

~ $5,000.00 Va. Code Ann. § 34-4 

0 100% of fair market value, up 

to any applicable statutory limit 

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

Case 21-50337-SCS Doc 27 Filed 05/22/21 Entered 05/22/21 16:46:43 Desc Main

Document Page 12 of 18
Debtor 1 

Debtor 2 

(Spouse, if filing) 

Donna 

First Name 

First Name 

United States Bankruptcy Court for the: 

Case number 

(if known) 

Official Form 106E/F 

Darnley 

Middle Name Last Name 

Middle Name Last Name 

Eastern District of Virginia 

Schedule E/F: Creditors Who Have Unsecured Claims 

liZl Check if this is an 

amended filing 

12/15 

Be as complete and accurate as possible. Use Part 1 for creditors with PRIORITY claims and Part 2 for creditors with NONPRIORITY claims. List the other 

party to any executory contracts or unexpired leases that could result in a claim. Also list executory contracts on Schedule A/B: Property (Official Form 

106A/B) and on Schedule G: Executory Contracts and Unexpired Leases (Official Form 106G). Do not include any creditors with partially secured claims that 

are listed in Schedule D: Creditors Who 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). 

List All of Your PRIORITY Unsecured Claims 

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

ll£I No. Go to Part 2. 

D Yes. 

2. List all of your priority unsecured claims. If a credrtor 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.) 

CJ 

Priority Creditor's Name 

Number Street 

City State 

Who incurred the debt? Check one. 

D Debtor 1 only 

D Debtor 2 only 

D Debtor 1 and Debtor 2 only 

ZIP Code 

D At least one of the debtors and another 

D Check if this claim is for a community debt 

Is the claim subject to offset? 

0 No 

D Yes 

Official Form 106E/F 

Last 4 digits of account number ____ _ 

When was the debt incurred? 

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

apply. 

D Contingent 

D Unliquidated 

0 Disputed 

Type of PRIORITY unsecured claim: 

D Domestic support obligations 

D Taxes and certain other debts you owe the 

government 

0 Claims for death or person injury while you were 

intoxicated 

D Other. Specify 

Schedule E/F: Creditors Who Have Unsecured Claims 

Total claim Priority 

amount 

Nonpriority 

amount 

page 1 of 5 

Case 21-50337-SCS Doc 27 Filed 05/22/21 Entered 05/22/21 16:46:43 Desc Main

Document Page 13 of 18
Debtor 1 Donna Darnley Case number (if known/ _________ _ 

First Name Middle Name Last Name 

List All of Your NONPRIORITY Unsecured Claims 

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

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

ilZI 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. 

E2J Capital One 

Nonpriority CreditMs Name 

PO Box 71083 

Number Street 

Charlotte, NC 28272 

City State ZIP Code 

Who incurred the debt? Check one. 

ilZI Debtor 1 only 

0 Debtor 2 only 

0 Debtor 1 and Debtor 2 only 

0 At least one of the debtors and another 

0 Check if this claim is for a community debt 

Is the claim subject to offset? 

ilZI No 

0 Yes 

Cavalry SPV, assignee of Citibank 

Nonpriority Creditor's Name 

c/o Schrier, Tolin & Wagman, LLC 

1390 Piccard Drive 315 

Number Street 

Rockville, MD 20850 

City State 

Who incurred the debt? Check one. 

ilZI Debtor 1 only 

0 Debtor 2 only 

0 Debtor 1 and Debtor 2 only 

ZIP Code 

0 At least one of the debtors and another 

0 Check if this claim is for a community debt 

Is the claim subject to offset? 

ilZI No 

0 Yes 

EI] Citibank N.A. 

Nonpriority Creditor's Name 

D&A Services LLC 

1400 E Touhy Av Ste G2 

Number Street 

Des Plaines, IL 60018 

City State 

Who incurred the debt? Check one. 

ilZI Debtor 1 only 

0 Debtor 2 only 

0 Debtor 1 and Debtor 2 only 

ZIP Code 

0 At least one of the debtors and another 

0 Check If this claim is for a community debt 

Is the claim subject to offset? 

ilZI No 

0 Yes 

Official Form 106E/F 

Last 4 digits of account number ____ _ 

When was the debt incurred? 

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

0 Contingent 

0 Unliquidated 

0 Disputed 

Type of NONPRIORITY unsecured claim: 

0 Student loans 

0 Obligations arising out of a separation agreement or 

divorce that you did not report as priority claims 

0 Debts to pension or profit-sharing plans, and other 

similar debts 

ilZI Other. Specify 

Credit Card 

Last 4 digits of account number ____ _ 

When was the debt incurred? 

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

0 Contingent 

0 Unliquidated 

0 Disputed 

Type of NONPRIORITY unsecured claim: 

0 Student loans 

0 Obligations arising out of a separation agreement or 

divorce that you did not report as priority claims 

0 Debts to pension or profit-sharing plans, and other 

similar debts 

ilZI Other. Specify 

Collection Agency 

Last 4 digits of account number ____ _ 

When was the debt incurred? 

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

0 Contingent 

0 Unliquidated 

D Disputed 

Type of NON PRIORITY unsecured claim: 

0 Student loans 

0 Obligations arising out of a separation agreement or 

divorce that you did not report as priority claims 

0 Debts to pension or profit-sharing plans, and other 

similar debts 

ilZI Other. Specify 

Credit Card 

Schedule E/F: Creditors Who Have Unsecured Claims 

Total claim 

$3,000.00 

$3,396.00 

$3,396.00 

page 2 of 5 

Case 21-50337-SCS Doc 27 Filed 05/22/21 Entered 05/22/21 16:46:43 Desc Main

Document Page 14 of 18
Debtor 1 Donna Darnley 

Last Name 

Case number (if known) _________ _ 

First Name Middle Name 

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. 

0 Credit Control Corp 

Nonpriority Creditor's Name 

PO Box 120568 

Number Street 

Newport News, VA 23612 

City State 

Who incurred the debt? Check one. 

iiZI Debtor 1 only 

0 Debtor 2 only 

0 Debtor 1 and Debtor 2 only 

ZIP Code 

0 At least one of the debtors and another 

0 Check if this claim is for a community debt 

Is the claim subject to offset? 

6ZI No 

0 Yes 

0 Discover 

Nonpriority Creditor's Name 

PO Box 71084 

Number Street 

Charlotte, NC 28274 

City State 

Who incurred the debt? Check one. 

6ZI Debtor 1 only 

0 Debtor 2 only 

0 Debtor 1 and Debtor 2 only 

ZIP Code 

0 At least one of the debtors and another 

0 Check if this claim is for a community debt 

Is the claim subject to offset? 

6ZI No 

0 Yes 

0 Discover 

Nonpriority Creditor's Name 

PO Box 6103 

Number Street 

Carol Stream, IL 60197 

City State 

Who incurred the debt? Check one. 

6ZI Debtor 1 only 

0 Debtor 2 only 

0 Debtor 1 and Debtor 2 only 

ZIP Code 

0 At least one of the debtors and another 

0 Check if this claim is for a community debt 

Is the claim subject to offset? 

6ZI No 

D Yes 

Official Form 106E/F 

Last 4 digits of account number -----

When was the debt incurred? 

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

D Contingent 

0 Unliquidated 

0 Disputed 

Type of NONPRIORITY unsecured claim: 

0 Student loans 

0 Obligations arising out of a separation agreement or 

divorce that you did not report as priority claims 

0 Debts to pension or profit-sharing plans, and other 

similar debts 

6ZI Other. Specify 

Collection Agency 

Last 4 digits of account number ____ _ 

When was the debt incurred? 

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

0 Contingent 

0 Unliquidated 

0 Disputed 

Type of NONPRIORITY unsecured claim: 

0 Student loans 

D Obligations arising out of a separation agreement or 

divorce that you did not report as priority claims 

0 Debts to pension or profit-sharing plans, and other 

similar debts 

6ZI Other. Specify 

Credit Card 

Last 4 digits of account number ____ _ 

When was the debt incurred? 

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

0 Contingent 

0 Unliquidated 

0 Disputed 

Type of NONPRIORITY unsecured claim: 

0 Student loans 

0 Obligations arising out of a separation agreement or 

divorce that you did not report as priority claims 

D Debts to pension or profit-sharing plans, and other 

similar debts 

6ZI Other. Specify 

Credit Card 

Schedule E/F: Creditors Who Have Unsecured Claims 

Total claim 

$769.00 

$400.00 

$4,768.00 

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Case 21-50337-SCS Doc 27 Filed 05/22/21 Entered 05/22/21 16:46:43 Desc Main

Document Page 15 of 18
Debtor 1 Donna Darnley Case number (if known) _________ _ 

First Name Middle Name Last Name 

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. 

0 Henrico Doctors Hospital 

Nonpriority Creditor's Name 

1602 Skipwith Rd 

Number Street 

Henrico, VA 23229 

City State 

Who incurred the debt? Check one. 

6Zi Debtor 1 only 

0 Debtor 2 only 

0 Debtor 1 and Debtor 2 only 

ZIP Code 

0 At least one of the debtors and another 

0 Check if this claim is for a community debt 

Is the claim subject to offset? 

6Zi No 

0 Yes 

0 JP Morgan Chase Bank 

Nonpriority Creditor's Name 

MRSBPO 

1930 Olney Av 

Number Street 

Cherry Hill, NJ 08003 

City State 

Who incurred the debt? Check one. 

6Zi Debtor 1 only 

0 Debtor 2 only 

0 Debtor 1 and Debtor 2 only 

ZIP Code 

0 At least one of the debtors and another 

0 Check if this claim is for a community debt 

Is the claim subject to offset? 

6Zi No 

0 Yes 

0 Riverside Hospital Ambulance 

Nonpriority Creditor's Name 

500 J Clyde Morris Blvd 

Number Street 

Newport News, VA 23601 

City State 

Who incurred the debt? Check one. 

6Zi Debtor 1 only 

0 Debtor 2 only 

0 Debtor 1 and Debtor 2 only 

ZIP Code 

0 At least one of the debtors and another 

0 Check if this claim is for a community debt 

Is the claim subject to offset? 

6Zi No 

0 Yes 

Official Form 106E/F 

Last 4 digits of account number ____ _ 

When was the debt incurred? 

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

0 Contingent 

0 Unliquidated 

0 Disputed 

Type of NONPRIORITY unsecured claim: 

0 Student loans 

0 Obligations arising out of a separation agreement or 

divorce that you did not report as priority claims 

0 Debts to pension or profit-sharing plans, and other 

similar debts 

6Zi Other. Specify 

Medical Bill 

Last 4 digits of account number ____ _ 

When was the debt incurred? 

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

0 Contingent 

0 Unliquidated 

0 Disputed 

Type of NONPRIORJTY unsecured claim: 

0 Student loans 

0 Obligations arising out of a separation agreement or 

divorce that you did not report as priority claims 

0 Debts to pension or profit-sharing plans, and other 

similar debts 

6Zi Other. Specify 

Credit Card 

Last 4 digits of account number ____ _ 

When was the debt incurred? 

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

0 Contingent 

0 Unliquidated 

0 Disputed 

Type of NONPRIORITY unsecured claim: 

0 Student loans 

0 Obligations arising out of a separation agreement or 

divorce that you did not report as priority claims 

0 Debts to pension or profit-sharing plans, and other 

similar debts 

6Zi Other. Specify 

Schedule E/F: Creditors Who Have Unsecured Claims 

Total claim 

$1,364.00 

$7,741 .00 

unknown 

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Case 21-50337-SCS Doc 27 Filed 05/22/21 Entered 05/22/21 16:46:43 Desc Main

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Debtor 1 Donna 

First Name Middle Name 

Darnley 

Last Name 

Add the Amounts for Each Type of Unsecured Claim 

Case number (if known) _________ _ 

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 claims 

from Part 1 

Total claims 

from Part 2 

6a. Domestic support obligations 

6b. Taxes and certain other debts you owe the 

government 

6c. Claims for death or personal injury while you 

were intoxicated 

6d. Other. Add all other priority unsecured claims. 

Write that amount here. 

6e. Total. Add lines 6a through 6d. 

6f. Student loans 

6g. Obligations arising out of a separation 

agreement or divorce that you did not report 

as priority claims 

6h. Debts to pension or profit-sharing plans, and 

other similar debts 

6i. Other. Add all other nonpriority unsecured 

claims. Write that amount here. 

6j. Total. Add lines 6f through 6i. 

6a. 

6b. 

6c. 

6d. + 

6e. 

6f. 

6g. 

6h. 

6i. + 

6j. 

Total claim 

Total claim 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

$0.00 

$24,834.00 

$24,834.00 

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

Case 21-50337-SCS Doc 27 Filed 05/22/21 Entered 05/22/21 16:46:43 Desc Main

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Debtor 1 

Debtor 2 

(Spouse, if filing) 

Donna 

First Name 

First Name 

United States Bankruptcy Court for the: 

Case number 

(if known) 

Official Form 106Dec 

Darnley 

Middle Name Last Name 

Middle Name Last Name 

Eastern District of Virginia 

Declaration About an Individual Debtor's Schedules 

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

Glf Check if this is an 

amended filing 

12/15 

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? 

O Yes. Name of person ___________________ Attach Bankruptcy Petition Preparer's Notice, Declaration, and 

Signature (Official Form 119). 

Under penalty of perjury, I declare that I have read the summary and schedules filed with this declaration and that they are true and correct. 

X Isl Donna Darnley 

Donna Darnley, Debtor 1 

Date 05/2112021 

MM/ DD/ YYYY 

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

Case 21-50337-SCS Doc 27 Filed 05/22/21 Entered 05/22/21 16:46:43 Desc Main

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