Fill in this information to identify your case:

Debtor 1 Charles Anthony Barbettini, Jr.

First Name Middle Name Last Name

Debtor 2 Tonia Danita Barbettini

(Spouse if, filing) First Name Middle Name Last Name

United States Bankruptcy Court for the: EASTERN DISTRICT OF VIRGINIA

Case number 19-34680-KRH

(if known)  Check if this is an

amended filing

Official Form 106Sum

Summary of Your Assets and Liabilities and Certain Statistical Information 12/15

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................................................................................................ $ 302,150.00

1b. Copy line 62, Total personal property, from Schedule A/B..................................................................................... $ 15,057.47

1c. Copy line 63, Total of all property on Schedule A/B............................................................................................... $ 317,207.47

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... $ 264,140.02

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................................. $ 9,280.00

3b. Copy the total claims from Part 2 (nonpriority unsecured claims) from line 6j of Schedule E/F............................ $ 96,694.58

Your total liabilities $ 370,114.60

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................................................................................ $ 5,382.11

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

Copy your monthly expenses from line 22c of Schedule J.......................................................................... $ 2,546.66

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

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

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Case 19-34680-KRH Doc 14 Filed 09/25/19 Entered 09/25/19 13:50:33 Desc Main

Document Page 1 of 15
Debtor 1

Debtor 2

Charles Anthony Barbettini, Jr.

Tonia Danita Barbettini Case number (if known) 19-34680-KRH

the court with your other schedules.

8. From the Statement of Your Current Monthly Income: Copy your total current monthly income from Official Form

122A-1 Line 11; OR, Form 122B Line 11; OR, Form 122C-1 Line 14. $ 5,452.36

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.) $ 9,280.00

9c. Claims for death or personal injury while you were intoxicated. (Copy line 6c.) $ 0.00

9d. Student loans. (Copy line 6f.) $ 89,038.00

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. $ 98,318.00

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

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Case 19-34680-KRH Doc 14 Filed 09/25/19 Entered 09/25/19 13:50:33 Desc Main

Document Page 2 of 15
Fill in this information to identify your case:

Debtor 1 Charles Anthony Barbettini, Jr.

First Name Middle Name Last Name

Debtor 2 Tonia Danita Barbettini

(Spouse if, filing) First Name Middle Name Last Name

United States Bankruptcy Court for the: EASTERN DISTRICT OF VIRGINIA

Case number 19-34680-KRH

(if known)  Check if this is an

amended filing

Official Form 106D

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

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

is needed, 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

Bridgecrest Formerly

Drivetime Describe the property that secures the claim: $14,493.00 $6,150.00 $8,343.00

Creditor's Name 2012 Buick Verano 114,000 miles

PO Box 29018

Phoenix, AZ 85038

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

apply.

 Contingent

Number, Street, City, State & Zip Code  Unliquidated

 Disputed

Who owes the debt? Check one. Nature of lien. Check all that apply.

 Debtor 1 only

 Debtor 2 only

 An agreement you made (such as mortgage or secured

car loan)

 Debtor 1 and Debtor 2 only  Statutory lien (such as tax lien, mechanic's lien)

 At least one of the debtors and another  Judgment lien from a lawsuit

 Check if this claim relates to a

community debt

 Other (including a right to offset) PMSI

Date debt was incurred 05/10/2016 Last 4 digits of account number

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

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Document Page 3 of 15
Debtor 1 Charles Anthony Barbettini, Jr. Case number (if known) 19-34680-KRH

First Name Middle Name Last Name

Debtor 2 Tonia Danita Barbettini

First Name Middle Name Last Name

2.2

Creekwood Owners

Assocations I Describe the property that secures the claim: $6,000.00 $299,900.00 $0.00

Creditor's Name 7812 Little Ridge Court Chesterfield,

VA 23832 Chesterfield County

Primary Residence

Parcel ID: 762688222300000

4225 Ketcham Drive

Chesterfield, VA 23832

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

apply.

 Contingent

Number, Street, City, State & Zip Code  Unliquidated

 Disputed

Who owes the debt? Check one. Nature of lien. Check all that apply.

 Debtor 1 only

 Debtor 2 only

 An agreement you made (such as mortgage or secured

car loan)

 Debtor 1 and Debtor 2 only  Statutory lien (such as tax lien, mechanic's lien)

 At least one of the debtors and another  Judgment lien from a lawsuit

 Check if this claim relates to a

community debt

 Other (including a right to offset) Homeowners Associations Fees

Date debt was incurred Last 4 digits of account number

2.3

Franklin Credit

Management Describe the property that secures the claim: $0.00 $299,900.00 $0.00

Creditor's Name 7812 Little Ridge Court Chesterfield,

VA 23832 Chesterfield County

Primary Residence

Parcel ID: 762688222300000 PO Box 2301

Jersey City, NJ

07303-2301

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

apply.

 Contingent

Number, Street, City, State & Zip Code  Unliquidated

 Disputed

Who owes the debt? Check one. Nature of lien. Check all that apply.

 Debtor 1 only

 Debtor 2 only

 An agreement you made (such as mortgage or secured

car loan)

 Debtor 1 and Debtor 2 only  Statutory lien (such as tax lien, mechanic's lien)

 At least one of the debtors and another  Judgment lien from a lawsuit

 Check if this claim relates to a

community debt

 Other (including a right to offset)

Date debt was incurred

January 24,

2005 Last 4 digits of account number

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

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Document Page 4 of 15
Debtor 1 Charles Anthony Barbettini, Jr. Case number (if known) 19-34680-KRH

First Name Middle Name Last Name

Debtor 2 Tonia Danita Barbettini

First Name Middle Name Last Name

2.4

Select Portfolio Servicing

Inc Describe the property that secures the claim: $243,647.02 $299,900.00 $0.00

Creditor's Name 7812 Little Ridge Court Chesterfield,

VA 23832 Chesterfield County

Primary Residence

Parcel ID: 762688222300000

PO Box 65350

Salt Lake City, UT 84165

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

apply.

 Contingent

Number, Street, City, State & Zip Code  Unliquidated

 Disputed

Who owes the debt? Check one. Nature of lien. Check all that apply.

 Debtor 1 only

 Debtor 2 only

 An agreement you made (such as mortgage or secured

car loan)

 Debtor 1 and Debtor 2 only  Statutory lien (such as tax lien, mechanic's lien)

 At least one of the debtors and another  Judgment lien from a lawsuit

 Check if this claim relates to a

community debt

 Other (including a right to offset) Deed of Trust

Date debt was incurred Last 4 digits of account number

Add the dollar value of your entries in Column A on this page. Write that number here: $264,140.02

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

Write that number here: $264,140.02

Part 2: List Others to Be Notified for a Debt That You Already Listed

Use this page only if you have others to be notified about your bankruptcy for a debt that you already listed in Part 1. For example, if a collection agency is

trying to collect from you for a debt you owe to someone else, list the creditor in Part 1, and then list the collection agency here. Similarly, if you have more

than one creditor for any of the debts that you listed in Part 1, list the additional creditors here. If you do not have additional persons to be notified for any

debts in Part 1, do not fill out or submit this page.

Name, Number, Street, City, State & Zip Code

Shapiro & Brown, LLP

10021 Balls Ford Rd

Suite 200

Manassas, VA 20109

On which line in Part 1 did you enter the creditor? 2.4 

Last 4 digits of account number 

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

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Case 19-34680-KRH Doc 14 Filed 09/25/19 Entered 09/25/19 13:50:33 Desc Main

Document Page 5 of 15
Fill in this information to identify your case:

Debtor 1 Charles Anthony Barbettini, Jr.

First Name Middle Name Last Name

Debtor 2 Tonia Danita Barbettini

(Spouse if, filing) First Name Middle Name Last Name

United States Bankruptcy Court for the: EASTERN DISTRICT OF VIRGINIA

Case number 19-34680-KRH

(if known)  Check if this is an

amended filing

Official Form 106E/F

Schedule E/F: Creditors Who Have Unsecured Claims 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 Have 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. If you have no information to report in a Part, do not file that Part. 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 County of Chesterfield Last 4 digits of account number $280.00 $280.00 $0.00

Priority Creditor's Name

Treasurer - Personal Property

P.O. Box 70

Chesterfield, VA 23832

When was the debt incurred?

Number Street City State Zip Code As of the date you file, the claim is: Check all that apply

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

 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

Tax Balance Due

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 1 of 9

Software Copyright (c) 1996-2019 Best Case, LLC - www.bestcase.com 26279 Best Case Bankruptcy

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Document Page 6 of 15
Debtor 1

Debtor 2

Charles Anthony Barbettini, Jr.

Tonia Danita Barbettini Case number (if known) 19-34680-KRH

2.2 Department of the Treasury Last 4 digits of account number $9,000.00 $1.00 $8,999.00

Priority Creditor's Name

Internal Revenue Services

P.O. Box 7346

Philadelphia, PA 19101-7346

When was the debt incurred? 2004, 2011

Number Street City State Zip Code As of the date you file, the claim is: Check all that apply

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

 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

Tax Balance Due

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 Barfish Emergency Phys LLC Last 4 digits of account number XXXX $1,534.00

Nonpriority Creditor's Name

7565 Dannaher Drive

Powell, TN 37849

When was the debt incurred?

Number Street City State Zip Code As of the date you file, the claim is: Check all that apply

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

 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

 Yes  Other. Specify Medical Services

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 2 of 9

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Document Page 7 of 15
Debtor 1

Debtor 2

Charles Anthony Barbettini, Jr.

Tonia Danita Barbettini Case number (if known) 19-34680-KRH

4.2 Capital One Bank USA NA Last 4 digits of account number XXXX $1,958.00

Nonpriority Creditor's Name

PO Box 30281

Salt Lake City, UT 84130

When was the debt incurred?

Number Street City State Zip Code As of the date you file, the claim is: Check all that apply

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

 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

 Yes  Other. Specify Account Balance

4.3 Capital One Bank USA NA Last 4 digits of account number XXXX $656.00

Nonpriority Creditor's Name

PO Box 30281

Salt Lake City, UT 84130

When was the debt incurred?

Number Street City State Zip Code As of the date you file, the claim is: Check all that apply

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

 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

 Yes  Other. Specify Account Balance

4.4 CJW Medical Center Last 4 digits of account number XXXX $1,050.00

Nonpriority Creditor's Name

PO Box 13620

Richmond, VA 23225

When was the debt incurred?

Number Street City State Zip Code As of the date you file, the claim is: Check all that apply

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

 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

 Yes  Other. Specify Medical Services

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 3 of 9

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Document Page 8 of 15
Debtor 1

Debtor 2

Charles Anthony Barbettini, Jr.

Tonia Danita Barbettini Case number (if known) 19-34680-KRH

4.5 Cornerstone/ Dept Of Ed. Last 4 digits of account number xxxx $19,423.00

Nonpriority Creditor's Name

P.O. Box 145122

Salt Lake City, UT 84114-5122

When was the debt incurred?

Number Street City State Zip Code As of the date you file, the claim is: Check all that apply

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

 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

 Yes  Other. Specify

Student Loan

4.6 County of Hanover General Dist Last 4 digits of account number XXXX $636.66

Nonpriority Creditor's Name

7530 County Complex Rd

Hanover, VA 23069

When was the debt incurred?

Number Street City State Zip Code As of the date you file, the claim is: Check all that apply

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

 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

 Yes  Other. Specify Account Balance

4.7 DMV Last 4 digits of account number Unknown $155.00

Nonpriority Creditor's Name

Attn: Bankruptcy Dept

2300 W. Broad St.

Richmond, VA 23220

When was the debt incurred? Unknown

Number Street City State Zip Code As of the date you file, the claim is: Check all that apply

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

 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

 Yes  Other. Specify

Reinstatement Fee $145.00

Multiple Order Fee(s) $10.00

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 4 of 9

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Document Page 9 of 15
Debtor 1

Debtor 2

Charles Anthony Barbettini, Jr.

Tonia Danita Barbettini Case number (if known) 19-34680-KRH

4.8 Elizabeth River Tunnels Last 4 digits of account number XXXX $110.30

Nonpriority Creditor's Name

152 Tunnel Facility Drive

Portsmouth, VA 23707-1802

When was the debt incurred?

Number Street City State Zip Code As of the date you file, the claim is: Check all that apply

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

 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

 Yes  Other. Specify Account Balance

4.9 Family Practice Specialists Last 4 digits of account number XXXX $114.65

Nonpriority Creditor's Name

Re: Bankruptcy

3742 Winterfield Road

Midlothian, VA 23113

When was the debt incurred?

Number Street City State Zip Code As of the date you file, the claim is: Check all that apply

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

 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

 Yes  Other. Specify Medical Services

4.1

0 James River Emergency Group Last 4 digits of account number XXXX $909.00

Nonpriority Creditor's Name

ATTN # 21109M

PO Box 14000

Belfast, ME 04915-4033

When was the debt incurred?

Number Street City State Zip Code As of the date you file, the claim is: Check all that apply

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

 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

 Yes  Other. Specify Medical Services

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 5 of 9

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Document Page 10 of 15
Debtor 1

Debtor 2

Charles Anthony Barbettini, Jr.

Tonia Danita Barbettini Case number (if known) 19-34680-KRH

4.1

1 Patient First Last 4 digits of account number Unknown $229.92

Nonpriority Creditor's Name

Attn: Patient Accounts

5000 Cox Road, Suite 100

Glen Allen, VA 23060

When was the debt incurred? Unknown

Number Street City State Zip Code As of the date you file, the claim is: Check all that apply

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

 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

 Yes  Other. Specify Medical Services

4.1

2 SunTrust Last 4 digits of account number XXXX $209.05

Nonpriority Creditor's Name

P.O. Box 305183

Nashville, TN 37230-5183

When was the debt incurred?

Number Street City State Zip Code As of the date you file, the claim is: Check all that apply

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

 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

 Yes  Other. Specify Account Balance

4.1

3 US Dept of Edcation Last 4 digits of account number xxxx $51,267.00

Nonpriority Creditor's Name

3130 Fairview Park Drive

Suite 800

Chesapeake, VA 23323

When was the debt incurred?

Number Street City State Zip Code As of the date you file, the claim is: Check all that apply

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

 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

 Yes  Other. Specify

Student Loan

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 6 of 9

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Debtor 1

Debtor 2

Charles Anthony Barbettini, Jr.

Tonia Danita Barbettini Case number (if known) 19-34680-KRH

4.1

4 US Dept of Edcation Last 4 digits of account number xxxx $18,348.00

Nonpriority Creditor's Name

3130 Fairview Park Drive

Suite 800

Chesapeake, VA 23323

When was the debt incurred?

Number Street City State Zip Code As of the date you file, the claim is: Check all that apply

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

 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

 Yes  Other. Specify

Student Loan

4.1

5 Verizon Last 4 digits of account number XXXX $94.00

Nonpriority Creditor's Name

PO Box 650584

Dallas, TX 75265-0584

When was the debt incurred?

Number Street City State Zip Code As of the date you file, the claim is: Check all that apply

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

 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

 Yes  Other. Specify Account Balance

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.

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

Commonwealth Finance

245 Main St

Scranton, PA 18519

Line 4.1 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number

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

Convergent Outsourcing

500 SW 7th St, Bld A 100

Renton, WA 98055

Line 4.12 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number

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

Debt Recovery Solutions

6800 Jericho Turnpike

Suite 113E

Syosset, NY 11791

Line 4.1 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number

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

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 7 of 9

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Case 19-34680-KRH Doc 14 Filed 09/25/19 Entered 09/25/19 13:50:33 Desc Main

Document Page 12 of 15
Debtor 1

Debtor 2

Charles Anthony Barbettini, Jr.

Tonia Danita Barbettini Case number (if known) 19-34680-KRH

IC Systems Collections

PO Box 64378

Saint Paul, MN 55164-0378

Line 4.10 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number

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

Internal Revenue Service

PO Box 7346

Philadelphia, PA 19101-7346

Line 2.2 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number

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

Internal Revenue Service

Proceedings & Insolvencies

P.O. Box 21126

Philadelphia, PA 19114-0326

Line 2.2 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number

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

Linebarger. Goggan, Blair & Sa

Re: Elizabeth River Tunnels

P.O. Box 23180

Richmond, VA 23223

Line 4.8 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number

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

Medicredit Corporation

PO Box 1629

Maryland Heights, MO 63043

Line 4.4 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number

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

Pendrick Capital Partners

625 US-1

Key West, FL 33040

Line 4.1 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number

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

Portfolio Recovery Assoc., LLC

120 Corporate Boulevard

Suite 100

Norfolk, VA 23502

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

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

6a. Domestic support obligations 6a. $ 0.00

Total

claims

from Part 1 6b. Taxes and certain other debts you owe the government 6b. $ 9,280.00

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 Priority. Add lines 6a through 6d. 6e. $ 9,280.00

Total Claim

6f. Student loans 6f. $ 89,038.00

Total

claims

from Part 2 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.

$ 7,656.58

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 8 of 9

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Case 19-34680-KRH Doc 14 Filed 09/25/19 Entered 09/25/19 13:50:33 Desc Main

Document Page 13 of 15
Debtor 1

Debtor 2

Charles Anthony Barbettini, Jr.

Tonia Danita Barbettini Case number (if known) 19-34680-KRH

6j. Total Nonpriority. Add lines 6f through 6i. 6j. $ 96,694.58

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

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Case 19-34680-KRH Doc 14 Filed 09/25/19 Entered 09/25/19 13:50:33 Desc Main

Document Page 14 of 15
Fill in this information to identify your case:

Debtor 1 Charles Anthony Barbettini, Jr.

First Name Middle Name Last Name

Debtor 2 Tonia Danita Barbettini

(Spouse if, filing) First Name Middle Name Last Name

United States Bankruptcy Court for the: EASTERN DISTRICT OF VIRGINIA

Case number 19-34680-KRH

(if known)  Check if this is an

amended filing

Official Form 106Dec

Declaration About an Individual Debtor's Schedules 12/15

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

You must file this form whenever you file bankruptcy schedules or amended schedules. Making a false statement, concealing property, or

obtaining money or property by fraud in connection with a bankruptcy case can result in fines up to $250,000, or imprisonment for up to 20

years, or both. 18 U.S.C. §§ 152, 1341, 1519, and 3571.

Sign Below

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

 No

 Yes. Name of person Attach Bankruptcy Petition Preparer’s Notice,

Declaration, and Signature (Official Form 119)

Under penalty of perjury, I declare that I have read the summary and schedules filed with this declaration and

that they are true and correct.

X /s/ Charles Anthony Barbettini, Jr. X /s/ Tonia Danita Barbettini

Charles Anthony Barbettini, Jr. Tonia Danita Barbettini

Signature of Debtor 1 Signature of Debtor 2

Date September 25, 2019 Date September 25, 2019

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

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