Fill in this information to identify your case:

United States Bankruptcy Court for the:

Eastern District of Virginia

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

Chapter 7

Chapter 11

Chapter 12

Chapter 13 Check if this is an

amended filing

Official Form 101

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

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

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

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

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

needed, attach a separate sheet to this form. On the top of any additional pages, write your name and case number (if known). Answer every question.

Part 1: Identify Yourself

1. Your full name

Write the name that is on your

government-issued picture

identification (for example, your

driver’s license or passport).

Bring your picture identification to

your meeting with the trustee.

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

Michelle

First name

Jason

First name

Ann

Middle name

Michael

Middle name

Kristiansen

Last name

Kristiansen

Last name

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

2. All other names you have used

in the last 8 years

Include your married or maiden

names.

Michelle

First name First name

A

Middle name Middle name

Pelfrey

Last name Last name

First name First name

Middle name Middle name

Last name Last name

3. Only the last 4 digits of your

Social Security number or

federal Individual Taxpayer

Identification number

(ITIN)

xxx - xx - 2 2 9 0 xxx - xx - 1 5 4 6

OR OR

9xx - xx - 9xx - xx -

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

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Voluntary Petition for Individuals Filing for Bankruptcy 04/20

Case 20-33421-KLP Doc 1 Filed 08/11/20 Entered 08/11/20 18:04:19 Desc Main

Document Page 1 of 91
Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

4. Any business names and

Employer Identification

Numbers (EIN) you have used

in the last 8 years

Include trade names and doing

business as names

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

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

Business name Business name

Business name Business name

-

EIN

-

EIN

-

EIN

-

EIN

5. Where you live

If Debtor 2 lives at a different address:

8790 Sage Court

Number Street Number Street

King George, VA 22485

City State ZIP Code City State ZIP Code

King George

County County

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

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

this mailing address.

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

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

mailing address.

Number Street Number Street

P.O. Box P.O. Box

City State ZIP Code City State ZIP Code

6. Why you are choosing this

district to file for bankruptcy

Check one: Check one:

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

lived in this district longer than in any other district.

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

lived in this district longer than in any other district.

I have another reason. Explain.

(See 28 U.S.C. § 1408)

I have another reason. Explain.

(See 28 U.S.C. § 1408)

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

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Document Page 2 of 91
Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

Part 2: Tell the Court About Your Bankruptcy Case

7. The chapter of the Bankruptcy

Code you are choosing to file

under

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

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

Chapter 7

Chapter 11

Chapter 12

Chapter 13

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

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

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

a pre-printed address.

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

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

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

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

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

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

9. Have you filed for bankruptcy

within the last 8 years?

No.

Yes. District When

MM / DD / YYYY

Case number

District When

MM / DD / YYYY

Case number

District When

MM / DD / YYYY

Case number

10. Are any bankruptcy cases

pending or being filed by a

spouse who is not filing this

case with you, or by a business

partner, or by an affiliate?

No.

Yes. Debtor Relationship to you

District When

MM / DD / YYYY

Case number, if known

Debtor Relationship to you

District When

MM / DD / YYYY

Case number, if known

11. Do you rent your residence?

No. Go to line 12.

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

No. Go to line 12.

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

of this bankruptcy petition.

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

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Document Page 3 of 91
Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

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

12. Are you a sole proprietor of any

full- or part-time business?

A sole proprietorship is a business

you operate as an individual, and is

not a separate legal entity such as

a corporation, partnership, or LLC.

If you have more than one sole

proprietorship, use a separate

sheet and attach it to this petition.

No. Go to Part 4.

Yes. Name and location of business

Name of business, if any

Number Street

City State ZIP Code

Check the appropriate box to describe your business:

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

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

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

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

None of the above

13. Are you filing under Chapter 11

of the Bankruptcy Code, and

are you a small business debtor

or a debtor as defined by 11

U.S. C. § 1182(1)?

For a definition of small business

debtor, see 11 U.S.C. § 101(51D).

If you are filing under Chapter 11, the court must know whether you are a small business debtor or a debtor choosing to proceed

under Subchapter V so that it can set appropriate deadlines. If you indicate that you are a small business debtor or you are

choosing to proceed under Subchapter V, you must attach your most recent balance sheet, statement of operations, cash-flow

statement, and federal income tax return or if any of these documents do not exist, follow the procedure in 11 U.S.C. § 1116(1)(B).

No. I am not filing under Chapter 11.

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

Bankruptcy Code.

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

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

Yes. I am filing under Chapter 11, I am a debtor according to the definition in § 1182(1) of the Bankruptcy Code,

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

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

14. Do you own or have any

property that poses or is

alleged to pose a threat of

imminent and identifiable

hazard to public health or

safety? Or do you own any

property that needs immediate

attention?

For example, do you own

perishable goods, or livestock that

must be fed, or a building that

needs urgent repairs?

No.

Yes. What is the hazard?

If immediate attention is needed, why is it needed? 

Where is the property?

Number Street

City State ZIP Code

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

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Document Page 4 of 91
Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

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

15. Tell the court whether you

have received a briefing

about credit counseling.

The law requires that you

receive a briefing about credit

counseling before you file for

bankruptcy. You must truthfully

check one of the following

choices. If you cannot do so, you

are not eligible to file.

If you file anyway, the court can

dismiss your case, you will lose

whatever filing fee you paid, and

your creditors can begin

collection activities again.

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

You must check one: You must check one:

I received a briefing from an approved credit counseling

agency within the 180 days before I filed this bankruptcy

petition, and I received a certificate of completion.

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

any, that you developed with the agency.

I received a briefing from an approved credit counseling

agency within the 180 days before I filed this bankruptcy

petition, and I received a certificate of completion.

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

any, that you developed with the agency.

I received a briefing from an approved credit counseling

agency within the 180 days before I filed this bankruptcy

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

Within 14 days after you file this bankruptcy petition, you

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

any.

I received a briefing from an approved credit counseling

agency within the 180 days before I filed this bankruptcy

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

Within 14 days after you file this bankruptcy petition, you

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

any.

I certify that I asked for credit counseling services from an

approved agency, but was unable to obtain those services

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

circumstances merit a 30-day temporary waiver of the

requirement.

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

attach a separate sheet explaining what efforts you made

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

before you filed for bankruptcy, and what exigent

circumstances required you to file this case.

I certify that I asked for credit counseling services from an

approved agency, but was unable to obtain those services

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

circumstances merit a 30-day temporary waiver of the

requirement.

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

attach a separate sheet explaining what efforts you made

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

before you filed for bankruptcy, and what exigent

circumstances required you to file this case.

Your case may be dismissed if the court is dissatisfied

with your reasons for not receiving a briefing before you

filed for bankruptcy.

Your case may be dismissed if the court is dissatisfied

with your reasons for not receiving a briefing before you

filed for bankruptcy.

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

receive a briefing within 30 days after you file.

You must file a certificate from the approved agency,

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

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

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

receive a briefing within 30 days after you file.

You must file a certificate from the approved agency,

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

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

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

cause and is limited to a maximum of 15 days.

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

cause and is limited to a maximum of 15 days.

I am not required to receive a briefing about credit

counseling because of:

Incapacity. I have a mental illness or a mental

deficiency that makes me incapable

of realizing or making rational

decisions about finances.

Disability. My physical disability causes me to

be unable to participate in a briefing

in person, by phone, or through the

internet, even after I reasonably tried

to do so.

Active duty. I am currently on active military duty in

a military combat zone.

I am not required to receive a briefing about credit

counseling because of:

Incapacity. I have a mental illness or a mental

deficiency that makes me incapable

of realizing or making rational

decisions about finances.

Disability. My physical disability causes me to

be unable to participate in a briefing

in person, by phone, or through the

internet, even after I reasonably tried

to do so.

Active duty. I am currently on active military duty in

a military combat zone.

If you believe you are not required to receive a briefing

about credit counseling, you must file a motion for waiver

of credit counseling with the court.

If you believe you are not required to receive a briefing

about credit counseling, you must file a motion for waiver

of credit counseling with the court.

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

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Case 20-33421-KLP Doc 1 Filed 08/11/20 Entered 08/11/20 18:04:19 Desc Main

Document Page 5 of 91
Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

Part 6: Answer These Questions for Reporting Purposes

16. What kind of debts do you

have?

16a. Are your debts primarily consumer debts? Consumer debts are defined in 11 U.S.C. § 101(8) as “incurred by

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

No. Go to line 16b.

Yes. Go to line 17.

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

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

No. Go to line 16c.

Yes. Go to line 17.

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

17. Are you filing under Chapter 7?

Do you estimate that after any

exempt property is excluded and

administrative expenses are paid

that funds will be available for

distribution to unsecured

creditors?

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

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

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

No

Yes

18. How many creditors do you

estimate that you owe?

1-49

50-99

100-199

200-999

1,000-5,000

5,001-10,000

10,001-25,000

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

19. How much do you estimate your

assets to be worth?

$0-$50,000

$50,001-$100,000

$100,001-$500,000

$500,001-$1 million

$1,000,001-$10 million

$10,000,001-$50 million

$50,000,001-$100 million

$100,000,001-$500 million

$500,000,001-$1 billion

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

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

More than $50 billion

20. How much do you estimate your

liabilities to be?

$0-$50,000

$50,001-$100,000

$100,001-$500,000

$500,001-$1 million

$1,000,001-$10 million

$10,000,001-$50 million

$50,000,001-$100 million

$100,000,001-$500 million

$500,000,001-$1 billion

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

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

More than $50 billion

Part 7: Sign Below

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

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

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

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

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

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

I understand making a false statement, concealing property, or obtaining money or property by fraud in connection with a bankruptcy case

can result in fines up to $250,000, or imprisonment for up to 20 years, or both. 18 U.S.C. §§ 152, 1341, 1519, and 3571.

✘ /s/ Michelle Ann Kristiansen

Michelle Ann Kristiansen, Debtor 1

Executed on 08/11/2020

MM/ DD/ YYYY

✘ /s/ Jason Michael Kristiansen

Jason Michael Kristiansen, Debtor 2

Executed on 08/11/2020

MM/ DD/ YYYY

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

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Document Page 6 of 91
Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

For your attorney, if you are

represented by one

If you are not represented by an

attorney, you do not need to file this

page.

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

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

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

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

filed with the petition is incorrect.

✘ /s/ Martin C. Conway

Signature of Attorney for Debtor

Date 08/11/2020

MM / DD / YYYY

Martin C. Conway

Printed name

Conway Law Group, PC

Firm name

12934 Harbor Drive Suite 107

Number Street

Woodbridge

City

VA

State

22192

ZIP Code

Contact phone (855) 848-3011 Email address martin@conwaylegal.com

34334

Bar number

VA

State

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

Case 20-33421-KLP Doc 1 Filed 08/11/20 Entered 08/11/20 18:04:19 Desc Main

Document Page 7 of 91
1.1 8790 Sage Court

Street address, if available, or other

description

King George, VA 22485

City State ZIP Code

King George

County

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

Debtor 1 Michelle Ann Kristiansen

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Jason Michael Kristiansen

First Name Middle Name Last Name

United States Bankruptcy Court for the: Eastern District of Virginia

Case number

Check if this is an

amended filing

Official Form 106A/B

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

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

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

Part 1: Describe Each Residence, Building, Land, or Other Real Estate You Own or Have an Interest In

1. Do you own or have any legal or equitable interest in any residence, building, land, or similar property?

No. Go to Part 2.

Yes. Where is the property?

What is the property? Check all that apply.

Single-family home

Duplex or multi-unit building

Condominium or cooperative

Manufactured or mobile home

Land

Investment property

Timeshare

Other 

Who has an interest in the property? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Do not deduct secured claims or exemptions. Put the

amount of any secured claims on Schedule D: Creditors

Who Have Claims Secured by Property.

Current value of the

entire property?

$395,336.00

Current value of the

portion you own?

$395,336.00

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)

Source of Value:

Zillow

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

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Schedule A/B: Property 12/15

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1.2 Parcel 15 Green Height King George

VA

Street address, if available, or other

description

City State ZIP Code

County

Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

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?

$80,000.00

Current value of the

portion you own?

$40,000.00

Describe the nature of your ownership interest (such

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

estate), if known.

Tenants by the entirety with common law right of

survivorship

Check if this is community property

(see instructions)

Other information you wish to add about this item, such as local property identification number:

10.410 acres

Source of Value:

Assessment - Broker opinion of value

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......................................................................................................... ➜ $435,336.00

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

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Document Page 9 of 91
3.1 Make:

Model:

Year:

Approximate mileage:

Nissan

NV

2016

71338

Other information:

3.2 Make:

Model:

Year:

Approximate mileage:

Ford

Edge

2013

153208

Other information:

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

portion you own?

Do not deduct secured

claims or exemptions.

Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

Part 2: Describe Your Vehicles

Do you own, lease, or have legal or equitable interest in any vehicles, whether they are registered or not? Include any vehicles

you own that someone else drives. If you lease a vehicle, also report it on Schedule G: Executory Contracts and Unexpired Leases.

3. Cars, vans, trucks, tractors, sport utility vehicles, motorcycles

No

Yes

Who has an interest in the property? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this is community property (see

instructions)

Do not deduct secured claims or exemptions. Put the

amount of any secured claims on Schedule D: Creditors

Who Have Claims Secured by Property.

Current value of the

entire property?

$18,075.00

Current value of the

portion you own?

$18,075.00

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?

$7,350.00

Current value of the

portion you own?

$7,350.00

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......................................................................................................... ➜ $25,425.00

Part 3: Describe Your Personal and Household Items

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

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Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

6.

No

Yes. Describe........

Household goods and furnishings: Kitchen/dining room microwave, 2 tables, 4 chairs, dishes, utensil,

cookware and clothes washer and dryer; Living/family room chair and 2 sofas; Bedroom table, 5 beds, 5

dressers, vacuum and 30 sheets, towels and blankets.

Household goods and furnishings

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

$805.00

7.

No

Yes. Describe........

Electronics: Game system, 3 TVs, 2 DVD players, 14 DVDs and 4 games.

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

$185.00

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: Bats, nets, gymnastics bar/beam, riding mower, push mower and weed

eater.

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

$200.00

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

$210.00

12.

No

Yes. Describe........

Wedding/engagement jewelry

Jewelry

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

$175.00

13.

No

Yes. Describe........

Family pet

Non-farm animals

Examples: Dogs, cats, birds, horses

$1.00

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

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Case 20-33421-KLP Doc 1 Filed 08/11/20 Entered 08/11/20 18:04:19 Desc Main

Document Page 11 of 91
Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

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........................................................................................................................................➜ $1,576.00

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

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: C&F account ending with 1606 $390.07

17.2. Checking account:

17.3. Savings account: C&F custodial account for child - account ending with

x7524

$5.08

17.4. Savings account: C&F custodial account for child - account ending with

x5924

$30.07

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 5

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Case 20-33421-KLP Doc 1 Filed 08/11/20 Entered 08/11/20 18:04:19 Desc Main

Document Page 12 of 91
Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

17.9. Other financial account:

18.

No

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

Bonds, mutual funds, or publicly traded stocks

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

Institution or issuer name:

19.

No

Yes. Give specific

information about

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

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

an LLC, partnership, and joint venture

Name of entity: % of ownership:

20.

No

Yes. Give specific

information about

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

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

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

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

Issuer name:

21.

No

Yes. List each account

separately.

Retirement or pension accounts

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

Type of account: Institution name:

401(k) or similar plan: Retirement Account $1,429.73

22.

No

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

Security deposits and prepayments

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

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

others

Institution name or individual:

Electric:

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

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Case 20-33421-KLP Doc 1 Filed 08/11/20 Entered 08/11/20 18:04:19 Desc Main

Document Page 13 of 91
Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

Gas:

Heating oil:

Security deposit on rental unit: 

Prepaid rent:

Telephone:

Water:

Rented furniture:

Other:

23.

No

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

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

Issuer name and description:

24.

No

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

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

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

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

25.

No

Yes. Give specific

information about them....

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

benefit

26.

No

Yes. Give specific

information about them....

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

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

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

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Case 20-33421-KLP Doc 1 Filed 08/11/20 Entered 08/11/20 18:04:19 Desc Main

Document Page 14 of 91
Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

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

31.

No

Yes. Name the insurance company

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

Interests in insurance policies

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

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

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Case 20-33421-KLP Doc 1 Filed 08/11/20 Entered 08/11/20 18:04:19 Desc Main

Document Page 15 of 91
Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

32.

No

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

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

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

because someone has died.

33.

No

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

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

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

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.

$1,894.44

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

for Part 4. Write that number here..................................................................................................................................➜

Part 5: Describe Any Business-Related Property You Own or Have an Interest In. List any real estate in Part 1.

37. Do you own or have any legal or equitable interest in any business-related property?

 No. Go to Part 6.

 Yes. Go to line 38.

Current value of the

portion you own?

Do not deduct secured

claims or exemptions.

38.

No

Yes. Describe........

Accounts receivable or commissions you already earned

39. Office equipment, furnishings, and supplies

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

No

Yes. Describe........

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

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Case 20-33421-KLP Doc 1 Filed 08/11/20 Entered 08/11/20 18:04:19 Desc Main

Document Page 16 of 91
Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

40.

No

Yes. Describe........

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

41.

No

Yes. Describe........

Inventory

42.

No

Yes. Describe........

Interests in partnerships or joint ventures

Name of entity: % of ownership:

%

43.

No

Yes. Describe........

Customer lists, mailing lists, or other compilations

No

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

44.

No

Yes. Give specific

information.........

Any business-related property you did not already list

45.

$0.00

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

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

Part 6: Describe Any Farm- and Commercial Fishing-Related Property You Own or Have an Interest In.

If you own or have an interest in farmland, list it in Part 1.

46. Do you own or have any legal or equitable interest in any farm- or commercial fishing-related property?

 No. Go to Part 7.

 Yes. Go to line 47.

Current value of the

portion you own?

Do not deduct secured

claims or exemptions.

47.

No

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

Farm animals

Examples: Livestock, poultry, farm-raised fish

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

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Case 20-33421-KLP Doc 1 Filed 08/11/20 Entered 08/11/20 18:04:19 Desc Main

Document Page 17 of 91
Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

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..........................................................................................................................................➜ $435,336.00

56. Part 2: Total vehicles, line 5 $25,425.00

57. Part 3: Total personal and household items, line 15 $1,576.00

58. Part 4: Total financial assets, line 36 $1,894.44

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

Official Form 106A/B Schedule A/B: Property page 11

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Case 20-33421-KLP Doc 1 Filed 08/11/20 Entered 08/11/20 18:04:19 Desc Main

Document Page 18 of 91
Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

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.............. $28,895.44 Copy personal property total➜ + $28,895.44

63. Total of all property on Schedule A/B. Add line 55 + line 62................................................................................................. $464,231.44

Official Form 106A/B Schedule A/B: Property page 12

Case 20-33421-KLP Doc 1 Filed 08/11/20 Entered 08/11/20 18:04:19 Desc Main

Document Page 19 of 91
Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

SCHEDULE A/B: PROPERTY

Continuation Page

17. Deposits of money

Savings account:

C&F custodial account for child - account ending with x8324

$8.81

Savings account:

C&F custodial account for child - account ending with x6724

$30.68

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

Case 20-33421-KLP Doc 1 Filed 08/11/20 Entered 08/11/20 18:04:19 Desc Main

Document Page 20 of 91
$30,000.00

100% of fair market value, up to

any applicable statutory limit

Va. Code Ann. § 34-4

$40,000.00

100% of fair market value, up to

any applicable statutory limit

11 U.S.C. § 522(b)(3)(B)

$7,000.00

100% of fair market value, up to

any applicable statutory limit

Va. Code Ann. § 34-4

Fill in this information to identify your case:

Debtor 1 Michelle Ann Kristiansen

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Jason Michael Kristiansen

First Name Middle Name Last Name

United States Bankruptcy Court for the: Eastern District of Virginia

Case number

(if known)

Check if this is an

amended filing

Official Form 106C

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

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

attach to this page as many copies of Part 2: Additional Page as necessary. On the top of any additional pages, write your name and case number (if known).

For each item of property you claim as exempt, you must specify the amount of the exemption you claim. One way of doing so is to state a specific dollar amount as

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

exemptions—such as those for health aids, rights to receive certain benefits, and tax-exempt retirement funds—may be unlimited in dollar amount. However, if you

claim an exemption of 100% of fair market value under a law that limits the exemption to a particular dollar amount and the value of the property is determined to

exceed that amount, your exemption would be limited to the applicable statutory amount.

Part 1: Identify the Property You Claim as Exempt

1.

Which set of exemptions are you claiming? Check one only, even if your spouse is filing with you.

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

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

2. For any property you list on Schedule A/B that you claim as exempt, fill in the information below.

Brief description of the property and line on

Schedule A/B that lists this property

Current value of the

portion you own

Copy the value from

Schedule A/B

Amount of the exemption you claim

Check only one box for each exemption.

Specific laws that allow exemption

Brief description:

8790 Sage Court King George, VA 22485

Line from

Schedule A/B: 1.1

$395,336.00

Brief description:

Parcel 15 Green Height King George VA

Line from

Schedule A/B: 1.2

$40,000.00

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

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

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Case 20-33421-KLP Doc 1 Filed 08/11/20 Entered 08/11/20 18:04:19 Desc Main

Document Page 21 of 91
Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

Part 2: Additional Page

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

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

No

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

No

Yes

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

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Case 20-33421-KLP Doc 1 Filed 08/11/20 Entered 08/11/20 18:04:19 Desc Main

Document Page 22 of 91
$0.00

100% of fair market value, up to

any applicable statutory limit

Va. Code Ann. § 34-26(8)

$805.00

100% of fair market value, up to

any applicable statutory limit

Va. Code Ann. § 34-26(4a)

$185.00

100% of fair market value, up to

any applicable statutory limit

Va. Code Ann. § 34-26(4a)

$1.00

100% of fair market value, up to

any applicable statutory limit

Va. Code Ann. § 34-4

$210.00

100% of fair market value, up to

any applicable statutory limit

Va. Code Ann. § 34-26(4)

$175.00

100% of fair market value, up to

any applicable statutory limit

Va. Code Ann. § 34-26(1a)

$1.00

100% of fair market value, up to

any applicable statutory limit

Va. Code Ann. § 34-26(5)

Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

Part 2: Additional Page

Brief description of the property and line on

Schedule A/B that lists this property

Current value of the

portion you own

Copy the value from

Schedule A/B

Amount of the exemption you claim

Check only one box for each exemption.

Specific laws that allow exemption

Brief description:

2013 Ford Edge

Line from

Schedule A/B: 3.2

$7,350.00

Brief description:

Household goods and furnishings: Kitchen/dining

room microwave, 2 tables, 4 chairs, dishes, utensil,

cookware and clothes washer and dryer; Living/family

room chair and 2 sofas; Bedroom table, 5 beds, 5

dressers, vacuum and 30 sheets, towels and blankets.

Line from

Schedule A/B: 6

$805.00

Brief description:

Electronics: Game system, 3 TVs, 2 DVD players, 14

DVDs and 4 games.

Line from

Schedule A/B: 7

$185.00

Brief description:

Equipment for sports and hobbies: Bats, nets,

gymnastics bar/beam, riding mower, push mower and

weed eater.

Line from

Schedule A/B: 9

$200.00

Brief description:

Clothes

Line from

Schedule A/B: 11

$210.00

Brief description:

Wedding/engagement jewelry

Line from

Schedule A/B: 12

$175.00

Brief description:

Family pet

Line from

Schedule A/B: 13

$1.00

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

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$390.07

100% of fair market value, up to

any applicable statutory limit

Va. Code Ann. § 34-4

$5.08

100% of fair market value, up to

any applicable statutory limit

Va. Code Ann. § 34-4

$30.07

100% of fair market value, up to

any applicable statutory limit

Va. Code Ann. § 34-4

$8.81

100% of fair market value, up to

any applicable statutory limit

Va. Code Ann. § 34-4

$30.68

100% of fair market value, up to

any applicable statutory limit

Va. Code Ann. § 34-4

$0.00

100% of fair market value, up to

any applicable statutory limit

Va. Code Ann. § 34-34

Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

Part 2: Additional Page

Brief description of the property and line on

Schedule A/B that lists this property

Current value of the

portion you own

Copy the value from

Schedule A/B

Amount of the exemption you claim

Check only one box for each exemption.

Specific laws that allow exemption

Brief description:

C&F account ending with 1606

Checking account

Line from

Schedule A/B: 17

$390.07

Brief description:

C&F custodial account for child - account ending with

x7524

Savings account

Line from

Schedule A/B: 17

$5.08

Brief description:

C&F custodial account for child - account ending with

x5924

Savings account

Line from

Schedule A/B: 17

$30.07

Brief description:

C&F custodial account for child - account ending with

x8324

Savings account

Line from

Schedule A/B: 17

$8.81

Brief description:

C&F custodial account for child - account ending with

x6724

Savings account

Line from

Schedule A/B: 17

$30.68

Brief description:

Retirement Account

Line from

Schedule A/B: 21

$1,429.73

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

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Case 20-33421-KLP Doc 1 Filed 08/11/20 Entered 08/11/20 18:04:19 Desc Main

Document Page 24 of 91
Fill in this information to identify your case:

Debtor 1 Michelle Ann Kristiansen

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Jason Michael Kristiansen

First Name Middle Name Last Name

United States Bankruptcy Court for the: Eastern District of Virginia

Case number

(if known)

Check if this is an

amended filing

Official Form 106D

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

needed, copy the Additional Page, fill it out, number the entries, and attach it to this form. On the top of any additional pages, write your name and case number (if

known).

1. Do any creditors have claims secured by your property?

No. Check this box and submit this form to the court with your other schedules. You have nothing else to report on this form.

Yes. Fill in all of the information below.

Part 1: List All Secured Claims

2. List all secured claims. If a creditor has more than one secured claim, list the creditor separately for

each claim. If more than one creditor has a particular claim, list the other creditors in Part 2. As much

as possible, list the claims in alphabetical order according to the creditor’s name.

Column A

Amount of claim

Do not deduct the

value of collateral.

Column B

Value of collateral

that supports

this claim

Column C

Unsecured

portion

If any

2.1 NMAC

Creditor's Name

Attn: Bankruptcy

PO Box 660360

Number Street

Dallas, TX 75266-0000

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

3/1/2017

Describe the property that secures the claim:

2016 Nissan NV

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

Contingent

Unliquidated

Disputed

Nature of lien. Check all that apply.

An agreement you made (such as mortgage or

secured car loan)

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

Judgment lien from a lawsuit

Other (including a right to offset)

Last 4 digits of account number 0 0 0 1

$27,713.00 $18,075.00 $9,638.00

Remarks: Nissan payment

Add the dollar value of your entries in Column A on this page. Write that number here: $27,713.00

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

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

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Case 20-33421-KLP Doc 1 Filed 08/11/20 Entered 08/11/20 18:04:19 Desc Main

Document Page 25 of 91
Part 1:

Additional Page

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

2.3, followed by 2.4, and so forth.

Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

Column A

Amount of claim

Do not deduct the

value of collateral.

Column B

Value of collateral

that supports

this claim

Column C

Unsecured

portion

If any

2.2 Suntrust Bk

Creditor's Name

Attn: Bankruptcy

Mail Code VA-RVW-6290 POB 8509

Number Street

Richmond, VA 23286

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

7/1/2017

Describe the property that secures the claim:

2013 Ford Edge

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

Contingent

Unliquidated

Disputed

Nature of lien. Check all that apply.

An agreement you made (such as mortgage or

secured car loan)

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

Judgment lien from a lawsuit

Other (including a right to offset)

Last 4 digits of account number 5 0 0 5

$10,135.00 $7,350.00 $2,785.00

Remarks: Ford payment

2.3 Wfhm

Creditor's Name

Po Box 10335

Number Street

Des Moines, IA 50306

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

12/1/2014

Describe the property that secures the claim:

8790 Sage Court King George, VA 22485

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

Contingent

Unliquidated

Disputed

Nature of lien. Check all that apply.

An agreement you made (such as mortgage or

secured car loan)

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

Judgment lien from a lawsuit

Other (including a right to offset)

Last 4 digits of account number 0 6 7 2

$315,336.00 $395,336.00 $0.00

Remarks: Mortgage

Add the dollar value of your entries in Column A on this page. Write that number here: $325,471.00

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

here:

$353,184.00

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

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Case 20-33421-KLP Doc 1 Filed 08/11/20 Entered 08/11/20 18:04:19 Desc Main

Document Page 26 of 91
Fill in this information to identify your case:

Debtor 1 Michelle Ann Kristiansen

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Jason Michael Kristiansen

First Name Middle Name Last Name

United States Bankruptcy Court for the: Eastern District of Virginia

Case number

(if known)

Check if this is an

amended filing

Official Form 106E/F

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

any executory contracts or unexpired leases that could result in a claim. Also list executory contracts on Schedule A/B: Property (Official Form 106A/B) and on

Schedule G: Executory Contracts and Unexpired Leases (Official Form 106G). Do not include any creditors with partially secured claims that are listed in Schedule

D: Creditors Who Hold Claims Secured by Property. If more space is needed, copy the Part you need, fill it out, number the entries in the boxes on the left. Attach

the Continuation Page to this page. On the top of any additional pages, write your name and case number (if known).

Part 1: List All of Your PRIORITY Unsecured Claims

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

No. Go to Part 2.

Yes.

2. List all of your priority unsecured claims. If a creditor has more than one priority unsecured claim, list the creditor separately for each claim. For each claim listed,

identify what type of claim it is. If a claim has both priority and nonpriority amounts, list that claim here and show both priority and nonpriority amounts. As much as

possible, list the claims in alphabetical order according to the creditor’s name. If you have more than two priority unsecured claims, fill out the Continuation Page of

Part 1. If more than one creditor holds a particular claim, list the other creditors in Part 3.

(For an explanation of each type of claim, see the instructions for this form in the instruction booklet.)

Total

claim

Priority

amount

Nonpriority

amount

Priority Creditor's Name

Number Street

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number

When was the debt incurred?

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

apply.

Contingent

Unliquidated

Disputed

Type of PRIORITY unsecured claim:

Domestic support obligations

Taxes and certain other debts you owe the

government

Claims for death or person injury while you were

intoxicated

Other. Specify

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 1 of 20

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

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Case 20-33421-KLP Doc 1 Filed 08/11/20 Entered 08/11/20 18:04:19 Desc Main

Document Page 27 of 91
Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

Part 2: List All of Your NONPRIORITY Unsecured Claims

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

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

Yes.

4. List all of your nonpriority unsecured claims in the alphabetical order of the creditor who holds each claim. If a creditor has more than one nonpriority

unsecured claim, list the creditor separately for each claim. For each claim listed, identify what type of claim it is. Do not list claims already included in Part 1. If more

than one creditor holds a particular claim, list the other creditors in Part 3. If you have more than three nonpriority unsecured claims fill out the Continuation Page of

Part 2.

Total claim

4.1 Aargon Agency Inc

Nonpriority Creditor's Name

Attn: Bankruptcy

8668 Spring Mountain Road

Number Street

Las Vegas, NV 89117

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 0165

When was the debt incurred? 03/01/2020

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 for George Washington University

$287.00

4.2 Amer. Collections Enterprise, Inc

Nonpriority Creditor's Name

Attn: Bankruptcy

PO Box 30096

Number Street

Alexandria, VA 22310

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 1559

When was the debt incurred? 04/01/2018

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 for the University of Maryland Faculty

Physicians

$61.00

4.3 Bank of America

Nonpriority Creditor's Name

4909 Savarese Circle

Number Street

Tampa, FL 33634

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 6013

When was the debt incurred? 07/01/2018

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

CreditCard

$2,799.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 2 of 20

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Case 20-33421-KLP Doc 1 Filed 08/11/20 Entered 08/11/20 18:04:19 Desc Main

Document Page 28 of 91
Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

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

4.4 Bank of America

Nonpriority Creditor's Name

4909 Savarese Circle

Number Street

Tampa, FL 33634

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 7293

When was the debt incurred? 07/01/2017

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

CreditCard

$7,995.00

4.5 Capital One

Nonpriority Creditor's Name

PO Box 71083

Number Street

Charlotte, NC 28272-0000

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 6462

When was the debt incurred? 12/01/2007

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

CreditCard

$3,272.00

4.6 Capital One

Nonpriority Creditor's Name

PO Box 71083

Number Street

Charlotte, NC 28272-0000

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 5473

When was the debt incurred? 11/01/2012

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

CreditCard

$2,652.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 3 of 20

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Case 20-33421-KLP Doc 1 Filed 08/11/20 Entered 08/11/20 18:04:19 Desc Main

Document Page 29 of 91
Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

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

4.7 Capital One

Nonpriority Creditor's Name

PO Box 71083

Number Street

Charlotte, NC 28272-0000

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 5856

When was the debt incurred? 10/01/2012

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

CreditCard

$2,630.00

4.8 Capital One

Nonpriority Creditor's Name

PO Box 71083

Number Street

Charlotte, NC 28272-0000

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 0126

When was the debt incurred? 12/01/2014

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

CreditCard

$3,136.00

4.9 Capital One

Nonpriority Creditor's Name

PO Box 71083

Number Street

Charlotte, NC 28272-0000

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 4503

When was the debt incurred? 01/01/2014

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

CreditCard

$2,846.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 4 of 20

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Case 20-33421-KLP Doc 1 Filed 08/11/20 Entered 08/11/20 18:04:19 Desc Main

Document Page 30 of 91
Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

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

4.10 Citibank/The Home Depot

Nonpriority Creditor's Name

Centralized Bankruptcy

PO Box 790034

Number Street

Saint Louis, MO 63179-0000

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 7848

When was the debt incurred? 04/01/2019

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

ChargeAccount

$3,656.00

4.11 Citibank/The Home Depot

Nonpriority Creditor's Name

Centralized Bankruptcy

PO Box 790034

Number Street

Saint Louis, MO 63179-0000

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 0608

When was the debt incurred? 02/01/2019

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

ChargeAccount

$1,759.00

4.12 Comenity Bank/Overstock

Nonpriority Creditor's Name

Attn: Bankruptcy

PO Box 182125

Number Street

Columbus, OH 43218

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 8300

When was the debt incurred? 07/01/2018

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

ChargeAccount

$2,018.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 5 of 20

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Case 20-33421-KLP Doc 1 Filed 08/11/20 Entered 08/11/20 18:04:19 Desc Main

Document Page 31 of 91
Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

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

4.13 Comenitybank/justice

Nonpriority Creditor's Name

Attn: Bankruptcy

PO Box 182273

Number Street

Columbus, OH 43218

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 0177

When was the debt incurred? 04/01/2018

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

ChargeAccount

$325.00

4.14 Credit One Bank

Nonpriority Creditor's Name

Attn Bankruptcy

PO Box 98873

Number Street

Las Vegas, NV 89193

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 6115

When was the debt incurred? 09/01/2019

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

CreditCard

$776.00

4.15 Credit One Bank

Nonpriority Creditor's Name

Attn Bankruptcy

PO Box 98873

Number Street

Las Vegas, NV 89193

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 5020

When was the debt incurred? 01/01/2020

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

CreditCard

$436.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 6 of 20

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Case 20-33421-KLP Doc 1 Filed 08/11/20 Entered 08/11/20 18:04:19 Desc Main

Document Page 32 of 91
Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

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

4.16 Creditors Collection Service

Nonpriority Creditor's Name

ATTN: Bankruptcy

PO Box 21504

Number Street

Roanoke, VA 24018

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 2278

When was the debt incurred? 08/01/2019

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 for RadiologY Association of

Fredericksburg

$261.00

4.17 D.C. - Dept of Motor Vehicles

Nonpriority Creditor's Name

Adjudication Services

PO Box 2014

Number Street

Washington, DC 20013

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 8512

When was the debt incurred? 11/19/2019

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

Parking Ticket

$250.00

4.18 Dominion Cardiac Care PC

Nonpriority Creditor's Name

PO Box 9432

Number Street

Mc Lean, VA 22102-0432

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 1560

When was the debt incurred? 2020

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 Bill

$416.27

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 7 of 20

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Case 20-33421-KLP Doc 1 Filed 08/11/20 Entered 08/11/20 18:04:19 Desc Main

Document Page 33 of 91
Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

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

4.19 First Savings Bank

Nonpriority Creditor's Name

Attn: Bankruptcy

PO Box 5019

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 7094

When was the debt incurred? 06/01/2011

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

CreditCard

$1,731.00

4.20 FREDERICKSBURG ORTHOPAEDIC

Nonpriority Creditor's Name

3310 FALL HILL AVE

Number Street

FREDERICKSBURG, VA 22401-0000

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 2630

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 Bill

$73.58

4.21 Granite State Management & Resources

Nonpriority Creditor's Name

4 Barrell Court

Number Street

Concord, NH 03301

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 7626

When was the debt incurred?

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

Student Loan

$25,487.50

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 8 of 20

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Case 20-33421-KLP Doc 1 Filed 08/11/20 Entered 08/11/20 18:04:19 Desc Main

Document Page 34 of 91
Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

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

4.22 LendingPoint LLC.

Nonpriority Creditor's Name

Attn: Bankruptcy

1201 Roberts Blvd Suite 200

Number Street

Kennesaw, GA 30144

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 6951

When was the debt incurred? 09/04/2018

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

Unsecured

$8,125.00

4.23 LightStream/Suntrust

Nonpriority Creditor's Name

Attn: Bankruptcy

655 W Broadway

Number Street

San Diego, CA 92101

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 0859

When was the debt incurred? 04/01/2019

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

Unsecured

$24,839.00

4.24 Mary Washington Healthcare

Nonpriority Creditor's Name

2300 Fall Hill Avenue Suite 101

Number Street

Fredericksburg, VA 22401-0000

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 3484

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 Bill

$300.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 9 of 20

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Case 20-33421-KLP Doc 1 Filed 08/11/20 Entered 08/11/20 18:04:19 Desc Main

Document Page 35 of 91
Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

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

4.25 Mary Washington Healthcare

Nonpriority Creditor's Name

2300 Fall Hill Avenue Suite 101

Number Street

Fredericksburg, VA 22401-0000

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 5-00

When was the debt incurred? 05/13/2020

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

Judgment from lawsuit

$8,125.00

4.26 Med. College of VA Collection

Nonpriority Creditor's Name

Attn: Billing Dept/Bankruptcy

403 N 13th St #238

Number Street

Richmond, VA 23298

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 6988

When was the debt incurred? 11/01/2018

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

MedicalDebt

$4,000.00

4.27 Mercury/FBT

Nonpriority Creditor's Name

Attn: Bankruptcy

PO Box 84064

Number Street

Columbus, GA 31908

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 5075

When was the debt incurred? 10/01/2013

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

CreditCard

$4,814.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 10 of 20

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Case 20-33421-KLP Doc 1 Filed 08/11/20 Entered 08/11/20 18:04:19 Desc Main

Document Page 36 of 91
Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

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

4.28 Merrick Bank/CardWorks

Nonpriority Creditor's Name

Attn: Bankruptcy

PO Box 9201

Number Street

Old Bethpage, NY 11804-9001

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 4880

When was the debt incurred? 11/01/2007

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

CreditCard

$2,883.00

4.29 NASA Federal Credit Union

Nonpriority Creditor's Name

Attn: Bankruptcy

PO Box 1778

Number Street

Bowie, MD 20717-1778

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 0201

When was the debt incurred? 04/01/2019

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

Unsecured

$48,027.00

4.30 Nemo's Investigations & Collections

Nonpriority Creditor's Name

Attn: Bankruptcy

PO Box 30517

Number Street

Phoenix, AZ 85046

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 8141

When was the debt incurred? 11/01/2019

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 for NextCare

$92.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 11 of 20

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Case 20-33421-KLP Doc 1 Filed 08/11/20 Entered 08/11/20 18:04:19 Desc Main

Document Page 37 of 91
Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

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

4.31 NH Higher Ed/Granite State Mgmt & Res.

Nonpriority Creditor's Name

Attn: Bankruptcy

PO Box 2097

Number Street

Concord, NH 03302-2097

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 9499

When was the debt incurred? 07/01/2019

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

Educational

$5,786.00

4.32 NH Higher Ed/Granite State Mgmt & Res.

Nonpriority Creditor's Name

Attn: Bankruptcy

PO Box 2097

Number Street

Concord, NH 03302-2097

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 5999

When was the debt incurred? 08/01/2017

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

Educational

$5,500.00

4.33 NH Higher Ed/Granite State Mgmt & Res.

Nonpriority Creditor's Name

Attn: Bankruptcy

PO Box 2097

Number Street

Concord, NH 03302-2097

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 6499

When was the debt incurred? 01/01/2019

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

Educational

$4,868.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 12 of 20

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Case 20-33421-KLP Doc 1 Filed 08/11/20 Entered 08/11/20 18:04:19 Desc Main

Document Page 38 of 91
Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

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

4.34 NH Higher Ed/Granite State Mgmt & Res.

Nonpriority Creditor's Name

Attn: Bankruptcy

PO Box 2097

Number Street

Concord, NH 03302-2097

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 6099

When was the debt incurred? 08/01/2017

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

Educational

$4,538.00

4.35 NH Higher Ed/Granite State Mgmt & Res.

Nonpriority Creditor's Name

Attn: Bankruptcy

PO Box 2097

Number Street

Concord, NH 03302-2097

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 2199

When was the debt incurred? 07/01/2018

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

Educational

$2,988.00

4.36 NH Higher Ed/Granite State Mgmt & Res.

Nonpriority Creditor's Name

Attn: Bankruptcy

PO Box 2097

Number Street

Concord, NH 03302-2097

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 2099

When was the debt incurred? 07/01/2018

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

Educational

$1,805.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 13 of 20

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Case 20-33421-KLP Doc 1 Filed 08/11/20 Entered 08/11/20 18:04:19 Desc Main

Document Page 39 of 91
Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

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

4.37 RACSB

Nonpriority Creditor's Name

600 Jackson Street

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 6779

When was the debt incurred? 2020

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 Bill

$709.70

4.38 Shifflett, Dennis

Nonpriority Creditor's Name

4802 Floral Rd.

Number Street

Brandywine, MD 20613

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 2014

When was the debt incurred? 03/10/2014

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

Judgment from lawsuit

$8,400.00

4.39 Suntrust Bank

Nonpriority Creditor's Name

PO Box 85024

Number Street

Richmond, VA 23285-5024

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 8186

When was the debt incurred? 09/01/2019

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

CreditCard

$4,954.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 14 of 20

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Case 20-33421-KLP Doc 1 Filed 08/11/20 Entered 08/11/20 18:04:19 Desc Main

Document Page 40 of 91
Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

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

4.40 Syncb/Walmart

Nonpriority Creditor's Name

Attn: Bankruptcy

PO Box 965060

Number Street

Orlando, FL 32896-5060

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 6278

When was the debt incurred? 06/01/2014

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

ChargeAccount

$1,390.00

4.41 Syncb/Walmart

Nonpriority Creditor's Name

Attn: Bankruptcy

PO Box 965060

Number Street

Orlando, FL 32896-5060

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 9408

When was the debt incurred? 08/01/2017

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

ChargeAccount

$1,202.00

4.42 Synchrony Bank/Care Credit

Nonpriority Creditor's Name

Attn: Bankruptcy Dept

PO Box 965064

Number Street

Orlando, FL 32896-5060

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 4123

When was the debt incurred? 10/01/2017

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

ChargeAccount

$981.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 15 of 20

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Case 20-33421-KLP Doc 1 Filed 08/11/20 Entered 08/11/20 18:04:19 Desc Main

Document Page 41 of 91
Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

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

4.43 Synchrony Bank/Lowes

Nonpriority Creditor's Name

PO Box 965060

Number Street

Orlando, FL 32896

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 1205

When was the debt incurred? 09/01/2018

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

ChargeAccount

$2,620.00

4.44 USDOE/GLELSI

Nonpriority Creditor's Name

Attn: Bankruptcy

PO Box 7860

Number Street

Madison, WI 53707-0000

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 8581

When was the debt incurred? 09/01/2018

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

Educational

$18,040.00

4.45 Wells Fargo Bank NA

Nonpriority Creditor's Name

MAC X2303-01A

1 Home Compus

Number Street

Des Moines, IA 50328-0010

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 0235

When was the debt incurred? 03/01/2017

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

CreditCard

$1,029.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 16 of 20

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Case 20-33421-KLP Doc 1 Filed 08/11/20 Entered 08/11/20 18:04:19 Desc Main

Document Page 42 of 91
Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

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

4.46 WF/FMG

Nonpriority Creditor's Name

Attn: Bankruptcy

PO Box 10438 MAC F8235-02F

Number Street

Des Moines, IA 50306

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 4684

When was the debt incurred? 05/01/2019

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

ChargeAccount

$1,046.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 17 of 20

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Case 20-33421-KLP Doc 1 Filed 08/11/20 Entered 08/11/20 18:04:19 Desc Main

Document Page 43 of 91
Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

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

5. Use this page only if you have others to be notified about your bankruptcy, for a debt that you already listed in Parts 1 or 2. For example, if a collection

agency is trying to collect from you for a debt you owe to someone else, list the original creditor in Parts 1 or 2, then list the collection agency here. Similarly,

if you have more than one creditor for any of the debts that you listed in Parts 1 or 2, list the additional creditors here. If you do not have additional persons

to be notified for any debts in Parts 1 or 2, do not fill out or submit this page.

Charles County General District Court

Name

11 Washington Ave.

Number Street

La Plata, MD 20646

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 2014

Fredericksburg Circuit Court

Name

702 Princess Ann Street Suite 100

Number Street

Fredericksburg, VA 22401-5916

City State ZIP Code

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

Line 4.25 of (Check one): Part 1: Creditors with Priority Unsecured Claims

Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 5-00

George Washington University

Name

2121 I St NW

Number Street

Washington, DC 20052

City State ZIP Code

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

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

Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number

Hotchkiss, Phyllis

Name

PO Box 465

Number Street

Riderwood, MD 21139

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 2014

Nextcare Urgent Care

Name

330 White Oak Rd

Number Street

Fredericksburg, VA 22405

City State ZIP Code

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

Line 4.30 of (Check one): Part 1: Creditors with Priority Unsecured Claims

Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number

R. Scott Pugh

Name

P.O. 999

9108 Courthouse Road

Number Street

Spotsylvania, VA 22553-0000

City State ZIP Code

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

Line 4.25 of (Check one): Part 1: Creditors with Priority Unsecured Claims

Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 5-00

Radiology Assoc. of Fredbrg

Name

PO Box 7819

Number Street

Fredericksburg, VA 22404-0000

City State ZIP Code

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

Line 4.16 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 18 of 20

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Case 20-33421-KLP Doc 1 Filed 08/11/20 Entered 08/11/20 18:04:19 Desc Main

Document Page 44 of 91
Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

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

Univ. of MD Faculty Physicians

Name

250 W. Pratt Street

Number Street

Baltimore, MD 21201

City State ZIP Code

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

Line 4.2 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 19 of 20

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Case 20-33421-KLP Doc 1 Filed 08/11/20 Entered 08/11/20 18:04:19 Desc Main

Document Page 45 of 91
Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

Part 4: Add the Amounts for Each Type of Unsecured Claim

6. Total the amounts of certain types of unsecured claims. This information is for statistical reporting purposes only. 28 U.S.C. §159. Add the amounts for each

type of unsecured claim.

Total claim

Total claims

from Part 1

6a. Domestic support obligations 6a. $0.00

6b. Taxes and certain other debts you owe the

government

6b. $0.00

6c. Claims for death or personal injury while you

were intoxicated

6c. $0.00

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

Write that amount here.

6d. + $0.00

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

Total claim

Total claims

from Part 2

6f. Student loans 6f. $43,525.00

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. + $186,404.05

6j. Total. Add lines 6f through 6i. 6j. $229,929.05

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 20 of 20

Case 20-33421-KLP Doc 1 Filed 08/11/20 Entered 08/11/20 18:04:19 Desc Main

Document Page 46 of 91
Fill in this information to identify your case:

Debtor 1 Michelle Ann Kristiansen

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Jason Michael Kristiansen

First Name Middle Name Last Name

United States Bankruptcy Court for the: Eastern District of Virginia

Case number

(if known)

Check if this is an

amended filing

Official Form 106G

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

needed, copy the additional page, fill it out, number the entries, and attach it to this page. On the top of any additional pages, write your name and case number (if

known).

1. Do you have any executory contracts or unexpired leases?

 No. Check this box and file this form with the court with your other schedules. You have nothing else to report on this form.

 Yes. Fill in all of the information below even if the contracts or leases are listed on Schedule A/B: Property (Official Form 106A/B).

2. List separately each person or company with whom you have the contract or lease. Then state what each contract or lease is for (for example, rent,

vehicle lease, cell phone). See the instructions for this form in the instruction booklet for more examples of executory contracts and unexpired leases.

Person or company with whom you have the contract or lease State what the contract or lease is for

2.1

Planet Fitness

Name

9723 Jefferson Davis Hwy

Number Street

Fredericksburg, VA 22407

City State ZIP Code

Gym Membership

2.2

Name

Number Street

City State ZIP Code

2.3

Name

Number Street

City State ZIP Code

2.4

Name

Number Street

City State ZIP Code

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

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Schedule G: Executory Contracts and Unexpired Leases 12/15

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Case 20-33421-KLP Doc 1 Filed 08/11/20 Entered 08/11/20 18:04:19 Desc Main

Document Page 47 of 91
Fill in this information to identify your case:

Debtor 1 Michelle Ann Kristiansen

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Jason Michael Kristiansen

First Name Middle Name Last Name

United States Bankruptcy Court for the: Eastern District of Virginia

Case number

(if known)

Check if this is an

amended filing

Official Form 106H

Codebtors are people or entities who are also liable for any debts you may have. Be as complete and accurate as possible. If two married people are filing together,

both are equally responsible for supplying correct information. If more space is needed, copy the Additional Page, fill it out, and number the entries in the boxes on

the left. Attach the Additional Page to this page. On the top of any Additional Pages, write your name and case number (if known). Answer every question.

1. Do you have any codebtors? (If you are filing a joint case, do not list either spouse as a codebtor.)

 No

 Yes

2. Within the last 8 years, have you lived in a community property state or territory? (Community property states and territories include Arizona, California, Idaho,

Louisiana, Nevada, New Mexico, Puerto Rico, Texas, Washington, and Wisconsin.)

 No. Go to line 3.

 Yes. Did your spouse, former spouse, or legal equivalent live with you at the time?

 No

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

Name

Number Street

City State ZIP Code

3. In Column 1, list all of your codebtors. Do not include your spouse as a codebtor if your spouse is filing with you. List the person shown in line 2 again as a

codebtor only if that person is a guarantor or cosigner. Make sure you have listed the creditor on Schedule D (Official Form 106D), Schedule E/F (Official

Form 106E/F), or Schedule G (Official Form 106G). Use Schedule D, Schedule E/F, or Schedule G to fill out Column 2.

Column 1: Your codebtor Column 2: The creditor to whom you owe the debt

Check all schedules that apply:

3.1

Name

Number Street

City State ZIP Code

 Schedule D, line 

 Schedule E/F, line 

 Schedule G, line 

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

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Case 20-33421-KLP Doc 1 Filed 08/11/20 Entered 08/11/20 18:04:19 Desc Main

Document Page 48 of 91
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 Michelle Ann Kristiansen

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Jason Michael Kristiansen

First Name Middle Name Last Name

United States Bankruptcy Court for the: Eastern District of Virginia

Case number

(if known)

Official Form 106I

Be as complete and accurate as possible. If two married people are filing together (Debtor 1 and Debtor 2), both are equally responsible for supplying correct

information. If you are married and not filing jointly, and your spouse is living with you, include information about your spouse. If you are separated and your

spouse is not filing with you, do not include information about your spouse. If more space is needed, attach a separate sheet to this form. On the top of any

additional pages, write your name and case number (if known). Answer every question.

Part 1: Describe Employment

1. Fill in your employment

information. Debtor 1 Debtor 2 or non-filing spouse

If you have more than one job,

attach a separate page with

information about additional

employers.

Include part time, seasonal, or

self-employed work.

Occupation may include student

or homemaker, if it applies.

Employment status

Occupation

Employer's name

Employer's address

Employed Not Employed

Registered Nurse

Mary Washington Healthcare

1001 Sam Perry Blvd

Number Street

Fredericksburg, VA 22401-0000

City State Zip Code

Employed Not Employed

Construction Manager

AFG Group, Inc.

950 Herndon Parkway 350

Number Street

Herndon, VA 20170

City State Zip Code

How long employed there? 2 years 6 months 10 months

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. $1,947.73 $8,329.17

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

4. Calculate gross income. Add line 2 + line 3. 4. $1,947.73 $8,329.17

Official Form 106I Schedule I: Your Income page 1

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Case 20-33421-KLP Doc 1 Filed 08/11/20 Entered 08/11/20 18:04:19 Desc Main

Document Page 49 of 91
Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

For Debtor 1 For Debtor 2 or

non-filing spouse

Copy line 4 here....................................................................................➔ 4. $1,947.73 $8,329.17

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.

$239.38

$0.00

$0.00

$0.00

$0.00

$0.00

$0.00

+ $0.00

$1,545.43

$0.00

$464.71

$0.00

$595.71

$0.00

$0.00

+ $64.19

6. Add the payroll deductions. Add lines 5a + 5b + 5c + 5d + 5e +5f + 5g + 5h. 6. $239.38 $2,670.03

7. Calculate total monthly take-home pay. Subtract line 6 from line 4. 7. $1,708.35 $5,659.15

8. List all other income regularly received:

8a. Net income from rental property and from operating a business,

profession, or farm

Attach a statement for each property and business showing gross receipts,

ordinary and necessary business expenses, and the total monthly net income. 8a. $0.00 $0.00

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

8c. Family support payments that you, a non-filing spouse, or a dependent

regularly receive

Include alimony, spousal support, child support, maintenance, divorce

settlement, and property settlement. 8c. $650.00 $0.00

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

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

8f. Other government assistance that you regularly receive

Include cash assistance and the value (if known) of any non-cash assistance

that you receive, such as food stamps (benefits under the Supplemental

Nutrition Assistance Program) or housing subsidies.

Specify: 8f. $0.00 $0.00

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

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

9. Add all other income. Add lines 8a + 8b + 8c + 8d + 8e + 8f +8g + 8h. 9. $650.00 $0.00

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

Add the entries in line 10 for Debtor 1 and Debtor 2 or non-filing spouse 10. $2,358.35 + $5,659.15 = $8,017.50

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. $8,017.50

Combined

monthly income

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

 No.

 Yes. Explain: 

Due to wife's health issues, her work hours will have to be reduced. Covid caused less work.

Official Form 106I Schedule I: Your Income page 2

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Case 20-33421-KLP Doc 1 Filed 08/11/20 Entered 08/11/20 18:04:19 Desc Main

Document Page 50 of 91
Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

1. Employment information for Debtor 1

Occupation

Employer's name

Employer's address

How long employed there?

Registered Nurse

MedStar Health

10980 Grantchester Way

Number Street

Columbia, MD 21044

City State Zip Code

3 months

Official Form 106I Schedule I: Your Income page 3

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Document Page 51 of 91
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 15 years No. Yes.

Child 9 years No. Yes.

Child 5 years No. Yes.

Child 3 years No. Yes.

 No. Yes.

Fill in this information to identify your case:

Debtor 1 Michelle Ann Kristiansen

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Jason Michael Kristiansen

First Name Middle Name Last Name

United States Bankruptcy Court for the: Eastern District of Virginia

Case number

(if known)

Official Form 106J

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

needed, attach another sheet to this form. On the top of any additional pages, write your name and case number (if known). Answer every question.

Part 1: Describe Your Household

1. Is this a joint case?

 No. Go to line 2.

 Yes. Does Debtor 2 live in a separate household?

 No

 Yes. Debtor 2 must file Official Form 106J-2, Expenses for Separate Household of Debtor 2.

2.

3. Do your expenses include expenses

of people other than yourself and

your dependents?

 No

 Yes

Part 2: Estimate Your Ongoing Monthly Expenses

Estimate your expenses as of your bankruptcy filing date unless you are using this form as a supplement in a Chapter 13 case to report expenses as of a date after

the bankruptcy is filed. If this is a supplemental Schedule J, check the box at the top of the form and fill in the applicable date.

Include expenses paid for with non-cash government assistance if you know the value of

such assistance and have included it on Schedule I: Your Income (Official Form 106I.)

Your expenses

4. The rental or home ownership expenses for your residence. Include first mortgage payments and any rent for the

ground or lot.

If not included in line 4:

4a. Real estate taxes

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

4c. Home maintenance, repair, and upkeep expenses

4d. Homeowner's association or condominium dues

4.

4a.

4b.

4c.

4d.

$2,031.04

$0.00

$0.00

$55.00

$0.00

Official Form 106J Schedule J: Your Expenses page 1

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Schedule J: Your Expenses 12/15

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Document Page 52 of 91
Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

Your expenses

5. Additional mortgage payments for your residence, such as home equity loans 5. $0.00

6. Utilities:

6a. Electricity, heat, natural gas

6b. Water, sewer, garbage collection

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

6d. Other. Specify: 

6a.

6b.

6c.

6d.

$320.00

$0.00

$530.88

$0.00

7. Food and housekeeping supplies 7. $840.00

8. Childcare and children’s education costs 8. $1,040.00

9. Clothing, laundry, and dry cleaning 9. $200.00

10. Personal care products and services 10. $100.00

11. Medical and dental expenses 11. $238.74

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

Do not include car payments. 12. $590.00

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

14. Charitable contributions and religious donations 14. $0.00

15. Insurance.

Do not include insurance deducted from your pay or included in lines 4 or 20.

15a. Life insurance

15b. Health insurance

15c. Vehicle insurance

15d. Other insurance. Specify: 

15a.

15b.

15c.

15d.

$0.00

$0.00

$181.13

$0.00

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

Specify: Personal Property Tax 16. $65.34

17. Installment or lease payments:

17a. Car payments for Vehicle 1

17b. Car payments for Vehicle 2

17c. Other. Specify: 

17d. Other. Specify: 

17a.

17b.

17c.

17d.

$0.00

$0.00

$0.00

$0.00

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

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Document Page 53 of 91
Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

21. Other. Specify: See Additional Page 21. + $388.00

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.

$6,680.13

$0.00

$6,680.13

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.

$8,017.50

– $6,680.13

$1,337.37

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

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Document Page 54 of 91
Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

Amount

8. Childcare and children's education costs

Childcare $640.00

Children's Activities $400.00

11. Medical and dental expenses

Medical $100.00

Braces $138.74

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

Gasoline and maintenance $520.00

Parking $70.00

21. Other

Pet Costs $62.00

Gym Membership $26.00

Children's Activities $300.00

Official Form 106J Schedule J: Your Expenses page 4

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Document Page 55 of 91
Fill in this information to identify your case:

Debtor 1 Michelle Ann Kristiansen

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Jason Michael Kristiansen

First Name Middle Name Last Name

United States Bankruptcy Court for the: Eastern District of Virginia

Case number

(if known)

Check if this is an

amended filing

Official Form 106Sum

Be as complete and accurate as possible. If two married people are filing together, both are equally responsible for supplying correct information. Fill out all of your

schedules first; then complete the information on this form. If you are filing amended schedules after you file your original forms, you must fill out a new Summary

and check the box at the top of this page.

Part 1: Summarize Your Assets

Your assets

Value of what you own

1. Schedule A/B: Property (Official Form 106A/B)

1a. Copy line 55, Total real estate, from Schedule A/B...........................................................................................................

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

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

$435,336.00

$28,895.44

$464,231.44

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.......

$353,184.00

3. Schedule E/F: Creditors Who Have Unsecured Claims (Official Form 106E/F)

3a. Copy the total claims from Part 1 (priority unsecured claims) from line 6e of Schedule E/F......................................

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

$0.00

+ $229,929.05

Your total liabilities $583,113.05

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

$8,017.50

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

Copy your monthly expenses from line 22c of Schedule J.................................................................................. $6,680.13

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

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Summary of Your Assets and Liabilities and Certain Statistical

Information 12/15

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Document Page 56 of 91
Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

Part 4: Answer These Questions for Administrative and Statistical Records

6. Are you filing for bankruptcy under Chapters 7, 11, or 13?

 No. You have nothing to report on this part of the form. Check this box and submit this form to the court with your other schedules.

 Yes

7. What kind of debt do you have?

Your debts are primarily consumer debts. Consumer debts are those “incurred by an individual primarily for a personal,

family, or household purpose.” 11 U.S.C. § 101(8). Fill out lines 8-9g for statistical purposes. 28 U.S.C. § 159.

Your debts are not primarily consumer debts. You have nothing to report on this part of the form. Check this box and submit

this form to the court with your other schedules.

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

Form 122A-1 Line 11; OR, Form 122B Line 11; OR, Form 122C-1 Line 14. $12,005.67

9. Copy the following special categories of claims from Part 4, line 6 of Schedule E/F:

Total claim

From Part 4 on Schedule E/F, copy the following:

9a. Domestic support obligations (Copy line 6a.) $0.00

9b. Taxes and certain other debts you owe the government. (Copy line 6b.) $0.00

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

9d. Student loans. (Copy line 6f.) $43,525.00

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. $43,525.00

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

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Document Page 57 of 91
Fill in this information to identify your case:

Debtor 1 Michelle Ann Kristiansen

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Jason Michael Kristiansen

First Name Middle Name Last Name

United States Bankruptcy Court for the: Eastern District of Virginia

Case number

(if known)

Check if this is an

amended filing

Official Form 106Dec

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

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

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

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

Sign Below

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

 No

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

(Official Form 119).

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

✘ /s/ Michelle Ann Kristiansen

Michelle Ann Kristiansen, Debtor 1

Date 08/11/2020

MM/ DD/ YYYY

✘ /s/ Jason Michael Kristiansen

Jason Michael Kristiansen, Debtor 2

Date 08/11/2020

MM/ DD/ YYYY

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

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Declaration About an Individual Debtor's Schedules 12/15

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Document Page 58 of 91
UNITED STATES BANKRUPTCY COURT

EASTERN DISTRICT OF VIRGINIA

Richmond Division

In re: Kristiansen, Michelle Ann

Kristiansen, Jason Michael

Debtor(s)

Case Number:

DISCLOSURE OF COMPENSATION OF ATTORNEY FOR DEBTOR

IN A CHAPTER 13 CASE

(for use in the Richmond Division only)

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

that compensation 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 ........................................................................................................................................$5,434.00

Prior to the filing of this statement I have received .............................................................................................................................$1,704.00

Balance Due ................................................................................................................................................ $3,730.00

2. The source of the compensation paid to me was:

Debtor Other (specify)

3. The source of the 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 a 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, as required by

Local Bankruptcy Rule 2016-1(C)(3).

6. I am electing to request compensation and reimbursement of expenses in this case:

a. In accordance with the “no-look” fee set forth in Local Bankruptcy Rule 2016-1(C)(1)(a) and (C)(3)(a).

b. By submitting applications for compensation in the manner set forth in Local Bankruptcy Rule 2016-1(C)(1)(c)(ii).

An attorney for the debtor that fails to make the election to request compensation pursuant to Local Bankruptcy Rule 2016-1(C)

(1)(a) and (C)(3)(a) at the commencement of the case will be deemed to have elected to request compensation in the manner set

forth within Local Bankruptcy Rule 2016-1(C)(1)(c)(ii).

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CERTIFICATION

I certify that the foregoing is an accurate statement of any agreement or arrangement for payment to me for representation of the

debtor(s) in this bankruptcy proceeding.

08/11/2020

Date

/s/ Martin C. Conway

Signature of Attorney

Conway Law Group, PC

Name of Law Firm

NOTICE TO DEBTOR(S), STANDING CHAPTER 13 TRUSTEE AND UNITED

STATES TRUSTEE

PURSUANT TO LOCAL BANKRUPTCY RULE 2016-1(C) AND

CLERK’S CM/ECF POLICY 9

Notice is hereby given that pursuant to Local Bankruptcy Rule 2016-1(C), you must file an objection with the court to the fees

requested in this disclosure of compensation opposing said fees in their entirety, or in a specific amount, no later than the last day

for filing objections to confirmation of the chapter 13 plan.

PROOF OF SERVICE

The undersigned hereby certifies that on this date the foregoing Notice was served upon the debtor(s), the standing Chapter

13 trustee, and U. S. trustee pursuant to Local Bankruptcy Rule 2016-1(C) and the Clerk’s CM/ECF Policy 9, either electronically or

in paper form (first class mail).

08/11/2020

Date

/s/ Martin C. Conway

Signature of Attorney

[2030R13edva ver. 12/15]

2

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Document Page 60 of 91
Fill in this information to identify your case:

Debtor 1 Michelle Ann Kristiansen

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Jason Michael Kristiansen

First Name Middle Name Last Name

United States Bankruptcy Court for the: Eastern District of Virginia

Case number

(if known)

Check if this is an

amended filing

Official Form 107

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

needed, attach a separate sheet to this form. On the top of any additional pages, write your name and case number (if known). Answer every question.

Part 1: Give Details About Your Marital Status and Where You Lived Before

1. What is your current marital status?

Married

Not married

2. During the last 3 years, have you lived anywhere other than where you live now?

No

Yes. List all of the places you lived in the last 3 years. Do not include where you live now.

Debtor 1: Dates Debtor 1 lived

there

Debtor 2: Dates Debtor 2 lived

there

Number Street

City State ZIP Code

From 

To

Same as Debtor 1

Number Street

City State ZIP Code

Same as Debtor 1

From 

To

Number Street

City State ZIP Code

From 

To

Same as Debtor 1

Number Street

City State ZIP Code

Same as Debtor 1

From 

To

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

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

No

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

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

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

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Document Page 61 of 91
Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

Part 2: Explain the Sources of Your Income

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

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

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

No

Yes. Fill in the details.

Debtor 1 Debtor 2

Sources of income

Check all that apply.

Gross Income

(before deductions and

exclusions)

Sources of income

Check all that apply.

Gross Income

(before deductions and

exclusions)

From January 1 of current year until the

date you filed for bankruptcy:

Wages, commissions,

bonuses, tips

 Operating a business

$22,097.38

Wages, commissions,

bonuses, tips

 Operating a business

$58,333.38

For last calendar year:

(January 1 to December 31, 2019 )

YYYY

Wages, commissions,

bonuses, tips

 Operating a business

$58,259.00

Wages, commissions,

bonuses, tips

 Operating a business

$95,461.00

For the calendar year before that:

(January 1 to December 31, 2018 )

YYYY

Wages, commissions,

bonuses, tips

 Operating a business

$81,791.74

Wages, commissions,

bonuses, tips

 Operating a business

$43,471.22

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:

Child Support $3,900.00

For last calendar year:

(January 1 to December 31, 2019 )

YYYY

Child Support $7,800.00

For the calendar year before that:

(January 1 to December 31, 2018 )

YYYY

Child Support $7,800.00

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

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Document Page 62 of 91
Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

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

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

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

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

During the 90 days before you filed for bankruptcy, did you pay any creditor a total of $6,825* or more?

 No. Go to line 7.

 Yes. List below each creditor to whom you paid a total of $6,825* or more in one or more payments and the total amount you paid that

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

payments to an attorney for this bankruptcy case.

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

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

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

 No. Go to line 7.

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

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

this bankruptcy case.

Dates of

payment

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

Creditor's Name

Number Street

City State ZIP Code

 Mortgage

 Car

 Credit card

 Loan repayment

 Suppliers or vendors

 Other 

7. Within 1 year before you filed for bankruptcy, did you make a payment on a debt you owed anyone who was an insider?

Insiders include your relatives; any general partners; relatives of any general partners; partnerships of which you are a general partner; corporations of which you are an

officer, director, person in control, or owner of 20% or more of their voting securities; and any managing agent, including one for a business you operate as a sole

proprietor. 11 U.S.C. § 101. Include payments for domestic support obligations, such as child support and alimony.

 No

 Yes. List all payments to an insider.

Dates of

payment

Total amount paid Amount you still owe Reason for this payment

Insider's Name

Number Street

City State ZIP Code

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

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Document Page 63 of 91
Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

8. Within 1 year before you filed for bankruptcy, did you make any payments or transfer any property on account of a debt that benefited an insider?

Include payments on debts guaranteed or cosigned by an insider.

 No

 Yes. List all payments that benefited an insider.

Dates of

payment

Total amount paid Amount you still owe Reason for this payment

Include creditor’s name

Insider's Name

Number Street

City State ZIP Code

Part 4: Identify Legal Actions, Repossessions, and Foreclosures

9. Within 1 year before you filed for bankruptcy, were you a party in any lawsuit, court action, or administrative proceeding?

List all such matters, including personal injury cases, small claims actions, divorces, collection suits, paternity actions, support or custody modifications, and contract

disputes.

 No

 Yes. Fill in the details.

Nature of the case Court or agency Status of the case

Case title 

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.

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

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Document Page 64 of 91
Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

Creditor’s Name

Number Street

City State ZIP Code

Describe the property

Explain what happened

 Property was repossessed.

 Property was foreclosed.

 Property was garnished.

 Property was attached, seized, or levied.

Date Value of the property

11. Within 90 days before you filed for bankruptcy, did any creditor, including a bank or financial institution, set off any amounts from your accounts or refuse

to make a payment because you owed a debt?

 No

 Yes. Fill in the details.

Creditor’s Name

Number Street

City State ZIP Code

Describe the action the creditor took

Last 4 digits of account number: XXXX– 

Date action was

taken

Amount

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

receiver, a custodian, or another official?

 No

 Yes

Part 5: List Certain Gifts and Contributions

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

 No

 Yes. Fill in the details for each gift.

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

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Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

Gifts with a total value of more than $600 per

person

Person to Whom You Gave the Gift

Number Street

City State ZIP Code

Person’s relationship to you 

Describe the gifts Dates you gave

the gifts

Value

14. Within 2 years before you filed for bankruptcy, did you give any gifts or contributions with a total value of more than $600 to any charity?

 No

 Yes. Fill in the details for each gift or contribution.

Gifts or contributions to charities that

total more than $600

Charity’s Name

Number Street

City State ZIP Code

Describe what you contributed Date you

contributed

Value

Part 6: List Certain Losses

15. Within 1 year before you filed for bankruptcy or since you filed for bankruptcy, did you lose anything because of theft, fire, other disaster, or gambling?

 No

 Yes. Fill in the details.

Describe the property you lost and

how the loss occurred

Describe any insurance coverage for the loss

Include the amount that insurance has paid. List pending

insurance claims on line 33 of Schedule A/B: Property.

Date of your loss Value of property lost

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

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Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

Part 7: List Certain Payments or Transfers

16. Within 1 year before you filed for bankruptcy, did you or anyone else acting on your behalf pay or transfer any property to anyone you consulted about

seeking bankruptcy or preparing a bankruptcy petition?

Include any attorneys, bankruptcy petition preparers, or credit counseling agencies for services required in your bankruptcy.

 No

 Yes. Fill in the details.

ABACUS CREDIT COUNSELING

Person Who Was Paid

15760 VENTURA BLVD STE 1240

Number Street

Encino, CA 91436-0000

City State ZIP Code

Email or website address

Debtors

Person Who Made the Payment, if Not You

Description and value of any property transferred

Credit counseling

Date payment or

transfer was made

07/22/2020

Amount of payment

$25.00

Conway Law Group, PC

Person Who Was Paid

12934 Harbor Drive Suite 107

Number Street

Woodbridge, VA 22192

City State ZIP Code

Email or website address

Debtors

Person Who Made the Payment, if Not You

Description and value of any property transferred

Attorney's Fee; Attorney's Fee; Attorney's Fee; Filing fee and

costs

Date payment or

transfer was made

06/16/2020

07/21/2020

07/31/2020

07/31/2020

Amount of payment

$300.00

$702.00

$258.00

$444.00

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

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

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Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

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

Cash For Cars

Person Who Received Transfer

123 Fleming St.

Number Street

Fredericksburg, VA 22408

City State ZIP Code

Person's relationship to you

None

2011 Nissan Altima $690

06/01/2020

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.

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

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Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

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 9

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Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

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 10

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Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

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 11

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Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

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

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/ Michelle Ann Kristiansen

Signature of Michelle Ann Kristiansen, Debtor 1

Date 08/11/2020

✘ /s/ Jason Michael Kristiansen

Signature of Jason Michael Kristiansen, Debtor 2

Date 08/11/2020

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).

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Check as directed in lines 17 and 21:

According to the calculations required by this

Statement:

1. Disposable income is not determined

under 11 U.S.C. § 1325(b)(3).

2. Disposable income is determined

under 11 U.S.C. § 1325(b)(3).

3. The commitment period is 3 years.

4. The commitment period is 5 years.

Check if this is an amended filing

Fill in this information to identify your case:

Debtor 1 Michelle Ann Kristiansen

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Jason Michael Kristiansen

First Name Middle Name Last Name

United States Bankruptcy Court for the: Eastern District of Virginia

Case number

(if known)

Official Form 122C-1

Be as complete and accurate as possible. If two married people are filing together, both are equally responsible for being accurate. If more space is needed, attach a

separate sheet to this form. Include the line number to which the additional information applies. On the top of any additional pages, write your name and case

number (if known).

Part 1: Calculate Your Average Monthly Income

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

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

Married. Fill out both Columns A and B, lines 2-11.

Fill in the average monthly income that you received from all sources, derived during the 6 full months before you file this bankruptcy case.11 U.S.C. §

101(10A). For example, if you are filing on September 15, the 6-month period would be March 1 through August 31. If the amount of your monthly income varied during the

6 months, add the income for all 6 months and divide the total by 6. Fill in the result. Do not include any income amount more than once. For example, if both spouses own

the same rental property, put the income from that property in one column only. If you have nothing to report for any line, write $0 in the space.

Column A

Debtor 1

Column B

Debtor 2 or

non-filing spouse

2. Your gross wages, salary, tips, bonuses, overtime, and commissions (before all

payroll deductions).

$3,026.50 $8,329.17

3. Alimony and maintenance payments. Do not include payments from a spouse. $0.00 $0.00

4. All amounts from any source which are regularly paid for household expenses of you or your

dependents, including child support. Include regular contributions from an unmarried partner,

members of your household, your dependents, parents, and roommates. Do not include payments

from a spouse. Do not include payments you listed on line 3. $650.00 $0.00

5. Net income from operating a business, profession, or

farm Debtor 1 Debtor 2

Gross receipts (before all deductions) $0.00 $0.00

Ordinary and necessary operating expenses - $0.00 - $0.00

Net monthly income from a business, profession, or farm $0.00 $0.00 Copy

here → $0.00 $0.00

6. Net income from rental and other real property Debtor 1 Debtor 2

Gross receipts (before all deductions) $0.00 $0.00

Ordinary and necessary operating expenses - $0.00 - $0.00

Net monthly income from rental or other real property $0.00 $0.00 Copy

here → $0.00 $0.00

Official Form 122C-1 Chapter 13 Statement of Your Current Monthly Income and Calculation of Commitment Period page 1

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For you.................................................................................... $0.00

For your spouse...................................................................... $0.00

Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

Column A

Debtor 1

Column B

Debtor 2 or

non-filing spouse

7. Interest, dividends, and royalties $0.00 $0.00

Unemployment compensation

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

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

8. $0.00 $0.00

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

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

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

connection with a disability, combat-related injury or disability, or death of a member of the

uniformed services. If you received any retired pay paid under chapter 61 of title 10, then

include that pay only to the extent that it does not exceed the amount of retired pay to which you

would otherwise be entitled if retired under any provision of title 10 other than chapter 61 of that

title.

9. $0.00 $0.00

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

include any benefits received under the Social Security Act; payments made under the

Federal law relating to the national emergency declared by the President under the National

Emergencies Act (50 U.S.C. 1601 et seq.) with respect to the coronavirus disease 2019

(COVID-19); payments received as a victim of a war crime, a crime against humanity, or

international or domestic terrorism; or compensation, pension, pay, annuity, or allowance paid

by the United States Government in connection with a disability, combat-related injury or

disability, or death of a member of the uniformed services. If necessary, list other sources on

a separate page and put the total below.

10.

Total amounts from separate pages, if any. + +

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

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

11. $3,676.50 + $8,329.17 = $12,005.67

Total average

monthly income

Part 2: Determine How to Measure Your Deductions from Income

12. Copy your total average monthly income from line 11. ................................................................................. $12,005.67

13. Calculate the marital adjustment. Check one:

 You are not married. Fill in 0 below.

 You are married and your spouse is filing with you. Fill in 0 below.

 You are married and your spouse is not filing with you.

Fill in the amount of the income listed in line 11, Column B, that was NOT regularly paid for the household expenses of you or your

dependents, such as payment of the spouse’s tax liability or the spouse’s support of someone other than you or your dependents.

Below, specify the basis for excluding this income and the amount of income devoted to each purpose. If necessary, list additional

adjustments on a separate page.

If this adjustment does not apply, enter 0 below.

+

Total........................................................................................... $0.00 Copy here. → - $0.00

14. Your current monthly income. Subtract the total in line 13 from line 12. $12,005.67

Official Form 122C-1 Chapter 13 Statement of Your Current Monthly Income and Calculation of Commitment Period page 2

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Virginia

6

Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

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

15a. Copy line 14 here →...............................................................................................................................................................

$12,005.67

Multiply line 15a by 12 (the number of months in a year). x 12

15b. The result is your current monthly income for the year for this part of the form..................................................................... $144,068.04

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

16a. Fill in the state in which you live.

16b. Fill in the number of people in your household.

16c. Fill in the median family income for your state and size of household. ....................................................................................

To find a list of applicable median income amounts, go online using the link specified in the separate

instructions for this form. This list may also be available at the bankruptcy clerk’s office.

$129,993.00

17. How do the lines compare?

17a. Line 15b is less than or equal to line 16c. On the top of page 1 of this form, check box 1, Disposable income is not determined under 11 U.S.C. §

1325(b)(3). Go to Part 3. Do NOT fill out Calculation of Your Disposable Income (Official Form 122C–2).

17b. Line 15b is more than line 16c. On the top of page 1 of this form, check box 2, Disposable income is determined under 11 U.S.C. § 1325(b)(3). Go

to Part 3 and fill out Calculation of Your Disposable Income (Official Form 122C–2). On line 39 of that form, copy your current monthly income

from line 14 above.

Part 3: Calculate Your Commitment Period Under 11 U.S.C. §1325(b)(4)

18. Copy your total average monthly income from line 11. .......................................................................................................... $12,005.67

Deduct the marital adjustment if it applies. If you are married, your spouse is not filing with you, and you contend that calculating the

commitment period under 11 U.S.C. § 1325(b)(4) allows you to deduct part of your spouse’s income, copy the amount from line 13.

19.

19a. If the marital adjustment does not apply, fill in 0 on line 19a. ..................................................................................................... - $0.00

19b. Subtract line 19a from line 18. $12,005.67

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

20a. Copy line 19b............................................................................................................................................................................. $12,005.67

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

20b. The result is your current monthly income for the year for this part of the form. $144,068.04

20c. Copy the median family income for your state and size of household from line 16c. ............................................................... $129,993.00

21. How do the lines compare?

Line 20b is less than line 20c. Unless otherwise ordered by the court, on the top of page 1 of this form, check box 3,

The commitment period is 3 years. Go to Part 4.

Line 20b is more than or equal to line 20c. Unless otherwise ordered by the court, on the top of page 1 of this form,

check box 4, The commitment period is 5 years. Go to Part 4.

Part 4: Sign Below

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

✘ /s/ Michelle Ann Kristiansen

Signature of Debtor 1

Date 08/11/2020

MM/ DD/ YYYY

✘ /s/ Jason Michael Kristiansen

Signature of Debtor 2

Date 08/11/2020

MM/ DD/ YYYY

If you checked 17a, do NOT fill out or file Form 122C–2.

If you checked 17b, fill out Form 122C–2 and file it with this form. On line 39 of that form, copy your current monthly income from line 14 above.

Official Form 122C-1 Chapter 13 Statement of Your Current Monthly Income and Calculation of Commitment Period page 3

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Fill in this information to identify your case:

Debtor 1 Michelle Ann Kristiansen

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Jason Michael Kristiansen

First Name Middle Name Last Name

United States Bankruptcy Court for the: Eastern District of Virginia

Case number

(if known)

Check if this is an

amended filing

Official Form 122C-2

To fill out this form, you will need your completed copy of Chapter 13 Statement of Your Current Monthly Income and Calculation of Commitment Period (Official

Form 122C–1).

Be as complete and accurate as possible. If two married people are filing together, both are equally responsible for being accurate. If more space is needed, attach

a separate sheet to this form. Include the line number to which the additional information applies. On the top of any additional pages, write your name and case

number (if known).

Part 1: Calculate Your Deductions from Your Income

The Internal Revenue Service (IRS) issues National and Local Standards for certain expense amounts. Use these amounts to answer the questions in lines

6-15. To find the IRS standards, go online using the link specified in the separate instructions for this form. This information may also be available at the

bankruptcy clerk’s office.

Deduct the expense amounts set out in lines 6-15 regardless of your actual expense. In later parts of the form, you will use some of your actual expenses if they are higher

than the standards. Do not include any operating expenses that you subtracted from income in lines 5 and 6 of Form 122C–1, and do not deduct any amounts that you

subtracted from your spouse’s income in line 13 of Form 122C–1.

If your expenses differ from month to month, enter the average expense.

Note: Line numbers 1-4 are not used in this form. These numbers apply to information required by a similar form used in chapter 7 cases.

5. The number of people used in determining your deductions from income

Fill in the number of people who could be claimed as exemptions on your federal income tax return, plus the number of

any additional dependents whom you support. This number may be different from the number of people in your household. 6

National

Standards You must use the IRS National Standards to answer the questions in lines 6-7.

6. Food, clothing, and other items: Using the number of people you entered in line 5 and the IRS National Standards, fill

in the dollar amount for food, clothing, and other items.

$2,496.00

7. Out-of-pocket health care allowance: Using the number of people you entered in line 5 and the IRS National Standards, fill in the dollar

amount for out-of-pocket health care. The number of people is split into two categories─people who are under 65 and people who are 65 or

older─because older people have a higher IRS allowance for health care costs. If your actual expenses are higher than this IRS amount, you

may deduct the additional amount on line 22.

Official Form 122C-2 Chapter 13 Calculation of Your Disposable Income page 1

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Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

People who are under 65 years of age

7a. Out-of-pocket health care allowance per person $56.00

7b. Number of people who are under 65 X 6

7c. Subtotal. Multiply line 7a by line 7b. $336.00 Copy

here → $336.00

People who are 65 years of age or older

7d. Out-of-pocket health care allowance per person $125.00

7e. Number of people who are 65 or older X 0

7f. Subtotal. Multiply line 7d by line 7e. $0.00 Copy

here →

+ $0.00

7g. Total. Add lines 7c and 7f. ............................................................................................................... $336.00 Copy here →.... $336.00

Local

Standards You must use the IRS Local Standards to answer the questions in lines 8-15.

Based on information from the IRS, the U.S. Trustee Program has divided the IRS Local Standard for housing for

bankruptcy purposes into two parts:

Housing and utilities – Insurance and operating expenses

Housing and utilities – Mortgage or rent expenses

To answer the questions in lines 8-9, use the U.S. Trustee Program chart. To find the chart, go online using the link

specified in the separate instructions for this form. This chart may also be available at the bankruptcy clerk’s office.

8. Housing and utilities – Insurance and operating expenses: Using the number of people you entered in line 5, fill in

the dollar amount listed for your county for insurance and operating expenses.

$714.00

9. Housing and utilities – Mortgage or rent expenses:

9a. Using the number of people you entered in line 5, fill in the dollar amount

listed for your county for mortgage or rent expenses.

$1,908.00

9b. Total average monthly payment for all mortgages and other debts secured by

your home.

To calculate the total average monthly payment, add all amounts that are

contractually due to each secured creditor in the 60 months after you file for

bankruptcy. Next divide by 60.

Name of the creditor Average monthly

payment

Wfhm $2,031.04

+

9b. Total average monthly payment $2,031.04 Copy

here →

– $2,031.04 Repeat this amount

on line 33a.

9c. Net mortgage or rent expense.

Subtract line 9b (total average monthly payment) from line 9a (mortgage or rent expense). If this

number is less than $0, enter $0. $0.00 Copy here →..... $0.00

10. If you claim that the U.S. Trustee Program’s division of the IRS Local Standard for housing is incorrect and affects

the calculation of your monthly expenses, fill in any additional amount you claim.

Explain

why:

$0.00

Official Form 122C-2 Chapter 13 Calculation of Your Disposable Income page 2

Case 20-33421-KLP Doc 1 Filed 08/11/20 Entered 08/11/20 18:04:19 Desc Main

Document Page 77 of 91
Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

11. Local transportation expenses: Check the number of vehicles for which you claim an ownership or operating expense.

0. Go to line 14.

1. Go to line 12.

2 or more. Go to line 12.

12. Vehicle operation expense: Using the IRS Local Standards and the number of vehicles for which you claim the operating expenses, fill in

the Operating Costs that apply for your Census region or metropolitan statistical area.

$386.00

13. Vehicle ownership or lease expense: Using the IRS Local Standards, calculate the net ownership or lease expense for each vehicle below.

You may not claim the expense if you do not make any loan or lease payments on the vehicle. In addition, you may not claim the expense for

more than two vehicles.

Vehicle 1 Describe Vehicle 1: 2016 Nissan NV

13a. Ownership or leasing costs using IRS Local Standard.......................................

$521.00

13b. Average monthly payment for all debts secured by Vehicle 1.

Do not include costs for leased vehicles.

To calculate the average monthly payment here and on line 13e, add all amounts

that are contractually due to each secured creditor in the 60 months after you

file for bankruptcy. Then divide by 60.

Name of each creditor for Vehicle 1 Average monthly

payment

NMAC $461.88

+

Total average monthly payment

$461.88 Copy

here → – $461.88

Repeat this amount

on line 33b.

13c. Net Vehicle 1 ownership or lease expense

Subtract line 13b from line 13a. If this number is less than $0, enter $0.............

$59.12

Copy net Vehicle 1

expense here → $59.12

Vehicle 2 Describe Vehicle 2: 2013 Ford Edge

13d. Ownership or leasing costs using IRS Local Standard....................................... $521.00

13e. Average monthly payment for all debts secured by Vehicle 2.

Do not include costs for leased vehicles.

Name of each creditor for Vehicle 2 Average monthly

payment

Suntrust Bk $168.92

+

Total average monthly payment

$168.92 Copy

here → – $168.92

Repeat this amount

on line 33c.

13f. Net Vehicle 2 ownership or lease expense

Subtract line 13e from 13d. If this number is less than $0, enter $0.............

$352.08

Copy net Vehicle 2

expense here → $352.08

14. Public transportation expense: If you claimed 0 vehicles in line 11, using the IRS Local Standards, fill in the Public Transportation

expense allowance regardless of whether you use public transportation.

15. Additional public transportation expense: If you claimed 1 or more vehicles in line 11 and if you claim that you may also deduct a public

transportation expense, you may fill in what you believe is the appropriate expense, but you may not claim more than the IRS Local Standard for

Public Transportation.

$0.00

Official Form 122C-2 Chapter 13 Calculation of Your Disposable Income page 3

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Case 20-33421-KLP Doc 1 Filed 08/11/20 Entered 08/11/20 18:04:19 Desc Main

Document Page 78 of 91
Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

Other Necessary

Expenses

In addition to the expense deductions listed above, you are allowed your monthly expenses for the

following IRS categories.

16. Taxes: The total monthly amount that you actually pay for federal, state and local taxes, such as income taxes, self-employment taxes, social

security taxes, and Medicare taxes. You may include the monthly amount withheld from your pay for these taxes. However, if you expect to receive a

tax refund, you must divide the expected refund by 12 and subtract that number from the total monthly amount that is withheld to pay for taxes.

Do not include real estate, sales, or use taxes.

$2,116.92

17. Involuntary deductions: The total monthly payroll deductions that your job requires, such as retirement contributions, union dues, and uniform

costs.

Do not include amounts that are not required by your job, such as voluntary 401(k) contributions or payroll savings.

$0.00

18. Life insurance: The total monthly premiums that you pay for your own term life insurance. If two married people are filing together, include

payments that you make for your spouse’s term life insurance.

Do not include premiums for life insurance on your dependents, for a non-filing spouse’s life insurance, or for any form of life insurance other

than term.

$0.00

19. Court-ordered payments: The total monthly amount that you pay as required by the order of a court or administrative agency, such as spousal

or child support payments.

Do not include payments on past due obligations for spousal or child support. You will list these obligations in line 35.

$0.00

20. Education: The total monthly amount that you pay for education that is either required:

as a condition for your job, or

for your physically or mentally challenged dependent child if no public education is available for similar services.

$0.00

21. Childcare: The total monthly amount that you pay for childcare, such as babysitting, daycare, nursery, and preschool.

Do not include payments for any elementary or secondary school education.

$0.00

22. Additional health care expenses, excluding insurance costs: The monthly amount that you pay for health care that is required for the health

and welfare of you or your dependents and that is not reimbursed by insurance or paid by a health savings account. Include only the amount that is

more than the total entered in line 7.

Payments for health insurance or health savings accounts should be listed only in line 25.

$0.00

23. Optional telephones and telephone services: The total monthly amount that you pay for telecommunication services for you and your

dependents, such as pagers, call waiting, caller identification, special long distance, or business cell phone service, to the extent necessary for

your health and welfare or that of your dependents or for the production of income, if it is not reimbursed by your employer.

Do not include payments for basic home telephone, internet or cell phone service. Do not include self-employment expenses, such as those

reported on line 5 of Form 122C-1, or any amount you previously deducted.

+ $0.00

24. Add all of the expenses allowed under the IRS expense allowances.

Add lines 6 through 23.

$6,460.12

Additional Expense

Deductions

These are additional deductions allowed by the Means Test.

Note: Do not include any expense allowances listed in lines 6-24.

25. Health insurance, disability insurance, and health savings account expenses. The monthly expenses for health insurance, disability

insurance, and health savings accounts that are reasonably necessary for yourself, your spouse, or your dependents.

Health insurance $659.80

Disability insurance $0.00

Health savings account + $0.00

Total $659.80 Copy total here → ........................................................................ $659.80

Do you actually spend this total amount?

 No. How much do you actually spend?

 Yes 

26. Continuing contributions to the care of household or family members.

The actual monthly expenses that you will continue to pay for the reasonable and necessary care and support of an elderly, chronically ill, or

disabled member of your household or member of your immediate family who is unable to pay for such expenses. These expenses may include

contributions to an account of a qualified ABLE program. 26 U.S.C. § 529A(b).

$0.00

27. Protection against family violence. The reasonably necessary monthly expenses that you incur to maintain the safety of you and your family

under the Family Violence Prevention and Services Act or other federal laws that apply.

By law, the court must keep the nature of these expenses confidential.

$0.00

Official Form 122C-2 Chapter 13 Calculation of Your Disposable Income page 4

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Case 20-33421-KLP Doc 1 Filed 08/11/20 Entered 08/11/20 18:04:19 Desc Main

Document Page 79 of 91
Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

28. Additional home energy costs. Your home energy costs are included in your insurance and operating expenses on line 8.

If you believe that you have home energy costs that are more than the home energy costs included in expenses on line 8, then fill in the excess

amount of home energy costs

You must give your case trustee documentation of your actual expenses, and you must show that the additional amount claimed is reasonable

and necessary.

$0.00

29. Education expenses for dependent children who are younger than 18. The monthly expenses (not more than $170.83* per child) that you

pay for your dependent children who are younger than 18 years old to attend a private or public elementary or secondary school.

You must give your case trustee documentation of your actual expenses, and you must explain why the amount claimed is reasonable and

necessary and not already accounted for in lines 6-23.

* Subject to adjustment on 4/01/22, and every 3 years after that for cases begun on or after the date of adjustment.

$0.00

30. Additional food and clothing expense. The monthly amount by which your actual food and clothing expenses are higher than the combined

food and clothing allowances in the IRS National Standards. That amount cannot be more than 5% of the food and clothing allowances in the

IRS National Standards.

To find a chart showing the maximum additional allowance, go online using the link specified in the separate instructions for this form. This

chart may also be available at the bankruptcy clerk’s office.

You must show that the additional amount claimed is reasonable and necessary.

$0.00

31. Continuing charitable contributions. The amount that you will continue to contribute in the form of cash or financial instruments to a

religious or charitable organization. 11 U.S.C. § 548(d)3 and (4).

Do not include any amount more than 15% of your gross monthly income.

+ $0.00

32. Add all of the additional expense deductions.

Add lines 25 through 31.

$659.80

Deductions for Debt Payment

33. For debts that are secured by an interest in property that you own, including home mortgages, vehicle loans, and other

secured debt, fill in lines 33a through 33e.

To calculate the total average monthly payment, add all amounts that are contractually due to each secured creditor in the 60

months after you file for bankruptcy. Then divide by 60.

Average monthly

payment

Mortgages on your home

33a. Copy line 9b here .....................................................................................................→

$2,031.04

Loans on your first two vehicles

33b. Copy line 13b here ..................................................................................................→

$461.88

33c. Copy line 13e here ..................................................................................................→

$168.92

33d. List other secured debts:

Name of each creditor for other

secured debt

Identify property that secures the debt Does payment

include taxes or

insurance?

No

Yes

No

Yes

No

Yes

+

33e. Total average monthly payment. Add lines 33a through 33d. ................................... $2,661.84 Copy total

here→ $2,661.84

Official Form 122C-2 Chapter 13 Calculation of Your Disposable Income page 5

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Case 20-33421-KLP Doc 1 Filed 08/11/20 Entered 08/11/20 18:04:19 Desc Main

Document Page 80 of 91
Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

34. Are any debts that you listed in line 33 secured by your primary residence, a vehicle, or other property necessary for your support or the

support of your dependents?

No. Go to line 35.

Yes. State any amount that you must pay to a creditor, in addition to the payments listed in line 33, to keep possession of your

property (called the cure amount). Next, divide by 60 and fill in the information below.

Name of the creditor Identify property that

secures the debt

Total cure

amount

Monthly cure

amount

Wfhm

8790 Sage Court King George,

VA 22485 $8,124.16 ÷ 60 =

135.40

÷ 60 =

÷ 60 = + 

Total $135.40 Copy total

here → $135.40

35. Do you owe any priority claims—such as a priority tax, child support, or alimony—that are past due as of the filing date of your

bankruptcy case? 11 U.S.C. § 507.

No. Go to line 36.

Yes. Fill in the total amount of all of these priority claims. Do not include current or ongoing priority claims, such as those you

listed in line 19.

Total amount of all past-due priority claims.................................................................. $3,730.00 ÷ 60 $62.17

36. Projected monthly Chapter 13 plan payment $0.00

Current multiplier for your district as stated on the list issued by the Administrative Office of the United

States Courts (for districts in Alabama and North Carolina) or by the Executive Office for United States

Trustees (for all other districts).

To find a list of district multipliers that includes your district, go online using the link specified in the

separate instructions for this form. This list may also be available at the bankruptcy clerk’s office. X 8.70 %

Average monthly administrative expense

$0.00

Copy

total

here → $0.00

37. Add all of the deductions for debt payment. Add lines 33e through 36. $2,859.41

Total Deductions from Income

38. Add all of the allowed deductions.

Copy line 24, All of the expenses allowed under IRS expense allowances .................................... $6,460.12

Copy line 32, All of the additional expense deductions.................................................................... $659.80

Copy line 37, All of the deductions for debt payment....................................................................... + $2,859.41

Total deductions..............................................................................................................................

$9,979.33

Copy

total

here →

$9,979.33

Official Form 122C-2 Chapter 13 Calculation of Your Disposable Income page 6

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Case 20-33421-KLP Doc 1 Filed 08/11/20 Entered 08/11/20 18:04:19 Desc Main

Document Page 81 of 91
Copy here →

Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

Part 2: Determine Your Disposable Income Under 11 U.S.C. § 1325(b)(2)

39. Copy your total current monthly income from line 14 of Form 122C-1, Chapter 13 Statement of

Your Current Monthly Income and Calculation of Commitment Period. ................................................................

$12,005.67

40. Fill in any reasonably necessary income you receive for support for dependent children. The

monthly average of any child support payments, foster care payments, or disability payments for a

dependent child, reported in Part I of Form 122C-1, that you received in accordance with applicable

nonbankruptcy law to the extent reasonably necessary to be expended for such child.

$0.00

41. Fill in all qualified retirement deductions. The monthly total of all amounts that your employer withheld

from wages as contributions for qualified retirement plans, as specified in 11 U.S.C. § 541(b)(7) plus

all required repayments of loans from retirement plans, as specified in 11 U.S.C. § 362(b)(19).

$464.70

42. Total of all deductions allowed under 11 U.S.C. § 707(b)(2)(A). Copy line 38 here .... → $9,979.33

43. Deduction for special circumstances. If special circumstances justify additional expenses and you

have no reasonable alternative, describe the special circumstances and their expenses. You must give

your case trustee a detailed explanation of the special circumstances and documentation for the

expenses.

Describe the special circumstances Amount of expense

Child's Braces $138.74

Pet Care $62.00

Total of separate pages. + $496.00

Total $696.74 Copy here

→ + $696.74

44. Total adjustments. Add lines 40 through 43........................................................................ $11,140.77 – $11,140.77

45. Calculate your monthly disposable income under § 1325(b)(2). Subtract line 44 from line 39. $864.90

Part 3: Change in Income or Expenses

46. Change in income or expenses. If the income in Form 122C-1 or the expenses you reported in this form have changed or

are virtually certain to change after the date you filed your bankruptcy petition and during the time your case will be open, fill

in the information below. For example, if the wages reported increased after you filed your petition, check 122C-1 in the first

column, enter line 2 in the second column, explain why the wages increased, fill in when the increase occurred, and fill in

the amount of the increase.

Form Line Reason for change Date of change Increase or

decrease?

Amount of change

122C-1

122C-2

13 Wife's health issues and Covid hour reductions. 03/15/2020 Increase

Decrease

($2,463.34)

122C-1

122C-2

Increase

Decrease

Official Form 122C-2 Chapter 13 Calculation of Your Disposable Income page 7

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Document Page 82 of 91
Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

Part 4: Sign Below

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

✘ /s/ Michelle Ann Kristiansen

Signature of Debtor 1

Date 08/11/2020

MM/ DD/ YYYY

✘ /s/ Jason Michael Kristiansen

Signature of Debtor 2

Date 08/11/2020

MM/ DD/ YYYY

Official Form 122C-2 Chapter 13 Calculation of Your Disposable Income page 8

Case 20-33421-KLP Doc 1 Filed 08/11/20 Entered 08/11/20 18:04:19 Desc Main

Document Page 83 of 91
Debtor 1

Debtor 2

Michelle Ann Kristiansen

Jason Michael Kristiansen

First Name Middle Name Last Name

Case number (if known)

Additional Page For 122C-2

43. Cont.

Describe the special circumstances Amount of

expense

Gym Membership $26.00

Children's Activities $400.00

Student Loan Payment $0.00

Parking for work $70.00

Official Form 122C-2 Chapter 13 Calculation of Your Disposable Income page 9

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Document Page 84 of 91
CASE NO

CHAPTER 13

IN THE UNITED STATES BANKRUPTCY COURT

EASTERN DISTRICT OF VIRGINIA

RICHMOND DIVISION

IN RE: Kristiansen, Michelle Ann

Kristiansen, Jason Michael

VERIFICATION OF CREDITOR MATRIX

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

Date 08/11/2020 Signature /s/ Michelle Ann Kristiansen

Michelle Ann Kristiansen, Debtor

Date 08/11/2020 Signature /s/ Jason Michael Kristiansen

Jason Michael Kristiansen, Joint Debtor

Case 20-33421-KLP Doc 1 Filed 08/11/20 Entered 08/11/20 18:04:19 Desc Main

Document Page 85 of 91
Aargon Agency Inc

Attn: Bankruptcy 8668 Spring Mountain

Road

Las Vegas, NV 89117

Amer. Collections Enterprise,

Inc

Attn: Bankruptcy

PO Box 30096

Alexandria, VA 22310

Bank of America

4909 Savarese Circle

Tampa, FL 33634

Capital One

PO Box 71083

Charlotte, NC 28272-0000

Charles County General

District Court

11 Washington Ave.

La Plata, MD 20646

Citibank/The Home Depot

Centralized Bankruptcy

PO Box 790034

Saint Louis, MO 63179-0000

Comenity Bank/Overstock

Attn: Bankruptcy

PO Box 182125

Columbus, OH 43218

Comenitybank/justice

Attn: Bankruptcy

PO Box 182273

Columbus, OH 43218

Case 20-33421-KLP Doc 1 Filed 08/11/20 Entered 08/11/20 18:04:19 Desc Main

Document Page 86 of 91
Credit One Bank

Attn Bankruptcy

PO Box 98873

Las Vegas, NV 89193

Creditors Collection Service

ATTN: Bankruptcy

PO Box 21504

Roanoke, VA 24018

D.C. - Dept of Motor Vehicles

Adjudication Services

PO Box 2014

Washington, DC 20013

Dominion Cardiac Care PC

PO Box 9432

Mc Lean, VA 22102-0432

First Savings Bank

Attn: Bankruptcy

PO Box 5019

Sioux Falls, SD 57117

Fredericksburg Circuit Court

702 Princess Ann Street Suite 100

Fredericksburg, VA 22401-5916

FREDERICKSBURG

ORTHOPAEDIC

3310 FALL HILL AVE

FREDERICKSBURG, VA 22401-0000

George Washington

University

2121 I St NW

Washington, DC 20052

Case 20-33421-KLP Doc 1 Filed 08/11/20 Entered 08/11/20 18:04:19 Desc Main

Document Page 87 of 91
Granite State Management &

Resources

4 Barrell Court

Concord, NH 03301

Phyllis Hotchkiss

PO Box 465

Riderwood, MD 21139

LendingPoint LLC.

Attn: Bankruptcy 1201 Roberts Blvd Suite

200

Kennesaw, GA 30144

LightStream/Suntrust

Attn: Bankruptcy 655 W Broadway

San Diego, CA 92101

Mary Washington Healthcare

2300 Fall Hill Avenue Suite 101

Fredericksburg, VA 22401-0000

Med. College of VA Collection

Attn: Billing Dept/Bankruptcy 403 N 13th

St #238

Richmond, VA 23298

Mercury/FBT

Attn: Bankruptcy

PO Box 84064

Columbus, GA 31908

Merrick Bank/CardWorks

Attn: Bankruptcy

PO Box 9201

Old Bethpage, NY 11804-9001

Case 20-33421-KLP Doc 1 Filed 08/11/20 Entered 08/11/20 18:04:19 Desc Main

Document Page 88 of 91
NASA Federal Credit Union

Attn: Bankruptcy

PO Box 1778

Bowie, MD 20717-1778

Nemo's Investigations &

Collections

Attn: Bankruptcy

PO Box 30517

Phoenix, AZ 85046

Nextcare Urgent Care

330 White Oak Rd

Fredericksburg, VA 22405

NH Higher Ed/Granite State

Mgmt & Res.

Attn: Bankruptcy

PO Box 2097

Concord, NH 03302-2097

NMAC

Attn: Bankruptcy

PO Box 660360

Dallas, TX 75266-0000

Planet Fitness

9723 Jefferson Davis Hwy

Fredericksburg, VA 22407

R. Scott Pugh

P.O. 999

9108 Courthouse Road

Spotsylvania, VA 22553-0000

RACSB

600 Jackson Street

Fredericksburg, VA 22401

Case 20-33421-KLP Doc 1 Filed 08/11/20 Entered 08/11/20 18:04:19 Desc Main

Document Page 89 of 91
Radiology Assoc. of Fredbrg

PO Box 7819

Fredericksburg, VA 22404-0000

Dennis Shifflett

4802 Floral Rd.

Brandywine, MD 20613

Suntrust Bank

PO Box 85024

Richmond, VA 23285-5024

Suntrust Bk

Attn: Bankruptcy Mail Code VA-RVW-6290

POB 8509

Richmond, VA 23286

Syncb/Walmart

Attn: Bankruptcy

PO Box 965060

Orlando, FL 32896-5060

Synchrony Bank/Care Credit

Attn: Bankruptcy Dept

PO Box 965064

Orlando, FL 32896-5060

Synchrony Bank/Lowes

PO Box 965060

Orlando, FL 32896

Univ. of MD Faculty

Physicians

250 W. Pratt Street

Baltimore, MD 21201

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Document Page 90 of 91
USDOE/GLELSI

Attn: Bankruptcy

PO Box 7860

Madison, WI 53707-0000

Wells Fargo Bank NA

MAC X2303-01A

1 Home Compus

Des Moines, IA 50328-0010

WF/FMG

Attn: Bankruptcy

PO Box 10438 MAC F8235-02F

Des Moines, IA 50306

Wfhm

Po Box 10335

Des Moines, IA 50306

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Document Page 91 of 91