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

2IILFLDO)RUP101

Voluntary Petition for Individuals Filing for Bankruptcy 12/15

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

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

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.

__________________________________________________ 

First name 

__________________________________________________ 

Middle name 

__________________________________________________ 

Last name 

___________________________ 

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

__________________________________________________ 

First name 

__________________________________________________ 

Middle name 

__________________________________________________ 

Last name 

___________________________ 

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

2. All other names you

have used in the last 8

years

Include your married or

maiden names.

__________________________________________________ 

First name 

__________________________________________________ 

Middle name 

__________________________________________________ 

Last name 

__________________________________________________ 

First name 

__________________________________________________ 

Middle name 

__________________________________________________ 

Last name 

__________________________________________________ 

First name 

__________________________________________________ 

Middle name 

__________________________________________________ 

Last name 

__________________________________________________ 

First name 

__________________________________________________ 

Middle name 

__________________________________________________ 

Last name 

3. Only the last 4 digits of

your Social Security

number or federal

Individual Taxpayer

Identification number

(ITIN)

xxx – xx – ____ ____ ____ ____

OR

9 xx – xx – ____ ____ ____ ____

xxx – xx – ____ ____ ____ ____

OR

9 xx – xx – ____ ____ ____ ____

United States Bankruptcy Court for the: 

__________ District of __________ 

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

 Chapter 7 

 Chapter 11 

 Chapter 12 

 Chapter 13 

Fill in this information to identify your case: 

 Check if this is an

amended filing

Northern District of Illinois

✔

John

C.

Pietrarosso

Jr.

Danette

M.

Pietrarosso

8 194 9467

Case 16-24743 Doc 1 Filed 08/01/16 Entered 08/01/16 18:34:02 Desc Main

 Document Page 1 of 55
Debtor 1 _______________________________________________________ Case number (if known)_____________________________________ First Name Middle Name Last Name

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

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

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

 I have not used any business names or EINs.

_________________________________________________ 

Business name

_________________________________________________ 

Business name 

___ ___ – ___ ___ ___ ___ ___ ___ ___ 

EIN 

___ ___ – ___ ___ ___ ___ ___ ___ ___ 

EIN 

 I have not used any business names or EINs.

_________________________________________________ 

Business name

_________________________________________________ 

Business name 

___ ___ – ___ ___ ___ ___ ___ ___ ___ 

EIN 

___ ___ – ___ ___ ___ ___ ___ ___ ___ 

EIN 

5. Where you live

_________________________________________________ 

Number Street 

_________________________________________________ 

_________________________________________________ 

City State ZIP Code 

_________________________________________________ 

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.

_________________________________________________ 

Number Street 

_________________________________________________ 

P.O. Box 

_________________________________________________ 

City State ZIP Code 

If Debtor 2 lives at a different address: 

_________________________________________________ 

Number Street 

_________________________________________________ 

_________________________________________________ 

City State ZIP Code

_________________________________________________ 

County

If Debtor 2’s mailing address is different from 

yours, fill it in here. Note that the court will send 

any notices to this mailing address.

_________________________________________________ 

Number Street 

_________________________________________________ 

P.O. Box 

_________________________________________________ 

City State ZIP Code

6. Why you are choosing

this district to file for

bankruptcy

Check one: 

 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.)

________________________________________

________________________________________

________________________________________

________________________________________

Check one: 

 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.)

________________________________________

________________________________________

________________________________________

________________________________________

John C. Pietrarosso

✔

2786 Lindgren Trail

Aurora IL 60503

Will

✔

Case 16-24743 Doc 1 Filed 08/01/16 Entered 08/01/16 18:34:02 Desc Main

 Document Page 2 of 55
Debtor 1 _______________________________________________________ Case number (if known)_____________________________________ First Name Middle Name Last Name

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

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 _______________ Case number ___________________________

MM / DD / YYYY

District __________________________ When _______________ Case number ___________________________

MM / DD / YYYY

District __________________________ When _______________ Case number ___________________________ 

MM / DD / YYYY

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 _______________ Case number, if known____________________ 

MM / DD / YYYY

 Debtor _________________________________________________ Relationship to you _____________________ 

District __________________________ When _______________ Case number, if known____________________

MM / DD / YYYY

11. Do you rent your

residence?

 No. Go to line 12.

 Yes. Has your landlord obtained an eviction judgment against you and do you want to stay in your

residence?

 No. Go to line 12.

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

this bankruptcy petition.

John C. Pietrarosso

✔

✔

✔

✔

✔

Case 16-24743 Doc 1 Filed 08/01/16 Entered 08/01/16 18:34:02 Desc Main

 Document Page 3 of 55
Debtor 1 _______________________________________________________ Case number (if known)_____________________________________ First Name Middle Name Last Name

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

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

12. Are you a sole proprietor

of any full- or part-time

business?

A sole proprietorship is a

business you operate as an

individual, and is not a

separate legal entity such as

a corporation, partnership, or

LLC.

If you have more than one

sole proprietorship, use a

separate sheet and attach it

to this petition.

 No. Go to Part 4.

 Yes. Name and location of business

_______________________________________________________________________________________ 

Name of business, if any 

_______________________________________________________________________________________ 

Number Street 

_______________________________________________________________________________________ 

_______________________________________________ _______ __________________________ 

City State ZIP Code

Check the appropriate box to describe your business:

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

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

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

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

 None of the above

13. Are you filing under

Chapter 11 of the

Bankruptcy Code and

are you a small business

debtor?

For a definition of small

business debtor, see

11 U.S.C. § 101(51D).

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

can set appropriate deadlines. If you indicate that you are a small business debtor, you must attach your 

most recent balance sheet, statement of operations, cash-flow statement, and federal income tax return or if 

any of these documents do not exist, follow the procedure in 11 U.S.C. § 1116(1)(B).

 No. I am not filing under Chapter 11.

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

the Bankruptcy Code. 

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

Bankruptcy Code. 

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 

John C. Pietrarosso

✔

✔

✔

Case 16-24743 Doc 1 Filed 08/01/16 Entered 08/01/16 18:34:02 Desc Main

 Document Page 4 of 55
Debtor 1 _______________________________________________________ Case number (if known)_____________________________________ First Name Middle Name Last Name

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

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: 

 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 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.

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.

 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. 

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, 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.

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.

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.

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.

John C. Pietrarosso

✔

Case 16-24743 Doc 1 Filed 08/01/16 Entered 08/01/16 18:34:02 Desc Main

 Document Page 5 of 55
Case number

@ Answer These euestions for Reporting purposes

16. What kind of debts do

you have?

17. Are you filing under

Chapter 7?

administrative expenses

are paid that funds will be

available for distribution

to unsecured creditors?

18. How many creditors do

you estimate that you

ot re?

1s. How much do you

estimate your assets to

be worth?

20. How much do you

estimate your liabilities

to be?

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16a. Are your debts primarily consumer debts? Consumerdebts are defined in 11 U.S.C. $ 101(8)

as "incurred by an individual primarily for a personal, family, or household purpose."

E No. co to line 16b.

Ul Yes. Go to line 17.

16b. Are your debts primarily business debts? Busmess debrs are debts that you incurred to obtain

money for a business or investment or through the operation of the business or investment"

"El Uo. eo to line 16c.

E Yes. Go to line 17.

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

E ruo. t am not filing under Chapter 7. Go to line 18

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

any exempt propefi is administrative expenses are paid that funds will be available to distribute to unsecured creditors?

excluded and El ruo

For you

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

correct.

lf I have chosen to file under Chapter 7, I am aware that I may proceed, if eligible, under Chapter 7,11,12, ot 13

of title 11, United States Code. I understand the relief available under each chapter, and I choose to proceed

under Chapter 7.

lf 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. S 342(b).

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

I understand a false statement, concealing property, or obtaining money or property by fraud in connection

with a

1B U.S.

Signature$ Debtor'1

*

Executed onf)-;Flr :ciL MM I DD /YYYY

Signature of Debtor 2

rt -7. /)/,t 4,,, ,

Executed on U i'JL/ '-4Ll Qt

MM / DD IYYYY

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

Case 16-24743 Doc 1 Filed 08/01/16 Entered 08/01/16 18:34:02 Desc Main

 Document Page 6 of 55
Case number

For your attorney, if you are

represented by one

lf you are not represented

by an attorney, you do not

need to file this page.

l, the attorney for the debto(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 certiry that I have delivered to the debtor(s)

the notice required by 11 U.S.C. S 342(b) and, in a case in which S 707(bX4XD) applies, certifo that I have no

knowledge after an inquiry that the information in the schedules filed with the petition is incorrect. xl4fu

Signature of Attomey for Debtor

Rarnqrr{ A Snhloqqar

Date 6

Printed name

Bernard A. Schlosser. Attorney at Law, P.C.

Firm name

181 S Rlnaminodale Road

Number Street

Bloominodale IL 601 08

State ZIP Code

Email address bernard.a@att.net

City

Contact phone (630) 529-'1740

2489139

Bar number state

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

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 Document Page 7 of 55
Official Form 106Sum Summary of Your Assets and Liabilities and Certain Statistical Information page 1 of 2 

2IILFLDO)RUP 106Sum 

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

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

information. Fill out all of your schedules first; then complete the information on this form. If you are filing amended schedules after you file 

your original forms, you must fill out a new Summary and check the box at the top of this page. 

Part 1: Summarize Your Assets 

Your assets

Value of what you own 

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

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

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

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

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 ............ $ ________________

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 ....................................... + $ ________________

Your total liabilities $ ________________

Part 3: Summarize Your Income and Expenses 

4. Schedule I: Your Income (Official Form 106I)

Copy your combined monthly income from line 12 of Schedule I .......................................................................................... $ ________________

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

Copy your monthly expenses from line 22c of Schedule J .................................................................................................... $ ________________

Debtor 1 __________________________________________________________________ First Name Middle Name Last Name

Debtor 2 ________________________________________________________________ 

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

United States Bankruptcy Court for the: __________ District of __________

Case number ___________________________________________ 

(If known)

Fill in this information to identify your case: 

 Check if this is an

amended filing

John C. Pietrarosso

Danette M. Pietrarosso

Northern District of Illinois

225,000.00

37,042.00

262,042.00

270,998.00

0.00

43,489.00

314,487.00

7,265.00

7,118.00

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 Document Page 8 of 55
Debtor 1 _______________________________________________________ Case number (if known)_____________________________________ First Name Middle Name Last Name

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

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. $ _________________ 

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.) $_____________________

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

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

9d. Student loans. (Copy line 6f.) $_____________________ 

9e. Obligations arising out of a separation agreement or divorce that you did not report as 

priority claims. (Copy line 6g.) $_____________________ 

9f. Debts to pension or profit-sharing plans, and other similar debts. (Copy line 6h.) + $_____________________

9g. Total. Add lines 9a through 9f. $_____________________ 

John C. Pietrarosso

✔

✔

10,482.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

Case 16-24743 Doc 1 Filed 08/01/16 Entered 08/01/16 18:34:02 Desc Main

 Document Page 9 of 55
Official Form 106A/B Schedule A/B: Property page 1

2IILFLDO)RUP 106A/B 

Schedule A/B: Property 12/15

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

category where you think it fits best. Be as complete and accurate as possible. If two married people are filing together, both are equally 

responsible for supplying correct information. If more space is needed, attach a separate sheet to this form. On the top of any additional pages, 

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

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?

1.1. _________________________________________ 

Street address, if available, or other description 

_________________________________________ 

_________________________________________ 

City State ZIP Code 

_________________________________________ 

County

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 __________________________________

Do not deduct secured claims or exemptions. Put 

the amount of any secured claims on Schedule D: 

Creditors Who Have Claims Secured by Property.

Current value of the 

entire property? 

$________________

Current value of the 

portion you own?

$_______________ 

Describe the nature of your ownership 

interest (such as fee simple, tenancy by 

the entireties, or a life estate), if known. 

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)

Other information you wish to add about this item, such as local 

property identification number: _______________________________

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

1.2. ________________________________________ 

Street address, if available, or other description 

________________________________________ 

________________________________________ 

City State ZIP Code 

________________________________________ 

County

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 __________________________________

Do not deduct secured claims or exemptions. Put 

the amount of any secured claims on Schedule D: 

Creditors Who Have Claims Secured by Property.

Current value of the 

entire property? 

$________________

Current value of the 

portion you own?

$_________________

Describe the nature of your ownership 

interest (such as fee simple, tenancy by 

the entireties, or a life estate), if known. 

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)

Other information you wish to add about this item, such as local 

property identification number: _______________________________

Debtor 1 __________________________________________________________________ First Name Middle Name Last Name

Debtor 2 ________________________________________________________________ 

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

United States Bankruptcy Court for the: __________ District of ___________

Case number ___________________________________________ 

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

 Check if this is an

amended filing

John C. Pietrarosso

Danette M. Pietrarosso

Northern District of Illinois

✔

2786 Lindgren

Aurora IL 60503

Will

✔

225,000.00 251,000.00

fee simple

✔

Case 16-24743 Doc 1 Filed 08/01/16 Entered 08/01/16 18:34:02 Desc Main

 Document Page 10 of 55
Debtor 1 _______________________________________________________ Case number (if known)_____________________________________ First Name Middle Name Last Name

2IILFLDO)RUP$% Schedule A/B: Property page 2

1.3. ________________________________________ 

Street address, if available, or other description 

________________________________________ 

________________________________________ 

City State ZIP Code 

________________________________________ 

County

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 __________________________________

Do not deduct secured claims or exemptions. Put 

the amount of any secured claims on Schedule D: 

Creditors Who Have Claims Secured by Property.

Current value of the 

entire property? 

$________________

Current value of the 

portion you own?

$_________________

Describe the nature of your ownership 

interest (such as fee simple, tenancy by 

the entireties, or a life estate), if known. 

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)

Other information you wish to add about this item, such as local 

property identification number: _______________________________

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. ...................................................................................... Î $_________________

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

3.1. Make: ______________ 

Model: ______________ 

Year: ____________

Approximate mileage: ____________ 

Other information: 

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? 

$________________

Current value of the 

portion you own?

$________________

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

3.2. Make: ______________ 

Model: ______________

Year: ____________

Approximate mileage: ____________ 

Other information: 

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? 

$________________

Current value of the 

portion you own?

$________________

John C. Pietrarosso

0.00

✔

Kia

Soul

2014

40000 ✔

10,114.00 10,114.00

Kia

Sedona

2010

118000 ✔

4,435.00 4,435.00

Case 16-24743 Doc 1 Filed 08/01/16 Entered 08/01/16 18:34:02 Desc Main

 Document Page 11 of 55
Debtor 1 _______________________________________________________ Case number (if known)_____________________________________ First Name Middle Name Last Name

2IILFLDO)RUP$% Schedule A/B: Property page 3

3.3. Make: ______________ 

Model: ______________

Year: ____________

Approximate mileage: ____________ 

Other information: 

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? 

$________________

Current value of the 

portion you own?

$________________

3.4. Make: ______________ 

Model: ______________

Year: ____________

Approximate mileage: ____________ 

Other information: 

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? 

$________________

Current value of the 

portion you own?

$________________

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

4.1. Make: ____________________ 

Model: ____________________ 

Year: ____________ 

Other information: 

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? 

$________________

Current value of the 

portion you own?

$________________

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

4.2. Make: ____________________ 

Model: ____________________ 

Year: ____________ 

Other information:

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? 

$________________

Current value of the 

portion you own?

$________________

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 ........................................................................................................................ Î $_________________

John C. Pietrarosso

✔

14,549.00

Case 16-24743 Doc 1 Filed 08/01/16 Entered 08/01/16 18:34:02 Desc Main

 Document Page 12 of 55
Debtor 1 _______________________________________________________ Case number (if known)_____________________________________ First Name Middle Name Last Name

2IILFLDO)RUP$% Schedule A/B: Property page 4

Part 3: Describe Your Personal and Household Items 

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

portion you own? 

Do not deduct secured claims 

or exemptions. 

6. Household goods and furnishings

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

 No

 Yes. Describe. ........ $___________________

7. Electronics

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

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

 No

 Yes. Describe. ......... $___________________

8. Collectibles of value

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

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

 No

 Yes. Describe. ......... $___________________

9. Equipment for sports and hobbies

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

and kayaks; carpentry tools; musical instruments 

 No

 Yes. Describe. ......... $___________________

10.Firearms

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

 No

 Yes. Describe. .......... $___________________

11.Clothes

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

 No

 Yes. Describe. .......... $___________________

12.Jewelry

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

gold, silver

 No

 Yes. Describe. .......... $___________________

13.Non-farm animals

Examples: Dogs, cats, birds, horses

 No

 Yes. Describe. .......... $___________________

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

 No

 Yes. Give specific

information. .............. $___________________

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 .................................................................................................................................................... Î $______________________ 

John C. Pietrarosso

✔ furniture, kitchenware 250.00

✔ laptop, TVs, Xbox, radios 300.00

✔

0.00

✔ air hockey table 50.00

✔

0.00

✔ miscellaneous clothes 0.00

✔ 2 wedding rings, necklace 2,000.00

✔ dog (3 legs)

0.00

✔

0.00

2,600.00

Case 16-24743 Doc 1 Filed 08/01/16 Entered 08/01/16 18:34:02 Desc Main

 Document Page 13 of 55
Debtor 1 _______________________________________________________ Case number (if known)_____________________________________ First Name Middle Name Last Name

2IILFLDO)RUP$% Schedule A/B: Property page 5

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.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. 

 No

 Yes ..................... Institution name:

17.1. Checking account: _________________________________________________________ 

17.2. Checking account: _________________________________________________________ 

17.3. Savings account: _________________________________________________________ 

17.4. Savings account: _________________________________________________________ 

17.5. Certificates of deposit: _________________________________________________________ 

17.6. Other financial account: _________________________________________________________ 

17.7. Other financial account: _________________________________________________________ 

17.8. Other financial account: _________________________________________________________ 

17.9. Other financial account: _________________________________________________________ 

$__________________ 

$__________________ 

$__________________ 

$__________________ 

$__________________ 

$__________________ 

$__________________ 

$__________________ 

$__________________ 

18.Bonds, mutual funds, or publicly traded stocks

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

 No

 Yes ................. Institution or issuer name: 

_________________________________________________________________________________________ 

_________________________________________________________________________________________ 

_________________________________________________________________________________________ 

$__________________ 

$__________________ 

$__________________ 

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

an LLC, partnership, and joint venture

 No

Yes. Give specific

information about

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

Name of entity: % of ownership: 

_____________________________________________________________________ ___________% 

_____________________________________________________________________ ___________% 

_____________________________________________________________________ ___________% 

$__________________ 

$__________________ 

$__________________ 

John C. Pietrarosso

✔

0.00

✔

Leyden C.U. 270.00

Leyden C.U. 25.00

0.00

0.00

✔

✔

0%

0%

0%

Case 16-24743 Doc 1 Filed 08/01/16 Entered 08/01/16 18:34:02 Desc Main

 Document Page 14 of 55
Debtor 1 _______________________________________________________ Case number (if known)_____________________________________ First Name Middle Name Last Name

2IILFLDO)RUP$% Schedule A/B: Property page 6

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

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

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

 No

Yes. Give specific

information about 

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

Issuer name: 

______________________________________________________________________________________ 

______________________________________________________________________________________ 

______________________________________________________________________________________ 

$__________________ 

$__________________ 

$__________________ 

21. Retirement or pension accounts

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

 No

 Yes. List each

account separately. Type of account: Institution name: 

401(k) or similar plan: ___________________________________________________________________ 

Pension plan: ___________________________________________________________________ 

IRA: ___________________________________________________________________ 

Retirement account: ___________________________________________________________________ 

Keogh: ___________________________________________________________________ 

Additional account: ___________________________________________________________________ 

Additional account: ___________________________________________________________________ 

$__________________ 

$__________________ 

$__________________ 

$__________________ 

$__________________ 

$__________________ 

$__________________ 

22.Security deposits and prepayments

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

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

companies, or others

 No

 Yes .......................... Institution name or individual: 

Electric: ______________________________________________________________________ 

Gas: ______________________________________________________________________ 

Heating oil: ______________________________________________________________________ 

Security deposit on rental unit: _____________________________________________________________ 

Prepaid rent: ______________________________________________________________________ 

Telephone: ______________________________________________________________________ 

Water: ______________________________________________________________________ 

Rented furniture: ______________________________________________________________________ 

Other: ______________________________________________________________________ 

$___________________ 

$___________________ 

$___________________ 

$___________________ 

$___________________ 

$___________________ 

$___________________ 

$___________________ 

$___________________

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

 No

 Yes .......................... Issuer name and description: 

 _______________________________________________________________________________________ 

_______________________________________________________________________________________ 

_______________________________________________________________________________________ 

$__________________ 

$__________________ 

$__________________ 

John C. Pietrarosso

✔

✔

IMRF 19,598.00

✔

✔

Case 16-24743 Doc 1 Filed 08/01/16 Entered 08/01/16 18:34:02 Desc Main

 Document Page 15 of 55
Debtor 1 _______________________________________________________ Case number (if known)_____________________________________ First Name Middle Name Last Name

2IILFLDO)RUP$% Schedule A/B: Property page 7

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

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

 No

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

____________________________________________________________________________________ 

____________________________________________________________________________________ 

____________________________________________________________________________________ 

 $_________________ 

$_________________ 

$_________________ 

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

exercisable for your benefit

 No

 Yes. Give specific

information about them. ... $__________________ 

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

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

 No

 Yes. Give specific

information about them. ... $__________________ 

27. Licenses, franchises, and other general intangibles

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

 No

 Yes. Give specific

information about them. ... $__________________

Money or property owed to you? Current value of the 

portion you own? 

Do not deduct secured 

claims or exemptions.

28.Tax refunds owed to you

 No

 Yes. Give specific information

about them, including whether 

you already filed the returns 

and the tax years. ....................... 

Federal: $_________________

State: $_________________

Local: $_________________

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. 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 

 No

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

$______________________

John C. Pietrarosso

✔

✔

✔

✔

✔

✔

✔

Case 16-24743 Doc 1 Filed 08/01/16 Entered 08/01/16 18:34:02 Desc Main

 Document Page 16 of 55
Debtor 1 _______________________________________________________ Case number (if known)_____________________________________ First Name Middle Name Last Name

2IILFLDO)RUP$% Schedule A/B: Property page 8

31. Interests in insurance policies

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

 No

 Yes. Name the insurance company

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

___________________________________________ ____________________________ 

___________________________________________ ____________________________ 

___________________________________________ ____________________________ 

Surrender or refund value: 

$__________________ 

$__________________ 

$__________________

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

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

property because someone has died.

 No

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

$_____________________ 

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

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

 No

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

$______________________

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

to set off claims

 No

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

$_____________________ 

35.Any financial assets you did not already list

 No

 Yes. Give specific information............ $_____________________ 

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

for Part 4. Write that number here .................................................................................................................................................... Î $_____________________ 

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.Accounts receivable or commissions you already earned

 No

 Yes. Describe .......

$_____________________

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 ....... $_____________________

John C. Pietrarosso

✔

✔

✔

✔

✔

19,893.00

✔

Case 16-24743 Doc 1 Filed 08/01/16 Entered 08/01/16 18:34:02 Desc Main

 Document Page 17 of 55
Debtor 1 _______________________________________________________ Case number (if known)_____________________________________ First Name Middle Name Last Name

2IILFLDO)RUP$% Schedule A/B: Property page 9

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

 No

 Yes. Describe ....... $_____________________

41. Inventory

 No

 Yes. Describe ....... $_____________________

42. Interests in partnerships or joint ventures

 No

 Yes. Describe ....... Name of entity: % of ownership: 

 ______________________________________________________________________ ________% 

 ______________________________________________________________________ ________% 

 ______________________________________________________________________ ________%

$_____________________

$_____________________

$_____________________

43.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))?

 No

 Yes. Describe. ....... 

$____________________

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

 No

 Yes. Give specific

information ......... ______________________________________________________________________________________ $____________________

______________________________________________________________________________________ $____________________

______________________________________________________________________________________ $____________________

______________________________________________________________________________________ $____________________

______________________________________________________________________________________ $____________________

______________________________________________________________________________________ $____________________

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

for Part 5. Write that number here .................................................................................................................................................... Î $____________________

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. Farm animals

Examples: Livestock, poultry, farm-raised fish

 No

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

$___________________

John C. Pietrarosso

0.00

✔

Case 16-24743 Doc 1 Filed 08/01/16 Entered 08/01/16 18:34:02 Desc Main

 Document Page 18 of 55
Debtor 1 _______________________________________________________ Case number (if known)_____________________________________ First Name Middle Name Last Name

2IILFLDO)RUP$% Schedule A/B: Property page 10

48.Crops—either growing or harvested

 No

 Yes. Give specific

information. ............ $___________________

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

 No

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

$___________________

50.Farm and fishing supplies, chemicals, and feed

 No

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

$___________________

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

 No

 Yes. Give specific

information. ............ $___________________

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

for Part 6. Write that number here .................................................................................................................................................... Î $___________________

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

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

Examples: Season tickets, country club membership

 No

 Yes. Give specific

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

$________________ 

$________________ 

$________________ 

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

Part 8: List the Totals of Each Part of this Form 

55.Part 1: Total real estate, line 2 ..............................................................................................................................................................Î $________________ 

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

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

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

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

60.Part 6: Total farm- and fishing-related property, line 52 $________________

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

62.Total personal property. Add lines 56 through 61. .................... $________________ Copy personal property total Î + $_________________

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

John C. Pietrarosso

0.00

✔

0.00

14,549.00

2,600.00

19,893.00

0.00

0.00

0.00

37,042.00 37,042.00

37,042.00

Case 16-24743 Doc 1 Filed 08/01/16 Entered 08/01/16 18:34:02 Desc Main

 Document Page 19 of 55
Official Form 106C Schedule C: The Property You Claim as Exempt page 1 of __ 

2IILFLDO)RUP 106C 

Schedule C: The Property You Claim as Exempt 12/15

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:

Line from 

Schedule A/B:

_________________________ $________________  $ ____________ 

 100% of fair market value, up to

any applicable statutory limit

____________________________ 

____________________________ 

____________________________ 

____________________________ ______ 

Brief

description:

Line from 

Schedule A/B:

_________________________ $________________  $ ____________ 

 100% of fair market value, up to

any applicable statutory limit

____________________________ 

____________________________ 

____________________________ 

____________________________ ______ 

Brief

description: _________________________ $________________  $ ____________ 

 100% of fair market value, up to

any applicable statutory limit

____________________________ 

____________________________ 

____________________________ 

____________________________ Line from 

Schedule A/B: ______ 

3. Are you claiming a homestead exemption of more than $155,675?

(Subject to adjustment on 4/01/16 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

Debtor 1 __________________________________________________________________ First Name Middle Name Last Name

Debtor 2 ________________________________________________________________ 

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

United States Bankruptcy Court for the: __________ District of __________

Case number ___________________________________________ 

 (If known) 

Fill in this information to identify your case: 

 Check if this is an

amended filing

John C. Pietrarosso

Danette M. Pietrarosso

Northern District of Illinois

✔

car 10,114.00 ✔ 2,400.00 735ILCS5/12-1001(c)

3.1

car 4,435.00 ✔ 2,400.00 735ILCS5/12-1001(c)

3.2

home 225,000.00 ✔ 30,000.00 735ILCS5/12-1001(a)

1.1

✔

2

Case 16-24743 Doc 1 Filed 08/01/16 Entered 08/01/16 18:34:02 Desc Main

 Document Page 20 of 55
Debtor 1 _______________________________________________________ Case number (if known)_____________________________________ First Name Middle Name Last Name

2IILFLDO)RUP& Schedule C: The Property You Claim as Exempt page ___ of __

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:

Line from 

Schedule A/B:

_________________________ $________________  $ ____________ 

 100% of fair market value, up to

any applicable statutory limit

____________________________ 

____________________________ 

____________________________ 

____________________________ ______ 

Brief

description:

Line from 

Schedule A/B:

_________________________ $________________  $ ____________ 

 100% of fair market value, up to

any applicable statutory limit

____________________________ 

____________________________ 

____________________________ 

______ ____________________________ 

Brief

description:

Line from 

Schedule A/B:

_________________________ $________________  $ ____________ 

 100% of fair market value, up to

any applicable statutory limit

____________________________ 

____________________________ 

____________________________ 

____________________________ ______ 

Brief

description:

Line from 

Schedule A/B:

_________________________ $________________  $ ____________ 

 100% of fair market value, up to

any applicable statutory limit

____________________________ 

____________________________ 

____________________________ 

____________________________ ______ 

Brief

description:

Line from 

Schedule A/B:

_________________________ $________________  $ ____________ 

 100% of fair market value, up to

any applicable statutory limit

____________________________ 

____________________________ 

____________________________ 

______ ____________________________ 

Brief

description:

Line from 

Schedule A/B:

_________________________ $________________  $ ____________ 

 100% of fair market value, up to

any applicable statutory limit

____________________________ 

____________________________ 

____________________________ 

____________________________ ______ 

Brief

description:

Line from 

Schedule A/B:

_________________________ $________________  $ ____________ 

 100% of fair market value, up to

any applicable statutory limit

____________________________ 

____________________________ 

____________________________ 

____________________________ ______ 

Brief

description:

Line from 

Schedule A/B:

_________________________ $________________  $ ____________ 

 100% of fair market value, up to

any applicable statutory limit

____________________________ 

____________________________ 

____________________________ 

______ ____________________________ 

Brief

description:

Line from 

Schedule A/B:

_________________________ $________________  $ ____________ 

 100% of fair market value, up to

any applicable statutory limit

____________________________ 

____________________________ 

____________________________ 

____________________________ ______ 

Brief

description:

Line from 

Schedule A/B:

_________________________ $________________  $ ____________ 

 100% of fair market value, up to

any applicable statutory limit

____________________________ 

____________________________ 

____________________________ 

____________________________ ______ 

Brief

description:

Line from 

Schedule A/B:

_________________________ $________________  $ ____________ 

 100% of fair market value, up to

any applicable statutory limit

____________________________ 

____________________________ 

____________________________ 

______ ____________________________ 

Brief

description:

Line from 

Schedule A/B:

_________________________ $________________  $ ____________ 

 100% of fair market value, up to

any applicable statutory limit

____________________________ 

____________________________ 

____________________________ 

____________________________ ______ 

John C. Pietrarosso

furniture/Kitchenwar 250.00 ✔ 250.00 735ILCS5/12-1001(b)

B-6

laptop, TVs 300.00 735ILCS5/12-1001(b) ✔ 300.00

B-7

air hockey table 50.00 ✔ 50.00 735ILCS5/12-1001(b)

B-9

wedding rngs neckl 2,000.00 ✔ 2,000.00 735ILCS5/12-1001(b)

B-12

checking account 270.00 ✔ 270.00 735ILCS5/12-1001(b)

B-17

savings account 25.00 ✔ 25.00 735ILCS5/12-1001(b)

B17

retirement account 19,598.00 ✔ 19,598.00 735ILCS5/12-1001(g)

B21

2 2

Case 16-24743 Doc 1 Filed 08/01/16 Entered 08/01/16 18:34:02 Desc Main

 Document Page 21 of 55
2fficial Form 106D Schedule D: Creditors Who Have Claims Secured by Property page 1 of ___ 

2IILFLDO)RUP 106D 

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

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

information. If more space is needed, copy the Additional Page, fill it out, number the entries, and attach it to this form. On the top of any 

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

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

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

 Yes. Fill in all of the information below.

Part 1: List All Secured Claims 

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

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

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

Column A 

Amount of claim

Do not deduct the 

value of collateral.

Column B 

Value of collateral 

that supports this 

claim

Column C 

Unsecured 

portion 

If any

2.1

______________________________________ 

Creditor’s Name 

______________________________________ 

Number Street 

______________________________________ 

______________________________________ 

City State ZIP Code

Describe the property that secures the claim: $_________________ $________________ $____________

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

 Contingent

 Unliquidated

 Disputed

Nature of lien. Check all that apply.

 An agreement you made (such as mortgage or secured 

car loan) 

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

 Judgment lien from a lawsuit 

 Other (including a right to offset) ____________________

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 ____________ Last 4 digits of account number ___ ___ ___ ___

2.2

______________________________________ 

Creditor’s Name 

______________________________________ 

Number Street 

______________________________________ 

______________________________________ 

City State ZIP Code

Describe the property that secures the claim: $_________________ $________________ $____________

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

 Contingent

 Unliquidated

 Disputed

Nature of lien. Check all that apply.

 An agreement you made (such as mortgage or secured 

car loan) 

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

 Judgment lien from a lawsuit 

 Other (including a right to offset) ____________________

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 ____________ Last 4 digits of account number ___ ___ ___ ___

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

Debtor 1 __________________________________________________________________ First Name Middle Name Last Name

Debtor 2 ________________________________________________________________ 

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

United States Bankruptcy Court for the: __________ District of __________

Case number ___________________________________________ 

(If known)

Fill in this information to identify your case: 

 Check if this is an

amended filing

John C. Pietrarosso

Danette M. Pietrarosso

Northern District of Illinois

✔

PNC Bank 19,486.00 10,114.00 9,372.00

PO Box 747 2014 Kia Soul

066

Pittsburgh PA 15274 ✔

✔

✔

✔

01/01/2014 4 19 1

US Bank 512.00 4,435.00 0.00

PO Box 790179 2010 Kia Sedona

St. Louis M 63179 ✔

✔

✔

✔

01/01/2014

19,998.00

2

Case 16-24743 Doc 1 Filed 08/01/16 Entered 08/01/16 18:34:02 Desc Main

 Document Page 22 of 55
John C. Pietrarosso Case number (fknowr)

Additional Page

After listing any entries on this page, number them beginning with 2.3, followed

by 2.4, and so forth.

Describe the property that secures the claim: $ 251,000.00

Column A

Amount of claim

Do not deduci the

value of collateral.

Column B

Value of collateral

that supports this

claim

$ 225,000.00

Column C

Unsecured

portion

lf any

$ 26,000.00

Who owes the debt? Check one.

E Debtor 1 only

E Debtor 2 only

( Oebtor t and Debtor 2 onty

E At least one of the debtors and another

d Cfecf if this claim relates to a

community debt

Date debt was incurred 0110112007

Creditods Name

Crty State ZIP Code

Who owes the debt? Check one.

D Debtor 1 only

U Debtor 2 only

D Debtor 1 and Debtor 2 only

E At least one of the debtors and another

E Cnecf if this claim relates to a

community debt

Date debt was incurred

Nationstar

Creditoas Name

PO Box 619063

Number Street

Dallas TX& 75261

State ZIP Code

State ZIP Code

Who owes the debt? Check one.

fl Debtor t only

E Debtor 2 only

E Deotor 1 and Debtor 2 onty

E At least one of the debtors and another

E Cnecf if this claim relates to a

community debt

Date debt was incurred

Write that number here:

Official Form 106D

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

E Contingent

il Unliquidated

fl Disputed

Nature of lien. Check all that apply.

il An ugruur"nt you made (such as mortgage or secured

car loan)

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

E Judgment lien from a lawsuit

fl Other (including a righi to offset)

Last 4 digits of account number

Describe the property that secures the claim:

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

E Contingent

fl Unliquidated

E Disputeo

Nature of lien. Check all that apply.

E An agreement you made (such as mortgage or secured

car Ioan)

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

E Judgment lien from a lawsuit

E Other (including a right to offset)

Last 4 digits of account number

Describe the prope(y that secures the claim:

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

E Contingent

E Unliquidated

E Disputed

Nature of lien. Check all that apply.

E An agreement you made (such as mortgage or secured

car loan)

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

E Judgment lien from a tawsuit

E Other (incluoing a right to offset)

Last 4 digits of account number

c_ c_

ihome

i

City

6283

tl

City

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

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

i-- ^ *- ----*- **" *'- --- --"i

n".", is__ z!1,ogg.o9 j

l* zzo,soa.oo I

t-:l

Additional Page of Schedule D: Creditors Who Have Claims Secured by Property page2 ot2

Case 16-24743 Doc 1 Filed 08/01/16 Entered 08/01/16 18:34:02 Desc Main

 Document Page 23 of 55
Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 1 of ___ 

2IILFLDO)RUP106E/F

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

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

List the other party to any executory contracts or unexpired leases that could result in a claim. Also list executory contracts on Schedule

A/B: Property (Official Form 106A/B) and on Schedule G: Executory Contracts and Unexpired Leases (Official Form 106G). Do not include any 

creditors with partially secured claims that are listed in Schedule D: Creditors Who Have Claims Secured by Property. If more space is 

needed, copy the Part you need, fill it out, number the entries in the boxes on the left. Attach the Continuation Page to this page. On the top of 

any additional pages, write your name and case number (if known). 

Part 1: List All of Your PRIORITY Unsecured Claims 

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

 No. Go to Part 2.

 Yes.

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

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

nonpriority amounts. As much as possible, list the claims in alphabetical order according to the creditor’s name. If you have more than two priority

unsecured claims, fill out the Continuation Page of Part 1. If more than one creditor holds a particular claim, list the other creditors in Part 3.

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

Total claim Priority 

amount 

Nonpriority 

amount

2.1 ____________________________________________ 

Priority Creditor’s Name 

____________________________________________ 

Number Street 

____________________________________________ 

____________________________________________ 

City State ZIP Code

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 personal injury while you were 

intoxicated 

 Other. Specify _________________________________

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

2.2 ____________________________________________ 

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 personal injury while you were 

intoxicated 

 Other. Specify _________________________________

$_____________ $___________ $____________

Debtor 1 __________________________________________________________________ First Name Middle Name Last Name

Debtor 2 ________________________________________________________________ 

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

United States Bankruptcy Court for the: __________ District of __________ 

Case number ___________________________________________ 

 (If known) 

Fill in this information to identify your case: 

 Check if this is an

amended filing

John C. Pietrarosso

Danette M. Pietrarosso

Northern District of Illinois

✔

Case 16-24743 Doc 1 Filed 08/01/16 Entered 08/01/16 18:34:02 Desc Main

 Document Page 24 of 55
Debtor 1 _______________________________________________________ Case number (if known)_____________________________________ First Name Middle Name Last Name

2IILFLDO)RUP() Schedule E/F: Creditors Who Have Unsecured Claims page __ of ___ 

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 

_____________________________________________________________ 

Nonpriority Creditor’s Name 

_____________________________________________________________ 

Number Street 

_____________________________________________________________ 

City State ZIP Code

Last 4 digits of account number ___ ___ ___ ___ $__________________

When was the debt incurred? ____________

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

 Contingent 

 Unliquidated 

 Disputed 

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce 

that you did not report as priority claims

 Debts to pension or profit-sharing plans, and other similar debts

 Other. Specify ______________________________________

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

4.2 _____________________________________________________________ 

Nonpriority Creditor’s Name 

_____________________________________________________________ 

Number Street 

_____________________________________________________________ 

City State ZIP Code

Last 4 digits of account number ___ ___ ___ ___ $__________________

When was the debt incurred? ____________

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

 Contingent 

 Unliquidated 

 Disputed 

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce 

that you did not report as priority claims

 Debts to pension or profit-sharing plans, and other similar debts

 Other. Specify ______________________________________

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

4.3 

_____________________________________________________________ 

Nonpriority Creditor’s Name 

_____________________________________________________________ 

Number Street 

_____________________________________________________________ 

City State ZIP Code

Last 4 digits of account number ___ ___ ___ ___ $_________________ 

When was the debt incurred? ____________

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

 Contingent 

 Unliquidated 

 Disputed 

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce 

that you did not report as priority claims

 Debts to pension or profit-sharing plans, and other similar debts

 Other. Specify ______________________________________

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

John C. Pietrarosso

✔

Associated Pathology Consultants c/o NCI 8 117 90.00

3601 Algonquin 01/01/2015

Rolling Meadows IL 60008

✔

✔

✔ ✔ medical

Rush Copley Medical Group 9309 815.00

01/01/2015

PO Box 2091

Aurora IL 60507

✔

✔

✔ ✔ medical

Rush Copley Med. c/o One Advantage 4 169 435.00

7650 Magna

01/01/2015

Belleville IL 62223

✔

✔

✔ ✔ medical

2

Case 16-24743 Doc 1 Filed 08/01/16 Entered 08/01/16 18:34:02 Desc Main

 Document Page 25 of 55
Debtor 1 _______________________________________________________ Case number (if known)_____________________________________ First Name Middle Name Last Name

2IILFLDO)RUP() Schedule E/F: Creditors Who Have Unsecured Claims page __ of ___ 

Part 2: Your NONPRIORITY Unsecured Claims Ʌ Continuation Page 

After listing any entries on this page, number them beginning with 4.4, followed by 4.5, and so forth. Total claim

_____________________________________________________________ 

Nonpriority 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 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________________________________

$____________

_____________________________________________________________ 

Nonpriority 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 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________________________________

$____________

_____________________________________________________________ 

Nonpriority 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 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________________________________

$____________

John C. Pietrarosso

4.4

Rush-Copley Medical Center 3488 372.00

2000 Ogden

01/01/2015

Aurora IL 60504

✔

✔

✔ medical

✔

4.5

Lindenhurst Anesthesia 2761 291.00

PO Box 5635

01/01/2015

Carol Stream IL 60197

✔

✔

✔ medical

✔

4.6

5647

253.00

Elmhurst Memorial Hospital c/o

5620 Southwyck

01/01/2015

Toledo OH 43614

✔

✔

✔ medical

✔

3

Case 16-24743 Doc 1 Filed 08/01/16 Entered 08/01/16 18:34:02 Desc Main

 Document Page 26 of 55
Debtor 1 _______________________________________________________ Case number (if known)_____________________________________ First Name Middle Name Last Name

2IILFLDO)RUP() Schedule E/F: Creditors Who Have Unsecured Claims page __ of ___ 

Part 2: Your NONPRIORITY Unsecured Claims Ʌ Continuation Page 

After listing any entries on this page, number them beginning with 4.4, followed by 4.5, and so forth. Total claim

_____________________________________________________________ 

Nonpriority 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 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________________________________

$____________

_____________________________________________________________ 

Nonpriority 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 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________________________________

$____________

_____________________________________________________________ 

Nonpriority 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 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________________________________

$____________

John C. Pietrarosso

4.7

Edward Hosp. c/o United Collection 64 19 334.00

5620 Southwyck

01/01/2015

Toledo OH 43614

✔

✔

✔ medical

✔

4.8

Edward Hosp. c/o Miramed Medical Group 8388 150.00

PO Box 77000

01/01/2015

Detroit MI 48277

✔

✔

✔ medical

✔

4.9

7627

119.00

Elmhurst Memorial Healthcare c/o ONCOAS 09

PO Box 1022

01/01/2015

Wixom MI 48393

✔

✔

✔ medical

✔

4

Case 16-24743 Doc 1 Filed 08/01/16 Entered 08/01/16 18:34:02 Desc Main

 Document Page 27 of 55
Debtor 1 _______________________________________________________ Case number (if known)_____________________________________ First Name Middle Name Last Name

2IILFLDO)RUP() Schedule E/F: Creditors Who Have Unsecured Claims page __ of ___ 

Part 2: Your NONPRIORITY Unsecured Claims Ʌ Continuation Page 

After listing any entries on this page, number them beginning with 4.4, followed by 4.5, and so forth. Total claim

_____________________________________________________________ 

Nonpriority 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 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________________________________

$____________

_____________________________________________________________ 

Nonpriority 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 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________________________________

$____________

_____________________________________________________________ 

Nonpriority 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 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________________________________

$____________

John C. Pietrarosso

.10

Blitt & Gaines - Target Credit 6504 3,210.00

661 Glenn

01/01/2014

Wheeling IL 60090

✔

✔

✔ credit

✔

.11

Discover Bank c/o Weltman & Weinberg 6 193 13,500.00

3705 Marlane

01/01/2013

Grove City OH 43123

✔

✔

✔ credit

.12

3925 1,820.00

Sears

PO Box 78051

01/01/2013

Phoenix AZ 85062

✔

✔

✔ credit

✔

5

Case 16-24743 Doc 1 Filed 08/01/16 Entered 08/01/16 18:34:02 Desc Main

 Document Page 28 of 55
Debtor 1 _______________________________________________________ Case number (if known)_____________________________________ First Name Middle Name Last Name

2IILFLDO)RUP() Schedule E/F: Creditors Who Have Unsecured Claims page __ of ___ 

Part 2: Your NONPRIORITY Unsecured Claims Ʌ Continuation Page 

After listing any entries on this page, number them beginning with 4.4, followed by 4.5, and so forth. Total claim

_____________________________________________________________ 

Nonpriority 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 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________________________________

$____________

_____________________________________________________________ 

Nonpriority 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 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________________________________

$____________

_____________________________________________________________ 

Nonpriority 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 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________________________________

$____________

John C. Pietrarosso

.13

Citibank c/o GC Services 3925 5,400.00

PO Box 3855

01/01/2013

Houston TX 77253

✔

✔

✔ credit

✔

.14

Citibank NA c/o Alliance One 1309 3,200.00

PO Box 3107

01/01/2013

Southeastern PA 19398

✔

✔

✔ credit

✔

.15

6866 5,000.00

Sears

PO Box 78051

01/01/2013

Phoeniz AZ 85062

✔

✔

✔ credit

✔

6

Case 16-24743 Doc 1 Filed 08/01/16 Entered 08/01/16 18:34:02 Desc Main

 Document Page 29 of 55
Debtor 1 _______________________________________________________ Case number (if known)_____________________________________ First Name Middle Name Last Name

2IILFLDO)RUP() Schedule E/F: Creditors Who Have Unsecured Claims page __ of ___ 

Part 2: Your NONPRIORITY Unsecured Claims Ʌ Continuation Page 

After listing any entries on this page, number them beginning with 4.4, followed by 4.5, and so forth. Total claim

_____________________________________________________________ 

Nonpriority 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 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________________________________

$____________

_____________________________________________________________ 

Nonpriority 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 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________________________________

$____________

_____________________________________________________________ 

Nonpriority 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 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________________________________

$____________

John C. Pietrarosso

.16

Value City Furniture c/o Encore 1694 1,800.00

400 N. Rogers

01/01/2014

Olanthe KS 66063

✔

✔

✔ credit

✔

.17

Leyden Credit Union 4551 4,800.00

PO Box 4521

01/01/2014

Carol Stream IL 60197

✔

✔

✔ credit

✔

.18

4005 1,900.00

Synchrony Bank

PO Box 965033

01/01/2013

Orlando FL 32896

✔

✔

✔ credit

✔

7

Case 16-24743 Doc 1 Filed 08/01/16 Entered 08/01/16 18:34:02 Desc Main

 Document Page 30 of 55
Debtor 1 _______________________________________________________ Case number (if known)_____________________________________ First Name Middle Name Last Name

2IILFLDO)RUP() Schedule E/F: Creditors Who Have Unsecured Claims page __ of ___ 

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. $_________________________ 

6b. Taxes and certain other debts you owe the 

government 6b. $_________________________ 

6c. Claims for death or personal injury while you were 

intoxicated 6c. $_________________________ 

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

Write that amount here. 6d. +$_________________________ 

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

 $_________________________ 

Total claim 

Total claims 

from Part 2

6f. Student loans 6f.

 $_________________________ 

6g. Obligations arising out of a separation agreement 

or divorce that you did not report as priority 

claims 6g. $_________________________ 

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

similar debts 6h. $_________________________ 

6i. Other. Add all other nonpriority unsecured claims. 

Write that amount here. 6i. + $_________________________

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

 $_________________________ 

John C. Pietrarosso

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

43,489.00

43,489.00

8

Case 16-24743 Doc 1 Filed 08/01/16 Entered 08/01/16 18:34:02 Desc Main

 Document Page 31 of 55
Official Form 106G Schedule G: Executory Contracts and Unexpired Leases page 1 of ___ 

2IILFLDO)RUP 106G 

Schedule G: Executory Contracts and Unexpired Leases 12/15

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

information. If more space is needed, copy the additional page, fill it out, number the entries, and attach it to this page. On the top of any 

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

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

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

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

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

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

unexpired leases.

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

2.1 _____________________________________________________________________ 

Name

_____________________________________________________________________ 

Number Street 

_____________________________________________________________________ 

City State ZIP Code

2.2 _____________________________________________________________________ 

Name

_____________________________________________________________________ 

Number Street 

_____________________________________________________________________ 

City State ZIP Code

2.3 _____________________________________________________________________ 

Name

_____________________________________________________________________ 

Number Street 

_____________________________________________________________________ 

City State ZIP Code

2.4 _____________________________________________________________________ 

Name

_____________________________________________________________________ 

Number Street 

_____________________________________________________________________ 

City State ZIP Code

2.5 _____________________________________________________________________ 

Name

_____________________________________________________________________ 

Number Street 

_____________________________________________________________________ 

City State ZIP Code

Debtor __________________________________________________________________ First Name Middle Name Last Name

Debtor 2 ________________________________________________________________ 

(Spouse If filing) First Name Middle Name Last Name

United States Bankruptcy Court for the: __________ District of ________

Case number ___________________________________________ 

 (If known) 

Fill in this information to identify your case: 

 Check if this is an

amended filing

John C. Pietrarosso

Danette M. Pietrarosso

Northern District of Illinois

✔

Case 16-24743 Doc 1 Filed 08/01/16 Entered 08/01/16 18:34:02 Desc Main

 Document Page 32 of 55
Official Form 106H Schedule H: Your Codebtors page 1 of ___ 

2IILFLDO)RUP 106H 

Schedule H: Your Codebtors 12/15

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 of your spouse, former spouse, or legal equivalent 

______________________________________________________________________

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 ______

3.2 ________________________________________________________________________________

Name 

________________________________________________________________________________

Number Street 

________________________________________________________________________________

City State ZIP Code

 Schedule D, line ______

 Schedule E/F, line ______

 Schedule G, line ______

3.3 ________________________________________________________________________________

Name 

________________________________________________________________________________

Number Street 

________________________________________________________________________________

City State ZIP Code

 Schedule D, line ______

 Schedule E/F, line ______

 Schedule G, line ______

Debtor 1 __________________________________________________________________ First Name Middle Name Last Name

Debtor 2 ________________________________________________________________ 

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

United States Bankruptcy Court for the: __________ District of ________

Case number ____________________________________________ 

(If known)

Fill in this information to identify your case: 

 Check if this is an

amended filing

John C. Pietrarosso

Danette M. Pietrarosso

Northern District of Illinois

✔

Case 16-24743 Doc 1 Filed 08/01/16 Entered 08/01/16 18:34:02 Desc Main

 Document Page 33 of 55
Debtor 1

Debtor 2

John C. Pietrarosso

Fht Name

Danette M. Pietrarosso

(Spouse, if filing) FirstName Middle Name

United States Bankruptcy Couri for the: Northem District of lllinois

Case number

(lf known)

Official Form 1061

Check if this is:

E An amended filing

fl n supptement showing postpetition chapter '13

income as of the following date:

Mfu,I / DD/ YYYY

Schedule l: Your lncome 121',|5

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

supplying correct information. lf you are married and not filing jointly, and your spouse is living with you, include information about your spouse.

lf you are separated and your spouse is not filing with you, do not include information about your spouse. lf 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.

IEf Describe Emptoyment

1. Fill in your employment

information. Debtor I Debtor 2 or non-filing spouse

lf you have more than one job,

attach a separate page with .4,

information about additional Employment status Ul Employed d Emptoyeo

E Not employed

Pavrollclerk

School Dist.

employers.

lnclude part-time, seasonal, or

self-employed work.

occupation may include student occupation

or homemaker, if it applies.

E Not employed

Suoervisor

Employer's name United Parcel Serv.

Employefs address 500 BuSSe 4175 RL71

Number Street Number Street

Elk Grove Villag lL 60007 Oswego lL 60543

City State ZIP Code City State ZIP Code

lo

Hovv long employed there? 28 yrS 25 yrs

l@| Give Detaits About Monthly lncome

Estimate monthly income as of the date you file this form. lf you have nothing to report for any line, write $0 in the space. lnclude your non-filing

spouse unless you are separated.

lf you or your non-filing spouse have more than one employer, combine the information for all employers for that person on the lines

below. lf you need more space, attach a separate sheet to this form.

For Debtor 1 For Debtor 2 or

J-oj-firgs:pg$g*

2. List monthly gross wages, salary, and commissions (before all payroll

deductions). lf not paid monthly, catcutate what the monthty wage would be. 2. $_ j,S!1.0q $__!,628.09_

3. +$ 0.00 + $ 0.00

$__3,6?9.00

3. Estimate and list monthly overtime pay.

4. Calculate gross income. Add line 2 + line 3.

Official Form 1061

. I * u^u**l l-l

Schedule l: Your lncome page I

Case 16-24743 Doc 1 Filed 08/01/16 Entered 08/01/16 18:34:02 Desc Main

 Document Page 34 of 55
Debtor 1 John C. Pietrarosso

Middle Name

s. 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. lnsurance

5f. Domestic support obligations

59. Union dues

5h. Other deductions. Specify:

Add the payroll deductions. Add lines 5a + 5b + 5c + 5d + 5e +5f+ 59 + 5h.

Calculate total monthly take-home pay. Subtract line 6 from line 4.

List all other income regularly received:

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

profession, orfarm

Attach a statement for each property and business showing gross

receipts, ordinary and necessary business expenses, and the total

monthly net income.

8b. lnterest and dividends

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

regularly receive

lnclude alimony, spousal support, child support, maintenance, divorce

settlement, and property settlement. 8c.

8d. Unemployment compensation 8d.

8e. Social Security 8e.

8f. Other government assistance that you regularly receive

lnclude 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:

89. Pension or retirement income

8h. Other monthly income. Specify:

9. Add all other income. Add lines 8a + 8b + 8c + 8d + 8e + 8f +Bg + th.

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.

s 6,854.00

Case number

For Debtor'l For Debtor 2 or

-nqp:fllngsgqugc--

$___1,629.09_

$_*392.08_

342.00

5a.

5b.

5c.

5d.

5e.

5f.

59.

5h.

6.

7.

$

$

$

$

$

+$ +$

$__l,Q!g.09_

$

I 270.00

$_

$

s 1,909.00

$__tp4g4q_

574.O0

6 1,308.00

$___?129.0q

$______Q.0Q_

s 0.00

8a.

Bb.

$ 0.00

$__ 0.00

$______q.09_

s 0.00

$

$

0.00

0.00

$______0=08_ $________0=00-

$_______0.00 $___-_0-Q8_

s 0.00 0.00

Bh. +s 0.00 +s______Q-.08_

$_____-__q.08-

$__ -Fry_

8f.

89.

n [l-o.oo I

l--

,o I ,-_1gtllql* l- ,r*-l l-l

$------ !,9q

l- ,r*-l lY-l

Combined

monthly income

1 1. State all other regular contributions to the expenses that you list in Schedule J.

lnclude 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.

Specifu:

12. Add the amount in the last column of line ,t0 to the amount in line ,l1. The result is the combined monthly income

Write that amount onthe Summary of YourAssefs and Liabilities and Cefiain Sfafisf,ba, lnformation, if it applies

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

11. +

12.

M No.

E Yes. Explain:

Official Form l06l Schedule l: Your lncome page 2

Case 16-24743 Doc 1 Filed 08/01/16 Entered 08/01/16 18:34:02 Desc Main

 Document Page 35 of 55
Official Form 106J Schedule J: Your Expenses page 1

2IILFLDO)RUP 106J 

Schedule J: Your Expenses 12/15 

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

information. If more space is needed, 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. 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?

_________________________ ________  No

 Yes

_________________________ ________  No

 Yes

_________________________ ________  No

 Yes

_________________________ ________  No

 Yes

_________________________ ________  No

 Yes

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. 4. $_____________________

If not included in line 4:

4a. Real estate taxes 4a. $_____________________ 

4b. Property, homeowner’s, or renter’s insurance 4b. $_____________________ 

4c. Home maintenance, repair, and upkeep expenses 4c. $_____________________ 

4d. Homeowner’s association or condominium dues 4d. $_____________________ 

Debtor 1 __________________________________________________________________ First Name Middle Name Last Name

Debtor 2 ________________________________________________________________ 

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

United States Bankruptcy Court for the: __________ District of __________

Case number ___________________________________________ 

 (If known) 

Fill in this information to identify your case: 

Check if this is: 

 An amended filing

 A supplement showing postpetition chapter 13

expenses as of the following date:

________________

MM / DD / YYYY 

John C. Pietrarosso

Danette M. Pietrarosso

Northern District of Illinois

✔

✔

✔

son 16 ✔

son 13 ✔

✔

2,904.00

0.00

62.00

150.00

30.00

Case 16-24743 Doc 1 Filed 08/01/16 Entered 08/01/16 18:34:02 Desc Main

 Document Page 36 of 55
Debtor 1 _______________________________________________________ Case number (if known)_____________________________________ First Name Middle Name Last Name

2IILFLDO)RUP- Schedule J: Your Expenses page 2

Your expenses

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

6. Utilities:

6a. Electricity, heat, natural gas 6a. $_____________________ 

6b. Water, sewer, garbage collection 6b. $_____________________ 

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

6d. Other. Specify: _______________________________________________ 6d. $_____________________ 

7. Food and housekeeping supplies 7. $_____________________

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

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

10. Personal care products and services 10. $_____________________

11. Medical and dental expenses 11. $_____________________

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

Do not include car payments. 12. $_____________________

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

14. Charitable contributions and religious donations 14. $_____________________

15. Insurance.

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

1

15a. Life insurance 15a. $_____________________ 

15b. Health insurance 15b. $_____________________ 

15c. Vehicle insurance 15c. $_____________________ 

15d. Other insurance. Specify:_______________________________________ 15d. $_____________________ 

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

Specify: ________________________________________________________ 16. $_____________________

17. Installment or lease payments:

17a. Car payments for Vehicle 1 17a. $_____________________ 

17b. Car payments for Vehicle 2 17b. $_____________________ 

17c. Other. Specify:_______________________________________________ 17c. $_____________________ 

17d. Other. Specify:_______________________________________________ 17d. $_____________________ 

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. $_____________________

19. Other payments you make to support others who do not live with you.

Specify:_______________________________________________________ 19. $_____________________

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 20a. $_____________________ 

20b. Real estate taxes 20b. $_____________________ 

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

20d. Maintenance, repair, and upkeep expenses 20d. $_____________________ 

20e. Homeowner’s association or condominium dues 20e. $_____________________ 

John C. Pietrarosso

0.00

127.00

162.00

257.00

0.00

992.00

0.00

85.00

25.00

100.00

490.00

580.00

40.00

0.00

0.00

214.00

0.00

0.00

416.00

484.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

Case 16-24743 Doc 1 Filed 08/01/16 Entered 08/01/16 18:34:02 Desc Main

 Document Page 37 of 55
Debtor 1 _______________________________________________________ Case number (if known)_____________________________________ First Name Middle Name Last Name

2IILFLDO)RUP- Schedule J: Your Expenses page 3

21. Other. Specify: _________________________________________________ 21. +$_____________________

22. Calculate your monthly expenses.

22a. Add lines 4 through 21. 22a.

22b. Copy line 22 (monthly expenses for Debtor 2), if any, from Official Form 106J-2 22b.

22c. Add line 22a and 22b. The result is your monthly expenses. 22c.

$_____________________ 

$_____________________ 

$_____________________ 

23. Calculate your monthly net income.

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

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

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

The result is your monthly net income. 23c. $_____________________

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. Explain here: 

John C. Pietrarosso

0.00

7,118.00

0.00

7,118.00

7,265.00

7,118.00

147.00

✔

Case 16-24743 Doc 1 Filed 08/01/16 Entered 08/01/16 18:34:02 Desc Main

 Document Page 38 of 55
Debror 1 John C. Pietrarosso

Middle Name Last Name

Debtor2 Danette M. Pietrarosso

(Spouse, if filing)

United States Bankruptcy Court for the: Northem District of lllinois

Case number

(lf known)

fl Cfrecf if this is an

amended filing

Official Form 106Dec

Declaration About an lndividual Debtorts $chedules ,t2t15

lf 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. 1 8 U.S.c. S$ 1SZ, 1341, 1 51 9, and 3571.

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

E[ ruo

EYes.Nameofperson.AftachBankruptcyPetitionPreparer1sNo,be,Dec!aration,and

Signature (Otricial Form 1 19)

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

that they are trfe€nd correct.

Signature of

oatJ]*) Jci XtL ,",. D7 "; q 

IUM/ DD / YYYY IVIM/ DD / YYYY"r)/c

Signature of Debtor 2

Official Form 106Dec Declaration About an lndividual Debtor,s Schedules

Case 16-24743 Doc 1 Filed 08/01/16 Entered 08/01/16 18:34:02 Desc Main

 Document Page 39 of 55
Official Form 107 Statement of Financial Affairs for Individuals Filing for Bankruptcy page 1

2IILFLDO)RUP 107 

Statement of Financial Affairs for Individuals Filing for Bankruptcy 12/15

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

information. If more space is needed, 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).

Part 2: Explain the Sources of Your Income 

Debtor 1 __________________________________________________________________ First Name Middle Name Last Name

Debtor 2 ________________________________________________________________ 

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

United States Bankruptcy Court for the: __________ District of ______________

Case number ___________________________________________ 

 (If known) 

Fill in this information to identify your case: 

 Check if this is an

amended filing

John C. Pietrarosso

Danette M. Pietrarosso

Northern District of Illinois

✔

✔

Case 16-24743 Doc 1 Filed 08/01/16 Entered 08/01/16 18:34:02 Desc Main

 Document Page 40 of 55
Debtor 1 _______________________________________________________ Case number (if known)_____________________________________ First Name Middle Name Last Name

2IILFLDO)RUP Statement of Financial Affairs for Individuals Filing for Bankruptcy page 2

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

$________________

 Wages, commissions,

bonuses, tips

 Operating a business

$________________

For last calendar year:

(January 1 to December 31, _________) YYYY

 Wages, commissions, 

bonuses, tips

 Operating a business

$________________

 Wages, commissions,

bonuses, tips

 Operating a business

$________________

For the calendar year before that: 

(January 1 to December 31, _________) YYYY

 Wages, commissions, 

bonuses, tips

 Operating a business $________________

 Wages, commissions,

bonuses, tips

 Operating a business $________________

5. Did you receive any other income during this year or the two previous calendar years?

Include income regardless of whether that income is taxable. Examples of other income are alimony; child support; Social Security,

unemployment, and other public benefit payments; pensions; rental income; interest; dividends; money collected from lawsuits; royalties; and

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

List each source and the gross income from each source separately. Do not include income that you listed in line 4.

 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:

__________________

__________________

__________________

$_________________

$_________________

$_________________

_____________________

_____________________

_____________________

$_________________

$_________________

$_________________

For last calendar year:

(January 1 to December 31, ______) YYYY

__________________

__________________

__________________

$_________________

$_________________

$_________________

_____________________

_____________________

_____________________

$_________________

$_________________

$_________________

For the calendar year before that: 

(January 1 to December 31, ______) YYYY

__________________

__________________

__________________

$_________________

$_________________

$_________________

_____________________

_____________________

_____________________

$_________________

$_________________

$_________________

John C. Pietrarosso

✔

✔

Case 16-24743 Doc 1 Filed 08/01/16 Entered 08/01/16 18:34:02 Desc Main

 Document Page 41 of 55
Debtor 1 _______________________________________________________ Case number (if known)_____________________________________ First Name Middle Name Last Name

2IILFLDO)RUP Statement of Financial Affairs for Individuals Filing for Bankruptcy page 3

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 $6,225* or more? 

 No. Go to line 7.

 Yes. List below each creditor to whom you paid a total of $6,225* 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 4/01/16 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. 

____________________________________

Creditor’s Name 

____________________________________

Number Street 

____________________________________

____________________________________

City State ZIP Code

Dates of 

payment

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

_________

_________

_________

$_________________ $__________________  Mortgage

 Car

 Credit card

 Loan repayment

 Suppliers or vendors

 Other ____________

____________________________________

Creditor’s Name 

____________________________________

Number Street 

____________________________________

____________________________________

City State ZIP Code

_________

_________

_________

$_________________ $__________________  Mortgage

 Car

 Credit card

 Loan repayment

 Suppliers or vendors

 Other ____________

____________________________________

Creditor’s Name 

____________________________________

Number Street 

____________________________________

____________________________________

City State ZIP Code

_________

_________

_________

$_________________ $__________________  Mortgage

 Car

 Credit card

 Loan repayment

 Suppliers or vendors

 Other ____________

John C. Pietrarosso

✔

✔

Case 16-24743 Doc 1 Filed 08/01/16 Entered 08/01/16 18:34:02 Desc Main

 Document Page 42 of 55
Debtor 1 _______________________________________________________ Case number (if known)_____________________________________ First Name Middle Name Last Name

2IILFLDO)RUP Statement of Financial Affairs for Individuals Filing for Bankruptcy page 4

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.

____________________________________________

Insider’s Name 

____________________________________________

Number Street 

____________________________________________

____________________________________________

City State ZIP Code

Dates of 

payment

Total amount 

paid

Amount you still 

owe 

Reason for this payment

_________

_________

_________

$____________ $____________

____________________________________________

Insider’s Name 

____________________________________________

Number Street 

____________________________________________

____________________________________________

City State ZIP Code

_________

_________

_________

$____________ $____________ 

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

an insider?

Include payments on debts guaranteed or cosigned by an insider.

 No

 Yes. List all payments that benefited an insider.

____________________________________________

Insider’s Name 

____________________________________________

Number Street 

____________________________________________

____________________________________________

City State ZIP Code

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

_________

_________

_________

$____________ $____________

John C. Pietrarosso

✔

John Pietrarossa Sr. 12/30/2015 300.00 0.00

2505 Lincoln

Franklin Pk IL 60131

✔

Case 16-24743 Doc 1 Filed 08/01/16 Entered 08/01/16 18:34:02 Desc Main

 Document Page 43 of 55
Debtor 1 _______________________________________________________ Case number (if known)_____________________________________ First Name Middle Name Last Name

2IILFLDO)RUP Statement of Financial Affairs for Individuals Filing for Bankruptcy page 5

 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.

Case title_____________________________ 

____________________________________

Case number ________________________ 

Nature of the case Court or agency Status of the case

________________________________________

Court Name 

________________________________________

Number Street 

________________________________________

City State ZIP Code

 Pending

 On appeal

 Concluded

Case title_____________________________ 

____________________________________

Case number ________________________

________________________________________

Court Name 

________________________________________

Number Street 

________________________________________

City State ZIP Code

 Pending

 On appeal

 Concluded

10. Within 1 year before you filed for bankruptcy, was any of your property repossessed, foreclosed, garnished, attached, seized, or levied?

Check all that apply and fill in the details below.

 No. Go to line 11.

 Yes. Fill in the information below.

_________________________________________

Creditor’s Name 

_________________________________________

Number Street 

_________________________________________

_________________________________________

City State ZIP Code

Describe the property Date Value of the property

__________ $______________

Explain what happened 

 Property was repossessed.

 Property was foreclosed.

 Property was garnished.

 Property was attached, seized, or levied.

_________________________________________

Creditor’s Name 

_________________________________________

Number Street 

_________________________________________

_________________________________________

City State ZIP Code

Describe the property Date Value of the property

__________ $______________

Explain what happened 

 Property was repossessed.

 Property was foreclosed.

 Property was garnished.

 Property was attached, seized, or levied.

John C. Pietrarosso

✔

✔

Case 16-24743 Doc 1 Filed 08/01/16 Entered 08/01/16 18:34:02 Desc Main

 Document Page 44 of 55
Debtor 1 _______________________________________________________ Case number (if known)_____________________________________ First Name Middle Name Last Name

2IILFLDO)RUP Statement of Financial Affairs for Individuals Filing for Bankruptcy page 6

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 Date action 

was taken 

Amount

____________ $________________

Last 4 digits of account number: XXXX–___ ___ ___ ___ 

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

creditors, a court-appointed receiver, a custodian, or another official?

 No

 Yes

Part 5: List Certain Gifts and Contributions 

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

 No

 Yes. Fill in the details for each gift.

Gifts with a total value of more than $600 

per person 

Describe the gifts Dates you gave 

the gifts 

Value 

______________________________________

Person to Whom You Gave the Gift 

______________________________________

______________________________________

Number Street 

______________________________________

City State ZIP Code

Person’s relationship to you ______________ 

_________

_________

$_____________

$_____________

Gifts with a total value of more than $600 

per person 

Describe the gifts Dates you gave 

the gifts 

Value 

______________________________________

Person to Whom You Gave the Gift 

______________________________________

______________________________________

Number Street 

______________________________________

City State ZIP Code

Person’s relationship to you ______________

_________

_________

$_____________

$_____________

John C. Pietrarosso

✔

✔

✔

Case 16-24743 Doc 1 Filed 08/01/16 Entered 08/01/16 18:34:02 Desc Main

 Document Page 45 of 55
Debtor 1 _______________________________________________________ Case number (if known)_____________________________________ First Name Middle Name Last Name

2IILFLDO)RUP Statement of Financial Affairs for Individuals Filing for Bankruptcy page 7

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 

Describe what you contributed Date you 

contributed

Value 

_____________________________________

Charity’s Name 

_____________________________________

_____________________________________

Number Street 

_____________________________________

City State ZIP Code

_________

_________

$_____________

$_____________

Part 6: List Certain Losses 

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

disaster, or gambling?

 No

 Yes. Fill in the details.

Describe the property you lost and 

how the loss occurred

Describe any insurance coverage for the loss

Include the amount that insurance has paid. List pending insurance 

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

Date of your 

loss 

Value of property 

lost 

_________ $_____________

Part 7: List Certain Payments or Transfers 

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

you consulted about seeking bankruptcy or preparing a bankruptcy petition?

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

 No

 Yes. Fill in the details.

___________________________________

Person Who Was Paid 

___________________________________

Number Street 

___________________________________

___________________________________

City State ZIP Code

____________________________________________

Email or website address

Description and value of any property transferred Date payment or 

transfer was 

made 

Amount of payment

_________

_________

$_____________

$_____________

___________________________________

Person Who Made the Payment, if Not You

John C. Pietrarosso

✔

✔

✔

Case 16-24743 Doc 1 Filed 08/01/16 Entered 08/01/16 18:34:02 Desc Main

 Document Page 46 of 55
Debtor 1 _______________________________________________________ Case number (if known)_____________________________________ First Name Middle Name Last Name

2IILFLDO)RUP Statement of Financial Affairs for Individuals Filing for Bankruptcy page 8

____________________________________

Person Who Was Paid 

____________________________________

Number Street 

____________________________________

____________________________________

City State ZIP Code

________________________________________________

Email or website address

Description and value of any property transferred Date payment or 

transfer was made 

Amount of 

payment 

_________

_________

$_____________

$_____________

___________________________________

Person Who Made the Payment, if Not You

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

promised to help you deal with your creditors or to make payments to your creditors?

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

 No

 Yes. Fill in the details.

____________________________________

Person Who Was Paid 

____________________________________

Number Street 

____________________________________

____________________________________

City State ZIP Code 

Description and value of any property transferred Date payment or 

transfer was 

made 

Amount of payment

_________

_________

$____________

$____________

18. Within 2 years before you filed for bankruptcy, did you sell, trade, or otherwise transfer any property to anyone, other than property

transferred in the ordinary course of your business or financial affairs?

Include both outright transfers and transfers made as security (such as the granting of a security interest or mortgage on your property).

Do not include gifts and transfers that you have already listed on this statement.

 No

 Yes. Fill in the details.

___________________________________

Person Who Received Transfer 

___________________________________

Number Street 

___________________________________

___________________________________

City State ZIP Code

Description and value of property 

transferred 

Describe any property or payments received 

or debts paid in exchange 

Date transfer 

was made 

_________

Person’s relationship to you _____________ 

___________________________________

Person Who Received Transfer 

___________________________________

Number Street 

___________________________________

___________________________________

City State ZIP Code

_________

Person’s relationship to you _____________ 

John C. Pietrarosso

✔

✔

Case 16-24743 Doc 1 Filed 08/01/16 Entered 08/01/16 18:34:02 Desc Main

 Document Page 47 of 55
Debtor 1 _______________________________________________________ Case number (if known)_____________________________________ First Name Middle Name Last Name

2IILFLDO)RUP Statement of Financial Affairs for Individuals Filing for Bankruptcy page 9

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.

____________________________________

Name of Financial Institution

____________________________________

Number Street 

____________________________________

____________________________________

City State ZIP Code 

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 

XXXX–___ ___ ___ ___ Checking 

 Savings

 Money market

 Brokerage

 Other__________

_________ $___________

____________________________________

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.

____________________________________

Name of Financial Institution

____________________________________

Number Street 

____________________________________

____________________________________

City State ZIP Code

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

have it? 

_______________________________________

Name 

_______________________________________

Number Street 

_______________________________________

City State ZIP Code

 No

 Yes



John C. Pietrarosso

✔

✔

✔

Case 16-24743 Doc 1 Filed 08/01/16 Entered 08/01/16 18:34:02 Desc Main

 Document Page 48 of 55
Debtor 1 _______________________________________________________ Case number (if known)_____________________________________ First Name Middle Name Last Name

2IILFLDO)RUP Statement of Financial Affairs for Individuals Filing for Bankruptcy page 10

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.

___________________________________

Name of Storage Facility 

___________________________________

Number Street 

___________________________________

___________________________________

City State ZIP Code

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

have it? 

_______________________________________

Name 

_______________________________________

Number Street 

_______________________________________

City State ZIP Code

 No

 Yes



Part 9: Identify Property You Hold or Control for Someone Else 

23. Do you hold or control any property that someone else owns? Include any property you borrowed from, are storing for,

or hold in trust for someone.

 No

 Yes. Fill in the details.

___________________________________

Owner’s Name 

___________________________________

Number Street 

___________________________________

___________________________________

City State ZIP Code

Where is the property? Describe the property Value 

_________________________________________

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.

____________________________________

Name of site 

____________________________________

Number Street 

____________________________________

____________________________________

City State ZIP Code

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

_______________________________

Governmental unit 

_______________________________

Number Street 

_______________________________

City State ZIP Code

_________

John C. Pietrarosso

✔

✔

✔

Case 16-24743 Doc 1 Filed 08/01/16 Entered 08/01/16 18:34:02 Desc Main

 Document Page 49 of 55
Debtor 1 _______________________________________________________ Case number (if known)_____________________________________ First Name Middle Name Last Name

2IILFLDO)RUP Statement of Financial Affairs for Individuals Filing for Bankruptcy page 11

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

 No

 Yes. Fill in the details.

____________________________________

Name of site 

____________________________________

Number Street 

____________________________________

____________________________________

City State ZIP Code

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

_______________________________

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.

Case title______________________________ 

______________________________________

______________________________________

Case number 

Court or agency Nature of the case Status of the 

case

________________________________

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.

____________________________________

Business Name 

____________________________________

Number Street 

____________________________________

____________________________________

City State ZIP Code

Describe the nature of the business Employer Identification number 

Do not include Social Security number or ITIN. 

EIN: ___ ___ – ___ ___ ___ ___ ___ ___ ___ 

Name of accountant or bookkeeper Dates business existed

From _______ To _______ 

____________________________________

Business Name 

____________________________________

Number Street 

____________________________________

____________________________________

City State ZIP Code

Describe the nature of the business Employer Identification number 

Do not include Social Security number or ITIN. 

EIN: ___ ___ – ___ ___ ___ ___ ___ ___ ___

Name of accountant or bookkeeper Dates business existed

From _______ To _______ 

John C. Pietrarosso

✔

✔

✔

Case 16-24743 Doc 1 Filed 08/01/16 Entered 08/01/16 18:34:02 Desc Main

 Document Page 50 of 55
Debtor 1 John C. Pietrarosso Case number {rr

First Name llliddle Name

Describe the naturc of the business Employer ldentification numbcr

Do not include Social Security number or lTlN.

Business Name

EIN:

Number Street Name of accountant or bookkeeper Dates business existed

From _ To

State ZIP Code

28. Within 2 years before you filed for bankruptcy, clid you give a financial statement to anyone about your business? lnclude all financial

institutions, creditors, or other parties.

Uno

E Yes. Fill in the details below.

Date issued

MMEDllFrtrNumber Street

State ZIP code

@ slsnBetow

Eruo fl ves

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

El uo

E yes. Name of person . Attach lhe Bankruptcy Petition Preparer's Notice,

I have read the answers on this Sfaterr ent 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 FltQa bankruptcy case can result in fines up to $250,000, or imprisonment for up to 20 years, or both.

1519, and 3571.

)1, o.,"c 7 ffi ilc/b

pages to Your Statement of Financial Affairs for tndividuats Filing for Bankruptcy (Official Form 107)?

Declantion, and Signature (Official Form 119),

Signature of

oate C'l

Signature of Debtor 2

Official Form 107 Statement of Financial Affairs for Individuals Filing for Bankruptcy page 1 2

Case 16-24743 Doc 1 Filed 08/01/16 Entered 08/01/16 18:34:02 Desc Main

 Document Page 51 of 55
Ibttur 1

Dabtor2-_

{5pGu$.IfffiE] Ftrrx:m t{dil.ltar Llr}tfr.

Unlld Statas Barrknqrlcy Court iartu: ilorlhsm Dbtrict of lllhois

Casa nurtar

Official Form 108

$tatement of Intentlon for lndiniduals Filing Under Chapter ? 12t18

lf you err en Indtvldurl lfllng undrr cheptrr 7, you must fttt out thls farm fl! I orudltors hrvo slrhns erosrud by your propcrtlr, or I you hevr hescd prrronel prcprrty end thr lmer hrs not rxplrod.

You musl fib th&r foml witlr tftr oourt wlthln 30 drye aftrr you lth your brnkruptcy pctltlon or by thr deir sot ior thc mrllng ot credltors,

whlohrver ls oerti*r, unloss ths oourt erhnd* the Hmt lor olusa. You must rlso ssnd ooplee to ths arudl6ors end loeso15 you llst cn lhr ienn

ll two manled proph err fillng togrthrr in a lolnt oeel, botft rro lquelty nepomlbh frr *pplylng corrrot lnfrrmrton. goth d.b!E s ltrust slgn rnd detr thr farm.

Bc rc complrlr and rcourrt es porslblc. lf morr *peat ls nildcd, et'taoh r srprrrlr shrrt to tlrls form. On thr top of eay eddldonrl Frgrctu writr your namo end oesc numler {tf kn*ra}.

@ Lht yo,r, c.rdrtor" who Har" sacured Glalmr

't. For eny ar:dltors thrt you llsird ln Prrt I o? Sctrsdule D: C,.drtDls lltro tlaye Clalnrs SecsrBd ey Prqparfy {Offolrl Form l0GD}, f ll ln ilrc

lnfonrtrdoa brlocr.

ld.ntty lhc cndltor rnd lhr proporty :hrt le eollrtinl

;tffil:t" pNC Bank

tle*ripllon d Caf property

securing debt:

Creditorrs

n;xne: US Bank

Description d Car propeny

secudng debt:

CredhoCs

ngrne: Nationstar

Deacrlplion of home

pmpeny

securing debt;

Crcdltor'o

name:

Oe*rlp0on af

preperty

aecuring debl:

E Sunerrd". the propertyE Retain ttre property and redeem iL

d n"r.n ilre property and e.nier into a

Feallirmalron lgrreornenl.

E neum the property and [explain]:

E Sunender lhe Froperty.

E netain lhe property and ledeem lL

EI R"t"tn lhe propeny and enter lnto a

Raaffmation AgreemerL

E Retain the properly and [explaint:

E Sunender the property.

El Retain the propcrty and redeem it.

fi R"uln th€ property and enter lnto a

FeallFnnaf on IgreamenL

E Retatn tlre prcperty and [exflain]:

E Surender tha property.

E Retatn lhe propefiand redeem ll.

E Relain the propertyand enterlnlo a

Eeallirmatbn A g rcs nE tt.

E Retain the propergand [explaint:

E Cnecf if this is an

arnended filing

Whnt do you lnbnd to da wlth tlr prcprrty tlret Dld you oldm thr prop.rty

erounc n dtht? ar lxrmpt sn Bohoduh C?

trta

dvu.

El tto

dvo

tr tto

dY..

fl tto

Eyes

Offidsl Form 108 Strtrmcnt of lilrntlon for lndfulduels Flllng Undr Chaptrr I psge 1

Case 16-24743 Doc 1 Filed 08/01/16 Entered 08/01/16 18:34:02 Desc Main

 Document Page 52 of 55
John C. Pietrarosso Gassnumber {t/koffi}

@ f:t roy uncxptred perronat proporry Laare*

For tny unerplrcd peitonal proP.rty tmso thet yau list d in Schedl,le G; Erecutory Coninc& and Unexpied Leasea (Oficlel Form 'loEG|,

flll tr ttr Infumtrfan bslor. Da not llgl rgel ss&t l.lsos. Uaarpfrad laeras er lcrsrs fhet src $lll ln ,fiacti lho tresr parlod hes Eot yoil

mdrd. Yau trley a*uma rn rmrxFhed p*lsonel Fup.rry hasc It tha truslBr dorE no( 'eumo tL I I U.S.A ! 365{pX?}.

Dcscrlh yosuncrplrcd pctroncl propcrt haraa

Lesso/s name:

Description of leased

property:

l-essods nans'

Descdplion ofhased

prop€rty:

Legsot'e naFte:

Descriplion d leased

propertf

Lessofs name:

DessriFfbil otlffied

proFerty:

Lessofs name:

IlwripUon of bas€d

Fropertf

LeEsols name:

t),escription of lessed

propedy

Lersofs fiame:

Descdplion of leased

prDperty:

tYtlt UrG laa ta eqsttlrdlt

ENo

fl ves

[]No

E ves

E t'to

Eves

E tto

E ver

El tto

E Yes

ENo

E yes

E tto

O Yes

Undar pualty of puiury, t dealara thrt I havs Indlasted my Intantion about rny proporty of my rcEto tlhgt scoun*E r drbt and rry

persoael praporty thlt ts sublcct to rc untx$ttd has€.

x

Slghstum ol Dcbtor 2

,." 07'31-20/b

HU' IID 

' 

YYYTT

Offcial Form 108 Strtrnrnt ol lnientlon lor lndlvidurls Flllng Undrr ChrFtrr 7 page 2

Case 16-24743 Doc 1 Filed 08/01/16 Entered 08/01/16 18:34:02 Desc Main

 Document Page 53 of 55
82030 (Form 2030) (12/15)

Northern District Of llliUois

In re John C. Pietrarosso and Danette M. pietrarosso

Debtor Chapter 7

DISCLOSURE OF COMPENSATTON OF'ATTORNEY T'OR DEBTOR

L Pursuant to 11 U .S.C. g 329(a) and Fed. Bankr. P. 2016(b), I certif,r that I am the attorney for the above

named debtor(s) and that compensation paid to me within one year before the filing of the petition in

bankruptcy, or agreed to be paid to me, for services rendered or to be rendered on behalfofthe debtor(s) in

contemplation of or in connection with the bankruptcy case is as follows:

Forlegal services,Ihaveagreedtoaccept ..... $ 1235.00

Prior to the filing of this statement I have received $ 335'00

^ BalanceDue... 900.00 .......D

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

E[o"uo, I orr,", (specifu)

3. The source of compensation to be paid to me is:

I o"bro. E] orr,", (specifu)

4. Ei , fru',r" not agreed to share the above-disclosed compensation with any other person unless they are

members and associates of my law firm.

I I I have agreed to share the above-disclosed compensation with a other 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 retum for the above-disclosed fee, I have agreed to render legal service for all aspects ofthe bankruptcy

case, including:

a. Analysis of the debtor' s financial situation, and rendering advice to the debtor in determining whether to

file a petition in bankruptcy;

b. Preparation and filing of any petition, schedules, statements of affairs and plan which may be required;

c. Representation of the debtor at the meeting of creditors and confirmation hearing, and any adjoumed

hearings thereof;

United States Bankruptcy Court

Case No.

Case 16-24743 Doc 1 Filed 08/01/16 Entered 08/01/16 18:34:02 Desc Main

 Document Page 54 of 55
B2030 (Form 2030) (12115)

d. Representation ofthe debtor in adversary proceedings and other contested bankruptcy matters;

e. [Other provisions as needed]

None

6. By agreement with the debtor(s), the above-disclosed fee does not include the following services:

Adversary proceedings, Motions, Objections.

CERTIFICATION

t cediry that the foregoing is a complete statement of any agreement or arrangement for payment to

me for representation of the debtor(s) int'is)@pr'Sy

?:^ 7'/G 43i

Date ' / Signature of AttorneY

Bernard A. Schlosser, Attorney at Law, P.C.

Name of law firm

Case 16-24743 Doc 1 Filed 08/01/16 Entered 08/01/16 18:34:02 Desc Main

 Document Page 55 of 55