Check if this is an

Fill in this information to identify your case:

United States Bankruptcy Court for the:

Case number (if known): Chapter you are filing under: Chapter 7

Chapter 11

Chapter 12

Chapter 13

amended filing

Official Form 101

Voluntary Petition for Individuals Filing for Bankruptcy 12/15

Part 1: Identify Yourself

1. Your full name About Debtor 1: About Debtor 2 (Spouse Only in a Joint Case):

First Name Middle Name

Last Name

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

First Name Middle Name

Last Name

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

Damian

Pieprz

NORTHERN DISTRICT OF ILLINOIS

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.

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.

2. All other names you

First Name Middle Name

Last Name

First Name Middle Name

Last Name

have used in the last 8

years

Include your married or maiden names.

3. xxx – xx –

9xx – xx –

OR

xxx – xx –

9xx – xx –

OR

4 7 4 8

Only the last 4 digits of

your Social Security number or federal

Individual Taxpayer

Identification number

(ITIN)

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

Business name

Business name

I have not used any business names or EINs.

Business name

Business name

Business name Business name

Any business names

and Employer

Identification Numbers

(EIN) you have used in

the last 8 years

Include trade names and

doing business as names

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

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Debtor 1

First Name Middle Name Last Name Damian Pieprz Case number (if known)

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

–

–

–

EIN EIN

EIN EIN

5. Where you live

Number Street

City

County

If Debtor 2 lives at a different address:

State ZIP Code

Number

State ZIP Code

County

City

Street

If your mailing address is different from

the one above, fill it in here. Note that the

court will send any notices to you at this mailing address.

If Debtor 2's mailing address is different

from yours, fill it in here. Note that the court will send any notices to you at this mailing

address.

Number Street

City State ZIP Code

P.O. Box

Number Street

City State ZIP Code

P.O. Box

1646 Orchard Ave.

Schaumburg IL 60193

Cook

6. Why you are choosing Check one: Check one: this district to file for bankruptcy 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.)

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.)

Part 2: Tell the Court About Your Bankruptcy Case

7. 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

The chapter of the Bankruptcy Code you

are choosing to file under

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

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Debtor 1

First Name Middle Name Last Name Damian Pieprz Case number (if known)

8. How you will pay the fee I will pay the entire fee when I file my petition.

I need to pay the fee in installments.

I request that my fee be waived

Please check with the clerk's office in your local

If you choose this option, sign and attach the Application for

Individuals to Pay Your Filing Fee in Installments (Official Form 103A).

(You may request this option only if you are filing for Chapter 7.

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.

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. NoYes. District When Case number MM / DD / YYYY

District When Case number MM / DD / YYYY

District When Case number MM / DD / YYYY

Have you filed for bankruptcy within the

last 8 years?

10. NoYes. Debtor District

Relationship to you

MM / DD / YYYY

When Case number,

if known

Debtor DistrictRelationship to you

MM / DD / YYYY

When Case number,

if known

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?

11. No. Yes. Go to line 12.

No. Go to line 12.

Do you rent your

residence? Has your landlord obtained an eviction judgment against you and do you want to stay in your

residence?

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

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

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Debtor 1

First Name Middle Name Last Name Damian Pieprz Case number (if known)

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

12. 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

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.

13. 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. No.

Yes.

I am not filing under Chapter 11.

I am filing under Chapter 11, but I am NOT a small business debtor according to the definition in

the Bankruptcy Code.

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

are you a small business debtor?

Are you filing under Chapter 11 of the Bankruptcy Code and

For a definition of small

business debtor, see

11 U.S.C. § 101(51D).

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

14. NoYes. What is the hazard?

If immediate attention is needed, why is it needed?

Where is the property?

Number Street

City State ZIP Code

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?

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

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Debtor 1

First Name Middle Name Last Name Damian Pieprz Case number (if known)

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

15. About Debtor 1: About Debtor 2 (Spouse Only in a Joint Case): You must check one:

Incapacity.

Disability.

Active duty.

Incapacity.

Disability.

Active duty.

You must check one: Tell the court whether you

have received

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.

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:

I have a mental illness or a mental

deficiency that makes me

incapable of realizing or making

rational decisions about finances. 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.

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.

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:

I have a mental illness or a mental

deficiency that makes me

incapable of realizing or making

rational decisions about finances. 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.

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.

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

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Debtor 1

First Name Middle Name Last Name Damian Pieprz Case number (if known)

Part 6: Answer These Questions for Reporting Purposes

16. 16a.

16b.

16c.

Are your debts primarily consumer debts?

Are your debts primarily business debts?

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

Consumer debts

Business debts

are defined in 11 U.S.C. § 101(8) as "incurred by an individual primarily for a personal, family, or household purpose."

are debts that you incurred to obtain money for a business or investment or through the operation of the business or investment.

No. Go to line 16b. Yes. Go to line 17.

No. Go to line 16c. Yes. Go to line 17.

What kind of debts do you

have?

17. No. Yes.

I am not filing under Chapter 7. Go to line 18.

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

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

NoYes

Are you filing under Chapter 7?

Do you estimate that after any exempt property is

excluded and

administrative expenses

are paid that funds will be

available for distribution

to unsecured creditors?

18. 1-49

50-99

100-199

200-999

1,000-5,000

5,001-10,000

10,001-25,000

25,001-50,000

50,001-100,000

More than 100,000

How many creditors do

you estimate that you

owe?

19. $0-$50,000

$50,001-$100,000

$100,001-$500,000

$500,001-$1 million

$1,000,001-$10 million

$10,000,001-$50 million

$50,000,001-$100 million

$500,000,001-$1 billion

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

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

$100,000,001-$500 million More than $50 billion

How much do you

estimate your assets to

be worth?

20. $0-$50,000

$50,001-$100,000

$100,001-$500,000

$500,001-$1 million

$1,000,001-$10 million

$10,000,001-$50 million

$50,000,001-$100 million

$500,000,001-$1 billion

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

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

$100,000,001-$500 million More than $50 billion

How much do you

estimate your liabilities to

be?

Part 7: Sign Below

X /s/ Damian Pieprz X

Damian Pieprz, Debtor 1 Signature of Debtor 2

Executed on MM / DD / YYYYExecuted on MM / DD / YYYY09/02/2016

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

and correct.

If I have chosen to file under Chapter 7, I am aware that I may proceed, if eligible, under Chapter 7, 11, 12, or 13 of title 11, United States Code. I understand the relief available under each chapter, and I choose to

proceed under Chapter 7.

If no attorney represents me and I did not pay or agree to pay someone who is not an attorney to help me

fill out this document, I have obtained and read the notice required by 11 U.S.C. § 342(b).

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

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

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

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

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Debtor 1

First Name Middle Name Last Name Damian Pieprz Case number (if known)

X /s/ M. Eryk Nowicki

Signature of Attorney for Debtor Date MM / DD / YYYY

Printed name

Firm Name Number Street

City State ZIP Code

Contact phone Email address

Bar number State

09/02/2016

M. Eryk Nowicki

Eryk Nowicki & Associates, P.C.

250 Parkway Drive, Suite 150

Lincolnshire IL 60069-4340

(847) 325-5020

6286984 IL

For your attorney, if you are

represented by one

If you are not represented by

an attorney, you do not need

to file this page.

I, the attorney for the debtor(s) named in this petition, declare that I have informed the debtor(s) about eligibility to proceed under Chapter 7, 11, 12, or 13 of title 11, United States Code, and have explained the

relief available under each chapter for which the person is eligible. I also certify that I have delivered to

the debtor(s) the notice required by 11 U.S.C. § 342(b) and, in a case in which § 707(b)(4)(D) applies, certify that I have no knowledge after an inquiry that the information in the schedules filed with the petition

is incorrect.

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

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Notice Required by 11 U.S.C. § 342(b) for

Individuals Filing for Bankruptcy (Form 2010)

This notice is for you if:

You are an individual filing for bankruptcy, and

Your debts are 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."

Chapter 7 -- Liqudation

Chapter 11 -- Reorganization

Chapter 12 --

Chapter 13 --

Chapter 7: Liquidation

+

most taxes;

most student loans;

domestic support and property settlement obligations;

The types of bankruptcy that are available

to individuals

Individuals who meet the qualifications may file under one

of four different chapters of the Bankruptcy Code:

Voluntary repayment plan for family

farmers or fishermen

Voluntary repayment plan for

individuals with regular income

You should have an attorney review your

decision to file for bankruptcy and the choice

of chapter.

$245

$75

$15

filing fee

administrative fee

trustee surcharge

Chapter 7 is for individuals who have financial difficulty

preventing them from paying their debts and who are

willing to allow their non-exempt property to be used to

pay their creditors. The primary purpose of filing under

chapter 7 is to have your debts discharged. The

bankruptcy discharge relieves you after bankruptcy from

having to pay many of your pre-bankruptcy debts. Exceptions exist for particular debts, and liens on

property may still be enforced after discharge. For

example, a creditor may have the right to foreclose a

home mortgage or repossess an automobile. However, if the court finds that you have committed

certain kinds of improper conduct described in the

Bankruptcy Code, the court may deny your discharge. You should know that the even if you file chapter 7 and

you receive a discharge, some debts are not discharged

under the law. Therefore, you may still be responsible to

pay:

$335 total fee

Notice Required by 11 U.S.C. § 342(b) for Individuals Filing for Bankruptcy (Form 2010) page 1

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Chapter 11: Reorganization

+

fraud or theft;

intentional injuries that you inflicted; and

Chapter 7 Statement of Your Current Monthly

Chapter 7 Means Test Calculation (Official Form

Chapter 7 Means Test Calculation

If your income is above the median for your state, you must

file a second form--the

(Official Form 122A-2). The calculations on the form-- sometimes called the Means Test-- deduct from your

income living expenses and payments on certain debts to

determine any amount available to pay unsecured

Means Test, the U.S. trustee,

called exempt property.

must list it on Schedule C: The Property You Claim as

must file

Income (Official Form 122A-1) if you are an individual filing

the

122A-2).

creditors. If your income is more than the median income

for your state of residence and family size, depending

on the results of the

Exemptions may enable you to

Exempt (Official Form 106C). If you do not list the

most fines, penalties, forfeitures, and criminal

restitution obligations; and

certain debts that are not listed in your bankruptcy

papers.

$1,167

$550

filing fee

administrative fee

If your debts are primarily consumer debts, the court can

dismiss your chapter 7 case if it finds that you have

enough income to repay creditors a certain amount. You

You may also be required to pay debts arising from:

fraud or defalcation while acting in breach of fiduciary

capacity;

death or personal injury caused by operating a motor

vehicle, vessel, or aircraft while intoxicated from

alcohol or drugs.

for bankruptcy under chapter 7. This form will determine

your current monthly income and compare whether your

income is more than the median income that applies in

your state.

If your income is not above the median for your state, you will not have to complete the other chapter 7 form,

bankruptcy administrator, or creditors can file a motion to

dismiss your case under § 707(b) of the Bankruptcy

Code. If a motion is filed, the court will decide if your

case should be dismissed. To avoid dismissal, you may

choose to proceed under another chapter of the

Bankruptcy Code.

If you are an individual filing for chapter 7 bankruptcy, the

trustee may sell your property to pay your debts, subject

to your right to exempt the property or a portion of the

proceeds from the sale of the property. The property, and the proceeds from property that your bankruptcy

trustee sells or liquidates that you are entitled to, is

keep your home, a car, clothing, and household items or

to receive some of the proceeds if the property is sold. Exemptions are not automatic. To exempt property, you

property, the trustee may sell it and pay all of the

proceeds to your creditors.

Chapter 11 is often used for reorganizing a business, but

is also available to individuals. The provisions of chapter

11 are too complicated to summarize briefly.

$1,717 total fee

Notice Required by 11 U.S.C. § 342(b) for Individuals Filing for Bankruptcy (Form 2010) page 2

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Read These Important Warnings

Chapter 12: Repayment plan for family farmers

+

or fishermen

Chapter 13: Repayment plan for individuals with

+

regular income

domestic support obligations, most student loans, certain taxes, debts for fraud or theft,

most criminal fines and restitution obligations,

certain long-term secured debts.

Because bankruptcy can have serious long-term financial and legal consequences, including loss of

your property, you should hire an attorney and carefully consider all of your options before you file. Only an attorney can give you legal advice about what can happen as a result of filing for bankruptcy

and what your options are. If you do file for bankruptcy, an attorney can help you fill out the forms

properly and protect you, your family, your home, and your possessions. Although the law allows you to represent yourself in bankruptcy court, you should understand that

many people find it difficult to represent themselves successfully. The rules are technical, and a

mistake or inaction may harm you. If you file without an attorney, you are still responsible for

knowing and following all of the legal requirements. You should not file for bankruptcy if you are not eligible to file or if you do not intend to file the

necessary documents. Bankruptcy fraud is a serious crime; you could be fined and imprisoned if you commit fraud in your

bankruptcy case. Making a false statement, concealing property, or obtaining money or property by

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

to 20 years, or both. 18 U.S.C. §§ 152, 1341, 1519, and 3571.

$200

$75

filing fee

administrative fee

Similar to chapter 13, chapter 12 permits family farmers

and fishermen to repay their debts over a period of time

using future earnings and to discharge some debts that

are not paid.

$235

$75

filing fee

administrative fee

Chapter 13 is for individuals who have regular income

and would like to pay all or part of their debts in

installments over a period of time and to discharge

some debts that are not paid. You are eligible for

chapter 13 only if your debts are not more than certain

dollar amounts set forth in 11 U.S.C. § 109.

Under chapter 13, you must file with the court a plan to

repay your creditors all or part of the money that you owe

them, usually using your future earnings. If the court

approves your plan, the court will allow you to repay your

debts, as adjusted by the plan, within 3 years or 5 years, depending on your income and other factors. After you make all the payments under your plan, many

of your debts are discharged. The debts that are not

discharged and that you may still be responsible to pay

include:

debts for fraud or defalcation while acting in a

fiduciary capacity,

certain debts that are not listed in your bankruptcy

papers,

certain debts for acts that caused death or personal

injury, and

$275

$310

total fee

total fee

Notice Required by 11 U.S.C. § 342(b) for Individuals Filing for Bankruptcy (Form 2010) page 3

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The bankruptcy court sends notices to the mailing address

Warning: File Your Forms on Time

you list onVoluntary Petition for Individuals Filing for

Bankruptcy (Official Form 101). To ensure you receive

A married couple may file a bankruptcy case together--

joint case. If you file a joint case and each

before you file your bankruptcy petition. This

In Alabama and North Carolina, go to:

called a

days

Section 521(a)(1) of the Bankruptcy Code requires

that you promptly file detailed information about

your creditors, assets, liabilities, income, expenses

and general financial condition. The court may

dismiss your bankruptcy case if you do not file this

information within the deadlines set by the

Bankruptcy Code, the Bankruptcy Rules, and local

rules of the court. For more information about the documents and

their deadlines, go to:

spouse lists the same mailing address on the

bankruptcy petition, the bankruptcy court generally will

mail you and your spouse one copy of each notice, unless you file a statement with the court asking that

each spouse receive separate copies.

If you knowingly and fraudulently conceal assets or

make a false oath or statement under penalty of

perjury--either orally or in writing--in connection with

a bankruptcy case, you may be fined, imprisoned, or

both.

All information you supply in connection with a

bankruptcy case is subject to examination by the

Attorney General acting through the Office of the

U.S. Trustee, the Office of the U.S. Attorney, and

other offices and employees of the U.S. Department

of Justice.

http://www.uscourts.gov/bkforms/bankruptcy_forms

.html#procedure.

Bankruptcy crimes have serious

consequences

Make sure the court has your mailing

address

information about your case, Bankruptcy Rule 4002

requires that you notify the court of any changes in your

address.

Understand which services you could

receive from credit counseling agencies

The law generally requires that you receive a credit

counseling briefing from an approved credit counseling

agency. 11 U.S.C. § 109(h). If you are filing a joint

case, both spouses must receive the briefing. With

limited exceptions, you must receive it within the 180

briefing is usually conducted by telephone or on the

Internet.

In addition, after filing a bankruptcy case, you generally

must complete a financial management instructional

course before you can receive a discharge. If you are

filing a joint case, both spouses must complete the

course. You can obtain the list of agencies approved to provide

both the briefing and the instructional course from:

http://justice.gov/ust/eo/hapcpa/ccde/cc_approved.html.

http://www.uscourts.gov/FederalCourts/Bankruptcy/Bankru

ptcyResources/ApprovedCreditAndDebtCounselors.aspx.

If you do not have access to a computer, the clerk of the

bankruptcy court may be able to help you obtain the list.

Notice Required by 11 U.S.C. § 342(b) for Individuals Filing for Bankruptcy (Form 2010) page 4

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UNITED STATES BANKRUPTCY COURT

NORTHERN DISTRICT OF ILLINOIS

EASTERN DIVISION (CHICAGO)

In re Case No. Chapter 7

DISCLOSURE OF COMPENSATION OF ATTORNEY FOR DEBTOR

B2030 (Form 2030) (12/15)

Damian Pieprz

1.

For legal services, I have agreed to accept......................................................................................................... Prior to the filing of this statement I have received............................................................................................. Balance Due..............................................................................................................................................................$1,200.00

$0.00

$1,200.00

Pursuant to 11 U.S.C. § 329(a) and Fed. Bankr. P. 2016(b), I certify that I am the attorney for the above named debtor(s) and

that compensation paid to me within one year before the filing of the petition in bankruptcy, or agreed to be paid to me, for

services rendered or to be rendered on behalf of the debtor(s) in contemplation of or in connection with the bankruptcy case

is as follows:

2. The source of the compensation paid to me was: Debtor Other (specify)

3. The source of compensation to be paid to me is: Debtor Other (specify)

4. I have not agreed to share the above-disclosed compensation with any other person unless they are members and

associates of my law firm.

I have agreed to share the above-disclosed compensation with another person or persons who are not members or

associates of my law firm. A copy of the agreement, together with a list of the names of the people sharing in the

compensation, is attached.

5. In return for the above-disclosed fee, I have agreed to render legal service for all aspects of the bankruptcy case, including:

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

bankruptcy;

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

c. Representation of the debtor at the meeting of creditors and confirmation hearing, and any adjourned hearings thereof;

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B2030 (Form 2030) (12/15)

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

CERTIFICATION

Date

09/02/2016 /s/ M. Eryk Nowicki

M. Eryk Nowicki

/s/ Damian Pieprz Damian Pieprz

Bar No. 6286984

Eryk Nowicki & Associates, P.C. 250 Parkway Drive, Suite 150

Lincolnshire, IL 60069-4340

Phone: (847) 325-5020 / Fax: (847) 325-0957

I certify that the foregoing is a complete statement of any agreement or arrangement for payment to me for

representation of the debtor(s) in this bankruptcy proceeding.

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UNITED STATES BANKRUPTCY COURT

NORTHERN DISTRICT OF ILLINOIS

EASTERN DIVISION (CHICAGO)

IN RE: CASE NO

CHAPTER 7

VERIFICATION OF CREDITOR MATRIX

Damian Pieprz

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

knowledge.

Date

Date

Signature

Signature

9/2/2016 /s/ Damian Pieprz Damian Pieprz

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Cap1/bstby

Cbna

50 Northwest Point Road

Elk Grove Village, IL 60007

Citi

Po Box 6241

Sioux Falls, SD 57117

Fifth Third Bank

5050 Kingsley Dr

Cincinnati, OH 45227

Pnc Bank

2730 Liberty Ave

Pittsburgh, PA 15222

State Farm Financial S

3 State Farm Plaza N-4

Bloomington, IL 61791

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