Fill in this information to identify your case:

United States Bankruptcy Court for the:

NORTHERN DISTRICT OF ILLINOIS

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

 Chapter 7

 Chapter 11

 Chapter 12

 Chapter 13  Check if this an

amended filing

Official Form 101

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.

Allen Rosa

First name First name

L. M.

Middle name Middle name

Givhens, Jr. Givhens

Last name and Suffix (Sr., Jr., II, III) Last name and Suffix (Sr., Jr., II, III)

2. All other names you have

used in the last 8 years

Include your married or

maiden names.

3. Only the last 4 digits of

your Social Security

number or federal

Individual Taxpayer

Identification number

(ITIN)

xxx-xx-2164 xxx-xx-3273

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

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Debtor 1

Debtor 2

Allen L. Givhens, Jr.

Rosa M. Givhens Case number (if known)

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

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

Include trade names and

doing business as names

Business name(s) Business name(s)

EINs EINs

5. Where you live If Debtor 2 lives at a different address:

6 Caribou Court

Bolingbrook, IL 60490

Number, Street, City, State & ZIP Code Number, Street, City, State & ZIP Code

Will

County County

If your mailing address is different from the one

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

notices to you at this mailing address.

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

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

mailing address.

Number, P.O. Box, Street, City, State & ZIP Code Number, P.O. Box, Street, 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.)

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

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Debtor 1

Debtor 2

Allen L. Givhens, Jr.

Rosa M. Givhens Case number (if known)

Part 2: Tell the Court About Your Bankruptcy Case

7. The chapter of the

Bankruptcy Code you are

choosing to file under

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

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

 Chapter 7

 Chapter 11

 Chapter 12

 Chapter 13

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

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

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

a pre-printed address.

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

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

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

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

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

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

9. Have you filed for

bankruptcy within the

last 8 years?

 No.

 Yes.

District

Northern District of

Illinois When 12/03/12 Case number 12-47537 (dismissed)

District

Northern District of

Illinois When 2/24/05 Case number 05-06378

District When Case number

10. Are any bankruptcy

cases pending or being

filed by a spouse who is

not filing this case with

you, or by a business

partner, or by an

affiliate?

 No

 Yes.

Debtor Relationship to you

District When Case number, if known

Debtor Relationship to you

District When Case number, if known

11. Do you rent your

residence?

 No. Go to line 12.

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

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

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Debtor 1

Debtor 2

Allen L. Givhens, Jr.

Rosa M. Givhens Case number (if known)

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

12. Are you a sole proprietor

of any full- or part-time

business?

 No. Go to Part 4.

 Yes. Name and location of 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.

Name of business, if any

If you have more than one

sole proprietorship, use a

separate sheet and attach

it to this petition.

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?

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).

For a definition of small

business debtor, see 11

U.S.C. § 101(51D).

 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?

 No.

 Yes.

What is the hazard?

If immediate attention is

needed, why is it needed?

For example, do you own

perishable goods, or

livestock that must be fed,

or a building that needs

urgent repairs?

Where is the property?

Number, Street, City, State & Zip Code

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

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Debtor 1

Debtor 2

Allen L. Givhens, Jr.

Rosa M. Givhens Case number (if known)

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

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

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.

You must check one: You must check one:

 I received a briefing from an approved credit

counseling agency within the 180 days before I

filed this bankruptcy petition, and I received a

certificate of completion.

Attach a copy of the certificate and the payment

plan, if any, that you developed with the agency.

 I received a briefing from an approved credit

counseling agency within the 180 days before I filed

this bankruptcy petition, and I received a certificate of

completion.

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

any, that you developed with the agency.

 I received a briefing from an approved credit

counseling agency within the 180 days before I

filed this bankruptcy petition, but I do not have

a certificate of completion.

Within 14 days after you file this bankruptcy

petition, you MUST file a copy of the certificate and

payment plan, if any.

 I received a briefing from an approved credit

counseling agency within the 180 days before I filed

this bankruptcy petition, but I do not have a certificate

of completion.

Within 14 days after you file this bankruptcy petition, you

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

any.

 I certify that I asked for credit counseling

services from an approved agency, but was

unable to obtain those services during the 7

days after I made my request, and exigent

circumstances merit a 30-day temporary waiver

of the requirement.

To ask for a 30-day temporary waiver of the

requirement, attach a separate sheet explaining

what efforts you made to obtain the briefing, why

you were unable to obtain it before you filed for

bankruptcy, and what exigent circumstances

required you to file this case.

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 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 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.

 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.

 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.

 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 credit counseling with the court.

If you believe you are not required to receive a briefing

about credit counseling, you must file a motion for waiver

of credit counseling with the court.

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

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Debtor 1

Debtor 2

Allen L. Givhens, Jr.

Rosa M. Givhens Case number (if known)

Part 6: Answer These Questions for Reporting Purposes

16. What kind of debts do

you have?

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

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

 No. Go to line 16b.

 Yes. Go to line 17.

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

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

 No. Go to line 16c.

 Yes. Go to line 17.

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

17. Are you filing under

Chapter 7?

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

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?

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

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

 No

 Yes

18. How many Creditors do

you estimate that you

owe?

 1-49

 50-99

 100-199

 200-999

 1,000-5,000

 5001-10,000

 10,001-25,000

 25,001-50,000

 50,001-100,000

 More than100,000

19. How much do you

estimate your assets to

be worth?

 $0 - $50,000

 $50,001 - $100,000

 $100,001 - $500,000

 $500,001 - $1 million

 $1,000,001 - $10 million

 $10,000,001 - $50 million

 $50,000,001 - $100 million

 $100,000,001 - $500 million

 $500,000,001 - $1 billion

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

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

 More than $50 billion

20. How much do you

estimate your liabilities

to be?

 $0 - $50,000

 $50,001 - $100,000

 $100,001 - $500,000

 $500,001 - $1 million

 $1,000,001 - $10 million

 $10,000,001 - $50 million

 $50,000,001 - $100 million

 $100,000,001 - $500 million

 $500,000,001 - $1 billion

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

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

 More than $50 billion

Part 7: Sign Below

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

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

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

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

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

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

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

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

and 3571.

/s/ Allen L. Givhens, Jr. /s/ Rosa M. Givhens

Allen L. Givhens, Jr. Rosa M. Givhens

Signature of Debtor 1 Signature of Debtor 2

Executed on August 24, 2016 Executed on August 24, 2016

MM / DD / YYYY MM / DD / YYYY

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

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Debtor 1

Debtor 2

Allen L. Givhens, Jr.

Rosa M. Givhens Case number (if known)

For your attorney, if you are

represented by one

If you are not represented by

an attorney, you do not need

to file this page.

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

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

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

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

schedules filed with the petition is incorrect.

/s/ Marc C. Scheinbaum Date August 24, 2016

Signature of Attorney for Debtor MM / DD / YYYY

Marc C. Scheinbaum

Printed name

Scheinbaum & West, LLC

Firm name

P. O. Box 5009

Vernon Hills, IL 60061-5009

Number, Street, City, State & ZIP Code

Contact phone 815-636-4676 Email address amerlincat@aol.com

6180394

Bar number & State

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

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 Document Page 7 of 73
Fill in this information to identify your case:

Debtor 1 Allen L. Givhens, Jr.

First Name Middle Name Last Name

Debtor 2 Rosa M. Givhens

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

United States Bankruptcy Court for the: NORTHERN DISTRICT OF ILLINOIS

Case number

(if known)  Check if this is an

amended filing

Official Form 106Sum

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

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

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

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

Part 1: Summarize Your Assets

Your assets

Value of what you own

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

1a. Copy line 55, Total real estate, from Schedule A/B................................................................................................ $ 215,000.00

1b. Copy line 62, Total personal property, from Schedule A/B..................................................................................... $ 56,820.00

1c. Copy line 63, Total of all property on Schedule A/B............................................................................................... $ 271,820.00

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... $ 244,000.00

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

3a. Copy the total claims from Part 1 (priority unsecured claims) from line 6e of Schedule E/F................................. $ 6,800.00

3b. Copy the total claims from Part 2 (nonpriority unsecured claims) from line 6j of Schedule E/F............................ $ 78,590.00

Your total liabilities $ 329,390.00

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................................................................................ $ 4,305.00

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

Copy your monthly expenses from line 22c of Schedule J.......................................................................... $ 4,337.00

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.

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

Software Copyright (c) 1996-2016 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

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Debtor 1

Debtor 2

Allen L. Givhens, Jr.

Rosa M. Givhens Case number (if known)

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. $ 7,225.00

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

Total claim

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

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

9b. Taxes and certain other debts you owe the government. (Copy line 6b.) $ 6,800.00

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

9d. Student loans. (Copy line 6f.) $ 0.00

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

priority claims. (Copy line 6g.) $ 0.00

9f. Debts to pension or profit-sharing plans, and other similar debts. (Copy line 6h.) +$ 0.00

9g. Total. Add lines 9a through 9f. $ 6,800.00

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

Software Copyright (c) 1996-2016 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

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

Debtor 1 Allen L. Givhens, Jr.

First Name Middle Name Last Name

Debtor 2 Rosa M. Givhens

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

United States Bankruptcy Court for the: NORTHERN DISTRICT OF ILLINOIS

Case number  Check if this is an

amended filing

Official Form 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 What is the property? Check all that apply

Do not deduct secured claims or exemptions. Put

the amount of any secured claims on Schedule D:

Creditors Who Have Claims Secured by Property.

6 Caribou Court 





Single-family home

Duplex or multi-unit building

Condominium or cooperative

Street address, if available, or other description

Bolingbrook IL 60490-0000





Manufactured or mobile home

Land

Current value of the

entire property?

Current value of the

portion you own?

City State ZIP Code  Investment property $215,000.00 $215,000.00

 Timeshare

Describe the nature of your ownership interest

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

a life estate), if known.

 Other

Who has an interest in the property? Check one

 Debtor 1 only

debtors have a 100% interest in real

estate

Will  Debtor 2 only

County  Debtor 1 and Debtor 2 only

 Check if this is community property  At least one of the debtors and another (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...........................................................................=> $215,000.00

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.

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

Software Copyright (c) 1996-2016 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

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Debtor 1

Debtor 2

Allen L. Givhens, Jr.

Rosa M. Givhens Case number (if known)

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

 No

 Yes

3.1 Make: Pontiac Who has an interest in the property? Check one Do not deduct secured claims or exemptions. Put

the amount of any secured claims on Schedule D:

Model: G-6  Debtor 1 only Creditors Who Have Claims Secured by Property.

Year: 2007  Debtor 2 only Current value of the

entire property?

Current value of the

Approximate mileage: 127,000  Debtor 1 and Debtor 2 only portion you own?

Other information:  At least one of the debtors and another

 Check if this is community property $2,500.00 $2,500.00

 (see instructions)

3.2 Make: Ford Who has an interest in the property? Check one Do not deduct secured claims or exemptions. Put

the amount of any secured claims on Schedule D:

Model: Expedition  Creditors Who Have Claims Secured by Property.

 Debtor 1 only

Year: 2006  Debtor 2 only Current value of the

entire property?

Current value of the

Approximate mileage: 150,000  Debtor 1 and Debtor 2 only portion you own?

Other information:  At least one of the debtors and another

 Check if this is community property $5,000.00 $5,000.00

 (see instructions)

3.3 Make: Ford Who has an interest in the property? Check one Do not deduct secured claims or exemptions. Put

the amount of any secured claims on Schedule D:

Model: E-150 Econoline van  Creditors Who Have Claims Secured by Property.

 Debtor 1 only

Year: 2008  Debtor 2 only Current value of the

entire property?

Current value of the

Approximate mileage:  Debtor 1 and Debtor 2 only portion you own?

Other information:  At least one of the debtors and another

To be surrendered

 Check if this is community property $7,000.00 $7,000.00

 (see instructions)

3.4 Make: Ford Who has an interest in the property? Check one Do not deduct secured claims or exemptions. Put

the amount of any secured claims on Schedule D:

Model: E-250 van  Creditors Who Have Claims Secured by Property.

 Debtor 1 only

Year: 2003  Debtor 2 only Current value of the

entire property?

Current value of the

Approximate mileage: 220,000  Debtor 1 and Debtor 2 only portion you own?

Other information:  At least one of the debtors and another

 Check if this is community property $1,000.00 $1,000.00

 (see instructions)

3.5 Make: Ford Who has an interest in the property? Check one Do not deduct secured claims or exemptions. Put

the amount of any secured claims on Schedule D:

Model: E-150 van  Creditors Who Have Claims Secured by Property.

 Debtor 1 only

Year: 2002  Debtor 2 only Current value of the

entire property?

Current value of the

Approximate mileage: 230,000  Debtor 1 and Debtor 2 only portion you own?

Other information:  At least one of the debtors and another

 Check if this is community property $1,000.00 $1,000.00

 (see instructions)

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

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 Document Page 11 of 73
Debtor 1

Debtor 2

Allen L. Givhens, Jr.

Rosa M. Givhens Case number (if known)

3.6 Make: Chevrolet Who has an interest in the property? Check one Do not deduct secured claims or exemptions. Put

the amount of any secured claims on Schedule D:

Model: G-2500 van  Creditors Who Have Claims Secured by Property.

 Debtor 1 only

Year: 2006  Debtor 2 only Current value of the

entire property?

Current value of the

Approximate mileage: 245,000  Debtor 1 and Debtor 2 only portion you own?

Other information:  At least one of the debtors and another

 Check if this is community property $3,500.00 $3,500.00

 (see instructions)

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

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

 No

 Yes

5

.

Add the dollar value of the portion you own for all of your entries from Part 2, including any entries for

pages you have attached for Part 2. Write that number here.............................................................................=> $20,000.00

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.....

bedroom set, 2 beds, living room furniture, dining room table,

kitchen set, kitchen appliances, washer, dryer, 3 t.v.s, 2

computers. $1,800.00

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.....

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

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 Document Page 12 of 73
Debtor 1

Debtor 2

Allen L. Givhens, Jr.

Rosa M. Givhens Case number (if known)

men's, women's and children's clothing $600.00

12. Jewelry

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

 No

 Yes. Describe.....

wedding ring, necklace, rings, misc costume jewelry. $800.00

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 .............................................................................. $3,200.00

Part 4: Describe Your Financial Assets

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

portion you own?

Do not deduct secured

claims or exemptions.

16. Cash

Examples: Money you have in your wallet, in your home, in a safe deposit box, and on hand when you file your petition

 No

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

cash $100.00

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 Chase Bank $120.00

17.2. checking U S Bank $100.00

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:

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

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 Document Page 13 of 73
Debtor 1

Debtor 2

Allen L. Givhens, Jr.

Rosa M. Givhens Case number (if known)

ALG Transportation, Inc. Business closed in

April, 2016. see S.O.F.A.

Allen has

100%

interest % $0.00

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) 401(k) thru Securtas Security $25,000.00

401(k) PNC Bank $3,300.00

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:

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.

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.......

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

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 Document Page 14 of 73
Debtor 1

Debtor 2

Allen L. Givhens, Jr.

Rosa M. Givhens Case number (if known)

29. Family support

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

 No

 Yes. Give specific information......

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..

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:

term life insurance thru work with no

cash value $0.00

term life insurance thru work with no

cash value $0.00

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.........

potential NLRB lawsuit against Fast-Way Transportation for

back pay. Successor corporation is Brumar Technologies,

Inc., however, the Debtor is not likely to pursue. $5,000.00

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..................................................................................................................... $33,620.00

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.

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

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 Document Page 15 of 73
Debtor 1

Debtor 2

Allen L. Givhens, Jr.

Rosa M. Givhens Case number (if known)

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.

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 .................................... $0.00

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

55. Part 1: Total real estate, line 2 ...................................................................................................................... $215,000.00

56. Part 2: Total vehicles, line 5 $20,000.00

57. Part 3: Total personal and household items, line 15 $3,200.00

58. Part 4: Total financial assets, line 36 $33,620.00

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

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

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

62. Total personal property. Add lines 56 through 61... $56,820.00 Copy personal property total $56,820.00

63. Total of all property on Schedule A/B. Add line 55 + line 62 $271,820.00

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

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 Document Page 16 of 73
Fill in this information to identify your case:

Debtor 1 Allen L. Givhens, Jr.

First Name Middle Name Last Name

Debtor 2 Rosa M. Givhens

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

United States Bankruptcy Court for the: NORTHERN DISTRICT OF ILLINOIS

Case number

(if known)  Check if this is an

amended filing

Official Form 106C

Schedule C: The Property You Claim as Exempt 4/16

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

6 Caribou Court Bolingbrook, IL

60490 Will County

Line from Schedule A/B: 1.1

$215,000.00  $30,000.00 735 ILCS 5/12-901

 100% of fair market value, up to

any applicable statutory limit

2007 Pontiac G-6 127,000 miles

Line from Schedule A/B: 3.1

$2,500.00  $2,400.00 735 ILCS 5/12-1001(c)

 100% of fair market value, up to

any applicable statutory limit

2006 Ford Expedition 150,000 miles

Line from Schedule A/B: 3.2

$5,000.00  $2,400.00 735 ILCS 5/12-1001(c)

 100% of fair market value, up to

any applicable statutory limit

2003 Ford E-250 van 220,000 miles

Line from Schedule A/B: 3.4

$1,000.00  $1,000.00 735 ILCS 5/12-1001(b)

 100% of fair market value, up to

any applicable statutory limit

2002 Ford E-150 van 230,000 miles

Line from Schedule A/B: 3.5

$1,000.00  $500.00 735 ILCS 5/12-1001(b)

 100% of fair market value, up to

any applicable statutory limit

Official Form 106C Schedule C: The Property You Claim as Exempt page 1 of 2

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 Document Page 17 of 73
Debtor 1

Debtor 2

Allen L. Givhens, Jr.

Rosa M. Givhens Case number (if known)

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

2006 Chevrolet G-2500 van 245,000

miles

Line from Schedule A/B: 3.6

$3,500.00  $2,200.00 735 ILCS 5/12-1001(b)

 100% of fair market value, up to

any applicable statutory limit

men's, women's and children's

clothing

Line from Schedule A/B: 11.1

$600.00  $600.00 735 ILCS 5/12-1001(a)

 100% of fair market value, up to

any applicable statutory limit

wedding ring, necklace, rings, misc

costume jewelry.

Line from Schedule A/B: 12.1

$800.00  $800.00 735 ILCS 5/12-1001(b)

 100% of fair market value, up to

any applicable statutory limit

cash

Line from Schedule A/B: 16.1

$100.00  $100.00 735 ILCS 5/12-1001(b)

 100% of fair market value, up to

any applicable statutory limit

checking: U S Bank

Line from Schedule A/B: 17.2

$100.00  $100.00 735 ILCS 5/12-1001(b)

 100% of fair market value, up to

any applicable statutory limit

401(k): 401(k) thru Securtas Security

Line from Schedule A/B: 21.1

$25,000.00  100% 735 ILCS 5/12-704

 100% of fair market value, up to

any applicable statutory limit

401(k): PNC Bank

Line from Schedule A/B: 21.2

$3,300.00  100% 735 ILCS 5/12-1006

 100% of fair market value, up to

any applicable statutory limit

potential NLRB lawsuit against

Fast-Way Transportation for back

pay. Successor corporation is

Brumar Technologies, Inc., however,

the Debtor is not likely to pursue.

Line from Schedule A/B: 34.1

$5,000.00  $3,100.00 735 ILCS 5/12-1001(b)

 100% of fair market value, up to

any applicable statutory limit

3. Are you claiming a homestead exemption of more than $160,375?

(Subject to adjustment on 4/01/19 and every 3 years after that for cases filed on or after the date of adjustment.)

 No

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

 No

 Yes

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

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 Document Page 18 of 73
Fill in this information to identify your case:

Debtor 1 Allen L. Givhens, Jr.

First Name Middle Name Last Name

Debtor 2 Rosa M. Givhens

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

United States Bankruptcy Court for the: NORTHERN DISTRICT OF ILLINOIS

Case number

(if known)  Check if this is an

amended filing

Official Form 106D

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

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

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

number (if known).

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

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

 Yes. Fill in all of the information below.

Part 1: List All Secured Claims

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

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

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

Column A

Amount of claim

Do not deduct the

value of collateral.

Column B

Value of collateral

that supports this

claim

Column C

Unsecured

portion

If any

2.1 Bank of America, NA Describe the property that secures the claim: Unknown $215,000.00 Unknown

Creditor's Name 6 Caribou Court Bolingbrook, IL

c/o Weiss McClelland, 60490 Will County

LLC

105 W. Adams Street,

suite 1850

Chicago, IL 60603

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

apply.

 Contingent

Number, Street, City, State & Zip Code  Unliquidated

 Disputed

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

 Debtor 1 only

 Debtor 2 only

 An agreement you made (such as mortgage or secured

car loan)

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

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

 Check if this claim relates to a

community debt

 Other (including a right to offset) mortgage default

Date debt was incurred Last 4 digits of account number 7537

2.2

Ford Motor Credit

Company Describe the property that secures the claim: $10,000.00 $7,000.00 $3,000.00

Creditor's Name 2008 Ford E-150 Econoline van

c/o National Bankruptcy To be surrendered

Service Ctr

P.O. Box 6275

Dearborn, MI 48121

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

apply.

 Contingent

Number, Street, City, State & Zip Code  Unliquidated

 Disputed

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

 Debtor 1 only

 Debtor 2 only

 An agreement you made (such as mortgage or secured

car loan)

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

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

 Check if this claim relates to a

community debt

 Other (including a right to offset) holds title to vehicle

Date debt was incurred Last 4 digits of account number 3870

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

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Debtor 1 Allen L. Givhens, Jr. Case number (if know)

First Name Middle Name Last Name

Debtor 2 Rosa M. Givhens

First Name Middle Name Last Name

2.3 Nationstar Mortgage Describe the property that secures the claim: $234,000.00 $215,000.00 $19,000.00

Creditor's Name 6 Caribou Court Bolingbrook, IL

60490 Will County

attn: bankruptcy notices

350 Highland Drive

Lewisville, TX 75067

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

apply.

 Contingent

Number, Street, City, State & Zip Code  Unliquidated

 Disputed

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

 Debtor 1 only

 Debtor 2 only

 An agreement you made (such as mortgage or secured

car loan)

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

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

 Check if this claim relates to a

community debt

 Other (including a right to offset) first mortgage

Date debt was incurred Last 4 digits of account number 1279

Add the dollar value of your entries in Column A on this page. Write that number here: $244,000.00

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

Write that number here: $244,000.00

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

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

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

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

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

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

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 Document Page 20 of 73
Fill in this information to identify your case:

Debtor 1 Allen L. Givhens, Jr.

First Name Middle Name Last Name

Debtor 2 Rosa M. Givhens

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

United States Bankruptcy Court for the: NORTHERN DISTRICT OF ILLINOIS

Case number

(if known)  Check if this is an

amended filing

Official Form 106E/F

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

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

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

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

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

left. Attach the Continuation Page to this page. If you have no information to report in a Part, do not file that Part. On the top of any additional pages, write your

name and case number (if known).

Part 1: List All of Your PRIORITY Unsecured Claims

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

 No. Go to Part 2.

 Yes.

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

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

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

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

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

Total claim Priority

amount

Nonpriority

amount

2.1 Internal Revenue Service Last 4 digits of account number 2164 $6,800.00 $6,800.00 $0.00

Priority Creditor's Name

P.O. Box 7346

Philadelphia, PA 19101-7346

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community debt

Is the claim subject to offset?

 No

 Yes

 Contingent

 Unliquidated

 Disputed

Type of PRIORITY unsecured claim:

 Domestic support obligations

 Taxes and certain other debts you owe the government

 Claims for death or personal injury while you were intoxicated

 Other. Specify

unpaid income taxes

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

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

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 Document Page 21 of 73
Debtor 1

Debtor 2

Allen L. Givhens, Jr.

Rosa M. Givhens Case number (if know)

4.1 Adventist Hinsdale Hospital Last 4 digits of account number 0070 $2,900.00

Nonpriority Creditor's Name

c/o Merchants Credit Giude

223 West Jackson Blvd., suite 900

Chicago, IL 60606

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

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

 Yes  Other. Specify medical services

4.2 AmeriCash Loans, LLC Last 4 digits of account number 3273 $4,400.00

Nonpriority Creditor's Name

1726 Jefferson Blvd

Joliet, IL 60435

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

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

 Yes  Other. Specify unsecured loan

4.3

Ashley Stewart Credit Card/

WFNNB Last 4 digits of account number 9815 $200.00

Nonpriority Creditor's Name

Bankruptcy Department

P.O. Box 182125

Columbus, OH 43218-2125

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

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

 Yes  Other. Specify credit card

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 2 of 23

Software Copyright (c) 1996-2016 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 16-27209 Doc 1 Filed 08/24/16 Entered 08/24/16 14:55:30 Desc Main

 Document Page 22 of 73
Debtor 1

Debtor 2

Allen L. Givhens, Jr.

Rosa M. Givhens Case number (if know)

4.4 Avenue / WFNNB Last 4 digits of account number 1265 $1,380.00

Nonpriority Creditor's Name

Bankruptcy Department

P.O. Box 182125

Columbus, OH 43218-2125

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

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

 Yes  Other. Specify credit card

4.5 Bill Me Later / Master Card Last 4 digits of account number 1877 $1,800.00

Nonpriority Creditor's Name

P.O. Box 2394

Omaha, NE 68103-2394

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

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

 Yes  Other. Specify credit card

4.6 Capital One Bank, USA Last 4 digits of account number 5365 $1,950.00

Nonpriority Creditor's Name

c/o Echelon Recovery

P O Box 1880

Voorhees, NJ 08043

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

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

 Yes  Other. Specify credit card

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 3 of 23

Software Copyright (c) 1996-2016 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 16-27209 Doc 1 Filed 08/24/16 Entered 08/24/16 14:55:30 Desc Main

 Document Page 23 of 73
Debtor 1

Debtor 2

Allen L. Givhens, Jr.

Rosa M. Givhens Case number (if know)

4.7 Capital One Master Card Last 4 digits of account number 2319 $1,050.00

Nonpriority Creditor's Name

P.O. Box 30285

Salt Lake City, UT 84130-0285

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

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

 Yes  Other. Specify credit card

4.8 Capital One Visa Last 4 digits of account number 9226 $4,500.00

Nonpriority Creditor's Name

P.O. Box 30285

Salt Lake City, UT 84130-0285

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

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

 Yes  Other. Specify credit card

4.9 Chase Bank Last 4 digits of account number 0602 $650.00

Nonpriority Creditor's Name

Cardmember Services

P.O. Box 15298

Wilmington, DE 19885-5298

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

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

 Yes  Other. Specify credit card

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 4 of 23

Software Copyright (c) 1996-2016 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 16-27209 Doc 1 Filed 08/24/16 Entered 08/24/16 14:55:30 Desc Main

 Document Page 24 of 73
Debtor 1

Debtor 2

Allen L. Givhens, Jr.

Rosa M. Givhens Case number (if know)

4.1

0 Chase Bank Last 4 digits of account number 0672;0396 $1,350.00

Nonpriority Creditor's Name

P O Box 659754

San Antonio, TX 78265-9751

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

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

 Yes  Other. Specify checking overdrafts

4.1

1 City of Chicago Last 4 digits of account number 4930;3400 $2,000.00

Nonpriority Creditor's Name

Department of Revenue (parking

tic)

P.O. Box 88292

Chicago, IL 60680-1292

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

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

 Yes  Other. Specify parking tickets, etc

4.1

2 City of Chicago - Dept of Revenue Last 4 digits of account number 7308 $180.00

Nonpriority Creditor's Name

c/o Arnold Harris, Atty at Law

222 Merchandise Mart Plaza, # 1932

Chicago, IL 60680-5625

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

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

 Yes  Other. Specify parking ticket

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 5 of 23

Software Copyright (c) 1996-2016 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 16-27209 Doc 1 Filed 08/24/16 Entered 08/24/16 14:55:30 Desc Main

 Document Page 25 of 73
Debtor 1

Debtor 2

Allen L. Givhens, Jr.

Rosa M. Givhens Case number (if know)

4.1

3 City of Chicago - Dept of Revenue Last 4 digits of account number 3455 $520.00

Nonpriority Creditor's Name

c/o Lineberget Goggan Blair

Sampson

P O Box 06152

Chicago, IL 60606-0152

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

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

 Yes  Other. Specify fees to City of Chicago

4.1

4 Direct Merchants Bank Last 4 digits of account number 9088 $1,700.00

Nonpriority Creditor's Name

Cardmember Services

P.O. Box 5894

Carol Stream, IL 60197-5894

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

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

 Yes  Other. Specify credit card

4.1

5 Edward Health Ventures Last 4 digits of account number 9777 $80.00

Nonpriority Creditor's Name

c/o MiraMed Revenue Group, LLC

Dept 77304, P O Box 77000

Detroit, MI 48277-0304

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

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

 Yes  Other. Specify medical services

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 6 of 23

Software Copyright (c) 1996-2016 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 16-27209 Doc 1 Filed 08/24/16 Entered 08/24/16 14:55:30 Desc Main

 Document Page 26 of 73
Debtor 1

Debtor 2

Allen L. Givhens, Jr.

Rosa M. Givhens Case number (if know)

4.1

6 Edward-Elmhurst Health Last 4 digits of account number 7134 $420.00

Nonpriority Creditor's Name

P O Box 140250

Toledo, OH 43614

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

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

 Yes  Other. Specify medical services

4.1

7 F C & A Last 4 digits of account number 9588 $50.00

Nonpriority Creditor's Name

103 Clover Green

Peachtree City, GA 30269

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

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

 Yes  Other. Specify purchases on account

4.1

8 Family Foot and Ankle Care Last 4 digits of account number 9330 $220.00

Nonpriority Creditor's Name

550 E. Boughton Road

# 195

Bolingbrook, IL 60440-2189

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

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

 Yes  Other. Specify medical services

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 7 of 23

Software Copyright (c) 1996-2016 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 16-27209 Doc 1 Filed 08/24/16 Entered 08/24/16 14:55:30 Desc Main

 Document Page 27 of 73
Debtor 1

Debtor 2

Allen L. Givhens, Jr.

Rosa M. Givhens Case number (if know)

4.1

9 Fingerhut Advantage Last 4 digits of account number 6593 $750.00

Nonpriority Creditor's Name

P.O. Box 166

Newark, NJ 07101-0166

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

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

 Yes  Other. Specify credit card

4.2

0 First National Bank - Legacy Vis Last 4 digits of account number 2196 $1,300.00

Nonpriority Creditor's Name

c/o Focus Receiveables

Management

1130 Northchase Pkwy, # 150

Marietta, GA 30067

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

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

 Yes  Other. Specify

credit card

xxxx-xxxx-xxxx-5567

4.2

1 First Premier Bank Last 4 digits of account number 4759 $650.00

Nonpriority Creditor's Name

P.O. Box 5524

Sioux Falls, SD 57117-5524

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

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

 Yes  Other. Specify credit card

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 8 of 23

Software Copyright (c) 1996-2016 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 16-27209 Doc 1 Filed 08/24/16 Entered 08/24/16 14:55:30 Desc Main

 Document Page 28 of 73
Debtor 1

Debtor 2

Allen L. Givhens, Jr.

Rosa M. Givhens Case number (if know)

4.2

2 First Premier Bank Last 4 digits of account number 6545 $680.00

Nonpriority Creditor's Name

P.O. Box 5524

Sioux Falls, SD 57117-5524

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

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

 Yes  Other. Specify credit card

4.2

3 First Premier Bank Last 4 digits of account number 5447 $0.00

Nonpriority Creditor's Name

c/o Rushmore Service Center

P O Box 5508

Sioux Falls, SD 57117-5508

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

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

 Yes  Other. Specify notice only

4.2

4 First Premier Bank Last 4 digits of account number 2195 $420.00

Nonpriority Creditor's Name

P.O. Box 5524

Sioux Falls, SD 57117-5524

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

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

 Yes  Other. Specify credit card

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 9 of 23

Software Copyright (c) 1996-2016 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 16-27209 Doc 1 Filed 08/24/16 Entered 08/24/16 14:55:30 Desc Main

 Document Page 29 of 73
Debtor 1

Debtor 2

Allen L. Givhens, Jr.

Rosa M. Givhens Case number (if know)

4.2

5 First Rate Financial Last 4 digits of account number 3273 $750.00

Nonpriority Creditor's Name

880 Lee Street

suite 302

Des Plaines, IL 60016-6487

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

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

 Yes  Other. Specify unsecured loan

4.2

6 Ford Motor Credit Company Last 4 digits of account number 3870 $8,000.00

Nonpriority Creditor's Name

P O Box 689007

Franklin, TN 37068

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

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

 Yes  Other. Specify automobile deficiency

4.2

7 Gettington.com Last 4 digits of account number 9890 $1,100.00

Nonpriority Creditor's Name

P O Box 166

Newark, NJ 07101-0166

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

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

 Yes  Other. Specify credit card

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 10 of 23

Software Copyright (c) 1996-2016 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 16-27209 Doc 1 Filed 08/24/16 Entered 08/24/16 14:55:30 Desc Main

 Document Page 30 of 73
Debtor 1

Debtor 2

Allen L. Givhens, Jr.

Rosa M. Givhens Case number (if know)

4.2

8 Hollywood Video Last 4 digits of account number 8283 $20.00

Nonpriority Creditor's Name

c/o West Bay Acquisitions

P O Box 8009

Cranston, RI 02920

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

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

 Yes  Other. Specify video rental

4.2

9 HSBC Card Services Last 4 digits of account number 4031 $1,900.00

Nonpriority Creditor's Name

P.O. Box 80084

Salinas, CA 93912-0084

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

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

 Yes  Other. Specify credit card

4.3

0 HSBC Card Services Last 4 digits of account number 8099 $500.00

Nonpriority Creditor's Name

P.O. Box 80084

Salinas, CA 93912-0084

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

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

 Yes  Other. Specify credit card

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 11 of 23

Software Copyright (c) 1996-2016 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 16-27209 Doc 1 Filed 08/24/16 Entered 08/24/16 14:55:30 Desc Main

 Document Page 31 of 73
Debtor 1

Debtor 2

Allen L. Givhens, Jr.

Rosa M. Givhens Case number (if know)

4.3

1 HSBC Card Services Last 4 digits of account number 4031 $1,800.00

Nonpriority Creditor's Name

c/o Cardmember Services

P.O. Box 5262

Carol Stream, IL 60197-5262

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

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

 Yes  Other. Specify credit card

4.3

2

Illinois Department of Insurance Last 4 digits of account number 5118 $190.00

Nonpriority Creditor's Name

320 West Washington Street

Springfield, IL 62767

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

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

 Yes  Other. Specify hearing costs

4.3

3 Illinois State Tollway Highway Auth Last 4 digits of account number

7346;7919;2

060 $1,620.00

Nonpriority Creditor's Name

c/o Arnold Scott Harris, PC

222 Merchandise Mart Plaza, # 1932

Chicago, IL 60654-1420

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

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

 Yes  Other. Specify tollway fines

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 12 of 23

Software Copyright (c) 1996-2016 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 16-27209 Doc 1 Filed 08/24/16 Entered 08/24/16 14:55:30 Desc Main

 Document Page 32 of 73
Debtor 1

Debtor 2

Allen L. Givhens, Jr.

Rosa M. Givhens Case number (if know)

4.3

4

Illinois Tollway / State of Illinoi Last 4 digits of account number 1114 $70.00

Nonpriority Creditor's Name

Violation Processing Center

P O Box 5201

Lisle, IL 60532-5201

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

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

 Yes  Other. Specify tollway fine

4.3

5 J D Williams - Comenity Capital Last 4 digits of account number 0490 $150.00

Nonpriority Creditor's Name

attn: Bankruptcy Department

P.O. Box 183043

Columbus, OH 43218-3043

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

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

 Yes  Other. Specify credit card

4.3

6 Juniper Bank Last 4 digits of account number 2376 $1,950.00

Nonpriority Creditor's Name

Card Services

P.O. Box 8802

Wilmington, DE 19899-8802

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

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

 Yes  Other. Specify credit card

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 13 of 23

Software Copyright (c) 1996-2016 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 16-27209 Doc 1 Filed 08/24/16 Entered 08/24/16 14:55:30 Desc Main

 Document Page 33 of 73
Debtor 1

Debtor 2

Allen L. Givhens, Jr.

Rosa M. Givhens Case number (if know)

4.3

7 King Size Comenity Bank Last 4 digits of account number 4132 $100.00

Nonpriority Creditor's Name

attn: Bankruptcy Department

P.O. Box 182125

Columbus, OH 43218-2125

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

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

 Yes  Other. Specify credit card

4.3

8 Lane Bryant / WFNNB Last 4 digits of account number 1244 $100.00

Nonpriority Creditor's Name

Bankruptcy Department

P.O. Box 182125

Columbus, OH 43218-2125

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

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

 Yes  Other. Specify credit card

4.3

9 Lifetime Fitness Last 4 digits of account number 5814 $130.00

Nonpriority Creditor's Name

1220 Lakeview Drive

Romeoville, IL 60446

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

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

 Yes  Other. Specify health club membership

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 14 of 23

Software Copyright (c) 1996-2016 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 16-27209 Doc 1 Filed 08/24/16 Entered 08/24/16 14:55:30 Desc Main

 Document Page 34 of 73
Debtor 1

Debtor 2

Allen L. Givhens, Jr.

Rosa M. Givhens Case number (if know)

4.4

0 Massey's Last 4 digits of account number 94A2 $70.00

Nonpriority Creditor's Name

Special Account Handling

P O Box 2822

Monroe, WI 53566-8022

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

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

 Yes  Other. Specify credit card

4.4

1 Massey's Last 4 digits of account number 0584 $70.00

Nonpriority Creditor's Name

c/o Professional Recovery

Consultan

P O Box 51187

Durham, NC 27717-1187

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

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

 Yes  Other. Specify purchases on account

4.4

2 medical debt Last 4 digits of account number 1497 $80.00

Nonpriority Creditor's Name

c/o Professional Account

Management

2040 W. Wisconsin Avenue

Milwaukee, WI 53233

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

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

 Yes  Other. Specify medical debt

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 15 of 23

Software Copyright (c) 1996-2016 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 16-27209 Doc 1 Filed 08/24/16 Entered 08/24/16 14:55:30 Desc Main

 Document Page 35 of 73
Debtor 1

Debtor 2

Allen L. Givhens, Jr.

Rosa M. Givhens Case number (if know)

4.4

3 North Texas Tollway Authority Last 4 digits of account number 2940 $60.00

Nonpriority Creditor's Name

c/o Professional Acct Management

P O Box 866608

Plano, TX 75086-6608

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

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

 Yes  Other. Specify unpaid tolls

4.4

4 Quest Diagnostics Last 4 digits of account number 3A72 $280.00

Nonpriority Creditor's Name

c/o American Medical Collection

4 Westchester Plaza, suite 110

Elmsford, NY 10523

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

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

 Yes  Other. Specify medical services

4.4

5 Quick Click Last 4 digits of account number 3273 $700.00

Nonpriority Creditor's Name

P.O. Box 5040

Alpharetta, GA 30023

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

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

 Yes  Other. Specify unsecured loan

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 16 of 23

Software Copyright (c) 1996-2016 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 16-27209 Doc 1 Filed 08/24/16 Entered 08/24/16 14:55:30 Desc Main

 Document Page 36 of 73
Debtor 1

Debtor 2

Allen L. Givhens, Jr.

Rosa M. Givhens Case number (if know)

4.4

6 Speedway, LLC Last 4 digits of account number 1125 $1,200.00

Nonpriority Creditor's Name

c/o NCO Financial Systems, Inc

P O Box 9186

Dublin, OH 43017-4186

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

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

 Yes  Other. Specify credit card

4.4

7 TCF National Bank Last 4 digits of account number 0173 $100.00

Nonpriority Creditor's Name

c/o Professional Account

Management

P O Box 391

Milwaukee, WI 53201-0391

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

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

 Yes  Other. Specify checking overdrafts

4.4

8 The Kroger Company Last 4 digits of account number 3273 $30.00

Nonpriority Creditor's Name

1014 Vine Street

Cincinnati, OH 45202-1100

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

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

 Yes  Other. Specify n.s.f. check

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 17 of 23

Software Copyright (c) 1996-2016 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 16-27209 Doc 1 Filed 08/24/16 Entered 08/24/16 14:55:30 Desc Main

 Document Page 37 of 73
Debtor 1

Debtor 2

Allen L. Givhens, Jr.

Rosa M. Givhens Case number (if know)

4.4

9 The Rawlings Company Last 4 digits of account number 3433 $1,200.00

Nonpriority Creditor's Name

Subrogation Division

P O Box 2000

La Grange, KY 40031-2000

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

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

 Yes  Other. Specify medical services

4.5

0 Travelers Insurance Last 4 digits of account number 4921 $0.00

Nonpriority Creditor's Name

Premium Audit

P O Box 3556

Orlando, FL 32802

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

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

 Yes  Other. Specify notice only

4.5

1 Travelers Prop Casu of America Last 4 digits of account number 3117 $7,200.00

Nonpriority Creditor's Name

c/o Blitt and Gaines, PC

661 Glenn Avenue

Wheeling, IL 60090

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

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

 Yes  Other. Specify unpaid workman's comp insurance policy

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 18 of 23

Software Copyright (c) 1996-2016 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 16-27209 Doc 1 Filed 08/24/16 Entered 08/24/16 14:55:30 Desc Main

 Document Page 38 of 73
Debtor 1

Debtor 2

Allen L. Givhens, Jr.

Rosa M. Givhens Case number (if know)

4.5

2 U.S. Department of Education Last 4 digits of account number 2164 $10,000.00

Nonpriority Creditor's Name

Direct Loan Servicing Center

P. O. Box 530260

Atlanta, GA 30353-0260

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

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

 Yes  Other. Specify student loan

4.5

3 Village of Justice Last 4 digits of account number W3WY $200.00

Nonpriority Creditor's Name

P O Box 7728

Carol Stream, IL 60197-7728

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

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

 Yes  Other. Specify red light violation

4.5

4 Village of Justice Last 4 digits of account number 7911 $270.00

Nonpriority Creditor's Name

c/o Municipal Collections of Americ

3348 Ridge Road

Lansing, IL 60438-3112

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

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

 Yes  Other. Specify traffic signal

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 19 of 23

Software Copyright (c) 1996-2016 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 16-27209 Doc 1 Filed 08/24/16 Entered 08/24/16 14:55:30 Desc Main

 Document Page 39 of 73
Debtor 1

Debtor 2

Allen L. Givhens, Jr.

Rosa M. Givhens Case number (if know)

4.5

5 Village of Rockdale, Illinois Last 4 digits of account number 4872 $200.00

Nonpriority Creditor's Name

Photo Enforcement Program

811 S. Larkin Avenue

Rockdale, IL 60436

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

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

 Yes  Other. Specify red light violations

4.5

6 Village of Willowbrook Last 4 digits of account number 0884 $200.00

Nonpriority Creditor's Name

c/o Linebarger Goggan Blair &

Samps

P O Box 06357

Chicago, IL 60606-0357

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

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

 Yes  Other. Specify red light violation

4.5

7 Wal-Mart / Synchrony Bank Last 4 digits of account number 2214 $1,100.00

Nonpriority Creditor's Name

attn: Bankruptcy Dept.

P O Box 965060

Orlando, FL 32896-5060

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

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

 Yes  Other. Specify credit card

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 20 of 23

Software Copyright (c) 1996-2016 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 16-27209 Doc 1 Filed 08/24/16 Entered 08/24/16 14:55:30 Desc Main

 Document Page 40 of 73
Debtor 1

Debtor 2

Allen L. Givhens, Jr.

Rosa M. Givhens Case number (if know)

4.5

8 WebBank Last 4 digits of account number

Allen

Givhens $8,000.00

Nonpriority Creditor's Name

215 South State Street

suite 800

Salt Lake City, UT 84111

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

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

 Yes  Other. Specify unsecured loan

4.5

9 Willowbrook Police Department Last 4 digits of account number 0884 $100.00

Nonpriority Creditor's Name

Automated Red Light Enforcement

P O Box 22091

Tempe, AZ 85285-2091

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

 Obligations arising out of a separation agreement or divorce that you did not

report as priority claims

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

 Yes  Other. Specify red light violation

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

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

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

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

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

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

AmeriCash Loans, LLC

2620 Columbus

unit 100

Ottawa, IL 61350

Line 4.2 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number

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

AmeriCash Loans, LLC

c/o Installment Loan Dept

880 Lee Street, suite 302

Des Plaines, IL 60016

Line 4.2 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number

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

Edward Health Ventures

EMG Bolingbrook

3471 Eagle Way

Chicago, IL 60678

Line 4.15 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 21 of 23

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Case 16-27209 Doc 1 Filed 08/24/16 Entered 08/24/16 14:55:30 Desc Main

 Document Page 41 of 73
Debtor 1

Debtor 2

Allen L. Givhens, Jr.

Rosa M. Givhens Case number (if know)

Last 4 digits of account number

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

Edward Health Ventures

c/o Merchants Credit Giude

223 West Jackson Blvd., suite 700

Chicago, IL 60606

Line 4.15 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number

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

Edward Health Ventures

26185 Network Place

Chicago, IL 60673-1261

Line 4.15 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number

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

First National Credit Card

P.O. Box 5097

Sioux Falls, SD 57117-5097

Line 4.20 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number

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

Ford Motor Credit Company

National Bankruptcy Service Center

P.O. Box 62180

Colorado Springs, CO 80962

Line 4.26 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number

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

Juniper Bank

Card Services

P.O. Box 13337

Philadelphia, PA 19101-3337

Line 4.36 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number

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

Quest Diagnostics

1355 Mittel Boulevard

attn: patient billing

Wood Dale, IL 60191-1024

Line 4.44 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number

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

Quest Diagnostics

c/o Invoice Audit Service

P O Box 559

Moon Twp, PA 15108

Line 4.44 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number

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

Speedway LLC

c/o NCO Financial Systems, Inc

P.O. Box 15630, Dept. 05

Wilmington, DE 19850-5630

Line 4.46 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number

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

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

type of unsecured claim.

Total Claim

6a. Domestic support obligations 6a. $ 0.00

Total

claims

from Part 1 6b. Taxes and certain other debts you owe the government 6b. $ 6,800.00

6c. Claims for death or personal injury while you were intoxicated 6c. $ 0.00

6d. Other. Add all other priority unsecured claims. Write that amount here. 6d. $ 0.00

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 22 of 23

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Case 16-27209 Doc 1 Filed 08/24/16 Entered 08/24/16 14:55:30 Desc Main

 Document Page 42 of 73
Debtor 1

Debtor 2

Allen L. Givhens, Jr.

Rosa M. Givhens Case number (if know)

6e. Total Priority. Add lines 6a through 6d. 6e. $ 6,800.00

Total Claim

6f. Student loans 6f. $ 0.00

Total

claims

from Part 2 6g. Obligations arising out of a separation agreement or divorce that

you did not report as priority claims 6g. $ 0.00

6h. Debts to pension or profit-sharing plans, and other similar debts 6h. $ 0.00

6i. Other. Add all other nonpriority unsecured claims. Write that amount

here.

6i.

$ 78,590.00

6j. Total Nonpriority. Add lines 6f through 6i. 6j. $ 78,590.00

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 23 of 23

Software Copyright (c) 1996-2016 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 16-27209 Doc 1 Filed 08/24/16 Entered 08/24/16 14:55:30 Desc Main

 Document Page 43 of 73
Fill in this information to identify your case:

Debtor 1 Allen L. Givhens, Jr.

First Name Middle Name Last Name

Debtor 2 Rosa M. Givhens

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

United States Bankruptcy Court for the: NORTHERN DISTRICT OF ILLINOIS

Case number

(if known)  Check if this is an

amended filing

Official Form 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 contacts of leases are listed on Schedule A/B:Property (Official Form 106 A/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

Name, Number, Street, City, State and ZIP Code

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

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

Software Copyright (c) 1996-2016 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 16-27209 Doc 1 Filed 08/24/16 Entered 08/24/16 14:55:30 Desc Main

 Document Page 44 of 73
Fill in this information to identify your case:

Debtor 1 Allen L. Givhens, Jr.

First Name Middle Name Last Name

Debtor 2 Rosa M. Givhens

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

United States Bankruptcy Court for the: NORTHERN DISTRICT OF ILLINOIS

Case number

(if known)  Check if this is an

amended filing

Official Form 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?

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

Name, Number, Street, City, State and ZIP Code

Column 2: The creditor to whom you owe the debt

Check all schedules that apply:

3.1  Schedule D, line

Name  Schedule E/F, line

 Schedule G, line

Number Street

City State ZIP Code

3.2  Schedule D, line

Name  Schedule E/F, line

 Schedule G, line

Number Street

City State ZIP Code

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

Software Copyright (c) 1996-2016 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 16-27209 Doc 1 Filed 08/24/16 Entered 08/24/16 14:55:30 Desc Main

 Document Page 45 of 73
Fill in this information to identify your case:

Debtor 1 Allen L. Givhens, Jr.

Debtor 2 Rosa M. Givhens

(Spouse, if filing)

United States Bankruptcy Court for the: NORTHERN DISTRICT OF ILLINOIS

Case number Check if this is:

(If known)  An amended filing

 A supplement showing postpetition chapter

13 income as of the following date:

Official Form 106I MM / DD/ YYYY

Schedule I: Your Income 12/15

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

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

spouse. If you are separated and your spouse is not filing with you, do not include information about your spouse. If more space is needed,

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

Part 1: Describe Employment

1. Fill in your employment

information. Debtor 1 Debtor 2 or non-filing spouse

If you have more than one job,

attach a separate page with

information about additional

employers.

Include part-time, seasonal, or

self-employed work.

Occupation may include student

or homemaker, if it applies.

Employment status

 Employed

 Not employed

 Employed

 Not employed

Occupation security guard loan processor

Employer's name Securitas Security Services PNC Bank, NA

Employer's address

150 S Wacker Drive

Chicago, IL 60606

Two PNC Plaza

620 Liberty Avenue

Pittsburgh, PA 15222

How long employed there? 11 years 5 years

Part 2: Give Details About Monthly Income

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

spouse unless you are separated.

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

more space, attach a separate sheet to this form.

For Debtor 1 For Debtor 2 or

non-filing spouse

2.

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

deductions). If not paid monthly, calculate what the monthly wage would be. 2. $ 1,822.00 $ 5,417.00

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

4. Calculate gross Income. Add line 2 + line 3. 4. $ 1,822.00 $ 5,417.00

Official Form 106I Schedule I: Your Income page 1

Case 16-27209 Doc 1 Filed 08/24/16 Entered 08/24/16 14:55:30 Desc Main

 Document Page 46 of 73
Debtor 1

Debtor 2

Allen L. Givhens, Jr.

Rosa M. Givhens Case number (if known)

For Debtor 1 For Debtor 2 or

non-filing spouse

Copy line 4 here 4. $ 1,822.00 $ 5,417.00

5. List all payroll deductions:

5a. Tax, Medicare, and Social Security deductions 5a. $ 371.00 $ 1,504.00

5b. Mandatory contributions for retirement plans 5b. $ 0.00 $ 0.00

5c. Voluntary contributions for retirement plans 5c. $ 238.00 $ 0.00

5d. Required repayments of retirement fund loans 5d. $ 256.00 $ 43.00

5e. Insurance 5e. $ 13.00 $ 509.00

5f. Domestic support obligations 5f. $ 0.00 $ 0.00

5g. Union dues 5g. $ 0.00 $ 0.00

5h. Other deductions. Specify: 5h.+ $ 0.00 + $ 0.00

6. Add the payroll deductions. Add lines 5a+5b+5c+5d+5e+5f+5g+5h. 6. $ 878.00 $ 2,056.00

7. Calculate total monthly take-home pay. Subtract line 6 from line 4. 7. $ 944.00 $ 3,361.00

8. List all other income regularly received:

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

profession, or farm

Attach a statement for each property and business showing gross

receipts, ordinary and necessary business expenses, and the total

monthly net income. 8a. $ 0.00 $ 0.00

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

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

regularly receive

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

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

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

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

8f. Other government assistance that you regularly receive

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

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

Nutrition Assistance Program) or housing subsidies.

Specify: 8f. $ 0.00 $ 0.00

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

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

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

10. Calculate monthly income. Add line 7 + line 9. 10. $ 944.00 + $ 3,361.00 = $ 4,305.00

Add the entries in line 10 for Debtor 1 and Debtor 2 or non-filing spouse.

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

Include contributions from an unmarried partner, members of your household, your dependents, your roommates, and

other friends or relatives.

Do not include any amounts already included in lines 2-10 or amounts that are not available to pay expenses listed in Schedule J.

Specify: 11. +$ 0.00

12. Add the amount in the last column of line 10 to the amount in line 11. The result is the combined monthly income.

12. $ 4,305.00

Write that amount on the Summary of Schedules and Statistical Summary of Certain Liabilities and Related Data, if it

applies

Combined

monthly income

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

 No.

 Yes. Explain:

Official Form 106I Schedule I: Your Income page 2

Case 16-27209 Doc 1 Filed 08/24/16 Entered 08/24/16 14:55:30 Desc Main

 Document Page 47 of 73
Fill in this information to identify your case:

Debtor 1 Allen L. Givhens, Jr. Check if this is:

 An amended filing

Debtor 2 Rosa M. Givhens  A supplement showing postpetition chapter

(Spouse, if filing) 13 expenses as of the following date:

United States Bankruptcy Court for the: NORTHERN DISTRICT OF ILLINOIS MM / DD / YYYY

Case number

(If known)

Official Form 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?  No

Do not list Debtor 1 and

Debtor 2.

 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?

Do not state the

dependents names. 2 children 26, 20

 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. $ 1,990.00

If not included in line 4:

4a. Real estate taxes 4a. $ 0.00

4b. Property, homeowner’s, or renter’s insurance 4b. $ 0.00

4c. Home maintenance, repair, and upkeep expenses 4c. $ 75.00

4d. Homeowner’s association or condominium dues 4d. $ 0.00

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

Official Form 106J Schedule J: Your Expenses page 1

Case 16-27209 Doc 1 Filed 08/24/16 Entered 08/24/16 14:55:30 Desc Main

 Document Page 48 of 73
Debtor 1

Debtor 2

Allen L. Givhens, Jr.

Rosa M. Givhens Case number (if known)

6. Utilities:

6a. Electricity, heat, natural gas 6a. $ 260.00

6b. Water, sewer, garbage collection 6b. $ 98.00

6c. Telephone, cell phone, Internet, satellite, and cable services 6c. $ 96.00

6d. Other. Specify: internet, cable, phone 6d. $ 110.00

cell telephones $ 250.00

7. Food and housekeeping supplies 7. $ 600.00

8. Childcare and children’s education costs 8. $ 0.00

9. Clothing, laundry, and dry cleaning 9. $ 150.00

10. Personal care products and services 10. $ 0.00

11. Medical and dental expenses 11. $ 150.00

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

Do not include car payments. 12. $ 280.00

13. Entertainment, clubs, recreation, newspapers, magazines, and books 13. $ 0.00

14. Charitable contributions and religious donations 14. $ 120.00

15. Insurance.

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

15a. Life insurance 15a. $ 60.00

15b. Health insurance 15b. $ 0.00

15c. Vehicle insurance 15c. $ 98.00

15d. Other insurance. Specify: 15d. $ 0.00

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

Specify: 16. $ 0.00

17. Installment or lease payments:

17a. Car payments for Vehicle 1 17a. $ 0.00

17b. Car payments for Vehicle 2 17b. $ 0.00

17c. Other. Specify: 17c. $ 0.00

17d. Other. Specify: 17d. $ 0.00

18. Your payments of alimony, maintenance, and support that you did not report as

deducted from your pay on line 5, Schedule I, Your Income (Official Form 106I). 18. $ 0.00

19. Other payments you make to support others who do not live with you. $ 0.00

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. $ 0.00

20b. Real estate taxes 20b. $ 0.00

20c. Property, homeowner’s, or renter’s insurance 20c. $ 0.00

20d. Maintenance, repair, and upkeep expenses 20d. $ 0.00

20e. Homeowner’s association or condominium dues 20e. $ 0.00

21. Other: Specify: 21. +$ 0.00

22. Calculate your monthly expenses

22a. Add lines 4 through 21. $ 4,337.00

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

22c. Add line 22a and 22b. The result is your monthly expenses. $ 4,337.00

23. Calculate your monthly net income.

23a. Copy line 12 (your combined monthly income) from Schedule I. 23a. $ 4,305.00

23b. Copy your monthly expenses from line 22c above. 23b. -$ 4,337.00

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

The result is your monthly net income. 23c. $ -32.00

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:

Official Form 106J Schedule J: Your Expenses page 2

Case 16-27209 Doc 1 Filed 08/24/16 Entered 08/24/16 14:55:30 Desc Main

 Document Page 49 of 73
Fill in this information to identify your case:

Debtor 1 Allen L. Givhens, Jr.

First Name Middle Name Last Name

Debtor 2 Rosa M. Givhens

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

United States Bankruptcy Court for the: NORTHERN DISTRICT OF ILLINOIS

Case number

(if known)  Check if this is an

amended filing

Official Form 106Dec

Declaration About an Individual Debtor's Schedules 12/15

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

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

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

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

Sign Below

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

 No

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

Declaration, and Signature (Official Form 119)

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

that they are true and correct.

X /s/ Allen L. Givhens, Jr. X /s/ Rosa M. Givhens

Allen L. Givhens, Jr. Rosa M. Givhens

Signature of Debtor 1 Signature of Debtor 2

Date August 24, 2016 Date August 24, 2016

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

Software Copyright (c) 1996-2016 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 16-27209 Doc 1 Filed 08/24/16 Entered 08/24/16 14:55:30 Desc Main

 Document Page 50 of 73
Fill in this information to identify your case:

Debtor 1 Allen L. Givhens, Jr.

First Name Middle Name Last Name

Debtor 2 Rosa M. Givhens

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

United States Bankruptcy Court for the: NORTHERN DISTRICT OF ILLINOIS

Case number

(if known)  Check if this is an

amended filing

Official Form 107

Statement of Financial Affairs for Individuals Filing for Bankruptcy 4/16

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 Prior Address: Dates Debtor 1

lived there

Debtor 2 Prior Address: Dates Debtor 2

lived there

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

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

$13,000.00  Wages, commissions,

bonuses, tips

 Operating a business

$38,000.00

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

Software Copyright (c) 1996-2016 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 16-27209 Doc 1 Filed 08/24/16 Entered 08/24/16 14:55:30 Desc Main

 Document Page 51 of 73
Debtor 1

Debtor 2

Allen L. Givhens, Jr.

Rosa M. Givhens Case number (if known)

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)

For last calendar year:

(January 1 to December 31, 2015 )

 Wages, commissions,

bonuses, tips

 Operating a business

$22,000.00  Wages, commissions,

bonuses, tips

 Operating a business

$62,000.00

For the calendar year before that:

(January 1 to December 31, 2014 )

 Wages, commissions,

bonuses, tips

 Operating a business

$30,000.00  Wages, commissions,

bonuses, tips

 Operating a business

$54,000.00

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

(before deductions

and exclusions)

For last calendar year:

(January 1 to December 31, 2015 )

ALG Transportation $6,000.00

For the calendar year before that:

(January 1 to December 31, 2014 )

ALG Transportation $13,000.00

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 $6,425* or more?

 No. Go to line 7.

 Yes List below each creditor to whom you paid a total of $6,425* 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 4/01/19 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 and Address Dates of payment Total amount

paid

Amount you

still owe

Was this payment for ...

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

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Debtor 1

Debtor 2

Allen L. Givhens, Jr.

Rosa M. Givhens Case number (if known)

Creditor's Name and Address Dates of payment Total amount

paid

Amount you

still owe

Was this payment for ...

Nationstar Mortgage

attn: bankruptcy notices

350 Highland Drive

Lewisville, TX 75067

$1,990.00 $250,000.00  Mortgage

 Car

 Credit Card

 Loan Repayment

 Suppliers or vendors

 Other

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

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

of which you are an officer, director, person in control, or owner of 20% or more of their voting securities; and any managing agent, including one for

a business you operate as a sole proprietor. 11 U.S.C. § 101. Include payments for domestic support obligations, such as child support and

alimony.

 No

 Yes. List all payments to an insider.

Insider's Name and Address Dates of payment Total amount

paid

Amount you

still owe

Reason for this payment

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 to an insider

Insider's Name and Address Dates of payment Total amount

paid

Amount you

still owe

Reason for this payment

Include creditor's name

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

Travelers Property v. Givhens

16 SC 3117

unpaid insurance

premium

Circuit Court of Will County

Joliet, IL

 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 Name and Address Describe the Property

Explain what happened

Date Value of the

property

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

accounts or refuse to make a payment because you owed a debt?

 No

 Yes. Fill in the details.

Creditor Name and Address Describe the action the creditor took Date action was

taken

Amount

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

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Debtor 1

Debtor 2

Allen L. Givhens, Jr.

Rosa M. Givhens Case number (if known)

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

Person to Whom You Gave the Gift and

Address:

Describe the gifts Dates you gave

the gifts

Value

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

 No

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

Gifts or contributions to charities that total

more than $600

Charity's Name

Address (Number, Street, City, State and ZIP Code)

Describe what you contributed Dates you

contributed

Value

Part 6: List Certain Losses

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

or gambling?

 No

 Yes. Fill in the details.

Describe the property you lost and

how the loss occurred

Describe any insurance coverage for the loss

Include the amount that insurance has paid. List pending

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

Date of your

loss

Value of property

lost

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

Address

Email or website address

Person Who Made the Payment, if Not You

Description and value of any property

transferred

Date payment

or transfer was

made

Amount of

payment

Cricket Debt Counseling

10121 SE Sunnyside Road

Clackamas, OR 97015

$36 paid for pre-filing counseling $36.00

Scheinbaum & West, LLC

P.O. Box 5009

Vernon Hills, IL 60061-5009

$335 paid for filing fee and $900 paid

for bankruptcy fee

$1,235.00

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

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Debtor 1

Debtor 2

Allen L. Givhens, Jr.

Rosa M. Givhens Case number (if known)

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

Address

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

Address

Person's relationship to you

Description and value of

property transferred

Describe any property or

payments received or debts

paid in exchange

Date transfer was

made

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 of 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 and

Address (Number, Street, City, State and 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

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

Address (Number, Street, City, State and ZIP Code)

Who else had access to it?

Address (Number, Street, City,

State and ZIP Code)

Describe the contents Do you still

have it?

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

Address (Number, Street, City, State and ZIP Code)

Who else has or had access

to it?

Address (Number, Street, City,

State and ZIP Code)

Describe the contents Do you still

have it?

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

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Debtor 1

Debtor 2

Allen L. Givhens, Jr.

Rosa M. Givhens Case number (if known)

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

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

for someone.

 No

 Yes. Fill in the details.

Owner's Name

Address (Number, Street, City, State and ZIP Code)

Where is the property?

(Number, Street, City, State and ZIP

Code)

Describe the property Value

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

Address (Number, Street, City, State and ZIP Code)

Governmental unit

Address (Number, Street, City, State and

ZIP Code)

Environmental law, if you

know it

Date of notice

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

 No

 Yes. Fill in the details.

Name of site

Address (Number, Street, City, State and ZIP Code)

Governmental unit

Address (Number, Street, City, State and

ZIP Code)

Environmental law, if you

know it

Date of notice

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

Name

Address (Number, Street, City,

State and ZIP Code)

Nature of the case Status of the

case

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

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

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Debtor 1

Debtor 2

Allen L. Givhens, Jr.

Rosa M. Givhens Case number (if known)

 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

Address

(Number, Street, City, State and ZIP Code)

Describe the nature of the business

Name of accountant or bookkeeper

Employer Identification number

Do not include Social Security number or ITIN.

Dates business existed

ALG Transportation, Inc

6 Caribou Court

Bolingbrook, IL 60490

independent contractor; delivery

service for Fast Way Trucking.

Debtor has 3 drivers (independent

contractors) who drive his

vehicles.

EIN:

From-To

xx-xxx2113

July, 2010- April, 2016

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

institutions, creditors, or other parties.

 No

 Yes. Fill in the details below.

Name

Address

(Number, Street, City, State and ZIP Code)

Date Issued

Part 12: Sign Below

I have read the answers on this Statement of Financial Affairs and any attachments, and I declare under penalty of perjury that the answers

are true and correct. I understand that making a false statement, concealing property, or obtaining money or property by fraud in connection

with a bankruptcy case can result in fines up to $250,000, or imprisonment for up to 20 years, or both.

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

/s/ Allen L. Givhens, Jr. /s/ Rosa M. Givhens

Allen L. Givhens, Jr. Rosa M. Givhens

Signature of Debtor 1 Signature of Debtor 2

Date August 24, 2016 Date August 24, 2016

Did you attach additional pages to Your Statement of Financial Affairs for Individuals Filing for Bankruptcy (Official Form 107)?

 No

 Yes

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

 No

 Yes. Name of Person . Attach the Bankruptcy Petition Preparer's Notice, Declaration, and Signature (Official Form 119).

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

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Fill in this information to identify your case:

Debtor 1 Allen L. Givhens, Jr.

First Name Middle Name Last Name

Debtor 2 Rosa M. Givhens

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

United States Bankruptcy Court for the: NORTHERN DISTRICT OF ILLINOIS

Case number

(if known)  Check if this is an

amended filing

Official Form 108

Statement of Intention for Individuals Filing Under Chapter 7 12/15

If you are an individual filing under chapter 7, you must fill out this form if:

 creditors have claims secured by your property, or

 you have leased personal property and the lease has not expired.

You must file this form with the court within 30 days after you file your bankruptcy petition or by the date set for the meeting of creditors,

whichever is earlier, unless the court extends the time for cause. You must also send copies to the creditors and lessors you list

on the form

If two married people are filing together in a joint case, both are equally responsible for supplying correct information. Both debtors must

sign and date the form.

Be as complete and accurate as possible. 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).

Part 1: List Your Creditors Who Have Secured Claims

1. For any creditors that you listed in Part 1 of Schedule D: Creditors Who Have Claims Secured by Property (Official Form 106D), fill in the

information below.

Identify the creditor and the property that is collateral What do you intend to do with the property that

secures a debt?

Did you claim the property

as exempt on Schedule C?

Creditor's Bank of America, NA  Surrender the property.  No

 Yes

name:  Retain the property and redeem it.

 Retain the property and enter into a

Description of 6 Caribou Court Bolingbrook, Reaffirmation Agreement.

property IL 60490 Will County  Retain the property and [explain]:

securing debt: continue paying mortgage

Creditor's Ford Motor Credit Company  Surrender the property.  No

 Yes

name:  Retain the property and redeem it.

 Retain the property and enter into a

Description of 2008 Ford E-150 Econoline van Reaffirmation Agreement.

property To be surrendered  Retain the property and [explain]:

securing debt:

Creditor's Nationstar Mortgage  Surrender the property.  No

 Yes

name:  Retain the property and redeem it.

 Retain the property and enter into a

Description of 6 Caribou Court Bolingbrook, Reaffirmation Agreement.

property IL 60490 Will County  Retain the property and [explain]:

Official Form 108 Statement of Intention for Individuals Filing Under Chapter 7 page 1

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Debtor 1

Debtor 2

Allen L. Givhens, Jr.

Rosa M. Givhens Case number (if known)

securing debt: continue paying mortgage

Part 2: List Your Unexpired Personal Property Leases

For any unexpired personal property lease that you listed in Schedule G: Executory Contracts and Unexpired Leases (Official Form 106G), fill

in the information below. Do not list real estate leases. Unexpired leases are leases that are still in effect; the lease period has not yet ended.

You may assume an unexpired personal property lease if the trustee does not assume it. 11 U.S.C. § 365(p)(2).

Describe your unexpired personal property leases Will the lease be assumed?

Lessor's name:  No

 Yes

Description of leased

Property:

Lessor's name:  No

 Yes

Description of leased

Property:

Lessor's name:  No

 Yes

Description of leased

Property:

Lessor's name:  No

 Yes

Description of leased

Property:

Lessor's name:  No

 Yes

Description of leased

Property:

Lessor's name:  No

 Yes

Description of leased

Property:

Lessor's name:  No

 Yes

Description of leased

Property:

Part 3: Sign Below

Under penalty of perjury, I declare that I have indicated my intention about any property of my estate that secures a debt and any personal

property that is subject to an unexpired lease.

X /s/ Allen L. Givhens, Jr. X /s/ Rosa M. Givhens

Allen L. Givhens, Jr. Rosa M. Givhens

Signature of Debtor 1 Signature of Debtor 2

Date August 24, 2016 Date August 24, 2016

Official Form 108 Statement of Intention for Individuals Filing Under Chapter 7 page 2

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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: Liquidation

$245 filing fee

 $75 administrative fee

+ $15 trustee surcharge

$335 total fee

Chapter 7 is for individuals who have financial

difficulty preventing them from paying their debts

and who are willing to allow their nonexempt

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 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:

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 Bankruptcy Code:

Chapter 7 - Liquidation

Chapter 11 - Reorganization

Chapter 12 - Voluntary repayment plan

for family farmers or

fishermen

Chapter 13 - 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.

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

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most fines, penalties, forfeitures, and criminal

restitution obligations; and

certain debts that are not listed in your bankruptcy

papers.

You may also be required to pay debts arising from:

fraud or theft;

fraud or defalcation while acting in breach of

fiduciary capacity;

intentional injuries that you inflicted; and

death or personal injury caused by operating a

motor vehicle, vessel, or aircraft while intoxicated

from alcohol or drugs.

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 must file Chapter 7 Statement of Your Current

Monthly Income (Official Form 122A–1) if you are an

individual filing 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,

the Chapter 7 Means Test Calculation (Official Form

122A–2).

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

must file a second form —the Chapter 7 Means Test

Calculation (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 creditors. If

your income is more than the median income for your

state of residence and family size, depending on the

results of the Means Test, the U.S. trustee, 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 called exempt property. Exemptions may

enable you to 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 must list it on Schedule C: The Property You Claim

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

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

proceeds to your creditors.

Chapter 11: Reorganization

$1,167 filing fee

+ $550 administrative fee

$1,717 total fee

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.

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

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.

Chapter 12: Repayment plan for family

farmers or fishermen

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:

domestic support obligations,

most student loans,

certain taxes,

debts for fraud or theft,

debts for fraud or defalcation while acting in a

fiduciary capacity,

most criminal fines and restitution obligations,

certain debts that are not listed in your

bankruptcy papers,

certain debts for acts that caused death or

personal injury, and

certain long-term secured debts.

$200 filing fee

+ $75 administrative fee

$275 total 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.

Chapter 13: Repayment plan for

individuals with regular

income

$235 filing fee

+ $75 administrative fee

$310 total 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.

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

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Warning: File Your Forms on Time

A married couple may file a bankruptcy case

together—called a joint case. If you file a joint case and

each 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.

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

days before you file your bankruptcy petition. This

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

.

In Alabama and North Carolina, go to:

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

BankruptcyResources/ApprovedCredit

AndDebtCounselors.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.

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 the local rules of the court.

For more information about the documents and

their deadlines, go to:

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

s.html#procedure.

Bankruptcy crimes have serious consequences

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.

Make sure the court has your mailing address

The bankruptcy court sends notices to the mailing

address you list on Voluntary Petition for Individuals

Filing for Bankruptcy (Official Form 101). To ensure

that you receive information about your case,

Bankruptcy Rule 4002 requires that you notify the court

of any changes in your address.

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

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B2030 (Form 2030) (12/15)

United States Bankruptcy Court

Northern District of Illinois

In re

Allen L. Givhens, Jr.

Rosa M. Givhens Case No.

Debtor(s) Chapter 7

DISCLOSURE OF COMPENSATION OF ATTORNEY FOR DEBTOR(S)

1. 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:

For legal services, I have agreed to accept $ 900.00

Prior to the filing of this statement I have received $ 900.00

Balance Due $ 0.00

2. $ 335.00 of the filing fee has been paid.

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

 Debtor  Other (specify):

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

 Debtor  Other (specify):

5.  I have not agreed to share the above-disclosed compensation with any other person unless they are members and associates of my law firm.

 I have agreed to share the above-disclosed compensation with a person or persons who are not members or associates of my law firm. A

copy of the agreement, together with a list of the names of the people sharing in the compensation is attached.

6. 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, statement 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;

d. [Other provisions as needed]

Negotiations with secured creditors to reduce to market value; exemption planning; preparation and filing of

reaffirmation agreements and applications as needed; preparation and filing of motions pursuant to 11 USC

522(f)(2)(A) for avoidance of liens on household goods.

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

Representation of the debtors in any adversary proceeding.

CERTIFICATION

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.

August 24, 2016 /s/ Marc C. Scheinbaum

Date Marc C. Scheinbaum 6180394

Signature of Attorney

Scheinbaum & West, LLC

P. O. Box 5009

Vernon Hills, IL 60061-5009

815-636-4676

amerlincat@aol.com

Name of law firm

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United States Bankruptcy Court

Northern District of Illinois

In re

Allen L. Givhens, Jr.

Rosa M. Givhens Case No.

Debtor(s) Chapter 7

VERIFICATION OF CREDITOR MATRIX

Number of Creditors: 74

The above-named Debtor(s) hereby verifies that the list of creditors is true and correct to the best of my

(our) knowledge.

Date: August 24, 2016 /s/ Allen L. Givhens, Jr.

Allen L. Givhens, Jr.

Signature of Debtor

Date: August 24, 2016 /s/ Rosa M. Givhens

Rosa M. Givhens

Signature of Debtor

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}bk1{Credito AresMatix}bk{

Adventist Hinsdale Hospital

c/o Merchants Credit Giude

223 West Jackson Blvd., suite 900

Chicago, IL 60606

AmeriCash Loans, LLC

1726 Jefferson Blvd

Joliet, IL 60435

AmeriCash Loans, LLC

2620 Columbus

unit 100

Ottawa, IL 61350

AmeriCash Loans, LLC

c/o Installment Loan Dept

880 Lee Street, suite 302

Des Plaines, IL 60016

Ashley Stewart Credit Card/ WFNNB

Bankruptcy Department

P.O. Box 182125

Columbus, OH 43218-2125

Avenue / WFNNB

Bankruptcy Department

P.O. Box 182125

Columbus, OH 43218-2125

Bank of America, NA

c/o Weiss McClelland, LLC

105 W. Adams Street, suite 1850

Chicago, IL 60603

Bill Me Later / Master Card

P.O. Box 2394

Omaha, NE 68103-2394

Capital One Bank, USA

c/o Echelon Recovery

P O Box 1880

Voorhees, NJ 08043

Capital One Master Card

P.O. Box 30285

Salt Lake City, UT 84130-0285

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Capital One Visa

P.O. Box 30285

Salt Lake City, UT 84130-0285

Chase Bank

Cardmember Services

P.O. Box 15298

Wilmington, DE 19885-5298

Chase Bank

P O Box 659754

San Antonio, TX 78265-9751

City of Chicago

Department of Revenue (parking tic)

P.O. Box 88292

Chicago, IL 60680-1292

City of Chicago - Dept of Revenue

c/o Arnold Harris, Atty at Law

222 Merchandise Mart Plaza, # 1932

Chicago, IL 60680-5625

City of Chicago - Dept of Revenue

c/o Lineberget Goggan Blair Sampson

P O Box 06152

Chicago, IL 60606-0152

Direct Merchants Bank

Cardmember Services

P.O. Box 5894

Carol Stream, IL 60197-5894

Edward Health Ventures

c/o MiraMed Revenue Group, LLC

Dept 77304, P O Box 77000

Detroit, MI 48277-0304

Edward Health Ventures

EMG Bolingbrook

3471 Eagle Way

Chicago, IL 60678

Edward Health Ventures

26185 Network Place

Chicago, IL 60673-1261

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Edward Health Ventures

c/o Merchants Credit Giude

223 West Jackson Blvd., suite 700

Chicago, IL 60606

Edward-Elmhurst Health

P O Box 140250

Toledo, OH 43614

F C & A

103 Clover Green

Peachtree City, GA 30269

Family Foot and Ankle Care

550 E. Boughton Road

# 195

Bolingbrook, IL 60440-2189

Fingerhut Advantage

P.O. Box 166

Newark, NJ 07101-0166

First National Bank - Legacy Vis

c/o Focus Receiveables Management

1130 Northchase Pkwy, # 150

Marietta, GA 30067

First National Credit Card

P.O. Box 5097

Sioux Falls, SD 57117-5097

First Premier Bank

P.O. Box 5524

Sioux Falls, SD 57117-5524

First Premier Bank

P.O. Box 5524

Sioux Falls, SD 57117-5524

First Premier Bank

c/o Rushmore Service Center

P O Box 5508

Sioux Falls, SD 57117-5508

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First Premier Bank

P.O. Box 5524

Sioux Falls, SD 57117-5524

First Rate Financial

880 Lee Street

suite 302

Des Plaines, IL 60016-6487

Ford Motor Credit Company

c/o National Bankruptcy Service Ctr

P.O. Box 6275

Dearborn, MI 48121

Ford Motor Credit Company

P O Box 689007

Franklin, TN 37068

Ford Motor Credit Company

National Bankruptcy Service Center

P.O. Box 62180

Colorado Springs, CO 80962

Gettington.com

P O Box 166

Newark, NJ 07101-0166

Hollywood Video

c/o West Bay Acquisitions

P O Box 8009

Cranston, RI 02920

HSBC Card Services

P.O. Box 80084

Salinas, CA 93912-0084

HSBC Card Services

P.O. Box 80084

Salinas, CA 93912-0084

HSBC Card Services

c/o Cardmember Services

P.O. Box 5262

Carol Stream, IL 60197-5262

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Illinois Department of Insurance

320 West Washington Street

Springfield, IL 62767

Illinois State Tollway Highway Auth

c/o Arnold Scott Harris, PC

222 Merchandise Mart Plaza, # 1932

Chicago, IL 60654-1420

Illinois Tollway / State of Illinoi

Violation Processing Center

P O Box 5201

Lisle, IL 60532-5201

Internal Revenue Service

P.O. Box 7346

Philadelphia, PA 19101-7346

J D Williams - Comenity Capital

attn: Bankruptcy Department

P.O. Box 183043

Columbus, OH 43218-3043

Juniper Bank

Card Services

P.O. Box 8802

Wilmington, DE 19899-8802

Juniper Bank

Card Services

P.O. Box 13337

Philadelphia, PA 19101-3337

King Size Comenity Bank

attn: Bankruptcy Department

P.O. Box 182125

Columbus, OH 43218-2125

Lane Bryant / WFNNB

Bankruptcy Department

P.O. Box 182125

Columbus, OH 43218-2125

Lifetime Fitness

1220 Lakeview Drive

Romeoville, IL 60446

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Massey's

Special Account Handling

P O Box 2822

Monroe, WI 53566-8022

Massey's

c/o Professional Recovery Consultan

P O Box 51187

Durham, NC 27717-1187

medical debt

c/o Professional Account Management

2040 W. Wisconsin Avenue

Milwaukee, WI 53233

Nationstar Mortgage

attn: bankruptcy notices

350 Highland Drive

Lewisville, TX 75067

North Texas Tollway Authority

c/o Professional Acct Management

P O Box 866608

Plano, TX 75086-6608

Quest Diagnostics

c/o American Medical Collection

4 Westchester Plaza, suite 110

Elmsford, NY 10523

Quest Diagnostics

1355 Mittel Boulevard

attn: patient billing

Wood Dale, IL 60191-1024

Quest Diagnostics

c/o Invoice Audit Service

P O Box 559

Moon Twp, PA 15108

Quick Click

P.O. Box 5040

Alpharetta, GA 30023

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Speedway LLC

c/o NCO Financial Systems, Inc

P.O. Box 15630, Dept. 05

Wilmington, DE 19850-5630

Speedway, LLC

c/o NCO Financial Systems, Inc

P O Box 9186

Dublin, OH 43017-4186

TCF National Bank

c/o Professional Account Management

P O Box 391

Milwaukee, WI 53201-0391

The Kroger Company

1014 Vine Street

Cincinnati, OH 45202-1100

The Rawlings Company

Subrogation Division

P O Box 2000

La Grange, KY 40031-2000

Travelers Insurance

Premium Audit

P O Box 3556

Orlando, FL 32802

Travelers Prop Casu of America

c/o Blitt and Gaines, PC

661 Glenn Avenue

Wheeling, IL 60090

U.S. Department of Education

Direct Loan Servicing Center

P. O. Box 530260

Atlanta, GA 30353-0260

Village of Justice

P O Box 7728

Carol Stream, IL 60197-7728

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Village of Justice

c/o Municipal Collections of Americ

3348 Ridge Road

Lansing, IL 60438-3112

Village of Rockdale, Illinois

Photo Enforcement Program

811 S. Larkin Avenue

Rockdale, IL 60436

Village of Willowbrook

c/o Linebarger Goggan Blair & Samps

P O Box 06357

Chicago, IL 60606-0357

Wal-Mart / Synchrony Bank

attn: Bankruptcy Dept.

P O Box 965060

Orlando, FL 32896-5060

WebBank

215 South State Street

suite 800

Salt Lake City, UT 84111

Willowbrook Police Department

Automated Red Light Enforcement

P O Box 22091

Tempe, AZ 85285-2091

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