United States Bankruptcy Court for the:

Northern District of lllinois

Case number Uf known\:

?ffi#arefilins under;

E Chaprerll

E Chapterl2

E Chapter13 E Check if this is an

amended filing

Official Form 101

voluntary Petition for rndividuars Firing for Bankruptcy 12t15

s.

Be as comptete and accurate as possible' lf two married people are filing together, both are equally responsible for supprylng correct

ll?lffiffilt"fil";:ffiJ::,",:led' attach a separate sheet to this rorir. dn the top or any aooitionar pases, wrire your naml ana case number

t. Your full name

Write the name that is on your

govemment-issued picture

identification (for example,

your drive/s license or

passport).

Bring your picture

identification to your meeting

with the trustee.

Elvia

Middle name

Ayala

Sufiix (Sr., Jr., tt, il)

About Debtor 2 {Spouse Only in a Joint Gase):

Last name

Sufix (Sr., Jr., tl, ilt)

z. All other names you

have used in the last g

years

Include your manied or

maiden names.

-

Inruurttam' 

-

Last name

Last name Last name

s. Only the last 4 digits of

your Social Security

number or federal

Individual Taxpayer

ldentification number

0T|N)

xxx - )o( -

OR

. 9xx - xx -

0585 )oo( - nOR

9xx - xx -

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

Case 16-25219 Doc 1 Filed 08/05/16 Entered 08/05/16 11:40:08 Desc Main

 Document Page 1 of 8
Debtor 1

Case number

About Debtor l:

El I have not used any busrness names or ElNs.

About Debtor 2 (Spouse Only in a Joint Gase):

Q I hav" not used any business names or ElNs.

4. Any business names

i and Employer

i ldentificationNumbers

I (ElN) you have used in

, the last 8 years

Include kade names and

doing business €s names

5. Where you live

Why you are choosing

this dtstrictto file for

bankruptcy

Business name

Business name

IL 60638

address is different fiorn the one

here. Note that the court will send

t 180 days before filing this petition,

in this district longer than in any

D I have reason. Exdain.

s 1408.)

above, ffll lt

any notices you at this mailing address.

Check one:

E Over the

Eusiness name

Business name

EIN 

-

EIN 

-

lf Debtor 2 lives at a different address:

Stiate ZIP Code

county

lf Debtor 2's mailing address is difrerent from

yourc, fill it In here. Note that the court will send

any notices to this mailing address.

P.O. Box

Crty Z|PCode

EX.t

EIN

ch

6119W

Cook

lf your

I have

other

City

Check one:

E Over the last 180 days before filing this petition,

I have lived in this district longer than in any

other districl.

O I have anotherreason. Explain.

(See 28 U.s.C. S 1408.)

Official Form 101

(See 28

Petition for Individuab Filing fior Bankruptcy

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 Document Page 2 of 8
Debtor 1

Case number

Tell the Gourt About your Bankruptcy Case

?. The chapter ofthe

Bankruptcy Code you

are choosing to file

under

Check one. (For a brief description of each, see Nofrce Required by,, U.S.C. $ j

ror Bankrupicy ir"-lyrii) fu.;, ;"Iil;I;;;fi;;" 1 and check ne 

^pp,opl!(J?Jl.r 

tndividuats Fitins

El Chapter 7

E Chapter 11

D Chapter 12

E Chapter 13

a' How you will pay the fee E I witt pay the entire fee when | file my petition. please check with the clerk,s office in your locar court for more detairs about how.yoy may pay. Typicaily, if you are paying the fee yourself, you may pay with cash, cashier's cneci, br- ron"y orcei. tt youi 

"itor-n"v 

i" submitting your p€yment on your behall your attorney ,"j pry with a credit card or check with a pre-printed address.

fl I need to pay the fee in installments. lf you choose this option, sign and attach the Application for lndividuals to Pay The Fitiig Fee in tnstailmJnts lomciat Form 103A).

E lreque

By aw, ;:::::;H[]::il:Jiry#,:l#5',J less tha

pay the to your family size and you are unable to chapter fi: ;Hil*,#'J:,?fi:'"".n to Have the

s. Have you filed for E ruo bankruptcy within the

last 8 years? lJ Yes. Distict

Disbic{

MM/ DD/YYYY

MM/ DD/YYYY

MM/ DD/YYYY

Case number

Case number

Case number

ro. 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

affiiliate?

Z t'to

O Yes. tlebror

Districl

Debtor

Distdct

Relationship to you

When Case number.

MM/DD /YYYY

Relationship to you

Case number, if knorrrn

MM / DD /YYYY

tt. Do you rent your

residence? O wo.

El Yes

Go to line 12.

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

El No. Go ro tine 12.

D Yes' Fill out /nrlrbl Sta tement About an Eviction Judgment Against you (Form 1 01A) and lile it with this bankruptcy petition.

fficial Form 10'1 Voluntary Petition ior IndMduab Filing fior Bankruptcy page 3

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Debtor 1

Report About Any Businesses you Own as a Sole proprletor

Case number (/fk ownt

12. Aie you a sole proprietor

of any full- or part-time

business?

A sole proprietorship is a

business you operate as an

individual, and is not a

separate legal entity such as

a corporation, partnership, or

LLC.

lf you have more than one

sole proprietorship, use a

separate sheet and attach it

to this petition.

E No. co to part 4.

O Yes. Name and location of business

State ZIP Code

Check the appropriate box to describe your business:

D Health Care Business (as defined in 1 1 U.S.C. S 101 (27A))

D Singte Asset Real Estate (as defined in 1 1 U.S.C. S 1Ol (S1 B))

D Stockbroker (as defined in 1.t U.S.C. S 101(53,4))

E Commodity Broker (as defined in 11 U.S.C. S iOj(6))

O None ofthe above

i3. Are you filing under

Chapter 11 ofthe

Bankruptcy Code and

are you a small buslness

debto12

For a definition of small

busrness debtor,see 'rl u.s.c. s 101(51D).

lf you are tiling under Chapter 1 1, the couft must know whether you are a small busrness debtor so that it ?i;llili'" ;#3:,'"Hi"T:ff?:n#hffi'"1y""1il,H.. n

not exist, ure in 1j U.S.C. $ j 116(1XB).

E ruo. t am not filing under Chapter 1j.

O No. l. am filing under Chapter 1 1 , but I am NoT a small business debtor according to the definition in the Bankruptcy Code.

D Yes. I am. filing un-der Chapter 11 and I am a small business debtor according to the delinition in the Bankruptcy Code.

Own or Have Any Hazardous Properel or fuy property That l{eeds lrnmediaie Aftention

tl. 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 safetyr?

Or do you own any

propefi that needs

immediate aftention?

For example, do you own

perishable goods, or livestock

that must be fed, or a building

that needs urgent repairs?

El tto

E Yes. What is the hazard?

lf immediate attention is needed, why is it needed?

Where is the propertlp

Number Steet

City ZIP Code

page 4

fficial Form 101 Vduntary Petftion for lndividuab Filing for Bankruptcy

State

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 Document Page 4 of 8
Debtor 1

Case number

Explain Your Efforts to Receive a Briefing About credit counsering

ts. 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. lf you

cannot do so, you are not

eligible to file.

lf you file anyway, the court

can dismiss your case, you

will lose whatever filing iee

you paid, and your creditors

can begin collection activities

agatn.

About Debtor 1:

You musf checkone:

EI br an app

ag the 18 t

nk ion. an lc

Attach a copy of the certificate and the payment

plan, if any, that you developed with the 

"6"n"V. tr br an ap dit

ag the 1 fore I

nk ion, b have a

fc

Wtf11. ]J_Ogys after you fite this bankruptcy petition,

Ip, I\4.UST fite a copy of the certificate anOibyment plan, if any.

To ask for a

requirement

what efforts

you were un

bankruptcy,

required you to file this case.

dism

ur re ino a

filed

Any extension of the 30iay deadline is granted

only for cause and is limited to a maximr-irn of 15

days.

O I am.not required to receive a brie{ing about credit counseling because of:

E Incapacity. I have a mental illness or a mental

deficiency that makes me

incapable of realizing or making

rational decisions about finances.

E Disability. My physical disability causes me

to be unable to participate in a

briefing in person, by phone, or

through the interne! even after I

reasonably tried to do so.

E Active duty. I am cunenfly on active militarv

duty in a military combat zone.

lf you believe you ar ive a

briefing about credit file a

motion for waiver of the court.

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

You must check one

E I received a briefing from an approved credit counseling agency within the 1g0 days before I

flled tnts bankruptcy petition, and I received a

certificate of completion.

Attach a copy of the certificate and the oavment plan, if any, that you developed with the agen"y.

E I received a briefing from an approved credit counseling agency within the 1g0 days before I

filed this bankruptcy petition, but I do not trave a

certifi cate of completion.

Wtnj1. lJ_Ogys after you fite this bankruptcy petition,

you MUST file a copy of the certificate and'payment plan, if any.

E I certify that I asked for credit counseling

seryices from an approved agency, but ias

unable to obtain those servicls during the 7

days after I made my request, and exilent

ctrcumstances 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 tain the briefing, wliy

you were unable before you filed for 

-

bankruptcy, and igent circumstances

required you to file this case.

Your case may be dismissed if the court is

dissatisfied with your reasons for not receivino a

briefing before you filed for bankruptcy.

lf the court is satisfied with your reasons, you must

still receive.a briefing within 30 days after you file.

You must file a certmcate from the approved

agency, a copy of the payrnent plan you develop f you do not do sb, youi os"

may be

Any extension of the 30day deadline is granted

only for cause and is limited to a maximr.irn of 15

oays.

E I am-not required to receive a briefing about

credit counseling because of:

D lncapacity, I have a mental illness or a menfal

deficiency that makes me

incapable of realizino or makino

rational decisions about financJs.

D 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.

E Active duty. I am cunenfly on active militarv

duty in a military combat zone.

lf 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.

fficial Form 101 Voluntary Petition for lndividuals Filing for Bankruptcy page 5

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Debtor 1

Case number trkaowh)

Answer These Questions for Reporting purposes

16. What kind of debts do

you have?

17. Are you filing under

Chapter 7?

Do you estimate that after

any exempt property is

excluded and

administrative expenses

are paid that funds will be

available for distribution

you estimate that you

owe?

16a. Ar.e your debts primarily consumer debts? consumer debfs are defined in 11 U.s.c. s 101(s)

as "incuned by an individuar primariry for a personar, famiry, or househord purpose.,,

Er\o. Go to line 16b.

Ef Yes. Go to tine 17.

'16b' Are your debts primarily business debts? Busrness debts are debts that you incuned to obtain money for a business or investment or through the operation of the business or Investment.

El No. eo to line .16c.

E Yes. Go to line 17.

1 6c. State the type of debts you owe that are not consumer debts or business debts.

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

E Yes' I am.filing under Chapter 7. Do you eslimate that after any exempt property is excluded and administrative expenses are paid that funds will be availaLle to dlstribJte to unsecured creditors?

Druo

El Yes

to unsecured creditors?

ra. How many creditors do [i't<s

E so-se

El roo-rgg

O zoo-ses

D t,ooo-s,ooo

D s,oor-to,ooo

O ro,oor-zs,ooo

D zs,oor-so,ooo

D so,oot-roo.ooo

D More than 100,000

19. How much do you

estimate your assets to

be worth?

E $o-$so.ooo

E $so,oor-$roo,ooo

E $roo,oor-$soo.ooo

E $soo,oot-$1 milion

D $t,ooo,oot-$10 miilion

E $to,ooo,oo1-$50 milion

E $so,ooo,oo1-$1 oo miuion

E $too,ooo,oo1-$5oo miilion

D $soo,ooo,oo1-$1 bilion

E $r,ooo,ooo,oo1-$10 bilion

E $t o,ooo,ooo,oo1-$50 bilion

O More than $50 billion

zo. How much do you_ 

_ - E $o-$so,ooo E $t,ooo,oot-$10 milion D $soo,ooo,o01-$1 bilion estimate your llabilities ! $50,001-g't00,000 E $ro,ooo,oo1-$50 mirion o sr,ooopoo,oor-$,0 0,,,,- to be? tr sroo,oor-$500,000 E $so,ooo,oo'r-$100 mirion E $ro,ooo,oo0,001-$s0 birion

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

lf I have chosen to file under Chapter 7, I am aware that I may proceed, if eligible, under chapter 7 , 11,12, or 13 of title 1 1 , United States Code. I understand the relief availabie'under each c"napter, and I choose to prbGeJ under Chapter 7.

lf no attomey represents me and t did not pay or agree to pay someone who is not an attomey to help me fill out this document, I have obtained and read the notice requireo 6y t t u.s.c. s 342(b).

I request relief in accordance with the chapter of title 1 1, United States Code, specified in this petition.

I understand making a false statement, concealing property, or obtaining money or property by fraud in connection y:tf ,1blnllrql"y. W*.-l::sutt in fines up to $zso,obo, or imprisonmEnt for up to 20'years, or both.

,c ,C

Executedon 03/cS

Signature of Debtor 2

Executed on

MM '/ DD /YYYY

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

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 Document Page 6 of 8
Debtor 1

For your attomey, if you are

represented by one

lf you are not represented

by an attorney, you do not

need to file this page.

Case number (rr

l;t|i"lltlfiLll ff"'#Tt:l'?T:1'1"'T,',::^oP': *:!,:Iilrl'y" inrormed the debtor(s) about erisibirity

:""1,iff.":"'#:jgll,,::l:_11 j2:,"!1,s"rt'nr ri,'u",tJ;#:';;:'l::';'#';p::il:l:#?:il;

lr"jl"j[Tffi"rt".ii?j:{:,Xl'il,*".::"fl ::flt, i;.",""^5:",,1"?iT',i,f1"0,"<,r

ll"l,i::.",:i:l:""r" ?l"l l^i;l;g;i^?Lrlol T4 ;; " ;il;,cn ! /u/(DX4),"; knowledge after an inquiry that the information ff;::'Jil,TJir."i:lX in r," ."r,"ari", tirlj -|iti,.jt;Jrffit#";:##:

Date (B loS I lo lV

MM / DD /YYYY

+aryrgrr.of Khoi Dans-w

l-091-S-Ihrqagst

lrumDer Slreet 

-

rL 60608

-

s'tate Zlp Code

contact phone (312) 988-01 64 Emair address kvdangvu@gmail.com

U2+ ll uq rL Barnumber 

-

fficial Form'10'l Vduntary Petition for Individuals Filing for Bankruptcy page 7

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61!w-+<=,€i=.*is

For you if you are filing this The law allows you, as an individual, to represent yourself bankruptcy without an srrould in bankruptcy court, but you unoersianairr"t r"iv p"ople aftorney find it extremely difficult to represent themselve ccessfully. Because ban

lf you are represented by co 

' you are strongly urged :ffirT:r:"'"| 

and legal

an attomey, you do not To

need to file this page.

ur it case is selected for audit. lf that happens, you courd lose your right to file another case' or you may rose protections, incruding the benef]t of the automatic stay.

you must

court. Eve at you are required to file with the

in your sc ur bankruptcy, you must list that debt

property o, , be discharged. lf you do not list

also deny : PertY' Thejudge can

case, such I your bankruptcy

cases are 1 idual bankruptcy

Bankruptcy fraud is a serious crime; you courd be o""o"i"1Tilri"J"t[Tt", 

and comprete.

lf you deci

hired an " 

u to follow the rules as if you had

successful use you are filing for yourself. To be

Bankruptc ruptcy Gode, the Federal Rules of

be familiar ch your case is filed. you must also

Are you aware that filing for bankruptcy is a serious action with long-term financial and legal consequences?

E tto

E yes

Are you aware that bankruptcy fraud is a serious crime and that if your bankruptcy forms are rnaccurate or incomplete, you could be fined or imprisoned?

D tto

fl yes

Debtor 1

By signing here, I acknowledge that I understand 

have 

the risks involved in filing without an attomey. I

read and understood this notice, and I am aware that firing a oanl@ircy case without an attomey may 

",ruse 

me to rose my rights or property if l do not f,roperrv rrJnlre the case.

Case number 1ir

3tJ:" 

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

D Yes. Nameof

Atlach Ba n k ru ptcy p etiti on

J. j.

Signature of Debtor 1

Date

MMTDD- /yWVContact phone

Signature of Debtor 2

Date

MM/ DD /YYYY

Gell phone

Email address

Contad phone

Cell phone

Email address

fficial Form '101 Voluntary Petjtion fior lndividuats Filing for Bankruptcy page 8

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