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.

Keith Judith

First name First name

D.

Middle name Middle name

Heimpel Evelyn

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.

Judith Heimpel

Judith Evelyn-Heimpel

3. Only the last 4 digits of

your Social Security

number or federal

Individual Taxpayer

Identification number

(ITIN)

xxx-xx-6175 xxx-xx-0973

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

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Debtor 1

Debtor 2

Keith D. Heimpel

Judith Evelyn 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:

130 Liberty Lane, #5

Sycamore, IL 60178

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

DeKalb

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

Keith D. Heimpel

Judith Evelyn Case number (if known)

Part 2: Tell the Court About Your Bankruptcy Case

7. The chapter of the

Bankruptcy Code you are

choosing to file under

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

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

 Chapter 7

 Chapter 11

 Chapter 12

 Chapter 13

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

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

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

a pre-printed address.

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

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

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

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

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

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

9. Have you filed for

bankruptcy within the

last 8 years?

 No.

 Yes.

District When Case number

District When Case number

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

Keith D. Heimpel

Judith Evelyn 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

Keith D. Heimpel

Judith Evelyn 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

Keith D. Heimpel

Judith Evelyn 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/ Keith D. Heimpel /s/ Judith Evelyn

Keith D. Heimpel Judith Evelyn

Signature of Debtor 1 Signature of Debtor 2

Executed on September 14, 2016 Executed on September 14, 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

Keith D. Heimpel

Judith Evelyn 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/ Douglas W. Worrell Date September 14, 2016

Signature of Attorney for Debtor MM / DD / YYYY

Douglas W. Worrell

Printed name

Law office of Douglas Worrell, Ltd.

Firm name

1625 W. Colonial Parkway

Inverness, IL 60067

Number, Street, City, State & ZIP Code

Contact phone 847-241-2074 Email address bk@thelawoffice.us

3124416

Bar number & State

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

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Fill in this information to identify your case:

Debtor 1 Keith D. Heimpel

First Name Middle Name Last Name

Debtor 2 Judith Evelyn

(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................................................................................................ $ 0.00

1b. Copy line 62, Total personal property, from Schedule A/B..................................................................................... $ 8,365.82

1c. Copy line 63, Total of all property on Schedule A/B............................................................................................... $ 8,365.82

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... $ 1,530.00

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................................. $ 18,637.00

3b. Copy the total claims from Part 2 (nonpriority unsecured claims) from line 6j of Schedule E/F............................ $ 114,240.66

Your total liabilities $ 134,407.66

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................................................................................ $ 3,997.05

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

Copy your monthly expenses from line 22c of Schedule J.......................................................................... $ 3,991.76

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

Keith D. Heimpel

Judith Evelyn 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. $ 5,646.74

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.) $ 18,637.00

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. $ 18,637.00

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 Keith D. Heimpel

First Name Middle Name Last Name

Debtor 2 Judith Evelyn

(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?

Part 2: Describe Your Vehicles

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

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

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

 No

 Yes

3.1 Make: Honda 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: Passport  Debtor 1 only Creditors Who Have Claims Secured by Property.

Year: 2001  Debtor 2 only Current value of the

entire property?

Current value of the

Approximate mileage: 90,000  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 $1,900.00 $1,900.00

 (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.............................................................................=> $1,900.00

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.

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

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Debtor 1

Debtor 2

Keith D. Heimpel

Judith Evelyn Case number (if known)

6. Household goods and furnishings

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

 No

 Yes. Describe.....

Misc. household goods and furnishings $1,500.00

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.....

2013 refurbished iMac computer $40.00

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.....

4 Hummel figurines $100.00

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.....

Horse saddle used Wintech, & misc. horse tack. $200.00

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.....

Misc clothing $100.00

12. Jewelry

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

 No

 Yes. Describe.....

Wedding and egagement ring, old gold broches & costume

jewelry. $100.00

13. Non-farm animals

Examples: Dogs, cats, birds, horses

 No

 Yes. Describe.....

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

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

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Debtor 1

Debtor 2

Keith D. Heimpel

Judith Evelyn Case number (if known)

3 horses aged 26, 18, & 17; 2 cats. $1.00

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 .............................................................................. $2,041.00

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 $40.00

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 First Midwest Bank checking #1 $0.27

17.2. Checking First Midwest Bank #2 $5.00

17.3. Checking Heartland Bank $10.00

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:

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

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

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Debtor 1

Debtor 2

Keith D. Heimpel

Judith Evelyn Case number (if known)

 Yes. List each account separately.

Type of account: Institution name:

401(k) 401(k) Empower - aka Putnam - Employer

Lettuce Entertain Employee Savings Plan. $2,591.00

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:

Rental deposit Security Deposit on residential lease $500.00

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.......

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

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

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Debtor 1

Debtor 2

Keith D. Heimpel

Judith Evelyn Case number (if known)

 Yes. Name the insurance company of each policy and list its value.

Company name: Beneficiary: Surrender or refund

value:

Country Financial while live policy.

cash value $551.65 Spouse $551.65

Country Financial whole life, cash

value $581.89 Spouse $581.89

Country Financial Whole life, cash

value $145.01 Spouse $145.01

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.........

Personal Injury and Property damage claim arising out of car

accident which occurred on or about 1/1/2015. Other driver

was Hatigje L. Wallace, 1456 Sandcastle Drive, Sycamore, IL

60178. Unknown

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

 No

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

35. Any financial assets you did not already list

 No

 Yes. Give specific information..

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

for Part 4. Write that number here..................................................................................................................... $4,424.82

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.

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

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

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Debtor 1

Debtor 2

Keith D. Heimpel

Judith Evelyn Case number (if known)

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

56. Part 2: Total vehicles, line 5 $1,900.00

57. Part 3: Total personal and household items, line 15 $2,041.00

58. Part 4: Total financial assets, line 36 $4,424.82

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... $8,365.82 Copy personal property total $8,365.82

63. Total of all property on Schedule A/B. Add line 55 + line 62 $8,365.82

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

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Fill in this information to identify your case:

Debtor 1 Keith D. Heimpel

First Name Middle Name Last Name

Debtor 2 Judith Evelyn

(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

2001 Honda Passport 90,000 miles

Line from Schedule A/B: 3.1

$1,900.00  $370.00 735 ILCS 5/12-1001(c)

 100% of fair market value, up to

any applicable statutory limit

Misc. household goods and

furnishings

Line from Schedule A/B: 6.1

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

 100% of fair market value, up to

any applicable statutory limit

2013 refurbished iMac computer

Line from Schedule A/B: 7.1

$40.00  $40.00 735 ILCS 5/12-1001(b)

 100% of fair market value, up to

any applicable statutory limit

4 Hummel figurines

Line from Schedule A/B: 8.1

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

 100% of fair market value, up to

any applicable statutory limit

Horse saddle used Wintech, & misc.

horse tack.

Line from Schedule A/B: 9.1

$200.00  $200.00 735 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 3

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Debtor 1

Debtor 2

Keith D. Heimpel

Judith Evelyn 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

Misc clothing

Line from Schedule A/B: 11.1

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

 100% of fair market value, up to

any applicable statutory limit

Wedding and egagement ring, old

gold broches & costume jewelry.

Line from Schedule A/B: 12.1

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

 100% of fair market value, up to

any applicable statutory limit

3 horses aged 26, 18, & 17; 2 cats.

Line from Schedule A/B: 13.1

$1.00  $1.00 735 ILCS 5/12-1001(b)

 100% of fair market value, up to

any applicable statutory limit

Cash

Line from Schedule A/B: 16.1

$40.00  $40.00 735 ILCS 5/12-1001(b)

 100% of fair market value, up to

any applicable statutory limit

Checking: First Midwest Bank

checking #1

Line from Schedule A/B: 17.1

$0.27  $0.27 735 ILCS 5/12-1001(b)

 100% of fair market value, up to

any applicable statutory limit

Checking: First Midwest Bank #2

Line from Schedule A/B: 17.2

$5.00  $5.00 735 ILCS 5/12-1001(b)

 100% of fair market value, up to

any applicable statutory limit

Checking: Heartland Bank

Line from Schedule A/B: 17.3

$10.00  $10.00 735 ILCS 5/12-1001(b)

 100% of fair market value, up to

any applicable statutory limit

401(k): 401(k) Empower - aka Putnam

- Employer Lettuce Entertain

Employee Savings Plan.

Line from Schedule A/B: 21.1

$2,591.00  100% 735 ILCS 5/12-1006

 100% of fair market value, up to

any applicable statutory limit

Rental deposit: Security Deposit on

residential lease

Line from Schedule A/B: 22.1

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

 100% of fair market value, up to

any applicable statutory limit

Country Financial while live policy.

cash value $551.65

Beneficiary: Spouse

Line from Schedule A/B: 31.1

$551.65  100% 215 ILCS 5/238

 100% of fair market value, up to

any applicable statutory limit

Country Financial whole life, cash

value $581.89

Beneficiary: Spouse

Line from Schedule A/B: 31.2

$581.89  100% 215 ILCS 5/238

 100% of fair market value, up to

any applicable statutory limit

Official Form 106C Schedule C: The Property You Claim as Exempt page 2 of 3

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Debtor 1

Debtor 2

Keith D. Heimpel

Judith Evelyn 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

Country Financial Whole life, cash

value $145.01

Beneficiary: Spouse

Line from Schedule A/B: 31.3

$145.01  100% 215 ILCS 5/238

 100% of fair market value, up to

any applicable statutory limit

Personal Injury and Property damage

claim arising out of car accident

which occurred on or about 1/1/2015.

Other driver was Hatigje L. Wallace,

1456 Sandcastle Drive, Sycamore, IL

60178.

Line from Schedule A/B: 33.1

Unknown  $15,000.00 735 ILCS 5/12-1001(h)(4)

 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 3 of 3

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 Document Page 18 of 77
Fill in this information to identify your case:

Debtor 1 Keith D. Heimpel

First Name Middle Name Last Name

Debtor 2 Judith Evelyn

(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

Express Motors of

Palatine Describe the property that secures the claim: $1,530.00 $1,900.00 $0.00

Creditor's Name 2001 Honda Passport 90,000 miles

20063 North Rand Rd.

Palatine, IL 60074

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)

Date debt was incurred 3/2015 Last 4 digits of account number

Add the dollar value of your entries in Column A on this page. Write that number here: $1,530.00

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

Write that number here: $1,530.00

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 Schedule D: Creditors Who Have Claims Secured by Property page 1 of 1

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Fill in this information to identify your case:

Debtor 1 Keith D. Heimpel

First Name Middle Name Last Name

Debtor 2 Judith Evelyn

(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 Illinois Department of Revenue Last 4 digits of account number $6,952.00 $6,952.00 $0.00

Priority Creditor's Name

Bankruptcy Section

PO Box 64338

Chicago, IL 60664-0338

When was the debt incurred? 2011, 2012, 2013,2014

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

Income taxes

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 1 of 21

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Debtor 1

Debtor 2

Keith D. Heimpel

Judith Evelyn Case number (if know)

2.2 Illinois Department of Revenue Last 4 digits of account number $1,248.00 $1,248.00 $0.00

Priority Creditor's Name

Bankruptcy Section

PO Box 64338

Chicago, IL 60664-0338

When was the debt incurred? 2015

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

income taxes

2.3 Internal Revenue Service Last 4 digits of account number $7,968.00 $7,968.00 $0.00

Priority Creditor's Name

Department of the Treasury

PO Box 7346

Philadelphia, PA 19101-7346

When was the debt incurred? 2013, 2014

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

Income taxes

2.4 Internal Revenue Service Last 4 digits of account number $2,469.00 $2,469.00 $0.00

Priority Creditor's Name

Department of the Treasury

PO Box 7346

Philadelphia, PA 19101-7346

When was the debt incurred? 2015

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

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

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 2 of 21

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Debtor 1

Debtor 2

Keith D. Heimpel

Judith Evelyn Case number (if know)

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

Part 2.

Total claim

4.1 Amex Last 4 digits of account number 2543 $4,072.00

Nonpriority Creditor's Name

Correspondence

Po Box 981535

El Paso, TX 79998-1535

When was the debt incurred?

Opened 06/07 Last Active

1/22/11

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 Anderson Automotive Last 4 digits of account number $452.97

Nonpriority Creditor's Name

122 E. 4th Street

Byron, IL 61010

When was the debt incurred? 2012

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 Judy Heimpel - unauthorized car repairs

4.3 Associated Bank Last 4 digits of account number 4882 Unknown

Nonpriority Creditor's Name

P.O. Box 790408

Saint Louis, MO 63179-0408

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 Citibank credit card

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 3 of 21

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Debtor 1

Debtor 2

Keith D. Heimpel

Judith Evelyn Case number (if know)

4.4 AT&T Universal Card Last 4 digits of account number 9278 Unknown

Nonpriority Creditor's Name

P.O. Box 6500

Sioux Falls, SD 57117-6500

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 Bank Of America Last 4 digits of account number 6945 $6,263.00

Nonpriority Creditor's Name

Nc4-105-03-14

Po Box 26012

Greensboro, NC 27410

When was the debt incurred?

Opened 09/02 Last Active

9/24/10

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 Bank Of America Last 4 digits of account number 1956 $0.00

Nonpriority Creditor's Name

Nc4-105-03-14

Po Box 26012

Greensboro, NC 27410

When was the debt incurred?

Opened 08/03 Last Active

6/07/07

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 21

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

Case 16-82161 Doc 1 Filed 09/14/16 Entered 09/14/16 13:09:03 Desc Main

 Document Page 23 of 77
Debtor 1

Debtor 2

Keith D. Heimpel

Judith Evelyn Case number (if know)

4.7 Bank Of America Last 4 digits of account number 4306 Unknown

Nonpriority Creditor's Name

Nc4-105-03-14

Po Box 26012

Greensboro, NC 27410

When was the debt incurred?

Opened 3/10/97 Last Active

1/13/11

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 Bank Of America Last 4 digits of account number 9455 $7,215.00

Nonpriority Creditor's Name

Attn: Bankruptcy Dept.

P.O. Box 15026

Wilmington, DE 19850-5026

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 Calvary Portfolio Services Last 4 digits of account number 7657 $13,985.00

Nonpriority Creditor's Name

500 Summit Lake Ste 400

Valhalla, NY 10595

When was the debt incurred? Opened 08/15

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 Collection Attorney Citibank

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 5 of 21

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

Case 16-82161 Doc 1 Filed 09/14/16 Entered 09/14/16 13:09:03 Desc Main

 Document Page 24 of 77
Debtor 1

Debtor 2

Keith D. Heimpel

Judith Evelyn Case number (if know)

4.1

0 Capital One Last 4 digits of account number 8061 $12,177.00

Nonpriority Creditor's Name

P.O. Box 30285

Salt Lake City, UT 84130

When was the debt incurred?

Opened 12/07 Last Active

11/06/09

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

1 Capital One Last 4 digits of account number 1195 $645.00

Nonpriority Creditor's Name

Po Box 30285

Salt Lake City, UT 84130

When was the debt incurred?

Opened 07/16 Last Active

8/08/16

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

2 Capital One Last 4 digits of account number 8588 $287.00

Nonpriority Creditor's Name

Po Box 30285

Salt Lake City, UT 84130

When was the debt incurred?

Opened 12/07 Last Active

8/25/16

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 6 of 21

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

Case 16-82161 Doc 1 Filed 09/14/16 Entered 09/14/16 13:09:03 Desc Main

 Document Page 25 of 77
Debtor 1

Debtor 2

Keith D. Heimpel

Judith Evelyn Case number (if know)

4.1

3 Capital One Last 4 digits of account number 1584 $0.00

Nonpriority Creditor's Name

Attn: Bankruptcy

Po Box 30253

Salt Lake City, UT 84130

When was the debt incurred?

Opened 12/15/07 Last Active

12/04/08

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

4 Chase Card Services Last 4 digits of account number 6933 $0.00

Nonpriority Creditor's Name

Attn: Correspondence Dept

Po Box 15298

Wilmington, DE 19850

When was the debt incurred?

Opened 12/14/07 Last Active

12/08/09

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 Choice Recovery Inc Last 4 digits of account number 2928 $511.00

Nonpriority Creditor's Name

1550 Old Henderson Rd Ste 100

Columus, OH 43220

When was the debt incurred? Opened 09/15

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

Collection Attorney Midwest Orthopaedic

Institut

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 7 of 21

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

Case 16-82161 Doc 1 Filed 09/14/16 Entered 09/14/16 13:09:03 Desc Main

 Document Page 26 of 77
Debtor 1

Debtor 2

Keith D. Heimpel

Judith Evelyn Case number (if know)

4.1

6 Citibank / Sears Last 4 digits of account number 7124 $0.00

Nonpriority Creditor's Name

Citicorp Cr Srvs/Centralized BK

Po Box 790040

St. Louis, MO 63129

When was the debt incurred?

Opened 10/95 Last Active

12/27/01

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 Charge Account

4.1

7 Citibank/Best Buy Last 4 digits of account number 3548 $25,152.00

Nonpriority Creditor's Name

Central Bk/CitiCorp Credit S

Po Box 790040

St Louis, MO 63179

When was the debt incurred?

Opened 01/06 Last Active

9/16/10

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

8 Creative Therapeutics Last 4 digits of account number $1,869.00

Nonpriority Creditor's Name

400 E. Hillcrest Dr.

DeKalb, IL 60115

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 Bill

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 8 of 21

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

Case 16-82161 Doc 1 Filed 09/14/16 Entered 09/14/16 13:09:03 Desc Main

 Document Page 27 of 77
Debtor 1

Debtor 2

Keith D. Heimpel

Judith Evelyn Case number (if know)

4.1

9 DeKalb Dental Group Last 4 digits of account number $417.63

Nonpriority Creditor's Name

2707 Sycamore Road

DeKalb, IL 60115

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 Dental Bill

4.2

0 Discover Card Last 4 digits of account number 9424 Unknown

Nonpriority Creditor's Name

c/o Baker and Miller PC

29 N. Wacker Dr., Suite 500

Chicago, IL 60606-2854

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 / File 10-07106

4.2

1 Discover Financial Last 4 digits of account number 8351 $5,128.00

Nonpriority Creditor's Name

Po Box 3025

New Albany, OH 43054

When was the debt incurred?

Opened 07/07 Last Active

7/20/10

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 21

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

Case 16-82161 Doc 1 Filed 09/14/16 Entered 09/14/16 13:09:03 Desc Main

 Document Page 28 of 77
Debtor 1

Debtor 2

Keith D. Heimpel

Judith Evelyn Case number (if know)

4.2

2 Enterprise Rental Car Last 4 digits of account number 1809 $23.70

Nonpriority Creditor's Name

P.O. Box 759

Lombard, IL 60148

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

4.2

3 First National Bank of Omaha Last 4 digits of account number 9549 $14,097.86

Nonpriority Creditor's Name

P.O. Box 2557

Omaha, NE 68103-2557

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

4 Jack Martin Chiropractic Last 4 digits of account number $350.00

Nonpriority Creditor's Name

1601 E. Main St. #B

Saint Charles, IL 60174

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 Bill

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 10 of 21

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

Case 16-82161 Doc 1 Filed 09/14/16 Entered 09/14/16 13:09:03 Desc Main

 Document Page 29 of 77
Debtor 1

Debtor 2

Keith D. Heimpel

Judith Evelyn Case number (if know)

4.2

5 Medical-Oral Maxillofacial Surgeons Last 4 digits of account number $182.00

Nonpriority Creditor's Name

1675 Bethany Rd. #A

Sycamore, IL 60178

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 bill

4.2

6 Michael E. Evans DDS Last 4 digits of account number $303.01

Nonpriority Creditor's Name

444 E. Hillcrest Dr. #220

DeKalb, IL 60115

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 Dental Bill

4.2

7 Midland Funding Last 4 digits of account number 3570 $1,013.00

Nonpriority Creditor's Name

2365 Northside Dr

Suite 300

San Diego, CA 92108

When was the debt incurred? Opened 09/13

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 Factoring Company Account Citibank N.A.

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 11 of 21

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

Case 16-82161 Doc 1 Filed 09/14/16 Entered 09/14/16 13:09:03 Desc Main

 Document Page 30 of 77
Debtor 1

Debtor 2

Keith D. Heimpel

Judith Evelyn Case number (if know)

4.2

8 Midwest Orthopaedic Institute Last 4 digits of account number $511.00

Nonpriority Creditor's Name

2111 Midlands Ct. #100

Sycamore, IL 60178

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 Bills

4.2

9 Portfolio Recovery Last 4 digits of account number 6933 $3,129.00

Nonpriority Creditor's Name

Po Box 41067

Norfolk, VA 23541

When was the debt incurred? Opened 01/11

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

Factoring Company Account Chase Bank

Usa N.A.

4.3

0 Radiologists Ltd. Last 4 digits of account number $341.00

Nonpriority Creditor's Name

P.O. Box 128

Sycamore, IL 60178

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 Bill

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 12 of 21

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

Case 16-82161 Doc 1 Filed 09/14/16 Entered 09/14/16 13:09:03 Desc Main

 Document Page 31 of 77
Debtor 1

Debtor 2

Keith D. Heimpel

Judith Evelyn Case number (if know)

4.3

1 Rockford Mercantile Last 4 digits of account number 4679 $182.00

Nonpriority Creditor's Name

2502 S. Alpine Rd

Rockford, IL 61108

When was the debt incurred? Opened 09/11

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

Collection Attorney Oral Maxillofacial

Surgeons

4.3

2 Sears Gold Mastercard Last 4 digits of account number 6488 $1,013.00

Nonpriority Creditor's Name

P.O. Box 183082

Columbus, OH 43218-3082

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

3 Second Round Lp Last 4 digits of account number 2486 $14,860.00

Nonpriority Creditor's Name

4150 Friedrich Lane Suit

Austin, TX 78744

When was the debt incurred? Opened 07/11

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

Collection Attorney Us Bank National

Association N

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 13 of 21

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

Case 16-82161 Doc 1 Filed 09/14/16 Entered 09/14/16 13:09:03 Desc Main

 Document Page 32 of 77
Debtor 1

Debtor 2

Keith D. Heimpel

Judith Evelyn Case number (if know)

4.3

4 Sycamore Fire Ambulance Service Last 4 digits of account number $60.49

Nonpriority Creditor's Name

P.O. Box 1029

DeKalb, IL 60115

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 Bill

4.3

5 Us Bk Rms Cc Last 4 digits of account number 4739 $0.00

Nonpriority Creditor's Name

Po Box 108

Saint Louis, MO 63166

When was the debt incurred?

Opened 3/01/03 Last Active

9/10/10

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 Us Bk Rms Cc Last 4 digits of account number 0594 $0.00

Nonpriority Creditor's Name

Po Box 108

Saint Louis, MO 63166

When was the debt incurred?

Opened 3/01/05 Last Active

7/26/10

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

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

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 14 of 21

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 Document Page 33 of 77
Debtor 1

Debtor 2

Keith D. Heimpel

Judith Evelyn Case number (if know)

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?

AAA Financial Services

P.O. Box 851001

Dallas, TX 75285-1001

Line 4.8 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 9455

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

Alliance One

4850 Street Road, Suite 300

Trevose, PA 19053

Line 4.32 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 0112

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

American Coradius Int'l LLC

2420 Sweet Home Rd. Ste 150

Amherst, NY 14228-2244

Line 4.4 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 3502

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

American Express

P.O. Box 360001

Fort Lauderdale, FL 33336-0001

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

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 1001

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

American Express Blue Cash

Box 0001

Los Angeles, CA 90096-8000

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

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 1001

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

Asset Acceptance Recovery Svs.

P.O. Box 2004

Warren, MI 48090-2004

Line 4.8 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 3487

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

Associated Bank

Cardmember Service

P.O. Box 6335

Fargo, ND 58125-6335

Line 4.33 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 2486

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

Baker & Miller, P.C.

29 N. Wacker Dr., Suite 500

Chicago, IL 60606-2854

Line 4.21 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?

Bank of America

P.O. Box 851001

Dallas, TX 75285-1001

Line 4.5 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 6617

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

Blatt, Hasenmiller, Leibsker &Moore

10 S. LaSalle St., Suite 2200

Chicago, IL 60603-1069

Line 4.17 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number LM94

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

Blitt and Gaines, P.C.

Bankruptcy Department

661 Glenn Avenue

Line 4.10 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 15 of 21

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

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Debtor 1

Debtor 2

Keith D. Heimpel

Judith Evelyn Case number (if know)

Wheeling, IL 60090

Last 4 digits of account number C109

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

Blitt and Gaines, P.C.

Bankruptcy Department

661 Glenn Avenue

Wheeling, IL 60090

Line 4.27 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?

Blitt and Gaines, P.C.

Bankruptcy Department

661 Glenn Avenue

Wheeling, IL 60090

Line 4.32 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?

Bonded Collection Corp

P.O. Box 2373

Chicago, IL 60690-2373

Line 4.8 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 5875

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

CACI

PO Box 270480

Saint Louis, MO 63127-0480

Line 4.33 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 2486

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

CACI

PO Box 270480

Saint Louis, MO 63127-0480

Line 4.3 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 8486

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

Calvary Portfolio Services LLC

P.O. Box 27288

Tempe, AZ 85285-7288

Line 4.4 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 7657

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

Capital Management Services, LP

726 Exchange Street

Suite 700

Buffalo, NY 14210

Line 4.4 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 9278

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

Cardmember Services

P.O. Box 3331

Omaha, NE 68103-0331

Line 4.23 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 9549

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

Cavalry Portfolio Services LLC

500 Summit Lake Drive

Valhalla, NY 10595

Line 4.4 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 7657

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

CBCS

P.O. Box 163250

Columbus, OH 43216-3250

Line 4.21 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 5037

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

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 16 of 21

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

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Debtor 1

Debtor 2

Keith D. Heimpel

Judith Evelyn Case number (if know)

CCB Credit Services, Inc.

P.O. Box 272

Springfield, IL 62705-0272

Line 4.23 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 9549

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

Chase Freedom

P.O. Box 15153

Wilmington, DE 19886-5153

Line 4.14 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 6933

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

Choice Recovery LLC

P.O. Box 29790

Columbus, OH 43220

Line 4.28 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?

Citi Cards

P.O. Box 660370

Dallas, TX 75266-0370

Line 4.17 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 6944

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

Citi Simplicity Card

P.O. Box 688901

Des Moines, IA 50368-8901

Line 4.17 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 6944

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

Citi Simplicity Card

Customer Service

Box 6000

The Lakes, NV 89163-6000

Line 4.17 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 6944

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

Client Services

3451 Harry Truman Blvd.

Saint Charles, MO 63301-4047

Line 4.14 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 4773

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

Client Services

3451 Harry Truman Blvd.

Saint Charles, MO 63301-4047

Line 4.4 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 0754

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

Collectioncorp Corporation

455 North 3rd St., Suite 260

Phoenix, AZ 85004-3924

Line 4.8 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 3801

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

Cypress Financial Recoveries

c/o Silverman & Bornstein

13111 E. Briarwood Ave., Ste 340

Centennial, CO 80112

Line 4.23 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 4978

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

Discover Card

P.O. Box 6103

Carol Stream, IL 60197-6103

Line 4.21 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 3351

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 17 of 21

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

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 Document Page 36 of 77
Debtor 1

Debtor 2

Keith D. Heimpel

Judith Evelyn Case number (if know)

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

Discover Financial Services

P.O. Box 3008

New Albany, OH 43054-3008

Line 4.21 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 8351

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

Eagle Recovery Associates

424 S.W. Washington St.

Peoria, IL 61602

Line 4.19 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 1509

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

Elan Financial Services

Cardmember Service

P.O. Box 6354

Fargo, ND 58125-6354

Line 4.33 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 2486

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

Elan Financial Services

Cardmember Service

P.O. Box 790084

Saint Louis, MO 63179-0084

Line 4.33 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 2486

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

Elan Financial Services

P.O. Box 6354

Fargo, ND 58125-6354

Line 4.3 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 2486

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

Estate Information Services LLC

P.O. Box 1730

Reynoldsburg, OH 43068-8730

Line 4.17 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 6944

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

Estate Information Services LLC

dba EIS Collections

P.O. Box 1730

Reynoldsburg, OH 43068-8730

Line 4.4 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 0504

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

FIA Card Services - Bank of America

PO Box 22021

Greensboro, NC 27420

Line 4.8 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 Pacific Corporation

P.O. Box 3000

Salem, OR 97302

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 7106

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

Frederick J. Hanna & Assoc.

2253 Northwest Parkway

Marietta, GA 30067

Line 4.33 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 3658

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

Freedman Anselmo Lindberg

1771 West Diehl Road, Suite 120

P.O. Box 3228

Line 4.8 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 18 of 21

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 Document Page 37 of 77
Debtor 1

Debtor 2

Keith D. Heimpel

Judith Evelyn Case number (if know)

Naperville, IL 60566

Last 4 digits of account number 0447

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

Global Credit & Collection Corp.

P.O. Box 71083

Charlotte, NC 28272-1083

Line 4.10 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 6428

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

Global Credit & Collection Corp.

5440 N. Cumberland Suite 300

Chicago, IL 60656

Line 4.4 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 5457

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

James A. West PC

Ref Capital One Bank

6380 Rogerdale Road, Suite 130

Houston, TX 77072-1647

Line 4.10 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 8061

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

Leading Edge Recovery Solution

5440 N Cumberland Ave

Ste 300

Chicago, IL 60656-1490

Line 4.32 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 7865

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

Leading Edge Recovery Solutions

P.O. Box 129

Linden, MI 48451-0129

Line 4.8 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 1774

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

LTD Financial Services LP

7322 Southwest Freeway, Ste 1600

Houston, TX 77074

Line 4.4 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 1322

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

Midland Credit Management, Inc.

8875 Aero Drive, Suite 200

San Diego, CA 92123

Line 4.32 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 3570

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

Monarch Recovery Management,

Inc.

10965 Decatur Road

Philadelphia, PA 19154-3210

Line 4.32 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 6618

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

Nationwide Credit, Inc.

P.O. Box 26314

Lehigh Valley, PA 18002-6314

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

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 1001

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

NCO Financial Systems, Inc.

507 Prudential Road

Horsham, PA 19044

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

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 7285

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

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 19 of 21

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

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 Document Page 38 of 77
Debtor 1

Debtor 2

Keith D. Heimpel

Judith Evelyn Case number (if know)

Northland Group, Inc

P.O. Box 390846

Mail Code F164

Minneapolis, MN 55439

Line 4.4 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 3233

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

Northstar Location Services, LLC

4285 Genesee Street

Cheektowaga, NY 14225-1943

Line 4.8 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 9455

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

Portfolio Recovery Associates

Attn: Bankruptcy Dept.

140 Corporate Blvd.

Norfolk, VA 23502

Line 4.29 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 6933

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

Portfolio Recovery Associates LLC

P.O. Box 12914

Norfolk, VA 23541

Line 4.14 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 6933

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

RGS Collections

P.O. Box 852039

Richardson, TX 75085-2039

Line 4.23 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 9549

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

Rockford Mercantile Agency Inc.

2502 S. Alpine Road

Rockford, IL 61108

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

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number

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

Rockford Merchantile Agency

P.O. Box 5847

Rockford, IL 61125-0847

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

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number

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

Second Round LP

P.O. Box Round LP

Austin, TX 78704-1955

Line 4.3 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 2422

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

Silverman & Borenstein

13111 E. Briarwood Ave., Suite 340

Centennial, CO 80112

Line 4.23 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 4978

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

Transworld Systems

507 Prudential Road

Horsham, PA 19044

Line 4.18 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 9330

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

United Recovery Systems

P.O. Box 722929

Houston, TX 77272-2929

Line 4.10 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 5841

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 20 of 21

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

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 Document Page 39 of 77
Debtor 1

Debtor 2

Keith D. Heimpel

Judith Evelyn Case number (if know)

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

Van Ru Credit Corporation

P.O. Box 1612

Des Plaines, IL 60017

Line 4.21 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 9277

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. $ 18,637.00

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

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

6e. Total Priority. Add lines 6a through 6d. 6e. $ 18,637.00

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.

$ 114,240.66

6j. Total Nonpriority. Add lines 6f through 6i. 6j. $ 114,240.66

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

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 Document Page 40 of 77
Fill in this information to identify your case:

Debtor 1 Keith D. Heimpel

First Name Middle Name Last Name

Debtor 2 Judith Evelyn

(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 Oehlert Rentals

1770 W State St,

Sycamore, IL 60178

Residential Lease

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 16-82161 Doc 1 Filed 09/14/16 Entered 09/14/16 13:09:03 Desc Main

 Document Page 41 of 77
Fill in this information to identify your case:

Debtor 1 Keith D. Heimpel

First Name Middle Name Last Name

Debtor 2 Judith Evelyn

(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 16-82161 Doc 1 Filed 09/14/16 Entered 09/14/16 13:09:03 Desc Main

 Document Page 42 of 77
Fill in this information to identify your case:

Debtor 1 Keith D. Heimpel

Debtor 2 Judith Evelyn

(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 Server data entry

Employer's name

Lettuce Entertain You

Enterprises Technomic, Inc.

Employer's address 5419 N. Sheridan Road

Chicago, IL 60640

300 S. Riverside Plaza, Ste 1200

Chicago, IL 60606

How long employed there? 16 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. $ 4,386.93 $ 850.84

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

4. Calculate gross Income. Add line 2 + line 3. 4. $ 4,386.93 $ 850.84

Official Form 106I Schedule I: Your Income page 1

Case 16-82161 Doc 1 Filed 09/14/16 Entered 09/14/16 13:09:03 Desc Main

 Document Page 43 of 77
Debtor 1

Debtor 2

Keith D. Heimpel

Judith Evelyn Case number (if known)

For Debtor 1 For Debtor 2 or

non-filing spouse

Copy line 4 here 4. $ 4,386.93 $ 850.84

5. List all payroll deductions:

5a. Tax, Medicare, and Social Security deductions 5a. $ 561.00 $ 98.73

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

5c. Voluntary contributions for retirement plans 5c. $ 71.50 $ 0.00

5d. Required repayments of retirement fund loans 5d. $ 0.00 $ 0.00

5e. Insurance 5e. $ 509.49 $ 0.00

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. $ 1,141.99 $ 98.73

7. Calculate total monthly take-home pay. Subtract line 6 from line 4. 7. $ 3,244.94 $ 752.11

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. $ 3,244.94 + $ 752.11 = $ 3,997.05

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. $ 3,997.05

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 16-82161 Doc 1 Filed 09/14/16 Entered 09/14/16 13:09:03 Desc Main

 Document Page 44 of 77
Fill in this information to identify your case:

Debtor 1 Keith D. Heimpel Check if this is:

 An amended filing

Debtor 2 Judith Evelyn  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.

 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. $ 720.00

If not included in line 4:

4a. Real estate taxes 4a. $ 0.00

4b. Property, homeowner’s, or renter’s insurance 4b. $ 15.33

4c. Home maintenance, repair, and upkeep expenses 4c. $ 15.00

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 16-82161 Doc 1 Filed 09/14/16 Entered 09/14/16 13:09:03 Desc Main

 Document Page 45 of 77
Debtor 1

Debtor 2

Keith D. Heimpel

Judith Evelyn Case number (if known)

6. Utilities:

6a. Electricity, heat, natural gas 6a. $ 120.50

6b. Water, sewer, garbage collection 6b. $ 84.00

6c. Telephone, cell phone, Internet, satellite, and cable services 6c. $ 258.00

6d. Other. Specify: 6d. $ 0.00

7. Food and housekeeping supplies 7. $ 715.00

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

9. Clothing, laundry, and dry cleaning 9. $ 130.00

10. Personal care products and services 10. $ 62.00

11. Medical and dental expenses 11. $ 195.00

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

Do not include car payments. 12. $ 445.00

13. Entertainment, clubs, recreation, newspapers, magazines, and books 13. $ 110.00

14. Charitable contributions and religious donations 14. $ 10.00

15. Insurance.

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

15a. Life insurance 15a. $ 156.83

15b. Health insurance 15b. $ 0.00

15c. Vehicle insurance 15c. $ 140.00

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: Back taxes to IRS estimated payment plan amount 16. $ 155.00

Specify: Back Taxes to IL Dept. Rev. estimated payment plan $ 110.00

17. Installment or lease payments:

17a. Car payments for Vehicle 1 17a. $ 255.10

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

17c. Other. Specify: Storage rental 17c. $ 55.00

17d. Other. Specify: domain names 17d. $ 5.00

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: Meals at work 21. +$ 210.00

Printing officemax wife's job +$ 25.00

22. Calculate your monthly expenses

22a. Add lines 4 through 21. $ 3,991.76

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. $ 3,991.76

23. Calculate your monthly net income.

23a. Copy line 12 (your combined monthly income) from Schedule I. 23a. $ 3,997.05

23b. Copy your monthly expenses from line 22c above. 23b. -$ 3,991.76

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

The result is your monthly net income. 23c. $ 5.29

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 16-82161 Doc 1 Filed 09/14/16 Entered 09/14/16 13:09:03 Desc Main

 Document Page 46 of 77
Fill in this information to identify your case:

Debtor 1 Keith D. Heimpel

First Name Middle Name Last Name

Debtor 2 Judith Evelyn

(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/ Keith D. Heimpel X /s/ Judith Evelyn

Keith D. Heimpel Judith Evelyn

Signature of Debtor 1 Signature of Debtor 2

Date September 14, 2016 Date September 14, 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 16-82161 Doc 1 Filed 09/14/16 Entered 09/14/16 13:09:03 Desc Main

 Document Page 47 of 77
Fill in this information to identify your case:

Debtor 1 Keith D. Heimpel

First Name Middle Name Last Name

Debtor 2 Judith Evelyn

(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

$27,307.00  Wages, commissions,

bonuses, tips

 Operating a business

$7,147.01

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 16-82161 Doc 1 Filed 09/14/16 Entered 09/14/16 13:09:03 Desc Main

 Document Page 48 of 77
Debtor 1

Debtor 2

Keith D. Heimpel

Judith Evelyn 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

$41,078.00  Wages, commissions,

bonuses, tips

 Operating a business

$9,362.50

For the calendar year before that:

(January 1 to December 31, 2014 )

 Wages, commissions,

bonuses, tips

 Operating a business

$40,760.18  Wages, commissions,

bonuses, tips

 Operating a business

$13,750.50

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 )

withdrawl from

retirement account

$3,857.12 withdrawl from

retirement account

$167.73

For the calendar year before that:

(January 1 to December 31, 2014 )

withdrawl from

retirement account

$0.00 withdrawl from

retirement account

$4,000.00

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

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

Case 16-82161 Doc 1 Filed 09/14/16 Entered 09/14/16 13:09:03 Desc Main

 Document Page 49 of 77
Debtor 1

Debtor 2

Keith D. Heimpel

Judith Evelyn Case number (if known)

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

Unifund CCR LLC v. Keith D.

Heimpel

2014 LM 00094

collection on

Citibank card

DeKalb County

133 W. State St.

Sycamore, IL 60178

 Pending

 On appeal

 Concluded

Judgment & wage

garnishement

Midlund Funding LLC v. Keith

Heimpel

14 SC 316

collection original

debt Sears

DeKalb County  Pending

 On appeal

 Concluded

Judgment 1,113.03

Capital One Bank v. Judith Evelyn

11 SC 109

collection DeKalb  Pending

 On appeal

 Concluded

Judgment 9,156.48

Asset Acceptance LLC v. Judith

Evelyn Heimpel

13 SC 00447

collection original

debtor Bank of

America

DeKalb County

133 W. State St.

Sycamore, IL 60178

 Pending

 On appeal

 Concluded

Judgment $7,362

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

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

Case 16-82161 Doc 1 Filed 09/14/16 Entered 09/14/16 13:09:03 Desc Main

 Document Page 50 of 77
Debtor 1

Debtor 2

Keith D. Heimpel

Judith Evelyn Case number (if known)

Case title

Case number

Nature of the case Court or agency Status of the case

Discover Bank v. Judith

Evelyn-Heimpel

10 SC 1473

collection DeKalb County  Pending

 On appeal

 Concluded

Judgment 3,793

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

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

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

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Debtor 1

Debtor 2

Keith D. Heimpel

Judith Evelyn Case number (if known)

Part 7: List Certain Payments or Transfers

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

consulted about seeking bankruptcy or preparing a bankruptcy petition?

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

 No

 Yes. Fill in the details.

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

Law office of Douglas Worrell, Ltd.

1625 W. Colonial Parkway

Inverness, IL 60067

bk@thelawoffice.us

Attorney Fees September

2016

$1,665.00

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

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

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

 No

 Yes. Fill in the details.

Person Who Was Paid

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

Diamond Gallery

Naperville, IL

none

Sold gold ring with flawed

diamond, gold necklace, and

Kennedy half dollars

Received $137 June 2016

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

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

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Debtor 1

Debtor 2

Keith D. Heimpel

Judith Evelyn Case number (if known)

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?

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

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

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Debtor 1

Debtor 2

Keith D. Heimpel

Judith Evelyn Case number (if known)

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

 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

Wesavetherainforest.com

130 Liberty Lane, #5

Sycamore, IL 60178

sale of supplements on Trivita EIN:

From-To 2002 to present (last income was

2013)

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

Express Motors of Palatine

20063 North Rand Rd.

Palatine, IL 60074

Feb 2015

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

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Debtor 1

Debtor 2

Keith D. Heimpel

Judith Evelyn Case number (if known)

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/ Keith D. Heimpel /s/ Judith Evelyn

Keith D. Heimpel Judith Evelyn

Signature of Debtor 1 Signature of Debtor 2

Date September 14, 2016 Date September 14, 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 8

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Fill in this information to identify your case:

Debtor 1 Keith D. Heimpel

First Name Middle Name Last Name

Debtor 2 Judith Evelyn

(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 Express Motors of Palatine  Surrender the property.  No

 Yes

name:  Retain the property and redeem it.

 Retain the property and enter into a

Reaffirmation Agreement. Description of 2001 Honda Passport 90,000

property miles  Retain the property and [explain]:

securing debt:

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: Oehlert Rentals  No

 Yes

Description of leased

Property:

Residential Lease

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

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Debtor 1

Debtor 2

Keith D. Heimpel

Judith Evelyn Case number (if known)

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/ Keith D. Heimpel X /s/ Judith Evelyn

Keith D. Heimpel Judith Evelyn

Signature of Debtor 1 Signature of Debtor 2

Date September 14, 2016 Date September 14, 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.

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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.

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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.

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B2030 (Form 2030) (12/15)

United States Bankruptcy Court

Northern District of Illinois

In re

Keith D. Heimpel

Judith Evelyn 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 $ 1,665.00

Prior to the filing of this statement I have received $ 1,665.00

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 dischargeability actions, judicial lien avoidances, relief from stay actions or

any other 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.

September 14, 2016 /s/ Douglas W. Worrell

Date Douglas W. Worrell

Signature of Attorney

Law office of Douglas Worrell, Ltd.

1625 W. Colonial Parkway

Inverness, IL 60067

847-241-2074 Fax: 847-241-2080

bk@thelawoffice.us

Name of law firm

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United States Bankruptcy Court

Northern District of Illinois

In re

Keith D. Heimpel

Judith Evelyn Case No.

Debtor(s) Chapter 7

VERIFICATION OF CREDITOR MATRIX

Number of Creditors: 97

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

(our) knowledge.

Date: September 14, 2016 /s/ Keith D. Heimpel

Keith D. Heimpel

Signature of Debtor

Date: September 14, 2016 /s/ Judith Evelyn

Judith Evelyn

Signature of Debtor

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}bk1{Credito AresMatix}bk{

AAA Financial Services

P.O. Box 851001

Dallas, TX 75285-1001

Alliance One

4850 Street Road, Suite 300

Trevose, PA 19053

American Coradius Int'l LLC

2420 Sweet Home Rd. Ste 150

Amherst, NY 14228-2244

American Express

P.O. Box 360001

Fort Lauderdale, FL 33336-0001

American Express Blue Cash

Box 0001

Los Angeles, CA 90096-8000

Amex

Correspondence

Po Box 981535

El Paso, TX 79998-1535

Anderson Automotive

122 E. 4th Street

Byron, IL 61010

Asset Acceptance Recovery Svs.

P.O. Box 2004

Warren, MI 48090-2004

Associated Bank

P.O. Box 790408

Saint Louis, MO 63179-0408

Associated Bank

Cardmember Service

P.O. Box 6335

Fargo, ND 58125-6335

AT&T Universal Card

P.O. Box 6500

Sioux Falls, SD 57117-6500

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Baker & Miller, P.C.

29 N. Wacker Dr., Suite 500

Chicago, IL 60606-2854

Bank Of America

Nc4-105-03-14

Po Box 26012

Greensboro, NC 27410

Bank Of America

Attn: Bankruptcy Dept.

P.O. Box 15026

Wilmington, DE 19850-5026

Bank of America

P.O. Box 851001

Dallas, TX 75285-1001

Blatt, Hasenmiller, Leibsker &Moore

10 S. LaSalle St., Suite 2200

Chicago, IL 60603-1069

Blitt and Gaines, P.C.

Bankruptcy Department

661 Glenn Avenue

Wheeling, IL 60090

Bonded Collection Corp

P.O. Box 2373

Chicago, IL 60690-2373

CACI

PO Box 270480

Saint Louis, MO 63127-0480

Calvary Portfolio Services

500 Summit Lake Ste 400

Valhalla, NY 10595

Calvary Portfolio Services LLC

P.O. Box 27288

Tempe, AZ 85285-7288

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Capital Management Services, LP

726 Exchange Street

Suite 700

Buffalo, NY 14210

Capital One

P.O. Box 30285

Salt Lake City, UT 84130

Capital One

Po Box 30285

Salt Lake City, UT 84130

Capital One

Attn: Bankruptcy

Po Box 30253

Salt Lake City, UT 84130

Cardmember Services

P.O. Box 3331

Omaha, NE 68103-0331

Cavalry Portfolio Services LLC

500 Summit Lake Drive

Valhalla, NY 10595

CBCS

P.O. Box 163250

Columbus, OH 43216-3250

CCB Credit Services, Inc.

P.O. Box 272

Springfield, IL 62705-0272

Chase Card Services

Attn: Correspondence Dept

Po Box 15298

Wilmington, DE 19850

Chase Freedom

P.O. Box 15153

Wilmington, DE 19886-5153

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Choice Recovery Inc

1550 Old Henderson Rd Ste 100

Columus, OH 43220

Choice Recovery LLC

P.O. Box 29790

Columbus, OH 43220

Citi Cards

P.O. Box 660370

Dallas, TX 75266-0370

Citi Simplicity Card

P.O. Box 688901

Des Moines, IA 50368-8901

Citi Simplicity Card

Customer Service

Box 6000

The Lakes, NV 89163-6000

Citibank / Sears

Citicorp Cr Srvs/Centralized BK

Po Box 790040

St. Louis, MO 63129

Citibank/Best Buy

Central Bk/CitiCorp Credit S

Po Box 790040

St Louis, MO 63179

Client Services

3451 Harry Truman Blvd.

Saint Charles, MO 63301-4047

Collectioncorp Corporation

455 North 3rd St., Suite 260

Phoenix, AZ 85004-3924

Creative Therapeutics

400 E. Hillcrest Dr.

DeKalb, IL 60115

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Cypress Financial Recoveries

c/o Silverman & Bornstein

13111 E. Briarwood Ave., Ste 340

Centennial, CO 80112

DeKalb Dental Group

2707 Sycamore Road

DeKalb, IL 60115

Discover Card

c/o Baker and Miller PC

29 N. Wacker Dr., Suite 500

Chicago, IL 60606-2854

Discover Card

P.O. Box 6103

Carol Stream, IL 60197-6103

Discover Financial

Po Box 3025

New Albany, OH 43054

Discover Financial Services

P.O. Box 3008

New Albany, OH 43054-3008

Eagle Recovery Associates

424 S.W. Washington St.

Peoria, IL 61602

Elan Financial Services

Cardmember Service

P.O. Box 6354

Fargo, ND 58125-6354

Elan Financial Services

Cardmember Service

P.O. Box 790084

Saint Louis, MO 63179-0084

Elan Financial Services

P.O. Box 6354

Fargo, ND 58125-6354

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Enterprise Rental Car

P.O. Box 759

Lombard, IL 60148

Estate Information Services LLC

P.O. Box 1730

Reynoldsburg, OH 43068-8730

Estate Information Services LLC

dba EIS Collections

P.O. Box 1730

Reynoldsburg, OH 43068-8730

Express Motors of Palatine

20063 North Rand Rd.

Palatine, IL 60074

FIA Card Services - Bank of America

PO Box 22021

Greensboro, NC 27420

First National Bank of Omaha

P.O. Box 2557

Omaha, NE 68103-2557

First Pacific Corporation

P.O. Box 3000

Salem, OR 97302

Frederick J. Hanna & Assoc.

2253 Northwest Parkway

Marietta, GA 30067

Freedman Anselmo Lindberg

1771 West Diehl Road, Suite 120

P.O. Box 3228

Naperville, IL 60566

Global Credit & Collection Corp.

P.O. Box 71083

Charlotte, NC 28272-1083

Global Credit & Collection Corp.

5440 N. Cumberland Suite 300

Chicago, IL 60656

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Illinois Department of Revenue

Bankruptcy Section

PO Box 64338

Chicago, IL 60664-0338

Internal Revenue Service

Department of the Treasury

PO Box 7346

Philadelphia, PA 19101-7346

Jack Martin Chiropractic

1601 E. Main St. #B

Saint Charles, IL 60174

James A. West PC

Ref Capital One Bank

6380 Rogerdale Road, Suite 130

Houston, TX 77072-1647

Leading Edge Recovery Solution

5440 N Cumberland Ave

Ste 300

Chicago, IL 60656-1490

Leading Edge Recovery Solutions

P.O. Box 129

Linden, MI 48451-0129

LTD Financial Services LP

7322 Southwest Freeway, Ste 1600

Houston, TX 77074

Medical-Oral Maxillofacial Surgeons

1675 Bethany Rd. #A

Sycamore, IL 60178

Michael E. Evans DDS

444 E. Hillcrest Dr. #220

DeKalb, IL 60115

Midland Credit Management, Inc.

8875 Aero Drive, Suite 200

San Diego, CA 92123

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Midland Funding

2365 Northside Dr

Suite 300

San Diego, CA 92108

Midwest Orthopaedic Institute

2111 Midlands Ct. #100

Sycamore, IL 60178

Monarch Recovery Management, Inc.

10965 Decatur Road

Philadelphia, PA 19154-3210

Nationwide Credit, Inc.

P.O. Box 26314

Lehigh Valley, PA 18002-6314

NCO Financial Systems, Inc.

507 Prudential Road

Horsham, PA 19044

Northland Group, Inc

P.O. Box 390846

Mail Code F164

Minneapolis, MN 55439

Northstar Location Services, LLC

4285 Genesee Street

Cheektowaga, NY 14225-1943

Oehlert Rentals

1770 W State St,

Sycamore, IL 60178

Portfolio Recovery

Po Box 41067

Norfolk, VA 23541

Portfolio Recovery Associates

Attn: Bankruptcy Dept.

140 Corporate Blvd.

Norfolk, VA 23502

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Portfolio Recovery Associates LLC

P.O. Box 12914

Norfolk, VA 23541

Radiologists Ltd.

P.O. Box 128

Sycamore, IL 60178

RGS Collections

P.O. Box 852039

Richardson, TX 75085-2039

Rockford Mercantile

2502 S. Alpine Rd

Rockford, IL 61108

Rockford Mercantile Agency Inc.

2502 S. Alpine Road

Rockford, IL 61108

Rockford Merchantile Agency

P.O. Box 5847

Rockford, IL 61125-0847

Sears Gold Mastercard

P.O. Box 183082

Columbus, OH 43218-3082

Second Round Lp

4150 Friedrich Lane Suit

Austin, TX 78744

Second Round LP

P.O. Box Round LP

Austin, TX 78704-1955

Silverman & Borenstein

13111 E. Briarwood Ave., Suite 340

Centennial, CO 80112

Sycamore Fire Ambulance Service

P.O. Box 1029

DeKalb, IL 60115

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Transworld Systems

507 Prudential Road

Horsham, PA 19044

United Recovery Systems

P.O. Box 722929

Houston, TX 77272-2929

Us Bk Rms Cc

Po Box 108

Saint Louis, MO 63166

Van Ru Credit Corporation

P.O. Box 1612

Des Plaines, IL 60017

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