United States Bankruptcy Court for the: 

Northern District of Illinois 

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

Chapter 7 

U Chapter 11 

U Chapter 12 

U Chapter 13 

Official Form 101 

Voluntary Petition for Individuals Filing 

LJ Check if this is an 

amended filing 

for Bankruptcy 12/15 

The bankruptcy forms use you and Debtor Ito refer to a debtor filing alone. A married couple may file a bankruptcy case togethercalled 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 I and 

Debtor 2 to distinguish between them. In joint cases, one of the spouses must report information as Debtor I and the other as Debtor 2. The 

same person must be Debtor I 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. 

ii 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 Constantino Carl government-issued picture 

identification (for example, First name First name 

your driver’s license or Joseph Ann 

passport). Middle name Middle name 

Bring your picture Boccarsi Coglianese 

identification to your meeting Last name Last name 

with the trustee. 

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

2. All other names you 

have used in the last 8 First name First name 

years 

Include your married or Middle name Middle name 

maiden names. 

Last name Last name 

First name First name 

Middle name Middle name 

Last name Last name 

----------- 

3. Only the last 4 digits of 2 9 - XX 5 3 . .._Q. .....Q...... your Social Security XXX - XX 

number or federal OR OR 

Individual Taxpayer 

Identification number XX - XX 9 XX - XX 

(ITIN) 

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

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Debtor 1 Constantino Joseph Boccarsi Case number (if known)_____________________________ 

First Name Middle Name Last Name 

4. Any business names 

and Employer 

Identification Numbers 

(EIN) you have used in 

the last 8 years 

Include trade names and 

doing business as names 

About Debtor 1: 

U I have not used any business names or EINs. 

BoCar Asset Management Inc. 

Business name 

Business name 

47 -128 0 9 3 9 

EIN 

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

I have not used any business names or EIN5. 

Business name 

Business name 

EIN 

EIN EIN 

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

i0S700 Garfield Avenue 

Number Street Number Street 

Burr Ridge IL 60527 

City State ZIP Code 

DuPace 

County 

If your mailing address is different from the one 

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

any notices to you at this mailing address. 

Number Street 

P.O. Box 

City State ZIP Code 

City State ZIP Code 

County 

If Debtor 2’s mailing address is different from 

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

any notices to this mailing address. 

Number Street 

P.O. Box 

State ZIP Code 

6. Why you are choosing Check one: Check one: 

this district to file for 

Over the last 180 days before filing this petition, Over the last 180 days before filing this petition, bankruptcy 

I have lived in this district longer than in any I have lived in this district longer than in any 

other district, other district. 

U I have another reason. Explain. U I have another reason. Explain. 

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

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

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Debtor I Constantino Joseph Boccarsi Case number (if knmvn)___________________________ First Name Middle Name Last Name 

 Tell the Court About Your Bankruptcy Case 

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

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

are choosing to file i Chapter 7 under 

U Chapter 11 

U Chapter 12 

U Chapter 13 

8. How you will pay the fee 6d 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. 

U 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). 

U 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 No 

bankruptcy within the 

last 8 years? U Yes. District When Case number 

MM! DD/YYYY 

District When Case number 

MM! DD/YYYY 

District When Case number 

MM/ DD!YYYY 

10. Are any bankruptcy No 

cases pending or being 

filed by a spouse who is U Yes. Debtor Relationship to you 

not filing this case with District When Case number, if known___________________ 

you, or by a business MM! DD I YYYY 

partner, or by an 

affiliate? 

Debtor Relationship to you 

District When Case number, if known____________________ 

MM I DD /YYYY 

ii. Do you rent your U No. Go to line 12. 

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

residence? 

No. Go to line 12. 

U Yes. Fill out Initial Statement About an Eviction Judgment Against You (Form 101 A) 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 Constantino Joseph Boccarsi Case number 

Fast Name Middle Name Last Name 

Thc1U Report About Any Businesses You Own as a Sole Proprietor 

12. Are you a sole proprietor 

of any full- or part-time 

business? 

A sole proprietorship is a 

business you operate as an 

individual, and is not a 

separate legal entity such as 

a corporation, partnership, or 

LLC. 

If you have more than one 

sole proprietorship, use a 

separate sheet and attach it 

to this petition. 

No. Go to Part 4. 

U Yes. Name and location of business 

Name of business, if any 

Number Street 

City State ZIP Code 

Check the appropriate box to describe your business: 

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

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

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

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

U None of the above 

13. Are you filing under 

Chapter 11 of the 

Bankruptcy Code and 

are you a small business 

debtor? 

For a definition of small 

business debtor, see 

11 u.s.C.1o1(51D). 

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

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

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

any of these documents do not exist, follow the procedure in ii U.S.C. § 11 16(1)(B). 

No. I am not filing under Chapter 11 

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

the Bankruptcy Code. 

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

Bankruptcy Code. 

Report if You Own or Have Any Hazardous Property or Any Property That Needs Immediate Attention 

14. Do you own or have any 

property that poses or is 

alleged to pose a threat 

of imminent and 

identifiable hazard to 

public health or safety? 

Or do you own any 

property that needs 

immediate attention? 

For example, do you own 

perishable goods, or livestock 

that must be fed, or a building 

that needs urgent repairs? 

No 

U Yes. What is the hazard? 

If immediate attention is needed, why is it needed? 

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 Constantino Joseph Boccarsi Case number (if known)______________________________ 

First Name Middle Name Last Name 

 TiL-f Explain Your Efforts to Receive a Briefing About Credit Counseling 

About Debtor 1: 

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. 

U 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. 

U 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. 

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

You must check one: 

I received a briefing from an approved credit 

counseling agency within the 180 days before I 

filed this bankruptcy petition, and I received a 

certificate of completion. 

Attach a copy of the certificate and the payment 

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

U 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. 

U 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. 

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. 

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. 

U I am not required to receive a briefing about 

credit counseling because of: 

U Incapacity. I have a mental illness or a mental 

deficiency that makes me 

incapable of realizing or making 

rational decisions about finances. 

U 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. 

U Active duty. I am currently on active military 

duty in a military combat zone. 

If you believe you are not required to receive a 

briefing about credit counseling, you must file a 

motion for waiver of credit counseling with the court. 

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. 

U I am not required to receive a briefing about 

credit counseling because of: 

U Incapacity. I have a mental illness or a mental 

deficiency that makes me 

incapable of realizing or making 

rational decisions about finances. 

U 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. 

U Active duty. I am currently on active military 

duty in a military combat zone. 

If you believe you are not required to receive a 

briefing about credit counseling, you must file a 

motion for waiver of credit counseling with the court. 

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

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Debtor i Constantino JoseDh Boccarsi Case number aoa,_________________________ 

Fi,et Name Middle Name Last Name 

FII Answer These Questions for Reporting Purposes 

16a. Are your debts primarily consumer debts? Consumer debts are defined in 11 U.S.C. § 101 (8) is. What kind of debts do as incurred by an individual primarily for a personal, family, or household purpose." you have? 

 No. Go to line 16b. 

U 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. 

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

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

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

excluded and 4 No 

administrative expenses 

are paid that funds will be U Yes 

available for distribution 

to unsecured creditors? 

18. How many creditors do 1-49 U 1,000-5,000 U 25,001-50,000 

you estimate that you U 50-99 U 5,001-10,000 U 50,001-100,000 

owe? U 100-199 U 10,001-25,000 U More than 100,000 

U 200-999 

19. How much do you 0 $o-$50,000 U $1,000,001410 million U $500,000,00141 billion 

estimate your assets to U sso,00i-sioo,000 U $10,000,001-$50 million U $1,000,000,001-$10 billion 

be worth? U $100,001-$500,000 U $50,000,001-$100 million U $10,000,000,001-$50 billion 

U $500,00141 million U $100,000,001-$500 million U More than $50 billion 

20. How much do you U $0-$50,000 U $1,000,001-510 million U $500,000,001-$1 billion 

estimate your liabilities U $so,00i-sioo,000 U $10,000,001450 million U $1,000,000,001-$10 billion 

to be? U ioo,00i-soo,000 U $50,000,001-$100 million U $10,000,000,001-$50 billion 

$500,001-s1 million U $100,000,0014500 million U More than $50 billion 

Sign Below 

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

3571. 

t ignature of Debtor 2 

Executed on Executed on __ 

t$I DD YYYY M I DD 1 I’(YYY 

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

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Debtor 1 Constantino Joseph Boccarsi Case number (if 

First Name Middle Name Last Name 

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

For your attorney, if you are to proceed under Chapter 7, 11, 12, or 13 of title 11 United States Code, and have explained the relief 

represented by one 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 

If you are not represented knowledge after an inquiry that the information in the schedules filed with the petition is incorrect. 

by an attorney, you do not 

need to file this page. X Date 

Signat MM I D D /Y Y 

Michael C. Moody 

Printed name 

O’Rourke & Mood 

Firm name 

55 West Wacker Drive, 14th Floor 

Number Street 

Chicago IL 60601 

City State ZIP Code 

Contact phone (312) 8492020 Email address firmorourkeandmoody.com 

6205168 IL 

Bar number State 

. ..................... 

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

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Debtor Constantino Joseph Boccarsi Case number (ifkn,,)__________ 

First Name Middle Name Last Name 

For you if you are filing this The law allows you, as an individual, to represent yourself in bankruptcy court, but you 

bankruptcy without an should understand that many people find it extremely difficult to represent 

attorney themselves successfully. Because bankruptcy has long-term financial and legal 

consequences, you are strongly urged to hire a qualified attorney. 

If you are represented by 

an attorney, you do not To be successful, you must correctly file and handle your bankruptcy case. The rules are very 

need to file this page. technical, and a mistake or inaction may affect your rights. For example, your case may be 

dismissed because you did not file a required document, pay a fee on time r attend a meeting or 

hearing, or cooperate with the court, case trustee, U.S. trustee, bankruptcy administrator, or audit 

firm if your case is selected for audit. If that happens, you could lose your right to file another 

case, or you may lose protections, including the benefit of the automatic stay. 

You must list all your property and debts in the schedules that you are required to file with the 

court. Even if you plan to pay a particular debt outside of your bankruptcy, you must list that debt 

in your schedules. If you do not list a debt, the debt may not be discharged. If you do not list 

property or properly claim it as exempt, you may not be able to keep the property. The judge can 

also deny you a discharge of all your debts if you do something dishonest in your bankruptcy 

case, such as destroying or hiding property, falsifying records, or lying. Individual bankruptcy 

cases are randomly audited to determine if debtors have been accurate, truthful, and complete. 

Bankruptcy fraud is a serious crime; you could be fined and imprisoned. 

If you decide to file without an attorney, the court expects you to follow the rules as if you had 

hired an attorney. The court will not treat you differently because you are filing for yourself. To be 

successful, you must be familiar with the United States Bankruptcy Code, the Federal Rules of 

Bankruptcy Procedure, and the local rules of the court in which your case is filed. You must also 

be familiar with any state exemption laws that apply. 

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

consequences? 

U No 

U Yes 

Are you aware that bankruptcy fraud is a serious crime and that if your bankruptcy forms are 

inaccurate or incomplete, you could be fined or imprisoned? 

UNo 

U Yes 

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

UNo 

U Yes. Name of Person 

Attach Bankruptcy Petition Preparer’s Notice, Declaration, and Signature (Official Form 119). 

By signing here, I acknowledge that I understand the risks involved in filing without an attorney. I 

have read and understood this notice, and I am aware that filing a bankruptcy case without an 

attorney may cause me to lose my rights or property if I do not properly handle the case. 

x 

Signature of Debtor 1 

Date 

MM/DD /YYYY 

Contact phone 

Cell phone 

Email address 

x 

Signature of Debtor 2 

Date 

MM/ DID /YYYY 

Contact phone 

Cell phone 

Email address 

Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 8 

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