Fill in this information to identify your case: Debtor 1 Sheehan Hajaree

First Name Middle Name Last Name Debtor 2 Alicia Hajaree

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

United States Bankruptcy Court for the:

SOUTHERN DISTRICT OF FLORIDA, FORT LAUDERDALE

DIVISION

Case number 0:19-bk-21319

(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................................................................................................ $ 387,630.00

1b. Copy line 62, Total personal property, from Schedule A/B..................................................................................... $ 14,000.00

1c. Copy line 63, Total of all property on Schedule A/B............................................................................................... $ 401,630.00

Part 2: Summarize Your Liabilities

Your liabilities Amount you owe

2. Schedule D: Creditors Who Have Claims Secured by Property (Official Form 106D)

2a. Copy the total you listed in Column A, Amount of claim, at the bottom of the last page of Part 1 of Schedule D... $ 233,081.00

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................................. $ 42,005.00

3b. Copy the total claims from Part 2 (nonpriority unsecured claims) from line 6j of Schedule E/F............................ $ 54,142.57

Your total liabilities $ 329,228.57

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................................................................................ $ 8,496.65

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

Copy your monthly expenses from line 22c of Schedule J.......................................................................... $ 8,974.96

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.

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

Software Copyright (c) 2019 CINGroup - www.cincompass.com

Case 19-21319-JKO Doc 15 Filed 09/25/19 Page 1 of 53
Debtor 1

Debtor 2 Hajaree, Sheehan & Hajaree, Alicia Case number (if known) 0:19-bk-21319

 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.

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. $ 10,028.19

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.) $ 42,005.00

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. $ 42,005.00

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

Software Copyright (c) 2019 CINGroup - www.cincompass.com

Case 19-21319-JKO Doc 15 Filed 09/25/19 Page 2 of 53
 Fill in this information to identify your case and this filing: Debtor 1 Sheehan Hajaree

First Name Middle Name Last Name Debtor 2 Alicia Hajaree

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

United States Bankruptcy Court for the:

SOUTHERN DISTRICT OF FLORIDA, FORT LAUDERDALE

DIVISION

Case number 0:19-bk-21319  Check if this is an

amended filing

Official Form 106A/B

Schedule A/B: Property 12/15

In each category, separately list and describe items. List an asset only once. If an asset fits in more than one category, list the asset in the category where you

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

information. If more space is needed, attach a separate sheet to this form. On the top of any additional pages, write your name and case number (if known).

Answer every question.

Part 1: Describe Each Residence, Building, Land, or Other Real Estate You Own or Have an Interest In

1. Do you own or have any legal or equitable interest in any residence, building, land, or similar property?

 No. Go to Part 2.

 Yes. Where is the property?

1.1 What is the property? Check all that apply Do not deduct secured claims or exemptions. Put

the amount of any secured claims on Schedule D:

Creditors Who Have Claims Secured by Property . 8693 SW 51st Pl 





Single-family home

Duplex or multi-unit building

Condominium or cooperative

Street address, if available, or other description

Cooper City FL 33328-4310





Manufactured or mobile home

Land

Current value of the

entire property?

Current value of the

portion you own?

City State ZIP Code  Investment property $387,630.00 $387,630.00

 Timeshare Describe the nature of your ownership interest

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

a life estate), if known.

 Other

Who has an interest in the property? Check one  Debtor 1 only Fee Simple

 Debtor 2 only

County  Debtor 1 and Debtor 2 only

 Check if this is community property  At least one of the debtors and another (see instructions)

Other information you wish to add about this item, such as local

property identification number:

Homestead

2. Add the dollar value of the portion you own for all of your entries from Part 1, including any entries for pages

you have attached for Part 1. Write that number here...........................................................................=> $387,630.00

Part 2: Describe Your Vehicles

Do you own, lease, or have legal or equitable interest in any vehicles, whether they are registered or not? Include any vehicles you own that someone else drives. If you lease a vehicle, also report it on Schedule G: Executory Contracts and Unexpired Leases.

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

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Case 19-21319-JKO Doc 15 Filed 09/25/19 Page 3 of 53
Debtor 1

Debtor 2 Hajaree, Sheehan & Hajaree, Alicia Case number (if known) 0:19-bk-21319

3. Cars, vans, trucks, tractors, sport utility vehicles, motorcycles  No

Yes

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

the amount of any secured claims on Schedule D:

Model: F-250 Super Duty  Debtor 1 only Creditors Who Have Claims Secured by Property . Year: 2008  Debtor 2 only Current value of the

entire property?

Current value of the

Approximate mileage: 268677  Debtor 1 and Debtor 2 only portion you own?

Other information:  At least one of the debtors and another

VIN #1FTSW21R78ED81358

mileage 268,677 Check if this is community property $2,800.00 $2,800.00

 (see instructions)

3.2 Make: Volkswagen 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: Jetta  Debtor 1 only Creditors Who Have Claims Secured by Property . Year: 2007  Debtor 2 only Current value of the

entire property?

Current value of the

Approximate mileage: 115000  Debtor 1 and Debtor 2 only portion you own?

Other information:  At least one of the debtors and another

VIN #3VWRF71K97M123295

mileage 115,000 Check if this is community property $2,850.00 $2,850.00

 (see instructions)

3.3 Make: Dode 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: Nitro  Debtor 1 only Creditors Who Have Claims Secured by Property . Year: 2008  Debtor 2 only Current value of the

entire property?

Current value of the

Approximate mileage: 226980  Debtor 1 and Debtor 2 only portion you own?

Other information:  At least one of the debtors and another

Vin #1D8GT28K38W164442

Check if this is community property $950.00 $950.00

 (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 pagesyou have attached for Part 2. Write that number here.............................................................................=> $6,600.00

Part 3: Describe Your Personal and Household Items

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

Do not deduct secured

claims or exemptions.

6. Household goods and furnishings Examples: Major appliances, furniture, linens, china, kitchenware  No

Yes. Describe.....

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

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Case 19-21319-JKO Doc 15 Filed 09/25/19 Page 4 of 53
Debtor 1

Debtor 2 Hajaree, Sheehan & Hajaree, Alicia Case number (if known) 0:19-bk-21319

3 complete bedsets, 3 dressers sets, 2 Tv's; 1 computer table/ 1

computer and printer; 1 couch, sofa, side tables, lamps, cocktail

table, 1 dining table and 6 chairs, and several other

miscellaneous furniture all from 2005; cutlery glassware; cooking

utelnsils; plates, oven, fridge, microwave, coffee maker. All

household goods are at lease 10 to 15 years old. Liquidation

value. $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.....

8. Collectibles of value Examples: Antiques and figurines; paintings, prints, or other artwork; books, pictures, or other art objects; stamp, coin, or baseball card collections; other collections, memorabilia, collectibles

 No

Yes. Describe.....

9. Equipment for sports and hobbies Examples: Sports, photographic, exercise, and other hobby equipment; bicycles, pool tables, golf clubs, skis; canoes and kayaks; carpentry tools; musical

instruments

 No

Yes. Describe.....

10. Firearms Examples: Pistols, rifles, shotguns, ammunition, and related equipment

 No

Yes. Describe..... 1 hand gun $150.00

11. Clothes Examples: Everyday clothes, furs, leather coats, designer wear, shoes, accessories  No

Yes. Describe..... Used men's and women's clothing of value only to the debtors. $0.00

12. Jewelry

Examples: Everyday jewelry, costume jewelry, engagement rings, wedding rings, heirloom jewelry, watches, gems, gold, silver  No

Yes. Describe..... 1 wedding band (male) 1 wedding ring (female), 1 Michael Kors

watch $250.00

13. Non-farm animals Examples: Dogs, cats, birds, horses  No

Yes. Describe.....

14. Any other personal and household items you did not already list, including any health aids you did not list

 No

Yes. Give specific information.....

15. Add the dollar value of all of your entries from Part 3, including any entries for pages you have attached for Part 3. Write that number here .............................................................................. $1,900.00

Part 4: Describe Your Financial Assets

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

Software Copyright (c) 2019 CINGroup - www.cincompass.com

Case 19-21319-JKO Doc 15 Filed 09/25/19 Page 5 of 53
Debtor 1

Debtor 2 Hajaree, Sheehan & Hajaree, Alicia Case number (if known) 0:19-bk-21319

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

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 Account Bank: BOA # 8219 $500.00

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: Emergency Medical Consultant, Inc. [provides

free lance emergency medical services] 100.00 % $0.00

20. Government and corporate bonds and other negotiable and non-negotiable instruments Negotiable instruments include personal checks, cashiers’checks, promissory notes, and money orders. Non-negotiable instruments are those you cannot transfer to someone by signing or delivering them.  No

Yes. Give specific information about them

Issuer name:

21. Retirement or pension accounts Examples: Interests in IRA, ERISA, Keogh, 401(k), 403(b), thrift savings accounts, or other pension or profit-sharing plans

 No

Yes. List each account separately. Type of account: Institution name:

22. Security deposits and prepayments Your share of all unused deposits you have made so that you may continue service or use from a company

Examples: Agreements with landlords, prepaid rent, public utilities (electric, gas, water), telecommunications companies, or others  No

Yes. .....................

Institution name or individual:

23. Annuities (A contract for a periodic payment of money to you, either for life or for a number of years)

 No

Yes.............

Issuer name and description.

24. Interests in an education IRA, in an account in a qualified ABLE program, or under a qualified state tuition program. 26 U.S.C. §§ 530(b)(1), 529A(b), and 529(b)(1).  No

Yes.............

Institution name and description. Separately file the records of any interests.11 U.S.C. § 521(c):

25. Trusts, equitable or future interests in property (other than anything listed in line 1), and rights or powers exercisable for your benefit

 No

 Yes. Give specific information about them...

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

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Case 19-21319-JKO Doc 15 Filed 09/25/19 Page 6 of 53
Debtor 1

Debtor 2 Hajaree, Sheehan & Hajaree, Alicia Case number (if known) 0:19-bk-21319

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.......

Tax refunds expected based on 2018 tax

refunds $5,000.00

29. Family support

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

 No

Yes. Give specific information......

30. Other amounts someone owes you Examples: Unpaid wages, disability insurance payments, disability benefits, sick pay, vacation pay, workers’ compensation, Social Security benefits;

unpaid loans you made to someone else

 No

Yes. Give specific information..

31. Interests in insurance policies Examples: Health, disability, or life insurance; health savings account (HSA); credit, homeowner’s, or renter’s insurance  No

Yes. Name the insurance company of each policy and list its value. Company name: Beneficiary: Surrender or refund

value: Term life insurance with Banner Life

for $500K Alciia Hajaree $0.00

Term life insurance with Banner Life

for $500K Sheehan Hajaree $0.00

32. Any interest in property that is due you from someone who has died

If you are the beneficiary of a living trust, expect proceeds from a life insurance policy, or are currently entitled to receive property because someone has died.

 No

Yes. Give specific information..

33. Claims against third parties, whether or not you have filed a lawsuit or made a demand for payment

Examples: Accidents, employment disputes, insurance claims, or rights to sue

 No

 Yes. Describe each claim.........

34. Other contingent and unliquidated claims of every nature, including counterclaims of the debtor and rights to set off claims  No

 Yes. Describe each claim.........

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

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Case 19-21319-JKO Doc 15 Filed 09/25/19 Page 7 of 53
Debtor 1

Debtor 2 Hajaree, Sheehan & Hajaree, Alicia Case number (if known) 0:19-bk-21319

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..................................................................................................................... $5,500.00

Part 5: Describe Any Business-Related Property You Own or Have an Interest In. List any real estate in Part 1.

37. Do you own or have any legal or equitable interest in any business-related property?

 No. Go to Part 6.

 Yes. Go to line 38.

Part 6: Describe Any Farm- and Commercial Fishing-Related Property You Own or Have an Interest In.

If you own or have an interest in farmland, list it in Part 1.

46. Do you own or have any legal or equitable interest in any farm- or commercial fishing-related property?

 No. Go to Part 7.

 Yes. Go to line 47.

Part 7: Describe All Property You Own or Have an Interest in That You Did Not List Above

53. Do you have other property of any kind you did not already list?

Examples: Season tickets, country club membership

 No

Yes. Give specific information.........

54. Add the dollar value of all of your entries from Part 7. Write that number here .................................... $0.00

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

55. Part 1: Total real estate, line 2 ...................................................................................................................... $387,630.00

56. Part 2: Total vehicles, line 5 $6,600.00

57. Part 3: Total personal and household items, line 15 $1,900.00

58. Part 4: Total financial assets, line 36 $5,500.00

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

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

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

62. Total personal property. Add lines 56 through 61... $14,000.00 Copy personal property total $14,000.00

63. Total of all property on Schedule A/B. Add line 55 + line 62 $401,630.00

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

Software Copyright (c) 2019 CINGroup - www.cincompass.com

Case 19-21319-JKO Doc 15 Filed 09/25/19 Page 8 of 53
 Fill in this information to identify your case: Debtor 1 Sheehan Hajaree

First Name Middle Name Last Name Debtor 2

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

United States Bankruptcy Court for the:

SOUTHERN DISTRICT OF FLORIDA, FORT LAUDERDALE

DIVISION

Case number 0:19-bk-21319

(if known)  Check if this is an

amended filing

Official Form 106C

Schedule C: The Property You Claim as Exempt 4/19

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

Debtor 1 Exemptions

8693 SW 51st Pl

Cooper City FL, 33328-4310

Line from Schedule A/B: 1.1

$387,630.00  Fla. Const. Art. X, §4(a)(1);

Fla. Stat.§§ 222.01, 222.02

 100% of fair market value, up to

any applicable statutory limit

Ford

F-250 Super Duty

2008

268677

Line from Schedule A/B: 3.1

$2,800.00  $2,000.00 Fla. Stat. § 222.25(1)

 100% of fair market value, up to

any applicable statutory limit

Volkswagen

Jetta

2007

115000

Line from Schedule A/B: 3.2

$2,850.00  $2,000.00 Fla. Const. Art X, § 4(a)(2)

 100% of fair market value, up to

any applicable statutory limit

Term life insurance with Banner Life

for $500K

Line from Schedule A/B: 31.1

$0.00  Fla. Stat. § 222.13

 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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Case 19-21319-JKO Doc 15 Filed 09/25/19 Page 9 of 53
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

Term life insurance with Banner Life

for $500K

Line from Schedule A/B: 31.2

$0.00  Fla. Stat. § 222.13

 100% of fair market value, up to

any applicable statutory limit

3. Are you claiming a homestead exemption of more than $170,350

(Subject to adjustment on 4/01/22 and every 3 years after that for cases filed on or after the date of adjustment.)

 No

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

 No

 Yes

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

Software Copyright (c) 2019 CINGroup - www.cincompass.com

Case 19-21319-JKO Doc 15 Filed 09/25/19 Page 10 of 53
Fill in this information to identify your case: Debtor 1

First Name Middle Name Last Name Debtor 2 Alicia Hajaree

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

United States Bankruptcy Court for the:

SOUTHERN DISTRICT OF FLORIDA, FORT LAUDERDALE

DIVISION

Case number 0:19-bk-21319

(if known)  Check if this is an

amended filing

Official Form 106C

Schedule C: The Property You Claim as Exempt 4/19

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

Debtor 2 Exemptions

Brief description: Line from Schedule A/B: 

 100% of fair market value, up to

any applicable statutory limit

3. Are you claiming a homestead exemption of more than $170,350?

(Subject to adjustment on 4/01/22 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

Software Copyright (c) 2019 CINGroup - www.cincompass.com

Case 19-21319-JKO Doc 15 Filed 09/25/19 Page 11 of 53
 Fill in this information to identify your case: Debtor 1 Sheehan Hajaree

First Name Middle Name Last Name Debtor 2 Alicia Hajaree

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

United States Bankruptcy Court for the:

SOUTHERN DISTRICT OF FLORIDA, FORT LAUDERDALE

DIVISION

Case number 0:19-bk-21319

(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 Nationstar Mortgage Describe the property that secures the claim: $233,081.00 $387,630.00 $0.00

Creditor's Name 8693 SW 51st Pl, Cooper City, FL

33328-4310

Homestead

PO Box 650783

Dallas, TX 75265-0783

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 Last 4 digits of account number 8075

Add the dollar value of your entries in Column A on this page. Write that number here: $233,081.00

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

Write that number here: $233,081.00

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.

Name, Number, Street, City, State & Zip Code

Mr. Cooper

PO Box 650783

Dallas, TX 75265-0783

On which line in Part 1 did you enter the creditor? 2.1

Last 4 digits of account number 8075 

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

Software Copyright (c) 2019 CINGroup - www.cincompass.com

Case 19-21319-JKO Doc 15 Filed 09/25/19 Page 12 of 53
Fill in this information to identify your case: Debtor 1 Sheehan Hajaree

First Name Middle Name Last Name Debtor 2 Alicia Hajaree

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

United States Bankruptcy Court for the:

SOUTHERN DISTRICT OF FLORIDA, FORT LAUDERDALE

DIVISION

Case number 0:19-bk-21319

(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 Fed Loan Servicing Last 4 digits of account number $5,492.00 $5,492.00 $0.00

Priority Creditor's Name

PO Box 60610

Harrisburg, PA 17106-0610

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

 No

Yes

 Contingent

 Unliquidated

 Disputed

Type of PRIORITY unsecured claim:

 Domestic support obligations

 Taxes and certain other debts you owe the government

 Claims for death or personal injury while you were intoxicated

Other. Specify

2011 Student Loan

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 1 of 14

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Case 19-21319-JKO Doc 15 Filed 09/25/19 Page 13 of 53
Debtor 1

Debtor 2 Hajaree, Sheehan & Hajaree, Alicia Case number (if known) 0:19-bk-21319

2.2 Fed Loan Servicing Last 4 digits of account number $5,568.00 $5,568.00 $0.00

Priority Creditor's Name

PO Box 60610

Harrisburg, PA 17106-0610

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

 No

Yes

 Contingent

 Unliquidated

 Disputed

Type of PRIORITY unsecured claim:

 Domestic support obligations

 Taxes and certain other debts you owe the government

 Claims for death or personal injury while you were intoxicated

Other. Specify

2011 Student Loan

2.3 Fed Loan Servicing Last 4 digits of account number $5,709.00 $5,709.00 $0.00

Priority Creditor's Name

PO Box 60610

Harrisburg, PA 17106-0610

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

 No

Yes

 Contingent

 Unliquidated

 Disputed

Type of PRIORITY unsecured claim:

 Domestic support obligations

 Taxes and certain other debts you owe the government

 Claims for death or personal injury while you were intoxicated

Other. Specify

2011 Student Loan

2.4 Fed Loan Servicing Last 4 digits of account number $5,831.00 $5,831.00 $0.00

Priority Creditor's Name

PO Box 60610

Harrisburg, PA 17106-0610

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

 No

Yes

 Contingent

 Unliquidated

 Disputed

Type of PRIORITY unsecured claim:

 Domestic support obligations

 Taxes and certain other debts you owe the government

 Claims for death or personal injury while you were intoxicated

Other. Specify

2011 Student Loans

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 2 of 14

Software Copyright (c) 2019 CINGroup - www.cincompass.com

Case 19-21319-JKO Doc 15 Filed 09/25/19 Page 14 of 53
Debtor 1

Debtor 2 Hajaree, Sheehan & Hajaree, Alicia Case number (if known) 0:19-bk-21319

2.5 Fed Loan Servicing Last 4 digits of account number $5,315.00 $5,315.00 $0.00

Priority Creditor's Name

PO Box 60610

Harrisburg, PA 17106-0610

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

 No

Yes

 Contingent

 Unliquidated

 Disputed

Type of PRIORITY unsecured claim:

 Domestic support obligations

 Taxes and certain other debts you owe the government

 Claims for death or personal injury while you were intoxicated

Other. Specify

2011 Student Loans

2.6 Fed Loan Servicing Last 4 digits of account number $3,323.00 $3,323.00 $0.00

Priority Creditor's Name

PO Box 60610

Harrisburg, PA 17106-0610

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

 No

Yes

 Contingent

 Unliquidated

 Disputed

Type of PRIORITY unsecured claim:

 Domestic support obligations

 Taxes and certain other debts you owe the government

 Claims for death or personal injury while you were intoxicated

Other. Specify

2011 Student Loans

2.7 Fed Loan Servicing Last 4 digits of account number $3,509.00 $3,509.00 $0.00

Priority Creditor's Name

PO Box 60610

Harrisburg, PA 17106-0610

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

 No

Yes

 Contingent

 Unliquidated

 Disputed

Type of PRIORITY unsecured claim:

 Domestic support obligations

 Taxes and certain other debts you owe the government

 Claims for death or personal injury while you were intoxicated

Other. Specify

2011 School Loans

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 3 of 14

Software Copyright (c) 2019 CINGroup - www.cincompass.com

Case 19-21319-JKO Doc 15 Filed 09/25/19 Page 15 of 53
Debtor 1

Debtor 2 Hajaree, Sheehan & Hajaree, Alicia Case number (if known) 0:19-bk-21319

2.8 Fed Loan Servicing Last 4 digits of account number $3,509.00 $3,509.00 $0.00

Priority Creditor's Name

PO Box 60610

Harrisburg, PA 17106-0610

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

 No

Yes

 Contingent

 Unliquidated

 Disputed

Type of PRIORITY unsecured claim:

 Domestic support obligations

 Taxes and certain other debts you owe the government

 Claims for death or personal injury while you were intoxicated

Other. Specify

2010 School Loans

2.9 FedLoan Servicing Credit Last 4 digits of account number $3,749.00 $3,749.00 $0.00

Priority Creditor's Name

PO Box 60610

Harrisburg, PA 17106-0610

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

 No

Yes

 Contingent

 Unliquidated

 Disputed

Type of PRIORITY unsecured claim:

 Domestic support obligations

 Taxes and certain other debts you owe the government

 Claims for death or personal injury while you were intoxicated

Other. Specify

Part 2: List All of Your NONPRIORITY Unsecured Claims

3. Do any creditors have nonpriority unsecured claims against you?

 No. You have nothing to report in this part. Submit this form to the court with your other schedules.

Yes.

4. List all of your nonpriority unsecured claims in the alphabetical order of the creditor who holds each claim. If a creditor has more than one nonpriority

unsecured claim, list the creditor separately for each claim. For each claim listed, identify what type of claim it is. Do not list claims already included in Part 1. If more

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

2.

Total claim

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 4 of 14

Software Copyright (c) 2019 CINGroup - www.cincompass.com

Case 19-21319-JKO Doc 15 Filed 09/25/19 Page 16 of 53
Debtor 1

Debtor 2 Hajaree, Sheehan & Hajaree, Alicia Case number (if known) 0:19-bk-21319

4.1 ARS Account Resolution Last 4 digits of account number $75.00

Nonpriority Creditor's Name

POB 189018

Plantation, FL 33318-9018

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 2019 Medical Collections

4.2 Bank Of America Last 4 digits of account number 5058 $3,057.00

Nonpriority Creditor's Name

POB 982238

El Paso, TX 79998

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 2016-2017- Credit Card

4.3 Barclays Bank Delaware Last 4 digits of account number 5125 $3,088.00

Nonpriority Creditor's Name

POB 8803

Wilmington, DE 19899-8803

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 2013-2017- Credit Card

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 5 of 14

Software Copyright (c) 2019 CINGroup - www.cincompass.com

Case 19-21319-JKO Doc 15 Filed 09/25/19 Page 17 of 53
Debtor 1

Debtor 2 Hajaree, Sheehan & Hajaree, Alicia Case number (if known) 0:19-bk-21319

4.4 Capital One Last 4 digits of account number $9,734.00

Nonpriority Creditor's Name

POB 30281

Salt Lake City, UT 84130

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 2015 Credit Cards

4.5 Capital One Bank USA NA Last 4 digits of account number $1,302.00

Nonpriority Creditor's Name

POB 30281

Salt Lake City, UT 84130

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 2019 Credit Card

4.6 Capital One Bank USA NA Last 4 digits of account number $281.00

Nonpriority Creditor's Name

POB 30281

Salt Lake City, UT 84130

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 2019 Credit Card

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 6 of 14

Software Copyright (c) 2019 CINGroup - www.cincompass.com

Case 19-21319-JKO Doc 15 Filed 09/25/19 Page 18 of 53
Debtor 1

Debtor 2 Hajaree, Sheehan & Hajaree, Alicia Case number (if known) 0:19-bk-21319

4.7 Capital One Bank USA NA Last 4 digits of account number $1,000.00

Nonpriority Creditor's Name

POB 30281

Salt Lake City, UT 84130

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 2006-2019 Credit Card

4.8 CCS Collections Last 4 digits of account number $0.00

Nonpriority Creditor's Name

PO Box 551232

Fort Lauderdale, FL 33355-1232

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 Collection agent for unknown debt

4.9 Convergent Outsourcing Last 4 digits of account number $1,920.00

Nonpriority Creditor's Name

POB 9004

Renton, WA 98057

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 2019 Medical Collections

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 7 of 14

Software Copyright (c) 2019 CINGroup - www.cincompass.com

Case 19-21319-JKO Doc 15 Filed 09/25/19 Page 19 of 53
Debtor 1

Debtor 2 Hajaree, Sheehan & Hajaree, Alicia Case number (if known) 0:19-bk-21319

4.10 Credit One Bank Last 4 digits of account number $75.00

Nonpriority Creditor's Name

POB 98872

Las Vegas, NV 89193

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 2019 Credit Card

4.11 Discover Bank Last 4 digits of account number 3414 $3,116.00

Nonpriority Creditor's Name

POB 15316

Wilmington, DE 19850-5316

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 2015-2019- Credit Card

4.12 Doctors Business Bureau Last 4 digits of account number $744.00

Nonpriority Creditor's Name

202 N. Federal Hwy

Lake Worth, FL 33460-3438

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 2019 Medical

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 8 of 14

Software Copyright (c) 2019 CINGroup - www.cincompass.com

Case 19-21319-JKO Doc 15 Filed 09/25/19 Page 20 of 53
Debtor 1

Debtor 2 Hajaree, Sheehan & Hajaree, Alicia Case number (if known) 0:19-bk-21319

4.13 First Federal Credit Control Last 4 digits of account number $470.00

Nonpriority Creditor's Name

24700 Chagrin Blvd # 205

Beachwood, OH 44122

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 2019 Medical Collections

4.14 Florida Medical Center Last 4 digits of account number $1,420.00

Nonpriority Creditor's Name

POB 741226

Atlanta, GA 30374-1226

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 2019 Medical

4.15 Internal Revenue Service Last 4 digits of account number $0.00

Nonpriority Creditor's Name

PO Box 7346

Philadelphia, PA 19101-7346

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 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

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 9 of 14

Software Copyright (c) 2019 CINGroup - www.cincompass.com

Case 19-21319-JKO Doc 15 Filed 09/25/19 Page 21 of 53
Debtor 1

Debtor 2 Hajaree, Sheehan & Hajaree, Alicia Case number (if known) 0:19-bk-21319

4.16 LendUP Card - Tab Bank Last 4 digits of account number $382.00

Nonpriority Creditor's Name

47 Maiden Ln

San Francisco, CA 94108-5401

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 2019 Credit Card

4.17 Mercury Card/FB&T Last 4 digits of account number $0.00

Nonpriority Creditor's Name

PO Box 84064

Columbus, GA 31908-4064

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 2015 Credit Card

4.18 Merrick Bank Last 4 digits of account number $138.00

Nonpriority Creditor's Name

10705 S Jordan Gtwy #200

South Jordan, UT 84095

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 2019 Credit Card

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 10 of 14

Software Copyright (c) 2019 CINGroup - www.cincompass.com

Case 19-21319-JKO Doc 15 Filed 09/25/19 Page 22 of 53
Debtor 1

Debtor 2 Hajaree, Sheehan & Hajaree, Alicia Case number (if known) 0:19-bk-21319

4.19 Paypal Credit Last 4 digits of account number 0958 $2,661.57

Nonpriority Creditor's Name

PO Box 5138

Timonium, MD 21094-5138

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 2015 Credit Card

4.20 Robyn Woods Last 4 digits of account number $20,000.00

Nonpriority Creditor's Name

c/o Bradley S. Hartman, Esq.

10000 Stirling Rd # 1

Hollywood, FL 33024-8067

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 2019 Judgment

4.21 Southern Management Systm Last 4 digits of account number $859.00

Nonpriority Creditor's Name

625-C Herndon Av

Orlando, FL 32803

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 2018 Medical

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 11 of 14

Software Copyright (c) 2019 CINGroup - www.cincompass.com

Case 19-21319-JKO Doc 15 Filed 09/25/19 Page 23 of 53
Debtor 1

Debtor 2 Hajaree, Sheehan & Hajaree, Alicia Case number (if known) 0:19-bk-21319

4.22 Summit Acc Resolution Last 4 digits of account number $507.00

Nonpriority Creditor's Name

PO Box 551232

Fort Lauderdale, FL 33355-1232

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 2019 Medical collections

4.23 Summit Account Resolution Last 4 digits of account number $374.00

Nonpriority Creditor's Name

12209 Champlin Dr # 102

Champlin, MN 55316-1973

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 2013 Medical

4.24 TBOM-Milestone Last 4 digits of account number $293.00

Nonpriority Creditor's Name

216 W 2nd St

Dixon, MO 65459-8048

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 2019 Credit Card

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 12 of 14

Software Copyright (c) 2019 CINGroup - www.cincompass.com

Case 19-21319-JKO Doc 15 Filed 09/25/19 Page 24 of 53
Debtor 1

Debtor 2 Hajaree, Sheehan & Hajaree, Alicia Case number (if known) 0:19-bk-21319

4.25 TBOM-Milestone Last 4 digits of account number $396.00

Nonpriority Creditor's Name

216 W 2nd St

Dixon, MO 65459-8048

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 2019 Credit Card

4.26 TBOM/OLLO Last 4 digits of account number $1,818.00

Nonpriority Creditor's Name

1511 Friendship Rd

Jefferson City, MO 65101-8703

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 2015-2017 Credit Card

4.27 The Bank of Misouri Last 4 digits of account number $432.00

Nonpriority Creditor's Name

960 S Bishop Ave

Rolla, MO 65401-4415

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 2019 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

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.

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 13 of 14

Software Copyright (c) 2019 CINGroup - www.cincompass.com

Case 19-21319-JKO Doc 15 Filed 09/25/19 Page 25 of 53
Debtor 1

Debtor 2 Hajaree, Sheehan & Hajaree, Alicia Case number (if known) 0:19-bk-21319

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

CBCS

6450 Poe Ave

Dayton, OH 45414-2600

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

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

CCS Collections

725 Canton St

Norwood, MA 02062-2679

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

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

Summit Account Resolution

12209 Champlin Dr # 102

Champlin, MN 55316-1973

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

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. $ 42,005.00

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. $ 42,005.00

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.

$ 54,142.57

6j. Total Nonpriority. Add lines 6f through 6i. 6j. $ 54,142.57

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

Software Copyright (c) 2019 CINGroup - www.cincompass.com

Case 19-21319-JKO Doc 15 Filed 09/25/19 Page 26 of 53
 Fill in this information to identify your case: Debtor 1 Sheehan Hajaree

First Name Middle Name Last Name Debtor 2 Alicia Hajaree

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

United States Bankruptcy Court for the:

SOUTHERN DISTRICT OF FLORIDA, FORT LAUDERDALE

DIVISION

Case number 0:19-bk-21319

(if known)  Check if this is an

amended filing

Official Form 106G

Schedule G: Executory Contracts and Unexpired Leases 12/15

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

information. If more space is needed, copy the additional page, fill it out, number the entries, and attach it to this page. On the top of any

additional pages, write your name and case number (if known).

1. Do you have any executory contracts or unexpired leases?

No. Check this box and file this form with the court with your other schedules. You have nothing else to report on this form. Yes. Fill in all of the information below even if the contacts of leases are listed on Schedule A/B:Property (Official Form 106 A/B).

2. List separately each person or company with whom you have the contract or lease. Then state what each contract or lease is for (for example, rent, vehicle lease, cell phone). See the instructions for this form in the instruction booklet for more examples of executory contracts and

unexpired leases.

Person or company with whom you have the contract or lease

Name, Number, Street, City, State and ZIP Code State what the contract or lease is for

2.1

Name

Number Street

City State ZIP Code

2.2

Name

Number Street

City State ZIP Code

2.3

Name

Number Street

City State ZIP Code

2.4

Name

Number Street

City State ZIP Code

2.5

Name

Number Street

City State ZIP Code

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

Software Copyright (c) 2019 CINGroup - www.cincompass.com

Case 19-21319-JKO Doc 15 Filed 09/25/19 Page 27 of 53
 Fill in this information to identify your case: Debtor 1 Sheehan Hajaree

First Name Middle Name Last Name Debtor 2 Alicia Hajaree

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

United States Bankruptcy Court for the:

SOUTHERN DISTRICT OF FLORIDA, FORT LAUDERDALE

DIVISION

Case number 0:19-bk-21319

(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) 2019 CINGroup - www.cincompass.com

Case 19-21319-JKO Doc 15 Filed 09/25/19 Page 28 of 53
Fill in this information to identify your case:

Debtor 1 Sheehan Hajaree

Debtor 2 Alicia Hajaree

(Spouse, if filing)

United States Bankruptcy Court for the: SOUTHERN DISTRICT OF FLORIDA, FORT

LAUDERDALE DIVISION

Case number 0:19-bk-21319 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 Firefighter/Paramedic Teacher Assistant

Employer's name Board of County

Commissioners

The School Board of Broward

County

Employer's address 301 N Olive Ave

West Palm Beach, FL

33401-4700

600 SE 3rd Ave

Fort Lauderdale, FL 33301

How long employed there? 15 years 4 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. $ 8,860.00 $ 2,582.09

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

4. Calculate gross Income. Add line 2 + line 3. 4. $ 8,860.00 $ 2,582.09

Official Form 106I Schedule I: Your Income page 1

Case 19-21319-JKO Doc 15 Filed 09/25/19 Page 29 of 53
Debtor 1

Debtor 2 Hajaree, Sheehan & Hajaree, Alicia Case number (if known) 0:19-bk-21319

For Debtor 1 For Debtor 2 or non-filing spouse Copy line 4 here 4. $ 8,860.00 $ 2,582.09

5. List all payroll deductions: 5a. Tax, Medicare, and Social Security deductions 5a. $ 1,056.62 $ 356.43

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

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

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

5e. Insurance 5e. $ 600.17 $ 0.00

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

5g. Union dues 5g. $ 125.01 $ 0.00

5h. Other deductions. Specify: FR Dental HMO 5h.+ $ 33.54 + $ 0.00

BCC Nationwide 457 $ 433.33 $ 0.00

BCC FRS Special Risk $ 265.94 $ 0.00

FRS Contrb $ 0.00 $ 74.40

6. Add the payroll deductions. Add lines 5a+5b+5c+5d+5e+5f+5g+5h. 6. $ 2,514.61 $ 430.83

7. Calculate total monthly take-home pay. Subtract line 6 from line 4. 7. $ 6,345.39 $ 2,151.26

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. $ 6,345.39 + $ 2,151.26 = $ 8,496.65

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.

Write that amount on the Summary of Schedules 12. $ 8,496.65 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: Debtor is on FMLA time off from work, and is still getting his regular wages at this time. However,

the FMLA leave will end soon, and Income is expected to decrease substantially as debtor is

medically disabled, and will be receiving only disability payments in the future.

Official Form 106I Schedule I: Your Income page 2

Case 19-21319-JKO Doc 15 Filed 09/25/19 Page 30 of 53
Fill in this information to identify your case:

Debtor 1 Sheehan Hajaree Check if this is:

 An amended filing

Debtor 2 Alicia Hajaree  A supplement showing postpetition chapter 13

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

United States Bankruptcy Court for the: SOUTHERN DISTRICT OF FLORIDA, FORT

LAUDERDALE DIVISION

MM / DD / YYYY

Case number 0:19-bk-21319

(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 Householdof 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. Daughter 20

 No

Yes

Daughter 17

 No

Yes

son 11

 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. $ 2,374.96

If not included in line 4:

4a. Real estate taxes 4a. $ 0.00

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

4c. Home maintenance, repair, and upkeep expenses 4c. $ 150.00

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

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Debtor 1

Debtor 2 Hajaree, Sheehan & Hajaree, Alicia Case number (if known) 0:19-bk-21319

6. Utilities: 6a. Electricity, heat, natural gas 6a. $ 400.00

6b. Water, sewer, garbage collection 6b. $ 150.00

6c. Telephone, cell phone, Internet, satellite, and cable services 6c. $ 400.00

6d. Other. Specify: Pest Control 6d. $ 50.00

7. Food and housekeeping supplies 7. $ 1,200.00

8. Childcare and children’s education costs 8. $ 750.00

9. Clothing, laundry, and dry cleaning 9. $ 200.00

10. Personal care products and services 10. $ 200.00

11. Medical and dental expenses 11. $ 650.00

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

Do not include car payments. 12. $ 450.00

13. Entertainment, clubs, recreation, newspapers, magazines, and books 13. $ 200.00

14. Charitable contributions and religious donations 14. $ 650.00

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

15a. Life insurance 15a. $ 50.00

15b. Health insurance 15b. $ 0.00

15c. Vehicle insurance 15c. $ 600.00

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

16. Taxes. Do not include taxes deducted from your pay or included in lines 4 or 20. Specify: 16. $ 0.00

17. Installment or lease payments: 17a. Car payments for Vehicle 1 17a. $ 0.00

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

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

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

18. Your payments of alimony, maintenance, and support that you did not report as deducted from your pay on line 5, Schedule I, Your Income (Official Form 106I). 18. $ 0.00

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

Specify: 19.

20. Other real property expenses not included in lines 4 or 5 of this form or on Schedule I: Your Income. 20a. Mortgages on other property 20a. $ 0.00

20b. Real estate taxes 20b. $ 0.00

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

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

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

21. Other: Specify: Pest control 21. +$ 50.00

Lunch while at work +$ 450.00

22. Calculate your monthly expenses

22a. Add lines 4 through 21. $ 8,974.96

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. $ 8,974.96

23. Calculate your monthly net income. 23a. Copy line 12(your combined monthly income) from Schedule I. 23a. $ 8,496.65

23b. Copy your monthly expenses from line 22c above. 23b. -$ 8,974.96

23c. Subtract your monthly expenses from your monthly income. The result is your monthly net income. 23c. $ -478.31

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 19-21319-JKO Doc 15 Filed 09/25/19 Page 32 of 53
 Fill in this information to identify your case: Debtor 1 Sheehan Hajaree

First Name Middle Name Last Name Debtor 2 Alicia Hajaree

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

United States Bankruptcy Court for the:

SOUTHERN DISTRICT OF FLORIDA, FORT LAUDERDALE

DIVISION

Case number 0:19-bk-21319

(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/ Sheehan Hajaree X /s/ Alicia Hajaree

Sheehan Hajaree Alicia Hajaree

Signature of Debtor 1 Signature of Debtor 2

Date September 25, 2019 Date September 25, 2019

Case 19-21319-JKO Doc 15 Filed 09/25/19 Page 33 of 53
 Fill in this information to identify your case: Debtor 1 Sheehan Hajaree

First Name Middle Name Last Name Debtor 2 Alicia Hajaree

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

United States Bankruptcy Court for the:

SOUTHERN DISTRICT OF FLORIDA, FORT LAUDERDALE

DIVISION

Case number 0:19-bk-21319

(if known)  Check if this is an

amended filing

Official Form 107

Statement of Financial Affairs for Individuals Filing for Bankruptcy 4/19

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 2lived 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)

For last calendar year:

(January 1 to December 31, 2018 )

 Wages, commissions,

bonuses, tips  Operating a business

$141,869.00  Wages, commissions,

bonuses, tips  Operating a business

$0.00

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

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Debtor 1

Debtor 2 Hajaree, Sheehan & Hajaree, Alicia Case number (if known) 0:19-bk-21319

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 the calendar year before that:

(January 1 to December 31, 2017 )

 Wages, commissions,

bonuses, tips  Operating a business

$136,416.00  Wages, commissions,

bonuses, tips  Operating a business

$0.00

5. Did you receive any other income during this year or the two previous calendar years?

Include income regardless of whether that income is taxable. Examples of other income are alimony; child support; Social Security, unemployment, and

other public benefit payments; pensions; rental income; interest; dividends; money collected from lawsuits; royalties; and gambling and lottery winnings. If

you are filing a joint case and you have income that you received together, list it only once under Debtor 1.

List each source and the gross income from each source separately. Do not include income that you listed in line 4.  No

 Yes. Fill in the details.

Debtor 1 Debtor 2

Sources of income Describe below. Gross income from

each source

(before deductions and

exclusions)

Sources of income Describe below. Gross income

(before deductions and exclusions)

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 $6,825* or more?

 No. Go to line 7.

 Yes List below each creditor to whom you paid a total of $6,825* 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 4/01/22 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 ...

regular Mortgage and car payment Various $0.00 $0.00  Mortgage

 Car

 Credit Card

 Loan Repayment

Suppliers or vendors  Other household 

expenses 

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

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Debtor 1

Debtor 2 Hajaree, Sheehan & Hajaree, Alicia Case number (if known) 0:19-bk-21319

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 paymentInclude 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

Robyn Woods vs. ALicia hajaree

and Sheehan

CACE 16-11008

judgment Circuit Court in Broward

County, Florida

 Pending

 On appeal

 Concluded

10. Within 1 year before you filed for bankruptcy, was any of your property repossessed, foreclosed, garnished, attached, seized, or levied?

Check all that apply and fill in the details below.

 No. Go to line 11.

 Yes. Fill in the information below. Creditor Name and Address Describe the Property

Explain what happened

Date Value of the property

11. Within 90 days before you filed for bankruptcy, did any creditor, including a bank or financial institution, set off any amounts from your accounts or refuse to make a payment because you owed a debt?

 No

 Yes. Fill in the details.

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

taken Amount

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

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

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Debtor 1

Debtor 2 Hajaree, Sheehan & Hajaree, Alicia Case number (if known) 0:19-bk-21319

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 propertylost

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

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 propertytransferred

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 exchangeDate transfer was made

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

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Debtor 1

Debtor 2 Hajaree, Sheehan & Hajaree, Alicia Case number (if known) 0:19-bk-21319

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 exchangeDate transfer was made

Oscar Federico

None

2007 VW Volkwagen $200 9/2/2019

19. Within 10 years before you filed for bankruptcy, did you transfer any property to a self-settled trust or similar device of which you are a beneficiary? (These are often called asset-protection devices.)

 No

 Yes. Fill in the details.

Name of trust Description and value of the property transferred Date Transfer was made

Part 8: List of Certain Financial Accounts, Instruments, Safe Deposit Boxes, and Storage Units

20. Within 1 year before you filed for bankruptcy, were any financial accounts or instruments held in your name, or for your benefit, closed, sold, moved, or transferred?

Include checking, savings, money market, or other financial accounts; certificates of deposit; shares in banks, credit unions, brokerage houses, pension funds, cooperatives, associations, and other financial institutions.  No

 Yes. Fill in the details. Name of Financial Institution and

Address (Number, Street, City, State and ZIP

Code)

Last 4 digits of account number Type of account or

instrument

Date account was

closed, sold, moved, or

transferred

Last balance before

closing or transfer

21. Do you now have, or did you have within 1 year before you filed for bankruptcy, any safe deposit box or other depository for securities, cash, or other valuables?

 No

 Yes. Fill in the details. Name of Financial Institution Address (Number, Street, City, State and ZIP Code)

Who else had access to it?

Address (Number, Street, City, State

and ZIP Code)

Describe the contents Do you still

have it?

22. Have you stored property in a storage unit or place other than your home within 1 year before you filed for bankruptcy?

 No

 Yes. Fill in the details. Name of Storage Facility

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

Who else has or had access

to it?

Address (Number, Street, City, State

and ZIP Code)

Describe the contents Do you still

have it?

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

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

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Debtor 2 Hajaree, Sheehan & Hajaree, Alicia Case number (if known) 0:19-bk-21319

controlling the cleanup of these substances, wastes, or material.  Site means any location, facility, or property as defined under any environmental law, whether you now own, operate, or utilize it or used to

own, operate, or utilize it, including disposal sites.  Hazardous material means anything an environmental law defines as a hazardous waste, hazardous substance, toxic substance, hazardous material, pollutant, contaminant, or similar term.

Report all notices, releases, and proceedings that you know about, regardless of when they occurred.

24. Has any governmental unit notified you that you may be liable or potentially liable under or in violation of an environmental law?

 No

 Yes. Fill in the details. Name of site Address (Number, Street, City, State and ZIP Code)

Governmental unit

Address (Number, Street, City, State and

ZIP Code)

Environmental law, if you

know it

Date of notice

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

 No

 Yes. Fill in the details. Name of site Address (Number, Street, City, State and ZIP Code)

Governmental unit

Address (Number, Street, City, State and

ZIP Code)

Environmental law, if you

know it

Date of notice

26. Have you been a party in any judicial or administrative proceeding under any environmental law? Include settlements and orders.  No

 Yes. Fill in the details. Case Title Case Number Court or agency

Name Address (Number, Street, City, State

and ZIP Code)

Nature of the case Status of the

case

Part 11: Give Details About Your Business or Connections to Any Business

27. Within 4 years before you filed for bankruptcy, did you own a business or have any of the following connections to any business?

A sole proprietor or self-employed in a trade, profession, or other activity, either full-time or part-time A member of a limited liability company (LLC) or limited liability partnership (LLP)

A partner in a partnership

An officer, director, or managing executive of a corporation An owner of at least 5% of the voting or equity securities of a corporation  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

Emergency Medical Consultant,

Inc.

Emergency medical services EIN:

From-To

65-0433154

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

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

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Debtor 1

Debtor 2 Hajaree, Sheehan & Hajaree, Alicia Case number (if known) 0:19-bk-21319

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/ Sheehan Hajaree /s/ Alicia Hajaree

Sheehan Hajaree Alicia Hajaree

Signature of Debtor 1 Signature of Debtor 2

Date September 25, 2019 Date September 25, 2019

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

 No

Yes

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

 No

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

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

Software Copyright (c) 2019 CINGroup - www.cincompass.com

Case 19-21319-JKO Doc 15 Filed 09/25/19 Page 40 of 53
 Fill in this information to identify your case: Debtor 1 Sheehan Hajaree

First Name Middle Name Last Name Debtor 2 Alicia Hajaree

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

United States Bankruptcy Court for the:

SOUTHERN DISTRICT OF FLORIDA, FORT LAUDERDALE

DIVISION

Case number 0:19-bk-21319

(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 Nationstar Mortgage Surrender the property.  No

Yes

name:  Retain the property and redeem it.

Retain the property and enter into a Reaffirmation Description of 8693 SW 51st Pl, Cooper City, Agreement.

property FL 33328-4310 Retain the property and [explain]: securing debt: Retain and pay pursuant to contract

Part 2: List Your Unexpired Personal Property Leases For any unexpired personal property lease that you listed in Schedule G: Executory Contracts and Unexpired Leases (Official Form 106G), fill in

the information below. Do not list real estate leases. Unexpired leases are leases that are still in effect; the lease period has not yet ended. You may assume an unexpired personal property lease if the trustee does not assume it. 11 U.S.C. § 365(p)(2).

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

Lessor's name:  No

 Yes Description of leased

Property:

Lessor's name:  No

 Yes Description of leased

Property:

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

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Debtor 2 Hajaree, Sheehan & Hajaree, Alicia Case number (if known) 0:19-bk-21319

Lessor's name:  No

 Yes Description of leased

Property:

Lessor's name:  No

 Yes Description of leased

Property:

Lessor's name:  No

 Yes Description of leased

Property:

Lessor's name:  No

 Yes Description of leased

Property:

Lessor's name:  No

 Yes Description of leased

Property:

Part 3: Sign Below

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

property that is subject to an unexpired lease. X /s/ Sheehan Hajaree X /s/ Alicia Hajaree

Sheehan Hajaree Alicia Hajaree

Signature of Debtor 1 Signature of Debtor 2

Date September 25, 2019 Date September 25, 2019

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

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Case 19-21319-JKO Doc 15 Filed 09/25/19 Page 42 of 53
ARS Account Resolution

POB 189018

Plantation, FL 33318-9018

Bank Of America

POB 982238

El Paso, TX 79998-0000

Barclays Bank Delaware

POB 8803

Wilmington, DE 19899-8803

Capital One

POB 30281

Salt Lake City, UT 84130

Capital One Bank USA NA

POB 30281

Salt Lake City, UT 84130-0000

CBCS

6450 Poe Ave

Dayton, OH 45414-2600

CCS Collections

725 Canton St

Norwood, MA 02062-2679

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CCS Collections

PO Box 551232

Fort Lauderdale, FL 33355-1232

Convergent Outsourcing

POB 9004

Renton, WA 98057-0000

Credit One Bank

POB 98872

Las Vegas, NV 89193-0000

Discover Bank

POB 15316

Wilmington, DE 19850-5316

Doctors Business Bureau

202 N. Federal Hwy

Lake Worth, FL 33460-3438

Fed Loan Servicing

PO Box 60610

Harrisburg, PA 17106-0610

FedLoan Servicing Credit

PO Box 60610

Harrisburg, PA 17106-0610

Case 19-21319-JKO Doc 15 Filed 09/25/19 Page 44 of 53
First Federal Credit Control

24700 Chagrin Blvd # 205

Beachwood, OH 44122-0000

Florida Medical Center

POB 741226

Atlanta, GA 30374-1226

Internal Revenue Service

PO Box 7346

Philadelphia, PA 19101-7346

LendUP Card - Tab Bank

47 Maiden Ln

San Francisco, CA 94108-5401

Mercury Card/FB&T

PO Box 84064

Columbus, GA 31908-4064

Merrick Bank

10705 S Jordan Gtwy #200

South Jordan, UT 84095-0000

Mr. Cooper

PO Box 650783

Dallas, TX 75265-0783

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Nationstar Mortgage

PO Box 650783

Dallas, TX 75265-0783

Paypal Credit

PO Box 5138

Timonium, MD 21094-5138

Robyn Woods

c/o Bradley S. Hartman, Esq.

10000 Stirling Rd # 1

Hollywood, FL 33024-8067

Southern Management Systm

625-C Herndon Av

Orlando, FL 32803-0000

Summit Acc Resolution

PO Box 551232

Fort Lauderdale, FL 33355-1232

Summit Account Resolution

12209 Champlin Dr # 102

Champlin, MN 55316-1973

TBOM-Milestone

216 W 2nd St

Dixon, MO 65459-8048

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TBOM/OLLO

1511 Friendship Rd

Jefferson City, MO 65101-8703

The Bank of Misouri

960 S Bishop Ave

Rolla, MO 65401-4415

Case 19-21319-JKO Doc 15 Filed 09/25/19 Page 47 of 53
© 2019 CINgroup 1.866.218.1003 – CINcompass (www.cincompass.com)

United States Bankruptcy Court

IN RE: Case No. 

Debtor(s)

Chapter 

The above named debtor(s) hereby verify(ies) that the attached matrix listing creditorsistrue to the best of my(our) knowledge.

Date: Signature: 

Debtor

Date: Signature: 

Joint Debtor, if any

Southern District of Florida, Fort Lauderdale Division

VERIFICATION OF CREDITOR MATRIX

0:19-bk-21319

Hajaree, Sheehan & Hajaree, Alicia 7

September 25, 2019 /s/ Sheehan Hajaree

Sheehan Hajaree

September 25, 2019 /s/ Alicia Hajaree

Alicia Hajaree

Case 19-21319-JKO Doc 15 Filed 09/25/19 Page 48 of 53
© 2019 CINgroup 1.866.218.1003 – CINcompass (www.cincompass.com)

B201B (Form 201B) (12/09)

IN RE: Case No. 

Debtor(s)

Chapter 

UNDER § 342(b) OF THE BANKRUPTCY CODE

Certificate of [Non-Attorney] Bankruptcy Petition Preparer

I, the [non-attorney] bankruptcy petition preparer signing the debtor’s petition, hereby certify that I delivered to the debtor the attached

notice, as required by § 342(b) of the Bankruptcy Code.

Printed Name and title, if any, of Bankruptcy Petition Preparer

Address:

X

Signature of Bankruptcy Petition Preparer of officer, principal, responsible person, or

partner whose Social Security number is provided above.

Social Security number (If the bankruptcy

petition preparer is not an individual, state

the Social Security number of the officer,

principal, responsible person, or partner of

the bankruptcy petition preparer.)

(Required by 11 U.S.C. § 110.)

Certificate of the Debtor

I (We), the debtor(s), affirm that I (we) have received and read the attached notice, as required by § 342(b) of the Bankruptcy Code.

Printed Name(s) of Debtor(s)

X

Signature of Debtor Date

Case No. (if known) X

Signature of Joint Debtor (if any) Date

Instructions: Attach a copy of Form B 201A, Notice to Consumer Debtor(s) Under § 342(b) of the Bankruptcy Code.

Use this form to certify that the debtor has received the notice required by 11 U.S.C. § 342(b) only if the certification has

NOT been made on the Voluntary Petition, Official Form B1. Exhibit B on page 2 of Form B1 contains a certification by the debtor’s

attorney that the attorney has given the notice to the debtor. The Declarations made by debtors and bankruptcy petition preparers on

page 3 of Form B1 also include this certification.

United States Bankruptcy Court

Southern District of Florida, Fort Lauderdale Division

CERTIFICATION OF NOTICE TO CONSUMER DEBTOR(S)

0:19-bk-21319

Hajaree, Sheehan & Hajaree, Alicia 7

Hajaree, Sheehan & Hajaree, Alicia

0:19-bk-21319

/s/ Sheehan Hajaree 9/25/2019

/s/ Alicia Hajaree 9/25/2019

Case 19-21319-JKO Doc 15 Filed 09/25/19 Page 49 of 53
 Notice Required by 11 U.S.C. § 342(b) for

Individuals Filing for Bankruptcy (Form 2010)

This notice is for you if:

You are an individual filing for bankruptcy,

and

Your debts are primarily consumer debts.

Consumer debts are defined in 11 U.S.C.

§ 101(8) as “incurred by an individual

primarily for a personal, family, or

household purpose.”

Chapter 7: Liquidation

$245 filing fee

$75 administrative fee

+ $15 trustee surcharge

$335 total fee

Chapter 7 is for individuals who have financial

difficulty preventing them from paying their debts

and who are willing to allow their nonexempt

property to be used to pay their creditors. The

primary purpose of filing under chapter 7 is to have

your debts discharged. The bankruptcy discharge

relieves you after bankruptcy from having to pay

many of your pre-bankruptcy debts. Exceptions

exist for particular debts, and liens on property may

still be enforced after discharge. For example, a

creditor may have the right to foreclose a home

mortgage or repossess an automobile.

However, if the court finds that you have committed

certain kinds of improper conduct described in the

Bankruptcy Code, the court may deny your

discharge.

You should know that even if you file chapter 7 and

you receive a discharge, some debts are not

discharged under the law. Therefore, you may still

be responsible to pay:

most taxes;

most student loans;

domestic support and property settlement

obligations;

The types of bankruptcy that are available to

individuals

Individuals who meet the qualifications may file under

one of four different chapters of Bankruptcy Code:

Chapter 7 - Liquidation

Chapter 11 - Reorganization

Chapter 12 - Voluntary repayment plan

for family farmers or

fishermen

Chapter 13 - Voluntary repayment plan

for individuals with regular

income

You should have an attorney review your

decision to file for bankruptcy and the choice of

chapter.

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

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Case 19-21319-JKO Doc 15 Filed 09/25/19 Page 50 of 53
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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Case 19-21319-JKO Doc 15 Filed 09/25/19 Page 51 of 53
Read These Important Warnings

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

your property, you should hire an attorney and carefully consider all of your options before you file.

Only an attorney can give you legal advice about what can happen as a result of filing for bankruptcy

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

properly and protect you, your family, your home, and your possessions.

Although the law allows you to represent yourself in bankruptcy court, you should understand that

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

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

and following all of the legal requirements.

You should not file for bankruptcy if you are not eligible to file or if you do not intend to file the

necessary documents.

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

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

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

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

Chapter 12: Repayment plan for family

farmers or fishermen

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

to repay your creditors all or part of the money that

you owe them, usually using your future earnings. If

the court approves your plan, the court will allow you

to repay your debts, as adjusted by the plan, within 3

years or 5 years, depending on your income and other

factors.

After you make all the payments under your plan,

many of your debts are discharged. The debts that

are not discharged and that you may still be

responsible to pay include:

domestic support obligations,

most student loans,

certain taxes,

debts for fraud or theft,

debts for fraud or defalcation while acting in a

fiduciary capacity,

most criminal fines and restitution obligations,

certain debts that are not listed in your

bankruptcy papers,

certain debts for acts that caused death or

personal injury, and

certain long-term secured debts.

$200 filing fee

+ $75 administrative fee

$275 total fee

Similar to chapter 13, chapter 12 permits family farmers

and fishermen to repay their debts over a period of time

using future earnings and to discharge some debts that

are not paid.

Chapter 13: Repayment plan for

individuals with regular

income

$235 filing fee

+ $75 administrative fee

$310 total fee

Chapter 13 is for individuals who have regular income

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

installments over a period of time and to discharge

some debts that are not paid. You are eligible for

chapter 13 only if your debts are not more than certain

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

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

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Case 19-21319-JKO Doc 15 Filed 09/25/19 Page 52 of 53
Warning: File Your Forms on Time

A married couple may file a bankruptcy case

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

and each spouse lists the same mailing address on the

bankruptcy petition, the bankruptcy court generally will

mail you and your spouse one copy of each notice,

unless you file a statement with the court asking that

each spouse receive separate copies.

Understand which services you could receive from

credit counseling agencies

The law generally requires that you receive a credit

counseling briefing from an approved credit counseling

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

case, both spouses must receive the briefing. With

limited exceptions, you must receive it within the 180

days before you file your bankruptcy petition. This

briefing is usually conducted by telephone or on the

Internet.

In addition, after filing a bankruptcy case, you

generally must complete a financial management

instructional course before you can receive a

discharge. If you are filing a joint case, both spouses

must complete the course.

You can obtain the list of agencies approved to provide

both the briefing and the instructional course from:

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

.

In Alabama and North Carolina, go to:

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

BankruptcyResources/ApprovedCredit

AndDebtCounselors.aspx.

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

the bankruptcy court may be able to help you obtain

the list.

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

you promptly file detailed information about your

creditors, assets, liabilities, income, expenses and

general financial condition. The court may dismiss your

bankruptcy case if you do not file this information

within the deadlines set by the Bankruptcy Code, the

Bankruptcy Rules, and the local rules of the court.

For more information about the documents and

their deadlines, go to:

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

s.html#procedure.

Bankruptcy crimes have serious consequences

If you knowingly and fraudulently conceal assets

or make a false oath or statement under penalty

of perjury—either orally or in writing—in

connection with a bankruptcy case, you may be

fined, imprisoned, or both.

All information you supply in connection with a

bankruptcy case is subject to examination by the

Attorney General acting through the Office of the

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

other offices and employees of the U.S.

Department of Justice.

Make sure the court has your mailing address

The bankruptcy court sends notices to the mailing

address you list on Voluntary Petition for Individuals

Filing for Bankruptcy (Official Form 101). To ensure

that you receive information about your case,

Bankruptcy Rule 4002 requires that you notify the court

of any changes in your address.

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

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