6/25/19 2:43PM

Fill in this information to identify your case:

United States Bankruptcy Court for the:

SOUTHERN DISTRICT OF FLORIDA

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

 Chapter 7

 Chapter 11

 Chapter 12

 Chapter 13  Check if this an

amended filing

Official Form 101

Voluntary Petition for Individuals Filing for Bankruptcy 12/17

The bankruptcy forms use you and Debtor 1 to refer to a debtor filing alone. A married couple may file a bankruptcy case together—called a joint

case—and in joint cases, these forms use you to ask for information from both debtors. For example, if a form asks, “Do you own a car,” the answer

would be yes if either debtor owns a car. When information is needed about the spouses separately, the form uses Debtor 1 and Debtor 2 to distinguish

between them. In joint cases, one of the spouses must report information as Debtor 1 and the other as Debtor 2. The same person must be Debtor 1 in

all of the forms.

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

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

every question.

Part 1: Identify Yourself

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

1. Your full name

Write the name that is on

your government-issued

picture identification (for

example, your driver's

license or passport).

Bring your picture

identification to your

meeting with the trustee.

Katie Stephen

First name First name

Annette Cameron

Middle name Middle name

Kiss Kiss

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

2. All other names you have

used in the last 8 years

Include your married or

maiden names.

FKA Katie Ann Rinelli

Katie Annette Rinelli

Annette Rinelli

Katie Kiss Rinelli

Katie Annette Rinelli Kiss

Cameron Kiss

3. Only the last 4 digits of

your Social Security

number or federal

Individual Taxpayer

Identification number

(ITIN)

xxx-xx-5710 xxx-xx-5244

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

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 1 of 105
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Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

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

4. Any business names and

Employer Identification

Numbers (EIN) you have

used in the last 8 years

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

Include trade names and

doing business as names

Business name(s) Business name(s)

EINs EINs

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

1562 SE Saxony Street

Port Saint Lucie, FL 34983

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

Saint Lucie

County County

If your mailing address is different from the one

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

notices to you at this mailing address.

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

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

mailing address.

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

6. Why you are choosing

this district to file for

bankruptcy

Check one:

 Over the last 180 days before filing this petition,

I have lived in this district longer than in any

other district.

 I have another reason.

Explain. (See 28 U.S.C. § 1408.)

Check one:

 Over the last 180 days before filing this petition, I

have lived in this district longer than in any other

district.

 I have another reason.

Explain. (See 28 U.S.C. § 1408.)

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

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Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

Part 2: Tell the Court About Your Bankruptcy Case

7. The chapter of the

Bankruptcy Code you are

choosing to file under

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

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

 Chapter 7

 Chapter 11

 Chapter 12

 Chapter 13

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

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

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

a pre-printed address.

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

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

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

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

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

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

9. Have you filed for

bankruptcy within the

last 8 years?

 No.

 Yes.

District When Case number

District When Case number

District When Case number

10. Are any bankruptcy

cases pending or being

filed by a spouse who is

not filing this case with

you, or by a business

partner, or by an

affiliate?

 No

 Yes.

Debtor Relationship to you

District When Case number, if known

Debtor Relationship to you

District When Case number, if known

11. Do you rent your

residence?

 No. Go to line 12.

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

 No. Go to line 12.

 Yes. Fill out Initial Statement About an Eviction Judgment Against You (Form 101A) and file it as part of

this bankruptcy petition.

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

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Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

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

12. Are you a sole proprietor

of any full- or part-time

business?

 No. Go to Part 4.

 Yes. Name and location of business

A sole proprietorship is a

business you operate as

an individual, and is not a

separate legal entity such

as a corporation,

partnership, or LLC.

Name of business, if any

If you have more than one

sole proprietorship, use a

separate sheet and attach

it to this petition.

Number, Street, City, State & ZIP Code

Check the appropriate box to describe your business:

 Health Care Business (as defined in 11 U.S.C. § 101(27A))

 Single Asset Real Estate (as defined in 11 U.S.C. § 101(51B))

 Stockbroker (as defined in 11 U.S.C. § 101(53A))

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

 None of the above

13. Are you filing under

Chapter 11 of the

Bankruptcy Code and are

you a small business

debtor?

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

deadlines. If you indicate that you are a small business debtor, you must attach your most recent balance sheet, statement of

operations, cash-flow statement, and federal income tax return or if any of these documents do not exist, follow the procedure

in 11 U.S.C. 1116(1)(B).

For a definition of small

business debtor, see 11

U.S.C. § 101(51D).

 No. I am not filing under Chapter 11.

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

Code.

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

Part 4: Report if You Own or Have Any Hazardous Property or Any Property That Needs Immediate Attention

14. Do you own or have any

property that poses or is

alleged to pose a threat

of imminent and

identifiable hazard to

public health or safety?

Or do you own any

property that needs

immediate attention?

 No.

 Yes.

What is the hazard?

If immediate attention is

needed, why is it needed?

For example, do you own

perishable goods, or

livestock that must be fed,

or a building that needs

urgent repairs?

Where is the property?

Number, Street, City, State & Zip Code

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

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 4 of 105
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Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

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

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

15. Tell the court whether

you have received a

briefing about credit

counseling.

The law requires that you

receive a briefing about

credit counseling before

you file for bankruptcy.

You must truthfully check

one of the following

choices. If you cannot do

so, you are not eligible to

file.

If you file anyway, the court

can dismiss your case, you

will lose whatever filing fee

you paid, and your

creditors can begin

collection activities again.

You must check one: You must check one:

 I received a briefing from an approved credit

counseling agency within the 180 days before I

filed this bankruptcy petition, and I received a

certificate of completion.

Attach a copy of the certificate and the payment

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

 I received a briefing from an approved credit

counseling agency within the 180 days before I filed

this bankruptcy petition, and I received a certificate of

completion.

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

any, that you developed with the agency.

 I received a briefing from an approved credit

counseling agency within the 180 days before I

filed this bankruptcy petition, but I do not have

a certificate of completion.

Within 14 days after you file this bankruptcy

petition, you MUST file a copy of the certificate and

payment plan, if any.

 I received a briefing from an approved credit

counseling agency within the 180 days before I filed

this bankruptcy petition, but I do not have a certificate

of completion.

Within 14 days after you file this bankruptcy petition, you

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

any.

 I certify that I asked for credit counseling

services from an approved agency, but was

unable to obtain those services during the 7

days after I made my request, and exigent

circumstances merit a 30-day temporary waiver

of the requirement.

To ask for a 30-day temporary waiver of the

requirement, attach a separate sheet explaining

what efforts you made to obtain the briefing, why

you were unable to obtain it before you filed for

bankruptcy, and what exigent circumstances

required you to file this case.

Your case may be dismissed if the court is

dissatisfied with your reasons for not receiving a

briefing before you filed for bankruptcy.

If the court is satisfied with your reasons, you must

still receive a briefing within 30 days after you file.

You must file a certificate from the approved

agency, along with a copy of the payment plan you

developed, if any. If you do not do so, your case

may be dismissed.

Any extension of the 30-day deadline is granted

only for cause and is limited to a maximum of 15

days.

 I certify that I asked for credit counseling services

from an approved agency, but was unable to obtain

those services during the 7 days after I made my

request, and exigent circumstances merit a 30-day

temporary waiver of the requirement.

To ask for a 30-day temporary waiver of the requirement,

attach a separate sheet explaining what efforts you made

to obtain the briefing, why you were unable to obtain it

before you filed for bankruptcy, and what exigent

circumstances required you to file this case.

Your case may be dismissed if the court is dissatisfied

with your reasons for not receiving a briefing before you

filed for bankruptcy.

If the court is satisfied with your reasons, you must still

receive a briefing within 30 days after you file. You must

file a certificate from the approved agency, along with a

copy of the payment plan you developed, if any. If you do

not do so, your case may be dismissed.

Any extension of the 30-day deadline is granted only for

cause and is limited to a maximum of 15 days.

 I am not required to receive a briefing about

credit counseling because of:

 I am not required to receive a briefing about credit

counseling because of:

 Incapacity.

I have a mental illness or a mental deficiency

that makes me incapable of realizing or

making rational decisions about finances.

 Incapacity.

I have a mental illness or a mental deficiency that

makes me incapable of realizing or making rational

decisions about finances.

 Disability.

My physical disability causes me to be

unable to participate in a briefing in person,

by phone, or through the internet, even after I

reasonably tried to do so.

 Disability.

My physical disability causes me to be unable to

participate in a briefing in person, by phone, or

through the internet, even after I reasonably tried to

do so.

 Active duty.

I am currently on active military duty in a

military combat zone.

 Active duty.

I am currently on active military duty in a military

combat zone.

If you believe you are not required to receive a

briefing about credit counseling, you must file a

motion for waiver credit counseling with the court.

If you believe you are not required to receive a briefing

about credit counseling, you must file a motion for waiver

of credit counseling with the court.

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

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Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

Part 6: Answer These Questions for Reporting Purposes

16. What kind of debts do

you have?

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

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

 No. Go to line 16b.

 Yes. Go to line 17.

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

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

 No. Go to line 16c.

 Yes. Go to line 17.

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

17. Are you filing under

Chapter 7?

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

Do you estimate that

after any exempt

property is excluded and

administrative expenses

are paid that funds will

be available for

distribution to unsecured

creditors?

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

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

 No

 Yes

18. How many Creditors do

you estimate that you

owe?

 1-49

 50-99

 100-199

 200-999

 1,000-5,000

 5001-10,000

 10,001-25,000

 25,001-50,000

 50,001-100,000

 More than100,000

19. How much do you

estimate your assets to

be worth?

 $0 - $50,000

 $50,001 - $100,000

 $100,001 - $500,000

 $500,001 - $1 million

 $1,000,001 - $10 million

 $10,000,001 - $50 million

 $50,000,001 - $100 million

 $100,000,001 - $500 million

 $500,000,001 - $1 billion

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

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

 More than $50 billion

20. How much do you

estimate your liabilities

to be?

 $0 - $50,000

 $50,001 - $100,000

 $100,001 - $500,000

 $500,001 - $1 million

 $1,000,001 - $10 million

 $10,000,001 - $50 million

 $50,000,001 - $100 million

 $100,000,001 - $500 million

 $500,000,001 - $1 billion

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

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

 More than $50 billion

Part 7: Sign Below

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

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

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

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

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

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

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

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

and 3571.

/s/ Katie Annette Kiss /s/ Stephen Cameron Kiss

Katie Annette Kiss Stephen Cameron Kiss

Signature of Debtor 1 Signature of Debtor 2

Executed on June 25, 2019 Executed on June 25, 2019

MM / DD / YYYY MM / DD / YYYY

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

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 6 of 105
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Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

For your attorney, if you are

represented by one

If you are not represented by

an attorney, you do not need

to file this page.

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

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

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

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

schedules filed with the petition is incorrect.

/s/ Randall A. Fischer Date June 25, 2019

Signature of Attorney for Debtor MM / DD / YYYY

Randall A. Fischer 53804 Karen Schweikert, Paralegal

Printed name

Randall A. Fischer, PA

Firm name

2100 SE Ocean Blvd.

Suite 203

Stuart, FL 34996

Number, Street, City, State & ZIP Code

Contact phone 772-463-7737 Email address randall@rafischerattorney.com

53804 FL

Bar number & State

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

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 7 of 105
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Fill in this information to identify your case:

Debtor 1 Katie Annette Kiss

First Name Middle Name Last Name

Debtor 2 Stephen Cameron Kiss

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

United States Bankruptcy Court for the: SOUTHERN DISTRICT OF FLORIDA

Case number

(if known)  Check if this is an

amended filing

Official Form 106Sum

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

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

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

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

Part 1: Summarize Your Assets

Your assets

Value of what you own

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

1a. Copy line 55, Total real estate, from Schedule A/B................................................................................................ $ 197,000.00

1b. Copy line 62, Total personal property, from Schedule A/B..................................................................................... $ 138,857.27

1c. Copy line 63, Total of all property on Schedule A/B............................................................................................... $ 335,857.27

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... $ 64,871.35

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

3b. Copy the total claims from Part 2 (nonpriority unsecured claims) from line 6j of Schedule E/F............................ $ 193,503.22

Your total liabilities $ 258,374.57

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................................................................................ $ 3,122.74

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

Copy your monthly expenses from line 22c of Schedule J.......................................................................... $ 3,163.29

Part 4: Answer These Questions for Administrative and Statistical Records

6. Are you filing for bankruptcy under Chapters 7, 11, or 13?

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

 Yes

7. What kind of debt do you have?

 Your debts are primarily consumer debts. Consumer debts are those “incurred by an individual primarily for a personal, family, or

household purpose.” 11 U.S.C. § 101(8). Fill out lines 8-9g for statistical purposes. 28 U.S.C. § 159.

 Your debts are not primarily consumer debts. You have nothing to report on this part of the form. Check this box and submit this form to

the court with your other schedules.

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

Software Copyright (c) 1996-2019 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

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Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

8. From the Statement of Your Current Monthly Income: Copy your total current monthly income from Official Form

122A-1 Line 11; OR, Form 122B Line 11; OR, Form 122C-1 Line 14. $ 3,122.00

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

Total claim

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

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

9b. Taxes and certain other debts you owe the government. (Copy line 6b.) $ 0.00

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. $ 0.00

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

Software Copyright (c) 1996-2019 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

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

Debtor 1 Katie Annette Kiss

First Name Middle Name Last Name

Debtor 2 Stephen Cameron Kiss

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

United States Bankruptcy Court for the: SOUTHERN DISTRICT OF FLORIDA

Case number  Check if this is an

amended filing

Official Form 106A/B

Schedule A/B: Property 12/15

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

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

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

Answer every question.

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

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

 No. Go to Part 2.

 Yes. Where is the property?

1.1 What is the property? Check all that apply

Do not deduct secured claims or exemptions. Put

the amount of any secured claims on Schedule D:

Creditors Who Have Claims Secured by Property.

1562 SE Saxony Street 





Single-family home

Duplex or multi-unit building

Condominium or cooperative

Street address, if available, or other description

Port Saint Lucie FL 34983-0000





Manufactured or mobile home

Land

Current value of the

entire property?

Current value of the

portion you own?

City State ZIP Code  Investment property $197,000.00 $197,000.00

 Timeshare

Describe the nature of your ownership interest

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

a life estate), if known.

 Other

Who has an interest in the property? Check one

 Debtor 1 only Fee Owner

Saint Lucie  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:

Single Family Residence built in 1988 / 3BR and 2 Baths - 1563 sq ft

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...........................................................................=> $197,000.00

Part 2: Describe Your Vehicles

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

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

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

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Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 10 of 105
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Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

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: Fusion  Creditors Who Have Claims Secured by Property.

 Debtor 1 only

Year: 2014  Debtor 2 only Current value of the

entire property?

Current value of the

Approximate mileage: 59000  Debtor 1 and Debtor 2 only portion you own?

Other information:  At least one of the debtors and another

Gray Sedan 4 Door

VIN:3FA6P0K94ER330903  Check if this is community property $11,000.00 $11,000.00

 (see instructions)

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

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

 No

 Yes

5

.

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

pages you have attached for Part 2. Write that number here.............................................................................=> $11,000.00

Part 3: Describe Your Personal and Household Items

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

portion you own?

Do not deduct secured

claims or exemptions.

6. Household goods and furnishings

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

 No

 Yes. Describe.....

Couch, Table with four chairs; Crib; Bed; 2 end tables; 2 lamps $200.00

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.....

Television; Playstation; DVD player and cell phones $120.00

8. Collectibles of value

Examples: Antiques and figurines; paintings, prints, or other artwork; books, pictures, or other art objects; stamp, coin, or baseball card collections;

other collections, memorabilia, collectibles

 No

 Yes. Describe.....

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

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

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Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

 Yes. Describe.....

11. Clothes

Examples: Everyday clothes, furs, leather coats, designer wear, shoes, accessories

 No

 Yes. Describe.....

Women's, Men's and Toddlers clothing of no value other than to

owner $0.00

12. Jewelry

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

 No

 Yes. Describe.....

Woman's ring $100.00

13. Non-farm animals

Examples: Dogs, cats, birds, horses

 No

 Yes. Describe.....

2 dogs (not breed specific) - priceless to owners Unknown

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 .............................................................................. $420.00

Part 4: Describe Your Financial Assets

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

portion you own?

Do not deduct secured

claims or exemptions.

16. Cash

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

 No

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

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.

Joint Checking

XXXX2356 SeaCoast National Bank $507.11

17.2.

Advantage

Checking

XXXX65743 SunTrust Bank $178.16

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

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Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

18. Bonds, mutual funds, or publicly traded stocks

Examples: Bond funds, investment accounts with brokerage firms, money market accounts

 No

 Yes.................. Institution or issuer name:

19. Non-publicly traded stock and interests in incorporated and unincorporated businesses, including an interest in an LLC, partnership, and

joint venture

 No

 Yes. Give specific information about them...................

Name of entity: % of ownership:

20. Government and corporate bonds and other negotiable and non-negotiable instruments

Negotiable instruments include personal checks, cashiers’ checks, promissory notes, and money orders.

Non-negotiable instruments are those you cannot transfer to someone by signing or delivering them.

 No

 Yes. Give specific information about them

Issuer name:

21. Retirement or pension accounts

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

 No

 Yes. List each account separately.

Type of account: Institution name:

401k SunLife 401K matching with Employer

Midflorida Credit Union $752.00

Life Insurance -Group

Term- payable on death

Sun Life Assurance Company of Canada

$26,000.00

 Life Insurance - Term

Policy - payable on death

AFLAC Term Life Insurance Policy

$100,000.00

22. Security deposits and prepayments

Your share of all unused deposits you have made so that you may continue service or use from a company

Examples: Agreements with landlords, prepaid rent, public utilities (electric, gas, water), telecommunications companies, or others

 No

 Yes. ..................... Institution name or individual:

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

 No

 Yes............. Issuer name and description.

24. Interests in an education IRA, in an account in a qualified ABLE program, or under a qualified state tuition program.

26 U.S.C. §§ 530(b)(1), 529A(b), and 529(b)(1).

 No

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

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

 No

 Yes. Give specific information about them...

26. Patents, copyrights, trademarks, trade secrets, and other intellectual property

Examples: Internet domain names, websites, proceeds from royalties and licensing agreements

 No

 Yes. Give specific information about them...

27. Licenses, franchises, and other general intangibles

Examples: Building permits, exclusive licenses, cooperative association holdings, liquor licenses, professional licenses

 No

 Yes. Give specific information about them...

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

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Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

Money or property owed to you? Current value of the

portion you own?

Do not deduct secured

claims or exemptions.

28. Tax refunds owed to you

 No

 Yes. Give specific information about them, including whether you already filed the returns and the tax years.......

29. Family support

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

 No

 Yes. Give specific information......

30. Other amounts someone owes you

Examples: Unpaid wages, disability insurance payments, disability benefits, sick pay, vacation pay, workers’ compensation, Social Security

benefits; unpaid loans you made to someone else

 No

 Yes. Give specific information..

31. Interests in insurance policies

Examples: Health, disability, or life insurance; health savings account (HSA); credit, homeowner’s, or renter’s insurance

 No

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

Company name: Beneficiary: Surrender or refund

value:

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.........

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..................................................................................................................... $127,437.27

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

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

 No. Go to Part 6.

 Yes. Go to line 38.

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

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Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

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

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

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

 No. Go to Part 7.

 Yes. Go to line 47.

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

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

Examples: Season tickets, country club membership

 No

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

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

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

55. Part 1: Total real estate, line 2 ...................................................................................................................... $197,000.00

56. Part 2: Total vehicles, line 5 $11,000.00

57. Part 3: Total personal and household items, line 15 $420.00

58. Part 4: Total financial assets, line 36 $127,437.27

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... $138,857.27 Copy personal property total $138,857.27

63. Total of all property on Schedule A/B. Add line 55 + line 62 $335,857.27

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

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Fill in this information to identify your case:

Debtor 1 Katie Annette Kiss

First Name Middle Name Last Name

Debtor 2 Stephen Cameron Kiss

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

United States Bankruptcy Court for the: SOUTHERN DISTRICT OF FLORIDA

Case number

(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

1562 SE Saxony Street Port Saint

Lucie, FL 34983 Saint Lucie County

Single Family Residence built in 1988

/ 3BR and 2 Baths - 1563 sq ft

Line from Schedule A/B: 1.1

$197,000.00  $139,409.00 Fla. Const. art. X, § 4(a)(1);

Fla. Stat. Ann. §§ 222.01 &

 100% of fair market value, up to 222.02

any applicable statutory limit

2014 Ford Fusion 59000 miles

Gray Sedan 4 Door

VIN:3FA6P0K94ER330903

Line from Schedule A/B: 3.1

$11,000.00  $2,000.00 Fla. Const. art. X, § 4(a)(2)

 100% of fair market value, up to

any applicable statutory limit

2014 Ford Fusion 59000 miles

Gray Sedan 4 Door

VIN:3FA6P0K94ER330903

Line from Schedule A/B: 3.1

$11,000.00  $1,719.65 Fla. Stat. Ann. § 222.25(1)

 100% of fair market value, up to

any applicable statutory limit

Women's, Men's and Toddlers

clothing of no value other than to

owner

Line from Schedule A/B: 11.1

$0.00  $0.00 Fla. Const. art. X, § 4(a)(2)

 100% of fair market value, up to

any applicable statutory limit

401k: SunLife 401K matching with

Employer Midflorida Credit Union

Line from Schedule A/B: 21.1

$752.00  $752.00 Fla. Stat. Ann. § 222.21(2)

 100% of fair market value, up to

any applicable statutory limit

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

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Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

Brief description of the property and line on

Schedule A/B that lists this property

Current value of the

portion you own

Copy the value from

Schedule A/B

Amount of the exemption you claim

Check only one box for each exemption.

Specific laws that allow exemption

Life Insurance -Group Term- payable

on death: Sun Life Assurance

Company of Canada

Line from Schedule A/B: 21.2

$26,000.00  $26,000.00 Fla. Stat. Ann. § 222.21(2)

 100% of fair market value, up to

any applicable statutory limit

 Life Insurance - Term Policy -

payable on death: AFLAC Term Life

Insurance Policy

Line from Schedule A/B: 21.3

$100,000.00  $100,000.00 Fla. Stat. Ann. § 222.21(2)

 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 2

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Fill in this information to identify your case:

Debtor 1 Katie Annette Kiss

First Name Middle Name Last Name

Debtor 2 Stephen Cameron Kiss

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

United States Bankruptcy Court for the: SOUTHERN DISTRICT OF FLORIDA

Case number

(if known)  Check if this is an

amended filing

Official Form 106D

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

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

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

number (if known).

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

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

 Yes. Fill in all of the information below.

Part 1: List All Secured Claims

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

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

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

Column A

Amount of claim

Do not deduct the

value of collateral.

Column B

Value of collateral

that supports this

claim

Column C

Unsecured

portion

If any

2.1 Mr. Cooper Describe the property that secures the claim: $57,591.00 $197,000.00 $0.00

Creditor's Name 1562 SE Saxony Street Port Saint

Lucie, FL 34983 Saint Lucie County

Single Family Residence built in

1988 / 3BR and 2 Baths - 1563 sq ft

Attn: Bankruptcy

8950 Cypress Waters

Blvd

Coppell, TX 75019

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

apply.

 Contingent

Number, Street, City, State & Zip Code  Unliquidated

 Disputed

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

 Debtor 1 only

 Debtor 2 only

 An agreement you made (such as mortgage or secured

car loan)

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

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

 Check if this claim relates to a

community debt

 Other (including a right to offset) First Mortgage

Date debt was incurred

Opened

08/13 Last

Active

4/26/19 Last 4 digits of account number 9048

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

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Debtor 1 Katie Annette Kiss Case number (if known)

First Name Middle Name Last Name

Debtor 2 Stephen Cameron Kiss

First Name Middle Name Last Name

2.2 SunTrust Bank Describe the property that secures the claim: $7,280.35 $11,000.00 $0.00

Creditor's Name 2014 Ford Fusion 59000 miles

Gray Sedan 4 Door

VIN:3FA6P0K94ER330903

Attn: Bankruptcy

Po Box 85092

Mc Va-Wmrk-7952

Richmond, VA 23286

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 10/2015 Last 4 digits of account number 7547

Add the dollar value of your entries in Column A on this page. Write that number here: $64,871.35

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

Write that number here: $64,871.35

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

Group One Mortgage, Inc.

900 E. IndiantownRoad

Suite 110

Jupiter, FL 33477

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

Last 4 digits of account number 9048 

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 9048 

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

Mr. Cooper

Attn: Bankruptcy / Reaffirmation Dept

PO Box 619094

Dallas, TX 75261-9741

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

Last 4 digits of account number 9048 

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

SunTrust Bank

PO Box 305053

Nashville, TN 37230-5053

On which line in Part 1 did you enter the creditor? 2.2 

Last 4 digits of account number 7547 

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

Suntrust Bank South

1501 NE 26th Street

Fort Lauderdale, FL 33305

On which line in Part 1 did you enter the creditor? 2.2 

Last 4 digits of account number 7547 

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

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Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 19 of 105
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Fill in this information to identify your case:

Debtor 1 Katie Annette Kiss

First Name Middle Name Last Name

Debtor 2 Stephen Cameron Kiss

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

United States Bankruptcy Court for the: SOUTHERN DISTRICT OF FLORIDA

Case number

(if known)  Check if this is an

amended filing

Official Form 106E/F

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

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

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

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

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

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

name and case number (if known).

Part 1: List All of Your PRIORITY Unsecured Claims

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

 No. Go to Part 2.

 Yes.

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

4.1 Account Resolution Services Last 4 digits of account number 3556 $259.05

Nonpriority Creditor's Name

Attn: Bankruptcy

Po Box 459079

Sunrise, FL 33345

When was the debt incurred?

Opened 09/17 Last Active

05/16

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify

Collection Atty Treasure Coast Anesthesia

Group

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 1 of 45

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Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

4.2 Account Resolution Services Last 4 digits of account number 4920 $148.00

Nonpriority Creditor's Name

Attn: Bankruptcy

Po Box 459079

Sunrise, FL 33345

When was the debt incurred?

Opened 09/18 Last Active

04/17

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify

Collection Attorney Paragon Contracting

Svc

4.3 AFNI, Inc. Last 4 digits of account number 0471 $292.71

Nonpriority Creditor's Name

Attn: Bankruptcy

Po Box 3427

Bloomington, IL 61702

When was the debt incurred? Opened 11/17

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify Collection Attorney Comcast

4.4 AFNI, Inc. Last 4 digits of account number 5101 $571.88

Nonpriority Creditor's Name

PO Box 3517

Bloomington, IL 61702-3517

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 Direct TV

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 2 of 45

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Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

4.5 AMCA Last 4 digits of account number 3A87 $936.21

Nonpriority Creditor's Name

American Medical Collection

Agency

PO BOX 1235

Elmsford, NY 10523-0935

When was the debt incurred? 3/2017

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

CareCentrix / CAR56500092256 50.82 and

CAR56500075469 101.64 and

CAR56500070694 758.34 and

CAR56500075470 25.41

4.6

AMCA/American Medical Collection

Agency Last 4 digits of account number 0694 $758.34

Nonpriority Creditor's Name

Attention: Bankruptcy

4 Westchester Plaza, Suite 110

Elmsford, NY 10523

When was the debt incurred? Opened 8/14/17

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 Carecentrix

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 3 of 45

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Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

4.7

AMCA/American Medical Collection

Agency Last 4 digits of account number 5469 $101.00

Nonpriority Creditor's Name

Attention: Bankruptcy

4 Westchester Plaza, Suite 110

Elmsford, NY 10523

When was the debt incurred? Opened 8/14/17

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 Carecentrix

4.8 Amex/Bankruptcy Last 4 digits of account number 6432 $0.00

Nonpriority Creditor's Name

Correspondence/Bankruptcy

Po Box 981540

El Paso, TX 79998

When was the debt incurred?

Opened 10/04 Last Active

05/06

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify Credit Card

4.9 Bay Area Credit Service LLC Last 4 digits of account number 0854 $32.43

Nonpriority Creditor's Name

PO Box 467600

Atlanta, GA 31146

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 DockYard Emergency Physicians

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 4 of 45

Software Copyright (c) 1996-2019 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 23 of 105
 6/25/19 2:43PM

Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

4.1

0 BB&T Last 4 digits of account number 0408 $19,623.00

Nonpriority Creditor's Name

Attn: Bankruptcy

Po Box 1847

Wilson, NC 27894

When was the debt incurred?

Opened 01/15 Last Active

1/13/16

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify Recreational

4.1

1 Capio Partners LLC Last 4 digits of account number 0597 $2,361.17

Nonpriority Creditor's Name

Attn: Bankruptcy

Po Box 3498

Sherman, TX 75091

When was the debt incurred? Opened 05/18 DOS 6/1/2016

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify Collection Attorney Martin Health System

4.1

2 Capio Partners Llc Last 4 digits of account number 6879 $1,430.41

Nonpriority Creditor's Name

Attn: Bankruptcy

Po Box 3498

Sherman, TX 75091

When was the debt incurred? Opened 05/18 DOS 3/8/2017

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify

Collection Attorney St. Lucie Medical

Center

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 5 of 45

Software Copyright (c) 1996-2019 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 24 of 105
 6/25/19 2:43PM

Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

4.1

3 Capio Partners LLC Last 4 digits of account number 6233 $1,143.00

Nonpriority Creditor's Name

Attn: Bankruptcy

Po Box 3498

Sherman, TX 75091

When was the debt incurred? Opened 05/18

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify

Collection Attorney Martin Health System

original acct XXXX2319

4.1

4 Capio Partners LLC Last 4 digits of account number 28AI $839.33

Nonpriority Creditor's Name

Attn: Bankruptcy

Po Box 3498

Sherman, TX 75091

When was the debt incurred? Opened 12/18

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify

Collection Attorney for Anesthesia

Physician Solutions South Florida

4.1

5 Capio Partners LLC Last 4 digits of account number 4117 $692.59

Nonpriority Creditor's Name

PO Box 1378

Sherman, TX 75091

When was the debt incurred? 11/28/2015

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 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 Lawnwood Regional Medical Center

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 6 of 45

Software Copyright (c) 1996-2019 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 25 of 105
 6/25/19 2:43PM

Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

4.1

6

Capital One/Neiman

Marcus/Bergdorf Goodm Last 4 digits of account number 0147 $0.00

Nonpriority Creditor's Name

Attn: Bankruptcy Dept

Po Box 30285

Salt Lake City, UT 84130

When was the debt incurred?

Opened 10/05 Last Active

8/16/09

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify Charge Account

4.1

7 Care Centrix Last 4 digits of account number 7247 Unknown

Nonpriority Creditor's Name

PO Box 277947

Atlanta, GA 30384

When was the debt incurred? 3/2017

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

Invoice No 5650-0070694 and Invoice

5650-0075469 and Invoice No 5650-0092256

and Invoice No 5650-0075470

4.1

8 CHASE Last 4 digits of account number 2845 Unknown

Nonpriority Creditor's Name

3451 Harry S Truman Blvd

Saint Charles, MO 63301

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 7 of 45

Software Copyright (c) 1996-2019 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 26 of 105
 6/25/19 2:43PM

Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

4.1

9 Chase Card Services Last 4 digits of account number 5973 $10,903.83

Nonpriority Creditor's Name

Attn: Bankruptcy

Po Box 15298

Wilmington, DE 19850

When was the debt incurred?

Opened 01/08 Last Active

09/16

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify

Credit Card - sold to Nationwide Credit -

sold to Alltran Financial sold to Client

Services

4.2

0 Chase Card Services Last 4 digits of account number 2150 $0.00

Nonpriority Creditor's Name

Attn: Bankruptcy

Po Box 15298

Wilmington, DE 19850

When was the debt incurred?

Opened 05/06 Last Active

6/03/11

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify Credit Card

4.2

1 Citibank/Best Buy Last 4 digits of account number 6766 Unknown

Nonpriority Creditor's Name

Attn: Bankruptcy

Po Box 790441

St. Louis, MO 63179

When was the debt incurred?

Opened 8/23/15 Last Active

3/08/16

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify Charge Account

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 8 of 45

Software Copyright (c) 1996-2019 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 27 of 105
 6/25/19 2:43PM

Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

4.2

2 Citibank/Best Buy Last 4 digits of account number 4403 Unknown

Nonpriority Creditor's Name

Attn: Bankruptcy

Po Box 790441

St. Louis, MO 63179

When was the debt incurred?

Opened 10/13/10 Last Active

5/17/13

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify

Charge Account-debt purchased by

collections

4.2

3 Comenity Bank/Bealls Florida Last 4 digits of account number 5269 $0.00

Nonpriority Creditor's Name

Attn: Bankruptcy

Po Box 182125

Columbus, OH 43218

When was the debt incurred?

Opened 09/10 Last Active

10/24/12

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify Charge Account

4.2

4 Comenity Bank/beallsol Last 4 digits of account number 9717 $0.00

Nonpriority Creditor's Name

Attn: Bankruptcy

Po Box 182125

Columbus, OH 43218

When was the debt incurred?

Opened 12/11/10 Last Active

4/27/18

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify Charge Account

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 9 of 45

Software Copyright (c) 1996-2019 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 28 of 105
 6/25/19 2:43PM

Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

4.2

5 Comenity Bank/Pier 1 Last 4 digits of account number 0210 $0.00

Nonpriority Creditor's Name

Attn: Bankruptcy

Po Box 182125

Columbus, OH 43218

When was the debt incurred?

Opened 12/15/11 Last Active

1/17/12

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify Charge Account

4.2

6 Comenity Bank/Pier 1 Last 4 digits of account number 2689 $0.00

Nonpriority Creditor's Name

Attn: Bankruptcy

Po Box 182125

Columbus, OH 43218

When was the debt incurred?

Opened 12/11 Last Active

5/16/15

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify Charge Account

4.2

7 Comenity Bank/Victoria Secret Last 4 digits of account number 0486 $387.65

Nonpriority Creditor's Name

Attn: Bankruptcy Dept

Po Box 182125

Columbus, OH 45318

When was the debt incurred?

Opened 10/02 Last Active

09/17

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify

Charge Account sold to Comenity sold to

Portfolio Recovery Associates

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 10 of 45

Software Copyright (c) 1996-2019 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 29 of 105
 6/25/19 2:43PM

Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

4.2

8 Commonwealth Financial Systems Last 4 digits of account number 36N1 $2,361.00

Nonpriority Creditor's Name

Attn: Bankruptcy

245 Main Street

Dickson City, PA 18519

When was the debt incurred?

Opened 02/19 Last Active

06/16

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify Collection Attorney Martin Health System

4.2

9 Commonwealth Financial Systems Last 4 digits of account number 36N1 $1,143.32

Nonpriority Creditor's Name

Attn: Bankruptcy

245 Main Street

Dickson City, PA 18519

When was the debt incurred?

Opened 02/19 Last Active

05/16

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify

Collection Attorney Martin Health System

and sold to Credit Solutions sold to Medical

and Financial Mgmnt

4.3

0 Convergent Outsourcing, Inc. Last 4 digits of account number 5189 $1,074.29

Nonpriority Creditor's Name

PO Box 9004

Renton, WA 98057-9004

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify

Credit Account sold to American Coradius

sold to ARS National

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 11 of 45

Software Copyright (c) 1996-2019 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 30 of 105
 6/25/19 2:43PM

Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

4.3

1 Credence Resource Management Last 4 digits of account number 2404 $3,126.77

Nonpriority Creditor's Name

17000 Dallas Parkway

Suite 204

Dallas, TX 75248

When was the debt incurred? Opened 01/19

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify

Collection Attorney T-Mobile - debt sold to

Amsher Collection sold to IC System

4.3

2 Credence Resource Management Last 4 digits of account number 4617 $1,607.26

Nonpriority Creditor's Name

17000 Dallas Parkway

Suite 204

Dallas, TX 75248

When was the debt incurred? Opened 03/19

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify

Collection Attorney Att Mobility -sold to

AFNI-sold to Credence Resourcesold to

Allied Interstate

for mobile no.'s 772/812-9735 and

772/834-0668 and sold to CBE Group -sold

to ERC

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 12 of 45

Software Copyright (c) 1996-2019 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 31 of 105
 6/25/19 2:43PM

Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

4.3

3 Credit Collection Services Last 4 digits of account number 6924 Unknown

Nonpriority Creditor's Name

Payment Processing

PO Box 55126

Boston, MA 02205-5126

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

File No 05068670514 and File no

09019549876

4.3

4 Credit One Bank Last 4 digits of account number 2407 $768.58

Nonpriority Creditor's Name

Attn: Bankruptcy Department

Po Box 98873

Las Vegas, NV 89193

When was the debt incurred?

Opened 08/14 Last Active

08/15

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify

Credit Card debt sold to Allied Interstate

sold to LVNV Funding sold to JCC &

Associates

4.3

5 Discover Financial Last 4 digits of account number 6098 $7,504.00

Nonpriority Creditor's Name

Attn: Bankruptcy Department

Po Box 15316

Wilmington, DE 19850

When was the debt incurred?

Opened 08/14 Last Active

2/28/17

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify Credit Card

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 13 of 45

Software Copyright (c) 1996-2019 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 32 of 105
 6/25/19 2:43PM

Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

4.3

6 Diversified Consultants, Inc. Last 4 digits of account number 9192 $1,376.01

Nonpriority Creditor's Name

10550 Deerwood Park Blvd

Jacksonville, FL 32256

When was the debt incurred?

Opened 08/17 Last Active

06/15

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify Collection Attorney Sprint

4.3

7 Dsnb Bloomingdales Last 4 digits of account number 7381 $0.00

Nonpriority Creditor's Name

Attn: Recovery "Bk"

Po Box 9111

Mason, OH 45040

When was the debt incurred?

Opened 1/08/05 Last Active

4/22/11

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify Charge Account

4.3

8 Ford Motor Credit Company Last 4 digits of account number 9155 Unknown

Nonpriority Creditor's Name

1335 S Clearview Avenue

Mesa, AZ 85208

When was the debt incurred? 12/2017

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 14 of 45

Software Copyright (c) 1996-2019 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 33 of 105
 6/25/19 2:43PM

Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

4.3

9 GC Services Limited Partnership Last 4 digits of account number 0227 Unknown

Nonpriority Creditor's Name

PO Box 3855

Houston, TX 77253

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify

4.4

0 Geico Insurance Last 4 digits of account number 0807 $271.99

Nonpriority Creditor's Name

One Geico Plaza

Bethesda, MD 20810

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify

4.4

1 Gold Coast Fed Cr Unio Last 4 digits of account number 3157 $14,171.00

Nonpriority Creditor's Name

2226 S Congress Ave

Palm Springs, FL 33406

When was the debt incurred?

Opened 06/14 Last Active

7/31/15

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify Installment Loan-automobile

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 15 of 45

Software Copyright (c) 1996-2019 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 34 of 105
 6/25/19 2:43PM

Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

4.4

2 Gold Coast Fed Cr Unio Last 4 digits of account number 3159 $8,511.00

Nonpriority Creditor's Name

2226 S Congress Ave

Palm Springs, FL 33406

When was the debt incurred?

Opened 02/15 Last Active

7/31/15

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify Installment Loan

4.4

3 Gold Coast Fed Cr Unio Last 4 digits of account number 3144 $2,774.00

Nonpriority Creditor's Name

2226 S Congress Ave

Palm Springs, FL 33406

When was the debt incurred?

Opened 5/24/13 Last Active

9/03/15

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify Unsecured

4.4

4 Gold Coast Fed Cr Unio Last 4 digits of account number 3154 $4,221.00

Nonpriority Creditor's Name

2226 S Congress Av

West Palm Beach, FL 33406

When was the debt incurred?

Opened 02/14 Last Active

8/11/15

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify Installment Loan

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 16 of 45

Software Copyright (c) 1996-2019 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 35 of 105
 6/25/19 2:43PM

Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

4.4

5 Gold Coast Fed Cr Unio Last 4 digits of account number 3153 $0.00

Nonpriority Creditor's Name

2226 S Congress Av

West Palm Beach, FL 33406

When was the debt incurred?

Opened 11/13 Last Active

06/14

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify Automobile

4.4

6 Gold Coast Fed Cr Unio Last 4 digits of account number 3151 $0.00

Nonpriority Creditor's Name

2226 S Congress Av

West Palm Beach, FL 33406

When was the debt incurred?

Opened 06/13 Last Active

12/13

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify Automobile

4.4

7

I C System Inc Last 4 digits of account number 1348 $3,126.00

Nonpriority Creditor's Name

444 Highway 96 East

P.O. Box 64378

St. Paul, MN 55164

When was the debt incurred? Opened 01/18

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify Collection Attorney T Mobile Usa Inc

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 17 of 45

Software Copyright (c) 1996-2019 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 36 of 105
 6/25/19 2:43PM

Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

4.4

8

I C System Inc Last 4 digits of account number 8915 $150.00

Nonpriority Creditor's Name

444 Highway 96 East

P.O. Box 64378

St. Paul, MN 55164

When was the debt incurred? Opened 12/16

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify Collection Attorney Parrish Medical Center

4.4

9

IC System Last 4 digits of account number 6139 $434.53

Nonpriority Creditor's Name

PO BOX 64437

Saint Paul, MN 55164-0437

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 ATT Uverse 127925204

4.5

0

IC System Last 4 digits of account number 5267 $210.58

Nonpriority Creditor's Name

PO Box 64794

Saint Paul, MN 55164-0794

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 ATT Uverse collections

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 18 of 45

Software Copyright (c) 1996-2019 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 37 of 105
 6/25/19 2:43PM

Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

4.5

1 Jefferson Capital Systems, LLC Last 4 digits of account number 3003 $962.41

Nonpriority Creditor's Name

Po Box 1999

Saint Cloud, MN 56302

When was the debt incurred?

Opened 10/17 Last Active

12/14

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify

Factoring Company Account Verizon

Wireless

4.5

2 Jonathan Neil & Associates Last 4 digits of account number 3337 $188.53

Nonpriority Creditor's Name

PO Box 5600

Rancho Cucamonga, CA 91729

When was the debt incurred? 2017

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 Mercury Casualty Insurance

4.5

3 Joseph F. Rosen, Esq. Last 4 digits of account number 1159 Unknown

Nonpriority Creditor's Name

Pollack & Rosen, P.A.

806 Douglas Road

South Tower, Suite 200

Coral Gables, FL 33134

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 19 of 45

Software Copyright (c) 1996-2019 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 38 of 105
 6/25/19 2:43PM

Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

4.5

4 Kohls/Capital One Last 4 digits of account number 6582 $1,403.00

Nonpriority Creditor's Name

Kohls Credit

Po Box 3120

Milwaukee, WI 53201

When was the debt incurred?

Opened 02/10 Last Active

06/17

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify Charge Account

4.5

5 Lawnwood Regional Medical Center Last 4 digits of account number 5894 $2,075.15

Nonpriority Creditor's Name

PO BOX 740771

Cincinnati, OH 45274-0771

When was the debt incurred? 12/6/2017

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify Medical Bill

4.5

6

Lincoln Automotive Financial

Service Last 4 digits of account number 5871 $14,035.00

Nonpriority Creditor's Name

Attn: Bankruptcy

Po Box 542000

Omaha, NE 68154

When was the debt incurred?

Opened 02/16 Last Active

10/25/16

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify Automobile

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 20 of 45

Software Copyright (c) 1996-2019 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 39 of 105
 6/25/19 2:43PM

Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

4.5

7 LVNV Funding/Resurgent Capital Last 4 digits of account number 2069 $768.00

Nonpriority Creditor's Name

Attn: Bankruptcy

Po Box 10497

Greenville, SC 29603

When was the debt incurred?

Opened 03/16 Last Active

08/15

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify

Factoring Company Account Credit One

Bank N.A. sold to Tate & Kirlin Associates

sold to Financial Recovery

4.5

8 Martin Anesthesia Specialists Last 4 digits of account number 2901 $518.10

Nonpriority Creditor's Name

PO BOX 740712

Cincinnati, OH 45274-0712

When was the debt incurred? 7/2016

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify Medical Bill

4.5

9 Martin County Fire Rescue Last 4 digits of account number 315A $678.70

Nonpriority Creditor's Name

c/o MC Tax Collector

3485 SE Willoughby Blvd.

Stuart, FL 34994

When was the debt incurred? 9/14/2017

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 21 of 45

Software Copyright (c) 1996-2019 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 40 of 105
 6/25/19 2:43PM

Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

4.6

0 Martin Health System Last 4 digits of account number 9082 Unknown

Nonpriority Creditor's Name

PO Box 9033

Stuart, FL 34995-9033

When was the debt incurred? 2016 and 2017

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

Guarantor No:s 100046752 $2533.50 and

$226. and Guarantor No. 100042406

$1143.32 and $2361.17 and Guarantor No.

100618878

4.6

1 Medicredit Inc. Last 4 digits of account number 5527 $1,430.00

Nonpriority Creditor's Name

Po Box 1629

Maryland Heights, MO 63043

When was the debt incurred?

Opened 12/17 Last Active

03/17

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify Collection Attorney St Lucie Medical Center

4.6

2 Medicredit Inc. Last 4 digits of account number 9708 $248.00

Nonpriority Creditor's Name

Po Box 1629

Maryland Heights, MO 63043

When was the debt incurred? Opened 07/17

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify

Collection Attorney Treasure Coast

Surgical Specia

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 22 of 45

Software Copyright (c) 1996-2019 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 41 of 105
 6/25/19 2:43PM

Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

4.6

3 Midland Credit Management Last 4 digits of account number 5594 $12,233.59

Nonpriority Creditor's Name

PO Box 2121

Warren, MI 48090

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

Original debt w/Home Depot/CitiBank

xxxx8342 then sold to Midland Funding

then sold to Midland Credit Mngmnt MCM#

is XXXX1761 sold to GC Services

4.6

4 Midland Funding Last 4 digits of account number 1761 $12,234.00

Nonpriority Creditor's Name

2365 Northside Dr Ste 300

San Diego, CA 92108

When was the debt incurred?

Opened 12/17 Last Active

02/17

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify Factoring Company Account Citibank N.A.

4.6

5 Midland Funding Last 4 digits of account number 6569 $2,923.00

Nonpriority Creditor's Name

2365 Northside Dr

Suite 300

San Diego, CA 92108

When was the debt incurred?

Opened 07/16 Last Active

12/15

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify

Factoring Company Account Synchrony

Bank

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 23 of 45

Software Copyright (c) 1996-2019 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 42 of 105
 6/25/19 2:43PM

Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

4.6

6 Midland Funding Last 4 digits of account number 3291 $2,250.00

Nonpriority Creditor's Name

2365 Northside Dr Ste 300

San Diego, CA 92108

When was the debt incurred?

Opened 08/16 Last Active

01/16

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify

Factoring Company Account Synchrony

Bank

4.6

7 Midland Funding Last 4 digits of account number 6687 $417.00

Nonpriority Creditor's Name

2365 Northside Dr Ste 300

San Diego, CA 92108

When was the debt incurred?

Opened 02/18 Last Active

07/17

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify

Factoring Company Account - Synchrony

Bank

4.6

8

Mr. Richard and Mrs. Barbara

Rinelli Last 4 digits of account number ents $3,000.00

Nonpriority Creditor's Name

1585 SE Saxony Street

Port Saint Lucie, FL 34983

When was the debt incurred? 2014 thru 2018

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 Money Borrowed from Parents

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 24 of 45

Software Copyright (c) 1996-2019 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 43 of 105
 6/25/19 2:43PM

Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

4.6

9 Mr. Stephen and Mrs. Lynne Kiss Last 4 digits of account number ents $3,500.00

Nonpriority Creditor's Name

13300 NW Maplewood Road

Palm City, FL 34990

When was the debt incurred? 2015 thru 2018

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 Money Borrowed from Parents

4.7

0 Nordstrom FSB Last 4 digits of account number 6774 $0.00

Nonpriority Creditor's Name

Attn: Bankruptcy

Po Box 6555

Englewood, CO 80155

When was the debt incurred?

Opened 10/22/06 Last Active

12/16/13

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify Credit Card

4.7

1 Ocwen Loan Servicing, LLC Last 4 digits of account number 8826 $0.00

Nonpriority Creditor's Name

1661 Worthington Road

Suite 100

West Palm Beach, FL 33409

When was the debt incurred?

Opened 8/30/13 Last Active

10/16/15

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify Real Estate Mortgage

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 25 of 45

Software Copyright (c) 1996-2019 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 44 of 105
 6/25/19 2:43PM

Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

4.7

2 Paragon Contracting Services LLC Last 4 digits of account number 3011 $2,119.00

Nonpriority Creditor's Name

PO BOX 740022

Cincinnati, OH 45274

When was the debt incurred? 4/2017

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify Medical Bill

4.7

3 Phoenix Financial Services Last 4 digits of account number 8274 $256.82

Nonpriority Creditor's Name

PO BOX 361450

Indianapolis, IN 46236

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 Pendrick Capital Partners

4.7

4 Progressive Leasing Last 4 digits of account number 5117 $426.51

Nonpriority Creditor's Name

256 Data Drive

Draper, UT 84020

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 26 of 45

Software Copyright (c) 1996-2019 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 45 of 105
 6/25/19 2:43PM

Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

4.7

5 Progressive Leasing Last 4 digits of account number 2566 $75.04

Nonpriority Creditor's Name

256 Data Drive

Draper, UT 84020

When was the debt incurred? 11/2017

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

First Natl Bank & Trust Co of the Treasure

Coast XXXX2566

4.7

6 Sheffield Financial Co / BB&T Last 4 digits of account number 0408 $19,355.92

Nonpriority Creditor's Name

Attn: Bankruptcy

Po Box 1847

Wilson, NC 27894

When was the debt incurred?

Opened 01/15 Last Active

1/13/16

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify Suzuki Sport Motorcycle - Sale Deficiency

4.7

7 St Lucie Medical Center Last 4 digits of account number 9831 $3,397.41

Nonpriority Creditor's Name

PO Box 740771

Cincinnati, OH 45274

When was the debt incurred? 11/28/2015

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 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 St Lucie Medical Center

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 27 of 45

Software Copyright (c) 1996-2019 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 46 of 105
 6/25/19 2:43PM

Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

4.7

8 Sterling Jewelers, Inc. Last 4 digits of account number 4616 $0.00

Nonpriority Creditor's Name

375 Ghent Rd

Fairlawn, OH 44333

When was the debt incurred?

Opened 11/06 Last Active

5/08/09

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify Charge Account

4.7

9 Syncb/Rooms To Go Last 4 digits of account number 8619 $2,587.00

Nonpriority Creditor's Name

Attn: Bankruptcy

Po Box 965060

Orlando, FL 32896

When was the debt incurred?

Opened 01/15 Last Active

07/17

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify

Charge Account-debt purchased by

collections - dept sold to Portfolio

Recovery - sold to Allied Interstate

4.8

0 Synchrony Bank / HH Gregg Last 4 digits of account number 9246 $2,045.00

Nonpriority Creditor's Name

PO BOX 965060

Orlando, FL 32896-0061

When was the debt incurred?

Opened 01/15 Last Active

12/31/15

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify debt purchased by Encore

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 28 of 45

Software Copyright (c) 1996-2019 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 47 of 105
 6/25/19 2:43PM

Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

4.8

1 Synchrony Bank/ JC Penneys Last 4 digits of account number 6837 $416.88

Nonpriority Creditor's Name

Attn: Bankruptcy

Po Box 956060

Orlando, FL 32896

When was the debt incurred?

Opened 10/06 Last Active

07/17

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify

Charge Account sold to Atlantic Credit sold

to Midland Funding LLC

4.8

2 Synchrony Bank/BrandSmart Last 4 digits of account number 9474 $6,124.50

Nonpriority Creditor's Name

Attn: Bankruptcy

Po Box 965060

Orlando, FL 32896

When was the debt incurred?

Opened 09/12 Last Active

7/13/16

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify Charge Account - purchased by collections

4.8

3 Synchrony Bank/Care Credit Last 4 digits of account number 9865 $2,922.91

Nonpriority Creditor's Name

Attn: Bankruptcy Dept

Po Box 965060

Orlando, FL 32896

When was the debt incurred?

Opened 04/13 Last Active

12/15

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify

Charge Account - debt purchased by

collections

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 29 of 45

Software Copyright (c) 1996-2019 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 48 of 105
 6/25/19 2:43PM

Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

4.8

4 T-Mobile Last 4 digits of account number 2404 $690.42

Nonpriority Creditor's Name

PO BOX 742596

Cincinnati, OH 45274

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify

4.8

5 Transworld Sys Inc/33 Last 4 digits of account number 0892 $193.65

Nonpriority Creditor's Name

Attn: Compliance Dept

Po Box 15630

Wilmington, DE 19850

When was the debt incurred?

Opened 04/18 Last Active

11/17

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify

Collection Attorney Fivemile Creek

Emergency Phys

sold to Affiliate Asset sol. sold to Pendrick

Capital

Affiliate acct no 0471119306

4.8

6 Treasure Coast Pathology Last 4 digits of account number 9874 $177.25

Nonpriority Creditor's Name

PO Box 377

Stuart, FL 34995-0377

When was the debt incurred? 4/2017

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 30 of 45

Software Copyright (c) 1996-2019 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 49 of 105
 6/25/19 2:43PM

Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

4.8

7

Visa Dept Store National

Bank/Macy's Last 4 digits of account number 5208 $538.50

Nonpriority Creditor's Name

Attn: Bankruptcy

Po Box 8053

Mason, OH 45040

When was the debt incurred?

Opened 10/04 Last Active

06/17

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community

debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify Charge Account

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

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

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

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

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

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

Ability Recovery Services, LLC

PO BOX 4262

Scranton, PA 18505-6262

Line 4.85 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 1446

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

Account Resolution Services

PO BOX 459079

Sunrise, FL 33345-9079

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

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 3556

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

Affiliate Asset Solutions

145 Technology Parkway NW

Suite 100

Peachtree Corners, GA 30092

Line 4.85 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 9306

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

Afni, Inc.

1310 Martin Luther King Drive

Bloomington, IL 61702-3517

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

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 0471

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

AFNI, INC.

PO BOX 3097

Bloomington, IL 61702

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

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 4914

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

AFNI, Inc.

PO Box 3517

Bloomington, IL 61702-3517

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

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 1401

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

AFNI, Inc.

PO Box 3517

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

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 31 of 45

Software Copyright (c) 1996-2019 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 50 of 105
 6/25/19 2:43PM

Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

Bloomington, IL 61702-3517  Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 6759

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

Allied Interstate

7525 West Campus Rd

New Albany, OH 43054

Line 4.79 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 9415

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

Allied Interstate

PO Box 361445

Columbus, OH 43236

Line 4.34 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 2407

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

Allied Interstate

PO Box 361445

Columbus, OH 43236

Line 4.82 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 7947

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

Allied Interstate

Synchrony / Brandsmart

PO BOX 960061

Orlando, FL 32896-0061

Line 4.82 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 7947

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

Alltran Financial, LP

PO BOX 722929

Houston, TX 77272-2929

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

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 5973

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

Alltran Financial, LP

PO BOX 722929

Houston, TX 77272-2929

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

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 5973

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

American Coradius International

LLC

2420 Sweet Home Road

Suite 150

Amherst, NY 14228-2244

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

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 6811

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

American Medical Collection

Agency

4 Westchester Plaza

Building 4

Elmsford, NY 10523

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

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 3A87

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

AmSher Collection Services, Inc

4524 Southlake Parkway

Suite 15

Birmingham, AL 35244

Line 4.31 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 7895

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

Anesthesia Physician Solutions of S

FL

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

 Part 2: Creditors with Nonpriority Unsecured Claims

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 32 of 45

Software Copyright (c) 1996-2019 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 51 of 105
 6/25/19 2:43PM

Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

PO BOX 3495

Toledo, OH 43607

Last 4 digits of account number 28AI

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

Anesthesia Physician Solutions of S

FL

PO BOX 743983

Department 10103

Atlanta, GA 30374-3983

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 28AI

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

ARS

PO BOX 630806

Cincinnati, OH 45263-0806

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

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 3556

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

ARS

1643 NW 136th Avenue

Sunrise, FL 33323

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

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 1131

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

ARS

1643 NW 136th Avenue

Sunrise, FL 33323

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

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 4920

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

ARS National Services, Inc.

PO Box 469100

Escondido, CA 92046

Line 4.87 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 5208

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

ARS National Services, Inc.

PO Box 469046

Escondido, CA 92046-9046

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

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 5189

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

AT&T

PO Box 536216

Atlanta, GA 30353

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

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 6759

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

AT&T Mobility

PO Box 536216

Atlanta, GA 30353

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

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 8800

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

Atlantic Credit & Finance

PO Box 2083

Warren, MI 48090

Line 4.81 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 7881

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

Caine & Weiner

4101 McEwen Road

Dallas, TX 75244

Line 4.76 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 3048

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

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 33 of 45

Software Copyright (c) 1996-2019 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 52 of 105
 6/25/19 2:43PM

Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

Capio Partners

2222 Texoma Pkwy

Ste 150

Sherman, TX 75090

Line 4.11 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 7991

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

Capio Partners

2222 Texoma Pkwy

Ste 150

Sherman, TX 75090

Line 4.12 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 5527

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

Capio Partners

2222 Texoma Pkwy

Ste 150

Sherman, TX 75090

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

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 4117

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

Capio Partners LLC

PO Box 3209

Sherman, TX 75091

Line 4.11 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 7991

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

Capio Partners LLC

PO Box 1378

Sherman, TX 75091

Line 4.12 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 5527

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

Capio Partners LLC

PO Box 1378

Sherman, TX 75091

Line 4.77 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 9831

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

Care Centrix

PO Box 277947

Atlanta, GA 30384

Line 4.6 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 7247

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

Care Centrix

9119 Corporate Lake Drive

Tampa, FL 33634

Line 4.6 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 7247

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

Care Centrix

PO Box 277947

Atlanta, GA 30384

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

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 7247

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

Care Centrix

9119 Corporate Lake Drive

Tampa, FL 33634

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

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 7247

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

CBE Group Inc

Payment Processing Center

PO BOX 2545

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

 Part 2: Creditors with Nonpriority Unsecured Claims

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 34 of 45

Software Copyright (c) 1996-2019 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 53 of 105
 6/25/19 2:43PM

Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

Waterloo, IA 50704-2545

Last 4 digits of account number lity

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

Chase

PO Box 15123

Wilmington, DE 19886-5151

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

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 9508

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

Chase

PO Box 15298

Wilmington, DE 19850

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

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 9508

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

Citbank/Best Buy

PO Box 6497

Sioux Falls, SD 57117

Line 4.22 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 4403

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

Client Services, Inc.

3451 Harry S.Truman Blvd

Saint Charles, MO 63301-4047

Line 4.79 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 3226

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

Client Services, Inc.

3451 Harry S.Truman Blvd

Saint Charles, MO 63301-4047

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

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 2845

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

Collections

3400 Texoma Parkway

Sherman, TX 75092

Line 4.11 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 9082

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

Comenity Victoria Secret

PO Box 659728

San Antonio, TX 78265

Line 4.27 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 0486

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

Convergent Outsourcing, Inc.

800 SW 39th Street

Suite 100

Renton, WA 98057

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

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 4839

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

Credence Resource Mgmnt

PO BOX 2147

Southgate, MI 48195

Line 4.31 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 6759

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

Credence Resource Mgmnt LLC

PO Box 2300

Southgate, MI 48195-4210

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

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 4617

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

Credence Resource Mgmnt LLC

PO Box 2390

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

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 35 of 45

Software Copyright (c) 1996-2019 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 54 of 105
 6/25/19 2:43PM

Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

Southgate, MI 48195-4390  Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 4617

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

Credit Control LLC

PO BOX 31179

Tampa, FL 33631

Line 4.87 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 1800

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

Credit Corp Solutions, Inc.

63 East 11400 South 408

Sandy, UT 84070

Line 4.82 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 5347

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

Credit Solutions LLC

PO BOX 24710

Lexington, KY 40524-4710

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

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 2178

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

Dept. Store Natl. Bank / Macy's

Attn.:Bankruptcy

9111 Duke Blvd.

Mason, OH 45040

Line 4.87 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 0881

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

Direct TV

PO BOX 105261

Atlanta, GA 30348-5261

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

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 2147

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

Discover

PO Box 71084

Charlotte, NC 28272-1084

Line 4.35 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 6098

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

Diversified Adjustment Service Inc

PO BOX 32145

Fridley, MN 55432-0145

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

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 2061

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

Diversified Consultants

Attn Bankruptcy

PO BOX 679543

Dallas, TX 75267

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

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 9192

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

Diversified Consultants, Inc.

PO Box 5007

Carol Stream, IL 60197-5007

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

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 9042

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

Dockyard Emergency Physicians

PO Box 37855

Philadelphia, PA 19101-7855

Line 4.9 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 5270

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

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 36 of 45

Software Copyright (c) 1996-2019 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 55 of 105
 6/25/19 2:43PM

Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

Encore Receivable Management,

Inc.

400 N. Rogers Road

PO Box 3330

Olathe, KS 66063-3330

Line 4.80 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 3841

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

ERC

PO BOX 57610

Jacksonville, FL 32241

Line 4.54 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 6582

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

ERC

PO BOX 57610

Jacksonville, FL 32241

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

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 8800

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

Financial Recovery Services, Inc.

PO Box 385908

Minneapolis, MN 55438-5908

Line 4.57 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number W354

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

Fivemile Creek Emerg Phys, LLC

PO Box 37852

Philadelphia, PA 19101

Line 4.85 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 8949

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

Fivemile Creek Emergency

Physician LLC

PO Box 37852

Philadelphia, PA 19101-7852

Line 4.85 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 8949

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

Franklin Collection Service, Inc

PO BOX 3910

Tupelo, MS 38803-3910

Line 4.49 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 0198

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

Franklin Collection Service, Inc

PO BOX 3910

Tupelo, MS 38803-3910

Line 4.50 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 0198

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

Frost-Arnett Company

PO BOX 198988

Nashville, TN 37219

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 G870

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

GC Services Limited Partnership

PO BOX 2545

Houston, TX 77252

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

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 2061

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

GC Services Limited Partnership

PO Box 3855

Houston, TX 77253

Line 4.63 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 37 of 45

Software Copyright (c) 1996-2019 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 56 of 105
 6/25/19 2:43PM

Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

0227

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

Global Credit & Collection Corp

5440 N Cumberland Ave.

Suite 300

Chicago, IL 60656-1490

Line 4.79 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 2065

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

HH Gregg

PO BOX 960061

Orlando, FL 32896-0061

Line 4.80 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 9246

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

Home Depot Credit Services

PO BOX 9001010

Louisville, KY 40290-1010

Line 4.63 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 8342

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

HRRG

PO Box 5406

Cincinnati, OH 45273-7942

Line 4.72 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 8228

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

IC System Inc

PO Box 64378

Saint Paul, MN 55164

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

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 1167

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

IC System Inc

PO Box 64378

Saint Paul, MN 55164

Line 4.48 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 2350

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

IC System Inc

PO Box 64378

Saint Paul, MN 55164

Line 4.31 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 1169

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

JC Christensen & Associates

PO Box 519

Sauk Rapids, MN 56379

Line 4.34 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 2761

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

Jefferson Capital Systems

16 McLeland Road

Saint Cloud, MN 56303

Line 4.51 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 3003

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

Kohl's

PO Box 2983

Milwaukee, WI 53201

Line 4.54 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 1471

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

Kohls / Capital One

PO Box 30285

Salt Lake City, UT 84130

Line 4.54 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 38 of 45

Software Copyright (c) 1996-2019 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 57 of 105
 6/25/19 2:43PM

Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

Last 4 digits of account number 1471

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

Kohls/Chase

N56 W 17000 Ridgewood Dr

Menomonee Falls, WI 53051

Line 4.54 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 1471

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

Lawnwood Regional Medical Center

PO BOX 740771

Cincinnati, OH 45274-0771

Line 4.55 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 5894

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

Macy's

PO Box 8218

Mason, OH 45040

Line 4.87 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 0881

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

Macy's

PO BOX 9001094

Louisville, KY 40290

Line 4.87 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 0881

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

Martin Health System

PO Box 9033

Stuart, FL 34995-9033

Line 4.11 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 9082

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

MBA Law

Mitchell D Bluhm, Esq.

PO Box 3269

Sherman, TX 75091

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 2319

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

MBA Law

Mitchell D Bluhm, Esq.

PO Box 3269

Sherman, TX 75091

Line 4.60 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 6233

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

MBA Law Offices / Capio

3400 Texoma Parkway

Sherman, TX 75092

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 2319

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

MBA Law Offices / Mitchell Bluhm,

Esq

for CF Medical, LLC

PO BOX 3269

Sherman, TX 75091

Line 4.13 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 2916

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

Medical & Financial Management,

Inc.

Collection Services

PO Box 3299

Stuart, FL 34995

Line 4.11 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 39 of 45

Software Copyright (c) 1996-2019 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 58 of 105
 6/25/19 2:43PM

Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

9082

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

Medical & Financial Management,

Inc.

Collection Services

PO Box 3299

Stuart, FL 34995

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

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 2016

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

MediCredit Inc

PO Box 1629

Maryland Heights, MO 63043

Line 4.55 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 5894

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

Mercantile Adjustment Bureau

PO BOX 9055

Williamsville, NY 14231

Line 4.54 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 1264

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

Merchants & Medical Credit Corp

6324 Taylor Drive

Flint, MI 48507

Line 4.54 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 5970

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

Mercury Insurance

PO BOX 5600

Rancho Cucamonga, CA 91729

Line 4.52 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 3337

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

Midland Credit Management

PO Box 60578

Los Angeles, CA 90060

Line 4.83 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 6569

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

Midland Credit Management

PO BOX 939069

San Diego, CA 92193

Line 4.63 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 1761

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

Midland Credit Management / HH

Gregg

PO Box 60578

Los Angeles, CA 90060

Line 4.66 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 3291

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

Midland Credit Management Inc

PO Box 51319

Los Angeles, CA 90051-5619

Line 4.83 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 6569

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

Midland Credit Management Inc

PO Box 51319

Los Angeles, CA 90051-5619

Line 4.81 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 6687

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

Midland Credit Management Inc Line 4.39 of (Check one):

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 40 of 45

Software Copyright (c) 1996-2019 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 59 of 105
 6/25/19 2:43PM

Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

2365 Northside Drive

Suite 300

San Diego, CA 92108

 Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 8342

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

Midland Credit Management, Inc

PO BOX 51319

Los Angeles, CA 90051-5619

Line 4.66 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 3291

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

Midland Credit Management, Inc

PO Box 2000

Warren, MI 48090-2001

Line 4.81 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 6687

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

Midland Funding

350 S. Camino De La Reina South

San Diego, CA 92108

Line 4.64 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 1761

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

Midland Funding

350 S. Camino De La Reina South

San Diego, CA 92108

Line 4.65 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 6569

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

Midland Funding

350 S. Camino De La Reina South

San Diego, CA 92108

Line 4.66 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 3291

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

Midland Funding

350 S. Camino De La Reina South

San Diego, CA 92108

Line 4.67 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 6687

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

Moody, Jones, Ingino PA

1333 S University Blvd.

Suite 201

Fort Lauderdale, FL 33324

Line 4.38 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 5871

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

MRS Associates

1930 Olney Avenue

Cherry Hill, NJ 08003

Line 4.51 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 0001

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

MSCB, Inc.

PO BOX 1567

Paris, TN 38242

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

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 9513

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

Nationwide Credit Inc

PO Box 14581

Des Moines, IA 50306-3581

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

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 1191

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

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 41 of 45

Software Copyright (c) 1996-2019 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 60 of 105
 6/25/19 2:43PM

Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

Parrish Medical Center

PO BOX 850001

Dept 159

Orlando, FL 32885

Line 4.48 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 2350

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

PennCredit

916 South 14th Street

Harrisburg, PA 17108-0988

Line 4.11 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 9082

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

Portfolio Recovery & Affiliates

120 Corporate Blvd.

Norfolk, VA 23502

Line 4.79 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 5322

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

Portfolio Recovery Associates, LLC

PO Box 12914

Norfolk, VA 23541

Line 4.79 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 5322

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

Portfolio Recovery Associates, LLC

PO Box 12914

Norfolk, VA 23541-1223

Line 4.27 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 0486

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

Prince Parker & Associates

PO BOX 474690

Charlotte, NC 28247

Line 4.49 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 3584

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

Prince Parker & Associates

PO BOX 474690

Charlotte, NC 28247

Line 4.50 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 6119

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

Radius Global Solutions LLC

PO BOX 390905

Minneapolis, MN 55439

Line 4.87 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 5680

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

Resurgent Capital Services

55 Beattie Place

Greenville, SC 29601

Line 4.57 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 7181

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

RMCB

PO BOX 1235

Elmsford, NY 10523-0935

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

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 6513

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

RPM, LLC

PO BOX 1548

Lynnwood, WA 98046-1548

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

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 2147

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

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 42 of 45

Software Copyright (c) 1996-2019 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 61 of 105
 6/25/19 2:43PM

Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

Sheffield Financial

PO BOX 1704

Clemmons, NC 27012

Line 4.76 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 0408

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

Sheffield Financial Company

6010 Golding Center Drive

Winston Salem, NC 27103

Line 4.76 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 4304

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

SIMM Associates, Inc.

PO Box 7526

Newark, DE 19714-7526

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

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 7919

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

St Lucie Medical Center

PO Box 740771

Cincinnati, OH 45274

Line 4.12 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 5527

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

St Lucie Medical Center

PO Box 740771

Cincinnati, OH 45274

Line 4.61 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 5527

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

Synchrony Bank / Brandsmart

PO BOX 960061

Orlando, FL 32896

Line 4.82 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 5347

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

Synchrony Bank / Care Credit

950 Forrer Blvd.

Kettering, OH 45420

Line 4.83 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 9865

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

Synchrony Bank / HH Gregg

PO BOX 965033

Orlando, FL 32896-0061

Line 4.83 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 9865

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

Synchrony Bank / HH Gregg

Attn: Bankruptcy

PO BOX 965036

Orlando, FL 32896

Line 4.80 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 8676

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

Synchrony Bank / HH Gregg

PO BOX 965033

Orlando, FL 32896-0061

Line 4.80 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 9246

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

Synchrony Bank / JC Penney

Attn: Bankruptcy

PO BOX 965007

Orlando, FL 32896

Line 4.81 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 7881

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 43 of 45

Software Copyright (c) 1996-2019 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 62 of 105
 6/25/19 2:43PM

Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

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

Synchrony Bank/Brandsmart

Bankruptcy Dept.

PO Box 965036

Orlando, FL 32896-5064

Line 4.82 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 5347

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

Synchrony Bank/JC Penneys

PO Box 960090

Orlando, FL 32896

Line 4.81 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 7881

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

Synchrony Bank/Rooms to Go

PO Box 965036

Attn: Bankruptcy

Orlando, FL 32896

Line 4.79 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 5322

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

Synchrony Bank/Rooms to Go

PO Box 960061

Attn: Bankruptcy

Orlando, FL 32896

Line 4.79 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 5322

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

Tate & Kirlin Associates, Inc.

580 Middleton Blvd.

Suite 240

Langhorne, PA 19047

Line 4.57 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 3054

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

Transworld Systems Inc

PO Box 15609

Wilmington, DE 19850-5609

Line 4.85 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 0892

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

Treasure Coast Surgical Specialists

PO BOX 740776

Cincinnati, OH 45274

Line 4.62 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 8465

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

United Collection Bureau

PO Box 1418

Maumee, OH 43537

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

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 9399

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

United Collection Bureau, Inc.

5620 Southwyck Blvd.

Suite 206

Toledo, OH 43614

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

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 9399

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

Verizon Wireless

PO Box 660108

Dallas, TX 75266-0108

Line 4.51 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 9420

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

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 44 of 45

Software Copyright (c) 1996-2019 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 63 of 105
 6/25/19 2:43PM

Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

Zwicker & Associates

80 Minuteman Road

Andover, MA 01810

Line 4.35 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 6965

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

Zwicker & Associates PC

Attorneys for Discover Bank

10751 Deerwood park Blvd

Suite 100

Jacksonville, FL 32256

Line 4.35 of (Check one):  Part 1: Creditors with Priority Unsecured Claims

 Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number 2950

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. $ 0.00

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. $ 0.00

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.

$ 193,503.22

6j. Total Nonpriority. Add lines 6f through 6i. 6j. $ 193,503.22

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 45 of 45

Software Copyright (c) 1996-2019 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 64 of 105
 6/25/19 2:43PM

Fill in this information to identify your case:

Debtor 1 Katie Annette Kiss

First Name Middle Name Last Name

Debtor 2 Stephen Cameron Kiss

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

United States Bankruptcy Court for the: SOUTHERN DISTRICT OF FLORIDA

Case number

(if known)  Check if this is an

amended filing

Official Form 106G

Schedule G: Executory Contracts and Unexpired Leases 12/15

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

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

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

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

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

 Yes. Fill in all of the information below even if the contacts of leases are listed on Schedule A/B:Property (Official Form 106 A/B).

2. List separately each person or company with whom you have the contract or lease. Then state what each contract or lease is for (for

example, rent, vehicle lease, cell phone). See the instructions for this form in the instruction booklet for more examples of executory contracts

and unexpired leases.

Person or company with whom you have the contract or lease

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

State what the contract or lease is for

2.1

Name

Number Street

City State ZIP Code

2.2

Name

Number Street

City State ZIP Code

2.3

Name

Number Street

City State ZIP Code

2.4

Name

Number Street

City State ZIP Code

2.5

Name

Number Street

City State ZIP Code

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

Software Copyright (c) 1996-2019 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 65 of 105
 6/25/19 2:43PM

Fill in this information to identify your case:

Debtor 1 Katie Annette Kiss

First Name Middle Name Last Name

Debtor 2 Stephen Cameron Kiss

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

United States Bankruptcy Court for the: SOUTHERN DISTRICT OF FLORIDA

Case number

(if known)  Check if this is an

amended filing

Official Form 106H

Schedule H: Your Codebtors 12/15

Codebtors are people or entities who are also liable for any debts you may have. Be as complete and accurate as possible. If two married

people are filing together, both are equally responsible for supplying correct information. If more space is needed, copy the Additional Page,

fill it out, and number the entries in the boxes on the left. Attach the Additional Page to this page. On the top of any Additional Pages, write

your name and case number (if known). Answer every question.

1. Do you have any codebtors? (If you are filing a joint case, do not list either spouse as a codebtor.

 No

 Yes

2. Within the last 8 years, have you lived in a community property state or territory? (Community property states and territories include

Arizona, California, Idaho, Louisiana, Nevada, New Mexico, Puerto Rico, Texas, Washington, and Wisconsin.)

 No. Go to line 3.

 Yes. Did your spouse, former spouse, or legal equivalent live with you at the time?

3. In Column 1, list all of your codebtors. Do not include your spouse as a codebtor if your spouse is filing with you. List the person shown

in line 2 again as a codebtor only if that person is a guarantor or cosigner. Make sure you have listed the creditor on Schedule D (Official

Form 106D), Schedule E/F (Official Form 106E/F), or Schedule G (Official Form 106G). Use Schedule D, Schedule E/F, or Schedule G to fill

out Column 2.

Column 1: Your codebtor

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

Column 2: The creditor to whom you owe the debt

Check all schedules that apply:

3.1  Schedule D, line

Name  Schedule E/F, line

 Schedule G, line

Number Street

City State ZIP Code

3.2  Schedule D, line

Name  Schedule E/F, line

 Schedule G, line

Number Street

City State ZIP Code

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

Software Copyright (c) 1996-2019 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 66 of 105
 6/25/19 2:43PM

Fill in this information to identify your case:

Debtor 1 Katie Annette Kiss

Debtor 2 Stephen Cameron Kiss

(Spouse, if filing)

United States Bankruptcy Court for the: SOUTHERN DISTRICT OF FLORIDA

Case number Check if this is:

(If known)  An amended filing

 A supplement showing postpetition chapter

13 income as of the following date:

Official Form 106I MM / DD/ YYYY

Schedule I: Your Income 12/15

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

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

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

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

Part 1: Describe Employment

1. Fill in your employment

information. Debtor 1 Debtor 2 or non-filing spouse

If you have more than one job,

attach a separate page with

information about additional

employers.

Include part-time, seasonal, or

self-employed work.

Occupation may include student

or homemaker, if it applies.

Employment status

 Employed

 Not employed

 Employed

 Not employed

Occupation Bank Teller Construction

Employer's name MidFlorida Credit Union R2T Inc.

Employer's address 8351 South US HWY 1

Port Saint Lucie, FL 34952

580 W Crossville Road

Roswell, GA 30075

How long employed there? 1 year 5 months 2 1/2 months

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. $ 2,265.00 $ 857.74

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

4. Calculate gross Income. Add line 2 + line 3. 4. $ 2,265.00 $ 857.74

Official Form 106I Schedule I: Your Income page 1

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 67 of 105
 6/25/19 2:43PM

Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

For Debtor 1 For Debtor 2 or

non-filing spouse

Copy line 4 here 4. $ 2,265.00 $ 857.74

5. List all payroll deductions:

5a. Tax, Medicare, and Social Security deductions 5a. $ 0.00 $ 0.00

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. $ 0.00 $ 0.00

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

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

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

6. Add the payroll deductions. Add lines 5a+5b+5c+5d+5e+5f+5g+5h. 6. $ 0.00 $ 0.00

7. Calculate total monthly take-home pay. Subtract line 6 from line 4. 7. $ 2,265.00 $ 857.74

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. $ 2,265.00 + $ 857.74 = $ 3,122.74

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

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

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

other friends or relatives.

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

Specify: 11. +$ 0.00

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

12. $ 3,122.74

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

applies

Combined

monthly income

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

 No.

 Yes. Explain: Husband/Debtor2 has been unemployed for last 2 years to stay at home with newborn son and due

to a DUI his license was suspended. Husband/Debtor 2 is now employed full-time.

Official Form 106I Schedule I: Your Income page 2

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 68 of 105
 6/25/19 2:43PM

Fill in this information to identify your case:

Debtor 1 Katie Annette Kiss Check if this is:

 An amended filing

Debtor 2 Stephen Cameron Kiss  A supplement showing postpetition chapter

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

United States Bankruptcy Court for the: SOUTHERN DISTRICT OF FLORIDA MM / DD / YYYY

Case number

(If known)

Official Form 106J

Schedule J: Your Expenses 12/15

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

information. If more space is needed, attach another sheet to this form. On the top of any additional pages, write your name and case

number (if known). Answer every question.

Part 1: Describe Your Household

1. Is this a joint case?

 No. Go to line 2.

 Yes. Does Debtor 2 live in a separate household?

 No

 Yes. Debtor 2 must file Official Form 106J-2, Expenses for Separate Household of Debtor 2.

2. Do you have dependents?  No

Do not list Debtor 1 and

Debtor 2.

 Yes. Fill out this information for

each dependent..............

Dependent’s relationship to

Debtor 1 or Debtor 2

Dependent’s

age

Does dependent

live with you?

Do not state the

dependents names. Son 3

 No

 Yes

 No

 Yes

 No

 Yes

 No

 Yes

3. Do your expenses include

expenses of people other than

yourself and your dependents?

 No

 Yes

Part 2: Estimate Your Ongoing Monthly Expenses

Estimate your expenses as of your bankruptcy filing date unless you are using this form as a supplement in a Chapter 13 case to report

expenses as of a date after the bankruptcy is filed. If this is a supplemental Schedule J, check the box at the top of the form and fill in the

applicable date.

Include expenses paid for with non-cash government assistance if you know

the value of such assistance and have included it on Schedule I: Your Income

(Official Form 106I.) Your expenses

4. The rental or home ownership expenses for your residence. Include first mortgage

payments and any rent for the ground or lot. 4. $ 652.88

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. $ 120.00

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

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

Official Form 106J Schedule J: Your Expenses page 1

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 69 of 105
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Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

6. Utilities:

6a. Electricity, heat, natural gas 6a. $ 165.00

6b. Water, sewer, garbage collection 6b. $ 90.00

6c. Telephone, cell phone, Internet, satellite, and cable services 6c. $ 165.00

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

7. Food and housekeeping supplies 7. $ 800.00

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

9. Clothing, laundry, and dry cleaning 9. $ 125.00

10. Personal care products and services 10. $ 70.00

11. Medical and dental expenses 11. $ 115.00

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

Do not include car payments. 12. $ 270.00

13. Entertainment, clubs, recreation, newspapers, magazines, and books 13. $ 20.00

14. Charitable contributions and religious donations 14. $ 0.00

15. Insurance.

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

15a. Life insurance 15a. $ 23.08

15b. Health insurance 15b. $ 0.00

15c. Vehicle insurance 15c. $ 300.00

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. $ 247.33

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

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

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

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

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

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

Specify: 19.

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

20a. Mortgages on other property 20a. $ 0.00

20b. Real estate taxes 20b. $ 0.00

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

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

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

21. Other: Specify: 21. +$ 0.00

22. Calculate your monthly expenses

22a. Add lines 4 through 21. $ 3,163.29

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

22c. Add line 22a and 22b. The result is your monthly expenses. $ 3,163.29

23. Calculate your monthly net income.

23a. Copy line 12 (your combined monthly income) from Schedule I. 23a. $ 3,122.74

23b. Copy your monthly expenses from line 22c above. 23b. -$ 3,163.29

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

The result is your monthly net income. 23c. $ -40.55

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: Increase - Debtors will have a secondary vehicle expense (purchase, insurance and

maintenance) however Husband/Debtor2 is now employed and working fulltime.

Official Form 106J Schedule J: Your Expenses page 2

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 70 of 105
 6/25/19 2:43PM

Fill in this information to identify your case:

Debtor 1 Katie Annette Kiss

First Name Middle Name Last Name

Debtor 2 Stephen Cameron Kiss

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

United States Bankruptcy Court for the: SOUTHERN DISTRICT OF FLORIDA

Case number

(if known)  Check if this is an

amended filing

Official Form 106Dec

Declaration About an Individual Debtor's Schedules 12/15

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

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

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

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

Sign Below

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

 No

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

Declaration, and Signature (Official Form 119)

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

that they are true and correct.

X /s/ Katie Annette Kiss X /s/ Stephen Cameron Kiss

Katie Annette Kiss Stephen Cameron Kiss

Signature of Debtor 1 Signature of Debtor 2

Date June 25, 2019 Date June 25, 2019

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

Software Copyright (c) 1996-2019 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 71 of 105
 6/25/19 2:43PM

Fill in this information to identify your case:

Debtor 1 Katie Annette Kiss

First Name Middle Name Last Name

Debtor 2 Stephen Cameron Kiss

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

United States Bankruptcy Court for the: SOUTHERN DISTRICT OF FLORIDA

Case number

(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 2

lived there

3. Within the last 8 years, did you ever live with a spouse or legal equivalent in a community property state or territory? (Community property

states and territories include Arizona, California, Idaho, Louisiana, Nevada, New Mexico, Puerto Rico, Texas, Washington and Wisconsin.)

 No

 Yes. Make sure you fill out Schedule H: Your Codebtors (Official Form 106H).

Part 2 Explain the Sources of Your Income

4. Did you have any income from employment or from operating a business during this year or the two previous calendar years?

Fill in the total amount of income you received from all jobs and all businesses, including part-time activities.

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

 No

 Yes. Fill in the details.

Debtor 1 Debtor 2

Sources of income

Check all that apply.

Gross income

(before deductions and

exclusions)

Sources of income

Check all that apply.

Gross income

(before deductions

and exclusions)

From January 1 of current year until

the date you filed for bankruptcy:

 Wages, commissions,

bonuses, tips

 Operating a business

$21,112.28  Wages, commissions,

bonuses, tips

 Operating a business

$7,912.50

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

Software Copyright (c) 1996-2019 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

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Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

Debtor 1 Debtor 2

Sources of income

Check all that apply.

Gross income

(before deductions and

exclusions)

Sources of income

Check all that apply.

Gross income

(before deductions

and exclusions)

For last calendar year:

(January 1 to December 31, 2018 )

 Wages, commissions,

bonuses, tips

 Operating a business

$28,818.00  Wages, commissions,

bonuses, tips

 Operating a business

$0.00

For the calendar year before that:

(January 1 to December 31, 2017 )

 Wages, commissions,

bonuses, tips

 Operating a business

$40,644.00  Wages, commissions,

bonuses, tips

 Operating a business

$0.00

For the calendar year:

(January 1 to December 31, 2016 )

 Wages, commissions,

bonuses, tips

 Operating a business

$52,200.00  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 ...

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

Software Copyright (c) 1996-2019 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 73 of 105
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Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

Creditor's Name and Address Dates of payment Total amount

paid

Amount you

still owe

Was this payment for ...

NationStar/Mr Cooper

Attn. Bankruptcy

8950 Cypress Waters Blvd.

Coppell, TX 75019

4/01/2019 ;

5/01/2019 and

6/01/2019

$652.88 $57,590.90  Mortgage

 Car

 Credit Card

 Loan Repayment

 Suppliers or vendors

 Other

SunTrust Bank South

Attn: Bankruptcy

Po Box 85092

Mc Va-Wmrk-7952

Richmond, VA 23286

4/09/2019 ;

5/09/2019 and

6/09/2019

$247.33 $7,252.60  Mortgage

 Car

 Credit Card

 Loan Repayment

 Suppliers or vendors

 Other

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

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

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

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

alimony.

 No

 Yes. List all payments to an insider.

Insider's Name and Address Dates of payment Total amount

paid

Amount you

still owe

Reason for this payment

8. Within 1 year before you filed for bankruptcy, did you make any payments or transfer any property on account of a debt that benefited an

insider?

Include payments on debts guaranteed or cosigned by an insider.

 No

 Yes. List all payments to an insider

Insider's Name and Address Dates of payment Total amount

paid

Amount you

still owe

Reason for this payment

Include creditor's name

Part 4: Identify Legal Actions, Repossessions, and Foreclosures

9. Within 1 year before you filed for bankruptcy, were you a party in any lawsuit, court action, or administrative proceeding?

List all such matters, including personal injury cases, small claims actions, divorces, collection suits, paternity actions, support or custody

modifications, and contract disputes.

 No

 Yes. Fill in the details.

Case title

Case number

Nature of the case Court or agency Status of the case

Ford Motor Credit Company LLC

vs Katie Annette Kiss

2017CC009155

Garnishment Palm Beach County Clerk

of Court

205 North Dixie Highway

West Palm Beach, FL 33401

 Pending

 On appeal

 Concluded

Final Default Judgment OR

BK/PG 29572/1755

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

Software Copyright (c) 1996-2019 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 74 of 105
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Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

Case title

Case number

Nature of the case Court or agency Status of the case

Discover Financial v. Katie Ann

Rinelli

2017CC002950

Civil St Lucie County Clerk of

Court

Attn: County Civil Division

250 NW Country Club Drive

Port Saint Lucie, FL 34986

 Pending

 On appeal

 Concluded

Closed 2/26/2018 - Final

Judgment After Default

Credit Corp.

Solutions(Brandsmart) v. Stephen

Cameron Kiss and Katie Ann

Rinelli

2018CC001159

Civil St Lucie County Clerk of

Court

ATTN: County Civil/ Small

Claim

P.O. Box 700

Fort Pierce, FL 34954

 Pending

 On appeal

 Concluded

Debtors served on

6/14/2018

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

Sheffield Financial Company

6010 Golding Center Drive

Winston Salem, NC 27103

2013 Suzuki Sport Bike - Repossessed

 Property was repossessed.

 Property was foreclosed.

 Property was garnished.

 Property was attached, seized or levied.

6/25/2018 $19,355.92

Ford Motor Credit Company

P.O. Box 31111

Tampa, FL 33631-3111

2015 Ford Focus Automobile -

Repossessed and garnished

 Property was repossessed.

 Property was foreclosed.

 Property was garnished.

 Property was attached, seized or levied.

5/11/2018 Unknown

JP Morgan Chase Bank

PO Box 182051

Columbus, OH 43218

Had a checking account with Chase in Port

St Lucie Branch (account noXXXXX53762)

that was frozen and garnished by Ford

Motor Credit - Debtor 1/Katie Kiss went to a

hearing and Judge reversed the

garnishment as Debtor 1/Katie Kiss was

deemed the head of household at the time

because Debtor 2/Stephen Kiss was

unemployed.

 Property was repossessed.

 Property was foreclosed.

 Property was garnished.

 Property was attached, seized or levied.

2019 Unknown

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

Software Copyright (c) 1996-2019 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

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Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

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

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

 No

 Yes. Fill in the details.

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

taken

Amount

12. Within 1 year before you filed for bankruptcy, was any of your property in the possession of an assignee for the benefit of creditors, a

court-appointed receiver, a custodian, or another official?

 No

 Yes

Part 5: List Certain Gifts and Contributions

13. Within 2 years before you filed for bankruptcy, did you give any gifts with a total value of more than $600 per person?

 No

 Yes. Fill in the details for each gift.

Gifts with a total value of more than $600

per person

Person to Whom You Gave the Gift and

Address:

Describe the gifts Dates you gave

the gifts

Value

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

 No

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

Gifts or contributions to charities that total

more than $600

Charity's Name

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

Describe what you contributed Dates you

contributed

Value

Part 6: List Certain Losses

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

or gambling?

 No

 Yes. Fill in the details.

Describe the property you lost and

how the loss occurred

Describe any insurance coverage for the loss

Include the amount that insurance has paid. List pending

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

Date of your

loss

Value of property

lost

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

Randall A. Fischer, P.A.

2100 SE Ocean Blvd.

Suite 203

Stuart, FL 34996

randall@rafischerattorney.com

Debtor 1's Mother, Barbara Rinelli

Retainer and bankruptcy filing

fee/credit report and lien report fees

$1,600.00

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

Software Copyright (c) 1996-2019 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 76 of 105
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Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

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

Dollar Learning Foundation, Inc.

21900 Burbank Blvd.

Woodland Hills, CA 91367

First course financial management

certificate

6/3/2019 Unknown

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

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

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

 No

 Yes. Fill in the details.

Person Who Was Paid

Address

Description and value of any property

transferred

Date payment

or transfer was

made

Amount of

payment

18. Within 2 years before you filed for bankruptcy, did you sell, trade, or otherwise transfer any property to anyone, other than property

transferred in the ordinary course of your business or financial affairs?

Include both outright transfers and transfers made as security (such as the granting of a security interest or mortgage on your property). Do not

include gifts and transfers that you have already listed on this statement.

 No

 Yes. Fill in the details.

Person Who Received Transfer

Address

Person's relationship to you

Description and value of

property transferred

Describe any property or

payments received or debts

paid in exchange

Date transfer was

made

19. Within 10 years before you filed for bankruptcy, did you transfer any property to a self-settled trust or similar device of which you are a

beneficiary? (These are often called asset-protection devices.)

 No

 Yes. Fill in the details.

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

made

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

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

sold, moved, or transferred?

Include checking, savings, money market, or other financial accounts; certificates of deposit; shares in banks, credit unions, brokerage

houses, pension funds, cooperatives, associations, and other financial institutions.

 No

 Yes. Fill in the details.

Name of Financial Institution and

Address (Number, Street, City, State and ZIP

Code)

Last 4 digits of

account number

Type of account or

instrument

Date account was

closed, sold,

moved, or

transferred

Last balance

before closing or

transfer

JP Morgan Chase Bank

PO Box 182051

Columbus, OH 43218

XXXX-3762  Checking

 Savings

 Money Market

 Brokerage

 Other Checking 

account was 

closed after 

account was 

frozen due to 

garnishment 

1/16/2019 $-24.00

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

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Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

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

cash, or other valuables?

 No

 Yes. Fill in the details.

Name of Financial Institution

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

Who else had access to it?

Address (Number, Street, City,

State and ZIP Code)

Describe the contents Do you still

have it?

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

 No

 Yes. Fill in the details.

Name of Storage Facility

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

Who else has or had access

to it?

Address (Number, Street, City,

State and ZIP Code)

Describe the contents Do you still

have it?

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

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

for someone.

 No

 Yes. Fill in the details.

Owner's Name

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

Where is the property?

(Number, Street, City, State and ZIP

Code)

Describe the property Value

Part 10: Give Details About Environmental Information

For the purpose of Part 10, the following definitions apply:

 Environmental law means any federal, state, or local statute or regulation concerning pollution, contamination, releases of hazardous or

toxic substances, wastes, or material into the air, land, soil, surface water, groundwater, or other medium, including statutes or

regulations controlling the cleanup of these substances, wastes, or material.

 Site means any location, facility, or property as defined under any environmental law, whether you now own, operate, or utilize it or used

to own, operate, or utilize it, including disposal sites.

 Hazardous material means anything an environmental law defines as a hazardous waste, hazardous substance, toxic substance,

hazardous material, pollutant, contaminant, or similar term.

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

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

 No

 Yes. Fill in the details.

Name of site

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

Governmental unit

Address (Number, Street, City, State and

ZIP Code)

Environmental law, if you

know it

Date of notice

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

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

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Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 78 of 105
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Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

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

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

institutions, creditors, or other parties.

 No

 Yes. Fill in the details below.

Name

Address

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

Date Issued

Part 12: Sign Below

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

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

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

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

/s/ Katie Annette Kiss /s/ Stephen Cameron Kiss

Katie Annette Kiss Stephen Cameron Kiss

Signature of Debtor 1 Signature of Debtor 2

Date June 25, 2019 Date June 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 8

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Fill in this information to identify your case:

Debtor 1 Katie Annette Kiss

First Name Middle Name Last Name

Debtor 2 Stephen Cameron Kiss

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

United States Bankruptcy Court for the: SOUTHERN DISTRICT OF FLORIDA

Case number

(if known)  Check if this is an

amended filing

Official Form 108

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

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

 creditors have claims secured by your property, or

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

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

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

on the form

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

sign and date the form.

Be as complete and accurate as possible. If more space is needed, attach a separate sheet to this form. On the top of any additional pages,

write your name and case number (if known).

Part 1: List Your Creditors Who Have Secured Claims

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

information below.

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

secures a debt?

Did you claim the property

as exempt on Schedule C?

Creditor's Mr. Cooper  Surrender the property.  No

 Yes

name:  Retain the property and redeem it.

 Retain the property and enter into a

Reaffirmation Agreement. Description of 1562 SE Saxony Street Port

Saint Lucie, FL 34983 Saint

Lucie County

Single Family Residence built in

1988 / 3BR and 2 Baths - 1563

sq ft

property  Retain the property and [explain]:

securing debt:

Creditor's SunTrust Bank  Surrender the property.  No

 Yes

name:  Retain the property and redeem it.

 Retain the property and enter into a

Reaffirmation Agreement. Description of 2014 Ford Fusion 59000 miles

Gray Sedan 4 Door

VIN:3FA6P0K94ER330903

property  Retain the property and [explain]:

securing debt:

Part 2: List Your Unexpired Personal Property Leases

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

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

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

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

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Debtor 1

Debtor 2

Katie Annette Kiss

Stephen Cameron Kiss Case number (if known)

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

Lessor's name:  No

 Yes

Description of leased

Property:

Lessor's name:  No

 Yes

Description of leased

Property:

Lessor's name:  No

 Yes

Description of leased

Property:

Lessor's name:  No

 Yes

Description of leased

Property:

Lessor's name:  No

 Yes

Description of leased

Property:

Lessor's name:  No

 Yes

Description of leased

Property:

Lessor's name:  No

 Yes

Description of leased

Property:

Part 3: Sign Below

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

property that is subject to an unexpired lease.

X /s/ Katie Annette Kiss X /s/ Stephen Cameron Kiss

Katie Annette Kiss Stephen Cameron Kiss

Signature of Debtor 1 Signature of Debtor 2

Date June 25, 2019 Date June 25, 2019

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

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Notice Required by 11 U.S.C. § 342(b) for

Individuals Filing for Bankruptcy (Form 2010)

This notice is for you if:

You are an individual filing for bankruptcy,

and

Your debts are primarily consumer debts.

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

§ 101(8) as “incurred by an individual

primarily for a personal, family, or

household purpose.”

Chapter 7: Liquidation

$245 filing fee

$75 administrative fee

+ $15 trustee surcharge

$335 total fee

Chapter 7 is for individuals who have financial

difficulty preventing them from paying their debts

and who are willing to allow their nonexempt

property to be used to pay their creditors. The

primary purpose of filing under chapter 7 is to have

your debts discharged. The bankruptcy discharge

relieves you after bankruptcy from having to pay

many of your pre-bankruptcy debts. Exceptions exist

for particular debts, and liens on property may still

be enforced after discharge. For example, a creditor

may have the right to foreclose a home mortgage or

repossess an automobile.

However, if the court finds that you have committed

certain kinds of improper conduct described in the

Bankruptcy Code, the court may deny your

discharge.

You should know that even if you file chapter 7 and

you receive a discharge, some debts are not

discharged under the law. Therefore, you may still

be responsible to pay:

most taxes;

most student loans;

domestic support and property settlement

obligations;

The types of bankruptcy that are available to

individuals

Individuals who meet the qualifications may file under

one of four different chapters of Bankruptcy Code:

Chapter 7 - Liquidation

Chapter 11 - Reorganization

Chapter 12 - Voluntary repayment plan

for family farmers or

fishermen

Chapter 13 - Voluntary repayment plan

for individuals with regular

income

You should have an attorney review your

decision to file for bankruptcy and the choice of

chapter.

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

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most fines, penalties, forfeitures, and criminal

restitution obligations; and

certain debts that are not listed in your bankruptcy

papers.

You may also be required to pay debts arising from:

fraud or theft;

fraud or defalcation while acting in breach of

fiduciary capacity;

intentional injuries that you inflicted; and

death or personal injury caused by operating a

motor vehicle, vessel, or aircraft while intoxicated

from alcohol or drugs.

If your debts are primarily consumer debts, the court

can dismiss your chapter 7 case if it finds that you have

enough income to repay creditors a certain amount.

You must file Chapter 7 Statement of Your Current

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

individual filing for bankruptcy under chapter 7. This

form will determine your current monthly income and

compare whether your income is more than the median

income that applies in your state.

If your income is not above the median for your state,

you will not have to complete the other chapter 7 form,

the Chapter 7 Means Test Calculation (Official Form

122A–2).

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

must file a second form —the Chapter 7 Means Test

Calculation (Official Form 122A–2). The calculations on

the form— sometimes called the Means Test—deduct

from your income living expenses and payments on

certain debts to determine any amount available to pay

unsecured creditors. If

your income is more than the median income for your

state of residence and family size, depending on the

results of the Means Test, the U.S. trustee, bankruptcy

administrator, or creditors can file a motion to dismiss

your case under § 707(b) of the Bankruptcy Code. If a

motion is filed, the court will decide if your case should

be dismissed. To avoid dismissal, you may choose to

proceed under another chapter of the Bankruptcy

Code.

If you are an individual filing for chapter 7 bankruptcy,

the trustee may sell your property to pay your debts,

subject to your right to exempt the property or a portion

of the proceeds from the sale of the property. The

property, and the proceeds from property that your

bankruptcy trustee sells or liquidates that you are

entitled to, is called exempt property. Exemptions may

enable you to keep your home, a car, clothing, and

household items or to receive some of the proceeds if

the property is sold.

Exemptions are not automatic. To exempt property,

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

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

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

proceeds to your creditors.

Chapter 11: Reorganization

$1,167 filing fee

+ $550 administrative fee

$1,717 total fee

Chapter 11 is often used for reorganizing a business,

but is also available to individuals. The provisions of

chapter 11 are too complicated to summarize briefly.

Notice Required by 11 U.S.C. § 342(b) for Individuals Filing for Bankruptcy (Form 2010) page 2

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Read These Important Warnings

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

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

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

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

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

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

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

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

following all of the legal requirements.

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

necessary documents.

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

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

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

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

Chapter 12: Repayment plan for family

farmers or fishermen

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

to repay your creditors all or part of the money that

you owe them, usually using your future earnings. If

the court approves your plan, the court will allow you

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

years or 5 years, depending on your income and other

factors.

After you make all the payments under your plan,

many of your debts are discharged. The debts that are

not discharged and that you may still be responsible to

pay include:

domestic support obligations,

most student loans,

certain taxes,

debts for fraud or theft,

debts for fraud or defalcation while acting in a

fiduciary capacity,

most criminal fines and restitution obligations,

certain debts that are not listed in your

bankruptcy papers,

certain debts for acts that caused death or

personal injury, and

certain long-term secured debts.

$200 filing fee

+ $75 administrative fee

$275 total fee

Similar to chapter 13, chapter 12 permits family farmers

and fishermen to repay their debts over a period of time

using future earnings and to discharge some debts that

are not paid.

Chapter 13: Repayment plan for

individuals with regular

income

$235 filing fee

+ $75 administrative fee

$310 total fee

Chapter 13 is for individuals who have regular income

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

installments over a period of time and to discharge

some debts that are not paid. You are eligible for

chapter 13 only if your debts are not more than certain

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

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

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Warning: File Your Forms on Time

A married couple may file a bankruptcy case

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

each spouse lists the same mailing address on the

bankruptcy petition, the bankruptcy court generally will

mail you and your spouse one copy of each notice,

unless you file a statement with the court asking that

each spouse receive separate copies.

Understand which services you could receive from

credit counseling agencies

The law generally requires that you receive a credit

counseling briefing from an approved credit counseling

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

case, both spouses must receive the briefing. With

limited exceptions, you must receive it within the 180

days before you file your bankruptcy petition. This

briefing is usually conducted by telephone or on the

Internet.

In addition, after filing a bankruptcy case, you generally

must complete a financial management instructional

course before you can receive a discharge. If you are

filing a joint case, both spouses must complete the

course.

You can obtain the list of agencies approved to provide

both the briefing and the instructional course from:

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

.

In Alabama and North Carolina, go to:

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

BankruptcyResources/ApprovedCredit

AndDebtCounselors.aspx.

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

the bankruptcy court may be able to help you obtain

the list.

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

you promptly file detailed information about your

creditors, assets, liabilities, income, expenses and

general financial condition. The court may dismiss your

bankruptcy case if you do not file this information within

the deadlines set by the Bankruptcy Code, the

Bankruptcy Rules, and the local rules of the court.

For more information about the documents and

their deadlines, go to:

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

s.html#procedure.

Bankruptcy crimes have serious consequences

If you knowingly and fraudulently conceal assets

or make a false oath or statement under penalty

of perjury—either orally or in writing—in

connection with a bankruptcy case, you may be

fined, imprisoned, or both.

All information you supply in connection with a

bankruptcy case is subject to examination by the

Attorney General acting through the Office of the

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

other offices and employees of the U.S.

Department of Justice.

Make sure the court has your mailing address

The bankruptcy court sends notices to the mailing

address you list on Voluntary Petition for Individuals

Filing for Bankruptcy (Official Form 101). To ensure

that you receive information about your case,

Bankruptcy Rule 4002 requires that you notify the court

of any changes in your address.

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

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United States Bankruptcy Court

Southern District of Florida

In re

Katie Annette Kiss

Stephen Cameron Kiss Case No.

Debtor(s) Chapter 7

VERIFICATION OF CREDITOR MATRIX

The above-named Debtors hereby verify that the attached list of creditors is true and correct to the best of their knowledge.

Date: June 25, 2019 /s/ Katie Annette Kiss

Katie Annette Kiss

Signature of Debtor

Date: June 25, 2019 /s/ Stephen Cameron Kiss

Stephen Cameron Kiss

Signature of Debtor

Software Copyright (c) 1996-2019 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

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}bk1{Credito AresMatix}bk{

ABILITY RECOVERY SERVICES, LLC

PO BOX 4262

SCRANTON PA 18505-6262

ACCOUNT RESOLUTION SERVICES

PO BOX 459079

SUNRISE FL 33345-9079

AFFILIATE ASSET SOLUTIONS

145 TECHNOLOGY PARKWAY NW

SUITE 100

PEACHTREE CORNERS GA 30092

AFNI, INC.

ATTN: BANKRUPTCY

PO BOX 3427

BLOOMINGTON IL 61702

AFNI, INC.

1310 MARTIN LUTHER KING DRIVE

BLOOMINGTON IL 61702-3517

AFNI, INC.

PO BOX 3097

BLOOMINGTON IL 61702

AFNI, INC.

PO BOX 3517

BLOOMINGTON IL 61702-3517

ALLIED INTERSTATE

7525 WEST CAMPUS RD

NEW ALBANY OH 43054

ALLIED INTERSTATE

PO BOX 361445

COLUMBUS OH 43236

ALLIED INTERSTATE

SYNCHRONY / BRANDSMART

PO BOX 960061

ORLANDO FL 32896-0061

Kiss, Katie and Stephen -

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 87 of 105
ALLTRAN FINANCIAL, LP

PO BOX 722929

HOUSTON TX 77272-2929

AMCA

AMERICAN MEDICAL COLLECTION AGENCY

PO BOX 1235

ELMSFORD NY 10523-0935

AMCA/AMERICAN MEDICAL COLLECTION AGENCY

ATTENTION: BANKRUPTCY

4 WESTCHESTER PLAZA, SUITE 110

ELMSFORD NY 10523

AMERICAN CORADIUS INTERNATIONAL LLC

2420 SWEET HOME ROAD

SUITE 150

AMHERST NY 14228-2244

AMERICAN MEDICAL COLLECTION AGENCY

4 WESTCHESTER PLAZA

BUILDING 4

ELMSFORD NY 10523

AMEX/BANKRUPTCY

CORRESPONDENCE/BANKRUPTCY

PO BOX 981540

EL PASO TX 79998

AMSHER COLLECTION SERVICES, INC

4524 SOUTHLAKE PARKWAY

SUITE 15

BIRMINGHAM AL 35244

ANESTHESIA PHYSICIAN SOLUTIONS OF S FL

PO BOX 3495

TOLEDO OH 43607

ANESTHESIA PHYSICIAN SOLUTIONS OF S FL

PO BOX 743983

DEPARTMENT 10103

ATLANTA GA 30374-3983

ARS

PO BOX 630806

CINCINNATI OH 45263-0806

Kiss, Katie and Stephen -

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ARS

1643 NW 136TH AVENUE

SUNRISE FL 33323

ARS NATIONAL SERVICES, INC.

PO BOX 469100

ESCONDIDO CA 92046

ARS NATIONAL SERVICES, INC.

PO BOX 469046

ESCONDIDO CA 92046-9046

AT&T

PO BOX 536216

ATLANTA GA 30353

AT&T MOBILITY

PO BOX 536216

ATLANTA GA 30353

ATLANTIC CREDIT & FINANCE

PO BOX 2083

WARREN MI 48090

BAY AREA CREDIT SERVICE LLC

PO BOX 467600

ATLANTA GA 31146

BB&T

ATTN: BANKRUPTCY

PO BOX 1847

WILSON NC 27894

CAINE & WEINER

4101 MCEWEN ROAD

DALLAS TX 75244

CAPIO PARTNERS

2222 TEXOMA PKWY

STE 150

SHERMAN TX 75090

Kiss, Katie and Stephen -

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 89 of 105
CAPIO PARTNERS LLC

ATTN: BANKRUPTCY

PO BOX 3498

SHERMAN TX 75091

CAPIO PARTNERS LLC

PO BOX 3209

SHERMAN TX 75091

CAPIO PARTNERS LLC

PO BOX 1378

SHERMAN TX 75091

CAPITAL ONE/NEIMAN MARCUS/BERGDORF GOODM

ATTN: BANKRUPTCY DEPT

PO BOX 30285

SALT LAKE CITY UT 84130

CARE CENTRIX

PO BOX 277947

ATLANTA GA 30384

CARE CENTRIX

9119 CORPORATE LAKE DRIVE

TAMPA FL 33634

CBE GROUP INC

PAYMENT PROCESSING CENTER

PO BOX 2545

WATERLOO IA 50704-2545

CHASE

3451 HARRY S TRUMAN BLVD

SAINT CHARLES MO 63301

CHASE

PO BOX 15123

WILMINGTON DE 19886-5151

CHASE

PO BOX 15298

WILMINGTON DE 19850

Kiss, Katie and Stephen -

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 90 of 105
CHASE CARD SERVICES

ATTN: BANKRUPTCY

PO BOX 15298

WILMINGTON DE 19850

CITBANK/BEST BUY

PO BOX 6497

SIOUX FALLS SD 57117

CITIBANK/BEST BUY

ATTN: BANKRUPTCY

PO BOX 790441

ST. LOUIS MO 63179

CLIENT SERVICES, INC.

3451 HARRY S.TRUMAN BLVD

SAINT CHARLES MO 63301-4047

COLLECTIONS

3400 TEXOMA PARKWAY

SHERMAN TX 75092

COMENITY BANK/BEALLS FLORIDA

ATTN: BANKRUPTCY

PO BOX 182125

COLUMBUS OH 43218

COMENITY BANK/BEALLSOL

ATTN: BANKRUPTCY

PO BOX 182125

COLUMBUS OH 43218

COMENITY BANK/PIER 1

ATTN: BANKRUPTCY

PO BOX 182125

COLUMBUS OH 43218

COMENITY BANK/VICTORIA SECRET

ATTN: BANKRUPTCY DEPT

PO BOX 182125

COLUMBUS OH 45318

COMENITY VICTORIA SECRET

PO BOX 659728

SAN ANTONIO TX 78265

Kiss, Katie and Stephen -

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 91 of 105
COMMONWEALTH FINANCIAL SYSTEMS

ATTN: BANKRUPTCY

245 MAIN STREET

DICKSON CITY PA 18519

CONVERGENT OUTSOURCING, INC.

PO BOX 9004

RENTON WA 98057-9004

CONVERGENT OUTSOURCING, INC.

800 SW 39TH STREET

SUITE 100

RENTON WA 98057

CREDENCE RESOURCE MANAGEMENT

17000 DALLAS PARKWAY

SUITE 204

DALLAS TX 75248

CREDENCE RESOURCE MGMNT

PO BOX 2147

SOUTHGATE MI 48195

CREDENCE RESOURCE MGMNT LLC

PO BOX 2300

SOUTHGATE MI 48195-4210

CREDENCE RESOURCE MGMNT LLC

PO BOX 2390

SOUTHGATE MI 48195-4390

CREDIT COLLECTION SERVICES

PAYMENT PROCESSING

PO BOX 55126

BOSTON MA 02205-5126

CREDIT CONTROL LLC

PO BOX 31179

TAMPA FL 33631

CREDIT CORP SOLUTIONS, INC.

63 EAST 11400 SOUTH 408

SANDY UT 84070

Kiss, Katie and Stephen -

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 92 of 105
CREDIT ONE BANK

ATTN: BANKRUPTCY DEPARTMENT

PO BOX 98873

LAS VEGAS NV 89193

CREDIT SOLUTIONS LLC

PO BOX 24710

LEXINGTON KY 40524-4710

DEPT. STORE NATL. BANK / MACY'S

ATTN.:BANKRUPTCY

9111 DUKE BLVD.

MASON OH 45040

DIRECT TV

PO BOX 105261

ATLANTA GA 30348-5261

DISCOVER

PO BOX 71084

CHARLOTTE NC 28272-1084

DISCOVER FINANCIAL

ATTN: BANKRUPTCY DEPARTMENT

PO BOX 15316

WILMINGTON DE 19850

DIVERSIFIED ADJUSTMENT SERVICE INC

PO BOX 32145

FRIDLEY MN 55432-0145

DIVERSIFIED CONSULTANTS

ATTN BANKRUPTCY

PO BOX 679543

DALLAS TX 75267

DIVERSIFIED CONSULTANTS, INC.

10550 DEERWOOD PARK BLVD

JACKSONVILLE FL 32256

DIVERSIFIED CONSULTANTS, INC.

PO BOX 5007

CAROL STREAM IL 60197-5007

Kiss, Katie and Stephen -

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 93 of 105
DOCKYARD EMERGENCY PHYSICIANS

PO BOX 37855

PHILADELPHIA PA 19101-7855

DSNB BLOOMINGDALES

ATTN: RECOVERY "BK"

PO BOX 9111

MASON OH 45040

ENCORE RECEIVABLE MANAGEMENT, INC.

400 N. ROGERS ROAD

PO BOX 3330

OLATHE KS 66063-3330

ERC

PO BOX 57610

JACKSONVILLE FL 32241

FINANCIAL RECOVERY SERVICES, INC.

PO BOX 385908

MINNEAPOLIS MN 55438-5908

FIVEMILE CREEK EMERG PHYS, LLC

PO BOX 37852

PHILADELPHIA PA 19101

FIVEMILE CREEK EMERGENCY PHYSICIAN LLC

PO BOX 37852

PHILADELPHIA PA 19101-7852

FORD MOTOR CREDIT COMPANY

1335 S CLEARVIEW AVENUE

MESA AZ 85208

FRANKLIN COLLECTION SERVICE, INC

PO BOX 3910

TUPELO MS 38803-3910

FROST-ARNETT COMPANY

PO BOX 198988

NASHVILLE TN 37219

GC SERVICES LIMITED PARTNERSHIP

PO BOX 2545

HOUSTON TX 77252

Kiss, Katie and Stephen -

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 94 of 105
GC SERVICES LIMITED PARTNERSHIP

PO BOX 3855

HOUSTON TX 77253

GEICO INSURANCE

ONE GEICO PLAZA

BETHESDA MD 20810

GLOBAL CREDIT & COLLECTION CORP

5440 N CUMBERLAND AVE.

SUITE 300

CHICAGO IL 60656-1490

GOLD COAST FED CR UNIO

2226 S CONGRESS AVE

PALM SPRINGS FL 33406

GOLD COAST FED CR UNIO

2226 S CONGRESS AV

WEST PALM BEACH FL 33406

GROUP ONE MORTGAGE, INC.

900 E. INDIANTOWNROAD

SUITE 110

JUPITER FL 33477

HH GREGG

PO BOX 960061

ORLANDO FL 32896-0061

HOME DEPOT CREDIT SERVICES

PO BOX 9001010

LOUISVILLE KY 40290-1010

HRRG

PO BOX 5406

CINCINNATI OH 45273-7942

I C SYSTEM INC

444 HIGHWAY 96 EAST

P.O. BOX 64378

ST. PAUL MN 55164

Kiss, Katie and Stephen -

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 95 of 105
IC SYSTEM

PO BOX 64437

SAINT PAUL MN 55164-0437

IC SYSTEM

PO BOX 64794

SAINT PAUL MN 55164-0794

IC SYSTEM INC

PO BOX 64378

SAINT PAUL MN 55164

JC CHRISTENSEN & ASSOCIATES

PO BOX 519

SAUK RAPIDS MN 56379

JEFFERSON CAPITAL SYSTEMS

16 MCLELAND ROAD

SAINT CLOUD MN 56303

JEFFERSON CAPITAL SYSTEMS, LLC

PO BOX 1999

SAINT CLOUD MN 56302

JONATHAN NEIL & ASSOCIATES

PO BOX 5600

RANCHO CUCAMONGA CA 91729

JOSEPH F. ROSEN, ESQ.

POLLACK & ROSEN, P.A.

806 DOUGLAS ROAD

SOUTH TOWER, SUITE 200

CORAL GABLES FL 33134

KOHL'S

PO BOX 2983

MILWAUKEE WI 53201

KOHLS / CAPITAL ONE

PO BOX 30285

SALT LAKE CITY UT 84130

Kiss, Katie and Stephen -

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KOHLS/CAPITAL ONE

KOHLS CREDIT

PO BOX 3120

MILWAUKEE WI 53201

KOHLS/CHASE

N56 W 17000 RIDGEWOOD DR

MENOMONEE FALLS WI 53051

LAWNWOOD REGIONAL MEDICAL CENTER

PO BOX 740771

CINCINNATI OH 45274-0771

LINCOLN AUTOMOTIVE FINANCIAL SERVICE

ATTN: BANKRUPTCY

PO BOX 542000

OMAHA NE 68154

LVNV FUNDING/RESURGENT CAPITAL

ATTN: BANKRUPTCY

PO BOX 10497

GREENVILLE SC 29603

MACY'S

PO BOX 8218

MASON OH 45040

MACY'S

PO BOX 9001094

LOUISVILLE KY 40290

MARTIN ANESTHESIA SPECIALISTS

PO BOX 740712

CINCINNATI OH 45274-0712

MARTIN COUNTY FIRE RESCUE

C/O MC TAX COLLECTOR

3485 SE WILLOUGHBY BLVD.

STUART FL 34994

MARTIN HEALTH SYSTEM

PO BOX 9033

STUART FL 34995-9033

Kiss, Katie and Stephen -

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MBA LAW

MITCHELL D BLUHM, ESQ.

PO BOX 3269

SHERMAN TX 75091

MBA LAW OFFICES / CAPIO

3400 TEXOMA PARKWAY

SHERMAN TX 75092

MBA LAW OFFICES / MITCHELL BLUHM, ESQ

FOR CF MEDICAL, LLC

PO BOX 3269

SHERMAN TX 75091

MEDICAL & FINANCIAL MANAGEMENT, INC.

COLLECTION SERVICES

PO BOX 3299

STUART FL 34995

MEDICREDIT INC

PO BOX 1629

MARYLAND HEIGHTS MO 63043

MEDICREDIT INC.

PO BOX 1629

MARYLAND HEIGHTS MO 63043

MERCANTILE ADJUSTMENT BUREAU

PO BOX 9055

WILLIAMSVILLE NY 14231

MERCHANTS & MEDICAL CREDIT CORP

6324 TAYLOR DRIVE

FLINT MI 48507

MERCURY INSURANCE

PO BOX 5600

RANCHO CUCAMONGA CA 91729

MIDLAND CREDIT MANAGEMENT

PO BOX 2121

WARREN MI 48090

Kiss, Katie and Stephen -

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MIDLAND CREDIT MANAGEMENT

PO BOX 60578

LOS ANGELES CA 90060

MIDLAND CREDIT MANAGEMENT

PO BOX 939069

SAN DIEGO CA 92193

MIDLAND CREDIT MANAGEMENT / HH GREGG

PO BOX 60578

LOS ANGELES CA 90060

MIDLAND CREDIT MANAGEMENT INC

PO BOX 51319

LOS ANGELES CA 90051-5619

MIDLAND CREDIT MANAGEMENT INC

2365 NORTHSIDE DRIVE

SUITE 300

SAN DIEGO CA 92108

MIDLAND CREDIT MANAGEMENT, INC

PO BOX 51319

LOS ANGELES CA 90051-5619

MIDLAND CREDIT MANAGEMENT, INC

PO BOX 2000

WARREN MI 48090-2001

MIDLAND FUNDING

2365 NORTHSIDE DR

SUITE 300

SAN DIEGO CA 92108

MIDLAND FUNDING

350 S. CAMINO DE LA REINA SOUTH

SAN DIEGO CA 92108

MOODY, JONES, INGINO PA

1333 S UNIVERSITY BLVD.

SUITE 201

FORT LAUDERDALE FL 33324

Kiss, Katie and Stephen -

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MR. COOPER

ATTN: BANKRUPTCY

8950 CYPRESS WATERS BLVD

COPPELL TX 75019

MR. COOPER

PO BOX 650783

DALLAS TX 75265-0783

MR. COOPER

ATTN: BANKRUPTCY / REAFFIRMATION DEPT

PO BOX 619094

DALLAS TX 75261-9741

MR. RICHARD AND MRS. BARBARA RINELLI

1585 SE SAXONY STREET

PORT SAINT LUCIE FL 34983

MR. STEPHEN AND MRS. LYNNE KISS

13300 NW MAPLEWOOD ROAD

PALM CITY FL 34990

MRS ASSOCIATES

1930 OLNEY AVENUE

CHERRY HILL NJ 08003

MSCB, INC.

PO BOX 1567

PARIS TN 38242

NATIONWIDE CREDIT INC

PO BOX 14581

DES MOINES IA 50306-3581

NORDSTROM FSB

ATTN: BANKRUPTCY

PO BOX 6555

ENGLEWOOD CO 80155

OCWEN LOAN SERVICING, LLC

1661 WORTHINGTON ROAD

SUITE 100

WEST PALM BEACH FL 33409

Kiss, Katie and Stephen -

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 100 of 105
PARAGON CONTRACTING SERVICES LLC

PO BOX 740022

CINCINNATI OH 45274

PARRISH MEDICAL CENTER

PO BOX 850001

DEPT 159

ORLANDO FL 32885

PENNCREDIT

916 SOUTH 14TH STREET

HARRISBURG PA 17108-0988

PHOENIX FINANCIAL SERVICES

PO BOX 361450

INDIANAPOLIS IN 46236

PORTFOLIO RECOVERY & AFFILIATES

120 CORPORATE BLVD.

NORFOLK VA 23502

PORTFOLIO RECOVERY ASSOCIATES, LLC

PO BOX 12914

NORFOLK VA 23541-1223

PRINCE PARKER & ASSOCIATES

PO BOX 474690

CHARLOTTE NC 28247

PROGRESSIVE LEASING

256 DATA DRIVE

DRAPER UT 84020

RADIUS GLOBAL SOLUTIONS LLC

PO BOX 390905

MINNEAPOLIS MN 55439

RESURGENT CAPITAL SERVICES

55 BEATTIE PLACE

GREENVILLE SC 29601

RMCB

PO BOX 1235

ELMSFORD NY 10523-0935

Kiss, Katie and Stephen -

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 101 of 105
RPM, LLC

PO BOX 1548

LYNNWOOD WA 98046-1548

SHEFFIELD FINANCIAL

PO BOX 1704

CLEMMONS NC 27012

SHEFFIELD FINANCIAL CO / BB&T

ATTN: BANKRUPTCY

PO BOX 1847

WILSON NC 27894

SHEFFIELD FINANCIAL COMPANY

6010 GOLDING CENTER DRIVE

WINSTON SALEM NC 27103

SIMM ASSOCIATES, INC.

PO BOX 7526

NEWARK DE 19714-7526

ST LUCIE MEDICAL CENTER

PO BOX 740771

CINCINNATI OH 45274

STERLING JEWELERS, INC.

375 GHENT RD

FAIRLAWN OH 44333

SUNTRUST BANK

ATTN: BANKRUPTCY

PO BOX 85092

MC VA-WMRK-7952

RICHMOND VA 23286

SUNTRUST BANK

PO BOX 305053

NASHVILLE TN 37230-5053

SUNTRUST BANK SOUTH

1501 NE 26TH STREET

FORT LAUDERDALE FL 33305

Kiss, Katie and Stephen -

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SYNCB/ROOMS TO GO

ATTN: BANKRUPTCY

PO BOX 965060

ORLANDO FL 32896

SYNCHRONY BANK / BRANDSMART

PO BOX 960061

ORLANDO FL 32896

SYNCHRONY BANK / CARE CREDIT

950 FORRER BLVD.

KETTERING OH 45420

SYNCHRONY BANK / HH GREGG

PO BOX 965060

ORLANDO FL 32896-0061

SYNCHRONY BANK / HH GREGG

ATTN: BANKRUPTCY

PO BOX 965036

ORLANDO FL 32896

SYNCHRONY BANK / HH GREGG

PO BOX 965033

ORLANDO FL 32896-0061

SYNCHRONY BANK / JC PENNEY

ATTN: BANKRUPTCY

PO BOX 965007

ORLANDO FL 32896

SYNCHRONY BANK/ JC PENNEYS

ATTN: BANKRUPTCY

PO BOX 956060

ORLANDO FL 32896

SYNCHRONY BANK/BRANDSMART

ATTN: BANKRUPTCY

PO BOX 965060

ORLANDO FL 32896

SYNCHRONY BANK/BRANDSMART

BANKRUPTCY DEPT.

PO BOX 965036

ORLANDO FL 32896-5064

Kiss, Katie and Stephen -

Case 19-18398-EPK Doc 1 Filed 06/25/19 Page 103 of 105
SYNCHRONY BANK/CARE CREDIT

ATTN: BANKRUPTCY DEPT

PO BOX 965060

ORLANDO FL 32896

SYNCHRONY BANK/JC PENNEYS

PO BOX 960090

ORLANDO FL 32896

SYNCHRONY BANK/ROOMS TO GO

PO BOX 965036

ATTN: BANKRUPTCY

ORLANDO FL 32896

SYNCHRONY BANK/ROOMS TO GO

PO BOX 960061

ATTN: BANKRUPTCY

ORLANDO FL 32896

T-MOBILE

PO BOX 742596

CINCINNATI OH 45274

TATE & KIRLIN ASSOCIATES, INC.

580 MIDDLETON BLVD.

SUITE 240

LANGHORNE PA 19047

TRANSWORLD SYS INC/33

ATTN: COMPLIANCE DEPT

PO BOX 15630

WILMINGTON DE 19850

TRANSWORLD SYSTEMS INC

PO BOX 15609

WILMINGTON DE 19850-5609

TREASURE COAST PATHOLOGY

PO BOX 377

STUART FL 34995-0377

TREASURE COAST SURGICAL SPECIALISTS

PO BOX 740776

CINCINNATI OH 45274

Kiss, Katie and Stephen -

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UNITED COLLECTION BUREAU

PO BOX 1418

MAUMEE OH 43537

UNITED COLLECTION BUREAU, INC.

5620 SOUTHWYCK BLVD.

SUITE 206

TOLEDO OH 43614

VERIZON WIRELESS

PO BOX 660108

DALLAS TX 75266-0108

VISA DEPT STORE NATIONAL BANK/MACY'S

ATTN: BANKRUPTCY

PO BOX 8053

MASON OH 45040

ZWICKER & ASSOCIATES

80 MINUTEMAN ROAD

ANDOVER MA 01810

ZWICKER & ASSOCIATES PC

ATTORNEYS FOR DISCOVER BANK

10751 DEERWOOD PARK BLVD

SUITE 100

JACKSONVILLE FL 32256

Kiss, Katie and Stephen -

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