• 

UNITED STATES BANKRUPTCY COURT, SOUTHERN DISTRICT OF FLORIDA 

www.flsb.uscourts.gov 

J CHAPTER 13 PLAN (Individual Adjustment of Debts) 

~ Original Plan ------------- • Amended Plan (Indicate 1st, 2nd, etc. Amended, if applicable) 

D Modified Plan (Indicate 1st, 2nd, etc. Modified, if applicable) 

DEBTOR:JO..\J~e., £\(1\J10 G<.t±,e.rrez_ 

SS#: xxx-xx- °S9Y !> 

JOINTDEBTOR: _______ CASE NO.: (tj 'J;J3⁄4~I 

SS#: xxx-xx-513'15 

I. NOTICES 

To Debtors: Plans that do not comply with local rules and judicial rulings may not be confmnable. All plans, amended plans 

and modified plans shall be served upon all creditors and a certificate of service filed with the Clerk pursuant to 

Local Rules 2002-1 (C)(5), 3015-I(B)(2), and 3015-2. Debtor(s) must commence plan payments within 30 days of 

filing the chapter 13 petition or within 30 days of entry of the order converting the case to chapter 13. 

To Creditors: Your rights may be affected by this plan. You must file a timely proofof claim in order to be paid. Your claim may 

be reduced, modified or eliminated. 

To All Parties: The plan contains no nonstandard provisions other than those set out in paragraph VIII. Debtor(s) must check one 

box on each line listed below in this section to state whether the plan includes any of the following: 

The valuation of a secured claim, set out in Section ill, which may result in a • Included g- Not included partial payment or no payment at all to the secured creditor 

Avoidance of a judicial lien or nonpossessory, non purchase-money security interest, set • Included 11( Not included 

out in Section ill - Nonstandard provisions, set out in Section VIII • Included l( Not included 

II. PLAN PAYMENTS, LENGTH OF PLAN AND DEBTOR(S)' ATTORNEY'S FEE 

A. MONTHLY PLAN PAYMENT: This Plan pays for the benefit of the creditors the amounts listed below, including trustee's 

fees of 10%, beginning 30 days from the filing/conversion date. In the event the trustee does not retain the full 10%, any unused 

amount will be paid to unsecured nonpriority creditors pro-rata under the plan: 

1. 

2. 

3. 

_____ 3--=-o-=o ___ for months 3' to--1.n_; 

_______ for months __ to __ ; 

for months ------- to __ · , 

B. DEBTOR(S)' ATTORNEY'S FEE: "'NONE O PRO BONO 

Total Fees: Total Paid: Balance Due: ---------- ---------- --------- Payable /month (Months to -------- Allowed fees under LR 2016-l(B)(2) are itemized below: 

Applications for compensation must be filed for all fees over and above the Court's Guidelines for Compensation. 

III. TREATMENT OF SECURED CLAIMS 

A. SECURED CLAIMS: rs(NONE 

[Retain Liens pursuant to 11 U.S.C. § 1325 (a)(5)] Mortgage(s)/Lien on Real or Personal Property: 

1. Creditor: 

Address: 

Last 4 Digits of 

Account No.: 

Other: 

LF-31 (rev. 10/3/17) 

Arrearage/ Payoff on Petition Date 

[Select Payment Type] 

Page I of5 

______ /month (Months to 
, 

Real Property 

Q>rincipal Residence 

Q)ther Real Property 

Address of Collateral: 

D Personal PropertyNehicle 

Desc1iption of Collateral: 

B. VALUATION OF COLLATERAL: NONE 

Case number: 

Check one below for Real Property: 

• Escrow is included in the regular payments 

0The debtor(s) will pay Otaxes Oinsurance directly 

IF YOU ARE A SECURED CREDITOR LISTED BELOW, 1HE PLAN SEEKS TO VALUE 1HE COLLATERAL 

SECURING YOUR CLAIM IN 1HE AMOUNT INDICATED. A SEPARATE MOTION WILL ALSO BE SERVED UPON 

YOU PURSUANT TO BR 7004 AND LR 3015-3. 

1. REALPROPERTY: 0NONE 

1. Creditor: Value of Collateral: Payment 

Address: Amount of Creditor's Lien: Total paid in plan: 

Last 4 Digits of Account No.: Interest Rate: /month (Months to -- -

Real Property Check one below: 

• Principal Residence D Escrow is included in the monthly 

• Other Real Property mortgage payment listed in this section 

Address of Collateral: 

D The debtor(s) will pay 

Otaxes Oinsurance directly 

2. VEIDCLES(S): ~ NONE 

1. Creditor: Value of Collateral: Payment 

Address: Amount of Creditor's Lien: Total paid in plan: 

Last 4 Digits of Account No.: Interest Rate: /month (Months to - -

VIN: 

Description of Collateral: 

Check one below: 

DCl~i~ incurred 910 days or more prepet1t10n 

DCl~i~ incurred less than 910 days prepet1t1on 

3. PERSONALPROPERTY:(iNONE 

LF-31 (rev. 10/3/17) Page 2 of5 

) 

) 
✓ 

Case number: 

1. Creditor: Value of Collateral: Payment 

Address: Amount of Creditor's Lien: Total paid in plan: 

Last 4 Digits of Account No.: Interest Rate: /month (Months to - - Description of Collateral: 

Check one below: 

0 c1~~ incurred less than one year prepetit10n 

0 c1~i1:° incurred 1 year or more prepetition 

C. LIEN AVOIDANCE (v'NONE 

D Judicial liens or nonpossessory, nonpurchase money security interests securing the claimi; will be avoided to the extent that 

they impair the exemptions under 11 U.S.C. § 522 as listed below. A separate motion will also be served pursuant to BR 

7004 and LR 3015-3. 

1. Creditor: Collateral: --------------- Address: 

Exemption: 

Last 4 Digits of Account No.: ___ _ 

D. SURRENDER OF COLLATERAL: Secured claims filed by any creditor granted stay relief in this section shall not receive a 

dist,ibution fom the Chapter 13 Trustee. 

[yNONE 

D The debtor(s) elect to surrender to each creditor listed below the collateral that secures the creditor's claim. The debtor(s) 

request that upon confirmation of this plan the automatic stay be terminated in rem as to the debtor(s) and in rem and in 

personam as to any codebtor(s) as to these creditors. 

D Other: 

Name of Creditor Last 4 Digits of Account No. Description of Collateral (Address, Vehicle, etc.) 

1. 

E. DIRECT PAYMENTS: Secured claims filed by any creditor granted stay relief in this section shall not receive a distribution 

fom the Chapter 13 Trustee. 

is/NONE 

D The debtor(s) elect to make payments directly to each secured creditor listed below. The debtor(s) request that upon 

confirmation of this plan the automatic stay be terminated in rem as to the debtor(s) and in rem and in personam as to any 

codebtor(s) as to these creditors. Nothing herein is intended to terminate or abrogate the debtor(s)' state law contract rights. 

Name of Creditor Last 4 Digits of Account No. Description of Collateral (Address, Vehicle, etc.) 

1. 

IV. TREATMENT OF FEES AND PRIORITY CLAIMS [as defined in 11 U.S.C. §507 and 11 U.S.C. § 1322(a)(4)] 

A. ADMINISTRATIVE FEES OTHER THAN DEBTORS(S)' ATTORNEY'S FEE: IBNONE 

Name: 

Payment Address: 

Total Due: ----------- Pay able: ________ /month (Months to ) 

B. INTERNAL REVENUE SERVICE: !VNONE 

LF-31 (rev. 10/3/17) Page 3 of 5 

) 
v. 

VI. 

VII. 

Case number: 

Total Due: Total Payment _________ _ ---------- Pay able: /month (Months to 

C. DOMESTIC SUPPORT OBLIGATION(S): NONE O CURRENT AND PAID OUTSIDE 

I. Name of Creditor: 

--------------------------------------- Payment Address: 

--------------------------------------- Tot al Due: 

Payable /month (Months to ) 

Regular Paym~nt (if applicable) /month (Months to 

D. OTHER: rn4' NONE 

I. Name of Creditor: 

Payment Address: 

Total Due: 

Payable /month (Months to ) 

Regular Payment (if applicable) $0.00 /month (Months to ) 

TREATMENT OF UNSECURED NONPRIORITY CREDITORS 

A. Pay \ b> \ b S, i \ /month (Months 3 (, to _k ) 

Pro rata dividend will be calculated by the Trustee upon review of filed claims after bar date. 

B. 0 If checked, the Debtor(s) will amend/modify to pay 100% to all allowed unsecured nonpriority claims. 

C. SEPARATELY CLASSIFIED: @NONE 

1. Name of Creditor: ------------------------------------ Payment Address: ----------------------------------- Last 4 Digits of Account No.: ------ Basis for Separate Classification ------------------------------ Payable /month (Months to 

*Debtor(s) certify the separate classification(s) of the claim(s) listed above will not prejudice other unsecured nonpriority 

creditors pursuant to 11 U.S.C. § 1322. 

EXECUTORY CONTRACTS AND UNEXPIRED LEASES: Secured claims filed by any creditor/lessor granted stay relief in this 

section shall not receive a distribution from the Chapter 13 Trustee. 

1. 

~NONE 

0 Unless provided for under a separate section, the debtor(s) request that upon confirmation of this plan, the automatic stay be 

terminated in rem as to the debtor(s) and in rem and in personam as to any codebtor(s) as to these creditors/lessors. Nothing 

herein is intended to terminate or abrogate the debtor(s)' state law contract rights. 

Name of Creditor Collateral Acct. No. O-ast 4 Digits) Assume/Reject 

0 Assume O Reject --------- INCOME TAX RETURNS AND REFUNDS: 0 NONE 

MDebtor(s) will not provide tax returns unless requested by any interested party pursuant to 11 U.S.C. § 521. 

O The debtor(s) is hereby advised that the chapter 13 trustee has requested that the debtor(s) comply with 521(f) 1-4 on an 

annual basis during the pendency of this case. The debtor(s) hereby acknowledges that the deadline for providing the 

Trustee with their filed tax returns is on or before May 15 of each year the case is pending and that the debtor(s) shall 

provide the trustee (but not file with the Court) with verification of their disposable income if their gross household income 

increases by more than 3% over the previous year's income. [Miami cases] 

LF-31 (rev. 10/3/17) Page 4 of 5 
Debtor(s)::s~\litC F\o,\.jl\ (;4\~c<fe,7 Case number: ___ _ 

0 Debtor(s) shall provide copies of yearly income tax returns to the Trustee (but not file with the Court) no later than May 

15th during the pendency of the Chapter 13 case. In the event the debtor(s)' disposable income or tax refunds increase, 

debtor(s) shall increase payments to unsecured creditors over and above payments provided through the Plan up to 100% of 

allowed unsecured claims. [Broward/Palm Beach cases] 

VIII. NON-ST AND ARD PLAN PROVISIONS [3lNONE 

0 Nonstandard provisions must be set forth below. A nonstandard provision is a provision not otherwise included in the Local 

Fonn or deviating from it. Nonstandard provisions set out elsewhere in this plan are void. 

0 Mortgage Modification Mediation 

PROPERTY OF THE ESTATE WILL VEST IN THE DEBTOR(S) UPON PLAN CONFIRMATION. 

I deJo:M. ~~' foregoing obapto, 13 plan;, true ,nd oom,ct undo, penalty of perjury. 

_ __,,__,....______________ -~ Debtor l h -3 Date \-'le>\9 _________ J_oin_t_D_eb_to_r ______ _ 

Attorney with pennission to sign on 

Debtor(s)' behalf 

Date 

Date 

By filing this document, the Attorney for Debtor{s) or Debtor(s), if not represented by counsel, certifies that the wording and 

order of the provisions in this Chapter 13 plan are identical to those contained in Local Form Chapter 13 Plan and the plan 

contains no nonstandard provisions other than those set out in paragraph VIII. 

LF-31 (rev. 10/3/17) Page 5 of5