Fill in this information to identify your case:

Debtor 1 Olga Rodriguez

First Name Middle Name Last Name

Debtor 2

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

United States Bankruptcy Court for the: SOUTHERN DISTRICT OF FLORIDA

Case number 20-19468-AJC

(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................................................................................................ $ 259,274.00

1b. Copy line 62, Total personal property, from Schedule A/B..................................................................................... $ 693.03

1c. Copy line 63, Total of all property on Schedule A/B............................................................................................... $ 259,967.03

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... $ 5,337.23

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............................ $ 44,666.58

Your total liabilities $ 50,003.81

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................................................................................ $ 706.72

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

Copy your monthly expenses from line 22c of Schedule J.......................................................................... $ 670.00

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

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Case 20-19468-AJC Doc 11 Filed 09/29/20 Page 1 of 11
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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. $ 0.00

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) 1996-2020 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 20-19468-AJC Doc 11 Filed 09/29/20 Page 2 of 11
Fill in this information to identify your case and this filing:

Debtor 1 Olga Rodriguez

First Name Middle Name Last Name

Debtor 2

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

United States Bankruptcy Court for the: SOUTHERN DISTRICT OF FLORIDA

Case number 20-19468-AJC  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.

2572 W 72nd Place 





Single-family home

Duplex or multi-unit building

Condominium or cooperative

Street address, if available, or other description

Hialeah FL 33016-6507





Manufactured or mobile home

Land

Current value of the

entire property?

Current value of the

portion you own?

City State ZIP Code  Investment property $258,774.00 $258,774.00

 Timeshare

Describe the nature of your ownership interest

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

a life estate), if known.

 Other

Who has an interest in the property? Check one

 Debtor 1 only Fee simple

Miami-Dade  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:

Legal Description: 4TH ADDN TO ROBLES GARDENS PB 137-82 LOT 11

BLK 11 LOT SIZE 3405 SQ FT 04-2027-001-0380 OR 17775-2782 0897 1

COC 24303-3825 02 2006 5

- Valuation obtained from Miami Dade County Property Appraiser Office.

- Purchased and on title since 02/21/2006.

- Joint with Erich Gonzalez.

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

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Case 20-19468-AJC Doc 11 Filed 09/29/20 Page 3 of 11
Debtor 1 Olga Rodriguez Case number (if known) 20-19468-AJC

If you own or have more than one, list here:

1.2 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.

Caballero Rivero Hialeah

373 W 9th Street #377







Single-family home

Duplex or multi-unit building

Condominium or cooperative

Street address, if available, or other description

Hialeah FL 33010-0000





Manufactured or mobile home

Land

Current value of the

entire property?

Current value of the

portion you own?

City State ZIP Code  Investment property $1,000.00 $500.00

 Timeshare

Describe the nature of your ownership interest

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

a life estate), if known.

 Other Cemetery

Who has an interest in the property? Check one

 Debtor 1 only Cemetery

Miami-Dade  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:

Lawn Crypt

Section 18, Lot 48, Space 5DD

- Joint with Rodolfo E Bianco.

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...........................................................................=> $259,274.00

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.

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

 No

 Yes

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.............................................................................=> $0.00

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.....

Love seat, lamp, bed, dresser, two nigh stamp, lamp, plates, cups,

silverware, toaster, microwave, dishware, refrigerator, dinning

table with table. Value is debtor valuation based on age condition. $500.00

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

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Case 20-19468-AJC Doc 11 Filed 09/29/20 Page 4 of 11
Debtor 1 Olga Rodriguez Case number (if known) 20-19468-AJC

7. Electronics

Examples: Televisions and radios; audio, video, stereo, and digital equipment; computers, printers, scanners; music collections; electronic devices

including cell phones, cameras, media players, games

 No

 Yes. Describe.....

8. Collectibles of value

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

other collections, memorabilia, collectibles

 No

 Yes. Describe.....

9. Equipment for sports and hobbies

Examples: Sports, photographic, exercise, and other hobby equipment; bicycles, pool tables, golf clubs, skis; canoes and kayaks; carpentry tools;

musical instruments

 No

 Yes. Describe.....

10. Firearms

Examples: Pistols, rifles, shotguns, ammunition, and related equipment

 No

 Yes. Describe.....

11. Clothes

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

 No

 Yes. Describe.....

Used clothes and shoes, value is debtors valuation based on age

and condition. $60.00

12. Jewelry

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

 No

 Yes. Describe.....

Costume jewelry and Miscellaneous women accessories (not

name brand), value is debtors valuation based on age and

condition. $20.00

13. Non-farm animals

Examples: Dogs, cats, birds, horses

 No

 Yes. Describe.....

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

 No

 Yes. Give specific information.....

15. Add the dollar value of all of your entries from Part 3, including any entries for pages you have attached

for Part 3. Write that number here .............................................................................. $580.00

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

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

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Case 20-19468-AJC Doc 11 Filed 09/29/20 Page 5 of 11
Debtor 1 Olga Rodriguez Case number (if known) 20-19468-AJC

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

Cash on Hand $20.00

17. Deposits of money

Examples: Checking, savings, or other financial accounts; certificates of deposit; shares in credit unions, brokerage houses, and other similar

institutions. If you have multiple accounts with the same institution, list each.

 No

 Yes........................ Institution name:

17.1. Checking

SunTrust Bank

Checking Account No.: XXXX4422 $93.03

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:

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...

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

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Case 20-19468-AJC Doc 11 Filed 09/29/20 Page 6 of 11
Debtor 1 Olga Rodriguez Case number (if known) 20-19468-AJC

27. Licenses, franchises, and other general intangibles

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

 No

 Yes. Give specific information about them...

Money or property owed to you? Current value of the

portion you own?

Do not deduct secured

claims or exemptions.

28. Tax refunds owed to you

 No

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

29. Family support

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

 No

 Yes. Give specific information......

30. Other amounts someone owes you

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

benefits; unpaid loans you made to someone else

 No

 Yes. Give specific information..

31. Interests in insurance policies

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

 No

 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..................................................................................................................... $113.03

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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Case 20-19468-AJC Doc 11 Filed 09/29/20 Page 7 of 11
Debtor 1 Olga Rodriguez Case number (if known) 20-19468-AJC

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 ...................................................................................................................... $259,274.00

56. Part 2: Total vehicles, line 5 $0.00

57. Part 3: Total personal and household items, line 15 $580.00

58. Part 4: Total financial assets, line 36 $113.03

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... $693.03 Copy personal property total $693.03

63. Total of all property on Schedule A/B. Add line 55 + line 62 $259,967.03

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

Software Copyright (c) 1996-2020 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 20-19468-AJC Doc 11 Filed 09/29/20 Page 8 of 11
Fill in this information to identify your case:

Debtor 1 Olga Rodriguez

First Name Middle Name Last Name

Debtor 2

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

United States Bankruptcy Court for the: SOUTHERN DISTRICT OF FLORIDA

Case number 20-19468-AJC

(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

2572 W 72nd Place Hialeah, FL

33016-6507 Miami-Dade County

Legal Description: 4TH ADDN TO

ROBLES GARDENS PB 137-82 LOT

11 BLK 11 LOT SIZE 3405 SQ FT

04-2027-001-0380 OR 17775-2782

0897 1 COC 24303-3825 02 2006 5

- Valuation obtained from Miami

Dade Coun

Line from Schedule A/B: 1.1

$258,774.00  $258,774.00 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

Love seat, lamp, bed, dresser, two

nigh stamp, lamp, plates, cups,

silverware, toaster, microwave,

dishware, refrigerator, dinning table

with table. Value is debtor valuation

based on age condition.

Line from Schedule A/B: 6.1

$500.00  $500.00 Fla. Const. art. X, § 4(a)(2)

 100% of fair market value, up to

any applicable statutory limit

Used clothes and shoes, value is

debtors valuation based on age and

condition.

Line from Schedule A/B: 11.1

$60.00  $60.00 Fla. Const. art. X, § 4(a)(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 Olga Rodriguez Case number (if known) 20-19468-AJC

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

Costume jewelry and Miscellaneous

women accessories (not name

brand), value is debtors valuation

based on age and condition.

Line from Schedule A/B: 12.1

$20.00  $20.00 Fla. Const. art. X, § 4(a)(2)

 100% of fair market value, up to

any applicable statutory limit

Cash on Hand

Line from Schedule A/B: 16.1

$20.00  $20.00 Fla. Const. art. X, § 4(a)(2)

 100% of fair market value, up to

any applicable statutory limit

Checking: SunTrust Bank

Checking Account No.: XXXX4422

Line from Schedule A/B: 17.1

$93.03  $93.03 Fla. Const. art. X, § 4(a)(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

Software Copyright (c) 1996-2020 Best Case, LLC - www.bestcase.com Best Case Bankruptcy

Case 20-19468-AJC Doc 11 Filed 09/29/20 Page 10 of 11
Fill in this information to identify your case:

Debtor 1 Olga Rodriguez

First Name Middle Name Last Name

Debtor 2

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

United States Bankruptcy Court for the: SOUTHERN DISTRICT OF FLORIDA

Case number 20-19468-AJC

(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/ Olga Rodriguez X

Olga Rodriguez Signature of Debtor 2

Signature of Debtor 1

Date September 29, 2020 Date

Official Form 106Dec Declaration About an Individual Debtor's Schedules

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