Fill in this information to identify your case:

Debtor 1 Elvira 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 21-10645-RAM

(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................................................................................................ $ 401,506.00

1b. Copy line 62, Total personal property, from Schedule A/B..................................................................................... $ 985.00

1c. Copy line 63, Total of all property on Schedule A/B............................................................................................... $ 402,491.00

Part 2: Summarize Your Liabilities

Your liabilities

Amount you owe

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

2a. Copy the total you listed in Column A, Amount of claim, at the bottom of the last page of Part 1 of Schedule D... $ 369,174.18

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................................. $ 9,677.72

3b. Copy the total claims from Part 2 (nonpriority unsecured claims) from line 6j of Schedule E/F............................ $ 55,574.28

Your total liabilities $ 434,426.18

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................................................................................ $ 3,000.00

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

Copy your monthly expenses from line 22c of Schedule J.......................................................................... $ 1,687.00

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

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

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

Case 21-10645-RAM Doc 21 Filed 02/02/21 Page 1 of 22
Debtor 1 Elvira Rodriguez Case number (if known) 21-10645-RAM

the court with your other schedules.

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

122A-1 Line 11; OR, Form 122B Line 11; OR, Form 122C-1 Line 14. $ 3,000.00

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.) $ 9,677.72

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. $ 9,677.72

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 21-10645-RAM Doc 21 Filed 02/02/21 Page 2 of 22
Fill in this information to identify your case:

Debtor 1 Elvira 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 21-10645-RAM

(if known)  Check if this is an

amended filing

Official Form 106E/F

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

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

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

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

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

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

number (if known).

Part 1: List All of Your PRIORITY Unsecured Claims

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

 No. Go to Part 2.

 Yes.

2. List all of your priority unsecured claims. If a creditor has more than one priority unsecured claim, list the creditor separately for each claim. For each claim listed,

identify what type of claim it is. If a claim has both priority and nonpriority amounts, list that claim here and show both priority and nonpriority amounts. As much as

possible, list the claims in alphabetical order according to the creditor’s name. If you have more than two priority unsecured claims, fill out the Continuation Page of Part

1. If more than one creditor holds a particular claim, list the other creditors in Part 3.

(For an explanation of each type of claim, see the instructions for this form in the instruction booklet.)

Total claim Priority

amount

Nonpriority

amount

2.1 Internal Revenue Service Last 4 digits of account number 6832 $9,677.72 $3,943.17 $5,734.55

Priority Creditor's Name

Centralized Insolvency Operation

P. O. Box 7346

Philadelphia, PA 19101

When was the debt incurred? Tax Year 2013

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community debt

Is the claim subject to offset?

 No

 Yes

 Contingent

 Unliquidated

 Disputed

Type of PRIORITY unsecured claim:

 Domestic support obligations

 Taxes and certain other debts you owe the government

 Claims for death or personal injury while you were intoxicated

 Other. Specify

Part 2: List All of Your NONPRIORITY Unsecured Claims

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

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

 Yes.

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

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

creditor holds a particular claim, list the other creditors in Part 3.If you have more than three nonpriority unsecured claims fill out the Continuation Page of Part 2.

Total claim

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 1 of 19

Software Copyright (c) 1996-2020 Best Case, LLC - www.bestcase.com 51132 Best Case Bankruptcy

Case 21-10645-RAM Doc 21 Filed 02/02/21 Page 3 of 22
Debtor 1 Elvira Rodriguez Case number (if known) 21-10645-RAM

4.1 Baptist Hospital Last 4 digits of account number 5890 $1,705.00

Nonpriority Creditor's Name

P.O. Box 198116

Atlanta, GA 30364

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 Medical

4.2 Baptist Hospital Of Miami Last 4 digits of account number 8828 $15,725.00

Nonpriority Creditor's Name

P.O. Box 1988116

Atlanta, GA 30384

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 Medical

4.3 Beneficial/HFC Last 4 digits of account number 2327 $0.00

Nonpriority Creditor's Name

Attn: Bankruptcy

Po Box 5263

Carol Stream, IL 60197

When was the debt incurred?

Opened 6/30/06 Last Active

7/12/06

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 Check Credit Or Line Of Credit

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 2 of 19

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

Case 21-10645-RAM Doc 21 Filed 02/02/21 Page 4 of 22
Debtor 1 Elvira Rodriguez Case number (if known) 21-10645-RAM

4.4 Capio Partners LLC Last 4 digits of account number 5510 $492.80

Nonpriority Creditor's Name

Po Box 3209

Sherman, TX 75091

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 Medical

4.5 Capital One Last 4 digits of account number 2812 $0.00

Nonpriority Creditor's Name

Po Box 5253

Carol Stream, IL 60197

When was the debt incurred?

Opened 7/25/96 Last Active

6/22/07

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

4.6 Capital One Last 4 digits of account number 3731 $0.00

Nonpriority Creditor's Name

Po Box 30253

Salt Lake City, UT 84130

When was the debt incurred?

Opened 7/13/06 Last Active

6/30/07

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 3 of 19

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

Case 21-10645-RAM Doc 21 Filed 02/02/21 Page 5 of 22
Debtor 1 Elvira Rodriguez Case number (if known) 21-10645-RAM

4.7 Capital One Last 4 digits of account number 4813 $0.00

Nonpriority Creditor's Name

Po Box 5253

Carol Stream, IL 60197

When was the debt incurred?

Opened 7/25/96 Last Active

4/18/07

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

4.8 Capital One Last 4 digits of account number 3736 $0.00

Nonpriority Creditor's Name

Po Box 30253

Salt Lake City, UT 84130

When was the debt incurred?

Opened 7/13/06 Last Active

4/18/07

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 Carmax Auto Finance Last 4 digits of account number 9712 $7,311.80

Nonpriority Creditor's Name

P.O. Box 440609

Kennesaw, GA 30160

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 Auto

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 4 of 19

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

Case 21-10645-RAM Doc 21 Filed 02/02/21 Page 6 of 22
Debtor 1 Elvira Rodriguez Case number (if known) 21-10645-RAM

4.10 Ccs/bryant State Bank Last 4 digits of account number 8487 $254.00

Nonpriority Creditor's Name

500 E 60th St N

Sioux Falls, SD 57104

When was the debt incurred?

Opened 5/01/15 Last Active

9/13/15

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

4.11 Chase Card Services Last 4 digits of account number 0063 $0.00

Nonpriority Creditor's Name

Attn:Bankruptcy Dept

Po Box 15298

Wilmington, DE 19850

When was the debt incurred?

Opened 8/01/00 Last Active

8/18/05

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

4.12 Citi Last 4 digits of account number 3957 $0.00

Nonpriority Creditor's Name

CitiorpCredit Services/Centralized

Bankr

Po Box 790040

Saint Louis, MO 63179

When was the debt incurred?

Opened 12/01/99 Last Active

9/26/05

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 5 of 19

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

Case 21-10645-RAM Doc 21 Filed 02/02/21 Page 7 of 22
Debtor 1 Elvira Rodriguez Case number (if known) 21-10645-RAM

4.13 City Ntl Bk/Ocwen Loan Service Last 4 digits of account number 3241 $0.00

Nonpriority Creditor's Name

Attn:Bankruptcy Dept

Po Box 24738

West Palm Beach, FL 33416

When was the debt incurred?

Opened 1/01/06 Last Active

1/11/07

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

4.14

Columbia Gas (Formerly Baystate

Gas) Last 4 digits of account number 2001 $0.00

Nonpriority Creditor's Name

Po Box 2025

Attn: Bankruptcy Department

Springfield, MA 01102

When was the debt incurred? Opened 1/01/10

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 Columbia House

4.15

Credence Resource Management

LLC Last 4 digits of account number 4063 $59.22

Nonpriority Creditor's Name

P.O. Box 2420

Southgate, MI 48195

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify Collection

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 6 of 19

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

Case 21-10645-RAM Doc 21 Filed 02/02/21 Page 8 of 22
Debtor 1 Elvira Rodriguez Case number (if known) 21-10645-RAM

4.16 Credit Collections Svc Last 4 digits of account number 5240 $292.00

Nonpriority Creditor's Name

Po Box 773

Needham, MA 02494

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 06 Infinity Auto Insurance Compan

4.17 Credit One Bank Last 4 digits of account number 0927 $987.88

Nonpriority Creditor's Name

P.O. Box 60500

City of Industry, CA 91716

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 card purchases

4.18 Ditech Last 4 digits of account number 7194 $0.00

Nonpriority Creditor's Name

332 Minnesota St Ste 610

Saint Paul, MN 55101

When was the debt incurred? Last Active 7/20/06

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 Automobile

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 7 of 19

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

Case 21-10645-RAM Doc 21 Filed 02/02/21 Page 9 of 22
Debtor 1 Elvira Rodriguez Case number (if known) 21-10645-RAM

4.19 Ditech Last 4 digits of account number 7061 $0.00

Nonpriority Creditor's Name

332 Minnesota St Ste 610

Saint Paul, MN 55101

When was the debt incurred? Last Active 7/20/06

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 Automobile

4.20 First National Bank Last 4 digits of account number 0927 $576.00

Nonpriority Creditor's Name

Attn: FNN Legal Dept

1620 Dodge St., Stop Code 3290

Omaha, NE 68197

When was the debt incurred?

Opened 4/01/14 Last Active

9/13/15

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

4.21 First Premier Bank Last 4 digits of account number 7816 $626.00

Nonpriority Creditor's Name

Po Box 5524

Sioux Falls, SD 57117

When was the debt incurred?

Opened 3/01/15 Last Active

9/11/15

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 Credit Card

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 8 of 19

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

Case 21-10645-RAM Doc 21 Filed 02/02/21 Page 10 of 22
Debtor 1 Elvira Rodriguez Case number (if known) 21-10645-RAM

4.22 First Premier Bank Last 4 digits of account number 9508 $0.00

Nonpriority Creditor's Name

Po Box 5524

Sioux Falls, SD 57117

When was the debt incurred?

Opened 2/01/07 Last Active

7/01/07

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

4.23 Ford Motor Credit Corporation Last 4 digits of account number 4325 $0.00

Nonpriority Creditor's Name

Ford Motor Credit

Po Box 6275

Dearborn, MI 48121

When was the debt incurred?

Opened 5/01/06 Last Active

8/11/09

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 Lease

4.24 Ford Motor Credit Corporation Last 4 digits of account number 1185 $0.00

Nonpriority Creditor's Name

Ford Motor Credit

Po Box 6275

Dearborn, MI 48121

When was the debt incurred?

Opened 3/01/03 Last Active

7/12/06

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 Lease

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 9 of 19

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

Case 21-10645-RAM Doc 21 Filed 02/02/21 Page 11 of 22
Debtor 1 Elvira Rodriguez Case number (if known) 21-10645-RAM

4.25 Humana Last 4 digits of account number 1832 $819.02

Nonpriority Creditor's Name

P.O. Box 14642

Lexington, KY 40512

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 Insurance

4.26 Infinity Insurance Companies Last 4 digits of account number 6001 $356.60

Nonpriority Creditor's Name

P.O. Box 2153

Birmingham, AL 35287

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 Auto Insurance

4.27 Internal Revenue Service Last 4 digits of account number 6832 $2,306.98

Nonpriority Creditor's Name

Centralized Insolvency Operation

P. O. Box 7346

Philadelphia, PA 19101

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 Tax Year 2013

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 10 of 19

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

Case 21-10645-RAM Doc 21 Filed 02/02/21 Page 12 of 22
Debtor 1 Elvira Rodriguez Case number (if known) 21-10645-RAM

4.28 Internal Revenue Service Last 4 digits of account number 6832 $1,951.00

Nonpriority Creditor's Name

Centralized Insolvency Operation

P. O. Box 7346

Philadelphia, PA 19101

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 Tax Year 2014

4.29 Internal Revenue Service Last 4 digits of account number 6832 $2,217.68

Nonpriority Creditor's Name

Centralized Insolvency Operation

P. O. Box 7346

Philadelphia, PA 19101

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 Tax Year 2015

4.30 Internal Revenue Service Last 4 digits of account number 6832 $1,315.27

Nonpriority Creditor's Name

Centralized Insolvency Operation

P. O. Box 7346

Philadelphia, PA 19101

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 Tax Year 2016

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 11 of 19

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

Case 21-10645-RAM Doc 21 Filed 02/02/21 Page 13 of 22
Debtor 1 Elvira Rodriguez Case number (if known) 21-10645-RAM

4.31 Internal Revenue Service Last 4 digits of account number 6832 $1,042.99

Nonpriority Creditor's Name

Centralized Insolvency Operation

P. O. Box 7346

Philadelphia, PA 19101

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 Tax Year 2017

4.32 Jackson Health System Last 4 digits of account number 2674 Unknown

Nonpriority Creditor's Name

1611 NW 12 Ave

Miami, FL 33136

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 Medical

4.33 K To B Llc Last 4 digits of account number 1298 $0.00

Nonpriority Creditor's Name

700 S Royal Poinciana Bl

Miami Springs, FL 33166

When was the debt incurred?

Opened 10/01/09 Last Active

4/20/12

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 Automobile

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 12 of 19

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

Case 21-10645-RAM Doc 21 Filed 02/02/21 Page 14 of 22
Debtor 1 Elvira Rodriguez Case number (if known) 21-10645-RAM

4.34 Kohls/capone Last 4 digits of account number 3165 $277.00

Nonpriority Creditor's Name

N56 W 17000 Ridgewood Dr

Menomonee Falls, WI 53051

When was the debt incurred?

Opened 11/01/14 Last Active

9/10/15

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

4.35 Midwest Collections Last 4 digits of account number 4929 $1,388.00

Nonpriority Creditor's Name

MediCredit Corp.

Po Box 411187

St. Louis, MO 63141

When was the debt incurred? Opened 4/01/15

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 University Of Miami

4.36 My Money Monitor Last 4 digits of account number 9375 $336.50

Nonpriority Creditor's Name

3801 Pegasus Dr. Ste. 101

Bakersfield, CA 93308

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify Collection

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 13 of 19

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

Case 21-10645-RAM Doc 21 Filed 02/02/21 Page 15 of 22
Debtor 1 Elvira Rodriguez Case number (if known) 21-10645-RAM

4.37 Nationwide Acceptance Last 4 digits of account number 5194 $0.00

Nonpriority Creditor's Name

105 Decker Ct. Suite 725

Irving, TX 75062

When was the debt incurred?

Opened 1/01/05 Last Active

1/01/06

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 Real Estate Mortgage

4.38 NPAS, Inc Last 4 digits of account number 1553 $1,388.63

Nonpriority Creditor's Name

P.O. Box 99008

Bedford, TX 76095

When was the debt incurred?

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

Who incurred the debt? Check one.

 Debtor 1 only

 Debtor 2 only

 Debtor 1 and Debtor 2 only

 At least one of the debtors and another

 Check if this claim is for a community debt

Is the claim subject to offset?

 No

 Contingent

 Unliquidated

 Disputed

Type of NONPRIORITY unsecured claim:

 Student loans

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

report as priority claims

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

 Yes  Other. Specify Collection

4.39 Progressive Last 4 digits of account number 1225 $53.24

Nonpriority Creditor's Name

P.O. Box 105428

Atlanta, GA 30348

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 Insurance

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 14 of 19

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

Case 21-10645-RAM Doc 21 Filed 02/02/21 Page 16 of 22
Debtor 1 Elvira Rodriguez Case number (if known) 21-10645-RAM

4.40 Randle Eastern Amb Service Inc Last 4 digits of account number 8100 $57.53

Nonpriority Creditor's Name

P.O. Box 402079

Atlanta, GA 30384

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 Medical

4.41

Rushmore Loan Management

Services Last 4 digits of account number 4207 $0.00

Nonpriority Creditor's Name

Attn: Bankruptcy

15480 Laguna Canyon Rd

Irvine, CA 92619

When was the debt incurred?

Opened 1/24/06 Last Active

6/12/06

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 Real Estate Mortgage

4.42 Select Portfolio Servicing Last 4 digits of account number 4399 $0.00

Nonpriority Creditor's Name

Po Box 65250

Salt Lake City, UT 84165

When was the debt incurred?

Opened 1/01/07 Last Active

12/05/13

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 Real Estate Mortgage

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 15 of 19

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

Case 21-10645-RAM Doc 21 Filed 02/02/21 Page 17 of 22
Debtor 1 Elvira Rodriguez Case number (if known) 21-10645-RAM

4.43 Syncb/home Climate Last 4 digits of account number 5041 $0.00

Nonpriority Creditor's Name

C/o Po Box 965036

Orlando, FL 32896

When was the debt incurred?

Opened 9/25/05 Last Active

12/01/07

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

4.44 Synchrony Bank/Home Design Last 4 digits of account number 8498 $1,022.00

Nonpriority Creditor's Name

Attn: Bankruptcy

Po Box 103104

Roswell, GA 30076

When was the debt incurred?

Opened 9/01/14 Last Active

9/11/15

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 Charge Account

4.45 United Collection Serv Last 4 digits of account number 4250 $0.00

Nonpriority Creditor's Name

106 Commerce St Ste 101

Lake Mary, FL 32746

When was the debt incurred? Opened 8/01/13

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

Collection Attorney American Ambulance -

Falck

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 16 of 19

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

Case 21-10645-RAM Doc 21 Filed 02/02/21 Page 18 of 22
Debtor 1 Elvira Rodriguez Case number (if known) 21-10645-RAM

4.46 United Collection Serv Last 4 digits of account number 5696 $0.00

Nonpriority Creditor's Name

106 Commerce St Ste 101

Lake Mary, FL 32746

When was the debt incurred? Opened 4/01/12

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

Collection Attorney American Ambulance

Service

4.47 University Of Miami Health System Last 4 digits of account number 7955 $45.90

Nonpriority Creditor's Name

P.O. Box 741199

Atlanta, GA 30374

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 Medical

4.48 University Of Miami Health System Last 4 digits of account number 7955 $533.68

Nonpriority Creditor's Name

P.O. Box 741199

Atlanta, GA 30374

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 Medical

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 17 of 19

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

Case 21-10645-RAM Doc 21 Filed 02/02/21 Page 19 of 22
Debtor 1 Elvira Rodriguez Case number (if known) 21-10645-RAM

4.49 University Of Miami Health System Last 4 digits of account number 7955 $487.78

Nonpriority Creditor's Name

P.O. Box 741199

Atlanta, GA 30374

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 Medical

4.50 University Of Miami Health System Last 4 digits of account number 7955 $512.78

Nonpriority Creditor's Name

P.O. Box 741199

Atlanta, GA 30374

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 Medical

4.51 World Omni F Last 4 digits of account number 0518 $11,432.00

Nonpriority Creditor's Name

Po Box 91060

Mobile, AL 36691

When was the debt incurred?

Opened 3/01/15 Last Active

9/30/15

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 Lease

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.

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

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 18 of 19

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

Case 21-10645-RAM Doc 21 Filed 02/02/21 Page 20 of 22
Debtor 1 Elvira Rodriguez Case number (if known) 21-10645-RAM

6a. Domestic support obligations 6a. $ 0.00

Total claims

from Part 1 6b. Taxes and certain other debts you owe the government 6b. $ 9,677.72

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. $ 9,677.72

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. $ 55,574.28

6j. Total Nonpriority. Add lines 6f through 6i. 6j. $ 55,574.28

Official Form 106 E/F Schedule E/F: Creditors Who Have Unsecured Claims Page 19 of 19

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

Case 21-10645-RAM Doc 21 Filed 02/02/21 Page 21 of 22
Fill in this information to identify your case:

Debtor 1 Elvira 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 21-10645-RAM

(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/ Elvira Rodriguez X

Elvira Rodriguez Signature of Debtor 2

Signature of Debtor 1

Date February 2, 2021 Date

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

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Case 21-10645-RAM Doc 21 Filed 02/02/21 Page 22 of 22