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Fill in this information to identify your case: 

United States Bankruptcy Court for the: SOUTHERN DISTRICT OF FLORIDA 

Case number (If known): ___________ Chapter you are filing under: 

Id Chapter 7 

0 Chapter 11 

D Chapter 12 

0 Chapter 13 

Official Form 101 

FIL~O-USBC,FLS-WPB '20 JAN 15 PH3:00 

D Check if this is an 

amended filing 

Voluntary Petition for Individuals Filing for Bankruptcy 12/17 

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

joint case-and in joint cases, these forms use you to ask for information from both debtors. For example, if a form asks, "Do you own a car,'' 

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

Debtor 2 to distinguish between them. In joint cases, one of the spouses must report information as Debtor 1 and the other as Debtor 2. The 

same person must be Debtor 1 in all of the forms. 

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

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

(if known). Answer every question. 

rill Identify Yourself 

1. Your full name 

2. 

Write the name that is on your 

government-issued picture 

identification (for example, 

your driver's license or 

passport). 

Bring your picture 

identification to your meeting 

with the trustee. 

All other names you 

have used in the last 8 

years 

Include your married or 

maiden names. 

3. Only the last 4 digits of 

your Social Security 

number or federal 

Individual Taxpayer 

Identification number 

(ITIN) 

Official Form 101 

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

JENNIFER 

First name First name 

L 

Middle name Middle name 

WILSON 

Last name Last name 

Suffix (Sr., Jr., II, 111) Suffix (Sr., Jr., II, Ill) 

First name First name 

Middle name Middle name 

Last name Last name 

First name First name 

Middle name Middle name 

Last name Last name 

XXX - xx - _L _9 __ 7 __ 0_ XXX xx - -------- OR OR 

9 xx - xx 9 xx - xx -------- --------

Voluntary Petition for Individuals Filing for Bankruptcy page 1 

Case 20-10535-EPK Doc 1 Filed 01/15/20 Page 1 of 53
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Debtor 1 JENNIFER L. WILSON First Name Middle Name 

4. Any business names 

and Employer 

Identification Numbers 

(EIN) you have used in 

the last 8 years 

Include trade names and 

doing business as names 

s. Where you live 

6. Why you are choosing 

this district to file for 

bankruptcy 

Last Name 

About Debtor 1 : 

D I have not used any business names or EINs. 

JYNNDAZZLED NAILS 

Business name 

Business name 

83-4658061 

EIN 

EIN 

2121 JUANITA AVENUE 

Number Street 

FORT PIERCE 

City 

ST. LUCIE COUNTY 

County 

FL 34946 

State ZIP Code 

If your mailing address is different from the one 

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

any notices to you at this mailing address. 

Number Street 

P.O. Box 

City State ZIP Code 

Check one: 

0 Over the last 180 days before filing this petition, I 

have lived in this district longer than in any other 

district. 

D I have another reason. Explain. 

(See 28 U.S.C. § 1408.) 

Case number (ff known), _____________ _ 

About Debtor 2 (Spouse Only In a Joint Case): 

D I have not used any business names or EINs. 

Business name 

Business name 

EINEIN 

If Debtor 2 lives at a different address: 

Number Street 

City State ZIP Code 

County 

If Debtor 2's mailing address is different from 

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

any notices to this mailing address. 

Number Street 

P.O. Box 

City State ZIP Code 

Check one: 

D Over the last 180 days before filing this petition, I 

have lived in this district longer than in any other 

district. 

D I have another reason. Explain. 

(See 28 U.S.C. § 1408.) 

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

Case 20-10535-EPK Doc 1 Filed 01/15/20 Page 2 of 53
Debtor 1 JENNIFER L. WILSON Case number (if known) _____________ _ 

First Name Middle Name Last Name 

Tell the Court About Your Bankruptcy Case 

1. The chapter of the 

Bankruptcy Code you 

are choosing to file 

under 

Check one. (For a brief description of each, see Notice Required by 11 U.5.C. § 342(b) for Individuals Filing 

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

0 Chapter 7 

D Chapter 11 

D Chapter 12 

• Chapter 13 

s. How you will pay the fee D I will pay the entire fee when I file my petition. Please check with the clerk's office in your 

local court for more details about how you may pay. Typically, if you are paying the fee 

yourself, you may pay with cash, cashier's check, or money order. If your attorney is 

submitting your payment on your behalf, your attorney may pay with a credit card or check 

with a pre-printed address. 

9. Have you filed for 

bankruptcy within the 

last 8 years? 

10. Are any bankruptcy 

cases pending or being 

filed by a spouse who is 

not filing this case with 

you, or by a business 

partner, or by an 

affiliate? 

11. Do you rent your 

residence? 

Official Form 101 

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

for Individuals to Pay The Fifing Fee in Installments (Official Form 103A). 

0 I request that my fee be waived (You may request this option only if you are filing for Chapter 7. 

By law, a judge may, but is not required to, waive your fee, and may do so only if your income is 

less than 150% of the official poverty line that applies to your family size and you are unable to 

pay the fee in installments). If you choose this option, you must fill out the Application to Have the 

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

0No 

• Yes. 

Mi No 

D Yes. 

~No. 

• Yes. 

District When Case number 

MM/ DD/YYYY 

District When Case number 

MM/ DD/YYYY 

District When Case number 

MM/ DD/YYYY 

Debtor Relationship to you 

District When Case number, if known 

MM/DD /YYYY 

Debtor Relationship to you 

District When Case number, if known 

MM/DD/YYYY 

Go to line 12. 

Has your landlord obtained an eviction judgment against you? 

D No. Go to line 12. 

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

part of this bankruptcy petition. 

Voluntary Petition for Individuals Filing for Bankruptcy page 3 

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Debtor 1 JENNIFER L. WILSON Case number (ff known) _____________ _ 

First Name Middle Name Last Name 

Report About Any Businesses You Own as a Sole Proprietor 

12. Are you a sole proprietor 

of any full- or part-time 

business? 

A sole proprietorship is a 

business you operate as an 

individual, and is not a 

separate legal entity such as 

a corporation, partnership, or 

LLC. 

If you have more than one 

sole proprietorship, use a 

separate sheet and attach it 

to this petition. 

13. Are you filing under 

Chapter 11 of the 

Bankruptcy Code and 

are you a small business 

debtor? 

For a definition of small 

business debtor, see 

11 u.s.c. § 101(510). 

0 No. Go to Part 4. 

D Yes. Name and location of business 

Name of business, if any 

Number Street 

City 

Check the appropriate box to describe your business: 

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

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

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

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

D None of the above 

ZIP Code 

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

can set appropriate deadlines. If you indicate that you are a small business debtor, you must attach your 

most recent balance sheet, statement of operations, cash-flow statement, and federal income tax return or if 

any of these documents do not exist, follow the procedure in 11 U.S.C. § 1116(1 )(B). 

0 No. I am not filing under Chapter 11. 

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

the Bankruptcy Code. 

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

Bankruptcy Code. 

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

14. Do you own or have any 

property that poses or is 

alleged to pose a threat 

of imminent and 

identifiable hazard to 

public health or safety? 

Or do you own any 

property that needs 

immediate attention? 

For example, do you own 

perishable goods, or livestock 

that must be fed, or a building 

that needs urgent repairs? 

Official Form 101 

0No 

D Yes. What is the hazard?? 

If immediate attention is needed, why is it needed? _________________ _ 

Where is the property?? 

Number Street 

City State ZIP Code 

Voluntary Petition for Individuals Filing for Bankruptcy page 4 

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Debtor 1 JENNIFER L. WILSON Case number (if known) ______________ _ 

First Name Middle Name Last Name 

Explain Your Efforts to Receive a Briefing About Credit Counseling 

15. Tell the court whether 

you have received a 

briefing about credit 

counseling. 

The law requires that you 

receive a briefing about credit 

counseling before you file for 

bankruptcy. You must 

truthfully check one of the 

following choices. If you 

cannot do so, you are not 

eligible to file. 

If you file anyway, the court 

can dismiss your case, you 

will lose whatever filing fee 

you paid, and your creditors 

can begin collection activities 

again. 

Official Form 101 

About Debtor 1: 

You must check one: 

Iii I received a briefing from an approved credit 

counseling agency within the 180 days before I 

filed this bankruptcy petition, and I received a 

certificate of completion. 

Attach a copy of the certificate and the payment 

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

D I received a briefing from an approved credit 

counseling agency within the 180 days before I 

filed this bankruptcy petition, but I do not have a 

certificate of completion. 

Within 14 days after you file this bankruptcy petition, 

you MUST file a copy of the certificate and payment 

plan, if any. 

D I certify that I asked for credit counseling 

services from an approved agency, but was 

unable to obtain those services during the 7 

days after I made my request, and exigent 

circumstances merit a 30-day temporary waiver 

of the requirement. 

To ask for a 30-day temporary waiver of the 

requirement, attach a separate sheet explaining 

what efforts you made to obtain the briefing, why 

you were unable to obtain it before you filed for 

bankruptcy, and what exigent circumstances 

required you to file this case. 

Your case may be dismissed if the court is 

dissatisfied with your reasons for not receiving a 

briefing before you filed for bankruptcy. 

If the court is satisfied with your reasons, you must 

still receive a briefing within 30 days after you file. 

You must file a certificate from the approved 

agency, along with a copy of the payment plan you 

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

may be dismissed. 

Any extension of the 30-day deadline is granted 

only for cause and is limited to a maximum of 15 

days. 

D I am not required to receive a briefing about 

credit counseling because of: 

D Incapacity. I have a mental illness or a mental 

deficiency that makes me 

incapable of realizing or making 

rational decisions about finances. 

D Disability. My physical disability causes me 

to be unable to participate in a 

briefing in person, by phone, or 

through the internet, even after I 

reasonably tried to do so. 

D Active duty. I am currently on active military 

duty in a military combat zone. 

If you believe you are not required to receive a 

briefing about credit counseling, you must file a 

motion for waiver of credit counseling with the court. 

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

You must check one: 

D I received a briefing from an approved credit 

counseling agency within the 180 days before I 

filed this bankruptcy petition, and I received a 

certificate of completion. 

Attach a copy of the certificate and the payment 

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

D I received a briefing from an approved credit 

counseling agency within the 180 days before I 

filed this bankruptcy petition, but I do not have a 

certificate of completion. 

Within 14 days after you file this bankruptcy petition, 

you MUST file a copy of the certificate and payment 

plan, if any. 

D I certify that I asked for credit counseling 

services from an approved agency, but was 

unable to obtain those services during the 7 

days after I made my request, and exigent 

circumstances merit a 30-day temporary waiver 

of the requirement. 

To ask for a 30-day temporary waiver of the 

requirement, attach a separate sheet explaining 

what efforts you made to obtain the briefing, why 

you were unable to obtain it before you filed for 

bankruptcy, and what exigent circumstances 

required you to file this case. 

Your case may be dismissed if the court is 

dissatisfied with your reasons for not receiving a 

briefing before you filed for bankruptcy. 

If the court is satisfied with your reasons, you must 

still receive a briefing within 30 days after you file. 

You must file a certificate from the approved 

agency, along with a copy of the payment plan you 

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

may be dismissed. 

Any extension of the 30-day deadline is granted 

only for cause and is limited to a maximum of 15 

days. 

D I am not required to receive a briefing about 

credit counseling because of: 

D Incapacity. I have a mental illness or a mental 

deficiency that makes me 

incapable of realizing or making 

rational decisions about finances. 

D Disability. My physical disability causes me 

to be unable to participate in a 

briefing in person, by phone, or 

through the internet, even after I 

reasonably tried to do so. 

D Active duty. I am currently on active military 

duty in a military combat zone. 

If you believe you are not required to receive a 

briefing about credit counseling, you must file a 

motion for waiver of credit counseling with the court. 

Voluntary Petition for Individuals Filing for Bankruptcy page 5 

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Debtor 1 JENNIFER L. WILSON Case number (if known), _____________ _ 

First Name Middle Name Last Name 

Answer These Questions for Reporting Purposes 

16. What kind of debts do 

you have? 

11. Are you filing under 

Chapter 7? 

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

as "incurred by an individual primarily for a personal, family, or household purpose." 

D No. Go to line 16b. 

i;a Yes. Goto line 17. 

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

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

D No. Go to line 16c. 

D Yes. Go to line 17. 

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

D No. I am not filing under Chapter 7. 

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

any exempt property is administrative expenses are paid that funds will be available to distribute to unsecured creditors? 

excluded and liiif No 

administrative expenses 

are paid that funds will be 

available for distribution 

to unsecured creditors? 

18. How many creditors do 

you estimate that you 

owe? 

19. How much do you 

estimate your assets to 

be worth? 

20. How much do you 

estimate your liabilities 

to be? 

•¥fifi Sign Below 

For you 

Official Form 101 

D Yes 

i;a 1-49 

0 50-99 

0 100-199 

0 200-999 

i;a $0-$50,000 

0 $50,001-$100,000 

0 $100,001-$500,000 

D $500,001-$1 million 

i;a $0-$50,000 

0 $50,001-$100,000 

0 $100,001-$500,000 

D $500,001-$1 million 

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

correct. 

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

title 11, United States Code. I understand the relief available under each chapter 7, and I choose to proceed under 

Chapter 7. 

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

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

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

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

with a bankruptcy case can result in fines up to $250,000, or imprisonment for up to 20 years, or both. 

18 U.S.C. §§ 152, 1341, 1519, and 3 ~-

Executed on I ~o J;lD MM ID/ 

X 

Signature of Debtor 2 

Executed on ______ _ 

MM/ DD /YYYY 

Voluntary Petition for Individuals Filing for Bankruptcy page 6 

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Debtor 1 JENNIFER L. WILSON Case number (if known), _____________ _ 

First Name Middle Name 

For you if you are filing this 

bankruptcy without an 

attorney 

If you are represented by 

an attorney, you do not 

need to file this page. 

Official Form 101 

Last Name 

The law allows you, as an individual, to represent yourself in bankruptcy court, but you 

should understand that many people find it extremely difficult to represent 

themselves successfully. Because bankruptcy has long-term financial and legal 

consequences, you are strongly urged to hire a qualified attorney. 

To be successful, you must correctly file and handle your bankruptcy case. The rules are very 

technical, and a mistake or inaction may affect your rights. For example, your case may be 

dismissed because you did not file a required document, pay a fee on time, attend a meeting or 

hearing, or cooperate with the court, case trustee, U.S. trustee, bankruptcy administrator, or audit 

firm if your case is selected for audit. If that happens, you could lose your right to file another 

case, or you may lose protections, including the benefit of the automatic stay. 

You must list all your property and debts in the schedules that you are required to file with the 

court. Even if you plan to pay a particular debt outside of your bankruptcy, you must list that debt 

in your schedules. If you do not list a debt, the debt may not be discharged. If you do not list 

property or properly claim it as exempt, you may not be able to keep the property. The judge can 

also deny you a discharge of all your debts if you do something dishonest in your bankruptcy 

case, such as destroying or hiding property, falsifying records, or lying. Individual bankruptcy 

cases are randomly audited to determine if debtors have been accurate, truthful, and complete. 

Bankruptcy fraud is a serious crime; you could be fined and imprisoned. 

If you decide to file without an attorney, the court expects you to follow the rules as if you had 

hired an attorney. The court will not treat you differently because you are filing for yourself. To be 

successful, you must be familiar with the United States Bankruptcy Code, the Federal Rules of 

Bankruptcy Procedure, and the local rules of the court in which your case is filed. You must also 

be familiar with any state exemption laws that apply. 

Are you aware that filing for bankruptcy is a serious action with long-term financial and legal 

consequences? 

• No 

0 Yes 

Are you aware that bankruptcy fraud is a serious crime and that if your bankruptcy forms are 

inaccurate or incomplete, you could be fined or imprisoned? 

• No 

w:I Yes 

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

0 No 

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

By signing here, I acknowledge that I understand the risks involved in filing without an attorney. I 

have read and understood this notice, and I am aware that filing a bankruptcy case without an 

attorney may cause me to lose rights or property if I do not properly handle the case. 

X 

Signature of Debtor 2 

Date 

MM/ DD /YYYY 

Contact phone _32_1_31_1_11_2_3 __________ _ Contact phone 

Cell phone 3213171123 Cell phone 

Email address JYNNE93@GMAIL.COM Email address 

Voluntary Petition for Individuals Filing for Bankruptcy page 8 

Case 20-10535-EPK Doc 1 Filed 01/15/20 Page 7 of 53
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Fill in this information to identify your case: 

Debtor 1 JENNIFER L. WILSON First Name Middle Name Last Name 

Debtor2 

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

United States Bankruptcy Court for the: SOUTHERN DISTRICT OF FLORIDA 

Case number 

(If known) 

Official Form 106Sum 

D Check if this is an 

amended filing 

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. 

rill Summarize Your Assets 

Your assets 

Value of what you own 

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

1a. Copy line 55, Total real estate, from Schedule A/8 ........................................................................................................ .. $ 0.00 ------

1b. Copy line 62, Total personal property, from Schedule A/8 .............................................................................................. . $ __ 6_1_0_0._0_0 

1c. Copy line 63, Total of all property on Schedule AIB ........................................................................................................ . $ 6100.00 ------

f §fj 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 .. ......... . $ 0.00 

3. Schedule EIF: Creditors Who Have Unsecured Claims (Official Form 106EIF) 

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 EIF ..................................... .. + $ 21806.00 

Your total liabilities $ 21806.00 

l&fi Summarize Your Income and Expenses 

4. Schedule I: Your Income (Official Form 1061) 

Copy your combined monthly income from line 12 of Schedule I ......................................................................................... . $ 2100.00 ------

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

Copy your monthly expenses from line 22c of Schedule J ................................................................................................... . $ 2780.00 ------

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

Case 20-10535-EPK Doc 1 Filed 01/15/20 Page 8 of 53
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Debtor 1 JENNIFER L. WILSON Case number (if known), _____________ _ 

First Name Middle Name Last Name 

Answer These Questions for Administrative and Statistical Records 

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

• No. 

IBYes 

7. What kind of debt do you have? 

1B 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. 

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

this form to the court with your other schedules. 

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

Form 122A-1 Line 11; OR, Form 1228 Line 11; OR, Form 122C-1 Line 14. $ _ __;2=-4.:....::6...:..6:..=..6..:_7 

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

From Part 4 on Schedule EIF, copy the following: 

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

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

9c. Claims for death or personal injury while you were intoxicated. (Copy line 6c.) 

9d. Student loans. (Copy line 6f.) 

9e. Obligations arising out of a separation agreement or divorce that you did not report as 

priority claims. (Copy line 6g.) 

9f. Debts to pension or profit-sharing plans, and other similar debts. (Copy line 6h.) 

9g. Total. Add lines 9a through 9f. 

Total claim 

$ 

$ 

$ 

$ 

$ 

+ $ 

$ 

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

0.00 

0.00 

0.00 

0.00 

0.00 

0.00 

0.00 

page 2 

Case 20-10535-EPK Doc 1 Filed 01/15/20 Page 9 of 53
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Fill in this information to identify your case and this filing: 

Debtor 1 JENNIFER L. WILSON 

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 

D 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. 

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. 

0 Yes. Where is the property? 

1.1. 

Street address, if available, or other description 

City State ZIP Code 

County 

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

1.2. 

Street address, if available, or other description 

City State ZIP Code 

County 

Official Form 106A/B 

What is the property? Check all that apply. 

0 Single-family home 

0 Duplex or multi-unit building 

0 Condominium or cooperative 

0 Manufactured or mobile home 

0 Land 

0 Investment property 

0 Timeshare 

0 Other -------------- Who has an interest in the property? Check one. 

0 Debtor 1 only 

0 Debtor 2 only 

0 Debtor 1 and Debtor 2 only 

0 At least one of the debtors and another 

Do not deduct secured claims or exemptions. Put 

the amount of any secured claims on Schedule D: 

Creditors Who Have Claims Secured by Property. 

Current value of the 

entire property? 

$ ______ _ 

Current value of the 

portion you own? 

$ _____ _ 

Describe the nature of your ownership 

interest (such as fee simple, tenancy by 

the entireties, or a life estate), if known. 

D Check if this is community property 

(see instructions) 

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

property identification number: ______________ _ 

What is the property? Check all that apply. 

0 Single-family home 

0 Duplex or multi-unit building 

0 Condominium or cooperative 

0 Manufactured or mobile home 

0 Land 

0 Investment property 

0 Timeshare 

0 Other ____________ _ 

Who has an interest in the property? Check one. 

0 Debtor 1 only 

0 Debtor 2 only 

D Debtor 1 and Debtor 2 only 

0 At least one of the debtors and another 

Do not deduct secured claims or exemptions. Put 

the amount of any secured claims on Schedule D: 

Creditors Who Have Claims Secured by Property. 

Current value of the 

entire property? 

$ _______ _ 

Current value of the 

portion you own? 

$ ______ _ 

Describe the nature of your ownership 

interest (such as fee simple, tenancy by 

the entireties, or a life estate), if known. 

D Check if this is community property 

(see instructions) 

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

property identification number: ______________ _ 

Schedule A/B: Property page 1 

Case 20-10535-EPK Doc 1 Filed 01/15/20 Page 10 of 53
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1.3. 

Street address, if available, or other description 

City State ZIP Code 

County 

Case number (if known) ______________ _ 

What is the property? Check all that apply. 

D Single-family home 

D Duplex or multi-unit building 

D Condominium or cooperative 

D Manufactured or mobile home 

D Land 

D Investment property 

D Timeshare 

D Other ____________ _ 

Who has an interest in the property? Check one. 

D Debtor 1 only 

D Debtor 2 only 

D Debtor 1 and Debtor 2 only 

D At least one of the debtors and another 

Do not deduct secured claims or exemptions. Put 

the amount of any secured claims on Schedule D: 

Creditors Who Have Claims Secured by Property. 

Current value of the 

entire property? 

$ ______ _ 

Current value of the 

portion you own? 

$ ______ _ 

Describe the nature of your ownership 

interest (such as fee simple, tenancy by 

the entireties, or a life estate), if known. 

D Check if this is community property 

(see instructions) 

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

property identification number: ______________ _ 

2. Add the dollar value of the portion you own for all of your entries from Part 1, including any entries for pages I 0.00 I 

you have attached for Part 1. Write that number here . ...................................................................................... -+ .__$ _______ _._ 

•§f j 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 

if No 

D Yes 

3.1. Make: 

Model: 

Year: 

Approximate mileage: 

Other information: 

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

3.2. Make: 

Model: 

Year: 

Approximate mileage: 

Other information: 

Official Form 106NB 

Who has an interest in the property? Check one. 

D Debtor 1 only 

D Debtor 2 only 

D Debtor 1 and Debtor 2 only 

D At least one of the debtors and another 

D Check if this is community property (see 

instructions) 

Who has an interest in the property? Check one. 

D Debtor 1 only 

D Debtor 2 only 

D Debtor 1 and Debtor 2 only 

D At least one of the debtors and another 

D Check if this is community property (see 

instructions) 

Schedule NB: Property 

Do not deduct secured claims or exemptions. Put 

the amount of any secured claims on Schedule D: 

Creditors Who Have Claims Secured by Property. 

Current value of the 

entire property? 

$ ______ _ 

Current value of the 

portion you own? 

$ _____ _ 

Do not deduct secured claims or exemptions. Put 

the amount of any secured claims on Schedule D: 

Creditors Who Have Claims Secured by Property. 

Current value of the 

entire property? 

$ ______ _ 

Current value of the 

portion you own? 

$ ______ _ 

page 2 

Case 20-10535-EPK Doc 1 Filed 01/15/20 Page 11 of 53
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1 

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1 

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Debtor 1 JENNIFER L. WILSON First Name Middle Name Last Name 

3.3. Make: 

Model: 

Year: 

Approximate mileage: 

Other information: 

3.4. Make: 

Model: 

Year: 

Approximate mileage: 

Other information: 

Case number (if known) ______________ _ 

Who has an interest in the property? Check one. 

D Debtor 1 only 

D Debtor 2 only 

D Debtor 1 and Debtor 2 only 

D At least one of the debtors and another 

D Check if this is community property (see 

instructions) 

Who has an interest in the property? Check one. 

D Debtor 1 only 

D Debtor 2 only 

D Debtor 1 and Debtor 2 only 

D Al least one of the debtors and another 

D Check if this is community property (see 

instructions) 

Do not deduct secured claims or exemptions. Put 

the amount of any secured claims on Schedule D: 

Creditors Who Have Claims Secured by Property. 

Current value of the 

entire property? 

$ ______ _ 

Current value of the 

portion you own? 

$ ______ _ 

Do not deduct secured claims or exemptions. Put 

the amount of any secured claims on Schedule D: 

Creditors Who Have Claims Secured by Property. 

Current value of the 

entire property? 

$ ______ _ 

Current value of the 

portion you own? 

$ _______ _ 

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 

B No 

D Yes 

4.1. Make: 

Model: 

Year: 

Other information: 

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

4.2. Make: 

Model: 

Year: 

Other information: 

J 

Official Form 106A/B 

Who has an interest in the property? Check one. 

D Debtor 1 only 

D Debtor 2 only 

D Debtor 1 and Debtor 2 only 

D At least one of the debtors and another 

D Check if this is community property (see 

instructions) 

Who has an interest in the property? Check one. 

D Debtor 1 only 

D Debtor 2 only 

D Debtor 1 and Debtor 2 only 

D At least one of the debtors and another 

D Check if this is community property (see 

instructions) 

Schedule A/B: Property 

Do not deduct secured claims or exemptions. Put 

the amount of any secured claims on Schedule D: 

Creditors Who Have Claims Secured by Property. 

Current value of the 

entire property? 

$ ______ _ 

Current value of the 

portion you own? 

$ _____ _ 

Do not deduct secured claims or exemptions. Put 

the amount of any secured claims on Schedule D: 

Creditors Who Have Claims Secured by Property. 

Current value of the 

entire property? 

$ ______ _ 

Current value of the 

portion you own? 

$ ______ _ 

page 3 

Case 20-10535-EPK Doc 1 Filed 01/15/20 Page 12 of 53
Debtor 1 JENNIFER L. WILSON Case number (if known) _____________ _ 

First Name Middle Name Last Name 

Describe Your Personal and Household Items 

Do you own or have any legal or equitable Interest in any of the following items? 

6. Household goods and furnishings 

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

0 No 

0 Yes. Describe ......... , BED, BEDDING, COOKING UTENSILS, EATING UTENSILS, PICTURE 

• FRAMES, AND TOWELS 

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 

0 No .---------· 

0 Yes. Describe .......... ! COMPUTER, SMARTPHONE, AND TV 

B. 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 

0 No 

D 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 

0 No ,·------------··-·-···-· .. ------·····-----·· 

0 Yes. Describe.·········! GOLF CLUBS 

'-·--··----------··---~-------

10. Firearms 

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

0 No 

D Yes. Describe .......... : 

11.Clothes 

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

0 No r - - -- -·-·····-··--····· 

0 Yes. Describe .......... i ALL CLOTHES AND FOOTWEAR ! 

12.Jewelry 

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

gold, silver 

Current value of the 

portion you own? 

Do not deduct secured claims 

or exemptions. 

$ 900.00 --------

$ ____ 1 s_o_o_.o_o 

$ 0.00 --------

$ 200.00 --------

$ 0.00 --------

$ 3000.00 --------

~ ~~s. Describe .......... J~~~~~~ET, EARRINGS, NECK.LACE~-N-ON~WEDDING -~l~~-•--~~~-WATCHE~ $. ____ 3_0_0._0_0 

13. Non-farm animals 

Examples: Dogs, cats, birds, horses 

0 No 

D Yes. Describe .......... ) $ 0.00 --------

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

0 No 

D Yes. Give specific : 

information .............. , $ _____ 0._0_0 

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 .................................................................................................................................................... -+ $ ___ ~5=9=0=0-=0~0 

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

Case 20-10535-EPK Doc 1 Filed 01/15/20 Page 13 of 53
Debtor 1 JENNIFER L. WILSON Case number (if known) ______________ _ 

First Name Middle Name Last Name 

•Mil Describe Your Financial Assets 

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

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 

0 No 

Current value of the 

portion you own? 

Do not deduct secured claims 

or exemptions. 

0~ ............................................................................................................................................................... . Cash:....................... $ ____ 1_0_0_._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. 

0 No 

0 Yes .................... . 

17.1. Checking account: 

17.2. Checking account: 

17.3. Savings account: 

17.4. Savings account: 

17.5. Certificates of deposit: 

17.6. Other financial account: 

17.7. Other financial account: 

17.8. Other financial account: 

17.9. Other financial account: 

18. Bonds, mutual funds, or publicly traded stocks 

Institution name: 

PNC BANK 

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

0 No 

D 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 

0 No 

D Yes. Give specific 

information about 

them ....................... .. 

Name of entity: % of ownership: 

_____ % 

_____ % 

$ 100.00 -------

$ _______ _ 

$ ______ _ 

$ _______ _ 

$ ______ _ 

$ ______ _ 

$ _______ _ 

$ ______ _ 

$ ______ _ 

$ _______ _ 

$ _______ _ 

$ ______ _ 

$ ______ _ 

$ ______ _ 

_____ % $ _______ _ 

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

Case 20-10535-EPK Doc 1 Filed 01/15/20 Page 14 of 53
I 

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Debtor 1 JENNIFER L. WILSON Case number (if known) ______________ _ 

First Name Middle Name Last Name 

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. 

0 No 

D 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 

0 No 

D Yes. List each 

account separately. Type of account: Institution name: 

$ ______ _ 

$ ______ _ 

$ ______ _ 

401(k) or similar plan: ___________________________ $ _______ _ 

Pension plan: ___________________________ $ _______ _ 

IRA: _______________________ $ ______ _ 

Retirement account: ___________________________ $ _______ _ 

Keogh: ___________________________ $ _______ _ 

Additional account: ___________________________ $ _______ _ 

Additional account: ___________________________ $ _______ _ 

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 

Mil No 

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

Electric: 

Gas: 

Heating oil: 

Security deposit on rental unit: ________________________ _ 

Prepaid rent: 

Telephone: 

Water: 

Rented furniture: 

Other: 

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

0 No 

D Yes.......................... Issuer name and description: 

Official Form 106A/B Schedule A/8: Property 

$ _______ _ 

$ _______ _ 

$ _______ _ 

$ ________ _ 

$ ________ _ 

$ _______ _ 

$ _______ _ 

$ _______ _ 

$ _______ _ 

$ _______ _ 

$ ______ _ 

$ _______ _ 

page 6 

Case 20-10535-EPK Doc 1 Filed 01/15/20 Page 15 of 53
Debtor 1 JENNIFER L. WILSON Case number (dknown), ______________ _ 

First Name Middle Name Last Name 

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). 

0 No 

D 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 

0 No 

D 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 

0 No 

D Yes. Give specific 

information about them .... 

27. Licenses, franchises, and other general intangibles 

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

0 No 

$. ______ _ 

$ ______ _ 

$. ______ _ 

$ ____ o_.o_o 

$ 0.00 ·-------

D Yes. Give specific 

information about them .... 1 $ ______ o_.o_o_ 

Money or property owed to you? 

28. Tax refunds owed to you 

0 No 

D Yes. Give specific information 

about them, including whether 

you already filed the returns 

and the tax years ........................ ' 

29. Family support 

Federal: 

State: 

Local: 

Current value of the 

portion you own? 

Do not deduct secured 

claims or exemptions. 

$. ______ _ 

$ _______ _ 

$ _______ _ 

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

0 No 

D Yes. Give specific information .............. ' 

Alimony: $ ______ _ 

Maintenance: $ ______ _ 

Support: $ ______ _ 

Divorce settlement: $ ______ _ 

Property settlement: $ ______ _ 

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 

0 No 

D Yes. Give specific information ............. --! 

$. ____ --""0.'-=-00-=--

Official Form 106A/B Schedule A/B: Property page 7 

Case 20-10535-EPK Doc 1 Filed 01/15/20 Page 16 of 53
I 

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Debtor 1 JENNIFER L. WILSON Case number (if known), ______________ _ 

First Name Middle Name Last Name 

31. Interests in insurance policies 

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

0 No 

D Yes. Name the insurance company Company name: 

of each policy and list its value .... Beneficiary: 

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. 

ia No 

D 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 

ia No 

D Yes. Describe each claim ..................... ' 

34. Other contingent and unliquidated claims of every nature, including counterclaims of the debtor and rights 

to set off claims 

ia No 

D Yes. Describe each claim .................... . 

35. Any financial assets you did not already list 

ia No 

D 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 .................................................................................................................................................... -+ 

Surrender or refund value: 

$ ______ _ 

$ _______ _ 

$ _______ _ 

$ 0.00 --------

$ 0.00 --------

$ 0.00 ·--------

200.00 

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? 

ia No. Go to Part 6. 

D Yes. Go to line 38. 

38.Accounts receivable or commissions you already earned 

D No 

D Yes. Describe ...... . 

39. Office equipment, furnishings, and supplies 

···------------, 

Current value of the 

portion you own? 

Do not deduct secured claims 

or exemptions. 

_.J ~ ----------

Examples: Business-related computers, software, modems, printers, copiers, fax machines, rugs, telephones, desks, chairs, electronic devices 

D No 

D Yes. Describe ..... ..f 

Official Form 106A/B Schedule A/8: Property page 8 

Case 20-10535-EPK Doc 1 Filed 01/15/20 Page 17 of 53
Debtor 1 JENNIFER L. WILSON Case number (if known). _____________ _ 

First Name Middle Name Last Name 

40. Machinery, fixtures, equipment, supplies you use in business, and tools of your trade 

0 No 

D Yes. Describe ....... i 

41. Inventory 

0 No 

I 

L----------··· --·---~- -- -------

D Yes. Describe ....... i 

42. Interests in partnerships or joint ventures 

0 No 

D Yes. Describe....... Name of entity: 

43. Customer lists, mailing lists, or other compilations 

0 No 

~---------

... -··--- --- --~ 

,--------- .. ····-----·····--·--·---···-----' 

% of ownership: 

___ % $ ________ _ 

___% $ ________ _ 

___ % $ ________ _ 

D Yes. Do your lists include personally identifiable information (as defined in 11 U.S.C. § 101(41A))? 

0 No 

D Yes. Describe ........ , 

44. Any business-related property you did not already list 

0 No 

D Yes. Give specific 

information ........ . 

$ _______ _ 

$ _______ _ 

$ ________ _ 

$ ________ _ 

$ _______ _ 

$ ________ _ 

$ 

45. Add the dollar value of all of your entries from Part 5, including any entries for pages you have attached 

for Part 5. Write that number here .................................................................................................................................................... -+ l•--0

1 

Describe Any Fann- 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? 

ii' No. Go to Part 7. 

D Yes. Go to line 47. 

47. Farm animals 

Examples: Livestock, poultry, farm-raised fish 

0 No 

D Yes 

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

Current value of the 

portion you own? 

Do not deduct secured claims 

or exemptions. 

$ _______ _ 

page 9 

Case 20-10535-EPK Doc 1 Filed 01/15/20 Page 18 of 53
Debtor 1 JENNIFER L. WILSON Case number (if known) _____________ _ 

First Name Middle Name 

48. Crops-either growing or harvested 

• No 

D Yes. Give specific' 

information. 

Last Name 

49. Farm and fishing equipment, implements, machinery, fixtures, and tools of trade 

• No 

D Yes 

50. Farm and fishing supplies, chemicals, and feed 

• No 

D Yes .......................... ~ 

51.Any farm- and commercial fishing-related property you did not already list 

• No 

D Yes. Give specific 

information. 

52. Add the dollar value of all of your entries from Part 6, including any entries for pages you have attached 

for Part 6. Write that number here .................................................................................................................................................... -+ 

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 

0 No 

D Yes. Give specific 

information. 

---------·--•------·-·-·· 

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

• §f I List the Totals of Each Part of this Form 

$. _______ _ 

$ _______ _ 

$ _______ _ 

$ _______ _ 

$ _____ o_.o_o 

$ ______ _ 

$ ______ _ 

$ ______ _ 

$ ______ 0_ 

55. Part 1: Total real estate, line 2 .............................................................................................................................................................. ,+ $ _____ 0_.0_0_ 

56. Part 2: Total vehicles, line 5 $ ____ 0._00_ 

57. Part 3: Total personal and household items, line 15 $ ______ 5900.00 _ 

58. Part 4: Total financial assets, line 36 $ ______ 200.00 _ 

59. Part 5: Total business-related property, line 45 $ ______ 0 _ 

60. Part 6: Total farm- and fishing-related property, line 52 $ ____ 0_._00_ 

61. Part 7: Total other property not listed, line 54 0 

·-----------·-1 

62. Total personal property. Add lines 56 through 61 .................... . $ 61 00 · 00 I Copy personal property total -+ + $ I -------

6100.00 

1 

63. Total of all property on Schedule AJB. Add line 55 + line 62 ......................................................................................... . $ ______ 6100.00 _ 

Official Form 106A/B Schedule AJB: Property page 10 

Case 20-10535-EPK Doc 1 Filed 01/15/20 Page 19 of 53
Fill in this information to identify your case: 

Debtor 1 JENNIFER L. WILSON 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 

(If known) 

Official Form 106C 

Schedule C: The Property You Claim as Exempt 

D Check if this is an 

amended filing 

04/19 

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. 

Identify the Property You Claim as Exempt 

1. Which set of exemptions are you claiming? Check one only, even if your spouse is fifing with you. 

~ You are claiming state and federal nonbankruptcy exemptions. 11 U.S.C. § 522(b)(3) 

D 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 AIB that lists this property 

Brief HOUSEHOLD GOODS description: 

Line from 

Schedule A/8: 6 

Brief ELECTRONICS description: 

Line from 7 

Schedule A/B: 

Brief CLOTHES description: 

Line from 

Schedule A/8: 11 

Current value of the 

portion you own 

Copy the value from 

Schedule AIB 

$ 900.00 

$ 1500.00 

$ 3000.00 

Amount of the exemption you claim 

Check only one box for each exemption. 

l!I $ 800.00 

D 100% of fair market value, up to 

any applicable statutory limit 

l!I $ 1500.00 

D 100% of fair market value, up to 

any applicable statutory limit 

l!I $ 1400.00 

D 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.) 

0 No 

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

0 No 

D Yes 

Official Form 106C Schedule C: The Property You Claim as Exempt 

Specific laws that allow exemption 

Fla. Stat. Ann. § 222.25 

Fla. Stat. Ann. § 222.25 

Fla. Stat. Ann. § 222.25 

page 1 of _g_ 

Case 20-10535-EPK Doc 1 Filed 01/15/20 Page 20 of 53
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Debtor 1 JENNIFER L. WILSON Case number (it known) _____________ _ 

First Name Middle Name Last Name 

•Mil Additional Page 

Brief description of the property and line 

on Schedule AIB that lists this property 

Brief JEWELRY description: 

Line from 12 

Schedule AJB: 

Brief LICENSE 

description: 

Line from 27 Schedule AJB: 

Brief OFFICE EQUIPMENT 

description: 

Line from 

Schedule AJB: ~ 

Brief MACHINERY 

description: 

Line from 40 

Schedule AJB: 

Brief INVENTORY 

description: 

Line from 41 Schedule AJB: 

Brief 

description: 

Line from 

Schedule AJB: 

Brief 

description: 

Line from 

Schedule AJB: 

Brief 

description: 

Line from 

Schedule AJB: 

Brief 

description: 

Line from 

Schedule AJB: 

Brief 

description: 

Line from 

Schedule AJB: 

Brief 

description: 

Line from 

Schedule AIB: 

Brief 

description: 

Line from 

Schedule AJB: 

Official Form 106C 

Current value of the 

portion you own 

Copy the value from 

Schedule AIB 

$ 300.00 

$ 0.00 

$ 0.00 

$ 0.00 

$ 0.00 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

Amount of the exemption you claim 

Check only one box for each exemption 

iih 300.00 

0 100% of fair market value, up to 

any applicable statutory limit 

lia' $ 0.00 

0 100% of fair market value, up to 

any applicable statutory limit 

1H $ 0.00 

0 100% of fair market value, up to 

any applicable statutory limit 

1H $ 0.00 

0 100% of fair market value, up to 

any applicable statutory limit 

1H $ 0.00 

0 100% of fair market value, up to 

any applicable statutory limit 

0$ 

0 100% of fair market value, up to 

any applicable statutory limit 

0$ 

0 100% of fair market value, up to 

any applicable statutory limit 

0$ 

0 100% of fair market value, up to 

any applicable statutory limit 

0$ 

0 100% of fair market value, up to 

any applicable statutory limit 

0$ 

0 100% of fair market value, up to 

any applicable statutory limit 

0$ 

0 100% of fair market value, up to 

any applicable statutory limit 

0$ 

0 100% of fair market value, up to 

any applicable statutory limit 

Schedule C: The Property You Claim as Exempt 

Specific laws that allow exemption 

Fla. Stat. Ann. § 222.25 

Fla. Stat. Ann. § 222.25 

Fla. Stat. Ann.§ 222.25 

Fla. Stat. Ann. § 222.25 

Fla. Stat. Ann. § 222.25 

page 2 

Case 20-10535-EPK Doc 1 Filed 01/15/20 Page 21 of 53
Fill in this information to identify your case: 

Debtor 1 JENNIFER L. WILSON 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 

(If known) 

Official Form 106D 

D Check if this is an 

amended filing 

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

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

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

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

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

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

D Yes. Fill in all of the information below. 

•@f H List All Secured Claims 

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

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

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

Creditor's Name 

Number Street 

City State ZIP Code 

Who owes the debt? Check one. 

D Debtor 1 only 

D Debtor 2 only 

D Debtor 1 and Debtor 2 only 

D At least one of the debtors and another 

Describe the property that secures the claim: 

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

D Contingent 

D Unliquidated 

D Disputed 

Nature of lien. Check all that apply. 

D An agreement you made (such as mortgage or secured 

car loan) 

D Statutory lien (such as tax lien, mechanic's lien) 

D Judgment lien from a lawsuit 

ColumnA 

Amount of claim 

Do not deduct the 

value of collateral. 

$ 

D Check if this claim relates to a 

D Other (including a right to offset) _______ _ 

community debt 

Date debt was incurred 

Creditor's Name 

Number Street 

City State ZIP Code 

Who owes the debt? Check one. 

D Debtor 1 only 

D Debtor 2 only 

D Debtor 1 and Debtor 2 only 

D At least one of the debtors and another 

D Check if this claim relates to a 

community debt 

Date debt was incurred 

Last 4 digits of account number _ __ _ 

Describe the property that secures the claim: 

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

D Contingent 

D Unliquidated 

D Disputed 

Nature of lien. Check all that apply. 

D An agreement you made (such as mortgage or secured 

car loan) 

D Statutory lien (such as tax lien, mechanic's lien) 

D Judgment lien from a lawsuit 

D Other (including a right to offset) _______ _ 

Last 4 digits of account number _ __ _ 

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

$ ______ _ 

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

Columns ColumnC 

Value of collateral Unsecured 

that supports this pordon 

claim If any 

$ $ 

$ _______ $ ____ _ 

page 1 

Case 20-10535-EPK Doc 1 Filed 01/15/20 Page 22 of 53
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Fill in this information to identify your case: 

Debtor 1 JENNIFER L. WILSON 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 

(If known) 

Official Form 106E/F 

Schedule E/F: Creditors Who Have Unsecured Claims 

D Check if this is an 

amended filing 

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 

AJB: 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. On the top of 

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

List All of Your PRIORITY Unsecured Claims 

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

lia No. Go to Part 2. 

Dves. 

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.) 

EJ 

Priority Creditor's Name 

Number Street 

City State 

Who incurred the debt? Check one. 

0 Debtor 1 only 

0 Debtor 2 only 

0 Debtor 1 and Debtor 2 only 

ZIP Code 

0 At least one of the debtors and another 

0 Check if this claim is for a community debt 

Is the claim subject to offset? 

• No 

0 Yes 

§] ________ _ Priority Creditor's Name 

Number Street 

City State 

Who incurred the debt? Check one. 

0 Debtor 1 only 

0 Debtor 2 only 

0 Debtor 1 and Debtor 2 only 

ZIP Code 

0 At least one of the debtors and another 

0 Check if this claim is for a community debt 

Is the claim subject to offset? 

• No 

0 Yes 

Total claim Priority 

amount 

Nonpriorlty 

amount 

Last 4 digits of account number _ _ _ _ $ _____ $ _____ $ ____ _ 

When was the debt incurred? 

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

0 Contingent 

0 Unliquidated 

0 Disputed 

Type of PRIORITY unsecured claim: 

0 Domestic support obligations 

0 Taxes and certain other debts you owe the government 

0 Claims for death or personal injury while you were 

intoxicated 

0 Other. Specify _____________ _ 

Last 4 digits of account number _ _ _ _ $ _____ $ _____ $ ____ _ 

When was the debt incurred? 

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

0 Contingent 

0 Unliquidated 

0 Disputed 

Type of PRIORITY unsecured claim: 

0 Domestic support obligations 

0 Taxes and certain other debts you owe the government 

0 Claims for death or personal injury while you were 

intoxicated 

0 Other. Specify _____________ _ 

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 1 

Case 20-10535-EPK Doc 1 Filed 01/15/20 Page 23 of 53
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Debtor 1 JENNIFER L. WILSON Case number (if known) _______________ _ 

First Name Middle Name Last Name 

List All of Your NONPRIORITY Unsecured Claims 

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

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

!Ml Yes 

4. List all of your non priority 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. 

E] 

.2 

.3 

AMEX 

-------------------------- Nonpriority Creditor's Name 

PO BOX 297871 

Number Street 

FORT LAUDERDALE 

City 

Who incurred the debt? Check one. 

0 Debtor 1 only 

D Debtor 2 only 

0 Debtor 1 and Debtor 2 only 

D At least one of the debtors and another 

FL 

State 

0 Check if this claim is for a community debt 

Is the claim subject to offset? 

0 No 

D Yes 

CAPITAL ONE BANK USA N 

Nonpriority Creditor's Name 

POBOX85520 

Number Street 

RICHMOND 

City 

Who incurred the debt? Check one. 

0 Debtor 1 only 

D Debtor 2 only 

D Debtor 1 and Debtor 2 only 

D At least one of the debtors and another 

VA 

State 

D Check if this claim is for a community debt 

Is the claim subject to offset? 

i2f No 

D Yes 

CREDIT COLLECTION SVCS 

Nonpriority Creditor's Name 

PO BOX 9134 

Number 

NEEDHAM 

City 

Street 

Who incurred the debt? Check one. 

lil Debtor 1 only 

0 Debtor 2 only 

D Debtor 1 and Debtor 2 only 

D At least one of the debtors and another 

MA 

State 

D Check if this claim is for a community debt 

Is the claim subject to offset? 

lil No 

D Yes 

33329 

ZIP Code 

23285 

ZIP Code 

02494 

ZIP Code 

Last 4 digits of account number 563.£_ __ 

When was the debt incurred? 2/14/18 

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

D Contingent 

D Unliquidated 

D Disputed 

Type of NONPRIORITY unsecured claim: 

0 Student loans 

D Obligations arising out of a separation agreement or divorce 

that you did not report as priority claims 

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

liif' Other. Specify CREDIT CARD 

Last 4 digits of account number 9370 _ 

When was the debt incurred? fil29/f7 

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

D Contingent 

D Unliquidated 

D Disputed 

Type of NONPRIORITY unsecured claim: 

D Student loans 

D Obligations arising out of a separation agreement or divorce 

that you did not report as priority claims 

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

liif' Other. Specify CREDIT CARD 

Last 4 digits of account number ..Q53.9_ __ 

When was the debt incurred? 5/20/19 

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

0 Contingent 

0 Unliquidated 

D Disputed 

Type of NONPRIORITY unsecured claim: 

D Student loans 

D Obligations arising out of a separation agreement or divorce 

that you did not report as priority claims 

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

lil Other. Specify COLLECTION 

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

Totalc:lalm 

$_1'-=2'-=-5.=.,5 "c.=..00=-

$ _ __,__,77'-""2,.,_,..0c.=...O 

page 3 

Case 20-10535-EPK Doc 1 Filed 01/15/20 Page 24 of 53
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Debtor 1 JENNIFER L. WILSON Case number (if known) _______________ _ 

First Name Maddie Name Last Name 

Your NONPRIORITY Unsecured Claims - Continuation Page 

After listing any entries on this page, number them beginning with 4.4, followed by 4.5, and so forth. 

EJ FIRST FEDERAL CREDIT 

Nonpriority Creditor's Name 

1940 HARRISON STREET 

Number Street 

HOLLYWOOD FL 

City State 

Who incurred the debt? Check one. 

.a Debtor 1 only 

0 Debtor 2 only 

0 Debtor 1 and Debtor 2 only 

0 At least one of the debtors and another 

0 Check if this claim is for a community debt 

Is the claim subject to offset? 

el No 

0 Yes 

E] 

PHOENIX FINANCIAL 

Nonpriority Creditor's Name 

7680 UNIVERSAL BOULEVARD 

Number Street 

ORLANDO FL 

City State 

Who incurred the debt? Check one. 

Mil Debtor 1 only 

0 Debtor 2 only 

0 Debtor 1 and Debtor 2 only 

0 At least one of the debtors and another 

0 Check if this claim is for a community debt 

Is the claim subject to offset? 

el No 

0 Yes 

EJ 

TIME PAYMENT CORP 

Nonpriority Creditor's Name 

1600 DISTRICT AVENUE 

Number Street 

BURLINGTON MA 

City State 

Who incurred the debt? Check one. 

Mt Debtor 1 only 

0 Debtor 2 only 

0 Debtor 1 and Debtor 2 only 

0 At least one of the debtors and another 

0 Check if this claim is for a community debt 

Is the claim subject to offset? 

fl No 

0 Yes 

33020 

ZIP Code 

32819 

ZIP Code 

01803 

ZIP Code 

Last 4 digits of account number J:!...NKNOWf'-!_ 

When was the debt incurred? 2015 

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

0 Contingent 

0 Unliquidated 

0 Disputed 

Type of NONPRIORITY unsecured claim: 

0 Student loans 

0 Obligations arising out of a separation agreement or divorce that 

you did not report as priority claims 

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

.a Other. Specify_M_E_D_I_C_A_L ______ _ 

Last 4 digits of account number UNKNOWf'-!_ 

When was the debt incurred? 2015 

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

0 Contingent 

0 Unliquidated 

0 Disputed 

Type of NONPRIORITY unsecured claim: 

0 Student loans 

0 Obligations arising out of a separation agreement or divorce that 

you did not report as priority claims 

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

0' Other. Specity_M_E_D_IC_A_L ______ _ 

Last 4 digits of account number UNKNOWf'-!_ 

When was the debt incurred? 2019 

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

0 Contingent 

0 Unliquidated 

0 Disputed 

Type of NONPRIORITY unsecured claim: 

0 Student loans 

0 Obligations arising out of a separation agreement or divorce that 

you did not report as priority claims 

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

~ Other. Specify SALON FURNITURE 

Total claim 

$ 200.00 

$ 50.00 

$ 9000.00 

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 4 

Case 20-10535-EPK Doc 1 Filed 01/15/20 Page 25 of 53
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Debtor 1 JENNIFER L. WILSON Case number (if known), _______________ _ 

First Name Middle Name Last Name 

Your NONPRIORITY Unsecured Claims - Continuation Page 

After listing any entries on this page, number them beginning with 4.4, followed by 4.5, and so forth. 

EJ 

• 

UNITED AUTO CREDIT CO 

Nonpriority Creditor's Name 

1071 CAMELBACK ST STE 10 

Number Street 

NEWPORT BEACH CA 

City State 

Who incurred the debt? Check one. 

~ Debtor 1 only 

0 Debtor 2 only 

0 Debtor 1 and Debtor 2 only 

0 At least one of the debtors and another 

D Check if this claim is for a community debt 

Is the claim subject to offset? 

~ No 

D Yes 

Nonpriority Creditor's Name 

Number Street 

City 

Who incurred the debt? Check one. 

D Debtor 1 only 

0 Debtor 2 only 

D Debtor 1 and Debtor 2 only 

0 At least one of the debtors and another 

State 

D Check if this claim is for a community debt 

Is the claim subject to offset? 

D No 

D Yes 

Nonpriority Creditor's Name 

Number Street 

City 

Who incurred the debt? Check one. 

0 Debtor 1 only 

0 Debtor 2 only 

0 Debtor 1 and Debtor 2 only 

0 At least one of the debtors and another 

State 

D Check if this claim is for a community debt 

Is the claim subject to offset? 

0 No 

D Yes 

92660 

ZIP Code 

ZIP Code 

ZIP Code 

Last 4 digits of account number 000_1_ __ 

When was the debt incurred? 5/30/14 

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

0 Contingent 

D Unliquidated 

D Disputed 

Type of NONPRIORITY unsecured claim: 

0 Student loans 

0 Obligations arising out of a separation agreement or divorce that 

you did not report as priority claims 

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

wl Other. Specify AUTOMOBILE 

Last 4 digits of account number ___ _ 

When was the debt incurred? 

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

D Contingent 

D Unliquidated 

D Disputed 

Type of NONPRIORITY unsecured claim: 

D Student loans 

0 Obligations arising out of a separation agreement or divorce that 

you did not report as priority claims 

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

D Other. Specify _____________ _ 

Last 4 digits of account number ___ _ 

When was the debt incurred? 

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

D Contingent 

D Unliquidated 

D Disputed 

Type of NONPRIORITY unsecured claim: 

D Student loans 

0 Obligations arising out of a separation agreement or divorce that 

you did not report as priority claims 

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

D Other. Specify _____________ _ 

Total claim 

$ 7931.00 

$ ____ _ 

$ ____ _ 

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page4 

Case 20-10535-EPK Doc 1 Filed 01/15/20 Page 26 of 53
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Debtor 1 JENNIFER L. WILSON Case number (if known) ______________ _ 

First Name Middle Name Last Name 

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

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

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

2, then list the collection agency here. Similarly, if you have more than one creditor for any of the debts that you listed in Parts 1 or 2, list the 

additional creditors here. If you do not have additional persons to be notified for any debts in Parts 1 or 2, do not fill out or submit this page. 

Name 

Number Street 

City State 

Name 

Number Street 

City State 

Name 

Number Street 

Name 

Number Street 

City State 

Name 

Number Street 

Cit State 

Name 

Number Street 

City State 

Name 

Number Street 

City State 

Official Form 106E/F 

ZIP Code 

ZIP Code 

ZIP Code 

ZIP Code 

ZIP Code 

ZIP Code 

ZIP Code 

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

Line of (Check one): 0 Part 1: Creditors with Priority Unsecured Claims 

0 Part 2: Creditors with Nonpriority Unsecured Claims 

Last 4 digits of account number _ __ _ 

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

Line 

Claims 

of (Check one): 0 Part 1: Creditors with Priority Unsecured Claims 

0 Part 2: Creditors with Nonpriority Unsecured 

Last 4 digits of account number _ __ _ 

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

Line 

Claims 

of (Check one): 0 Part 1: Creditors with Priority Unsecured Claims 

0 Part 2: Creditors with Nonpriority Unsecured 

Last 4 digits of account number _ __ _ 

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

Line 

Claims 

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

0 Part 2: Creditors with Nonpriority Unsecured 

Last 4 digits of account number _ __ _ 

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

Line 

Claims 

of (Check one): 0 Part 1: Creditors with Priority Unsecured Claims 

0 Part 2: Creditors with Nonpriority Unsecured 

Last 4 digits of account number _ __ _ 

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

Line 

Claims 

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

0 Part 2: Creditors with Nonpriority Unsecured 

Last 4 digits of account number _ __ _ 

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

Line 

Claims 

of (Check one): 0 Part 1: Creditors with Priority Unsecured Claims 

0 Part 2: Creditors with Nonpriority Unsecured 

Last 4 digits of account number _ __ _ 

Schedule E/F: Creditors Who Have Unsecured Claims page 13 

Case 20-10535-EPK Doc 1 Filed 01/15/20 Page 27 of 53
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Debtor 1 JENNIFER L. WILSON Case number (ff known) _____________ _ 

First Name Middle Name Last Name 

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 

I 6a. Domestic support obligations 6a. 0.00 Total claims $ 

from Part 1 6b. Taxes and certain other debts you owe the 

government 6b. $ 0.00 

6c. Claims for death or personal injury while you were 

intoxicated 6c. $ 0.00 

6d. Other. Add all other priority unsecured claims. 

Write that amount here. 6d. +$ 0.00 

6e. Total. Add lines 6a through 6d. 6e. 

$ 0.00 

Total claim 

Total claims 6f. Student loans 6f. 

$ 0.00 

from Part 2 6g. Obligations arising out of a separation agreement 

or divorce that you did not report as priority 0.00 claims 6g. $ 

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. +$ 21806.00 

6j. Total. Add lines 6f through 6i. 6j. 21806.00 $ 

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

Case 20-10535-EPK Doc 1 Filed 01/15/20 Page 28 of 53
1 

Fill in this information to identify your case: 

Debtor JENNIFER L. WILSON 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 

(If known) 

Official Form 106G 

Schedule G: Executory Contracts and Unexpired Leases 

D Check if this is an 

amended filing 

12/15 

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

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

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

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

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

D Yes. Fill in all of the information below even if the contracts or leases are listed on Schedule AIB: Property (Official Form 106NB). 

2. List separately each person or company with whom you have the contract or lease. Then state what each contract or lease is for (for 

example, rent, vehicle lease, cell phone). See the instructions for this form in the instruction booklet for more examples of executory contracts and 

unexpired leases. 

Person or company with whom you have the contract or lease State what the contract or lease is for 

2.1 

ame 

Number Street 

City State ZIP Code 

2.2 

Name 

Number Street 

City State ZIP Code 

2.3 

ame 

lilum6er Slreel 

City State ZIP Code 

2.4 

ame 

Number Street 

City State ZIP Code 

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

Case 20-10535-EPK Doc 1 Filed 01/15/20 Page 29 of 53
Fill in this information to identify your case: 

Debtor 1 JENNIFER L. WILSON First Name Middle Name Last Name 

Debtor2 

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

United states Bankruptcy court tor the: SOUTHERN DISTRICT OF FLORIDA 

Case number 

(If known) D Check if this is an 

amended filing 

Official Form 106H 

Schedule H: Your Codebtors 12/15 

Codebtors are people or entities who are also liable for any debts you may have. Be as complete and accurate as possible. If two married people 

are filing together, both are equally responsible for supplying correct information. If more space is needed, copy the Additional Page, fill it out, 

and number the entries in the boxes on the left. Attach the Additional Page to this page. On the top of any Additional Pages, write your name and 

case number (if known). Answer every question. 

1. Do you have any codebtors? (If you are filing a joint case, do not list either spouse as a codebtor.) 

i2I No 

D Yes 

2. Within the last 8 years, have you lived in a community property state or territory? ( Community property states and territories include 

Arizona, California, Idaho, Louisiana, Nevada, New Mexico, Puerto Rico, Texas, Washington, and Wisconsin.) 

!fl' No. Go to line 3. 

0 Yes. Did your spouse, former spouse, or legal equivalent live with you at the time? 

• No 

D Yes. In which community state or territory did you live? ________ . Fill in the name and current address of that person. 

Name of your spouse, former spouse, or legal equivalent 

Number Street 

City State ZIP Code 

3. In Column 1, list all of your codebtors. Do not include your spouse as a codebtor if your spouse is filing with you. List the person 

shown in line 2 again as a codebtor only if that person is a guarantor or cosigner. Make sure you have listed the creditor on 

Schedule D (Official Form 106D), Schedule E/F (Official Form 106E/F), or Schedule G (Official Form 106G). Use Schedule D, 

Schedule E/F, or Schedule G to fill out Column 2. 

Column 1: Your codebtor Column 2: The creditor to whom you owe the debt 

Check all schedules that apply: 

Ei] • Schedule D, line Name 

• Schedule E/F, line 

Number Street • Schedule G, line 

City State ZIP Code 

§] • Schedule D, line ___ Name 

• Schedule E/F, line 

Number Street • Schedule G, line 

City State ZIP Code 

§] • Schedule D, line Name 

• Schedule E/F, line 

Number Street • Schedule G, line 

City State ZIP Code 

Official Form 106H Schedule H: Your Codebtors page 1 

Case 20-10535-EPK Doc 1 Filed 01/15/20 Page 30 of 53
I 

Fill in this information to identify your case: 

Debtor 1 JENNIFER L. WILSON First Name Middle Name Last Name 

Debtor 2 

(Spouse, if filing} Fir>t Name Middle Name Last Name 

United States Bankruptcy Court tor the: SOUTHERN DISTRICT OF FLORIDA 

Case number 

(If known} 

Official Form 1061 

Schedule I: Your Income 

Check if this is: 

0 An amended filing 

0 A supplement showing postpetition chapter 13 

income as of the following date: 

MM/ DD/ YYYY 

12/15 

Be as complete and accurate as possible. If two married people are filing together (Debtor 1 and Debtor 2), both are equally responsible for 

supplying correct information. If you are married and not filing jointly, and your spouse is living with you, include information about your spouse. 

If you are separated and your spouse is not filing with you, do not include information about your spouse. If more space is needed, attach a 

separate sheet to this form. On the top of any additional pages, write your name and case number (if known). Answer every question. 

•Mil Describe Employment 

1. Fill in your employment 

information. 

If you have more than one job, 

attach a separate page with 

information about additional 

employers. 

Include part-time, seasonal, or 

self-employed work. 

Employment status 

Occupation Occupation may include student 

or homemaker, if it applies. 

Employer's name 

Employer's address 

Debtor 1 

~ Employed 

D Not employed 

NAIL TECHNICIAN 

SELF-EMPLOYED 

Number Street 

City State ZIP Code 

How long employed there? 2 YEARS 

•if• Give Details About Monthly Income 

Debtor 2 or non-filing spouse 

D Employed 

D Not employed 

Number Street 

City State ZIP Code 

Estimate monthly income as of the date you file this form. If you have nothing to report for any line, write $0 in the space. Include your non-filing 

spouse unless you are separated. 

If you or your non-filing spouse have more than one employer, combine the information for all employers for that person on the lines 

below. If you need more space, attach a separate sheet to this form. 

2. List monthly gross wages, salary, and commissions (before all payroll 

deductions). If not paid monthly, calculate what the monthly wage would be. 

3. Estimate and list monthly overtime pay. 

4. Calculate gross income. Add line 2 + line 3. 

2. 

3. 

4. 

Official Form 1061 Schedule I: Your Income 

$ 

+$ 

$ 

For Debtor 1 For Debtor 2 or 

non-filing spouse 

0.00 $ 

0.00 + $ 

0.00 I I $ 

page 1 

Case 20-10535-EPK Doc 1 Filed 01/15/20 Page 31 of 53
Debtor 1 JENNIFER L. WILSON First Name Middle Name Last Name 

Case number (if known) ______________ _ 

Copy line 4 here ............................................................................................... -+ 4. 

5. Indicate whether you have the payroll deductions below: 

5a. Tax, Medicare, and Social Security deductions 

5b. Mandatory contributions for retirement plans 

5c. Voluntary contributions for retirement plans 

5d. Required repayments of retirement fund loans 

5e. Insurance 

5f. Domestic support obligations 

5g. Union dues 

5h. Other deductions. Specify: ______________ _ 

6. Add the payroll deductions. Add lines 5a + 5b + 5c + 5d + 5e + 5f + 5g + 5h. 

7. Calculate total monthly take-home pay. Subtract line 6 from line 4. 

8. List all other income regularly received: 

Ba. Net income from rental property and from operating a business, 

profession, or farm 

Attach a statement for each property and business showing gross receipts, ordinary and 

necessary business expenses, and the total monthly net income. 

Bb. Interest and dividends 

5a. 

5b. 

5c. 

5d. 

5e. 

5f. 

5g. 

5h. 

6. 

7. 

Ba. 

Be. Family support payments that you, a non-filing spouse, or a dependent 

regularly receive 

Include alimony, spousal support, child support, maintenance, divorce settlement, and 

property settlement. 

Bd. Unemployment compensation 

Be. Social Security 

Bf. Other government assistance that you regularly receive 

Include cash assistance and the value (if known) of any non-cash assistance that you 

receive, such as food stamps or housing subsidies. 

Specify (Debtor 1 ): Specify (Debtor 2 or Non-Filing Spouse): 

Bg. Pension or retirement income 

Bh. Other monthly income. 

Specify (Debtor 1 ): Specify (Debtor 2 or Non-Filing Spouse): 

9. Add all other income. Add lines Sa+ Sb + Sc + Sd + Se+ Sf +Sg + Sh. 

10. Calculate monthly income. Add line 7 + line 9. 

Add the entries in line 10 for Debtor 1 and Debtor 2 or non-filing spouse. 

11. State all other regular contributions to the expenses that you list in Schedule J. 

For Debtor 1 

$ __ o_.o_o 

$ 0.00 

$ 0.00 

$ 0.00 

$ 0.00 

$ 0.00 

$ 0.00 

$ 0.00 

+$ 0.00 

$ 0.00 

$ 0.00 

$ 100.00 

$ 0.00 -----

$ 0.00 -----

$ ___ o_.o_o 

$ 0.00 -----

$ ___ o_.o_o 

$ ___ 0._00_ 

$ 0.00 

1$ 100.00 

I $ 100.00 

Include contributions from an unmarried partner, members of your household, your dependents, your roommates, and other friends or 

relatives. Do not include any amounts already included in lines 2-10 or amounts that are not available to pay expenses listed in Schedule J. 

+ 

Specify: ____ B_E_TTY __ W_I_LS_O_N_G_E_O_R_G_E_W_IL_S_O_N_W_I_L_LI_E_T_H_O_M_P_S_O_N __ _ 

For Debtor 2 or 

non-filing spouse 

$ _____ _ 

$ 

$ 

$ 

$ 

$ 

$ 

$ 

+ $ 

$ 

$ 

$ 

$ ____ _ 

$ ____ _ 

$ ____ _ 

$ ____ _ 

$ _____ _ 

$ ____ _ 

$ 

$ 

I $ o.oo I= I$ 100.0011 

11. + $ 2000.00 ..--_-_-:_-_-_-_-_-_-_-_-_-... 12. Add the amount in the last column of line 10 to the amount in line 11. The result is the combined monthly income. 12. 2100.00 

Write that amount on the Summary of Your Assets and Liabilities and Certain Statistical Information, if it applies 

12. Do you expect an increase or decrease within the year after you file this form? 

0 No. 

0 Yes. Explain: 

Official Form 1061 Schedule I: Your Income 

Combined 

monthly income 

page 2 

Case 20-10535-EPK Doc 1 Filed 01/15/20 Page 32 of 53
l 

Fill in this information to identify your case· 

Debtor 1 JENNIFER L. WILSON First Name Middle Name Last Name Check if this is: 

Debtor 2 

(Spouse, if filing) First Name Middle Name Last Name D An amended filing 

United states Bankruptcy court tor the: SOUTHERN DISTRICT OF FLORIDA 

D A supplement showing postpetition chapter 13 

expenses as of the following date: 

Case number 

(If known) 

Official Form 106J 

Schedule J: Your Expenses 

MM/ DD/ YYYY 

12/15 

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

information. If more space is needed, attach another sheet to this form. On the top of any additional pages, write your name and case number 

(if known). Answer every question. 

1. Is this a joint case? 

1H No. Go to line 2. 

D Yes. Does Debtor 2 live in a separate household? 

• No 

D Yes. Debtor 2 must file Official Form 106J-2, Expenses for Separate Household of Debtor 2. ---------··--·-----------~-----·------·-----··---·------·---···-. ---------------·-- ··- --··-··-------------------------------------------·--·--------··------- -----

2. Do you have dependents? 

Do not list Debtor 1 and 

Debtor 2. 

Do not state the dependents' 

names. 

3. Do your expenses include 

expenses of people other than 

yourself and your dependents? 

llJ No 

D Yes. Fill out this information for 

Dependent's relationship to 

Debtor 1 or Debtor 2 

each dependent.. ........................ ------------

if No 

D Yes 

Estimate Your Ongoing Monthly Expenses 

Dependent's 

age 

Does dependent live 

with you? 

• No 

D Yes 

• No 

D Yes 

• No 

D Yes 

• No 

D Yes 

• No 

D Yes 

Estimate your expenses as of your bankruptcy filing date unless you are using this form as a supplement in a Chapter 13 case to report 

expenses as of a date after the bankruptcy is filed. If this is a supplemental Schedule J, check the box at the top of the form and fill in the 

applicable date. 

Include expenses paid for with non-cash government assistance if you know the value of 

such assistance and have included it on Schedule I: Your Income (Official Form 1061.) 

4. The rental or home ownership expenses for your residence. Include first mortgage payments and 

any rent for the ground or lot. 

If not included in line 4: 

4a. Real estate taxes 

4b. Property, homeowner's, or renter's insurance 

4c. Home maintenance, repair, and upkeep expenses 

4d. Homeowner's association or condominium dues 

Official Form 106J Schedule J: Your Expenses 

Your expenses 

4. $ 1100.00 

4a. $ 0.00 

4b. $ 0.00 

4c. $ 0.00 

4d. $ 0.00 

page 1 

Case 20-10535-EPK Doc 1 Filed 01/15/20 Page 33 of 53
Debtor 1 JENNIFER L. WILSON First Name Middle Name 

Case number (if known), _____________ _ 

5. 

6. 

7. 

8. 

9. 

10. 

11. 

12. 

13. 

14. 

15. 

Last Name 

Additional mortgage payments for your residence, such as home equity loans 

Utilities: 

6a. Electricity, heat, natural gas 

6b. Water, sewer, garbage collection 

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

6d. Other. Specify: LAWN. 

Food and housekeeping supplies 

Childcare and children's education costs 

Clothing, laundry, and dry cleaning 

Personal care products and services 

Medical and dental expenses 

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

Do not include car payments. 

Entertainment, clubs, recreation, newspapers, magazines, and books 

Charitable contributions and religious donations 

Insurance. 

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

15a. Life insurance 

15b. Health insurance 

15c. Vehicle insurance 

15d. Other insurance. Specify:. ________________ _ 

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

Specify: _______________________ _ 

17. Installment or lease payments: 

17a. Car payments for Vehicle 1 

17b. Car payments for Vehicle 2 

17c. Other. Specify: ____________________ _ 

17d. Other. Specify: ____________________ _ 

18. Your payments of alimony, maintenance, and support that you did not report as deducted from 

your pay on line 5, Schedule I, Your Income (Official Form 1061). 

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

Specify: ______________________ _ 

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

20a. Mortgages on other property 

20b. Real estate taxes 

20c. Property, homeowner's, or renter's insurance 

20d. Maintenance, repair, and upkeep expenses 

20e. Homeowner's association or condominium dues 

Official Form 106J Schedule J: Your Expenses 

Your expenses 

$ 0.00 

5. 

6a. $ 300.00 

6b. $ 0.00 

6c. $ 300.00 

6d. $ 180.00 

7. $ 300.00 

8. $ 0.00 

9. $ 60.QQ 

10. $ 40,QQ 

11. $ 100 00 

$ 300.00 

12. 

13. $ 0.00 

14. $ 1QQ.QQ 

15a. $ 0.00 

15b. $ 0.00 

15c. $ 0.00 

15d. $ 0.00 

16. $ 0.00 

17a. $ 

17b. $ 

17c. $ 

17d. $ 

18. $ 0.00 

19. $ 0.00 

20a. $ 0.00 

20b. $ 0.00 

20c. $ 0.00 

20d. $ 0.00 

20e. $ 0.00 

page 2 

Case 20-10535-EPK Doc 1 Filed 01/15/20 Page 34 of 53
Debtor 1 JENNIFER L. WILSON Case number (if known), _____________ _ 

First Name Middle Name Last Name 

21. Other. Specify: 

22. Calculate your monthly expenses. 

22a. Add lines 4 through 21. 

22b. Copy line 22 (monthly expenses for Debtor 2), if any, from Official Form 106J-2 

22c. Add line 22a and 22b. The result is your monthly expenses. 

23. Calculate your monthly net income. 

23a. Copy line 12 (your combined monthly income) from Schedule I. 

23b. Copy your monthly expenses from line 22c above. 

23c. Subtract your monthly expenses from your monthly income. 

The result is your monthly net income. 

24. Do you expect an increase or decrease in your expenses within the year after you file this form? 

For example, do you expect to finish paying for your car loan within the year or do you expect your 

mortgage payment to increase or decrease because of a modification to the terms of your mortgage? 

if No. 

D Yes. Explain here: 

Official Form 106J Schedule J: Your Expenses 

21. +$ 0.00 

22a. $ 2780.00 

22b. $ 0.00 

22c. $ 2780.00 I 

$ 2100.00 

23a. 

23b. -$ 2780.00 

-680.00 

23c. $ 

page 3 

Case 20-10535-EPK Doc 1 Filed 01/15/20 Page 35 of 53
Fill in this information to identify your case· 

Debtor 1 JENNIFER L. WILSON First Name Middle Name Last Name 

Debtor 2 

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

United States Bankruptcy court tor the: SOUTHERN DISTRICT OF FLORIDA 

Case number 

(~known) 

Official Form 106Dec 

Declaration About an Individual Debtor's Schedules 

If two married people are filing together, both are equally responsible for supplying correct information. 

D Check if this is an 

amended filing 

12/15 

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? 

id No 

0 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 flled with this declaration and 

that they are true and correct. 

Date ) ~' r/ ;21);-0 MM/ D I YYYY 

Official Form 106Dec 

X 

Signature of Debtor 2 

Date ______ _ 

MM/ DD I YYYY 

Declaration About an Individual Debtor's Schedules 

Case 20-10535-EPK Doc 1 Filed 01/15/20 Page 36 of 53
Fill in this mformat1on to 1dent1fy your case: 

Debtor 1 JENNIFER L. WILSON First Name Middle Name Last Name 

Debtor 2 

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

United States Bankruptcy court tor the: SOUTHERN DISTRICT OF FLORIDA 

Case number 

(If known) 

Official Form 107 

D Check if this is an 

amended filing 

Statement of Financial Affairs for Individuals Filing for Bankruptcy 04/19 

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

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

number (if known). Answer every question. 

Give Details About Your Marital Status and Where You Lived Before 

1. What is your current marital status? 

D Married 

0 Not married 

2. During the last 3 years, have you lived anywhere other than where you live now? 

fia' No 

D Yes. List all of the places you lived in the last 3 years. Do not include where you live now. 

Debtor 1: 

Number Street 

City State ZIP Code 

Number Street 

City State ZIP Code 

Dates Debtor 1 

lived there 

From 

To 

From 

To 

Debtor 2: 

D Same as Debtor 1 

Number Street 

City 

D Same as Debtor 1 

Number Street 

City 

Dates Debtor 2 

lived there 

D Same as Debtor 1 

From 

To 

State ZIP Code 

D Same as Debtor 1 

From __ _ 

To 

State ZIP Code 

3. Within the last 8 years, did you ever live with a spouse or legal equivalent in a community property state or territory? ( Community property 

states and territories include Arizona, California, Idaho, Louisiana, Nevada, New Mexico, Puerto Rico, Texas, Washington, and Wisconsin.) 

0 No 

D Yes. Make sure you fill out Schedule H: Your Codebtors (Official Form 106H). 

•ifj Explain the Sources of Your Income 

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

Case 20-10535-EPK Doc 1 Filed 01/15/20 Page 37 of 53
l 

I 

Debtor 1 JENNIFER L. WILSON Case number (it known) ______________ _ 

First Name Middle Name Last Name 

4. Did you have any income from employment or from operating a business during this year or the two previous calendar years? 

Fill in the total amount of income you received from all jobs and all businesses, including part-time activities. 

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

D No 

10 Yes. Fill in the details. 

Sources of income Gross income Sources of income 

Check all that apply. (before deductions and Check all that apply. 

exclusions) 

From January 1 of current year until D Wages, commissions, 

$ 0 D Wages, commissions, 

the date you filed for bankruptcy: bonuses.tips bonuses, tips 

D Operating a business D Operating a business 

For last calendar year: D Wages, commissions, D Wages, commissions, 

bonuses.tips $ 5600 bonuses, tips 

(January 1 to December 31, 2019 lia' Operating a business D Operating a business yyyy 

For the calendar year before that: D Wages, commissions, D Wages, commissions, 

2018 bonuses.tips $ 5678 bonuses, tips 

(January 1 to December 31, 0 Operating a business D Operating a business yyyy 

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

Gross income 

(before deductions and 

exclusions) 

$ 

$ 

$ 

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

unemployment, and other public benefit payments; pensions; rental income; interest; dividends; money collected from lawsuits; royalties; and 

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

List each source and the gross income from each source separately. Do not include income that you listed in line 4. 

D No 

[il Yes. Fill in the details. 

From January 1 of current year until 

the date you filed for bankruptcy: 

For last calendar year: 

(January 1 to December 31, 2019 ) yyyy 

For the calendar year before that: 

(January 1 to December 31, 2018 ) yyyy 

Sources of income 

Describe below. 

Gross income from 

each source 

(before deductions and 

exclusions) 

Sources of income 

Describe below. 

$ ________ ----------

$ ________ ----------

$ ________ ----------

$ __ 2_2_0_00_.o_o_ 

$ ______ _ 

$ ______ _ 

$ 24000.00 -------

$ ______ _ 

$ _______ _ 

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

Gross income from 

each source 

(before deductions and 

exclusions) 

$ _______ _ 

$ ______ _ 

$ ______ _ 

$ _______ _ 

$ ______ _ 

$ ______ _ 

$ ______ _ 

$ _______ _ 

$ _______ _ 

page 2 

Case 20-10535-EPK Doc 1 Filed 01/15/20 Page 38 of 53
1 

l 

Debtor 1 JENNIFER L. WILSON Case number (if known) ______________ _ 

First Name Middle Name Last Name 

List Certain Payments You Made Before You Filed for Bankruptcy 

6. Are either Debtor 1 's or Debtor 2's debts primarily consumer debts? 

D No. Neither Debtor 1 nor Debtor 2 has primarily consumer debts. Consumer debts are defined in 11 U.S.C. § 101 (8) as 

"incurred by an individual primarily for a personal, family, or household purpose." 

During the 90 days before you filed for bankruptcy, did you pay any creditor a total of $6,825* or more? 

D No. Go to line 7. 

D Yes. List below each creditor to whom you paid a total of $6,825* or more in one or more payments and the 

total amount you paid that creditor. Do not include payments for domestic support obligations, such as 

child support and alimony. Also, do not include payments to an attorney for this bankruptcy case. 

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

~ Yes. Debtor 1 or Debtor 2 or both have primarily consumer debts. 

During the 90 days before you filed for bankruptcy, did you pay any creditor a total of $600 or more? 

0' No. Go to line 7. 

D Yes. List below each creditor to whom you paid a total of $600 or more and the total amount you paid that 

creditor. Do not include payments for domestic support obligations, such as child support and 

alimony. Also, do not include payments to an attorney for this bankruptcy case. 

Creditor's Name 

Number Street 

City 

Creditor's Name 

Number Street 

City 

Creditor's Name 

Number Street 

City 

----------·-··------

Official Form 107 

State 

State 

State 

ZIP Code 

ZIP Code 

ZIP Code 

Dates of 

payment 

Total amount paid Amount you still owe 

$ ________ $ _______ _ 

$ ________ $ ________ _ 

$ ______ _ $ ______ _ 

Statement of Financial Affairs for Individuals Filing for Bankruptcy 

Was this payment for ... 

D Mortgage 

Dear 

D Credit card 

D Loan repayment 

D Suppliers or vendors 

D Other ____ _ 

D Mortgage 

Dear 

D Credit card 

D Loan repayment 

D Suppliers or vendors 

D Other ____ _ 

D Mortgage 

Dear 

D Credit card 

D Loan repayment 

D Suppliers or vendors 

D Other ____ _ 

page 3 

Case 20-10535-EPK Doc 1 Filed 01/15/20 Page 39 of 53
Debtor 1 JENNIFER L. WILSON Case number (if known) _______________ _ 

First Name Middle Name Last Name 

7. Within 1 year before you filed for bankruptcy, did you make a payment on a debt you owed anyone who was an insider? 

Insiders include your relatives; any general partners; relatives of any general partners; partnerships of which you are a general partner; 

corporations of which you are an officer, director, person in control, or owner of 20% or more of their voting securities; and any managing 

agent, including one for a business you operate as a sole proprietor. 11 U.S.C. § 101. Include payments for domestic support obligations, 

such as child support and alimony. 

!f No 

D Yes. List all payments to an insider. 

Insider's Name 

Number Street 

City State ZIP Code 

Insider's Name 

Number Street 

City State ZIP Code 

Dates of 

payment 

Total amount 

paid 

$ ____ _ 

$ _____ _ 

Amount you still Reason for this payment 

owe 

$ ____ _ 

$ _____ _ 

a. Within 1 year before you filed for bankruptcy, did you make any payments or transfer any property on account of a debt that benefited 

an insider? 

Include payments on debts guaranteed or cosigned by an insider. 

!f No 

D Yes. List all payments that benefited an insider. 

Insider's Name 

Number Street 

City State ZIP Code 

Insider's Name 

Number Street 

City State ZIP Code 

Dates of 

payment 

Total amount 

paid 

Amount you still 

owe 

$ _____ $ ____ _ 

$ _____ $ ____ _ 

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

Reason for this payment 

Include creditor's name 

page 4 

Case 20-10535-EPK Doc 1 Filed 01/15/20 Page 40 of 53
Debtor 1 JENNIFER L. WILSON Case number (if known) ______________ _ 

First Name Middle Name Last Name 

Identify Legal Actions, Repossessions, and Foreclosures 

9. Within 1 year before you filed for bankruptcy, were you a party in any lawsuit, court action, or administrative proceeding? 

List all such matters, including personal injury cases, small claims actions, divorces, collection suits, paternity actions, support or custody modifications, 

and contract disputes. 

l!f No 

D Yes. Fill in the details. 

Nature of the case Court or agency 

Case title ___________ _ Court Name 

Number Street 

Case number 

City 

Case title ___________ _ Court Name 

Number Street 

Case number 

City 

State ZIP Code 

State ZIP Code 

Status of the case 

D Pending 

D On appeal 

D Concluded 

D Pending 

D On appeal 

D Concluded 

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

Check all that apply and fill in the details below. 

l!f No. Go to line 11. 

D Yes. Fill in the information below. 

Creditor·s Name 

Number Street 

City State ZIP Code 

Creditor·s Name 

Number Street 

City State ZIP Code 

Describe the property 

Explain what happened 

D Property was repossessed. 

D Property was foreclosed. 

D Property was garnished. 

D Property was attached, seized, or levied. 

Describe the property 

Explain what happened 

D Property was repossessed. 

D Property was foreclosed. 

D Property was garnished. 

D Property was attached, seized, or levied. 

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

Date Value of the property 

$ _____ _ 

Date Value of the propert) 

$ _____ _ 

page 5 

Case 20-10535-EPK Doc 1 Filed 01/15/20 Page 41 of 53
Debtor 1 JENNIFER L. WILSON Case number (if known), _______________ _ 

First Name Middle Name Last Name 

11. Within 90 days before you filed for bankruptcy, did any creditor, including a bank or financial institution, set off any amounts from your 

accounts or refuse to make a payment because you owed a debt? 

~ No 

D Yes. Fill in the details. 

Creditor's Name 

Number Street 

City State ZIP Code 

Describe the action the creditor took 

Last 4 digits of account number: XXXX-___ _ 

Date action 

was taken 

Amount 

$ ______ _ 

12. Within 1 year before you filed for bankruptcy, was any of your property in the possession of an assignee for the benefit of 

creditors, a court-appointed receiver, a custodian, or another official? 

10 No 

D Yes 

•Mil List Certain Gifts and Contributions 

13. Within 2 years before you filed for bankruptcy, did you give any gifts with a total value of more than $600 per person? 

10 No 

D Yes. Fill in the details for each gift. 

Gifts with a total value of more than $600 

per person 

Person to Whom You Gave the Gift 

Number Street 

City State ZIP Code 

Person's relationship to you 

Gifts with a total value of more than $600 

per person 

Person to Whom You Gave the Gift 

Number Street 

City State ZIP Code 

Person's relationship to you _____ _ 

Describe the gifts 

Describe the gifts 

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

Dates you gave 

the gifts 

Dates you gave 

the gifts 

Value 

$ _____ _ 

$ _____ _ 

Value 

$ _____ _ 

$ _____ _ 

page 6 

Case 20-10535-EPK Doc 1 Filed 01/15/20 Page 42 of 53
l 

Debtor 1 JENNIFER L. WILSON Case number (if known) _______________ _ 

First Name Middle Name Last Name 

14. Within 2 years before you filed for bankruptcy, did you give any gifts or contributions with a total value of more than $600 to any charity? 

10' No 

D Yes. Fill in the details for each gift or contribution. 

Gifts or contributions to charities 

that total more than $600 

Charity's Name 

Number Street 

City State ZIP Code 

•HI-¥ List Certain Losses 

Describe what you contributed Date you 

contributed 

Value 

$ ____ _ 

$ _____ _ 

15. Within 1 year before you filed for bankruptcy or since you filed for bankruptcy, did you lose anything because of theft, fire, other 

disaster, or gambling? 

(B' No 

D Yes. Fill in the details. 

Describe the property you lost and 

how the loss occurred 

Describe any insurance coverage for the loss Date of your 

loss 

Include the amount that insurance has paid. List pending insurance 

claims on line 33 of Schedule AIB: Property. 

List Certain Payments or Transfers 

Value of property 

lost 

$ _____ _ 

16. Within 1 year before you filed for bankruptcy, did you or anyone else acting on your behalf pay or transfer any property to anyone 

you consulted about seeking bankruptcy or preparing a bankruptcy petition? 

Include any attorneys, bankruptcy petition preparers, or credit counseling agencies for services required in your bankruptcy. 

if No 

D Yes. Fill in the details. 

Description and value of any property transferred Date payment or Amount of payment 

transfer was 

Person Who Was Paid made 

Number Street $ _____ _ 

$ _____ _ 

City State ZIP Code 

Email or website address 

Person Who Made the Payment. if Not You 

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

Case 20-10535-EPK Doc 1 Filed 01/15/20 Page 43 of 53
Debtor 1 JENNIFER L. WILSON Case number (if known), _______________ _ 

First Name Middle Name 

Person Who Was Paid 

Number Street 

City State ZIP Code 

Email or website address 

Person Who Made the Payment, ~ Not You 

Last Name 

Description and value of any property transferred Date payment or 

transfer was made 

Amount of 

payment 

$ ____ _ 

$ _____ _ 

17. Within 1 year before you filed for bankruptcy, did you or anyone else acting on your behalf pay or transfer any property to anyone who 

promised to help you deal with your creditors or to make payments to your creditors? 

Do not include any payment or transfer that you listed on line 16. 

l!f' No 

D Yes. Fill in the details. 

Description and value of any property transferred Date payment or Amount of payment 

transfer was 

made 

Person Who Was Paid 

Number Street 

$ _____ _ 

$ ____ _ 

.. City State ZIP Code 

18. Within 2 years before you filed for bankruptcy, did you sell, trade, or otherwise transfer any property to anyone, other than property 

transferred in the ordinary course of your business or financial affairs? 

Include both outright transfers and transfers made as security (such as the granting of a security interest or mortgage on your property). 

Do not include gifts and transfers that you have already listed on this statement. 

l!f No 

D Yes. Fill in the details. 

Person Who Received Transfer 

Number Street 

City State ZIP Code 

Person's relationship to you _____ _ 

Person Who Received Transfer 

Number Street 

City State ZIP Code 

Person's relationship to you _____ _ 

Description and value of property 

transferred 

Describe any property or payments received 

or debts paid in exchange 

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

Date transfer 

was made 

page 8 

Case 20-10535-EPK Doc 1 Filed 01/15/20 Page 44 of 53
Debtor 1 JENNIFER L. WILSON Case number (if known), _______________ _ 

First Name Middle Name Last Name 

19, Within 10 years before you filed for bankruptcy, did you transfer any property to a self-settled trust or similar device of which you 

are a beneficiary? (These are often called asset-protection devices.) 

if No 

D Yes. Fill in the details. 

Description and value of the property transferred 

Name of trust 

List Certain Flnanclal Accounts, Instruments, Safe Deposit Boxes, and Storage Units 

Date transfer 

was made 

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

closed, sold, moved, or transferred? 

Include checking, savings, money market, or other financial accounts; certificates of deposit; shares in banks, credit unions, 

brokerage houses, pension funds, cooperatives, associations, and other financial institutions. 

B No 

0 Yes. Fill in the details. 

Name of Financial Institution 

Number Street 

City State ZIP Code 

Name of Financial Institution 

Number Street 

City State ZIP Code 

Last 4 digits of account number 

XXXX-_ - - -

XXXX-_ - - -

Type of account or 

instrument 

0 Checking 

0 Savings 

0 Money market 

0 Brokerage 

0 Other ___ _ 

0 Checking 

0 Savings 

0 Money market 

0 Brokerage 

Oother ___ _ 

Date account was 

closed, sold, moved, 

or transferred 

Last balance before 

closing or transfer 

$, ____ _ 

$ ____ _ 

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

securities, cash, or other valuables? 

lif No 

0 Yes. Fill in the details. 

Who else had access to It? Describe the contents 

Name of Financial Institution Name 

Number Street Number Street 

City State ZIP Code 

City State ZIP Code 

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

Do you still 

have it? 

0 No 

0 Yes 

page 9 

Case 20-10535-EPK Doc 1 Filed 01/15/20 Page 45 of 53
Debtor 1 JENNIFER L. WILSON Case number (it known) ______________ _ 

First Name Middle Name Last Name 

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

el No 

• Yes. Fill in the details. 

Who else has or had access to it? Describe the contents 

Name of Storage Facility Name 

Number Street Number Street 

City State ZIP Code 

City State ZIP Code 

Identify Property You Hold or Control for Someone Elsa 

23. Do you hold or control any property that someone else owns? Include any property you borrowed from, are storing for, 

or hold in trust for someone. 

IS' No 

• Yes. Fill in the details. 

Where is the property? Describe the property 

Owner's Name 

Number Street Number Street 

! City State ZIP Code City State ZIP Code 

Fili·+ Give Datalla About Environmental Information 

For the purpose of Part 10, the following definitions apply: 

• Environmental law means any federal, state, or local statute or regulation concerning pollution, contamination, releases of 

hazardous or toxic substances, wastes, or material into the air, land, soil, surface water, groundwater, or other medium, 

including statutes or regulations controlling the cleanup of these substances, wastes, or material. 

• Site means any location, facility, or property as defined under any environmental law, whether you now own, operate, or 

utilize it or used to own, operate, or utilize it, including disposal sites. 

• Hazardous material means anything an environmental law defines as a hazardous waste, hazardous substance, toxic 

substance, hazardous material, pollutant, contaminant, or similar term. 

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

Do you still 

have It? 

• No 

• Yes 

Value 

$ ___ _ 

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

el No 

• Yes. Fill in the details. 

Governmental unit Environmental law, If you know it Date of notice 

Name of site Governmental unit 

Number Street Number Street 

City State ZIP Code 

City State ZIP Code 

Official Form 107 Statement of Financial Affairs for Individuals Filing for Bankruptcy page 10 

Case 20-10535-EPK Doc 1 Filed 01/15/20 Page 46 of 53
Debtor 1 JENNIFER L. WILSON First Name Middle Name Last Name 

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

1B' No 

• Yes. Fill in the details. 

Case number (if known) ______________ _ 

Governmental unit Environmental law, if you know it Date of notice 

Name of site Governmental unit 

Number Street Number Street 

City State ZIP Code 

City State ZIP Code 

26. Have you been a party in any judicial or administrative proceeding under any environmental law? Include settlements and orders. 

0 No 

• Yes. Fill in the details. 

Court or agency Nature of the case Status of the 

case 

Case title ___________ _ 

Court Name • Pending 

• On appeal 

Number Street • Concluded 

Case number City State ZIP Code 

Give Details About Your Business or Connections to Any Business 

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

• A sole proprietor or self-employed in a trade, profession, or other activity, either full-time or part-time 

1B A member of a limited liability company (LLC) or limited liability partnership (LLP) 

• A partner in a partnership 

• An officer, director, or managing executive of a corporation 

• An owner of at least 5% of the voting or equity securities of a corporation 

• No. None of the above applies. Go to Part 12. 

Iii Yes. Check all that apply above and fill in the details below for each business. 

JYNNDAZZLED NAILS Business Name 

Describe the nature of the business Employer Identification number 

Do not include Social Security number or ITIN. 

SERVICE BUSINESS 

2017 SOUTH 10TH STREET EIN: 83-4658061 ____ _ 

Number Street 

Name of accountant or bookkeeper Dates business existed 

FORT PIERCE FL 34950 From 2019 To --- City State ZIP Code 

Describe the nature of the business Employer Identification number 

Business Name Do not include Social Security number or ITIN. 

EIN: ________ _ 

Number Street 

Name of accountant or bookkeeper Dates business existed 

From ___ To __ _ 

City State ZIP Code 

Official Form 107 Statement of Financial Affairs for Individuals Filing for Bankruptcy page 11 

Case 20-10535-EPK Doc 1 Filed 01/15/20 Page 47 of 53
Debtor 1 JENNIFER L. WILSON Case number (i/known) ______________ _ 

First Name Middle Name Last Name 

Describe the nature of the business Employer Identification number 

Do not include Social Security number or ITIN. 

Business Name 

EIN: _________ _ 

Number Street Name of accountant or bookkeeper Dates business existed 

From ___ To __ _ 

City State ZIP Code 

----------------------------------------------1 

28. Within 2 years before you filed for bankruptcy, did you give a financial statement to anyone about your business? Include all financial 

institutions, creditors, or other parties. 

~ No 

D Yes. Fill in the details below. 

Date issued 

Name MM/ DD/YYYY 

Number Street 

City State ZIP Code 

Sign Balow 

I have read the answers on this Statement of Financial Affairs and any attachments, and I declare under penalty of perjury that the 

answers are true and correct. I understand that making a false statement, concealing property, or obtaining money or property by fraud 

in connection with a bankruptcy case can result in fines up to $250,000, or imprisonment for up to 20 years, or both. 

~-* JC 

Signature of Debtor 2 

Date f ) J.~-1 :;o)/) Date __ 

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

1H No 

D Yes 

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

0 No 

D Yes. Name of person _________________________ . Attach the Bankruptcy Petition Preparer's Notice, 

Declaration, and Signature (Official Form 119). 

Official Form 107 Statement of Financial Affairs for Individuals Filing for Bankruptcy page 12 

Case 20-10535-EPK Doc 1 Filed 01/15/20 Page 48 of 53
! 

Fill in this information to identify your case: 

Debtor 1 JENNIFER L. WILSON 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 

(If known) 

Official Form 108 

D Check if this is an 

amended filing 

Statement of Intention for Individuals Filing Under Chapter 7 1211s 

If you are an individual filing under chapter 7, you must fill out this form if: 

• creditors have claims secured by your property, or 

• you have leased personal property and the lease has not expired. 

You must file this form with the court within 30 days after you file your bankruptcy petition or by the date set for the meeting of creditors, 

whichever is earlier, unless the court extends the time for cause. You must also send copies to the creditors and lessors you list on the form. 

If two married people are filing together in a joint case, both are equally responsible for supplying correct information. 

Both debtors must sign and date the form. 

Be as complete and accurate as possible. If more space is needed, attach a separate sheet to this form. On the top of any additional pages, 

write your name and case number (if known). 

List Your Creditors Who Have Secured Claims 

1. For any creditors that you listed in Part 1 of Schedule D: Creditors Who Have Claims Secured by Property (Official Form 106D), fill in the 

information below. 

Identify the creditor and the property that is collateral What do you intend to do with the property that 

secures a debt? 

Did you claim the property 

as exempt on Schedule C? 

Creditor's 

name: 

Description of 

property 

securing debt: 

Creditor's 

name: 

Description of 

property 

securing debt: 

Creditor's 

name: 

Description of 

property 

securing debt: 

Creditor's 

name: 

Description of 

property 

securing debt: 

Official Form 108 

0 Surrender the property. 

0 Retain the property and redeem it. 

0 Retain the property and enter into a 

Reaffirmation Agreement. 

0 Retain the property and [explain]: ___ _ 

0 Surrender the property. 

0 Retain the property and redeem it. 

0 Retain the property and enter into a 

Reaffirmation Agreement. 

0 Retain the property and [explain]: ___ _ 

• No 

• Yes 

• No 

OYes 

·-·--------·-----------------------------------

0 Surrender the property. 

0 Retain the property and redeem it. 

0 Retain the property and enter into a 

Reaffirmation Agreement. 

0 Retain the property and [explain]: ___ _ 

0 Surrender the property. 

0 Retain the property and redeem it. 

0 Retain the property and enter into a 

Reaffirmation Agreement. 

0 Retain the property and [explain]: ____ _ 

Statement of Intention for Individuals Filing Under Chapter 7 

• No 

OYes 

• No 

• Yes 

page 1 

Case 20-10535-EPK Doc 1 Filed 01/15/20 Page 49 of 53
Debtor1 JENNIFER L. WILSON Case number (If known), ______________ _ 

First Name Middle Name Last Name 

List Your Unexpired Personal Property Leases 

For any unexpired personal property lease that you listed in Schedule G: Executory Contracts and Unexpired Leases (Official Form 106G), 

fill in the information below. Do not list real estate leases. Unexpired leases are leases that are still in effect; the lease period has not yet 

ended. You may assume an unexpired personal property lease if the trustee does not assume it. 11 U.S.C. § 365(p)(2). 

Describe your unexpired personal property leases 

Lessor's name: 

Description of leased 

property: 

Lessor's name: 

Description of leased 

property: 

Lessor's name: 

Description of leased 

property: 

Lessor's name: 

Description of leased 

property: 

Lessor's name: 

Description of leased 

property: 

Lessor's name: 

Description of leased 

property: 

Lessor's name: 

Description of leased 

property: 

•ate Sign Below 

Will the lease be assumed? 

• No 

• Yes 

• No 

0Yes 

• No 

• Yes 

• No 

• Yes 

------------- ----------------------

• No 

• Yes 

• No 

• Yes 

------------------------------

• No 

• Yes 

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

personal property that is subject to an unexpired lease. 

Official Form 108 

Signature of Debtor 2 

Date _______ _ 

MM/ DD/ YYYY 

Statement of Intention for Individuals Filing Under Chapter 7 page 2 

Case 20-10535-EPK Doc 1 Filed 01/15/20 Page 50 of 53
UNITED STATES BANKRUPTCY COURT FOR THE 

SOUTHERN DISTRICT OF FLORIDA 

In re: 

JENNIFER L. WILSON 

Debtor. 

) 

) 

) 

) 

) 

Chapter 7 

DECLARATION OF PRO SE ASSISTANCE 

I, __ J_E_N_N_I_F_E_R_L_._W_I_L_S_Q_N __ , received free legal assistance in preparing 

my bankruptcy forms from the legal aid nonprofit Upsolve. Upsolve is a national legal aid nonprofit 

funded by the Legal Services Corporation and leading philanthropic foundations. It provides free 

Chapter 7 assistance for low-income debtors who need a fresh start but cannot afford counsel. 

Upsolve is not my attorney. I am filing this case without a lawyer or "prose." Because Upsolve 

has provided its services pro bona, Upsolve is not a petition preparer under Section 110 of the 

Bankruptcy Code, and Official Form 119 is not required and has not been provided. 

Date: / / fsjt<JJ:W I 

Upsolve Contact Information: 

TINA TRAN, MANAGING ATTORNEY 

TINA@UPSOLVE.ORG 

t 

Case 20-10535-EPK Doc 1 Filed 01/15/20 Page 51 of 53
SOUTHERN DISTRICT OF FLORIDA 

IN THE UNITED STATES BANKRUPTCY COURT FOR THE 

IN RE: 

JENNIFER L. WILSON 

Debtor. 

) 

) 

) 

) 

) 

Case No. 

Chapter 7 

-----------

VERIFICATION OF MATRIX 

The above named debtor hereby verifies that the attached List of Creditors is true 

and correct to the best of his/her/their knowledge. 

~ 

Date: ,,_Jan~ JG ,:JQ)-1) 

J 

Case 20-10535-EPK Doc 1 Filed 01/15/20 Page 52 of 53
Amex 

Po Box 297871 

Fort Lauderdale, FL 33329 

Capital One Bank Usa N 

Po Box 85520 

Richmond, VA 23285 

Credit Collection Svcs 

Po Box 9134 

Needham, MA 02494 

First Federal Credit 

1940 Harrison Street 

Hollywood, FL 33020 

Phoenix Financial 

7680 Universal Boulevard 

Orlando, FL 32819 

Time Payment Corp 

1600 District Avenue 

Burlington, MA 01803 

United Auto Credit Co 

1071 Camelback St Ste 1 O 

Newport Beach, CA 92660 

Case 20-10535-EPK Doc 1 Filed 01/15/20 Page 53 of 53