UNITED STATES BA KRUPTCY COURT, SOUTHERN DISTRICT OF FLORIDA 

www.flsb. uscourts.gov v CHAPTER 13 PLAN (Individual Adjustment of Debts) 

)A-'l I- /BFJJ;i_ - S/>f (J Original Plan 

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

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

DEBTOR, -R, J,, 1⁄4~If 'f:fts._o/2 JOINTDEBTOR ______ CASE NO.: 'J. I- / 86 5 .1-S/'f 4 

SS#: xxx-xx- 7':;6 .3 SS#: xxx-xx-__ _ 

I. OTICES 

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

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

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

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

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

be reduced, modified or eliminated. 

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

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

The valuation of a secured claim, set out in Section III, which may result in a 

partial payment or no payment at all to the secured creditor Included D ot included 

Avoidance of a judicial lien or nonpossessory, nonpurchase-money security interest, set 

out in Section III 

Nonstandard provisions, set out in Section IX 

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

Included Not included 

Included Not included 

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

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

III. 

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

$8.fltl" _jf 5oO formonths_,_to-18.; 

~.ee- 5o 00 for months4 to 36 ; 

3. ~ 7 7 ~o for months 3J_ toM ; 

I. 

2. 

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

Total Fees: $0.00 Total Paid: $0.00 Balance Due: $0.00 --------- --------- ---------

Payable $0.00 /month (Months to -------

Allowed fees under LR 2016-l(B )(2) are itemized below: 

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

TREATMENT OF SECURED CLAIMS O NONE 

A. SECURED CLAIMS: 0 NONE 

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

l. Creditor: LB -I. I 00 ~eA j ~ US-1-

Address: 7 // lf , >fef5o'W ~Arrearage/ Payoff on Petition Date 

Other: 

) v1fc. .l~O Sc.oi{;dA-fl. 1 A- 2-9 ~ :l-[Select Payment Type] 

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.t>fo.f/oN fo v1t/11 {.. chrJ.r- w;-+1- /.lpf'/1/MJ A- / (q/'1' 1/11 

LF-3 1 (rev. 06/04/2 1) Page I of 6 

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Debtor(s): 

Check one below for Real Property: 

[]Principal Residence • Escrow is included in the regular payments 

~her Real Property 

Address of Collateral: // '7 DI 

')4The debtor(s) will pay )<1taxes ~nsurance directly 

Siti I bo.4-'-t- bp.., v~ C ooff--1?- Ci'-fy1 FL 3 3 oJ-6 

Personal PropertyNehicle 

Description of Collateral: ~OOb Fo Fl ~o f,'t1i le-c1rl 

B. VALUATION OF COLLATERAL: 0 NONE 

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

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

YOU PURSUANT TO BR 7004 AND LR 3015-3. 

1. REAL PROPERTY: 0 NONE ' oiJ ?-). </-l.f ooo 

I. Creditor: t-B ,,,r 00 Value of Collateral: ;'1 - $8.fllo/ Payment :;_&5;000 

Address:7//j f . 5-ni'fo,J '/) Amount of Creditor's Lien: -$9.86- Total paid in plan: 5!6.6& 

.,,;rt 1⁄2"o u0+h&rrlefrl:B~'-q 11'671/ 0)-£,5~ J,'s.ovifb - -- Last• Digits of Accmm!No., J13t IntmstRJec 0.06'&- 7[ f. _-- /month (Months _to_ 

Real Property Check one below: J, ~ 0 /-I~ r 5 00 

• Principal Residence 

Other Real Property 

1. Creditor: 

Address: 

Last 4 Digits of Account No.: --,---,---

VIN: i-r, 0 ?-'.l--1 b 

Description of Collateral: 

Check one below: 

D Cl~ii_n incurred 910 days or more prepet1t10n 

D Cl~i1:1 incurred less than 910 days prepetition 

3. PERSONAL PROPERTY: 

LF-31 (rev. 06/04/21) 

D Escrow is included in the monthly 

mortgage payment listed in this section 

The debtor(s) will pay 

x:itaxes 'insurance directly 

Value of Collateral: 

J{->b S[)oo 

57-60 77.YJ 

Payment 

Amount of Creditor's Lien: $0.00 Total paid in plan: $0.00 -----

Interest Rate: 0.00% 

~ lsq~ 

~006 r::, Co JJo / ,e 

awrJ rdPage 2 of6 

$0.00 /month (Months to -----

Case 21-18832-SMG Doc 19 Filed 09/27/21 Page 2 of 6
l. Creditor: Value of Collateral: $0.00 Pannent 

Address: Amount of Creditor's Lien: $0.00 Total paid in plan: $0.00 

Last 4 Digits of Account No.: Interest Rate: 0.00% $0.00 /month (Months to - -

Description of Collateral: 

Check one below: 

DCl~ii:" incurred less than one year prepet1t1on 

DCl~ii:" incurred 1 year or more prepet1t1on 

C. LIEN A :V~I~ANCE~ONE 

D Judicial hens or nonpossessory, nonpurchase money security mterests securing the claims will be avoided to the extent that 

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

7004 and LR 3015-3. 

1. Creditor: Collateral: 

Address: 

Exemption: 

Last 4 Digits of Account No.: ___ _ 

D. SURRENDER OF COLLATERAL: 

Secured claims filed by any creditor granted stay relief in this section shall not receive a distribution fom the Chapter 13 Trustee. 

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

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

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

D Other: 

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

l. • 

E. DIRECT p A YMENTS X NONE 

Secured claims filed by any creditor granted stay relief in this section shall not receive a distribution fom the Chapter 13 Trustee. 

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

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

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

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

l. 

IV. TREATMENT OF FEES AND PRIORITY CLAIMS [as defined in 11 U.S.C. §507 and 11 U.S.C. § 1322(a)(4)] 0 NONE 

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

1. Name: 

Payment Address: 

Total Due: $0.00 

Payable $0.00 /month (Months ------

Payable $0.00 /month (Months 

B. INTERNAL REVENUE SERVICE: 

LF-31 (rev. 06/04/21) 

to 

to 

Page 3 of6 

) 

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V. 

VI. 

Case number: J-\-IB03:2--)/tf. i 

Total Due: $0.00 Total Payment $0.00 

Payable: $0.00 /month (Months .. to ) 

C. DQMESTIC Sl!PPQRT QBLIGATION(S): ~ONE 0 CURRENT AND PAID OUTSIDE 

1. Name of Creditor: 

I 

Payment Address: 

Total Due: $0.00 

Payable $0.00 /month (Months to ) - -

Regular Payemnt (if applicable) $0.00 /month (Months to ) - -

D. OTHER: -~NONE 

I , 

1. Name of Creditor: 

Payment Address: 

Total Due: $0.00 

Payable $0.00 /month (Months to ) - -

Regular Payemnt (if applicable) $0.00 /month (Months to ) - -

TREATMENT OF UNSECURED NOr-!PRIORITY CREDIIQRS ~NONE 

A. Pa y ______ $0.00 _ /month (M onths to 

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

B. D If checked, the Debtor(s) will amend/modify to pay l 00% to all allowed unsecured nonpriority claims. 

C. SEPARATELY CLASSIFIED: NONE 

1. Name of Creditor: 

Payment Address: ----------------------------------- Last 4 Digits of Account No.: ------

Basis for Separate Classification _____________________________ _ 

Payable $0.00 /month (Months to 

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

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

STl!DENTLQANPRQGRAM )Q ONE 

A. FEDERAL - Direct Pay 0 one 

Name of student who benefitted from the loan (if different than the Debtor) ------------------- 1. Name of Private Student Loan Holder and/or Servicer: 

Address: ------------------------------------------ Last 4 Digits of Account No.: ______ _ 

The debtor(s) filed the Local Form Notice of Income Driven Repayment Plan. All Federal Student loan payments shall be paid directly 

by the debtor(s) and the debtor(s) will be solely responsible for ensuring that the direct payments to the Federal Student Loan Holder(s) 

are received timely. The monthly IDR payment is set forth in the Local Form Notice of Income Driven Repayment Plan. 

The debtor(s) expressly waive(s) any and all causes of action and claims against the Federal Student Loan Holder(s) and Servicer(s) for 

any alleged violation of the automatic stay under 11 U.S.C. § 362(a) with regard to and in consideration of the benefits of enrollment 

and participation in an IDR plan during the Chapter 13 case. Debtor(s) must file a certificate of service indicating that a copy of the plan 

was served in accordance with the provisions of Section IV of the Court's Student Loan Program Procedures. 

The debtor(s) shall file annual recertifications on or before the anniversary date of any IDR plan until such time as the Department of 

Education establishes the automatic recertification of income for IDR bo1Towers. If the IDR plan payment changes after recertification 

LF-31 (rev. 06/04/21) Page 4 of6 

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VII. 

Debtm(s) I!: cA fj_/1..J f< ' <;'fR~ C= mbe, ?-I 'I BB3~-5J'1Q, or after the debtor(s) receive(s) the Department of Education annual certification, thei;, no later than 14 days after receiving notice of the 

payment change, the debtor(s) must file the Local Form Notice of IDR Payment Change noting the change in the monthly IDR plan 

payment. 

Any Notice required to be given to the Federal Student Loan Holder under this Section must include the name(s) of the debtor(s) and the 

bankruptcy case number and Chapter 13 designation, must identify the Federal Student Loans, and must be served in accordance with 

the provisions in Section IV of the Cowi's Student Loan Program Procedures. 

B. PRIVATE - Paid in the Chapter 13 Plan )Q None 

Name of student who benefitted from the loan (if different than the Debtor) ------------------- 1. Name of Private Student Lender: 

Address: 

Last 4 Digits of Account No.: -----

EXECUTORY CO TRACTS A D UNEXPIRED LEASES ~ NONE 

Payable $0.00 /month (Months to ------

Secured claims filed by any creditor/lessor granted stay relief in this section shall not receive a distribution from the Chapter 13 Trustee. 

VIII. 

l. 

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

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

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

Name of Creditor Collateral Acct. No. (Last 4 Digits) Assume/Reject 

INCOME TAX RETURNS AND REFUNDS:~NONE 'X Debtor(s) will not provide tax returns unless requested by any interested party pursuant to 11 U.S.C. § 521. 

D Assume D Reject ---------

D The debtor(s) is hereby advised that the chapter 13 trustee has requested that the debtor(s) comply with 52l(f) 1-4 on an 

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

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

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

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

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

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

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

allowed unsecured claims. [Broward/Palm Beach cases] 

IX. ON-ST AND ARD PLAN PROVISIONS O NONE 

')<'I Nonstandard provisions must be set forth below. A nonstandard provision is a provision not otherwise included in the Local 

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

Case 21-18832-SMG Doc 19 Filed 09/27/21 Page 5 of 6
PROPERTY OF THE ESTATE WILL VEST IN THE DEBTOR(S) UPON PLAN CONFIRMATION. 

I declare that the foregoing chapter 13 plan is true and correct under penalty of perjury. 

~~ Debtm 

Attorney with permission to sign on 

Debtor(s)' behalf 

Date 

Joint Debtor 

Date 

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

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

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

LF-3 1 (rev. 06/04/2 1) Page 6 of 6 

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