4/22

Fill in this information to identify your case:

Debtor 1 Danny Jason Martinez III

Debtor 2

(Spouse, if filing)

United States Bankruptcy Court for the: Northern District of Texas

Case number

(if know)

Official Form 107

Statement of Financial Affairs for Individuals Filing for Statement of Financial Affairs for Individuals Filing for Bankruptcy Bankruptcy

Be as complete and accurate as possible. If two married people are filing together, both are equally responsible for supplying correct information. If more space is needed, attach

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

Part 1: Give Details About Your Marital Status and Where You Lived Before

Part 2: Explain the Sources of Your Income

First Name Middle Name Last Name

First Name Middle Name Last Name

24-70139-13 Check if this is

an amended

filing

What is your current marital status?

 Married

 Not married

1.

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

 No

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

2.

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.)

 No

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

3.

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.

 No

 Yes. Fill in the details.

Debtor 1

Sources of income

Check all that apply

Gross income

(before deductions and

exclusions)

Debtor 2

Sources of income

Check all that apply

Gross income

(before deductions and

exclusions)

4.

From January 1 of current year until the date

you filed for bankruptcy:

Wages, commissions,

bonuses, tips

Operating a business

$ 0.00

Wages, commissions,

bonuses, tips

Operating a business

$ 

For last calendar year:

(January 1 to December 31, 2023

Wages, commissions,

bonuses, tips

Operating a business

$ 0.00

Wages, commissions,

bonuses, tips

Operating a business

$ 

For the calendar year before that:

(January 1 to December 31, 2022

Wages, commissions,

bonuses, tips

Operating a business

$ 0.00

Wages, commissions,

bonuses, tips

Operating a business

$ 

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

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.

5.

Official Form 107 Statement of Financial Affairs for Individuals Filing for Bankruptcy page 1 of 6

Case 24-70139-swe13 Doc 21 Filed 05/20/24 Entered 05/20/24 16:25:24 Desc Main

Document Page 1 of 6
Part 3: List Certain Payments You Made Before You Filed for Bankruptcy

Part 4: Identify Legal Actions, Repossessions, and Foreclosures

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

 No

 Yes. Fill in the details.

Are either Debtor 1’s or Debtor 2’s debts primarily consumer debts?

 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 $7,575* or more?

 No. Go to line 7.

Yes. List below each creditor to whom you paid a total of $7,575* 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 4/01/25 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?

 No. Go to line 7.

 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.

6.

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.

 No.

 Yes. List all payments to an insider.

7.

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.

 No.

 Yes. List all payments that benefited an insider.

8.

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.

 No

 Yes. Fill in the details.

9.

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.

 No. Go to line 11.

 Yes. Fill in the information below.

10.

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

 Yes. Fill in the details

11.

Debtor Case number(if known) 24-70139-13 Danny Jason Martinez III

First Name Middle Name Last Name

Official Form 107 Statement of Financial Affairs for Individuals Filing for Bankruptcy page 2 of 6

Case 24-70139-swe13 Doc 21 Filed 05/20/24 Entered 05/20/24 16:25:24 Desc Main

Document Page 2 of 6
Part 5: List Certain Gifts and Contributions

Part 6: List Certain Losses

Part 7: List Certain Payments or Transfers

Part 8: List Certain Financial Accounts, Instruments, Safe Deposit Boxes, and Storage Units

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?

 No

 Yes

12.

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

 No

 Yes. Fill in the details for each gift.

13.

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?

 No

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

14.

Describe the property you lost and how

the loss occurred

Describe any insurance coverage for the loss

Include the amount that insurance has paid. List pending

insurance claims on line 33 of Schedule A/B: Property.

Date of your loss Value of

property lost

2023 Toyota Highlander was stolen. Debtor

continued to pay vehicle payment and

insurance premiums while police were looking

for vehicle. Once vehicle was returned, Debtor

surrendered vehicle.

Progressive Insurance 12/2023 $ Unknown

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?

 No

 Yes. Fill in the details.

15.

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.

 No

 Yes. Fill in the details.

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 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.

 No

 Yes. Fill in the details.

17.

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.

 No

 Yes. Fill in the details.

18.

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.)

 No

 Yes. Fill in the details.

19.

Debtor Case number(if known) 24-70139-13 Danny Jason Martinez III

First Name Middle Name Last Name

Official Form 107 Statement of Financial Affairs for Individuals Filing for Bankruptcy page 3 of 6

Case 24-70139-swe13 Doc 21 Filed 05/20/24 Entered 05/20/24 16:25:24 Desc Main

Document Page 3 of 6
Part 9: Identify Property You Hold or Control for Someone Else

Part 10: Give Details About Environmental Information

Part 11: Give Details About Your Business or Connections to Any Business

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.

 No

 Yes. Fill in the details.

20.

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?

 No

 Yes. Fill in the details.

21.

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

 No

 Yes. Fill in the details.

22.

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.

 No

 Yes. Fill in the details.

23.

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.

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

 No

 Yes. Fill in the details.

24.

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

 No

 Yes. Fill in the details.

25.

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

 No

 Yes. Fill in the details.

26.

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

 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.

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

27.

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.

28.

Debtor Case number(if known) 24-70139-13 Danny Jason Martinez III

First Name Middle Name Last Name

Official Form 107 Statement of Financial Affairs for Individuals Filing for Bankruptcy page 4 of 6

Case 24-70139-swe13 Doc 21 Filed 05/20/24 Entered 05/20/24 16:25:24 Desc Main

Document Page 4 of 6
 No. None of the above applies. Go to Part 12.

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

Debtor Case number(if known) 24-70139-13 Danny Jason Martinez III

First Name Middle Name Last Name

Official Form 107 Statement of Financial Affairs for Individuals Filing for Bankruptcy page 5 of 6

Case 24-70139-swe13 Doc 21 Filed 05/20/24 Entered 05/20/24 16:25:24 Desc Main

Document Page 5 of 6
Part 12: Sign Below

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.

18 U.S.C. §§ 152, 1341, 1519, and 3571.

Date 05/20/2024

/s/ Danny Jason Martinez III

Signature of Debtor 1

Date 

Signature of Debtor 2

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

 No

 Yes. Name of person Attach the Bankruptcy Petition Preparer’s Notice, 

Declaration, and Signature (Official Form 119).

Debtor Case number(if known) 24-70139-13 Danny Jason Martinez III

First Name Middle Name Last Name

Official Form 107 Statement of Financial Affairs for Individuals Filing for Bankruptcy page 6 of 6

Case 24-70139-swe13 Doc 21 Filed 05/20/24 Entered 05/20/24 16:25:24 Desc Main

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