Official Form 107

Statement of Financial Affairs for Individuals Filing for Bankruptcy 04/22 

Fill in this information to identify your case:

Debtor 1

Debtor 2

(Spouse, if filing)

First Name Middle Name Last Name

First Name Middle Name Last Name

United States Bankruptcy Court for the:

Case number

(if known)

Donny Sanchez Brokenberry

NORTHERN DISTRICT OF TEXAS

24-40189-13

1. What is your current marital status?





Married

Not married

 Check if this is an

amended filing

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

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.

2. 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.

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





No

Yes. Make sure you fill out

(Community property states and territories include Arizona, California, Idaho, Louisiana, Nevada, New Mexico, Puerto Rico, Texas,

Washington, and Wisconsin.)

Schedule H: Your Codebtors (Official Form 106H).

Part 2: Explain the Sources of Your Income

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





No

Yes. Fill in the details.

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.



Operating a business

For last calendar year:

(January 1 to December 31,

YYYY

)



Operating a business



Operating a business

For the calendar year before that:

(January 1 to December 31,

YYYY

)



Operating a business



Operating a business



Operating a business

Debtor 1 Debtor 2

Sources of income

Check all that apply.

Gross income

(before deductions

and exclusions

Sources of income

Check all that apply.

Gross income

(before deductions

and exclusions

2023

2022

$1,500.00 

$38,000.00 

$29,636.00 

Wages, commissions, 

bonuses, tips

From January 1 of the current year until 

the date you filed for bankruptcy:

Wages, commissions, 

bonuses, tips

Wages, commissions, 

bonuses, tips

Wages, commissions, 

bonuses, tips

Wages, commissions, 

bonuses, tips

Wages, commissions, 

bonuses, tips

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

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Debtor 1 Donny Sanchez Brokenberry Case number (if known) 24-40189-13

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





No

Yes. Fill in the details.

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.

Part 3: List Certain Payments You Made Before You Filed for Bankruptcy

6. 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.

* 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 $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.

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.

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;





No

Yes. List all payments to an insider.

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.

8. 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?





No

Yes. List all payments that benefited an insider.

Include payments on debts guaranteed or cosigned by an insider.

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

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Debtor 1 Donny Sanchez Brokenberry Case number (if known) 24-40189-13

Part 4: 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?





No

Yes. Fill in the details.

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

modifications, and contract disputes.

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





No. Go to line 11.

Yes. Fill in the information below.

seized, or levied?

Check all that apply and fill in the details below.

11.





No

Yes. Fill in the details.

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?

12.





No

Yes

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?

Part 5: 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?





No

Yes. Fill in the details for each gift.

14.





No

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

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?

Part 6: List Certain Losses

15.





No

Yes. Fill in the details.

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?

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

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Debtor 1 Donny Sanchez Brokenberry Case number (if known) 24-40189-13

Part 7: List Certain Payments or Transfers

16.





No

Yes. Fill in the details.

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

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?

Description and value of any property transferred Date payment

or transfer was

Amount of

Person Who Was Paid

Number Street

City State ZIP Code

Email or website address

Person Who Made the Payment, if Not You

payment CINLegla Data Services

4540 Honeywell Court

Dayton OH

1/19/2024 $61.00

www.cinlegla.com

made

Credit Reprt $37

Credit Counseling Course $24

Description and value of any property transferred Date payment

or transfer was

Amount of

Person Who Was Paid

Number Street

City State ZIP Code

Email or website address

Person Who Made the Payment, if Not You

payment Steele Law Firm, PLLC

3629 Lovell Avenue

Suite 100

Fort Worth TX 76107

01/19/2024 $518.00

www.SteeleBankruptcy.com

made

Chapter 13 Attorney Fees

17.





No

Yes. Fill in the details.

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

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

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Debtor 1 Donny Sanchez Brokenberry Case number (if known) 24-40189-13

18.





No

Yes. Fill in the details.

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 granting of a security interest or mortgage on your property).

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

19.





No

Yes. Fill in the details.

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.)

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

20.





No

Yes. Fill in the details.

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.











Checking

Savings

Money market

Brokerage

Other

XXXXName of Financial Institution

Number Street

City State ZIP Code

Chase Bank 

 883 02/2023 ($700.00)

Type of account or 

instrument

Last 4 digits of account 

number

Date account 

was closed, 

sold, moved, 

or transferred

Last balance 

before closing 

or transfer

21.





No

Yes. Fill in the details.

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?

22.





No

Yes. Fill in the details.

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

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

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Debtor 1 Donny Sanchez Brokenberry Case number (if known) 24-40189-13

Part 9: Identify Property You Hold or Control for Someone Else

23.





No

Yes. Fill in the details.

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.

Owner's Name

Number Street

City State ZIP Code

Number Street

City State ZIP Code

Where is the property? Describe the property Value

Donaisha Brokenberry (Daughter) 

Lewisville TX Lewisville TX

2016 Dodge Dart SXT $6,500.00

(Mr. Brokenberry is co-signer 

only) 

Part 10: Give Details About Environmental Information





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

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

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

 means anything an environmental law defines as a hazardous waste, hazardous substance, toxic

Environmental law

Site

Hazardous material

hazardous or toxic substance, 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.

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

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

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

24.





No

Yes. Fill in the details.

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

law?

25.





No

Yes. Fill in the details.

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

26.





No

Yes. Fill in the details.

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

orders.

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

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Debtor 1 Donny Sanchez Brokenberry Case number (if known) 24-40189-13

27.

 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)

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

 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.

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

business?

Business Name

Number Street

City State ZIP Code

Describe the nature of the business Employer Identification number

Name of accountant or bookkeeper

Do not include Social Security number or ITIN.

EIN: –

Dates business existed

From To

1st Choice Notary Service

3620 Silverado Trail 

Roanoke TX 76262

12/20/2020 Present 

Notary Signing Services 

28.





No

Yes. Fill in the details below.

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.

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

X /s/ Donny Sanchez Brokenberry X

Donny Sanchez Brokenberry, Debtor 1 Signature of Debtor 2

Date Date

Did you attach additional pages toYour Statement of Financial Affairs for Individuals Filing for Bankruptcy (Official Form 107)?





No

Yes

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).

02/19/2024

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.

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

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