Fill in this information to identify your case:

United States Bankruptcy Court for the:

Northern District of Texas

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

Chapter 7

Chapter 11

Chapter 12

Chapter 13 Check if this is an

amended filing

Official Form 101

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.

Part 1: Identify Yourself

1. Your full name

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.

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

Jerry

First name

Sarah

First name

Dean

Middle name

Joann

Middle name

Holt

Last name

Holt

Last name

Jr

Suffix (Sr., Jr, II, III) Suffix (Sr., Jr, II, III)

2. All other names you have

used in the last 8 years

Include your married or maiden

names and any assumed, trade

names and doing business as

names.

Do NOT list the name of any

separate legal entity such as a

corporation, partnership, or LLC

that is not filing this petition.

First name First name

Middle name Middle name

Last name Last name

Business name (if applicable) Business name (if applicable)

Business name (if applicable) Business name (if applicable)

3. Only the last 4 digits of your

Social Security number or

federal Individual Taxpayer

Identification number

(ITIN)

xxx - xx - 2 2 0 4 xxx - xx - 9 0 9 0

OR OR

9xx - xx - 9xx - xx -

Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 1

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Voluntary Petition for Individuals Filing for Bankruptcy 12/22

Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 1 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

4. Your Employer Identification

Number (EIN), if any.

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

-

EIN

-

EIN

-

EIN

-

EIN

5. Where you live

If Debtor 2 lives at a different address:

250 Tweetie Pie

Number Street Number Street

Abilene, TX 79602

City State ZIP Code City State ZIP Code

Taylor

County County

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.

If Debtor 2's mailing address is different from yours, fill

it in here. Note that the court will send any notices to you

at this mailing address.

Number Street Number Street

P.O. Box P.O. Box

City State ZIP Code City State ZIP Code

6. Why you are choosing this

district to file for bankruptcy

Check one: Check one:

Over the last 180 days before filing this petition, I

have lived in this district longer than in any other

district.

Over the last 180 days before filing this petition, I

have lived in this district longer than in any other

district.

I have another reason. Explain.

(See 28 U.S.C. § 1408)

I have another reason. Explain.

(See 28 U.S.C. § 1408)

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

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Document Page 2 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Part 2: Tell the Court About Your Bankruptcy Case

7. 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.S.C. § 342(b) for Individuals Filing for

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

Chapter 7

Chapter 11

Chapter 12

Chapter 13

8. How you will pay the fee 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.

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

to Pay The Filing Fee in Installments (Official Form 103A).

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.

9. Have you filed for bankruptcy

within the last 8 years?

No.

Yes. District When

MM / DD / YYYY

Case number

District When

MM / DD / YYYY

Case number

District When

MM / DD / YYYY

Case number

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?

No.

Yes. Debtor Relationship to you

District When

MM / DD / YYYY

Case number, if known

Debtor Relationship to you

District When

MM / DD / YYYY

Case number, if known

11. Do you rent your residence? No. Go to line 12.

Yes. Has your landlord obtained an eviction judgment against you?

No. Go to line 12.

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

as part of this bankruptcy petition.

Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 3

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Document Page 3 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Part 3: 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.

No. Go to Part 4.

Yes. Name and location of business

Name of business, if any

Number Street

City State ZIP Code

Check the appropriate box to describe your business:

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

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

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

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

None of the above

13. Are you filing under Chapter

11 of the Bankruptcy Code,

and are you a small business

debtor or a debtor as defined

by 11 U.S. C. § 1182(1)?

For a definition of small business

debtor, see 11 U.S.C. §

101(51D).

If you are filing under Chapter 11, the court must know whether you are a small business debtor or a debtor choosing to

proceed under Subchapter V so that it can set appropriate deadlines. If you indicate that you are a small business

debtor or you are choosing to proceed under Subchapter V, 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).

No. I am not filing under Chapter 11.

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

Bankruptcy Code.

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

Bankruptcy Code, and I do not choose to proceed under Subchapter V of Chapter 11.

Yes. I am filing under Chapter 11, I am a debtor according to the definition in § 1182(1) of the Bankruptcy

Code, and I choose to proceed under Subchapter V of Chapter 11.

Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 4

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Document Page 4 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Part 4: 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?

No.

Yes. What is the hazard?

If immediate attention is needed, why is it needed?

Where is the property?

Number Street

City State ZIP Code

Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 5

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Document Page 5 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Part 5: 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.

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

You must check one: You must check one:

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.

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.

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.

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.

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.

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.

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.

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.

Any extension of the 30-day deadline is granted only for

cause and is limited to a maximum of 15 days.

I am not required to receive a briefing about credit

counseling because of:

Incapacity. I have a mental illness or a mental

deficiency that makes me incapable of

realizing or making rational decisions

about finances.

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.

Active duty. I am currently on active military duty in

a military combat zone.

I am not required to receive a briefing about credit

counseling because of:

Incapacity. I have a mental illness or a mental

deficiency that makes me incapable of

realizing or making rational decisions

about finances.

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.

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.

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.

Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 6

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 6 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Part 6: Answer These Questions for Reporting Purposes

16. What kind of debts do you

have?

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.”

No. Go to line 16b.

Yes. Go to 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.

No. Go to line 16c.

Yes. Go to line 17.

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

17. Are you filing under Chapter 7?

Do you estimate that after any

exempt property is excluded

and administrative expenses are

paid that funds will be available

for distribution to unsecured

creditors?

No. I am not filing under Chapter 7. Go to line 18.

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

administrative expenses are paid that funds will be available to distribute to unsecured creditors?

No

Yes

18. How many creditors do you

estimate that you owe?

1-49

50-99

100-199

200-999

1,000-5,000

5,001-10,000

10,001-25,000

25,001-50,000 50,000-100,000 More than 100,000

19. How much do you estimate your

assets to be worth?

$0-$50,000

$50,001-$100,000

$100,001-$500,000

$500,001-$1 million

$1,000,001-$10 million

$10,000,001-$50 million

$50,000,001-$100 million

$100,000,001-$500 million

$500,000,001-$1 billion

$1,000,000,001-$10 billion

$10,000,000,001-$50 billion

More than $50 billion

20. How much do you estimate your

liabilities to be?

$0-$50,000

$50,001-$100,000

$100,001-$500,000

$500,001-$1 million

$1,000,001-$10 million

$10,000,001-$50 million

$50,000,001-$100 million

$100,000,001-$500 million

$500,000,001-$1 billion

$1,000,000,001-$10 billion

$10,000,000,001-$50 billion

More than $50 billion

Part 7: Sign Below

For you 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, 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 3571.

✘ /s/ Jerry Dean Holt, Jr

Jerry Dean Holt, Jr, Debtor 1

Executed on 05/23/2023

MM/ DD/ YYYY

✘ /s/ Sarah Joann Holt

Sarah Joann Holt, Debtor 2

Executed on 05/23/2023

MM/ DD/ YYYY

Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 7

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Document Page 7 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

For your attorney, if you are

represented by one

If you are not represented by an

attorney, you do not need to file this

page.

I, the attorney for the debtor(s) named in this petition, declare that I have informed the debtor(s) about eligibility to

proceed under Chapter 7, 11, 12, or 13 of title 11, United States Code, and have explained the relief available under

each chapter for which the person is eligible. I also certify that I have delivered to the debtor(s) the notice required by

11 U.S.C. § 342(b) and, in a case in which § 707(b)(4)(D) applies, certify that I have no knowledge after an inquiry

that the information in the schedules filed with the petition is incorrect.

✘ /s/ Kevin W. Willhelm

Signature of Attorney for Debtor

Date 05/23/2023

MM / DD / YYYY

Kevin W. Willhelm

Printed name

Willhelm Law Firm

Firm name

Po Box 3536

Number Street

Abilene

City

TX

State

79604-3536

ZIP Code

Contact phone (325) 692-0900 Email address justice@willhelmlaw.com

00785252

Bar number

TX

State

Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 8

Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 8 of 115
Fill in this information to identify your case:

Debtor 1 Jerry Dean Holt, Jr

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Sarah Joann Holt

First Name Middle Name Last Name

United States Bankruptcy Court for the: Northern District of Texas

Case number

(if known)

Check if this is an

amended filing

Official Form 107

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

1. What is your current marital status?

Married

Not married

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.

Debtor 1: Dates Debtor 1 lived

there

Debtor 2: Dates Debtor 2 lived

there

2045 Grandon Loop Rd.

Number Street

Virginia Beach, VA 23456

City State ZIP Code

From 08/1/2019

To 4/1/2021

Same as Debtor 1

Number Street

City State ZIP Code

Same as Debtor 1

From 

To

Number Street

City State ZIP Code

From 

To

Same as Debtor 1

Number Street

City State ZIP Code

Same as Debtor 1

From 

To

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.)

No

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

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

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

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Document Page 9 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

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?

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 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)

From January 1 of current year until the

date you filed for bankruptcy:

Wages, commissions,

bonuses, tips

 Operating a business

$71,621.95

$29,509.04

Wages, commissions,

bonuses, tips

 Operating a business

$19,703.80

For last calendar year:

(January 1 to December 31, 2022 )

YYYY

Wages, commissions,

bonuses, tips

 Operating a business

$149,242.00

$4,420.00

Wages, commissions,

bonuses, tips

 Operating a business

For the calendar year before that:

(January 1 to December 31, 2021 )

YYYY

Wages, commissions,

bonuses, tips

 Operating a business

$198,422.00

Wages, commissions,

bonuses, tips

 Operating a business

$51,124.00

5. 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.

No

Yes. Fill in the details.

Debtor 1 Debtor 2

Sources of income

Describe below.

Gross income from

each source

(before deductions and

exclusions)

Sources of income

Describe below.

Gross Income from

each source

(before deductions and

exclusions)

From January 1 of current year until the

date you filed for bankruptcy:

For last calendar year:

(January 1 to December 31, 2022 )

YYYY

For the calendar year before that:

(January 1 to December 31, 2021 )

YYYY

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

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Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

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. 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.

Dates of

payment

Total amount paid Amount you still owe Was this payment for...

CITIZENS BANK NA

Creditor's Name

4201 S TREADAWAY BLVD

Number Street

ABILENE, TX 79602

City State ZIP Code

02/01/2023

01/01/2023

12/01/2022

$1,908.00 $74,196.00

 Mortgage

 Car

 Credit card

 Loan repayment

 Suppliers or vendors

 Other 

CITY BANK- INDIRECT

Creditor's Name

PO BOX 5060

Number Street

LUBBOCK, TX 79408

City State ZIP Code

02/01/2023

01/01/2023

12/01/2022

$2,847.00 $45,897.00

 Mortgage

 Car

 Credit card

 Loan repayment

 Suppliers or vendors

 Other 

ESB/HARLEY DAVIDSON CR

Creditor's Name

PO BOX 21829

Number Street

CARSON CITY, NV 89721

City State ZIP Code

02/01/2023

01/01/2023

12/01/2022

$2,142.00 $28,140.00

 Mortgage

 Car

 Credit card

 Loan repayment

 Suppliers or vendors

 Other 

GTWY 1ST FKA GTWY MRTG

Creditor's Name

244 S GATEWAY PL

Number Street

JENKS, OK 74037

City State ZIP Code

02/01/2023

01/01/2023

12/01/2022

$9,558.00 $351,396.00

 Mortgage

 Car

 Credit card

 Loan repayment

 Suppliers or vendors

 Other 

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 11 of 115
Official Form 107 Statement of Financial Affairs for Individuals Filing for Bankruptcy page 3

Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 12 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

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.

 No

 Yes. List all payments to an insider.

Dates of

payment

Total amount paid Amount you still

owe

Reason for this payment

Insider's Name

Number Street

City State ZIP Code

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?

Include payments on debts guaranteed or cosigned by an insider.

 No

 Yes. List all payments that benefited an insider.

Dates of

payment

Total amount paid Amount you still

owe

Reason for this payment

Include creditor’s name

Insider's Name

Number Street

City State ZIP Code

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?

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.

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

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 13 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Nature of the case Court or agency Status of the case

Case title 

Case number 

Court Name

Number Street

City State ZIP Code

 Pending

 On appeal

 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.

 No. Go to line 11.

 Yes. Fill in the information below.

Creditor’s Name

Number Street

City State ZIP Code

Describe the property

Explain what happened

 Property was repossessed.

 Property was foreclosed.

 Property was garnished.

 Property was attached, seized, or levied.

Date Value of the property

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

 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 courtappointed receiver, a custodian, or another official?

 No

 Yes

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

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 14 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

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.

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 Dates you gave

the gifts

Value

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?

 No

 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

Describe what you contributed Date you

contributed

Value

Part 6: List Certain Losses

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?

 No

 Yes. Fill in the details.

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

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

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 15 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Part 7: List Certain Payments or Transfers

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.

 No

 Yes. Fill in the details.

Willhelm Law Firm

Person Who Was Paid

Po Box 3536

Number Street

Abilene, TX 79604-3536

City State ZIP Code

Email or website address

Person Who Made the Payment, if Not You

Description and value of any property transferred

Attorney’s Fee

Date payment or

transfer was made

2/13/2023

Amount of payment

$0.00

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.

 No

 Yes. Fill in the details.

Person Who Was Paid

Number Street

City State ZIP Code

Description and value of any property transferred Date payment or

transfer was made

Amount of payment

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.

 No

 Yes. Fill in the details.

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

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 16 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Description and value of property

transferred

Describe any property or payments

received or debts paid in exchange

Date transfer was

made

Person Who Received Transfer

Number Street

City State ZIP Code

Person's relationship to you 

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.)

 No

 Yes. Fill in the details.

Name of trust 

Description and value of the property transferred Date transfer was

made

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

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.

 No

 Yes. Fill in the details.

Last 4 digits of account number Type of account or

instrument

Date account was

closed, sold, moved, or

transferred

Last balance

before closing or

transfer

USAA Bank

Name of Financial Institution

9800 Fredericksburg Rd

Number Street

San Antonio, TX 78288

City State ZIP Code

XXXX– Checking

 Savings

 Money market

 Brokerage

 Other 

Sept. 2022

Official Form 107 Statement of Financial Affairs for Individuals Filing for Bankruptcy page 8

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 17 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Last 4 digits of account number Type of account or

instrument

Date account was

closed, sold, moved, or

transferred

Last balance

before closing or

transfer

USAA Bank

Name of Financial Institution

9800 Fredericksburg Rd

Number Street

San Antonio, TX 78288

City State ZIP Code

XXXX– Checking

 Savings

 Money market

 Brokerage

 Other 

Sept. 2022

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?

 No

 Yes. Fill in the details.

Who else had access to it? Describe the contents Do you still have

it?

Name of Financial Institution

Number Street

City State ZIP Code

Name

Number Street

City State ZIP Code

 No

 Yes

22. 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.

Who else has or had access to it? Describe the contents Do you still have

it?

Name of Storage Facility

Number Street

City State ZIP Code

Name

Number Street

City State ZIP Code

 No

 Yes

Official Form 107 Statement of Financial Affairs for Individuals Filing for Bankruptcy page 9

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 18 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

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

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.

 No

 Yes. Fill in the details.

Where is the property? Describe the property Value

Owner's Name

Number Street

City State ZIP Code

Number Street

City State ZIP Code

Part 10: Give Details 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.

24. 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.

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

Name of site

Number Street

City State ZIP Code

Governmental unit

Number Street

City State ZIP Code

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

 No

 Yes. Fill in the details.

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

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 19 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

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

Name of site

Number Street

City State ZIP Code

Governmental unit

Number Street

City State ZIP Code

26. 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.

Court or agency Nature of the case Status of the case

Case title

Case number

Court Name

Number Street

City State ZIP Code

 Pending

 On appeal

 Concluded

Part 11: 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

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.

Name

Number Street

City State ZIP Code

Describe the nature of the business

Name of accountant or bookkeeper

Employer Identification number

Do not include Social Security number or ITIN.

EIN: –

Dates business existed

From To 

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

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 20 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

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

 Yes. Fill in the details below.

Date issued

Name

Number Street

City State ZIP Code

MM / DD / YYYY

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.

✘ /s/ Jerry Dean Holt, Jr

Signature of Jerry Dean Holt, Jr, Debtor 1

Date 05/23/2023

✘ /s/ Sarah Joann Holt

Signature of Sarah Joann Holt, Debtor 2

Date 05/23/2023

Did you attach additional pages to your 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).

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

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 21 of 115
Fill in this information to identify your case:

Debtor 1 Jerry Dean Holt, Jr

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Sarah Joann Holt

First Name Middle Name Last Name

United States Bankruptcy Court for the: Northern District of Texas

Case number

(if known)

Check if this is an

amended filing

Official Form 106Sum

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

of your schedules first; then complete the information on this form. If you are filing amended schedules after you file your original forms, you must fill out a

new Summary and check the box at the top of this page.

Part 1: Summarize Your Assets

Your assets

Value of what you own

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

1a. Copy line 55, Total real estate, from Schedule A/B...........................................................................................................

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

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

$499,788.00

$136,735.00

$636,523.00

Part 2: Summarize Your Liabilities

Your liabilities

Amount you owe

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

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

$549,377.00

3. Schedule E/F: Creditors Who Have Unsecured Claims (Official Form 106E/F)

3a. Copy the total claims from Part 1 (priority unsecured claims) from line 6e of Schedule E/F......................................

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

$15,430.34

+ $272,022.97

Your total liabilities $836,830.31

Part 3: Summarize Your Income and Expenses

4. Schedule I: Your Income (Official Form 106I)

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

$16,310.88

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

Copy your monthly expenses from line 22c of Schedule J.................................................................................. $5,930.88

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

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Summary of Your Assets and Liabilities and Certain Statistical

Information 12/15

Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 22 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Part 4: Answer These Questions for Administrative and Statistical Records

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

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

 Yes

7. What kind of debt do you have?

Your debts are primarily consumer debts. Consumer debts are those “incurred by an individual primarily for a personal,

family, or household purpose.” 11 U.S.C. § 101(8). Fill out lines 8-9g for statistical purposes. 28 U.S.C. § 159.

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

this form to the court with your other schedules.

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

Form 122A-1 Line 11; OR, Form 122B Line 11; OR, Form 122C-1 Line 14. $17,058.05

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

Total claim

From Part 4 on Schedule E/F, copy the following:

9a. Domestic support obligations (Copy line 6a.) $0.00

9b. Taxes and certain other debts you owe the government. (Copy line 6b.) $11,230.34

9c. Claims for death or personal injury while you were intoxicated. (Copy line 6c.) $0.00

9d. Student loans. (Copy line 6f.) $154,699.00

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

claims. (Copy line 6g.)

$0.00

9f. Debts to pension or profit-sharing plans, and other similar debts. (Copy line 6h.) + $0.00

9g. Total. Add lines 9a through 9f. $165,929.34

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

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 23 of 115
Fill in this information to identify your case and this filing:

Debtor 1 Jerry Dean Holt, Jr

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Sarah Joann Holt

First Name Middle Name Last Name

United States Bankruptcy Court for the: Northern District of Texas

Case number 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.

Part 1: 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.

Yes. Where is the property?

1.1 PACK SADDLE PRAIRIE SEC 1,

BLOCK B, LOT 7, ACRES 1.03

Street address, if available, or other

description

250 Tweetie Pie

Abilene, TX 79602

City State ZIP Code

Taylor

County

What is the property? Check all that apply.

Single-family home

Duplex or multi-unit building

Condominium or cooperative

Manufactured or mobile home

Land

Investment property

Timeshare

Other

Who has an interest in the property? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

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?

$425,592.00

Current value of the

portion you own?

$425,592.00

Describe the nature of your ownership interest

(such as fee simple, tenancy by the entireties, or

a life estate), if known.

Fee Simple

Check if this is community property

(see instructions)

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

property identification number: 

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

1.2 PACK SADDLE PRAIRIE SEC 2,

BLOCK C, LOT 47, ACRES 1.02

Street address, if available, or other

description

250 Tweetie Pie

Abilene, TX 79602

City State ZIP Code

Taylor

County

What is the property? Check all that apply.

Single-family home

Duplex or multi-unit building

Condominium or cooperative

Manufactured or mobile home

Land

Investment property

Timeshare

Other

Who has an interest in the property? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

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?

$74,196.00

Current value of the

portion you own?

$74,196.00

Describe the nature of your ownership interest

(such as fee simple, tenancy by the entireties, or

a life estate), if known.

Fee Simple

Check if this is community property

(see instructions)

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

property identification number: 

Official Form 106A/B Schedule A/B: Property page 1

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 24 of 115
Debtor Holt, Jerry Dean; Holt, Sarah Joann Case number (if known)

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

you have attached for Part 1. Write that number here ...................................................................................................➔ $499,788.00

Part 2: 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

No

Yes

3.1 Make: Jeep

Model: Grand Cherokee

Year: 2021

Approximate mileage:

Other information:

Who has an interest in the property? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this 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?

$49,748.00

Current value of the

portion you own?

$49,748.00

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

3.2 Make: Chevrolet

Model: Silverado

Year: 2021

Approximate mileage:

Other information:

Who has an interest in the property? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this 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?

$45,897.00

Current value of the

portion you own?

$45,897.00

3.3 Make: Harley

Model: Triglide Ultra

Year: 2021

Approximate mileage:

Other information:

Who has an interest in the property? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this 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?

$28,140.00

Current value of the

portion you own?

$28,140.00

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

No

Yes

Official Form 106A/B Schedule A/B: Property page 2

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Debtor Holt, Jerry Dean; Holt, Sarah Joann Case number (if known)

4.1 Make:

Model:

Year:

Other information:

Who has an interest in the property? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this 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?

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

you have attached for Part 2. Write that number here ...................................................................................................➔ $123,785.00

Part 3: Describe Your Personal and Household Items

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

portion you own?

Do not deduct secured

claims or exemptions.

6. Household goods and furnishings

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

No

Yes. Describe. ......... Stove, microwave, refrigerator, dishwasher, living room furniture, bedroom furniture, lawn

furniture, den furniture, kitchen wares, dining room furniture, washer/dryer

$4,000.00

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

No

Yes. Describe. ......... Computer, printer, tablets, TVS $2,700.00

8. 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

No

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

No

Yes. Describe. .........

10. Firearms

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

No

Yes. Describe. ......... See Attached. $1,750.00

Official Form 106A/B Schedule A/B: Property page 3

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11. Clothes

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

No

Yes. Describe. ......... Misc. wearing apparel and accessories $500.00

12. Jewelry

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

silver

No

Yes. Describe. ......... Misc. jewelry $200.00

13. Non-farm animals

Examples: Dogs, cats, birds, horses

No

Yes. Describe. ......... 3 dogs unknown

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

No

Yes. Give specific

information. .............

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 .................................................................................................................................➔ $9,150.00

Part 4: Describe Your Financial Assets

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

portion you own?

Do not deduct secured

claims or exemptions.

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

No

Yes ................................................................................................................................................... Cash: ...................

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.

No

Yes ..................... Institution name:

17.1. Checking account: First Financial Bank $1,000.00

17.2. Savings account: First Financial Bank unknown

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

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18. Bonds, mutual funds, or publicly traded stocks

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

No

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

No

Yes. Give specific

information about

them.................... Name of entity: % of ownership:

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.

No

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

No

Yes. List each

account separately. Type of account: Institution name:

401(k) or similar plan: Debtor 1 $200.00

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

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Debtor Holt, Jerry Dean; Holt, Sarah Joann Case number (if known)

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

No

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

Electric:

Gas:

Heating oil:

Security deposit on rental unit:

Prepaid rent:

Telephone:

Water:

Rented furniture:

Other:

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

No

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

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).

No

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

No

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

No

Yes. Give specific

information about them. ...

Official Form 106A/B Schedule A/B: Property page 6

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Debtor Holt, Jerry Dean; Holt, Sarah Joann Case number (if known)

27. Licenses, franchises, and other general intangibles

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

No

Yes. Give specific

information about them. ...

Money or property owed to you? Current value of the

portion you own?

Do not deduct secured

claims or exemptions.

28. Tax refunds owed to you

No

Yes. Give specific information about

them, including whether you

already filed the returns and

the tax years. ...................

Federal:

State:

Local:

29. Family support

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

settlement

No

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

No

Yes. Give specific information. ........

31. Interests in insurance policies

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

No

Yes. Name the insurance company

of each policy and list its value. ... Company name: Beneficiary: Surrender or refund value:

Term Life $160,000 Jerry D. Holt, Jr. unknown

Term Life $250,000 Sarah J. Holt unknown

Term Life $500,000 Jerry D. Holt, Jr. unknown

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

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Debtor Holt, Jerry Dean; Holt, Sarah Joann Case number (if known)

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.

No

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

No

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

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

claims

No

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

35. Any financial assets you did not already list

No

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 .................................................................................................................................➔ $1,200.00

Part 5: 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?

No. Go to Part 6.

Yes. Go to line 38.

Current value of the

portion you own?

Do not deduct secured

claims or exemptions.

38. Accounts receivable or commissions you already earned

No

Yes. Describe. .........

39. Office equipment, furnishings, and supplies

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

electronic devices

No

Yes. Describe. .........

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

No

Yes. Describe. .........

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

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Debtor Holt, Jerry Dean; Holt, Sarah Joann Case number (if known)

41. Inventory

No

Yes. Describe. .........

42. Interests in partnerships or joint ventures

No

Yes. Describe .......

Name of entity: % of ownership:

43. Customer lists, mailing lists, or other compilations

No

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

No

Yes. Describe. .........

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

No

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 .................................................................................................................................➔ $0.00

Part 6: Describe Any Farm- 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?

No. Go to Part 7.

Yes. Go to line 47.

Current value of the

portion you own?

Do not deduct secured

claims or exemptions.

Official Form 106A/B Schedule A/B: Property page 9

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47. Farm animals

Examples: Livestock, poultry, farm-raised fish

No

Yes .......................... See Attached. $2,600.00

48. Crops—either growing or harvested

No

Yes. Give specific

information. ............

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

No

Yes ..........................

50. Farm and fishing supplies, chemicals, and feed

No

Yes ..........................

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

No

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 .................................................................................................................................➔ $2,600.00

Part 7: 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

No

Yes. Give specific

information. ............

54. Add the dollar value of all of your entries from Part 7. Write that number here .......................................................➔ $0.00

Part 8: List the Totals of Each Part of this Form

55. Part 1: Total real estate, line 2 ........................................................................................................................................➔ $499,788.00

56. Part 2: Total vehicles, line 5 $123,785.00

57. Part 3: Total personal and household items, line 15 $9,150.00

58. Part 4: Total financial assets, line 36 $1,200.00

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

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Debtor Holt, Jerry Dean; Holt, Sarah Joann Case number (if known)

59. Part 5: Total business-related property, line 45 $0.00

60. Part 6: Total farm- and fishing-related property, line 52 $2,600.00

61. Part 7: Total other property not listed, line 54 + $0.00

62. Total personal property. Add lines 56 through 61. ............... $136,735.00 Copy personal property total ➔ + $136,735.00

63. Total of all property on Schedule A/B. Add line 55 + line 62. ........................................................................................ $636,523.00

Official Form 106A/B Schedule A/B: Property page 11

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Debtor Holt, Jerry Dean; Holt, Sarah Joann Case number (if known)

Continuation Page

10. Firearms

Benelli 20g Shotgun $700

Glock 17 9mm handgun $600 $1,300.00

MMP 2.0 9mm handgun $450.00

47. Farm animals

2 goats at $250 each $500.00

2 Horses at $1,000 Each $2,000.00

20 chickens at $5 each $100.00

Official Form 106A/B Schedule A/B: Property page 12

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$74,196.00

100% of fair market value, up

to any applicable statutory limit

Const. art. 16 §§ 50, 51, Texas Prop.

Code §§ 41.001-.002

$0.00

100% of fair market value, up

to any applicable statutory limit

Const. art. 16 §§ 50, 51, Texas Prop.

Code §§ 41.001-.002

Fill in this information to identify your case:

Debtor 1 Jerry Dean Holt, Jr

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Sarah Joann Holt

First Name Middle Name Last Name

United States Bankruptcy Court for the: Northern District of Texas

Case number

(if known)

Check if this is an

amended filing

Official Form 106C

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.

Part 1: Identify the Property You Claim as Exempt

1.

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

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

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 A/B that lists this property

Current value of the

portion you own

Copy the value from

Schedule A/B

Amount of the exemption you claim

Check only one box for each exemption.

Specific laws that allow exemption

Brief description:

PACK SADDLE PRAIRIE SEC 1, BLOCK B, LOT

7, ACRES 1.03

250 Tweetie Pie Abilene, TX 79602

Line from

Schedule A/B: 1.1

$425,592.00

Brief description:

PACK SADDLE PRAIRIE SEC 2, BLOCK C, LOT

47, ACRES 1.02

250 Tweetie Pie Abilene, TX 79602

Line from

Schedule A/B: 1.2

$74,196.00

3. Are you claiming a homestead exemption of more than $189,050?

(Subject to adjustment on 4/01/25 and every 3 years after that for cases filed on or after the date of adjustment.)

No

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

No

Yes

Official Form 106C Schedule C: The Property You Claim as Exempt page 1 of 4

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Schedule C: The Property You Claim as Exempt 04/22

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$0.00

100% of fair market value, up

to any applicable statutory limit

Tex. Prop. Code §§ 42.001(a),

42.002(a)(9)

$0.00

100% of fair market value, up

to any applicable statutory limit

Tex. Prop. Code §§ 42.001(a),

42.002(a)(9)

$0.00

100% of fair market value, up

to any applicable statutory limit

Tex. Prop. Code §§ 42.001(a),

42.002(a)(9)

$4,000.00

100% of fair market value, up

to any applicable statutory limit

Tex. Prop. Code §§ 42.001(a),

42.002(a)(1)

$2,700.00

100% of fair market value, up

to any applicable statutory limit

Tex. Prop. Code §§ 42.001(a),

42.002(a)(1)

$1,300.00

100% of fair market value, up

to any applicable statutory limit

Tex. Prop. Code §§ 42.001(a),

42.002(a)(7)

$500.00

100% of fair market value, up

to any applicable statutory limit

Tex. Prop. Code §§ 42.001(a),

42.002(a)(5)

$200.00

100% of fair market value, up

to any applicable statutory limit

Tex. Prop. Code §§ 42.001(a),

42.002(a)(6)

Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Part 2: Additional Page

Brief description of the property and line on

Schedule A/B that lists this property

Current value of the

portion you own

Copy the value from

Schedule A/B

Amount of the exemption you claim

Check only one box for each exemption.

Specific laws that allow exemption

Brief description:

2021 Jeep Grand Cherokee

Line from

Schedule A/B: 3.1

$49,748.00

Brief description:

2021 Chevrolet Silverado

Line from

Schedule A/B: 3.2

$45,897.00

Brief description:

2021 Harley Triglide Ultra

Line from

Schedule A/B: 3.3

$28,140.00

Brief description:

Stove, microwave, refrigerator, dishwasher, living

room furniture, bedroom furniture, lawn furniture,

den furniture, kitchen wares, dining room furniture,

washer/dryer

Line from

Schedule A/B: 6

$4,000.00

Brief description:

Computer, printer, tablets, TVS

Line from

Schedule A/B: 7

$2,700.00

Brief description:

Benelli 20g Shotgun $700 Glock 17 9mm handgun

$600

Line from

Schedule A/B: 10

$1,300.00

Brief description:

Misc. wearing apparel and accessories

Line from

Schedule A/B: 11

$500.00

Brief description:

Misc. jewelry

Line from

Schedule A/B: 12

$200.00

Official Form 106C Schedule C: The Property You Claim as Exempt page 2 of 4

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unknown

100% of fair market value, up

to any applicable statutory limit

Tex. Prop. Code §§ 42.001(a),

42.002(a)(11)

unknown

100% of fair market value, up

to any applicable statutory limit

Tex. Prop. Code § 42.001(b)(1)

$200.00

100% of fair market value, up

to any applicable statutory limit

Tex. Prop. Code § 42.0021

unknown

100% of fair market value, up

to any applicable statutory limit

Tex. Ins. Code §§ 1108.001, 1108.051

unknown

100% of fair market value, up

to any applicable statutory limit

Tex. Ins. Code §§ 1108.001, 1108.051

unknown

100% of fair market value, up

to any applicable statutory limit

Tex. Ins. Code §§ 1108.001, 1108.051

$2,000.00

100% of fair market value, up

to any applicable statutory limit

Tex. Prop. Code §§ 42.001(a),

42.002(a)(10)

$500.00

100% of fair market value, up

to any applicable statutory limit

Tex. Prop. Code §§ 42.001(a),

42.002(a)(10)

Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Part 2: Additional Page

Brief description of the property and line on

Schedule A/B that lists this property

Current value of the

portion you own

Copy the value from

Schedule A/B

Amount of the exemption you claim

Check only one box for each exemption.

Specific laws that allow exemption

Brief description:

3 dogs

Line from

Schedule A/B: 13

unknown

Brief description:

First Financial Bank

Savings account

Line from

Schedule A/B: 17

unknown

Brief description:

Debtor 1

Line from

Schedule A/B: 21

$200.00

Brief description:

Term Life $500,000

Line from

Schedule A/B: 31

unknown

Brief description:

Term Life $160,000

Line from

Schedule A/B: 31

unknown

Brief description:

Term Life $250,000

Line from

Schedule A/B: 31

unknown

Brief description:

2 Horses at $1,000 Each

Line from

Schedule A/B: 47

$2,000.00

Brief description:

2 goats at $250 each

Line from

Schedule A/B: 47

$500.00

Official Form 106C Schedule C: The Property You Claim as Exempt page 3 of 4

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$100.00

100% of fair market value, up

to any applicable statutory limit

Tex. Prop. Code §§ 42.001(a),

42.002(a)(10)

Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Part 2: Additional Page

Brief description of the property and line on

Schedule A/B that lists this property

Current value of the

portion you own

Copy the value from

Schedule A/B

Amount of the exemption you claim

Check only one box for each exemption.

Specific laws that allow exemption

Brief description:

20 chickens at $5 each

Line from

Schedule A/B: 47

$100.00

Official Form 106C Schedule C: The Property You Claim as Exempt page 4 of 4

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 39 of 115
Fill in this information to identify your case:

Debtor 1 Jerry Dean Holt, Jr

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Sarah Joann Holt

First Name Middle Name Last Name

United States Bankruptcy Court for the: Northern District of Texas

Case number

(if known)

Check if this is an

amended filing

Official Form 106D

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?

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

Yes. Fill in all of the information below.

Part 1: List All Secured Claims

2. List all secured claims. 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.

Column A

Amount of claim

Do not deduct the

value of

collateral.

Column B

Value of

collateral that

supports this

claim

Column C

Unsecured

portion

If any

2.1 BAYPORT CREDIT UNION

Creditor's Name

3711 HUNTINGTON AVE

Number Street

NEWPORT NEWS, VA 23607

City State ZIP Code

Who owes the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and

another

Check if this claim relates to a

community debt

Date debt was incurred

1/11/2021

Describe the property that secures the claim:

2021 Jeep Grand Cherokee

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

apply.

Contingent

Unliquidated

Disputed

Nature of lien. Check all that apply.

An agreement you made (such as mortgage

or secured car loan)

Statutory lien (such as tax lien, mechanic's

lien)

Judgment lien from a lawsuit

Other (including a right to offset)

Last 4 digits of account number 0 0 0 0

$49,748.00 $49,748.00 $0.00

Add the dollar value of your entries in Column A on this page. Write that number here: $49,748.00

Official Form 106D Schedule D: Creditors Who Have Claims Secured by Property page 1 of 3

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

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 40 of 115
Part 1:

Additional Page

After listing any entries on this page, number them beginning with

2.3, followed by 2.4, and so forth.

Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Column A

Amount of claim

Do not deduct the

value of

collateral.

Column B

Value of

collateral that

supports this

claim

Column C

Unsecured

portion

If any

2.2 CITIZENS BANK NA

Creditor's Name

4201 S TREADAWAY BLVD

Number Street

ABILENE, TX 79602

City State ZIP Code

Who owes the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and

another

Check if this claim relates to a

community debt

Date debt was incurred

5/25/2021

Describe the property that secures the claim:

PACK SADDLE PRAIRIE SEC 2, BLOCK C,

LOT 47, ACRES 1.02

250 Tweetie Pie Abilene, TX 79602

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

apply.

Contingent

Unliquidated

Disputed

Nature of lien. Check all that apply.

An agreement you made (such as mortgage

or secured car loan)

Statutory lien (such as tax lien, mechanic's

lien)

Judgment lien from a lawsuit

Other (including a right to offset)

Last 4 digits of account number X X X X

$74,196.00 $74,196.00 $0.00

2.3 CITY BANK- INDIRECT

Creditor's Name

PO BOX 5060

Number Street

LUBBOCK, TX 79408

City State ZIP Code

Who owes the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and

another

Check if this claim relates to a

community debt

Date debt was incurred

7/2/2021

Describe the property that secures the claim:

2021 Chevrolet Silverado

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

apply.

Contingent

Unliquidated

Disputed

Nature of lien. Check all that apply.

An agreement you made (such as mortgage

or secured car loan)

Statutory lien (such as tax lien, mechanic's

lien)

Judgment lien from a lawsuit

Other (including a right to offset)

Last 4 digits of account number 7 0 8 0

$45,897.00 $45,897.00 $0.00

Add the dollar value of your entries in Column A on this page. Write that number here: $120,093.00

Official Form 106D Additional Page of Schedule D: Creditors Who Have Claims Secured by Property page 2 of 3

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 41 of 115
Part 1:

Additional Page

After listing any entries on this page, number them beginning with

2.3, followed by 2.4, and so forth.

Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Column A

Amount of claim

Do not deduct the

value of

collateral.

Column B

Value of

collateral that

supports this

claim

Column C

Unsecured

portion

If any

2.4 ESB/HARLEY DAVIDSON CR

Creditor's Name

PO BOX 21829

Number Street

CARSON CITY, NV 89721

City State ZIP Code

Who owes the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and

another

Check if this claim relates to a

community debt

Date debt was incurred

8/12/2021

Describe the property that secures the claim:

2021 Harley Triglide Ultra

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

apply.

Contingent

Unliquidated

Disputed

Nature of lien. Check all that apply.

An agreement you made (such as mortgage

or secured car loan)

Statutory lien (such as tax lien, mechanic's

lien)

Judgment lien from a lawsuit

Other (including a right to offset)

Last 4 digits of account number 7 6 0 7

$28,140.00 $28,140.00 $0.00

2.5 GTWY 1ST FKA GTWY MRTG

Creditor's Name

244 S GATEWAY PL

Number Street

JENKS, OK 74037

City State ZIP Code

Who owes the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and

another

Check if this claim relates to a

community debt

Date debt was incurred

5/25/2021

Describe the property that secures the claim:

PACK SADDLE PRAIRIE SEC 1, BLOCK B,

LOT 7, ACRES 1.03

250 Tweetie Pie Abilene, TX 79602

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

apply.

Contingent

Unliquidated

Disputed

Nature of lien. Check all that apply.

An agreement you made (such as mortgage

or secured car loan)

Statutory lien (such as tax lien, mechanic's

lien)

Judgment lien from a lawsuit

Other (including a right to offset)

Last 4 digits of account number 5 5 7 3

$351,396.00 $425,592.00 $0.00

Add the dollar value of your entries in Column A on this page. Write that number here: $379,536.00

If this is the last page of your form, add the dollar value totals from all pages. Write that number

here:

$549,377.00

Official Form 106D Additional Page of Schedule D: Creditors Who Have Claims Secured by Property page 3 of 3

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 42 of 115
Fill in this information to identify your case:

Debtor 1 Jerry Dean Holt, Jr

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Sarah Joann Holt

First Name Middle Name Last Name

United States Bankruptcy Court for the: Northern District of Texas

Case number

(if known)

Check if this is an

amended filing

Official Form 106E/F

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

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

106A/B) and on Schedule G: Executory Contracts and Unexpired Leases (Official Form 106G). Do not include any creditors with partially secured claims that

are listed in Schedule D: Creditors Who Hold 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).

Part 1: List All of Your PRIORITY Unsecured Claims

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

No. Go to Part 2.

Yes.

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

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

amounts. As much as possible, list the claims in alphabetical order according to the creditor’s name. If you have more than two priority unsecured claims,

fill out the Continuation Page of Part 1. If more than one creditor holds a particular claim, list the other creditors in Part 3.

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

Total

claim

Priority

amount

Nonpriority

amount

2.1 City of Virginia Beach

Priority Creditor's Name

2401 Courthouse Drive Bldg 1

Number Street

Virginia Beach, VA 23456

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number

When was the debt incurred?

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

apply.

Contingent

Unliquidated

Disputed

Type of PRIORITY unsecured claim:

Domestic support obligations

Taxes and certain other debts you owe the

government

Claims for death or personal injury while you

were intoxicated

Other. Specify

$319.23 $319.23 $0.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 1 of 44

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

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 43 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Part 1: Your PRIORITY Unsecured Claims - Continuation Page

After listing any entries on this page, number them beginning with 2.3, followed by 2.4, and so forth. Total

claim

Priority

amount

Nonpriority

amount

2.2 IRS

Priority Creditor's Name

Attn: Bankruptcy

PO Box 931200

Number Street

Louisville, KY 40293

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number

When was the debt incurred?

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

apply.

Contingent

Unliquidated

Disputed

Type of PRIORITY unsecured claim:

Domestic support obligations

Taxes and certain other debts you owe the

government

Claims for death or personal injury while you

were intoxicated

Other. Specify

$10,911.11 $10,911.11 $0.00

Remarks: 1040 2020

2.3 Willhelm Law Firm

Priority Creditor's Name

Po Box 3536

Number Street

Abilene, TX 79604-3536

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number

When was the debt incurred?

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

apply.

Contingent

Unliquidated

Disputed

Type of PRIORITY unsecured claim:

Domestic support obligations

Taxes and certain other debts you owe the

government

Claims for death or personal injury while you

were intoxicated

Other. Specify

Attorney Fees

$4,200.00 $4,200.00 $0.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 2 of 44

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 44 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Part 2: List All of Your NONPRIORITY Unsecured Claims

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

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

Yes.

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

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

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

Continuation Page of Part 2.

Total claim

4.1 ACCEPTANCE NOW

Nonpriority Creditor's Name

5501 HEADQUARTERS DR

Number Street

PLANO, TX 75024

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 2142

When was the debt incurred? 07/02/2016

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

RentalAgreement

$6,778.00

4.2 AFFIRM INC

Nonpriority Creditor's Name

650 CALIFORNIA ST FL 12

Number Street

SAN FRANCISCO, CA 94108

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number TWXX

When was the debt incurred? 06/13/2022

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

Unsecured

$899.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 3 of 44

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 45 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

After listing any entries on this page, number them beginning with 4.5, followed by 4.6, and so forth. Total claim

4.3 AFFIRM INC

Nonpriority Creditor's Name

650 CALIFORNIA ST FL 12

Number Street

SAN FRANCISCO, CA 94108

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number L4XX

When was the debt incurred? 06/22/2022

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

Unsecured

$834.00

4.4 CONN APPLIANCES INC

Nonpriority Creditor's Name

1401 RANKIN RD STE 300

Number Street

HOUSTON, TX 77073

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 2270

When was the debt incurred? 08/07/2022

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

$3,098.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 4 of 44

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 46 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

After listing any entries on this page, number them beginning with 4.5, followed by 4.6, and so forth. Total claim

4.4 AFFIRM INC

Nonpriority Creditor's Name

650 CALIFORNIA ST FL 12

Number Street

SAN FRANCISCO, CA 94108

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 2VXX

When was the debt incurred? 09/26/2022

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

Unsecured

$651.00

4.5 AFFIRM INC

Nonpriority Creditor's Name

650 CALIFORNIA ST FL 12

Number Street

SAN FRANCISCO, CA 94108

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number BTXX

When was the debt incurred? 06/03/2022

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

Unsecured

$554.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 5 of 44

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 47 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

After listing any entries on this page, number them beginning with 4.5, followed by 4.6, and so forth. Total claim

4.6 AFFIRM INC

Nonpriority Creditor's Name

650 CALIFORNIA ST FL 12

Number Street

SAN FRANCISCO, CA 94108

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 6HXX

When was the debt incurred? 09/26/2022

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

Unsecured

$533.00

4.7 AMERICAN EXPRESS

Nonpriority Creditor's Name

PO BOX 297871

Number Street

FORT LAUDERDALE, FL 33329

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 7053

When was the debt incurred? 07/07/2021

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

CreditCard

$1,132.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 6 of 44

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 48 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

After listing any entries on this page, number them beginning with 4.5, followed by 4.6, and so forth. Total claim

4.8 AMERICAN EXPRESS

Nonpriority Creditor's Name

PO BOX 297871

Number Street

FORT LAUDERDALE, FL 33329

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 9603

When was the debt incurred? 07/25/2021

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

CreditCard

$1,116.00

4.9 BARCLAYS BANK DELAWARE

Nonpriority Creditor's Name

PO BOX 8803

Number Street

WILMINGTON, DE 19899

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 4098

When was the debt incurred? 01/29/2020

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

CreditCard

$625.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 7 of 44

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 49 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

After listing any entries on this page, number them beginning with 4.5, followed by 4.6, and so forth. Total claim

4.10 Bryant State Bank

Nonpriority Creditor's Name

PO Box 5161

Number Street

Sioux Falls, SD 57117

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 9318

When was the debt incurred?

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

$2,731.16

4.11 CAPITAL ONE

Nonpriority Creditor's Name

PO BOX 31293

Number Street

Salt Lake City, UT 84131

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 8306

When was the debt incurred? 05/10/2016

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

CreditCard

$638.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 8 of 44

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 50 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

After listing any entries on this page, number them beginning with 4.5, followed by 4.6, and so forth. Total claim

4.12 CAPITAL ONE

Nonpriority Creditor's Name

PO BOX 31293

Number Street

Salt Lake City, UT 84131

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 7042

When was the debt incurred? 10/10/2019

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

CreditCard

$478.00

4.13 CAPITAL ONE/WALMART

Nonpriority Creditor's Name

PO BOX 31293

Number Street

SALT LAKE CITY, UT 84131

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 0622

When was the debt incurred? 11/18/2018

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

ChargeAccount

$120.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 9 of 44

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 51 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

After listing any entries on this page, number them beginning with 4.5, followed by 4.6, and so forth. Total claim

4.14 CCS/BRYANT STATE BANK

Nonpriority Creditor's Name

500 E 60TH ST N

Number Street

SIOUX FALLS, SD 57104

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 9318

When was the debt incurred? 08/24/2019

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

CreditCard

$2,824.00

4.15 CITIBANK/CBNA

Nonpriority Creditor's Name

PO BOX 6497

Number Street

SIOUX FALLS, SD 57117

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 4870

When was the debt incurred? 05/18/2019

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

ChargeAccount

$553.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 10 of 44

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 52 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

After listing any entries on this page, number them beginning with 4.5, followed by 4.6, and so forth. Total claim

4.16 CITIZENS PAY CREDIT LI

Nonpriority Creditor's Name

1 CITIZENS BANK WAY

Number Street

JOHNSTON, RI 02919

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 2220

When was the debt incurred? 02/25/2022

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

LineOfCredit

$4,695.00

4.17 COMENITYCAPITAL/ACADMY

Nonpriority Creditor's Name

PO BOX 182120

Number Street

COLUMBUS, OH 43218

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 2143

When was the debt incurred? 07/16/2022

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

ChargeAccount

$339.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 11 of 44

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 53 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

After listing any entries on this page, number them beginning with 4.5, followed by 4.6, and so forth. Total claim

4.18 COMENITYCAPITAL/ACADMY

Nonpriority Creditor's Name

PO BOX 182120

Number Street

COLUMBUS, OH 43218

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 3546

When was the debt incurred?

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

$101.00

4.19 COMENITYCAPITAL/ULTA

Nonpriority Creditor's Name

PO BOX 182120

Number Street

COLUMBUS, OH 43218

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 1577

When was the debt incurred? 03/10/2019

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

ChargeAccount

$212.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 12 of 44

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 54 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

After listing any entries on this page, number them beginning with 4.5, followed by 4.6, and so forth. Total claim

4.20 CONN APPLIANCES INC

Nonpriority Creditor's Name

1401 RANKIN RD STE 300

Number Street

HOUSTON, TX 77073

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 6631

When was the debt incurred? 06/02/2016

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

$7,985.00

4.21 CREDIT CONTROL CORP

Nonpriority Creditor's Name

11821 ROCK LANDING DR

Number Street

NEWPORT NEWS, VA 23606

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 3576

When was the debt incurred? 06/25/2021

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

CollectionAttorney

$179.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 13 of 44

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 55 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

After listing any entries on this page, number them beginning with 4.5, followed by 4.6, and so forth. Total claim

4.22 CREDIT ONE BANK NA

Nonpriority Creditor's Name

PO BOX 98875

Number Street

LAS VEGAS, NV 89193

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 1378

When was the debt incurred? 06/11/2018

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

CreditCard

$1,385.00

4.23 CREDIT ONE BANK NA

Nonpriority Creditor's Name

PO BOX 98875

Number Street

LAS VEGAS, NV 89193

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 4816

When was the debt incurred? 03/09/2022

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

CreditCard

$1,278.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 14 of 44

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 56 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

After listing any entries on this page, number them beginning with 4.5, followed by 4.6, and so forth. Total claim

4.24 CREDIT ONE BANK NA

Nonpriority Creditor's Name

PO BOX 98875

Number Street

LAS VEGAS, NV 89193

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 3444

When was the debt incurred? 02/17/2020

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

CreditCard

$1,203.00

4.25 CREDIT ONE BANK NA

Nonpriority Creditor's Name

PO BOX 98875

Number Street

LAS VEGAS, NV 89193

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 1826

When was the debt incurred? 11/11/2020

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

CreditCard

$1,158.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 15 of 44

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 57 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

After listing any entries on this page, number them beginning with 4.5, followed by 4.6, and so forth. Total claim

4.26 FEB/GFSCS-RETAIL

Nonpriority Creditor's Name

PO BOX 4499

Number Street

BEAVERTON, OR 97076

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 2091

When was the debt incurred? 08/19/2019

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

CreditCard

$1,579.00

4.27 FETTI FINGERHUT/WEBBAN

Nonpriority Creditor's Name

13300 PIONEER TRL

Number Street

EDEN PRAIRIE, MN 55347

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number XXXX

When was the debt incurred? 04/12/2022

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

ChargeAccount

$4,403.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 16 of 44

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 58 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

After listing any entries on this page, number them beginning with 4.5, followed by 4.6, and so forth. Total claim

4.28 FETTIFHT/WEB

Nonpriority Creditor's Name

13300 PIONEER TRAIL

Number Street

EDEN PRAIRIE, MN 55347

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 5842

When was the debt incurred? 04/12/2022

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

ChargeAccount

$4,513.00

4.29 Genesis FS Card Services

Nonpriority Creditor's Name

Attn: Bankruptcy

PO Box 84059

Number Street

Columbus, GA 31908

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 2091

When was the debt incurred?

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

$1,499.66

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 17 of 44

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 59 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

After listing any entries on this page, number them beginning with 4.5, followed by 4.6, and so forth. Total claim

4.30 IRS

Nonpriority Creditor's Name

Attn: Bankruptcy

PO Box 931200

Number Street

Louisville, KY 40293

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number

When was the debt incurred?

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

1040's, 2017 & 2018

$18,087.00

4.31 JEFFERSON CAPITAL SYST

Nonpriority Creditor's Name

16 MCLELAND RD

Number Street

SAINT CLOUD, MN 56303

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number XXXX

When was the debt incurred? 06/12/2019

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

FactoringCompanyAccount

$1,969.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 18 of 44

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 60 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

After listing any entries on this page, number them beginning with 4.5, followed by 4.6, and so forth. Total claim

4.32 KOHLS/CAPITAL ONE

Nonpriority Creditor's Name

N56 RIDGEWOOD DR

Number Street

MENOMONEE FAL, WI 53051

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 4981

When was the debt incurred? 11/21/2018

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

ChargeAccount

$386.00

4.33 KOHLS/CAPITAL ONE

Nonpriority Creditor's Name

N56 RIDGEWOOD DR

Number Street

MENOMONEE FAL, WI 53051

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 2635

When was the debt incurred? 11/25/2020

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

ChargeAccount

$347.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 19 of 44

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 61 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

After listing any entries on this page, number them beginning with 4.5, followed by 4.6, and so forth. Total claim

4.34 MACYS/CITIBANK, N.A.

Nonpriority Creditor's Name

PO BOX 8218

Number Street

MASON, OH 45040

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 7565

When was the debt incurred? 04/28/2022

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

ChargeAccount

$330.00

4.35 MERRICK BANK CORP

Nonpriority Creditor's Name

PO BOX 9201

Number Street

OLD BETHPAGE, NY 11804

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 0367

When was the debt incurred? 07/12/2018

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

CreditCard

$1,655.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 20 of 44

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 62 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

After listing any entries on this page, number them beginning with 4.5, followed by 4.6, and so forth. Total claim

4.36 MIDLAND FUNDING

Nonpriority Creditor's Name

350 CAMINO DE LA REINA

Number Street

SAN DIEGO, CA 92108

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 6407

When was the debt incurred? 08/25/2017

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

FactoringCompanyAccount

$917.00

4.37 MOHELA/DEPT OF ED

Nonpriority Creditor's Name

633 SPIRIT DR

Number Street

CHESTERFIELD, MO 63005

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 0020

When was the debt incurred? 04/30/2015

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

Educational

$14,990.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 21 of 44

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 63 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

After listing any entries on this page, number them beginning with 4.5, followed by 4.6, and so forth. Total claim

4.38 MOHELA/DEPT OF ED

Nonpriority Creditor's Name

633 SPIRIT DR

Number Street

CHESTERFIELD, MO 63005

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 0005

When was the debt incurred? 01/31/2017

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

Educational

$13,101.00

4.39 MOHELA/DEPT OF ED

Nonpriority Creditor's Name

633 SPIRIT DR

Number Street

CHESTERFIELD, MO 63005

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 0002

When was the debt incurred? 08/24/2015

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

Educational

$12,977.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 22 of 44

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 64 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

After listing any entries on this page, number them beginning with 4.5, followed by 4.6, and so forth. Total claim

4.40 MOHELA/DEPT OF ED

Nonpriority Creditor's Name

633 SPIRIT DR

Number Street

CHESTERFIELD, MO 63005

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 0006

When was the debt incurred? 07/05/2017

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

Educational

$10,672.00

4.41 MOHELA/DEPT OF ED

Nonpriority Creditor's Name

633 SPIRIT DR

Number Street

CHESTERFIELD, MO 63005

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 0017

When was the debt incurred? 02/27/2018

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

Educational

$9,175.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 23 of 44

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 65 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

After listing any entries on this page, number them beginning with 4.5, followed by 4.6, and so forth. Total claim

4.42 MOHELA/DEPT OF ED

Nonpriority Creditor's Name

633 SPIRIT DR

Number Street

CHESTERFIELD, MO 63005

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 0001

When was the debt incurred? 07/07/2015

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

Educational

$8,247.00

4.43 MOHELA/DEPT OF ED

Nonpriority Creditor's Name

633 SPIRIT DR

Number Street

CHESTERFIELD, MO 63005

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 0016

When was the debt incurred? 08/15/2014

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

Educational

$6,531.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 24 of 44

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 66 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

After listing any entries on this page, number them beginning with 4.5, followed by 4.6, and so forth. Total claim

4.44 MOHELA/DEPT OF ED

Nonpriority Creditor's Name

633 SPIRIT DR

Number Street

CHESTERFIELD, MO 63005

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 0012

When was the debt incurred? 08/16/2013

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

Educational

$6,501.00

4.45 MOHELA/DEPT OF ED

Nonpriority Creditor's Name

633 SPIRIT DR

Number Street

CHESTERFIELD, MO 63005

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 0003

When was the debt incurred? 06/01/2016

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

Educational

$6,304.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 25 of 44

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 67 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

After listing any entries on this page, number them beginning with 4.5, followed by 4.6, and so forth. Total claim

4.46 MOHELA/DEPT OF ED

Nonpriority Creditor's Name

633 SPIRIT DR

Number Street

CHESTERFIELD, MO 63005

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 0007

When was the debt incurred? 01/15/2013

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

Educational

$4,724.00

4.47 MOHELA/DEPT OF ED

Nonpriority Creditor's Name

633 SPIRIT DR

Number Street

CHESTERFIELD, MO 63005

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 0018

When was the debt incurred? 07/31/2018

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

Educational

$4,546.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 26 of 44

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 68 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

After listing any entries on this page, number them beginning with 4.5, followed by 4.6, and so forth. Total claim

4.48 MOHELA/DEPT OF ED

Nonpriority Creditor's Name

633 SPIRIT DR

Number Street

CHESTERFIELD, MO 63005

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 0011

When was the debt incurred? 08/16/2013

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

Educational

$4,305.00

4.49 MOHELA/DEPT OF ED

Nonpriority Creditor's Name

633 SPIRIT DR

Number Street

CHESTERFIELD, MO 63005

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 0015

When was the debt incurred? 08/15/2014

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

Educational

$4,256.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 27 of 44

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 69 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

After listing any entries on this page, number them beginning with 4.5, followed by 4.6, and so forth. Total claim

4.50 MOHELA/DEPT OF ED

Nonpriority Creditor's Name

633 SPIRIT DR

Number Street

CHESTERFIELD, MO 63005

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 0004

When was the debt incurred? 08/20/2016

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

Educational

$4,250.00

4.51 MOHELA/DEPT OF ED

Nonpriority Creditor's Name

633 SPIRIT DR

Number Street

CHESTERFIELD, MO 63005

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 0010

When was the debt incurred? 05/24/2013

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

Educational

$2,692.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 28 of 44

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 70 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

After listing any entries on this page, number them beginning with 4.5, followed by 4.6, and so forth. Total claim

4.52 MOHELA/DEPT OF ED

Nonpriority Creditor's Name

633 SPIRIT DR

Number Street

CHESTERFIELD, MO 63005

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 0014

When was the debt incurred? 05/28/2014

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

Educational

$2,227.00

4.53 MOHELA/DEPT OF ED

Nonpriority Creditor's Name

633 SPIRIT DR

Number Street

CHESTERFIELD, MO 63005

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 0013

When was the debt incurred? 05/28/2014

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

Educational

$1,507.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 29 of 44

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 71 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

After listing any entries on this page, number them beginning with 4.5, followed by 4.6, and so forth. Total claim

4.54 MOHELA/DEPT OF ED

Nonpriority Creditor's Name

633 SPIRIT DR

Number Street

CHESTERFIELD, MO 63005

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 0009

When was the debt incurred? 05/24/2013

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

Educational

$1,497.00

4.55 MOHELA/DEPT OF ED

Nonpriority Creditor's Name

633 SPIRIT DR

Number Street

CHESTERFIELD, MO 63005

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 0008

When was the debt incurred? 01/15/2013

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

Educational

$1,276.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 30 of 44

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 72 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

After listing any entries on this page, number them beginning with 4.5, followed by 4.6, and so forth. Total claim

4.56 NEMO'S COLL

Nonpriority Creditor's Name

14631 N CAVE CREEK

Number Street

PHOENIX, AZ 85022

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 9158

When was the debt incurred? 10/01/2021

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

$160.00

4.57 PORTFOLIO RECOV ASSOC

Nonpriority Creditor's Name

150 CORPORATE BLVD

Number Street

NORFOLK, VA 23502

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 1429

When was the debt incurred? 07/19/2017

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

FactoringCompanyAccount

$1,384.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 31 of 44

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 73 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

After listing any entries on this page, number them beginning with 4.5, followed by 4.6, and so forth. Total claim

4.58 PORTFOLIO RECOV ASSOC

Nonpriority Creditor's Name

150 CORPORATE BLVD

Number Street

NORFOLK, VA 23502

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 3184

When was the debt incurred? 09/19/2017

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

FactoringCompanyAccount

$627.00

4.59 Reliant Capital Solutions

Nonpriority Creditor's Name

PO Box 30469

Number Street

Columbus, OH 43230

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 9797

When was the debt incurred?

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

$4,568.83

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 32 of 44

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 74 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

After listing any entries on this page, number them beginning with 4.5, followed by 4.6, and so forth. Total claim

4.60 SYNCB/AMAZON PLCC

Nonpriority Creditor's Name

PO BOX 965015

Number Street

ORLANDO, FL 32896

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 6398

When was the debt incurred? 08/18/2019

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

ChargeAccount

$1,843.00

4.61 SYNCB/CARE CREDIT

Nonpriority Creditor's Name

950 FORRER BLVD

Number Street

KETTERING, OH 45420

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 0099

When was the debt incurred? 04/15/2019

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

ChargeAccount

$4,908.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 33 of 44

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 75 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

After listing any entries on this page, number them beginning with 4.5, followed by 4.6, and so forth. Total claim

4.62 SYNCB/CHEVRON DC

Nonpriority Creditor's Name

PO BOX 965015

Number Street

ORLANDO, FL 32896

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 9989

When was the debt incurred? 09/01/2021

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

CreditCard

$651.00

4.63 SYNCB/PPC

Nonpriority Creditor's Name

PO BOX 530975

Number Street

ORLANDO, FL 32896

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 4835

When was the debt incurred? 05/08/2022

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

CreditCard

$1,507.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 34 of 44

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 76 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

After listing any entries on this page, number them beginning with 4.5, followed by 4.6, and so forth. Total claim

4.64 SYNCB/SAMS CLUB

Nonpriority Creditor's Name

PO BOX 965005

Number Street

ORLANDO, FL 32896

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 9951

When was the debt incurred? 04/27/2022

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

ChargeAccount

$525.00

4.65 SYNCB/SLEEP NUMBER

Nonpriority Creditor's Name

PO BOX 965036

Number Street

ORLANDO, FL 32896

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 8251

When was the debt incurred? 01/17/2021

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

ChargeAccount

$737.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 35 of 44

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 77 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

After listing any entries on this page, number them beginning with 4.5, followed by 4.6, and so forth. Total claim

4.66 T Mobile

Nonpriority Creditor's Name

PO Box 629025

Number Street

El Dorado Hills, CA 95762

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 9205

When was the debt incurred?

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

$518.32

4.67 TBOM/ASPIRE MC

Nonpriority Creditor's Name

PO BOX 105555

Number Street

ATLANTA, GA 30348

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 8334

When was the debt incurred? 02/19/2021

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

CreditCard

$1,337.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 36 of 44

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 78 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

After listing any entries on this page, number them beginning with 4.5, followed by 4.6, and so forth. Total claim

4.68 TBOM/ATLS/ASPIRE

Nonpriority Creditor's Name

5 CONCOURSE PKWY STE 400

Number Street

ATLANTA, GA 30328

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number XXXX

When was the debt incurred? 02/19/2021

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

CreditCard

$1,249.00

4.69 TELECOM SELF-REPORTED

Nonpriority Creditor's Name

PO BOX 4500

Number Street

ALLEN, TX 75013

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number XXXX

When was the debt incurred? 06/28/2021

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

MobilePhone

$317.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 37 of 44

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 79 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

After listing any entries on this page, number them beginning with 4.5, followed by 4.6, and so forth. Total claim

4.70 THD/CBNA

Nonpriority Creditor's Name

PO BOX 6497

Number Street

SIOUX FALLS, SD 57117

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 7828

When was the debt incurred? 12/05/2021

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

ChargeAccount

$635.00

4.71 THD/CBNA

Nonpriority Creditor's Name

PO BOX 6497

Number Street

SIOUX FALLS, SD 57117

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 6945

When was the debt incurred? 12/05/2021

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

ChargeAccount

$390.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 38 of 44

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 80 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

After listing any entries on this page, number them beginning with 4.5, followed by 4.6, and so forth. Total claim

4.72 TRACTOR SUPPLY/CBNA

Nonpriority Creditor's Name

PO BOX 6497

Number Street

SIOUX FALLS, SD 57117

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 7251

When was the debt incurred? 07/05/2021

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

ChargeAccount

$2,521.00

4.73 TRACTOR SUPPLY/CBNA

Nonpriority Creditor's Name

PO BOX 6497

Number Street

SIOUX FALLS, SD 57117

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 4639

When was the debt incurred? 02/27/2022

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

ChargeAccount

$2,153.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 39 of 44

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 81 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

After listing any entries on this page, number them beginning with 4.5, followed by 4.6, and so forth. Total claim

4.74 UPSTART NETWORK INC.

Nonpriority Creditor's Name

2950 S DELAWARE ST STE 3

Number Street

SAN MATEO, CA 94403

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 2365

When was the debt incurred? 08/01/2022

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

Unsecured

$4,546.00

4.75 UPSTART NETWORK INC/F

Nonpriority Creditor's Name

PO BOX 1503

Number Street

SAN CARLOS, CA 94070

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 8545

When was the debt incurred? 05/31/2022

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

Unsecured

$8,352.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 40 of 44

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 82 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

After listing any entries on this page, number them beginning with 4.5, followed by 4.6, and so forth. Total claim

4.76 US DEPT OF ED/GLELSI

Nonpriority Creditor's Name

PO BOX 7860

Number Street

MADISON, WI 53707

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 8581

When was the debt incurred? 09/29/2012

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

Educational

$34,921.00

4.77 USAA SAVINGS BANK

Nonpriority Creditor's Name

PO BOX 47504

Number Street

SAN ANTONIO, TX 78265

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 82XX

When was the debt incurred? 07/06/2018

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

CreditCard

$453.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 41 of 44

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 83 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Part 2: Your NONPRIORITY Unsecured Claims - Continuation Page

After listing any entries on this page, number them beginning with 4.5, followed by 4.6, and so forth. Total claim

4.78 USAA SAVINGS BANK

Nonpriority Creditor's Name

PO BOX 47504

Number Street

SAN ANTONIO, TX 78265

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 9040

When was the debt incurred? 08/12/2016

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

CreditCard

$118.00

4.79 W CENTRAL TX COLLECT

Nonpriority Creditor's Name

1131 N 2ND STREET STE 101

Number Street

ABILENE, TX 79601

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 4227

When was the debt incurred? 01/31/2022

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

Contingent

Unliquidated

Disputed

Type of NONPRIORITY unsecured claim:

Student loans

Obligations arising out of a separation agreement or

divorce that you did not report as priority claims

Debts to pension or profit-sharing plans, and other

similar debts

Other. Specify

$39.00

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 42 of 44

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 84 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Part 3: List Others to Be Notified About a Debt That You Already Listed

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

collection agency is trying to collect from you for a debt you owe to someone else, list the original creditor in Parts 1 or 2, then list the collection

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

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

Texas A&M University

Name

Student Business Services

6001 TAMU

Number Street

College Station, TX 77843

City State ZIP Code

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

Line 4.59 of (Check one): Part 1: Creditors with Priority Unsecured Claims

Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number

Name

Number Street

City State ZIP Code

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

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

Part 2: Creditors with Nonpriority Unsecured Claims

Last 4 digits of account number

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 43 of 44

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 85 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Part 4: Add the Amounts for Each Type of Unsecured Claim

6. Total the amounts of certain types of unsecured claims. This information is for statistical reporting purposes only. 28 U.S.C. §159. Add the amounts

for each type of unsecured claim.

Total claim

Total claims

from Part 1

6a. Domestic support obligations 6a. $0.00

6b. Taxes and certain other debts you owe the

government

6b. $11,230.34

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. + $4,200.00

6e. Total. Add lines 6a through 6d. 6e. $15,430.34

Total claim

Total claims

from Part 2

6f. Student loans 6f. $154,699.00

6g. Obligations arising out of a separation

agreement or divorce that you did not report

as priority claims

6g. $0.00

6h. Debts to pension or profit-sharing plans, and

other similar debts

6h. $0.00

6i. Other. Add all other nonpriority unsecured

claims. Write that amount here.

6i. + $117,323.97

6j. Total. Add lines 6f through 6i. 6j. $272,022.97

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 44 of 44

Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 86 of 115
Fill in this information to identify your case:

Debtor 1 Jerry Dean Holt, Jr

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Sarah Joann Holt

First Name Middle Name Last Name

United States Bankruptcy Court for the: Northern District of Texas

Case number

(if known)

Check if this is an

amended filing

Official Form 106G

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?

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

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

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

Name

Number Street

City State ZIP Code

2.2

Name

Number Street

City State ZIP Code

2.3

Name

Number Street

City State ZIP Code

2.4

Name

Number Street

City State ZIP Code

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

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Schedule G: Executory Contracts and Unexpired Leases 12/15

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Document Page 87 of 115
Fill in this information to identify your case:

Debtor 1 Jerry Dean Holt, Jr

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Sarah Joann Holt

First Name Middle Name Last Name

United States Bankruptcy Court for the: Northern District of Texas

Case number

(if known)

Check if this is an

amended filing

Official Form 106H

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.)

 No

 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.)

 No. Go to line 3.

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

 No

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

Name

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:

3.1

Name

Number Street

City State ZIP Code

 Schedule D, line 

 Schedule E/F, line 

 Schedule G, line 

Official Form 106H Schedule H: Your Codebtors Page 1 of 1

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Schedule H: Your Codebtors 12/15

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 88 of 115
Check if this is:

 An amended filing

A supplement showing postpetition

chapter 13 income as of the following date:

MM / DD / YYYY

Fill in this information to identify your case:

Debtor 1 Jerry Dean Holt, Jr

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Sarah Joann Holt

First Name Middle Name Last Name

United States Bankruptcy Court for the: Northern District of Texas

Case number

(if known)

Official Form 106I

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.

Part 1: Describe Employment

1. Fill in your employment

information. Debtor 1 Debtor 2 or non-filing spouse

If you have more than one job,

attach a separate page with

information about additional

employers.

Include part time, seasonal, or

self-employed work.

Occupation may include student

or homemaker, if it applies.

Employment status

Occupation

Employer's name

Employer's address

Employed Not Employed

Eating Recovery Center

Number Street

City State Zip Code

Employed Not Employed

Orion Talent

Number Street

City State Zip Code

How long employed there?

Part 2: Give Details About Monthly Income

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.

For Debtor 1 For Debtor 2 or

non-filing spouse

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

deductions.) If not paid monthly, calculate what the monthly wage would be. 2. $12,707.39 $6,304.57

3. Estimate and list monthly overtime pay. 3. + $0.00 + $0.00

4. Calculate gross income. Add line 2 + line 3. 4. $12,707.39 $6,304.57

Official Form 106I Schedule I: Your Income page 1

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 89 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

For Debtor 1 For Debtor 2 or

non-filing spouse

Copy line 4 here....................................................................................➔ 4. $12,707.39 $6,304.57

5. List all payroll deductions:

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: 

5a.

5b.

5c.

5d.

5e.

5f.

5g.

5h.

$955.37

$0.00

$63.44

$0.00

$415.78

$0.00

$0.00

+ $0.00

$828.47

$0.00

$0.00

$0.00

$438.01

$0.00

$0.00

+ $0.00

6. Add the payroll deductions. Add lines 5a + 5b + 5c + 5d + 5e +5f + 5g + 5h. 6. $1,434.59 $1,266.48

7. Calculate total monthly take-home pay. Subtract line 6 from line 4. 7. $11,272.80 $5,038.08

8. List all other income regularly received:

8a. 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. 8a. $0.00 $0.00

8b. Interest and dividends 8b. $0.00 $0.00

8c. 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. 8c. $0.00 $0.00

8d. Unemployment compensation 8d. $0.00 $0.00

8e. Social Security 8e. $0.00 $0.00

8f. 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 (benefits under the

Supplemental Nutrition Assistance Program) or housing subsidies.

Specify: 8f. $0.00 $0.00

8g. Pension or retirement income 8g. $0.00 $0.00

8h. Other monthly income. Specify: 8h. + $0.00 + $0.00

9. Add all other income. Add lines 8a + 8b + 8c + 8d + 8e + 8f +8g + 8h. 9. $0.00 $0.00

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 10. $11,272.80 + $5,038.08 = $16,310.88

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

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: 11. + $0.00

12. Add the amount in the last column of line 10 to the amount in line 11. The result is the combined monthly income. Write that

amount on the Summary of Your Assets and Liabilities and Certain Statistical Information, if it applies 12. $16,310.88

Combined

monthly income

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

 No.

 Yes. Explain: 

Official Form 106I Schedule I: Your Income page 2

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 90 of 115
Check if this is:

An amended filing

A supplement showing postpetition chapter 13

expenses as of the following date:

MM / DD / YYYY

Do you have dependents?

Do not list Debtor 1 and

Debtor 2.

Do not state the dependents'

names.

 No

Yes. Fill out this information

for each dependent...............

Dependent's relationship to

Debtor 1 or Debtor 2

Dependent's

age

Does dependent live

with you?

Child 17 No. Yes.

Child 12 No. Yes.

 No. Yes.

 No. Yes.

 No. Yes.

Fill in this information to identify your case:

Debtor 1 Jerry Dean Holt, Jr

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Sarah Joann Holt

First Name Middle Name Last Name

United States Bankruptcy Court for the: Northern District of Texas

Case number

(if known)

Official Form 106J

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.

Part 1: Describe Your Household

1. Is this a joint case?

 No. Go to line 2.

 Yes. Does Debtor 2 live in a separate household?

 No

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

2.

3. Do your expenses include

expenses of people other than

yourself and your dependents?

 No

 Yes

Part 2: Estimate Your Ongoing Monthly Expenses

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 106I.)

Your expenses

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

4.

4a.

4b.

4c.

4d.

$0.00

$44.00

$0.00

$75.00

$0.00

Official Form 106J Schedule J: Your Expenses page 1

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Schedule J: Your Expenses 12/15

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

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Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Your expenses

5. Additional mortgage payments for your residence, such as home equity loans 5. $636.00

6. Utilities:

6a. Electricity, heat, natural gas

6b. Water, sewer, garbage collection

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

6d. Other. Specify: 

6a.

6b.

6c.

6d.

$300.00

$130.80

$300.00

$0.00

7. Food and housekeeping supplies 7. $935.08

8. Childcare and children’s education costs 8. $0.00

9. Clothing, laundry, and dry cleaning 9. $279.00

10. Personal care products and services 10. $96.00

11. Medical and dental expenses 11. $300.00

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

Do not include car payments. 12. $500.00

13. Entertainment, clubs, recreation, newspapers, magazines, and books 13. $0.00

14. Charitable contributions and religious donations 14. $0.00

15. 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: 

15a.

15b.

15c.

15d.

$0.00

$0.00

$672.00

$0.00

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

Specify: 16. $0.00

17. Installment or lease payments:

17a. Car payments for Vehicle 1

17b. Car payments for Vehicle 2

17c. Other. Specify: 

17d. Other. Specify: 

17a.

17b.

17c.

17d.

$949.00

$714.00

$0.00

$0.00

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 106I). 18. $0.00

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

Specify: 19. $0.00

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

20a.

20b.

20c.

20d.

20e.

$0.00

$0.00

$0.00

$0.00

$0.00

Official Form 106J Schedule J: Your Expenses page 2

Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 92 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

21. Other. Specify: 21. + $0.00

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.

22a.

22b.

22c.

$5,930.88

$0.00

$5,930.88

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.

23a.

23b.

23c.

$16,310.88

– $5,930.88

$10,380.00

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?

 No.

 Yes.

None

Official Form 106J Schedule J: Your Expenses page 3

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 93 of 115
Fill in this information to identify your case:

Debtor 1 Jerry Dean Holt, Jr

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Sarah Joann Holt

First Name Middle Name Last Name

United States Bankruptcy Court for the: Northern District of Texas

Case number

(if known)

Check if this is an

amended filing

Official Form 106Dec

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

You must file this form whenever you file bankruptcy schedules or amended schedules. Making a false statement, concealing property, or obtaining money

or property by fraud in connection with a bankruptcy case can result in fines up to $250,000, or imprisonment for up to 20

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

Sign Below

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

 No

 Yes. Name of person . Attach Bankruptcy Petition Preparer's Notice, Declaration, and

Signature (Official Form 119).

Under penalty of perjury, I declare that I have read the summary and schedules filed with this declaration and that they are true and correct.

✘ /s/ Jerry Dean Holt, Jr

Jerry Dean Holt, Jr, Debtor 1

Date 05/23/2023

MM/ DD/ YYYY

✘ /s/ Sarah Joann Holt

Sarah Joann Holt, Debtor 2

Date 05/23/2023

MM/ DD/ YYYY

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

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Declaration About an Individual Debtor's Schedules 12/15

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B2030 (Form 2030) (12/15)

United States Bankruptcy Court

Northern District of Texas

In re Holt, Jerry Dean

Holt, Sarah Joann

Debtor

Case No. 

Chapter 13

DISCLOSURE OF COMPENSATION OF ATTORNEY FOR DEBTOR

1. Pursuant to 11 U .S.C. § 329(a) and Fed. Bankr. P. 2016(b), I certify that I am the attorney for the above named debtor(s) and that

compensation paid to me within one year before the filing of the petition in bankruptcy, or agreed to be paid to me, for services rendered

or to be rendered on behalf of the debtor(s) in contemplation of or in connection with the bankruptcy case is as follows:

For legal services, I have agreed to accept ................................................................................................................................................ $4,200.00

Prior to the filing of this statement I have received ................................................................................................................................................ $0.00

Balance Due ................................................................................................................................................ $4,200.00

2. The source of the compensation paid to me was:

Debtor Other (specify)

3. The source of compensation to be paid to me is:

Debtor Other (specify)

4. I have not agreed to share the above-disclosed compensation with any other person unless they are members and associates of my

law firm.

 I have agreed to share the above-disclosed compensation with a other person or persons who are not members or associates of my

law firm. A copy of the agreement, together with a list of the names of the people sharing in the compensation, is attached.

5. In return for the above-disclosed fee, I have agreed to render legal service for all aspects of the bankruptcy case, including:

a. Analysis of the debtor' s financial situation, and rendering advice to the debtor in determining whether to file a petition in

bankruptcy;

b. Preparation and filing of any petition, schedules, statements of affairs and plan which may be required;

c. Representation of the debtor at the meeting of creditors and confirmation hearing, and any adjourned hearings thereof;

6. By agreement with the debtor(s), the above-disclosed fee does not include the following services:

Page 1 of 2

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B2030 (Form 2030) (12/15)

By agreement with the debtor(s), the above-disclosed fee does not include the following services:

1. Responses to Motions to Lift Stay for Post Petition default by debtors, except one (1) Motion to Lift Stay

2. Adversary Proceedings

3. Motions to Incur Debt

4. Motion to Sell Property

5. Modifications

6. Conversions to Chapter 7

7. Motions to Reinstate, except one (1) Motion to Reinstate

8. Hardship Discharges of Chapter 13

9. Hardship Discharges of Student Loans

10. Adding Creditors of Property not listed in Bankruptcy Questionnaire

11. Conversions to Chapter 13

12. Responses to Objections to Discharge

13. Evidentiary hearing on ANY Motion to Lift Stay, or Evidentiary Hearing of more than 30 minutes on Motions to Dismiss, Objections to

Exemption, Confirmation Hearing, Claims Objections, or other contested matters.

Debtors(s) argee to pay attorney an additional fee of $400.00 for each of the following services:

1. Plan Modification

2. Motions to Sell Property

3. Motions to Incur Debt

4. Motion to Liftstay (not included in the standard fee)

CERTIFICATION

I certify that the foregoing is a complete statement of any agreement or arrangement for payment to

me for representation of the debtor(s) in this bankruptcy proceeding.

05/23/2023

Date

/s/ Kevin W. Willhelm

Kevin W. Willhelm

Signature of Attorney

Bar Number: 00785252

Willhelm Law Firm

Po Box 3536

Abilene, TX 79604-3536

Phone: (325) 692-0900

Willhelm Law Firm

Name of law firm

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Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

Document Page 96 of 115
CASE NO

CHAPTER 13

IN THE UNITED STATES BANKRUPTCY COURT

NORTHERN DISTRICT OF TEXAS

ABILENE DIVISION

IN RE: Holt, Jerry Dean

Holt, Sarah Joann

VERIFICATION OF CREDITOR MATRIX

The above named Debtor hereby verifies that the attached list of creditors is true and correct to the best of his/her knowledge.

Date 05/23/2023 Signature /s/ Jerry Dean Holt, Jr

Jerry Dean Holt, Jr, Debtor

Date 05/23/2023 Signature /s/ Sarah Joann Holt

Sarah Joann Holt, Joint Debtor

Case 23-10067-rlj13 Doc 1 Filed 05/23/23 Entered 05/23/23 11:31:50 Desc Main

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ACCEPTANCE NOW

5501 HEADQUARTERS DR

PLANO, TX 75024

AFFIRM INC

650 CALIFORNIA ST FL 12

SAN FRANCISCO, CA 94108

AMERICAN EXPRESS

PO BOX 297871

FORT LAUDERDALE, FL 33329

BARCLAYS BANK DELAWARE

PO BOX 8803

WILMINGTON, DE 19899

BAYPORT CREDIT UNION

3711 HUNTINGTON AVE

NEWPORT NEWS, VA 23607

Bryant State Bank

PO Box 5161

Sioux Falls, SD 57117

CAPITAL ONE

PO BOX 31293

Salt Lake City, UT 84131

CAPITAL ONE/WALMART

PO BOX 31293

SALT LAKE CITY, UT 84131

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CCS/BRYANT STATE BANK

500 E 60TH ST N

SIOUX FALLS, SD 57104

CITIBANK/CBNA

PO BOX 6497

SIOUX FALLS, SD 57117

CITIZENS BANK NA

4201 S TREADAWAY BLVD

ABILENE, TX 79602

CITIZENS PAY CREDIT LI

1 CITIZENS BANK WAY

JOHNSTON, RI 02919

CITY BANK- INDIRECT

PO BOX 5060

LUBBOCK, TX 79408

City of Virginia Beach

2401 Courthouse Drive Bldg 1

Virginia Beach, VA 23456

COMENITYCAPITAL/ACADMY

PO BOX 182120

COLUMBUS, OH 43218

COMENITYCAPITAL/ULTA

PO BOX 182120

COLUMBUS, OH 43218

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CONN APPLIANCES INC

1401 RANKIN RD STE 300

HOUSTON, TX 77073

CREDIT CONTROL CORP

11821 ROCK LANDING DR

NEWPORT NEWS, VA 23606

CREDIT ONE BANK NA

PO BOX 98875

LAS VEGAS, NV 89193

ESB/HARLEY DAVIDSON CR

PO BOX 21829

CARSON CITY, NV 89721

FEB/GFSCS-RETAIL

PO BOX 4499

BEAVERTON, OR 97076

FETTI FINGERHUT/WEBBAN

13300 PIONEER TRL

EDEN PRAIRIE, MN 55347

FETTIFHT/WEB

13300 PIONEER TRAIL

EDEN PRAIRIE, MN 55347

Genesis FS Card Services

Attn: Bankruptcy

PO Box 84059

Columbus, GA 31908

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GTWY 1ST FKA GTWY MRTG

244 S GATEWAY PL

JENKS, OK 74037

IRS

Attn: Bankruptcy

PO Box 931200

Louisville, KY 40293

JEFFERSON CAPITAL SYST

16 MCLELAND RD

SAINT CLOUD, MN 56303

KOHLS/CAPITAL ONE

N56 RIDGEWOOD DR

MENOMONEE FAL, WI 53051

MACYS/CITIBANK, N.A.

PO BOX 8218

MASON, OH 45040

MERRICK BANK CORP

PO BOX 9201

OLD BETHPAGE, NY 11804

MIDLAND FUNDING

350 CAMINO DE LA REINA

SAN DIEGO, CA 92108

MOHELA/DEPT OF ED

633 SPIRIT DR

CHESTERFIELD, MO 63005

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NEMO'S COLL

14631 N CAVE CREEK

PHOENIX, AZ 85022

PORTFOLIO RECOV ASSOC

150 CORPORATE BLVD

NORFOLK, VA 23502

Reliant Capital Solutions

PO Box 30469

Columbus, OH 43230

SYNCB/AMAZON PLCC

PO BOX 965015

ORLANDO, FL 32896

SYNCB/CARE CREDIT

950 FORRER BLVD

KETTERING, OH 45420

SYNCB/CHEVRON DC

PO BOX 965015

ORLANDO, FL 32896

SYNCB/PPC

PO BOX 530975

ORLANDO, FL 32896

SYNCB/SAMS CLUB

PO BOX 965005

ORLANDO, FL 32896

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SYNCB/SLEEP NUMBER

PO BOX 965036

ORLANDO, FL 32896

T Mobile

PO Box 629025

El Dorado Hills, CA 95762

TBOM/ASPIRE MC

PO BOX 105555

ATLANTA, GA 30348

TBOM/ATLS/ASPIRE

5 CONCOURSE PKWY STE 400

ATLANTA, GA 30328

TELECOM SELF-REPORTED

PO BOX 4500

ALLEN, TX 75013

Texas A&M University

Student Business Services

6001 TAMU

College Station, TX 77843

THD/CBNA

PO BOX 6497

SIOUX FALLS, SD 57117

TRACTOR SUPPLY/CBNA

PO BOX 6497

SIOUX FALLS, SD 57117

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UPSTART NETWORK INC.

2950 S DELAWARE ST STE 3

SAN MATEO, CA 94403

UPSTART NETWORK INC/F

PO BOX 1503

SAN CARLOS, CA 94070

US DEPT OF ED/GLELSI

PO BOX 7860

MADISON, WI 53707

USAA SAVINGS BANK

PO BOX 47504

SAN ANTONIO, TX 78265

W CENTRAL TX COLLECT

1131 N 2ND STREET STE 101

ABILENE, TX 79601

Willhelm Law Firm

Po Box 3536

Abilene, TX 79604-3536

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Check as directed in lines 17 and 21:

According to the calculations required by this

Statement:

1. Disposable income is not determined

under 11 U.S.C. § 1325(b)(3).

2. Disposable income is determined

under 11 U.S.C. § 1325(b)(3).

3. The commitment period is 3 years.

4. The commitment period is 5 years.

Check if this is an amended filing

Fill in this information to identify your case:

Debtor 1 Jerry Dean Holt, Jr

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Sarah Joann Holt

First Name Middle Name Last Name

United States Bankruptcy Court for the: Northern District of Texas

Case number

(if known)

Official Form 122C-1

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

attach a separate sheet to this form. Include the line number to which the additional information applies. On the top of any additional pages, write your name

and case number (if known).

Part 1: Calculate Your Average Monthly Income

1. What is your marital and filing status? Check one only.

Not married. Fill out Column A, lines 2-11.

Married. Fill out both Columns A and B, lines 2-11.

Fill in the average monthly income that you received from all sources, derived during the 6 full months before you file this bankruptcy case.11 U.S.C. §

101(10A). For example, if you are filing on September 15, the 6-month period would be March 1 through August 31. If the amount of your monthly income

varied during the 6 months, add the income for all 6 months and divide the total by 6. Fill in the result. Do not include any income amount more than once. For

example, if both spouses own the same rental property, put the income from that property in one column only. If you have nothing to report for any line, write

$0 in the space.

Column A

Debtor 1

Column B

Debtor 2 or

non-filing spouse

2. Your gross wages, salary, tips, bonuses, overtime, and commissions (before all

payroll deductions).

$10,752.41 $6,305.64

3. Alimony and maintenance payments. Do not include payments from a spouse. $0.00 $0.00

4. All amounts from any source which are regularly paid for household expenses of you or

your dependents, including child support. Include regular contributions from an

unmarried partner, members of your household, your dependents, parents, and

roommates. Do not include payments from a spouse. Do not include payments you listed

on line 3. $0.00 $0.00

5. Net income from operating a business, profession, or

farm Debtor 1 Debtor 2

Gross receipts (before all deductions) $0.00 $0.00

Ordinary and necessary operating expenses - $0.00 - $0.00

Net monthly income from a business, profession, or farm $0.00 $0.00 Copy

here → $0.00 $0.00

6. Net income from rental and other real property Debtor 1 Debtor 2

Gross receipts (before all deductions) $0.00 $0.00

Ordinary and necessary operating expenses - $0.00 - $0.00

Net monthly income from rental or other real property $0.00 $0.00 Copy

here → $0.00 $0.00

Official Form 122C-1 Chapter 13 Statement of Your Current Monthly Income and Calculation of Commitment Period page 1

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Chapter 13 Statement of Your Current Monthly Income

and Calculation of Commitment Period 10/19

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For you.................................................................................... $0.00

For your spouse...................................................................... $0.00

Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Column A

Debtor 1

Column B

Debtor 2 or

non-filing spouse

7. Interest, dividends, and royalties $0.00 $0.00

Unemployment compensation

Do not enter the amount if you contend that the amount received was a benefit under

the Social Security Act. Instead, list it here: .................................................. ↓

8. $0.00 $0.00

Pension or retirement income. Do not include any amount received that was a benefit

under the Social Security Act. Also, except as stated in the next sentence, do not

include any compensation, pension, pay, annuity, or allowance paid by the United

States Government in connection with a disability, combat-related injury or disability, or

death of a member of the uniformed services. If you received any retired pay paid

under chapter 61 of title 10, then include that pay only to the extent that it does not

exceed the amount of retired pay to which you would otherwise be entitled if retired

under any provision of title 10 other than chapter 61 of that title.

9. $0.00 $0.00

Income from all other sources not listed above. Specify the source and amount. Do

not include any benefits received under the Social Security Act; payments received as

a victim of a war crime, a crime against humanity, or international or domestic

terrorism; or compensation, pension, pay, annuity, or allowance paid by the United

States Government in connection with a disability, combat-related injury or disability, or

death of a member of the uniformed services. If necessary, list other sources on a

separate page and put the total below.

10. 

Total amounts from separate pages, if any. + +

Calculate your total average monthly income. Add lines 2 through 10 for each

column. Then add the total for Column A to the total for Column B.

11. $10,752.41 + $6,305.64 = $17,058.05

Total average

monthly income

Part 2: Determine How to Measure Your Deductions from Income

12. Copy your total average monthly income from line 11. ................................................................................. $17,058.05

13. Calculate the marital adjustment. Check one:

 You are not married. Fill in 0 below.

 You are married and your spouse is filing with you. Fill in 0 below.

 You are married and your spouse is not filing with you.

Fill in the amount of the income listed in line 11, Column B, that was NOT regularly paid for the household expenses of you or

your dependents, such as payment of the spouse’s tax liability or the spouse’s support of someone other than you or your

dependents.

Below, specify the basis for excluding this income and the amount of income devoted to each purpose. If necessary, list

additional adjustments on a separate page.

If this adjustment does not apply, enter 0 below.

+

Total........................................................................................... $0.00 Copy here. → - $0.00

14. Your current monthly income. Subtract the total in line 13 from line 12. $17,058.05

Official Form 122C-1 Chapter 13 Statement of Your Current Monthly Income and Calculation of Commitment Period page 2

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Texas

4

Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

15. Calculate your current monthly income for the year. Follow these steps:

15a. Copy line 14 here →...............................................................................................................................................................

$17,058.05

Multiply line 15a by 12 (the number of months in a year). x 12

15b. The result is your current monthly income for the year for this part of the form..................................................................... $204,696.60

16. Calculate the median family income that applies to you. Follow these steps:

16a. Fill in the state in which you live.

16b. Fill in the number of people in your household.

16c. Fill in the median family income for your state and size of household. ....................................................................................

To find a list of applicable median income amounts, go online using the link specified in the separate

instructions for this form. This list may also be available at the bankruptcy clerk’s office.

$101,753.00

17. How do the lines compare?

17a. Line 15b is less than or equal to line 16c. On the top of page 1 of this form, check box 1, Disposable income is not determined under 11

U.S.C. § 1325(b)(3). Go to Part 3. Do NOT fill out Calculation of Your Disposable Income (Official Form 122C–2).

17b. Line 15b is more than line 16c. On the top of page 1 of this form, check box 2, Disposable income is determined under 11 U.S.C. §

1325(b)(3). Go to Part 3 and fill out Calculation of Your Disposable Income (Official Form 122C–2). On line 39 of that form, copy your

current monthly income from line 14 above.

Part 3: Calculate Your Commitment Period Under 11 U.S.C. §1325(b)(4)

18. Copy your total average monthly income from line 11. .......................................................................................................... $17,058.05

Deduct the marital adjustment if it applies. If you are married, your spouse is not filing with you, and you contend that

calculating the commitment period under 11 U.S.C. § 1325(b)(4) allows you to deduct part of your spouse’s income, copy the

amount from line 13.

19. 

19a. If the marital adjustment does not apply, fill in 0 on line 19a. ..................................................................................................... - $0.00

19b. Subtract line 19a from line 18. $17,058.05

20. Calculate your current monthly income for the year. Follow these steps.

20a. Copy line 19b............................................................................................................................................................................. $17,058.05

Multiply by 12 (the number of months in a year). x 12

20b. The result is your current monthly income for the year for this part of the form. $204,696.60

20c. Copy the median family income for your state and size of household from line 16c. ............................................................... $101,753.00

21. How do the lines compare?

Line 20b is less than line 20c. Unless otherwise ordered by the court, on the top of page 1 of this form, check box 3,

The commitment period is 3 years. Go to Part 4.

Line 20b is more than or equal to line 20c. Unless otherwise ordered by the court, on the top of page 1 of this form,

check box 4, The commitment period is 5 years. Go to Part 4.

Part 4: Sign Below

By signing here, under penalty of perjury I declare that the information on this statement and in any attachments is true and correct.

✘ /s/ Jerry Dean Holt, Jr

Signature of Debtor 1

Date 05/23/2023

MM/ DD/ YYYY

✘ /s/ Sarah Joann Holt

Signature of Debtor 2

Date 05/23/2023

MM/ DD/ YYYY

If you checked 17a, do NOT fill out or file Form 122C–2.

If you checked 17b, fill out Form 122C–2 and file it with this form. On line 39 of that form, copy your current monthly income from line 14 above.

Official Form 122C-1 Chapter 13 Statement of Your Current Monthly Income and Calculation of Commitment Period page 3

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Document Page 107 of 115
Fill in this information to identify your case:

Debtor 1 Jerry Dean Holt, Jr

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Sarah Joann Holt

First Name Middle Name Last Name

United States Bankruptcy Court for the: Northern District of Texas

Case number

(if known)

Check if this is an

amended filing

Official Form 122C-2

To fill out this form, you will need your completed copy of Chapter 13 Statement of Your Current Monthly Income and Calculation of Commitment Period

(Official Form 122C–1).

Be as complete and accurate as possible. If two married people are filing together, both are equally responsible for being accurate. If more space is

needed, attach a separate sheet to this form. Include the line number to which the additional information applies. On the top of any additional pages, write

your name and case number (if known).

Part 1: Calculate Your Deductions from Your Income

The Internal Revenue Service (IRS) issues National and Local Standards for certain expense amounts. Use these amounts to answer the questions in

lines 6-15. To find the IRS standards, go online using the link specified in the separate instructions for this form. This information may also be available

at the bankruptcy clerk’s office.

Deduct the expense amounts set out in lines 6-15 regardless of your actual expense. In later parts of the form, you will use some of your actual expenses if

they are higher than the standards. Do not include any operating expenses that you subtracted from income in lines 5 and 6 of Form 122C–1, and do not

deduct any amounts that you subtracted from your spouse’s income in line 13 of Form 122C–1.

If your expenses differ from month to month, enter the average expense.

Note: Line numbers 1-4 are not used in this form. These numbers apply to information required by a similar form used in chapter 7 cases.

5. The number of people used in determining your deductions from income

Fill in the number of people who could be claimed as exemptions on your federal income tax return, plus the

number of any additional dependents whom you support. This number may be different from the number of

people in your household.

4

National

Standards You must use the IRS National Standards to answer the questions in lines 6-7.

6. Food, clothing, and other items: Using the number of people you entered in line 5 and the IRS National

Standards, fill in the dollar amount for food, clothing, and other items.

$1,993.00

7. Out-of-pocket health care allowance: Using the number of people you entered in line 5 and the IRS National Standards, fill in the

dollar amount for out-of-pocket health care. The number of people is split into two categories─people who are under 65 and people

who are 65 or older─because older people have a higher IRS allowance for health care costs. If your actual expenses are higher

than this IRS amount, you may deduct the additional amount on line 22.

Official Form 122C-2 Chapter 13 Calculation of Your Disposable Income page 1

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Chapter 13 Calculation of Your Disposable Income 04/22

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Document Page 108 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

People who are under 65 years of age

7a. Out-of-pocket health care allowance per person $79.00

7b. Number of people who are under 65 X 4

7c. Subtotal. Multiply line 7a by line 7b. $316.00 Copy

here → $316.00

People who are 65 years of age or older

7d. Out-of-pocket health care allowance per person $154.00

7e. Number of people who are 65 or older X 0

7f. Subtotal. Multiply line 7d by line 7e. $0.00 Copy

here →

+ $0.00

7g. Total. Add lines 7c and 7f. ............................................................................................................... $316.00 Copy here →.... $316.00

Local

Standards You must use the IRS Local Standards to answer the questions in lines 8-15.

Based on information from the IRS, the U.S. Trustee Program has divided the IRS Local Standard for housing for

bankruptcy purposes into two parts:

Housing and utilities – Insurance and operating expenses

Housing and utilities – Mortgage or rent expenses

To answer the questions in lines 8-9, use the U.S. Trustee Program chart. To find the chart, go online using the link

specified in the separate instructions for this form. This chart may also be available at the bankruptcy clerk’s office.

8. Housing and utilities – Insurance and operating expenses: Using the number of people you entered in line 5, fill in

the dollar amount listed for your county for insurance and operating expenses.

$834.00

9. Housing and utilities – Mortgage or rent expenses:

9a. Using the number of people you entered in line 5, fill in the dollar amount

listed for your county for mortgage or rent expenses.

$1,461.00

9b. Total average monthly payment for all mortgages and other debts secured by

your home.

To calculate the total average monthly payment, add all amounts that are

contractually due to each secured creditor in the 60 months after you file for

bankruptcy. Next divide by 60.

Name of the creditor Average monthly

payment

GTWY 1ST FKA GTWY MRTG $3,186.00

+

9b. Total average monthly payment $3,186.00 Copy

here →

– $3,186.00 Repeat this amount

on line 33a.

9c. Net mortgage or rent expense.

Subtract line 9b (total average monthly payment) from line 9a (mortgage or rent expense). If

this number is less than $0, enter $0. $0.00 Copy here →..... $0.00

10. If you claim that the U.S. Trustee Program’s division of the IRS Local Standard for housing is incorrect and affects

the calculation of your monthly expenses, fill in any additional amount you claim.

Explain

why:

$0.00

Official Form 122C-2 Chapter 13 Calculation of Your Disposable Income page 2

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Document Page 109 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

11. Local transportation expenses: Check the number of vehicles for which you claim an ownership or operating expense.

0. Go to line 14.

1. Go to line 12.

2 or more. Go to line 12.

12. Vehicle operation expense: Using the IRS Local Standards and the number of vehicles for which you claim the operating

expenses, fill in the Operating Costs that apply for your Census region or metropolitan statistical area.

$484.00

13. Vehicle ownership or lease expense: Using the IRS Local Standards, calculate the net ownership or lease expense for each

vehicle below. You may not claim the expense if you do not make any loan or lease payments on the vehicle. In addition, you may

not claim the expense for more than two vehicles.

Vehicle 1 Describe Vehicle 1:

2021 Jeep Grand Cherokee

13a. Ownership or leasing costs using IRS Local Standard....................................... $629.00

13b. Average monthly payment for all debts secured by Vehicle 1.

Do not include costs for leased vehicles.

To calculate the average monthly payment here and on line 13e, add all

amounts that are contractually due to each secured creditor in the 60

months after you file for bankruptcy. Then divide by 60.

Name of each creditor for Vehicle 1 Average monthly

payment

BAYPORT CREDIT UNION $1,064.00

+

Total average monthly payment

$1,064.00 Copy

here →

– $1,064.00

Repeat this amount

on line 33b.

13c. Net Vehicle 1 ownership or lease expense

Subtract line 13b from line 13a. If this number is less than $0, enter $0.............

$0.00

Copy net Vehicle 1

expense here → $0.00

Vehicle 2 Describe Vehicle 2:

2021 Chevrolet Silverado

13d. Ownership or leasing costs using IRS Local Standard....................................... $629.00

13e. Average monthly payment for all debts secured by Vehicle 2.

Do not include costs for leased vehicles.

Name of each creditor for Vehicle 2 Average monthly

payment

CITY BANK- INDIRECT $949.00

+

Total average monthly payment

$949.00 Copy

here →

– $949.00

Repeat this amount

on line 33c.

13f. Net Vehicle 2 ownership or lease expense

Subtract line 13e from 13d. If this number is less than $0, enter $0.............

$0.00

Copy net Vehicle 2

expense here → $0.00

14. Public transportation expense: If you claimed 0 vehicles in line 11, using the IRS Local Standards, fill in the Public

Transportation expense allowance regardless of whether you use public transportation.

15. Additional public transportation expense: If you claimed 1 or more vehicles in line 11 and if you claim that you may also deduct a

public transportation expense, you may fill in what you believe is the appropriate expense, but you may not claim more than the

IRS Local Standard for Public Transportation.

$0.00

Official Form 122C-2 Chapter 13 Calculation of Your Disposable Income page 3

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Document Page 110 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Other Necessary

Expenses

In addition to the expense deductions listed above, you are allowed your monthly expenses for the

following IRS categories.

16. Taxes: The total monthly amount that you actually pay for federal, state and local taxes, such as income taxes, self-employment taxes,

social security taxes, and Medicare taxes. You may include the monthly amount withheld from your pay for these taxes. However, if

you expect to receive a tax refund, you must divide the expected refund by 12 and subtract that number from the total monthly amount

that is withheld to pay for taxes.

Do not include real estate, sales, or use taxes.

$1,540.18

17. Involuntary deductions: The total monthly payroll deductions that your job requires, such as retirement contributions, union dues, and

uniform costs.

Do not include amounts that are not required by your job, such as voluntary 401(k) contributions or payroll savings.

$0.00

18. Life insurance: The total monthly premiums that you pay for your own term life insurance. If two married people are filing together,

include payments that you make for your spouse’s term life insurance.

Do not include premiums for life insurance on your dependents, for a non-filing spouse’s life insurance, or for any form of life insurance

other than term.

$28.35

19. Court-ordered payments: The total monthly amount that you pay as required by the order of a court or administrative agency, such as

spousal or child support payments.

Do not include payments on past due obligations for spousal or child support. You will list these obligations in line 35.

$0.00

20. Education: The total monthly amount that you pay for education that is either required:

as a condition for your job, or

for your physically or mentally challenged dependent child if no public education is available for similar services.

$0.00

21. Childcare: The total monthly amount that you pay for childcare, such as babysitting, daycare, nursery, and preschool.

Do not include payments for any elementary or secondary school education.

$0.00

22. Additional health care expenses, excluding insurance costs: The monthly amount that you pay for health care that is required for the

health and welfare of you or your dependents and that is not reimbursed by insurance or paid by a health savings account. Include

only the amount that is more than the total entered in line 7.

Payments for health insurance or health savings accounts should be listed only in line 25.

$0.00

23. Optional telephones and telephone services: The total monthly amount that you pay for telecommunication services for you and your

dependents, such as pagers, call waiting, caller identification, special long distance, or business cell phone service, to the extent

necessary for your health and welfare or that of your dependents or for the production of income, if it is not reimbursed by your

employer.

Do not include payments for basic home telephone, internet or cell phone service. Do not include self-employment expenses, such as

those reported on line 5 of Form 122C-1, or any amount you previously deducted.

+ $0.00

24. Add all of the expenses allowed under the IRS expense allowances.

Add lines 6 through 23.

$5,195.53

Additional Expense

Deductions

These are additional deductions allowed by the Means Test.

Note: Do not include any expense allowances listed in lines 6-24.

25. Health insurance, disability insurance, and health savings account expenses. The monthly expenses for health insurance, disability

insurance, and health savings accounts that are reasonably necessary for yourself, your spouse, or your dependents.

Health insurance $681.67

Disability insurance $0.00

Health savings account + $0.00

Total $681.67 Copy total here → ........................................................................ $681.67

Do you actually spend this total amount?

 No. How much do you actually spend?

 Yes 

26. Continuing contributions to the care of household or family members.

The actual monthly expenses that you will continue to pay for the reasonable and necessary care and support of an elderly, chronically

ill, or disabled member of your household or member of your immediate family who is unable to pay for such expenses. These

expenses may include contributions to an account of a qualified ABLE program. 26 U.S.C. § 529A(b).

$0.00

27. Protection against family violence. The reasonably necessary monthly expenses that you incur to maintain the safety of you and your

family under the Family Violence Prevention and Services Act or other federal laws that apply.

By law, the court must keep the nature of these expenses confidential.

$0.00

Official Form 122C-2 Chapter 13 Calculation of Your Disposable Income page 4

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Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

28. Additional home energy costs. Your home energy costs are included in your insurance and operating expenses on line 8.

If you believe that you have home energy costs that are more than the home energy costs included in expenses on line 8, then fill in

the excess amount of home energy costs

You must give your case trustee documentation of your actual expenses, and you must show that the additional amount claimed is

reasonable and necessary.

$0.00

29. Education expenses for dependent children who are younger than 18. The monthly expenses (not more than $189.58* per child)

that you pay for your dependent children who are younger than 18 years old to attend a private or public elementary or secondary

school.

You must give your case trustee documentation of your actual expenses, and you must explain why the amount claimed is

reasonable and necessary and not already accounted for in lines 6-23.

* Subject to adjustment on 4/01/25, and every 3 years after that for cases begun on or after the date of adjustment.

$0.00

30. Additional food and clothing expense. The monthly amount by which your actual food and clothing expenses are higher than the

combined food and clothing allowances in the IRS National Standards. That amount cannot be more than 5% of the food and clothing

allowances in the IRS National Standards.

To find a chart showing the maximum additional allowance, go online using the link specified in the separate instructions for this form.

This chart may also be available at the bankruptcy clerk’s office.

You must show that the additional amount claimed is reasonable and necessary.

$0.00

31. Continuing charitable contributions. The amount that you will continue to contribute in the form of cash or financial instruments to a

religious or charitable organization. 11 U.S.C. § 548(d)3 and (4).

Do not include any amount more than 15% of your gross monthly income.

+ $0.00

32. Add all of the additional expense deductions.

Add lines 25 through 31.

$681.67

Deductions for Debt Payment

33. For debts that are secured by an interest in property that you own, including home mortgages, vehicle loans, and

other secured debt, fill in lines 33a through 33e.

To calculate the total average monthly payment, add all amounts that are contractually due to each secured creditor in

the 60 months after you file for bankruptcy. Then divide by 60.

Average monthly

payment

Mortgages on your home

33a. Copy line 9b here .....................................................................................................→

$3,186.00

Loans on your first two vehicles

33b. Copy line 13b here ..................................................................................................→

$1,064.00

33c. Copy line 13e here ..................................................................................................→

$949.00

33d. List other secured debts:

Name of each creditor for other

secured debt

Identify property that secures the

debt

Does payment

include taxes or

insurance?

ESB/HARLEY DAVIDSON CR 2021 Harley Triglide Ultra

 No

 Yes $714.00

CITIZENS BANK NA

PACK SADDLE PRAIRIE SEC 2,

BLOCK C, LOT 47, ACRES 1.02

250 Tweetie Pie Abilene, TX 79602

 No

 Yes $636.00

No

Yes +

33e. Total average monthly payment. Add lines 33a through 33d. ...................................

$6,549.00 Copy total

here→ $6,549.00

Official Form 122C-2 Chapter 13 Calculation of Your Disposable Income page 5

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Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

34. Are any debts that you listed in line 33 secured by your primary residence, a vehicle, or other property necessary for your

support or the support of your dependents?

No. Go to line 35.

Yes. State any amount that you must pay to a creditor, in addition to the payments listed in line 33, to keep

possession of your property (called the cure amount). Next, divide by 60 and fill in the information below.

Name of the creditor Identify property that

secures the debt

Total cure

amount

Monthly cure

amount

GTWY 1ST FKA GTWY MRTG

PACK SADDLE PRAIRIE SEC

1, BLOCK B, LOT 7, ACRES

1.03

250 Tweetie Pie Abilene, TX 79602 $12,747.36 ÷ 60 =

212.46

÷ 60 =

÷ 60 = + 

Total $212.46 Copy total

here → $212.46

35. Do you owe any priority claims—such as a priority tax, child support, or alimony—that are past due as of the filing date of your

bankruptcy case? 11 U.S.C. § 507.

No. Go to line 36.

Yes. Fill in the total amount of all of these priority claims. Do not include current or ongoing priority claims, such as

those you listed in line 19.

Total amount of all past-due priority claims.................................................................. ÷ 60

36. Projected monthly Chapter 13 plan payment $5,786.00

Current multiplier for your district as stated on the list issued by the Administrative Office of the

United States Courts (for districts in Alabama and North Carolina) or by the Executive Office for

United States Trustees (for all other districts).

To find a list of district multipliers that includes your district, go online using the link specified in

the separate instructions for this form. This list may also be available at the bankruptcy clerk’s

office. X 10.00%

Average monthly administrative expense

$578.60

Copy

total

here → $578.60

37. Add all of the deductions for debt payment. Add lines 33e through 36. $7,340.06

Total Deductions from Income

38. Add all of the allowed deductions.

Copy line 24, All of the expenses allowed under IRS expense allowances .................................... $5,195.53

Copy line 32, All of the additional expense deductions.................................................................... $681.67

Copy line 37, All of the deductions for debt payment....................................................................... + $7,340.06

Total deductions..............................................................................................................................

$13,217.26

Copy

total

here →

$13,217.26

Official Form 122C-2 Chapter 13 Calculation of Your Disposable Income page 6

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Document Page 113 of 115
Copy here →

Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Part 2: Determine Your Disposable Income Under 11 U.S.C. § 1325(b)(2)

39. Copy your total current monthly income from line 14 of Form 122C-1, Chapter 13

Statement of Your Current Monthly Income and Calculation of Commitment Period. ................................................................

$17,058.05

40. Fill in any reasonably necessary income you receive for support for dependent children.

The monthly average of any child support payments, foster care payments, or disability

payments for a dependent child, reported in Part I of Form 122C-1, that you received in

accordance with applicable nonbankruptcy law to the extent reasonably necessary to be

expended for such child.

$0.00

41. Fill in all qualified retirement deductions. The monthly total of all amounts that your

employer withheld from wages as contributions for qualified retirement plans, as specified in

11 U.S.C. § 541(b)(7) plus all required repayments of loans from retirement plans, as

specified in 11 U.S.C. § 362(b)(19).

$53.68

42. Total of all deductions allowed under 11 U.S.C. § 707(b)(2)(A). Copy line 38 here .... → $13,217.26

43. Deduction for special circumstances. If special circumstances justify additional expenses

and you have no reasonable alternative, describe the special circumstances and their

expenses. You must give your case trustee a detailed explanation of the special

circumstances and documentation for the expenses.

Describe the special circumstances Amount of expense

+

Total $0.00 Copy here

→ + $0.00

44. Total adjustments. Add lines 40 through 43........................................................................ $13,270.94

– $13,270.94

45. Calculate your monthly disposable income under § 1325(b)(2). Subtract line 44 from line 39. $3,787.11

Part 3: Change in Income or Expenses

46. Change in income or expenses. If the income in Form 122C-1 or the expenses you reported in this form have

changed or are virtually certain to change after the date you filed your bankruptcy petition and during the time your

case will be open, fill in the information below. For example, if the wages reported increased after you filed your

petition, check 122C-1 in the first column, enter line 2 in the second column, explain why the wages increased, fill

in when the increase occurred, and fill in the amount of the increase.

Form Line Reason for change Date of change Increase or

decrease?

Amount of change

122C-1

122C-2

Increase

Decrease

122C-1

122C-2

Increase

Decrease

Official Form 122C-2 Chapter 13 Calculation of Your Disposable Income page 7

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Document Page 114 of 115
Debtor 1

Debtor 2

Jerry Dean Holt, Jr

Sarah Joann Holt

First Name Middle Name Last Name

Case number (if known)

Part 4: Sign Below

By signing here, under penalty of perjury I declare that the information on this statement and in any attachments is true and correct.

✘ /s/ Jerry Dean Holt, Jr

Signature of Debtor 1

Date 05/23/2023

MM/ DD/ YYYY

✘ /s/ Sarah Joann Holt

Signature of Debtor 2

Date 05/23/2023

MM/ DD/ YYYY

Official Form 122C-2 Chapter 13 Calculation of Your Disposable Income page 8

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