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):

Johnny

First name

Horalia

First name

Gasca

Middle name

Patino

Middle name

Rodriguez

Last name

Rodriguez

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 - 4 3 7 2 xxx - xx - 2 2 4 1

OR OR

9xx - xx - 9xx - xx -

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

❑✔

❑

❑

❑ ❑

Voluntary Petition for Individuals Filing for Bankruptcy 06/24
Debtor 1

Debtor 2

Johnny Gasca Rodriguez, Jr

Horalia Patino Rodriguez

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:

7545 Harris Pkwy 4107

Number Street Number Street

Fort Worth, TX 76123

City State ZIP Code City State ZIP Code

Tarrant

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

❑✔ ❑✔

❑ ❑
Debtor 1

Debtor 2

Johnny Gasca Rodriguez, Jr

Horalia Patino Rodriguez

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

❑✔

❑

❑

❑

❑✔

❑

❑

❑✔

❑

❑✔

❑

❑

❑✔

❑✔

❑
Debtor 1

Debtor 2

Johnny Gasca Rodriguez, Jr

Horalia Patino Rodriguez

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?

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 so that it can set

appropriate deadlines. If you indicate that you are a small business debtor, you must attach your most recent balance

sheet, statement of operations, cash-flow statement, and federal income tax return or if any of these documents do not

exist, follow the procedure in 11 U.S.C. § 1116(1)(B).

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 small business debtor according to the definition in 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

❑✔

❑

❑

❑

❑

❑

❑

❑✔

❑

❑

❑
Debtor 1

Debtor 2

Johnny Gasca Rodriguez, Jr

Horalia Patino Rodriguez

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

❑✔

❑
Debtor 1

Debtor 2

Johnny Gasca Rodriguez, Jr

Horalia Patino Rodriguez

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

❑✔ ❑✔

❑ ❑

❑ ❑

❑

❑

❑

❑

❑

❑

❑

❑
Debtor 1

Debtor 2

Johnny Gasca Rodriguez, Jr

Horalia Patino Rodriguez

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/ Johnny Gasca Rodriguez, Jr

Johnny Gasca Rodriguez, Jr, Debtor 1

Executed on 10/31/2024

MM/ DD/ YYYY

✘ /s/ Horalia Patino Rodriguez

Horalia Patino Rodriguez, Debtor 2

Executed on 10/31/2024

MM/ DD/ YYYY

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

❑

❑✔

❑

❑

❑

❑✔

❑✔

❑

❑✔

❑

❑

❑

❑

❑

❑

❑ ❑ ❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑

❑

❑

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑

❑
Debtor 1

Debtor 2

Johnny Gasca Rodriguez, Jr

Horalia Patino Rodriguez

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/ Christopher Lee

Signature of Attorney for Debtor

Date 10/31/2024

MM / DD / YYYY

Christopher Lee

Printed name

Lee Law Firm, PLLC

Firm name

8701 Bedford Euless Rd 510

Number Street

Hurst

City

TX

State

76053

ZIP Code

Contact phone (214) 440-1414 Email address clee@leelawtx.com

24041319

Bar number

TX

State

Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 8
Fill in this information to identify your case and this filing:

Debtor 1 Johnny Gasca Rodriguez, Jr

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Horalia Patino Rodriguez

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

Street address, if available, or other

description

City State ZIP Code

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?

Current value of the

portion you own?

Describe the nature of your ownership interest

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

a life estate), if known.

Check if this is community property

(see instructions)

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

property identification number: 

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

you have attached for Part 1. Write that number here ...................................................................................................➔ $0.00

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

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

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑

❑

❑

❑

❑

❑

❑

❑

❑✔
Debtor Rodriguez, Johnny Gasca; Rodriguez, Horalia Patino Case number (if known)

3.1 Make: BMW

Model: 750 Li

Year: 2015

Approximate mileage: 113800

Other information:

Source of Value: JD Power

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?

$16,560.00

Current value of the

portion you own?

$16,560.00

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

3.2 Make: Honda

Model: CRV

Year: 2018

Approximate mileage: 75000

Other information:

Source of Value: JD Power

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?

$17,440.00

Current value of the

portion you own?

$17,440.00

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

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 ...................................................................................................➔ $34,000.00

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.

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

❑

❑

❑✔

❑

❑✔

❑

❑

❑✔

❑

❑✔

❑✔

❑

❑

❑

❑

❑

❑
Debtor Rodriguez, Johnny Gasca; Rodriguez, Horalia Patino Case number (if known)

6. Household goods and furnishings

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

No

Yes. Describe. ......... See Attached. $160.00

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. ......... Televisions $15.00

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. .........

11. Clothes

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

No

Yes. Describe. ......... Clothes

Shoes

$25.00

12. Jewelry

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

silver

No

Yes. Describe. ......... See Attached. $58.00

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

❑

❑✔

❑

❑✔

❑✔

❑

❑✔

❑

❑✔

❑

❑

❑✔

❑

❑✔
Debtor Rodriguez, Johnny Gasca; Rodriguez, Horalia Patino Case number (if known)

13. Non-farm animals

Examples: Dogs, cats, birds, horses

No

Yes. Describe. ......... 2 Dogs $5.00

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 .................................................................................................................................➔ $263.00

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:

Bank of America

Account Number: 5121 $1,268.14

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:

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

❑

❑✔

❑✔

❑

❑✔

❑

❑

❑✔

❑✔

❑
Debtor Rodriguez, Johnny Gasca; Rodriguez, Horalia Patino Case number (if known)

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:

Retirement account: Fidelity Investments Institutional Operations, Co. (Johnny) $0.00

Retirement account: The Northern Trust Company (Horalia) $0.00

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

❑✔

❑

❑✔

❑

❑

❑✔
Debtor Rodriguez, Johnny Gasca; Rodriguez, Horalia Patino 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. ...

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

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑
Debtor Rodriguez, Johnny Gasca; Rodriguez, Horalia Patino Case number (if known)

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. ...

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. ........

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

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑
Debtor Rodriguez, Johnny Gasca; Rodriguez, Horalia Patino Case number (if known)

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:

American Term Life (Horalia) spouse $0.00

Farmers Term Life Insurance

(Johnny) spouse $0.00

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 .................................................................................................................................➔ $1,268.14

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.

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

❑

❑✔

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑
Debtor Rodriguez, Johnny Gasca; Rodriguez, Horalia Patino Case number (if known)

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. .........

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. .........

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

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑

❑
Debtor Rodriguez, Johnny Gasca; Rodriguez, Horalia Patino Case number (if known)

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.

47. Farm animals

Examples: Livestock, poultry, farm-raised fish

No

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

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 ..........................

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

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑
Debtor Rodriguez, Johnny Gasca; Rodriguez, Horalia Patino Case number (if known)

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

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

56. Part 2: Total vehicles, line 5 $34,000.00

57. Part 3: Total personal and household items, line 15 $263.00

58. Part 4: Total financial assets, line 36 $1,268.14

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

60. Part 6: Total farm- and fishing-related property, line 52 $0.00

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

62. Total personal property. Add lines 56 through 61. ............... $35,531.14 Copy personal property total ➔ + $35,531.14

63. Total of all property on Schedule A/B. Add line 55 + line 62. ........................................................................................ $35,531.14

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

❑✔

❑

❑✔

❑
Debtor Rodriguez, Johnny Gasca; Rodriguez, Horalia Patino Case number (if known)

Continuation Page

6. Household goods and furnishings

Bedroom Furniture $50.00

Dining Room Furniture $50.00

Living Room Furniture $50.00

Plates/China $10.00

12. Jewelry

Bracelets $1.00

Costume Jewelry $1.00

Earrings $1.00

Rings/Wedding Rings $50.00

Watches $5.00

Official Form 106A/B Schedule A/B: Property page 12
Fill in this information to identify your case:

Debtor 1 Johnny Gasca Rodriguez, Jr

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Horalia Patino Rodriguez

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

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

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:

2015 BMW 750 Li

Line from

Schedule A/B: 3.1

$16,560.00

$3,061.00

100% of fair market value, up to

any applicable statutory limit

11 U.S.C. § 522(d)(2)

Brief

description:

2018 Honda CRV

Line from

Schedule A/B: 3.2

$17,440.00 $4,450.00

100% of fair market value, up to

any applicable statutory limit

11 U.S.C. § 522(d)(2)

$1,492.00

100% of fair market value, up to

any applicable statutory limit

11 U.S.C. § 522(d)(5)

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 3

❑

❑

❑✔

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑

❑
Debtor 1 Johnny Gasca Rodriguez, Jr

Debtor 2 Horalia Patino Rodriguez

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:

Living Room

Furniture

Line from

Schedule A/B: 6

$50.00

$50.00

100% of fair market value, up to

any applicable statutory limit

11 U.S.C. § 522(d)(3)

Brief

description:

Bedroom Furniture

Line from

Schedule A/B: 6

$50.00

$50.00

100% of fair market value, up to

any applicable statutory limit

11 U.S.C. § 522(d)(3)

Brief

description:

Plates/China

Line from

Schedule A/B: 6

$10.00

$10.00

100% of fair market value, up to

any applicable statutory limit

11 U.S.C. § 522(d)(3)

Brief

description:

Dining Room

Furniture

Line from

Schedule A/B: 6

$50.00

$50.00

100% of fair market value, up to

any applicable statutory limit

11 U.S.C. § 522(d)(3)

Brief

description:

Televisions

Line from

Schedule A/B: 7

$15.00

$15.00

100% of fair market value, up to

any applicable statutory limit

11 U.S.C. § 522(d)(3)

Brief

description:

Clothes Shoes

Line from

Schedule A/B: 11

$25.00

$25.00

100% of fair market value, up to

any applicable statutory limit

11 U.S.C. § 522(d)(3)

Brief

description:

Rings/Wedding

Rings

Line from

Schedule A/B: 12

$50.00

$50.00

100% of fair market value, up to

any applicable statutory limit

11 U.S.C. § 522(d)(4)

Brief

description:

Watches

Line from

Schedule A/B: 12

$5.00

$5.00

100% of fair market value, up to

any applicable statutory limit

11 U.S.C. § 522(d)(4)

Official Form 106C Schedule C: The Property You Claim as Exempt page 2 of 3

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑
Debtor 1 Johnny Gasca Rodriguez, Jr

Debtor 2 Horalia Patino Rodriguez

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:

Costume Jewelry

Line from

Schedule A/B: 12

$1.00

$1.00

100% of fair market value, up to

any applicable statutory limit

11 U.S.C. § 522(d)(4)

Brief

description:

Earrings

Line from

Schedule A/B: 12

$1.00

$1.00

100% of fair market value, up to

any applicable statutory limit

11 U.S.C. § 522(d)(4)

Brief

description:

Bracelets

Line from

Schedule A/B: 12

$1.00

$1.00

100% of fair market value, up to

any applicable statutory limit

11 U.S.C. § 522(d)(4)

Brief

description:

2 Dogs

Line from

Schedule A/B: 13

$5.00

$5.00

100% of fair market value, up to

any applicable statutory limit

11 U.S.C. § 522(d)(3)

Brief

description:

Bank of America

Checking account

Acct. No.: 5121

Line from

Schedule A/B: 17

$1,268.14

$1,268.14

100% of fair market value, up to

any applicable statutory limit

11 U.S.C. § 522(d)(5)

Brief

description:

The Northern Trust

Company (Horalia)

Line from

Schedule A/B: 21

$0.00

$0.00

100% of fair market value, up to

any applicable statutory limit

11 U.S.C. § 522(d)(12)

Brief

description:

Fidelity

Investments

Institutional

Operations, Co.

(Johnny)

Line from

Schedule A/B: 21

$0.00

$0.00

100% of fair market value, up to

any applicable statutory limit

11 U.S.C. § 522(d)(12)

Brief

description:

Farmers Term Life

Insurance (Johnny)

Line from

Schedule A/B: 31

$0.00

$0.00

100% of fair market value, up to

any applicable statutory limit

11 U.S.C. § 522(d)(7)

Brief

description:

American Term

Life (Horalia)

Line from

Schedule A/B: 31

$0.00

$0.00

100% of fair market value, up to

any applicable statutory limit

11 U.S.C. § 522(d)(7)

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

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑
UNITED STATES BANKRUPTCY COURT

NORTHERN DISTRICT OF TEXAS

FORT WORTH DIVISION

IN RE: Rodriguez, Johnny Gasca

Rodriguez, Horalia Patino

CASE NO

CHAPTER 7

SCHEDULE C-1 (SUPPLEMENTAL EXEMPTION ANALYSIS)

Exemption Totals by Category:

(Values and liens of surrendered property are NOT included in this section) Scheme Selected: Federal

No. Category

Gross

Property Value

Total

Encumbrances Total Equity

Total Amount

Exempt

Total Amount

Non-Exempt

1. Real Estate $0.00 $0.00 $0.00 $0.00 $0.00

3. Motor vehicle $34,000.00 $24,997.00 $9,003.00 $9,003.00 $0.00

4. Watercraft, trailers, motors homes, and

accessories

$0.00 $0.00 $0.00 $0.00 $0.00

6. Household goods and furnishings $160.00 $0.00 $160.00 $160.00 $0.00

7. Electronics $15.00 $0.00 $15.00 $15.00 $0.00

8. Collectibles of value $0.00 $0.00 $0.00 $0.00 $0.00

9. Equipment for sports and hobbies $0.00 $0.00 $0.00 $0.00 $0.00

10. Firearms $0.00 $0.00 $0.00 $0.00 $0.00

11. Clothes $25.00 $0.00 $25.00 $25.00 $0.00

12. Jewelry $58.00 $0.00 $58.00 $58.00 $0.00

13. Nonfarm animals $5.00 $0.00 $5.00 $5.00 $0.00

14. Other $0.00 $0.00 $0.00 $0.00 $0.00

16. Cash $0.00 $0.00 $0.00 $0.00 $0.00

17. Deposits of money $1,268.14 $0.00 $1,268.14 $1,268.14 $0.00

18. Bonds, mutual funds, or publicly traded

stocks

$0.00 $0.00 $0.00 $0.00 $0.00

19. Business Interests, LLC's,

Partnerships, Joint Ventures and

Nonpublicly traded stock

$0.00 $0.00 $0.00 $0.00 $0.00

20. Bonds and other financial instruments $0.00 $0.00 $0.00 $0.00 $0.00

21. Retirement or pension accounts $0.00 $0.00 $0.00 $0.00 $0.00

22. Security deposits and prepayments $0.00 $0.00 $0.00 $0.00 $0.00

23. Annuities $0.00 $0.00 $0.00 $0.00 $0.00

24. Interest in a qualified education fund,

such as an education IRA

$0.00 $0.00 $0.00 $0.00 $0.00

25. Trusts, equitable or future interests in

property

$0.00 $0.00 $0.00 $0.00 $0.00
UNITED STATES BANKRUPTCY COURT

NORTHERN DISTRICT OF TEXAS

FORT WORTH DIVISION

IN RE: Rodriguez, Johnny Gasca

Rodriguez, Horalia Patino

CASE NO

CHAPTER 7

SCHEDULE C-1 (SUPPLEMENTAL EXEMPTION ANALYSIS)

Continuation Sheet #1

Exemption Totals by Category:

(Values and liens of surrendered property are NOT included in this section) Scheme Selected: Federal

No. Category

Gross

Property Value

Total

Encumbrances Total Equity

Total Amount

Exempt

Total Amount

Non-Exempt

26. Copyrights, trademarks, websites and

other intellectual property

$0.00 $0.00 $0.00 $0.00 $0.00

27. Licenses, Franchises, and other

general intangibles

$0.00 $0.00 $0.00 $0.00 $0.00

28. Tax refunds $0.00 $0.00 $0.00 $0.00 $0.00

29. Family support $0.00 $0.00 $0.00 $0.00 $0.00

30. Other amounts owed to the debtor $0.00 $0.00 $0.00 $0.00 $0.00

31. Insurance policies $0.00 $0.00 $0.00 $0.00 $0.00

32. Interest in property from deceased $0.00 $0.00 $0.00 $0.00 $0.00

33. Claims against third parties $0.00 $0.00 $0.00 $0.00 $0.00

34. All other claims, includes

contingent/unliquidated claims, counter

claims, and creditor set offs

$0.00 $0.00 $0.00 $0.00 $0.00

35. Other financial asset $0.00 $0.00 $0.00 $0.00 $0.00

38. Accounts receivable $0.00 $0.00 $0.00 $0.00 $0.00

39. Office equipment, furnishings, and

supplies

$0.00 $0.00 $0.00 $0.00 $0.00

40. Machinery, fixtures and equipment $0.00 $0.00 $0.00 $0.00 $0.00

41. Inventory $0.00 $0.00 $0.00 $0.00 $0.00

42. Interests in partnerships or joint

ventures

$0.00 $0.00 $0.00 $0.00 $0.00

43. Customer lists $0.00 $0.00 $0.00 $0.00 $0.00

44. Other businessrelated property $0.00 $0.00 $0.00 $0.00 $0.00

47. Farm animals $0.00 $0.00 $0.00 $0.00 $0.00

48. Crops $0.00 $0.00 $0.00 $0.00 $0.00

49. Equipment $0.00 $0.00 $0.00 $0.00 $0.00

50. Supplies $0.00 $0.00 $0.00 $0.00 $0.00
UNITED STATES BANKRUPTCY COURT

NORTHERN DISTRICT OF TEXAS

FORT WORTH DIVISION

IN RE: Rodriguez, Johnny Gasca

Rodriguez, Horalia Patino

CASE NO

CHAPTER 7

SCHEDULE C-1 (SUPPLEMENTAL EXEMPTION ANALYSIS)

Continuation Sheet #2

Exemption Totals by Category:

(Values and liens of surrendered property are NOT included in this section) Scheme Selected: Federal

No. Category

Gross

Property Value

Total

Encumbrances Total Equity

Total Amount

Exempt

Total Amount

Non-Exempt

51. Other farm or fishing related property $0.00 $0.00 $0.00 $0.00 $0.00

53. Other $0.00 $0.00 $0.00 $0.00 $0.00

TOTALS: $35,531.14 $24,997.00 $10,534.14 $10,534.14 $0.00
UNITED STATES BANKRUPTCY COURT

NORTHERN DISTRICT OF TEXAS

FORT WORTH DIVISION

IN RE: Rodriguez, Johnny Gasca

Rodriguez, Horalia Patino

CASE NO

CHAPTER 7

SCHEDULE C-1 (SUPPLEMENTAL EXEMPTION ANALYSIS)

Continuation Sheet #3

Surrendered Property:

The following property is to be surrendered by the debtor. Although this property is NOT exempt, it is NOT considered "non-exempt" for

purposes of this analysis. The below listed items are to be returned to the lienholder

Property Description Market Value Lien Equity

Real Property

(None)

Personal Property

(None)

TOTALS: $0.00 $0.00 $0.00

Non-exempt Property by Item:

The following property, or a portion thereof, is non-exempt.

Property Description Market Value Lien Equity Non-Exempt Amount

Real Property

(None)

Personal Property

(None)

TOTALS: $35,531.14 $24,997.00 $10,534.14 $0.00
UNITED STATES BANKRUPTCY COURT

NORTHERN DISTRICT OF TEXAS

FORT WORTH DIVISION

IN RE: Rodriguez, Johnny Gasca

Rodriguez, Horalia Patino

CASE NO

CHAPTER 7

SCHEDULE C-1 (SUPPLEMENTAL EXEMPTION ANALYSIS)

Continuation Sheet #4

Summary

A. Gross Property Value (not including surrendered property) $35,531.14

B. Gross Property Value of Surrendered Property $0.00

C. Total Gross Property Value (A+B) $35,531.14

D. Gross Amount of Encumbrances (not including surrendered property) $24,997.00

E. Gross Amount of Encumbrances on Surrendered Property $0.00

F. Total Gross Encumbrances (D+E) $24,997.00

G. Total Equity (not including surrendered property) / (A-D) $10,534.14

H. Total Equity in surrendered items (B-E) $0.00

I. Total Equity (C-F) $10,534.14

J. Total Exemptions Claimed (Wild Card Used: $2,760.14, Available:

$28,089.86)

$10,534.14

K. Total Non-Exempt Property Remaining (G-J) $0.00
Fill in this information to identify your case:

Debtor 1 Johnny Gasca Rodriguez, Jr

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Horalia Patino Rodriguez

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

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

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

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

name and case number (if known).

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

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 Bank of America

Creditor’s Name

PO Box 15026

Number Street

Wilmington, DE 19850

City State ZIP Code

Describe the property that secures the claim: $11,498.00 $17,440.00 $0.00

2018 Honda CRV

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

Contingent

Unliquidated

Disputed

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

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)

Certificate of Title

Date debt was incurred 2/1/2022 Last 4 digits of account number 3 7 3 5

Add the dollar value of your entries in Column A on this page. Write that number here: $11,498.00

Official Form 106D Schedule D: Creditors Who Have Claims Secured by Property page 1 of 2

❑

❑

❑✔

❑

❑

❑

❑

❑✔

❑

❑

❑

❑✔

❑

❑

❑
Debtor 1 Johnny Gasca Rodriguez, Jr

Debtor 2 Horalia Patino Rodriguez

First Name Middle Name Last Name

Case number (if known)

Part 1:

Additional Page

After listing any entries on this page, number them beginning with 2.3,

followed by 2.4, and so forth.

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 Evergreen Bank

Creditor’s Name

3842 95th St W

Number Street

Evergreen Park, IL 60805

City State ZIP Code

Describe the property that secures the claim: $13,499.00 $16,560.00 $0.00

2015 BMW 750 Li

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

Contingent

Unliquidated

Disputed

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

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)

Certificate of Title

Date debt was incurred 9/1/2022 Last 4 digits of account number 3 2 8 4

Add the dollar value of your entries in Column A on this page. Write that number here: $13,499.00

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

Write that number here: $24,997.00

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

❑

❑

❑

❑

❑

❑✔

❑

❑

❑✔

❑

❑

❑✔
Fill in this information to identify your case:

Debtor 1 Johnny Gasca Rodriguez, Jr

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Horalia Patino Rodriguez

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

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

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

other party to any executory contracts or unexpired leases that could result in a claim. Also list executory contracts on Schedule 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 Have Claims Secured by Property. If more space is needed, copy the Part you need, fill it out,

number the entries in the boxes on the left. Attach the Continuation Page to this page. On the top of any additional pages, write your name and case

number (if known).

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 Internal Revenue Service

Priority Creditor’s Name

Insolvency

PO Box 7346

Number Street

Philadelphia, PA 19101-7346

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 4 3 7 2

When was the debt incurred? 12/31/2021

$26,174.98 $26,174.98 $0.00

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

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 1 of 14

❑

❑

❑✔

❑

❑

❑✔

❑

❑✔

❑✔

❑

❑

❑

❑

❑

❑✔

❑

❑
Debtor 1 Johnny Gasca Rodriguez, Jr

Debtor 2 Horalia Patino Rodriguez

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 Bank of America

Nonpriority Creditor’s Name

PO Box 660441

Number Street

Dallas, TX 75266

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 1 0 6 2

When was the debt incurred? 2024

$0.00

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 Credit Card

4.2 Bank of America

Nonpriority Creditor’s Name

PO Box 15026

Number Street

Wilmington, DE 19850

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 2 0 4 4

When was the debt incurred? 1/1/2015

$29,759.00

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

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 2 of 14

❑

❑✔

❑

❑

❑✔

❑

❑✔

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

❑

❑

❑✔

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔
Debtor 1 Johnny Gasca Rodriguez, Jr

Debtor 2 Horalia Patino Rodriguez

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 4.4, followed by 4.5, and so forth. Total claim

4.3 Citibank

Nonpriority Creditor’s Name

Po Box 78045

Number Street

Phoenix, AZ 85062-8045

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 9 9 6 0

When was the debt incurred? 11/1/2016

$2,849.00

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

4.4 Citibank

Nonpriority Creditor’s Name

PO Box 790406

Number Street

Saint Louis, MO 63179

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 2 1 1 3

When was the debt incurred? 03/01/2024

$14,025.00

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 Credit Card

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 3 of 14

❑

❑✔

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

❑

❑

❑✔

❑

❑✔

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔
Debtor 1 Johnny Gasca Rodriguez, Jr

Debtor 2 Horalia Patino Rodriguez

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 4.4, followed by 4.5, and so forth. Total claim

4.5 Citibank/Exxon Mobile

Nonpriority Creditor’s Name

PO Box 790040

Number Street

Saint Louis, MO 63179

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 5 4 1 1

When was the debt incurred? 7/1/2023

$837.00

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

4.6 Citibank/The Home Depot

Nonpriority Creditor’s Name

Citicorp Cr Srvs/Centralized Bankruptcy

PO Box 790040

Number Street

St Louis, MO 63179-0040

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 2 9 4 5

When was the debt incurred? 10/1/2005

$865.00

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

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 4 of 14

❑✔

❑

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

❑✔

❑

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔
Debtor 1 Johnny Gasca Rodriguez, Jr

Debtor 2 Horalia Patino Rodriguez

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 4.4, followed by 4.5, and so forth. Total claim

4.7 Comenity Capital/Acadmy

Nonpriority Creditor’s Name

Attn: Bankruptcy

PO Box 182125

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 0 0 1 5

When was the debt incurred? 8/1/2021

$368.00

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

4.8 Costco Citi Card

Nonpriority Creditor’s Name

Attn: Bankruptcy

PO Box 6500

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 8 0 8 9

When was the debt incurred? 10/1/2021

$4,275.00

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

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 5 of 14

❑✔

❑

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

❑

❑✔

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔
Debtor 1 Johnny Gasca Rodriguez, Jr

Debtor 2 Horalia Patino Rodriguez

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 4.4, followed by 4.5, and so forth. Total claim

4.9 Evergreen Bank

Nonpriority Creditor’s Name

3842 95th St W

Number Street

Evergreen Park, IL 60805

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 3 1 6 1

When was the debt incurred? 9/1/2022

$14,656.00

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 Signature loan

4.10 Freedom Debt Relief

Nonpriority Creditor’s Name

PO Box 2330

Number Street

Phoenix, AZ 85002

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 1 0 6 2

When was the debt incurred? 2024

$0.00

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 Collecting for Bank of America

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 6 of 14

❑

❑

❑✔

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

❑

❑

❑✔

❑

❑✔

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔
Debtor 1 Johnny Gasca Rodriguez, Jr

Debtor 2 Horalia Patino Rodriguez

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 4.4, followed by 4.5, and so forth. Total claim

4.11 Goldman Sachs Bank USA

Nonpriority Creditor’s Name

By AIS Infosource, LP as Agent

P.O. Box 4457

Number Street

Houston, TX 77210

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 4 6 0 8

When was the debt incurred? 8/1/2019

$6,770.00

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

4.12 Headway Capital

Nonpriority Creditor’s Name

4700 W Daybreak Pkwy Suite 200

Number Street

South Jordan, UT 84009

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 6 2 9 6

When was the debt incurred? 2024

$38,592.77

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 Business Debt

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 7 of 14

❑

❑✔

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

❑

❑

❑✔

❑

❑✔

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔
Debtor 1 Johnny Gasca Rodriguez, Jr

Debtor 2 Horalia Patino Rodriguez

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 4.4, followed by 4.5, and so forth. Total claim

4.13 Home Depot

Nonpriority Creditor’s Name

PO Box Box 650121

Number Street

Hawkins, TX 75765

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 5 3 1 9

When was the debt incurred? 2024

$3,986.75

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 Credit Card

4.14 Justice of the Peace, Precinct 6

Nonpriority Creditor’s Name

6551 Granbury Rd

Number Street

Fort Worth, TX 76133

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 0 8 2 7

When was the debt incurred? 07/22/2024

$0.00

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 Notice only

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 8 of 14

❑

❑

❑✔

❑

❑✔

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

❑

❑

❑✔

❑

❑✔

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔
Debtor 1 Johnny Gasca Rodriguez, Jr

Debtor 2 Horalia Patino Rodriguez

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 4.4, followed by 4.5, and so forth. Total claim

4.15 Kohl's

Nonpriority Creditor’s Name

PO Box 30510

Number Street

Los Angeles, CA 90030

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 3 4 0 7

When was the debt incurred? 1/1/2008

$314.00

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

4.16 LVNV Funding

Nonpriority Creditor’s Name

PO Box 740281

Number Street

Houston, TX 77274-0281

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 0 8 2 7

When was the debt incurred? 07/22/2024

$0.00

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 Judgement

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 9 of 14

❑

❑✔

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

❑

❑

❑✔

❑

❑✔

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔
Debtor 1 Johnny Gasca Rodriguez, Jr

Debtor 2 Horalia Patino Rodriguez

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 4.4, followed by 4.5, and so forth. Total claim

4.17 Lvnv Funding/Resurgent Capital

Nonpriority Creditor’s Name

Attn: Bankruptcy

PO Box 10497

Number Street

Greenville, SC 29603

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 2 1 1 3

When was the debt incurred? 3/1/2024

$0.00

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 Collecting for Citibank, N.A.

4.18 Scott & Associates, PC

Nonpriority Creditor’s Name

PO Box 115220

Number Street

Carrollton, TX 75011

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 0 8 2 7

When was the debt incurred? 7/22/2024

$0.00

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 Attorney for LVNV Funding

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 10 of 14

❑

❑✔

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

❑

❑

❑✔

❑

❑✔

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔
Debtor 1 Johnny Gasca Rodriguez, Jr

Debtor 2 Horalia Patino Rodriguez

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 4.4, followed by 4.5, and so forth. Total claim

4.19 Synchrony Bank/Car Care

Nonpriority Creditor’s Name

Attn: Bankruptcy

P.O. Box 965060

Number Street

Orlando, FL 32896-5060

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 3 5 7 2

When was the debt incurred? 3/1/2023

$3,310.00

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

4.20 Synchrony Bank/Care Credit

Nonpriority Creditor’s Name

P.O. Box 71715

Number Street

Philadelphia, PA 19176

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 8 7 0 4

When was the debt incurred? 5/1/2017

$1,941.00

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

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 11 of 14

❑✔

❑

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

❑✔

❑

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔
Debtor 1 Johnny Gasca Rodriguez, Jr

Debtor 2 Horalia Patino Rodriguez

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 4.4, followed by 4.5, and so forth. Total claim

4.21 Synchrony Bank/Rooms To Go

Nonpriority Creditor’s Name

Attn: Bankruptcy

PO Box 965060

Number Street

Orlando, FL 32896-5060

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 7 7 8 6

When was the debt incurred? 5/1/2021

$2,485.00

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

4.22 Synchrony Bank/Sams Club

Nonpriority Creditor’s Name

Attn: Bankruptcy

PO Box 965060

Number Street

Orlando, FL 32896-5060

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 6 2 8 7

When was the debt incurred? 6/1/2022

$2,139.00

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

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 12 of 14

❑

❑✔

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

❑

❑✔

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔
Debtor 1 Johnny Gasca Rodriguez, Jr

Debtor 2 Horalia Patino Rodriguez

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 4.4, followed by 4.5, and so forth. Total claim

4.23 US Bank

Nonpriority Creditor’s Name

Attn: Bankruptcy

800 Nicollet Mall

Number Street

Minneapolis, MN 55402

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 0 6 0 5

When was the debt incurred? 10/1/2021

$32,647.26

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 Lease

4.24 Wells Fargo Bank NA

Nonpriority Creditor’s Name

PO Box 10335

Number Street

Des Moines, IA 50306

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 2 8 0 4

When was the debt incurred? 9/1/2011

$6,473.00

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

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 13 of 14

❑✔

❑

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔

❑

❑✔

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑✔
Debtor 1 Johnny Gasca Rodriguez, Jr

Debtor 2 Horalia Patino Rodriguez

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. $26,174.98

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

intoxicated

6c. $0.00

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

Write that amount here.

6d. + $0.00

6e. Total. Add lines 6a through 6d. 6e. $26,174.98

Total claim

Total claims

from Part 2

6f. Student loans 6f. $0.00

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. + $166,292.78

6j. Total. Add lines 6f through 6i. 6j. $166,292.78

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 14 of 14
Fill in this information to identify your case:

Debtor 1 Johnny Gasca Rodriguez, Jr

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Horalia Patino Rodriguez

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

EPC Sparrow Tavolo, LLC

Name

7545 Harris Pkwy

Number Street

Fort Worth, TX 76123

City State ZIP Code

Assisted Living Residence

Contract to be ASSUMED

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

❑

Schedule G: Executory Contracts and Unexpired Leases 12/15

❑

❑✔
Fill in this information to identify your case:

Debtor 1 Johnny Gasca Rodriguez, Jr

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Horalia Patino Rodriguez

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

Schedule H: Your Codebtors 12/15

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

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

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

known). Answer every question.

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

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? Texas . Fill in the name and current address of that person.

Rodriguez, Horalia Patino

Name of your spouse, former spouse, or legal equivalent

7545 Harris Pkwy 4107

Number Street

Fort Worth, TX 76123

City State ZIP Code

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

Rodriguez, Johnny Gasca

Name of your spouse, former spouse, or legal equivalent

7545 Harris Pkwy 4107

Number Street

Fort Worth, TX 76123

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: Codebtors page 1 of 2

❑

❑✔

❑

❑

❑✔

❑

❑✔

❑✔

❑

❑

❑
Debtor 1 Johnny Gasca Rodriguez, Jr

Debtor 2 Horalia Patino Rodriguez

First Name Middle Name Last Name

Case number (if known)

Additional Page to List More Codebtors

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

Check all schedules that apply:

3.2

Name

Number Street

City State ZIP Code

 Schedule D, line 

 Schedule E/F, line 

 Schedule G, line 

Official Form 106H Schedule H: Codebtors page 2 of 2

❑

❑

❑
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 Johnny Gasca Rodriguez, Jr

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Horalia Patino Rodriguez

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

Retired

Number Street

City State Zip Code

Employed Not Employed

Retired

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. $0.00 $0.00

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

4. Calculate gross income. Add line 2 + line 3. 4. $0.00 $0.00

Official Form 106I Schedule I: Your Income page 1

❑

❑

Schedule I: Your Income 12/15

❑ ❑✔ ❑ ❑✔
Debtor 1

Debtor 2

Johnny Gasca Rodriguez, Jr

Horalia Patino Rodriguez

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. $0.00 $0.00

5. List all payroll deductions:

5a. Tax, Medicare, and Social Security deductions 5a. $0.00 $0.00

5b. Mandatory contributions for retirement plans 5b. $0.00 $0.00

5c. Voluntary contributions for retirement plans 5c. $0.00 $0.00

5d. Required repayments of retirement fund loans 5d. $0.00 $0.00

5e. Insurance 5e. $0.00 $0.00

5f. Domestic support obligations 5f. $0.00 $0.00

5g. Union dues 5g. $0.00 $0.00

5h. Other deductions. Specify: 5h. + $0.00 + $0.00

6. Add the payroll deductions. Add lines 5a + 5b + 5c + 5d + 5e +5f + 5g + 5h. 6. $0.00 $0.00

7. Calculate total monthly take-home pay. Subtract line 6 from line 4. 7. $0.00 $0.00

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. $2,635.00 $1,560.00

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. $996.62 $528.57

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. $3,631.62 $2,088.57

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. $3,631.62 + $2,088.57 = $5,720.19

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. $5,720.19

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

❑✔

❑
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?

 No. Yes.

 No. Yes.

 No. Yes.

 No. Yes.

 No. Yes.

Fill in this information to identify your case:

Debtor 1 Johnny Gasca Rodriguez, Jr

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Horalia Patino Rodriguez

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. 4. $2,400.00

If not included in line 4:

4a. Real estate taxes 4a. $0.00

4b. Property, homeowner's, or renter's insurance 4b. $22.50

4c. Home maintenance, repair, and upkeep expenses 4c. $0.00

4d. Homeowner's association or condominium dues 4d. $0.00

Official Form 106J Schedule J: Your Expenses page 1

❑

❑

Schedule J: Your Expenses 12/15

❑

❑✔

❑✔

❑

❑✔

❑

❑ ❑

❑ ❑

❑ ❑

❑ ❑

❑ ❑

❑✔

❑
Debtor 1

Debtor 2

Johnny Gasca Rodriguez, Jr

Horalia Patino Rodriguez

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. $0.00

6. Utilities:

6a. Electricity, heat, natural gas 6a. $200.00

6b. Water, sewer, garbage collection 6b. $70.00

6c. Telephone, cell phone, Internet, satellite, and cable services 6c. $100.00

6d. Other. Specify: 6d. $0.00

7. Food and housekeeping supplies 7. $500.00

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

9. Clothing, laundry, and dry cleaning 9. $100.00

10. Personal care products and services 10. $125.00

11. Medical and dental expenses 11. $100.00

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

Do not include car payments. 12. $250.00

13. Entertainment, clubs, recreation, newspapers, magazines, and books 13. $100.00

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 15a. $300.09

15b. Health insurance 15b. $0.00

15c. Vehicle insurance 15c. $300.00

15d. Other insurance. Specify: 15d. $0.00

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

Specify: IRS 16. $300.00

17. Installment or lease payments:

17a. Car payments for Vehicle 1 2015 BMW 750 Li 17a. $325.00

17b. Car payments for Vehicle 2 2018 Honda CRV 17b. $417.00

17c. Other. Specify: 17c. $0.00

17d. Other. Specify: 17d. $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 20a. $0.00

20b. Real estate taxes 20b. $0.00

20c. Property, homeowner’s, or renter’s insurance 20c. $22.50

20d. Maintenance, repair, and upkeep expenses 20d. $0.00

20e. Homeowner’s association or condominium dues 20e. $0.00

Official Form 106J Schedule J: Your Expenses page 2
Debtor 1

Debtor 2

Johnny Gasca Rodriguez, Jr

Horalia Patino Rodriguez

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.

$5,632.09

$0.00

$5,632.09

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.

$5,720.19

– $5,632.09

$88.10

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

❑✔

❑
Fill in this information to identify your case:

Debtor 1 Johnny Gasca Rodriguez, Jr

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Horalia Patino Rodriguez

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...........................................................................................................

$0.00

$35,531.14

$35,531.14

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....... $24,997.00

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.................................

$26,174.98

+ $166,292.78

Your total liabilities $217,464.76

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.......................................................................................... $5,720.19

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

Copy your monthly expenses from line 22c of Schedule J.................................................................................. $5,632.09

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

❑

Summary of Your Assets and Liabilities and Certain Statistical

Information 12/15
Debtor 1

Debtor 2

Johnny Gasca Rodriguez, Jr

Horalia Patino Rodriguez

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. $1,525.19

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.) $26,174.98

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

9d. Student loans. (Copy line 6f.) $0.00

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. $26,174.98

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

❑

❑✔

❑✔

❑
Fill in this information to identify your case:

Debtor 1 Johnny Gasca Rodriguez, Jr

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Horalia Patino Rodriguez

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/ Johnny Gasca Rodriguez, Jr

Johnny Gasca Rodriguez, Jr, Debtor 1

Date 10/31/2024

MM/ DD/ YYYY

✘ /s/ Horalia Patino Rodriguez

Horalia Patino Rodriguez, Debtor 2

Date 10/31/2024

MM/ DD/ YYYY

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

❑

Declaration About an Individual Debtor's Schedules 12/15

❑✔

❑
Notice Required by 11 U.S.C. § 342(b) for

Individuals Filing for Bankruptcy (Form 2010)

This notice is for you if:

You are an individual filing for

bankruptcy, and

Your debts are 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.”

The types of bankruptcy that are

available to individuals

Individuals who meet the qualifications may file

under one of four different chapters of the

Bankruptcy Code:

Chapter 7 — Liquidation

Chapter 11— Reorganization

Chapter 12— Voluntary repayment plan

for family farmers or

fishermen

Chapter 13— Voluntary repayment plan

for individuals with regular

income

You should have an attorney review your

decision to file for bankruptcy and the choice of

chapter.

Chapter 7: Liquidation

$245 filing fee

$78 administrative fee

+ $15 trustee surcharge

$338 total fee

Chapter 7 is for individuals who have financial

difficulty preventing them from paying their

debts and who are willing to allow their nonexempt property to be used to pay their

creditors. The primary purpose of filing under

chapter 7 is to have your debts discharged.

The bankruptcy discharge relieves you after

bankruptcy from having to pay many of your

pre-bankruptcy debts. Exceptions exist for

particular debts, and liens on property may

still be enforced after discharge. For example,

a creditor may have the right to foreclose a

home mortgage or repossess an automobile.

However, if the court finds that you have committed

certain kinds of improper conduct described in the

Bankruptcy Code, the court may deny your

discharge.

You should know that even if you file chapter 7 and

you receive a discharge, some debts are not

discharged under the law. Therefore, you may still

be responsible to pay:

most taxes;

most student loans;

most domestic support and property

settlement obligations;

Notice Required by 11 U.S.C. U.S.C. § 342(b) for Individuals Filing for Bankruptcy (Form 2010) page 1
most fines, penalties, forfeitures, and

criminal restitution obligations; and

certain debts that are not listed in your

bankruptcy papers.

You may also be required to pay debts arising

from:

fraud or theft;

fraud or defalcation while acting in breach

of fiduciary capacity;

intentional injuries that you inflicted; and

death or personal injury caused by

operating a motor vehicle, vessel, or

aircraft while intoxicated from alcohol or

drugs.

If your debts are primarily consumer debts, the

court can dismiss your chapter 7 case if it finds that

you have enough income to repay creditors a

certain amount. You must file Chapter 7 Statement

of Your Current Monthly Income (Official Form

122A–1) if you are an individual filing for

bankruptcy under chapter 7. This form will

determine your current monthly income and

compare whether your income is more than the

median income that applies in your state.

If your income is not above the median for your

state, you will not have to complete the other

chapter 7 form, the Chapter 7 Means Test

Calculation (Official Form 122A–2).

If your income is above the median for your state,

you must file a second form —the Chapter 7

Means Test Calculation (Official Form 122A–2).

The calculations on the form— sometimes called

the Means Test —deduct from your income living

expenses and payments on certain debts to

determine any amount available to pay unsecured

creditors. If

your income is more than the median income for

your state of residence and family size, depending

on the results of the Means Test, the U.S. trustee,

bankruptcy administrator, or creditors can file a

motion to dismiss your case under § 707(b) of the

Bankruptcy Code. If a motion is filed, the court will

decide if your case should be dismissed. To avoid

dismissal, you may choose to proceed under

another chapter of the Bankruptcy Code.

If you are an individual filing for chapter 7

bankruptcy, the trustee may sell your property to

pay your debts, subject to your right to exempt the

property or a portion of the proceeds from the sale

of the property. The property, and the proceeds

from property that your bankruptcy trustee sells or

liquidates that you are entitled to, is called exempt

property. Exemptions may enable you to keep your

home, a car, clothing, and household items or to

receive some of the proceeds if the property is

sold.

Exemptions are not automatic. To exempt property,

you must list it on Schedule C: The Property You

Claim as Exempt (Official Form 106C). If you do

not list the property, the trustee may sell it and pay

all of the proceeds to your creditors.

Chapter 11: Reorganization

$1,167 filing fee

+ $571 administrative fee

$1,738 total fee

Chapter 11 is often used for reorganizing a

business, but is also available to individuals. The

provisions of chapter 11 are too complicated to

summarize briefly.

Notice Required by 11 U.S.C. U.S.C. § 342(b) for Individuals Filing for Bankruptcy (Form 2010) page 2
Read These Important Warnings

Because bankruptcy can have serious long-term financial and legal consequences, including loss of

your property, you should hire an attorney and carefully consider all of your options before you file.

Only an attorney can give you legal advice about what can happen as a result of filing for bankruptcy

and what your options are. If you do file for bankruptcy, an attorney can help you fill out the forms

properly and protect you, your family, your home, and your possessions.

Although the law allows you to represent yourself in bankruptcy court, you should understand that

many people find it difficult to represent themselves successfully. The rules are technical, and a

mistake or inaction may harm you. If you file without an attorney, you are still responsible for

knowing and following all of the legal requirements.

You should not file for bankruptcy if you are not eligible to file or if you do not intend to file the

necessary documents.

Bankruptcy fraud is a serious crime; you could be fined and imprisoned if you commit fraud in your

bankruptcy case. 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.

Chapter 12: Repayment plan for family

farmers or fishermen

$200 filing fee

+ $78 administrative fee

$278 total fee

Similar to chapter 13, chapter 12 permits family

farmers and fishermen to repay their debts over a

period of time using future earnings and to

discharge some debts that are not paid.

Chapter 13: Repayment plan for

individuals with regular

income

$235 filing fee

+ $78 administrative fee

$313 total fee

Chapter 13 is for individuals who have regular

income and would like to pay all or part of their

debts in installments over a period of time and to

discharge some debts that are not paid. You are

eligible for chapter 13 only if your debts are not

more than certain dollar amounts set forth in 11

U.S.C. § 109.

Under chapter 13, you must file with the court a

plan to repay your creditors all or part of the money

that you owe them, usually using your future

earnings. If the court approves your plan, the court

will allow you to repay your debts, as adjusted by

the plan, within 3 years or 5 years, depending on

your income and other factors.

After you make all the payments under your plan,

many of your debts are discharged. The debts that

are not discharged and that you may still be

responsible to pay include:

domestic support obligations,

most student loans,

certain taxes,

debts for fraud or theft,

debts for fraud or defalcation while acting

in a fiduciary capacity,

most criminal fines and restitution

obligations,

certain debts that are not listed in your

bankruptcy papers,

certain debts for acts that caused death or

personal injury, and

certain long-term secured debts

Notice Required by 11 U.S.C. U.S.C. § 342(b) for Individuals Filing for Bankruptcy (Form 2010) page 3
Warning: File Your Forms on Time

Section 521(a)(1) of the Bankruptcy Code

requires that you promptly file detailed

information about your creditors, assets,

liabilities, income, expenses and general

financial condition. The court may dismiss your

bankruptcy case if you do not file this

information within the deadlines set by the

Bankruptcy Code, the Bankruptcy Rules, and

the local rules of the court.

For more information about the documents and

their deadlines, go to:

http://www.uscourts.gov/bkforms

/bankruptcy_form

s.html#procedure.

Bankruptcy crimes have serious

consequences

If you knowingly and fraudulently conceal

assets or make a false oath or statement

under penalty of perjury—either orally or

in writing—in connection with a

bankruptcy case, you may be fined,

imprisoned, or both.

All information you supply in connection

with a bankruptcy case is subject to

examination by the Attorney General acting

through the Office of the U.S. Trustee, the

Office of the U.S. Attorney, and other

offices and employees of the U.S.

Department of Justice.

Make sure the court has your

mailing address

The bankruptcy court sends notices to the mailing

address you list on Voluntary Petition for

Individuals Filing for Bankruptcy(Official Form 101).

To ensure that you receive information about your

case, Bankruptcy Rule 4002 requires that you

notify the court of any changes in your address.

A married couple may file a bankruptcy case

together—called a joint case. If you file a joint

case and each spouse lists the same mailing

address on the bankruptcy petition, the

bankruptcy court generally will mail you and

your spouse one copy of each notice, unless

you file a statement with the court asking that

each spouse receive separate copies.

Understand which services you

could receive from credit

counseling agencies

The law generally requires that you receive a

credit counseling briefing from an approved

credit counseling agency. 11 U.S.C. § 109(h).

If you are filing a joint case, both spouses

must receive the briefing. With limited

exceptions, you must receive it within the 180

days before you file your bankruptcy petition.

This briefing is usually conducted by

telephone or on the Internet.

In addition, after filing a bankruptcy case, you

generally must complete a financial

management instructional course before you

can receive a discharge. If you are filing a

joint case, both spouses must complete the

course.

You can obtain the list of agencies approved

to provide both the briefing and the

instructional course from:

http://justice.gov/ust/eo/hapcpa

/ccde/cc_approved.html.

In Alabama and North Carolina, go to:

http://www.uscourts.gov/FederalCourts

/Bankruptcy/

BankruptcyResources/ApprovedCredit

AndDebtCounselors.aspx.

If you do not have access to a computer, the

clerk of the bankruptcy court may be able to

help you obtain the list.

Notice Required by 11 U.S.C. U.S.C. § 342(b) for Individuals Filing for Bankruptcy (Form 2010) page 4
Fill in this information to identify your case:

Debtor 1 Johnny Gasca Rodriguez, Jr

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Horalia Patino Rodriguez

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

7545 Harris Pkwy Apt. 4107

Number Street

Fort Worth, TX 76123

City State ZIP Code

From 

To

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

❑

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

❑✔

❑

❑

❑✔

❑✔ ❑✔

❑ ❑

❑

❑✔
Debtor 1

Debtor 2

Johnny Gasca Rodriguez, Jr

Horalia Patino Rodriguez

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

Wages, commissions,

bonuses, tips

 Operating a business

For last calendar year:

(January 1 to December 31, 2023 )

YYYY

Wages, commissions,

bonuses, tips

 Operating a business 1555.00 (Est.)

Wages, commissions,

bonuses, tips

 Operating a business 2758.00 (Est.)

For the calendar year before that:

(January 1 to December 31, 2022 )

YYYY

Wages, commissions,

bonuses, tips

 Operating a business

$2,758.00

$2,286.00

Wages, commissions,

bonuses, tips

 Operating a business 2286.00 (Est.)

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:

Pension

Social Security

$9,966.00

$26,350.00

Pension

Social Security

$5,286.00

$15,600.00

For last calendar year:

(January 1 to December 31, 2023 )

YYYY

Pension

Social Security

$11,959.00

$32,675.00

Pension

Social Security

$6,343.00

$20,170.00

For the calendar year before that:

(January 1 to December 31, 2022 )

YYYY

Pension $11,959.00 Pension $6,343.00

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

❑

❑✔

❑

❑

❑

❑

❑

❑✔

❑

❑✔

❑✔

❑✔

❑

❑✔

❑

❑✔
Debtor 1

Debtor 2

Johnny Gasca Rodriguez, Jr

Horalia Patino Rodriguez

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...

Evergreen Bank

Creditor's Name

3842 95th St W

Number Street

Evergreen Park, IL 60805

City State ZIP Code

10/2024

9/2024

8/2024

$975.00 $13,499.58 Mortgage

 Car

 Credit card

 Loan repayment

 Suppliers or vendors

 Other 

Bank of America

Creditor's Name

PO Box 15026

Number Street

Wilmington, DE 19850

City State ZIP Code

10/2024

9/2024

8/2024

$1,251.00 $11,494.10 Mortgage

 Car

 Credit card

 Loan repayment

 Suppliers or vendors

 Other 

Freedom Settlement

Creditor's Name

1875 S. Grant Street Ste. 400

Number Street

San Mateo, CA 94402

City State ZIP Code

4/30/2024

5/30/2024

6/28/2024

$4,005.00 $0.00 Mortgage

 Car

 Credit card

 Loan repayment

 Suppliers or vendors

 Other 

Bank of

America

Settlement

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

❑

❑

❑

❑✔

❑

❑✔

❑

❑✔

❑

❑

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑

❑

❑✔
Debtor 1

Debtor 2

Johnny Gasca Rodriguez, Jr

Horalia Patino Rodriguez

First Name Middle Name Last Name

Case number (if known)

Dates of

payment

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

Freedom Settlement

Creditor's Name

1875 S. Grant Street Ste. 400

Number Street

San Mateo, CA 94402

City State ZIP Code

7/19/2024

8/16/2024

9/17/2024

$773.69 $0.00 Mortgage

 Car

 Credit card

 Loan repayment

 Suppliers or vendors

 Other 

Settlement

with

Synchrony

Bank/Sams

Club

Freedom Settlement

Creditor's Name

1875 S. Grant Street Ste. 400

Number Street

San Mateo, CA 94402

City State ZIP Code

7/31/2024

8/30/2024

9/27/2024

$1,101.78 $0.00 Mortgage

 Car

 Credit card

 Loan repayment

 Suppliers or vendors

 Other 

Settlement

with

Synchrony

Bank/Rooms

To Go

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.

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

❑

❑

❑

❑

❑

❑✔

❑

❑

❑

❑

❑

❑✔

❑✔

❑

❑✔

❑
Debtor 1

Debtor 2

Johnny Gasca Rodriguez, Jr

Horalia Patino Rodriguez

First Name Middle Name Last Name

Case number (if known)

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.

Nature of the case Court or agency Status of the case

Case title LVNV Funding, LLC

vs. Horalia

Rodriguez

Case number JP06-24-DC00020827

Lawsuit

Justice of the Peace, Precinct 6

Court Name

6551 Granbury Rd

Number Street

Fort Worth, TX 76133

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

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

❑

❑✔

❑✔

❑

❑

❑✔

❑

❑

❑

❑

❑
Debtor 1

Debtor 2

Johnny Gasca Rodriguez, Jr

Horalia Patino Rodriguez

First Name Middle Name Last Name

Case number (if known)

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

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.

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

❑✔

❑

❑✔

❑

❑✔

❑

❑✔

❑
Debtor 1

Debtor 2

Johnny Gasca Rodriguez, Jr

Horalia Patino Rodriguez

First Name Middle Name Last Name

Case number (if known)

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

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.

Lee Law Firm, PLLC

Person Who Was Paid

8701 Bedford Euless Rd 510

Number Street

Hurst, TX 76053

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

10/28/2024

Amount of payment

$2,512.00

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

❑✔

❑

❑

❑✔
Debtor 1

Debtor 2

Johnny Gasca Rodriguez, Jr

Horalia Patino Rodriguez

First Name Middle Name Last Name

Case number (if known)

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.

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

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

❑✔

❑

❑✔

❑

❑✔

❑
Debtor 1

Debtor 2

Johnny Gasca Rodriguez, Jr

Horalia Patino Rodriguez

First Name Middle Name Last Name

Case number (if known)

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

Name of Financial Institution

Number Street

City State ZIP Code

XXXX– Checking

 Savings

 Money market

 Brokerage

 Other 

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.

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

❑✔

❑

❑

❑

❑

❑

❑

❑✔

❑

❑

❑

❑✔

❑
Debtor 1

Debtor 2

Johnny Gasca Rodriguez, Jr

Horalia Patino Rodriguez

First Name Middle Name Last Name

Case number (if known)

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

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.

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

❑

❑

❑✔

❑

❑✔

❑
Debtor 1

Debtor 2

Johnny Gasca Rodriguez, Jr

Horalia Patino Rodriguez

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

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

 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

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

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

❑✔

❑

❑✔

❑

❑

❑

❑
Debtor 1

Debtor 2

Johnny Gasca Rodriguez, Jr

Horalia Patino Rodriguez

First Name Middle Name Last Name

Case number (if known)

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 

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

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

❑

❑

❑

❑

❑

❑✔

❑

❑✔

❑
Debtor 1

Debtor 2

Johnny Gasca Rodriguez, Jr

Horalia Patino Rodriguez

First Name Middle Name Last Name

Case number (if known)

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/ Johnny Gasca Rodriguez, Jr

Signature of Johnny Gasca Rodriguez, Jr, Debtor 1

Date 10/31/2024

✘ /s/ Horalia Patino Rodriguez

Signature of Horalia Patino Rodriguez, Debtor 2

Date 10/31/2024

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 13

❑✔

❑

❑✔

❑
Fill in this information to identify your case:

Debtor 1 Johnny Gasca Rodriguez, Jr

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Horalia Patino Rodriguez

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 108

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

■ creditors have claims secured by your property, or

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

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

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

If two married people are filing together in a joint case, both are equally responsible for supplying correct information. Both debtors must sign and date the

form.

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

and case number (if known).

Part 1: List Your Creditors Who Have Secured Claims

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

below.

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

a debt?

Did you claim the property as

exempt on Schedule C?

Creditor’s

name: Evergreen Bank

Description of

property

securing debt:

2015 BMW 750 Li

Surrender the property.

Retain the property and redeem it.

Retain the property and enter into a

Reaffirmation Agreement.

Retain the property and [explain]:

No

Yes

Creditor’s

name: Bank of America

Description of

property

securing debt:

2018 Honda CRV

Surrender the property.

Retain the property and redeem it.

Retain the property and enter into a

Reaffirmation Agreement.

Retain the property and [explain]:

No

Yes

Official Form 108 Statement of Intention for Individuals Filing Under Chapter 7 page 1

❑

Statement of Intention for Individuals Filing Under Chapter 7 12/15

❑

❑

❑

❑✔

❑

❑✔

❑

❑

❑

❑✔

❑

❑✔
Debtor 1

Debtor 2

Johnny Gasca Rodriguez, Jr

Horalia Patino Rodriguez

First Name Middle Name Last Name

Case number (if known)

Part 2: List Your Unexpired Personal Property Leases

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

information below. Do not list real estate leases. Unexpired leases are leases that are still in effect; the lease period has not yet ended. You may assume an

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

Describe your unexpired personal property leases Will the lease be assumed?

Lessor’s name: EPC Sparrow Tavolo, LLC

Description of leased

property: Assisted Living Residence

No

Yes

Lessor’s name:

Description of leased

property:

No

Yes

Lessor’s name:

Description of leased

property:

No

Yes

Lessor’s name:

Description of leased

property:

No

Yes

Lessor’s name:

Description of leased

property:

No

Yes

Lessor’s name:

Description of leased

property:

No

Yes

Lessor’s name:

Description of leased

property:

No

Yes

Part 3: Sign Below

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

property that is subject to an unexpired lease.

✘ /s/ Johnny Gasca Rodriguez, Jr

Signature of Debtor 1

Date 10/31/2024

MM/ DD/ YYYY

✘ /s/ Horalia Patino Rodriguez

Signature of Debtor 2

Date 10/31/2024

MM/ DD/ YYYY

Official Form 108 Statement of Intention for Individuals Filing Under Chapter 7 page 2

❑

❑✔

❑

❑

❑

❑

❑

❑

❑

❑

❑

❑

❑

❑
B2030 (Form 2030) (12/15)

United States Bankruptcy Court

Northern District of Texas

In re Rodriguez, Johnny Gasca

Rodriguez, Horalia Patino

Debtor

Case No. 

Chapter 7

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 ................................................................................................................................................ $2,512.00

Prior to the filing of this statement I have received ................................................................................................................................................ $2,512.00

Balance Due ................................................................................................................................................ $0.00

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

❑✔ ❑

❑✔ ❑

❑✔

❑
B2030 (Form 2030) (12/15)

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.

10/31/2024

Date

/s/ Christopher Lee

Christopher Lee

Signature of Attorney

Bar Number: 24041319

Lee Law Firm, PLLC

8701 Bedford Euless Rd 510

Hurst, TX 76053

Phone: (214) 440-1414

Lee Law Firm, PLLC

Name of law firm

Date: 10/31/2024 /s/ Johnny Gasca Rodriguez, Jr

Johnny Gasca Rodriguez, Jr

/s/ Horalia Patino Rodriguez

Horalia Patino Rodriguez

Page 2 of 2
Check one box only as directed in this form and in

Form 122A-1Supp:

1. There is no presumption of abuse.

2. The calculation to determine if a presumption

of abuse applies will be made under Chapter 7

Means Test Calculation (Official Form 122A-2).

3. The Means Test does not apply now because

of qualified military service but it could apply later.

Check if this is an amended filing

Fill in this information to identify your case:

Debtor 1 Johnny Gasca Rodriguez, Jr

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Horalia Patino Rodriguez

First Name Middle Name Last Name

United States Bankruptcy Court for the: Northern District of Texas

Case number

(if known)

Official Form 122A-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). If you believe that you are exempted from a presumption of abuse because you do not have primarily consumer debts or

because of qualifying military service, complete and file Statement of Exemption from Presumption of Abuse Under § 707(b)(2) (Official Form 122A-1Supp)

with this form.

Part 1: Calculate Your Current Monthly Income

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

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

Married and your spouse is filing with you. Fill out both Columns A and B, lines 2-11.

Married and your spouse is NOT filing with you. You and your spouse are:

Living in the same household and are not legally separated. Fill out both Column A and B, lines 2-11.

Living separately or are legally separated. Fill out Column A, lines 2-11; do not fill out Column B. By checking this box, you declare

under penalty of perjury that you and your spouse are legally separated under nonbankruptcy law that applies or that you and your

spouse are living apart for reasons that do not include evading the Means Test requirements. 11 U.S.C. § 707(b)(7)(B).

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). $0.00 $0.00

3. Alimony and maintenance payments. Do not include payments from a spouse if Column B

is filled in. $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. Include regular contributions from a spouse only if Column B is not filled in. 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

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

Official Form 122A-1 Chapter 7 Statement of Your Current Monthly Income page 1

❑✔

❑

❑

❑

Chapter 7 Statement of Your Current Monthly Income 12/19

❑

❑✔

❑

❑

❑
For you.................................................................................... $2,635.00

For your spouse...................................................................... $1,560.00

Copy line 11 here →

12b.

13.

Debtor 1

Debtor 2

Johnny Gasca Rodriguez, Jr

Horalia Patino Rodriguez

First Name Middle Name Last Name

Case number (if known)

Column A

Debtor 1

Column B

Debtor 2 or

non-filing spouse

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. $996.62 $528.57

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 current monthly income. Add lines 2 through 10 for

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

11. $996.62 + $528.57 = $1,525.19

Total current

monthly income

Part 2: Determine Whether the Means Test Applies to You

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

12a. Copy your total current monthly income from line 11.................................................................................... $1,525.19

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

12b. The result is your annual income for this part of the form. $18,302.28

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

Fill in the state in which you live. Texas

Fill in the number of people in your household. 2

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.

$79,870.00

14. How do the lines compare?

14a. Line 12b is less than or equal to line 13. On the top of page 1, check box 1, There is no presumption of abuse.

Go to Part 3. Do NOT fill out or file Official Form 122A-2.

14b. Line 12b is more than line 13. On the top of page 1, check box 2, The presumption of abuse is determined by Form 122A-2.

Go to Part 3 and fill out Form 122A–2.

Official Form 122A-1 Chapter 7 Statement of Your Current Monthly Income page 2

❑✔

❑
Debtor 1

Debtor 2

Johnny Gasca Rodriguez, Jr

Horalia Patino Rodriguez

First Name Middle Name Last Name

Case number (if known)

Part 3: Sign Below

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

✘ /s/ Johnny Gasca Rodriguez, Jr

Signature of Debtor 1

Date 10/31/2024

MM/ DD/ YYYY

✘ /s/ Horalia Patino Rodriguez

Signature of Debtor 2

Date 10/31/2024

MM/ DD/ YYYY

If you checked line 14a, do NOT fill out or file Form 122A–2.

If you checked line 14b, fill out Form 122A–2 and file it with this form.

Official Form 122A-1 Chapter 7 Statement of Your Current Monthly Income page 3
CASE NO

CHAPTER 7

IN THE UNITED STATES BANKRUPTCY COURT

NORTHERN DISTRICT OF TEXAS

FORT WORTH DIVISION

IN RE: Rodriguez, Johnny Gasca

Rodriguez, Horalia Patino

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 10/31/2024 Signature /s/ Johnny Gasca Rodriguez, Jr

Johnny Gasca Rodriguez, Jr, Debtor

Date 10/31/2024 Signature /s/ Horalia Patino Rodriguez

Horalia Patino Rodriguez, Joint Debtor
Attorney General

PO Box 12017

Austin, TX 78711

Attorney General of Texas

Bankruptcy Section

400 South Zang, Ste 1100

Dallas, TX 75208

Bank of America

PO Box 660441

Dallas, TX 75266

Bank of America

PO Box 15026

Wilmington, DE 19850

Citibank

Po Box 78045

Phoenix, AZ 85062-8045

Citibank

PO Box 790406

Saint Louis, MO 63179

Citibank/Exxon Mobile

PO Box 790040

Saint Louis, MO 63179

Citibank/The Home Depot

Citicorp Cr Srvs/Centralized Bankruptcy

PO Box 790040

St Louis, MO 63179-0040

Comenity Capital/Acadmy

Attn: Bankruptcy

PO Box 182125

Columbus, OH 43218

Costco Citi Card

Attn: Bankruptcy

PO Box 6500

Sioux Falls, SD 57117

EPC Sparrow Tavolo, LLC

7545 Harris Pkwy

Fort Worth, TX 76123

Evergreen Bank

3842 95th St W

Evergreen Park, IL 60805

Freedom Debt Relief

PO Box 2330

Phoenix, AZ 85002

Goldman Sachs Bank USA

By AIS Infosource, LP as Agent

P.O. Box 4457

Houston, TX 77210

Headway Capital

4700 W Daybreak Pkwy Suite 200

South Jordan, UT 84009

Home Depot

PO Box Box 650121

Hawkins, TX 75765

Internal Revenue Service

Insolvency

PO Box 7346

Philadelphia, PA 19101-7346

Internal Revenue Service

IRS - SBSE Insolvency Area 10

1100 Commerce St., MC 5026 DAL

Dallas, TX 75242

Internal Revenue Service

Insolvency

PO Box 21126

Philadelphia, PA 19114

Internal Revenue Service

Insolvency

PO Box 7346

Philadelphia, PA 19101

Justice of the Peace, Precinct

6

6551 Granbury Rd

Fort Worth, TX 76133

Kohl's

PO Box 30510

Los Angeles, CA 90030

Linebarger Goggan Blair et al

2323 Bryan 1600

Dallas, TX 75201

Linebarger Goggan Blair et al

2777 N Stemmons Freeway 1100

Dallas, TX 75207

Linebarger, Goggan, Blair &

Sampson, LLC

2777 N. Stemmons Freeway 1000

Dallas, TX 75207

LVNV Funding

PO Box 740281

Houston, TX 77274-0281

Lvnv Funding/Resurgent

Capital

Attn: Bankruptcy

PO Box 10497

Greenville, SC 29603

Scott & Associates, PC

PO Box 115220

Carrollton, TX 75011

State Comptroller

Revenue Accounting Div Bankruptcy

PO Box 13528

Ecleto, TX 78111

State Comptroller

Revenue Accounting Div Bankruptcy

PO Box 13528

Austin, TX 78711
Synchrony Bank/Car Care

Attn: Bankruptcy

P.O. Box 965060

Orlando, FL 32896-5060

Synchrony Bank/Care Credit

P.O. Box 71715

Philadelphia, PA 19176

Synchrony Bank/Rooms To

Go

Attn: Bankruptcy

PO Box 965060

Orlando, FL 32896-5060

Synchrony Bank/Sams Club

Attn: Bankruptcy

PO Box 965060

Orlando, FL 32896-5060

Texas Alcohol Beverage

Commission

Licenses & Permits Division

PO Box 13127

Austin, TX 78711-3127

Texas Alcohol Beverage

Commission

Licenses and Permits Division

PO Box 13127

Austin, TX 78711-3127

Texas Comptroller of Public

Accounts

PO Box 13528

Austin, TX 78711

Texas Employment

Commission

TEC Building - Bankruptcy

101 E. 15th Street

Austin, TX 78778

Texas Employment

Commission

TEC Building - Bankruptcy

101 E. 15th St.

Austin, TX 78778

United States Attorney -

North

1100 Commerce St., Third Floor

Dallas, TX 75242

United States Attorney

General

Main Justice Building

10th and Constitution Ave 5111

Washington, DC 20530

United States Trustee

1100 Commerce St., Room 976

Dallas, TX 75242

United States Trustee

1100 Commerce St., Room 9C60

Dallas, TX 75242

US Bank

Attn: Bankruptcy 800 Nicollet Mall

Minneapolis, MN 55402

Wells Fargo Bank NA

PO Box 10335

Des Moines, IA 50306