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

Official Form 106Sum 

Summary of Your Assets and Liabilities and Certain Statistical Information 12/15

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 ....................................................................................................... $ ________________

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

$ ________________

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....................................... + $ ________________

Your total liabilities $ ________________

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

Copy your monthly expenses from line 22c of Schedule J .................................................................................................. $ ________________

Debtor 1 __________________________________________________________________ 

First Name Middle Name Last Name

Debtor 2 ________________________________________________________________

(Spouse, if filing) First Name Middle Name Last Name

United States Bankruptcy Court for the: ______________________ District of __________

(State) 

Case number ___________________________________________

(If known)

 Fill in this information to identify your case:

 Check if this is an

amended filing

70,954.82

42,452.00

697,483.73

386,786.75

Northern District of Texas

5,967.78

6,110.63

386,786.75

0.00

Calvin Christopher Scott

810,890.55

24-31493-7

Case 24-31493-sgj7 Doc 27 Filed 09/19/24 Entered 09/19/24 13:10:05 Desc Main

Document Page 1 of 13
Debtor 1 _______________________________________________________ Case number (if known)_____________________________________ 

First Name Middle Name Last Name

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

Part 4: Answ er 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. $ _________________

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.) $_____________________

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

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

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

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

priority claims. (Copy line 6g.)

$_____________________

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

9g. Total. Add lines 9a through 9f. $_____________________

✔

Calvin Scott 24-31493-7

✔

Case 24-31493-sgj7 Doc 27 Filed 09/19/24 Entered 09/19/24 13:10:05 Desc Main

Document Page 2 of 13
12/15

Fill in this information to identify your case:

Debtor 1 Calvin Christopher Scott

Debtor 2

(Spouse, if filing)

United States Bankruptcy Court for the: Northern District of Texas

Case number

(if know)

Official Form 106E/F

Schedule E/F: Creditors Who Have Unsecured Claims

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

Part 2: List All of Your NONPRIORITY Unsecured Claims

Middle Name First Name Last Name

Middle Name First Name Last Name

24-31493-7 Check if this is

an amended

filing

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.)

Priority

amount

Nonpriority

amount

Do any creditors have priority unsecured claims against you?

 No. Go to Part 2.

 Yes.

1.

Total claim

2.1 $ 0.00 $ 42,452.00

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

Is the claim subject to offset?

 No

 Yes

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 Student Loans

Dpt Ed/Aidv

Priority Creditor's Name

Po Box 9635

Street Number

Wilkes Barre

City

PA

State

18773

ZIP Code

Last 4 digits of account number 0518

When was the debt incurred? 03-02-2009

$ 42,452.00

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

Do any creditors have nonpriority unsecured claims against you?

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

 Yes. Fill in all of the information below.

3.

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 1 of 10

Case 24-31493-sgj7 Doc 27 Filed 09/19/24 Entered 09/19/24 13:10:05 Desc Main

Document Page 3 of 13
4.1 $ Unknown

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

Is the claim subject to offset?

 No

 Yes

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 

Admiral Investments, LLC

Nonpriority Creditor's Name

Couch Lambert, LLC

4144 North Central Expressway, Suite 1260

Street Number

Dallas

City

TX

State

75204

ZIP Code

Last 4 digits of account number 2898

When was the debt incurred? 

4.2 $ Unknown

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

Is the claim subject to offset?

 No

 Yes

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

Amazon

Nonpriority Creditor's Name

440 Terry Ave N,

Street Number

Seattle

City

WA

State

98109

ZIP Code

Last 4 digits of account number ****

When was the debt incurred? 

4.3 $ Unknown

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

Is the claim subject to offset?

 No

 Yes

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

AtoB

Nonpriority Creditor's Name

CElegans Labs, Inc.

Four Embarcadero Center, Suite #1400,

Street Number

San Francisco

City

CA

State

94111

ZIP Code

Last 4 digits of account number  

When was the debt incurred? 

Debtor Case number(if known) 24-31493-7 Calvin Christopher Scott

First Name Middle Name Last Name

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 2 of 10

Case 24-31493-sgj7 Doc 27 Filed 09/19/24 Entered 09/19/24 13:10:05 Desc Main

Document Page 4 of 13
4.4 $ Unknown

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

Is the claim subject to offset?

 No

 Yes

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

Ben E. Kieth (Dallas/ Fort Worth)

Nonpriority Creditor's Name

7650 Will Rogers Blvd

Street Number

Fort Worth

City

TX

State

76140

ZIP Code

Last 4 digits of account number ** **

When was the debt incurred? 

4.5 $ 4,566.00

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

Is the claim subject to offset?

 No

 Yes

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 Debt

Capital One

Nonpriority Creditor's Name

11013 W Broad St

Street Number

Glen Allen

City

VA

State

23060

ZIP Code

Last 4 digits of account number 3711

When was the debt incurred? 02-22-2017

4.6 $ Unknown

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

Is the claim subject to offset?

 No

 Yes

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

City of Fort Worth Water Department

Nonpriority Creditor's Name

908 Monroe St.

Street Number

Fort Worth

City

TX

State

76102

ZIP Code

Last 4 digits of account number 

When was the debt incurred? 

Debtor Case number(if known) 24-31493-7 Calvin Christopher Scott

First Name Middle Name Last Name

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 3 of 10

Case 24-31493-sgj7 Doc 27 Filed 09/19/24 Entered 09/19/24 13:10:05 Desc Main

Document Page 5 of 13
4.7 $ 5,000.00

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

Is the claim subject to offset?

 No

 Yes

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

Fivestar Registration System, LLC

Nonpriority Creditor's Name

Attn: Ted Haselman

3200 County Road EF

Street Number

Swanton

City

OH

State

43558

ZIP Code

Last 4 digits of account number  

When was the debt incurred? 

4.8 $ 14,892.00

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

Is the claim subject to offset?

 No

 Yes

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 Debt

Ft Worth Com

Nonpriority Creditor's Name

Po Box 210848

Street Number

Bedford

City

TX

State

76021

ZIP Code

Last 4 digits of account number 0142

When was the debt incurred? 10-12-2018

4.9 $ Unknown

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

Is the claim subject to offset?

 No

 Yes

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

Healthy Meal

Nonpriority Creditor's Name

22802 Hockaday Drive

Street Number

Katy

City

TX

State

77450

ZIP Code

Last 4 digits of account number ** **

When was the debt incurred? 

Debtor Case number(if known) 24-31493-7 Calvin Christopher Scott

First Name Middle Name Last Name

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 4 of 10

Case 24-31493-sgj7 Doc 27 Filed 09/19/24 Entered 09/19/24 13:10:05 Desc Main

Document Page 6 of 13
4.10 $ 250,000.00

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

Is the claim subject to offset?

 No

 Yes

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

International Kids Academy Inc.

Nonpriority Creditor's Name

145 Sheffield Drive

Street Number

Fort Worth

City

TX

State

76134

ZIP Code

Last 4 digits of account number 2252

When was the debt incurred? 

4.11 $ Unknown

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

Is the claim subject to offset?

 No

 Yes

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

Jakeena H. Sweet

Nonpriority Creditor's Name

7334 Kingswood Circle

Street Number

Fort Worth

City

TX

State

76133

ZIP Code

Last 4 digits of account number 

When was the debt incurred? 

4.12 $ 18,930.00

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

Is the claim subject to offset?

 No

 Yes

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 15%

Jpmcb Card

Nonpriority Creditor's Name

800 Brooksedge Blvd

Street Number

Westerville

City

OH

State

43081

ZIP Code

Last 4 digits of account number 9671

When was the debt incurred? 04-30-2018

Debtor Case number(if known) 24-31493-7 Calvin Christopher Scott

First Name Middle Name Last Name

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 5 of 10

Case 24-31493-sgj7 Doc 27 Filed 09/19/24 Entered 09/19/24 13:10:05 Desc Main

Document Page 7 of 13
4.13 $ Unknown

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

Is the claim subject to offset?

 No

 Yes

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 

Oakmont Capital Holdings

Nonpriority Creditor's Name

600 Willowbrook Lane

Suite 601

Street Number

West Chester

City

PA

State

19382

ZIP Code

Last 4 digits of account number  

When was the debt incurred? 

4.14 $ 0.00

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

Is the claim subject to offset?

 No

 Yes

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

Premium Finance

Nonpriority Creditor's Name

5316 Hwy 290 W Ste 310

Street Number

Austin

City

TX

State

78735

ZIP Code

Last 4 digits of account number 

When was the debt incurred? 

4.15 $ Unknown

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

Is the claim subject to offset?

 No

 Yes

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

Progressive

Nonpriority Creditor's Name

6300 Wilson Mills Rd.

Street Number

Cleveland

City

OH

State

44143

ZIP Code

Last 4 digits of account number ** **

When was the debt incurred? 

Debtor Case number(if known) 24-31493-7 Calvin Christopher Scott

First Name Middle Name Last Name

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 6 of 10

Case 24-31493-sgj7 Doc 27 Filed 09/19/24 Entered 09/19/24 13:10:05 Desc Main

Document Page 8 of 13
4.16 $ Unknown

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

Is the claim subject to offset?

 No

 Yes

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

Spectrum Internet

Nonpriority Creditor's Name

400 Washington Blvd.

Street Number

Stamford

City

CT

State

06902

ZIP Code

Last 4 digits of account number  

When was the debt incurred? 

4.17 $ 845.73

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

Is the claim subject to offset?

 No

 Yes

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

SpectrumVoIP

Nonpriority Creditor's Name

7600 Windrose Ave

Unit 350

Street Number

Plano

City

TX

State

75024

ZIP Code

Last 4 digits of account number ** **

When was the debt incurred? 

4.18 $ Unknown

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

Is the claim subject to offset?

 No

 Yes

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

Stream Energy

Nonpriority Creditor's Name

14675 Dallas Parkway

Suite 150

Street Number

Dallas

City

TX

State

75254

ZIP Code

Last 4 digits of account number 

When was the debt incurred? 

Debtor Case number(if known) 24-31493-7 Calvin Christopher Scott

First Name Middle Name Last Name

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 7 of 10

Case 24-31493-sgj7 Doc 27 Filed 09/19/24 Entered 09/19/24 13:10:05 Desc Main

Document Page 9 of 13
4.19 $ Unknown

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

Is the claim subject to offset?

 No

 Yes

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

Texas Mutal

Nonpriority Creditor's Name

433 E Las Colinas Blvd,

Street Number

Dallas

City

TX

State

75247

ZIP Code

Last 4 digits of account number  

When was the debt incurred? 

4.20 $ 325,000.00

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

Is the claim subject to offset?

 No

 Yes

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

Texshire Properties

Nonpriority Creditor's Name

PO Box 63012

Street Number

Irving

City

TX

State

75063

ZIP Code

Last 4 digits of account number ** **

When was the debt incurred? 

4.21 $ 76,302.00

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

Is the claim subject to offset?

 No

 Yes

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

Texshire Properties or N&N Properties, LLC

Nonpriority Creditor's Name

PO Box 63012

Street Number

Irving

City

TX

State

75063

ZIP Code

Last 4 digits of account number  

When was the debt incurred? 

Debtor Case number(if known) 24-31493-7 Calvin Christopher Scott

First Name Middle Name Last Name

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 8 of 10

Case 24-31493-sgj7 Doc 27 Filed 09/19/24 Entered 09/19/24 13:10:05 Desc Main

Document Page 10 of 13
Part 3: List Others to Be Notified About a Debt That You Already Listed

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

4.22 $ 1,948.00

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

Is the claim subject to offset?

 No

 Yes

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 Collection Agency

United Revenue

Nonpriority Creditor's Name

204 Billings St Ste 120

Street Number

Arlington

City

TX

State

76010

ZIP Code

Last 4 digits of account number 3107

When was the debt incurred? 01-23-2021

4.23 $ Unknown

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

Is the claim subject to offset?

 No

 Yes

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

USLI

Nonpriority Creditor's Name

7708 Rialto Blvd.

Street Number

Austin

City

TX

State

78735

ZIP Code

Last 4 digits of account number ** **

When was the debt incurred? 

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

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

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

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

5.

Camille A Avant, Attorney for Plaintiff

Creditor’s Name

1700 Pacific Avenue

Suite 2390

Street Number

Dallas

City

TX

State

75201

ZIP Code

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

Line 4.10 of (Check one): Part 1: Creditors with Priority Unsecured Claims

Part 2: Creditors with Nonpriority Unsecured

Claims

Last 4 digits of account number 2-24

Tarrant County District Court

Creditor’s Name

100 N. Calhoun

Street Number

Fort Worth

City

TX

State

76196

ZIP Code

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

Line 4.10 of (Check one): Part 1: Creditors with Priority Unsecured Claims

Part 2: Creditors with Nonpriority Unsecured

Claims

Last 4 digits of account number 2-24

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.

6.

Debtor Case number(if known) 24-31493-7 Calvin Christopher Scott

First Name Middle Name Last Name

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 9 of 10

Case 24-31493-sgj7 Doc 27 Filed 09/19/24 Entered 09/19/24 13:10:05 Desc Main

Document Page 11 of 13
Total claim

6a. Domestic support obligations 6a. $ 0.00

6b. Taxes and certain other debts you owe the

government

6b. $ 0.00

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. $ 42,452.00

6e. Total. Add lines 6a through 6d. 6e. 

$ 42,452.00

Total claims

from Part 1

Total claim

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. $ 697,483.73

6j. Total. Add lines 6f through 6i. 6j. 

$ 697,483.73

Total claims

from Part 2

Debtor Case number(if known) 24-31493-7 Calvin Christopher Scott

First Name Middle Name Last Name

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

Case 24-31493-sgj7 Doc 27 Filed 09/19/24 Entered 09/19/24 13:10:05 Desc Main

Document Page 12 of 13
Official Form 106Dec Declaration About an Individual Debtor’s Schedules 

Official Form 106Dec

Declaration About an Individual Debtor’s Schedules 12/15

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.

______________________________________________  _____________________________

Signature of Debtor 1 Signature of Debtor 2

Date _________________ Date _________________

MM / DD / YYYY MM / DD / YYYY

Debtor 1 __________________________________________________________________ 

First Name Middle Name Last Name

Debtor 2 ________________________________________________________________

(Spouse, if filing) First Name Middle Name Last Name

United States Bankruptcy Court for the: ______________________ District of __________

(State) 

Case number ___________________________________________

(If known)

 Fill in this information to identify your case:

 Check if this is an

amended filing

Northern District of Texas

09/19/2024

✔

24-31493-7

Calvin Christopher Scott

/s/ Calvin Christopher Scott

Case 24-31493-sgj7 Doc 27 Filed 09/19/24 Entered 09/19/24 13:10:05 Desc Main

Document Page 13 of 13