Fill in this information to identify your case and this filing:

Debtor 1 Jose Miguel Mendez Collazo

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Cynthia Aixa Rodriguez Rivera

First Name Middle Name Last Name

United States Bankruptcy Court for the: Northern District of Texas

Case number 24-42332-MXM-13 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

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Debtor Mendez Collazo, Jose Miguel; Rodriguez Rivera, Cynthia Aixa Case number (if known) 24-42332-MXM-13

3.1 Make: Ford

Model: F150 XLT

Year: 2017

Approximate mileage: 134000

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?

$17,838.00

Current value of the

portion you own?

$17,838.00

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

3.2 Make: Toyota

Model: 4Runner

Year: 2022

Approximate mileage: 60032

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?

$34,203.00

Current value of the

portion you own?

$34,203.00

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 ...................................................................................................➔ $52,041.00

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

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Debtor Mendez Collazo, Jose Miguel; Rodriguez Rivera, Cynthia Aixa Case number (if known) 24-42332-MXM-13

6. Household goods and furnishings

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

No

Yes. Describe. ......... See Attached. $1,670.00

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. ......... See Attached. $1,200.00

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. ......... Bicycles $200.00

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. ......... See Attached. $950.00

12. Jewelry

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

silver

No

Yes. Describe. ......... Watches $80.00

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

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Debtor Mendez Collazo, Jose Miguel; Rodriguez Rivera, Cynthia Aixa Case number (if known) 24-42332-MXM-13

13. Non-farm animals

Examples: Dogs, cats, birds, horses

No

Yes. Describe. ......... Dog $150.00

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 .................................................................................................................................➔ $4,250.00

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:

JPMorgan Chase Bank

Account Number: 8925 $92.94

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

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Debtor Mendez Collazo, Jose Miguel; Rodriguez Rivera, Cynthia Aixa Case number (if known) 24-42332-MXM-13

19. Non-publicly traded stock and interests in incorporated and unincorporated businesses, including an interest in an

LLC, partnership, and joint venture

No

Yes. Give specific

information about

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

20. Government and corporate bonds and other negotiable and non-negotiable instruments

Negotiable instruments include personal checks, cashiers’ checks, promissory notes, and money orders.

Non-negotiable instruments are those you cannot transfer to someone by signing or delivering them.

No

Yes. Give specific

information about

them.................... Issuer name:

21. Retirement or pension accounts

Examples: Interests in IRA, ERISA, Keogh, 401(k), 403(b), thrift savings accounts, or other pension or profit-sharing plans

No

Yes. List each

account separately. Type of account: Institution name:

401(k) or similar plan:

Pension plan:

IRA:

Retirement account:

Keogh:

Additional account:

Additional account:

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:

Security deposit on rental unit: Artisan Village, LP $1,505.00

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

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Debtor Mendez Collazo, Jose Miguel; Rodriguez Rivera, Cynthia Aixa Case number (if known) 24-42332-MXM-13

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

No

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

24. Interests in an education IRA, in an account in a qualified ABLE program, or under a qualified state tuition program.

26 U.S.C. §§ 530(b)(1), 529A(b), and 529(b)(1).

No

Yes ..................... Institution name and description. Separately file the records of any interests.11 U.S.C. § 521(c):

25. Trusts, equitable or future interests in property (other than anything listed in line 1), and rights or powers exercisable

for your benefit

No

Yes. Give specific

information about them. ...

26. Patents, copyrights, trademarks, trade secrets, and other intellectual property

Examples: Internet domain names, websites, proceeds from royalties and licensing agreements

No

Yes. Give specific

information about them. ...

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:

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

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Debtor Mendez Collazo, Jose Miguel; Rodriguez Rivera, Cynthia Aixa Case number (if known) 24-42332-MXM-13

29. Family support

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

settlement

No

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

Alimony:

Maintenance:

Support:

Divorce settlement:

Property settlement:

30. Other amounts someone owes you

Examples: Unpaid wages, disability insurance payments, disability benefits, sick pay, vacation pay, workers’ compensation,

Social Security benefits; unpaid loans you made to someone else

No

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

31. Interests in insurance policies

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

No

Yes. Name the insurance company

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

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. .............. Lawsuit against Vladimir Pozdynakov (former landlord) for

expenses related to fixing AC unit ($18,800.00)

$18,000.00

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

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

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Debtor Mendez Collazo, Jose Miguel; Rodriguez Rivera, Cynthia Aixa Case number (if known) 24-42332-MXM-13

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 .................................................................................................................................➔ $19,597.94

Part 5: Describe Any Business-Related Property You Own or Have an Interest In. List any real estate in Part 1.

37. Do you own or have any legal or equitable interest in any business-related property?

No. Go to Part 6.

Yes. Go to line 38.

Current value of the

portion you own?

Do not deduct secured

claims or exemptions.

38. Accounts receivable or commissions you already earned

No

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

39. Office equipment, furnishings, and supplies

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

electronic devices

No

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

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

No

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

41. Inventory

No

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

42. Interests in partnerships or joint ventures

No

Yes. Describe .......

Name of entity: % of ownership:

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

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Debtor Mendez Collazo, Jose Miguel; Rodriguez Rivera, Cynthia Aixa Case number (if known) 24-42332-MXM-13

43. Customer lists, mailing lists, or other compilations

No

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

No

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

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

No

Yes. Give specific

information .........

45. Add the dollar value of all of your entries from Part 5, including any entries for pages you have attached

for Part 5. Write that number here .................................................................................................................................➔ $0.00

Part 6: Describe Any Farm- and Commercial Fishing-Related Property You Own or Have an Interest In.

If you own or have an interest in farmland, list it in Part 1.

46. Do you own or have any legal or equitable interest in any farm- or commercial fishing-related property?

No. Go to Part 7.

Yes. Go to line 47.

Current value of the

portion you own?

Do not deduct secured

claims or exemptions.

47. Farm animals

Examples: Livestock, poultry, farm-raised fish

No

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

48. Crops—either growing or harvested

No

Yes. Give specific

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

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

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Debtor Mendez Collazo, Jose Miguel; Rodriguez Rivera, Cynthia Aixa Case number (if known) 24-42332-MXM-13

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

No

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

50. Farm and fishing supplies, chemicals, and feed

No

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

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

No

Yes. Give specific

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

52. Add the dollar value of all of your entries from Part 6, including any entries for pages you have attached

for Part 6. Write that number here .................................................................................................................................➔ $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 $52,041.00

57. Part 3: Total personal and household items, line 15 $4,250.00

58. Part 4: Total financial assets, line 36 $19,597.94

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. ............... $75,888.94 Copy personal property total ➔ + $75,888.94

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

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Debtor Mendez Collazo, Jose Miguel; Rodriguez Rivera, Cynthia Aixa Case number (if known) 24-42332-MXM-13

63. Total of all property on Schedule A/B. Add line 55 + line 62. ........................................................................................ $75,888.94

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

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Debtor Mendez Collazo, Jose Miguel; Rodriguez Rivera, Cynthia Aixa Case number (if known) 24-42332-MXM-13

Continuation Page

6. Household goods and furnishings

Bedroom Furniture $300.00

Dining Room Furniture $700.00

Living Room Furniture $600.00

Microwave $50.00

Plates/Silverware $20.00

7. Electronics

Cell Phones $400.00

Computers $200.00

Games $100.00

Televisions $500.00

11. Clothes

Accessories $150.00

Clothing $600.00

Shoes $200.00

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

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Document Page 12 of 51
Fill in this information to identify your case:

Debtor 1 Jose Miguel Mendez Collazo

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Cynthia Aixa Rodriguez Rivera

First Name Middle Name Last Name

United States Bankruptcy Court for the: Northern District of Texas

Case number

(if known)

24-42332-MXM-13

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:

2017 Ford F150

XLT

Line from

Schedule A/B: 3.1

$17,838.00 $1,985.00

100% of fair market value, up to

any applicable statutory limit

11 U.S.C. § 522(d)(2)

$163.00

100% of fair market value, up to

any applicable statutory limit

11 U.S.C. § 522(d)(5)

Brief

description:

2022 Toyota

4Runner

Line from

Schedule A/B: 3.2

$34,203.00

$0.00

100% of fair market value, up to

any applicable statutory limit

11 U.S.C. § 522(d)(2)

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

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

No

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

No

Yes

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

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Debtor 1 Jose Miguel Mendez Collazo

Debtor 2 Cynthia Aixa Rodriguez Rivera

First Name Middle Name Last Name

Case number (if known) 24-42332-MXM-13

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:

Bedroom Furniture

Line from

Schedule A/B: 6

$300.00

$300.00

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

$700.00

$700.00

100% of fair market value, up to

any applicable statutory limit

11 U.S.C. § 522(d)(3)

Brief

description:

Living Room

Furniture

Line from

Schedule A/B: 6

$600.00

$600.00

100% of fair market value, up to

any applicable statutory limit

11 U.S.C. § 522(d)(3)

Brief

description:

Microwave

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/Silverware

Line from

Schedule A/B: 6

$20.00

$20.00

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

$500.00

$500.00

100% of fair market value, up to

any applicable statutory limit

11 U.S.C. § 522(d)(3)

Brief

description:

Games

Line from

Schedule A/B: 7

$100.00

$100.00

100% of fair market value, up to

any applicable statutory limit

11 U.S.C. § 522(d)(3)

Brief

description:

Computers

Line from

Schedule A/B: 7

$200.00

$200.00

100% of fair market value, up to

any applicable statutory limit

11 U.S.C. § 522(d)(3)

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

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Case 24-42332-mxm13 Doc 18 Filed 07/30/24 Entered 07/30/24 20:04:02 Desc Main

Document Page 14 of 51
Debtor 1 Jose Miguel Mendez Collazo

Debtor 2 Cynthia Aixa Rodriguez Rivera

First Name Middle Name Last Name

Case number (if known) 24-42332-MXM-13

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:

Cell Phones

Line from

Schedule A/B: 7

$400.00

$400.00

100% of fair market value, up to

any applicable statutory limit

11 U.S.C. § 522(d)(3)

Brief

description:

Bicycles

Line from

Schedule A/B: 9

$200.00

$200.00

100% of fair market value, up to

any applicable statutory limit

11 U.S.C. § 522(d)(3)

Brief

description:

Clothing

Line from

Schedule A/B: 11

$600.00 $600.00

100% of fair market value, up to

any applicable statutory limit

11 U.S.C. § 522(d)(3)

$0.00

100% of fair market value, up to

any applicable statutory limit

11 U.S.C. § 522(d)(5)

Brief

description:

Shoes

Line from

Schedule A/B: 11

$200.00

$200.00

100% of fair market value, up to

any applicable statutory limit

11 U.S.C. § 522(d)(3)

Brief

description:

Accessories

Line from

Schedule A/B: 11

$150.00

$150.00

100% of fair market value, up to

any applicable statutory limit

11 U.S.C. § 522(d)(3)

Brief

description:

Watches

Line from

Schedule A/B: 12

$80.00

$80.00

100% of fair market value, up to

any applicable statutory limit

11 U.S.C. § 522(d)(4)

Brief

description:

Dog

Line from

Schedule A/B: 13

$150.00 $150.00

100% of fair market value, up to

any applicable statutory limit

11 U.S.C. § 522(d)(3)

$0.00

100% of fair market value, up to

any applicable statutory limit

11 U.S.C. § 522(d)(5)

Brief

description:

JPMorgan Chase

Bank

Checking account

Acct. No.: 8925

Line from

Schedule A/B: 17

$92.94

$123.16

100% of fair market value, up to

any applicable statutory limit

11 U.S.C. § 522(d)(5)

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

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Case 24-42332-mxm13 Doc 18 Filed 07/30/24 Entered 07/30/24 20:04:02 Desc Main

Document Page 15 of 51
Debtor 1 Jose Miguel Mendez Collazo

Debtor 2 Cynthia Aixa Rodriguez Rivera

First Name Middle Name Last Name

Case number (if known) 24-42332-MXM-13

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:

Artisan Village, LP

Security deposit on

rental unit

Line from

Schedule A/B: 22

$1,505.00

$1,505.00

100% of fair market value, up to

any applicable statutory limit

11 U.S.C. § 522(d)(5)

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

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Case 24-42332-mxm13 Doc 18 Filed 07/30/24 Entered 07/30/24 20:04:02 Desc Main

Document Page 16 of 51
Fill in this information to identify your case:

Debtor 1 Jose Miguel Mendez Collazo

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Cynthia Aixa Rodriguez Rivera

First Name Middle Name Last Name

United States Bankruptcy Court for the: Northern District of Texas

Case number (if

known)

24-42332-MXM-13

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 Ally Financial, Inc

Creditor’s Name

Attn: Bankruptcy

500 Woodard Ave

Number Street

Detroit, MI 48226

City State ZIP Code

Describe the property that secures the claim: $49,918.00 $34,203.00 $15,715.00

2022 Toyota 4Runner

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)

Date debt was incurred 3/1/2022 Last 4 digits of account number 5 0 6 0

Add the dollar value of your entries in Column A on this page. Write that number here: $49,918.00

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

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Case 24-42332-mxm13 Doc 18 Filed 07/30/24 Entered 07/30/24 20:04:02 Desc Main

Document Page 17 of 51
Debtor 1 Jose Miguel Mendez Collazo

Debtor 2 Cynthia Aixa Rodriguez Rivera

First Name Middle Name Last Name

Case number (if known) 24-42332-MXM-13

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 PNC Financial Services

Creditor’s Name

Attn: Bankruptcy

300 Fifth Ave

Number Street

Pittsburgh, PA 15222

City State ZIP Code

Describe the property that secures the claim: $15,690.00 $17,838.00 $0.00

2017 Ford F150 XLT

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)

Date debt was incurred 1/1/2019 Last 4 digits of account number 6 3 8 4

Add the dollar value of your entries in Column A on this page. Write that number here: $15,690.00

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

Write that number here: $65,608.00

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

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Case 24-42332-mxm13 Doc 18 Filed 07/30/24 Entered 07/30/24 20:04:02 Desc Main

Document Page 18 of 51
Fill in this information to identify your case:

Debtor 1 Jose Miguel Mendez Collazo

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Cynthia Aixa Rodriguez Rivera

First Name Middle Name Last Name

United States Bankruptcy Court for the: Northern District of Texas

Case number

(if known)

24-42332-MXM-13

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 Lee Law Firm, PLLC

Priority Creditor’s Name

8701 Bedford Euless Rd 510

Number Street

Hurst, TX 76053

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a

community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number

When was the debt incurred?

$4,008.00 $4,008.00 $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 Attorney Fees

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 1 of 20

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Case 24-42332-mxm13 Doc 18 Filed 07/30/24 Entered 07/30/24 20:04:02 Desc Main

Document Page 19 of 51
Debtor 1 Jose Miguel Mendez Collazo

Debtor 2 Cynthia Aixa Rodriguez Rivera

First Name Middle Name Last Name

Case number (if known) 24-42332-MXM-13

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 American Express National Bank, AENB

Nonpriority Creditor’s Name

C/O Zwicker and Associates, PC

P.O. Box 9043

Number Street

Andover, MA 01810-1041

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 0 0 4

When was the debt incurred? 7/1/2018

$1,099.62

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 Amex

Nonpriority Creditor’s Name

PO Box 297871

Number Street

Fort Lauderdale, FL 33329

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 5 9 7 3

When was the debt incurred? 12/15/2019

$7,212.00

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 2 of 20

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Case 24-42332-mxm13 Doc 18 Filed 07/30/24 Entered 07/30/24 20:04:02 Desc Main

Document Page 20 of 51
Debtor 1 Jose Miguel Mendez Collazo

Debtor 2 Cynthia Aixa Rodriguez Rivera

First Name Middle Name Last Name

Case number (if known) 24-42332-MXM-13

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 Amex

Nonpriority Creditor’s Name

PO Box 297871

Number Street

Fort Lauderdale, FL 33329

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 9 5 1 3

When was the debt incurred? 12/1/2019

$9,879.00

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

4.4 Amex

Nonpriority Creditor’s Name

PO Box 297871

Number Street

Fort Lauderdale, FL 33329

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 2 8 2 3

When was the debt incurred? 3/1/2007

$13,405.00

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 20

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Case 24-42332-mxm13 Doc 18 Filed 07/30/24 Entered 07/30/24 20:04:02 Desc Main

Document Page 21 of 51
Debtor 1 Jose Miguel Mendez Collazo

Debtor 2 Cynthia Aixa Rodriguez Rivera

First Name Middle Name Last Name

Case number (if known) 24-42332-MXM-13

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 Amex

Nonpriority Creditor’s Name

PO Box 297871

Number Street

Fort Lauderdale, FL 33329

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 9 5 1 3

When was the debt incurred? 12/1/2019

$6,777.00

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

4.6 Banco Popular de Puerto Rico

Nonpriority Creditor’s Name

Attn: Bankruptcy

PO Box 362708

Number Street

San Juan, PR 00936-2708

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 7 3 0

When was the debt incurred? 7/1/2005

$249.00

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 4 of 20

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Case 24-42332-mxm13 Doc 18 Filed 07/30/24 Entered 07/30/24 20:04:02 Desc Main

Document Page 22 of 51
Debtor 1 Jose Miguel Mendez Collazo

Debtor 2 Cynthia Aixa Rodriguez Rivera

First Name Middle Name Last Name

Case number (if known) 24-42332-MXM-13

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 Banco Popular de Puerto Rico

Nonpriority Creditor’s Name

Attn: Bankruptcy

PO Box 362708

Number Street

San Juan, PR 00936-2708

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 1 2 2

When was the debt incurred? 10/1/2013

$3,045.00

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

4.8 Banco Popular de Puerto Rico

Nonpriority Creditor’s Name

Attn: Bankruptcy

PO Box 362708

Number Street

San Juan, PR 00936-2708

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 7 3 0

When was the debt incurred? 7/1/2005

$499.00

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 5 of 20

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Case 24-42332-mxm13 Doc 18 Filed 07/30/24 Entered 07/30/24 20:04:02 Desc Main

Document Page 23 of 51
Debtor 1 Jose Miguel Mendez Collazo

Debtor 2 Cynthia Aixa Rodriguez Rivera

First Name Middle Name Last Name

Case number (if known) 24-42332-MXM-13

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 Barclays Bank Delaware

Nonpriority Creditor’s Name

PO Box 8803

Number Street

Wilmington, DE 19899

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 5 7 7 5

When was the debt incurred? 2/3/2019

$8,208.00

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

4.10 Capital One

Nonpriority Creditor’s Name

PO Box 70886

Number Street

Charlotte, NC 28272

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 4 7 3

When was the debt incurred? 3/1/2018

$3,039.00

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 6 of 20

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Case 24-42332-mxm13 Doc 18 Filed 07/30/24 Entered 07/30/24 20:04:02 Desc Main

Document Page 24 of 51
Debtor 1 Jose Miguel Mendez Collazo

Debtor 2 Cynthia Aixa Rodriguez Rivera

First Name Middle Name Last Name

Case number (if known) 24-42332-MXM-13

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 Capital One

Nonpriority Creditor’s Name

PO Box 70886

Number Street

Charlotte, NC 28272

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 7 6 8

When was the debt incurred? 9/1/2019

$1,655.00

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

4.12 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 5 8 7 9

When was the debt incurred? 3/9/2019

$4,342.00

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 7 of 20

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Case 24-42332-mxm13 Doc 18 Filed 07/30/24 Entered 07/30/24 20:04:02 Desc Main

Document Page 25 of 51
Debtor 1 Jose Miguel Mendez Collazo

Debtor 2 Cynthia Aixa Rodriguez Rivera

First Name Middle Name Last Name

Case number (if known) 24-42332-MXM-13

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 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 7 8 2 5

When was the debt incurred? 5/18/2019

$3,547.00

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

4.14 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 7 8 2 5

When was the debt incurred? 5/1/2019

$2,002.00

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 8 of 20

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Case 24-42332-mxm13 Doc 18 Filed 07/30/24 Entered 07/30/24 20:04:02 Desc Main

Document Page 26 of 51
Debtor 1 Jose Miguel Mendez Collazo

Debtor 2 Cynthia Aixa Rodriguez Rivera

First Name Middle Name Last Name

Case number (if known) 24-42332-MXM-13

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 Citibank/Best Buy

Nonpriority Creditor’s Name

PO Box 790034

Number Street

Saint Louis, MO 63179-9819

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 8 3 3

When was the debt incurred? 8/1/2013

$8,032.00

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

4.16 Cornerstone

Nonpriority Creditor’s Name

633 Spirit Drive

Number Street

Chesterfield, MO 63005

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 8 2 8 3

When was the debt incurred? 2/1/2019

$38,063.00

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

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 9 of 20

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Case 24-42332-mxm13 Doc 18 Filed 07/30/24 Entered 07/30/24 20:04:02 Desc Main

Document Page 27 of 51
Debtor 1 Jose Miguel Mendez Collazo

Debtor 2 Cynthia Aixa Rodriguez Rivera

First Name Middle Name Last Name

Case number (if known) 24-42332-MXM-13

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 Department of Education

Nonpriority Creditor’s Name

PO Box 82561

Number Street

Lincoln, NE 68501

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 0 2

When was the debt incurred?

$5,500.00

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 Student Loans

4.18 Discover Financial

Nonpriority Creditor’s Name

Attn: Bankruptcy

PO Box 3025

Number Street

New Albany, OH 43054

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 2 4 7

When was the debt incurred? 3/1/2018

$15,787.04

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 10 of 20

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Case 24-42332-mxm13 Doc 18 Filed 07/30/24 Entered 07/30/24 20:04:02 Desc Main

Document Page 28 of 51
Debtor 1 Jose Miguel Mendez Collazo

Debtor 2 Cynthia Aixa Rodriguez Rivera

First Name Middle Name Last Name

Case number (if known) 24-42332-MXM-13

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 Discover Financial

Nonpriority Creditor’s Name

Attn: Bankruptcy

PO Box 3025

Number Street

New Albany, OH 43054

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 7 2

When was the debt incurred? 4/1/2018

$467.00

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

4.20 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 8 2 3 1

When was the debt incurred? 7/1/2021

$2,650.00

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 11 of 20

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Case 24-42332-mxm13 Doc 18 Filed 07/30/24 Entered 07/30/24 20:04:02 Desc Main

Document Page 29 of 51
Debtor 1 Jose Miguel Mendez Collazo

Debtor 2 Cynthia Aixa Rodriguez Rivera

First Name Middle Name Last Name

Case number (if known) 24-42332-MXM-13

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 Jpmcb

Nonpriority Creditor’s Name

MailCode LA4-7100 700 Kansas Lane

Number Street

Monroe, LA 71203

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 3 7 7

When was the debt incurred? 10/1/2021

$7,551.00

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

4.22 Justice of the Peace Precinct One

Nonpriority Creditor’s Name

100 W Weatherford Street Ste 450

Number Street

Fort Worth, TX 76196

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number

When was the debt incurred?

unknown

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 12 of 20

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Case 24-42332-mxm13 Doc 18 Filed 07/30/24 Entered 07/30/24 20:04:02 Desc Main

Document Page 30 of 51
Debtor 1 Jose Miguel Mendez Collazo

Debtor 2 Cynthia Aixa Rodriguez Rivera

First Name Middle Name Last Name

Case number (if known) 24-42332-MXM-13

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 Macy's/ DSNB

Nonpriority Creditor’s Name

Atytn: Bankruptcy 701 E. 60th Street North

Number Street

Sioux Falls, SD 57104

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 4 7 5 2

When was the debt incurred? 12/1/2004

$4,294.00

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

4.24 Navient

Nonpriority Creditor’s Name

123 S Justice St

Number Street

Wilmington, DE 19801

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 4 2 5

When was the debt incurred? 4/1/2008

$2,141.00

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

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 13 of 20

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Case 24-42332-mxm13 Doc 18 Filed 07/30/24 Entered 07/30/24 20:04:02 Desc Main

Document Page 31 of 51
Debtor 1 Jose Miguel Mendez Collazo

Debtor 2 Cynthia Aixa Rodriguez Rivera

First Name Middle Name Last Name

Case number (if known) 24-42332-MXM-13

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

4.25 Nelnet

Nonpriority Creditor’s Name

PO Box 82505

Number Street

Lincoln, NE 68501-2505

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 2 8 3

When was the debt incurred? 2/1/2019

$38,773.00

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

4.26 Nelnet

Nonpriority Creditor’s Name

PO Box 82561

Number Street

Lincoln, NE 68501

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 0 1

When was the debt incurred?

$5,500.00

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 Student loan

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 14 of 20

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Case 24-42332-mxm13 Doc 18 Filed 07/30/24 Entered 07/30/24 20:04:02 Desc Main

Document Page 32 of 51
Debtor 1 Jose Miguel Mendez Collazo

Debtor 2 Cynthia Aixa Rodriguez Rivera

First Name Middle Name Last Name

Case number (if known) 24-42332-MXM-13

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

4.27 Nelnet

Nonpriority Creditor’s Name

PO Box 82561

Number Street

Lincoln, NE 68501

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 0 5

When was the debt incurred?

$3,900.00

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 Student loan

4.28 Syncb/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 6 6 5 5

When was the debt incurred? 7/17/2022

$3,242.00

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 15 of 20

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Case 24-42332-mxm13 Doc 18 Filed 07/30/24 Entered 07/30/24 20:04:02 Desc Main

Document Page 33 of 51
Debtor 1 Jose Miguel Mendez Collazo

Debtor 2 Cynthia Aixa Rodriguez Rivera

First Name Middle Name Last Name

Case number (if known) 24-42332-MXM-13

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

4.29 Synchrony Bank/Old Navy

Nonpriority Creditor’s Name

Attn: Bankruptcy

Po Box 965060

Number Street

Orlando, FL 32896

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 8 2 0 2

When was the debt incurred? 9/21/2018

$198.00

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

4.30 Synchrony Bank/TJX

Nonpriority Creditor’s Name

Attn: Bankruptcy

PO Box 965060

Number Street

Orlando, FL 32896

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number 1 2 2 6

When was the debt incurred? 11/3/2016

$15,725.00

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 16 of 20

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Case 24-42332-mxm13 Doc 18 Filed 07/30/24 Entered 07/30/24 20:04:02 Desc Main

Document Page 34 of 51
Debtor 1 Jose Miguel Mendez Collazo

Debtor 2 Cynthia Aixa Rodriguez Rivera

First Name Middle Name Last Name

Case number (if known) 24-42332-MXM-13

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

4.31 Tally Technologies, Inc

Nonpriority Creditor’s Name

Attn: Bankruptcy

375 Alabama St #325

Number Street

San Francisco, CA 94110

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 C 2 0 1

When was the debt incurred? 12/1/2018

$6,937.00

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 CheckCreditOrLineOfCredit

4.32 TD Bank, NA

Nonpriority Creditor’s Name

P.O. Box 1931

Number Street

Burlingame, CA 94011

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 1 9 1

When was the debt incurred?

$8,280.36

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 17 of 20

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Case 24-42332-mxm13 Doc 18 Filed 07/30/24 Entered 07/30/24 20:04:02 Desc Main

Document Page 35 of 51
Debtor 1 Jose Miguel Mendez Collazo

Debtor 2 Cynthia Aixa Rodriguez Rivera

First Name Middle Name Last Name

Case number (if known) 24-42332-MXM-13

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

4.33 Texas Health Resources

Nonpriority Creditor’s Name

c/o Texas Health Alliance

4515 N Santa Fe Ave

Number Street

Oklahoma City, OK 73118-7901

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 5 0 2

When was the debt incurred?

$324.80

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 Medical

4.34 Tribar Properties

Nonpriority Creditor’s Name

120 Precinct Line Road

Number Street

Hurst, TX 76053

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number

When was the debt incurred? 7/1/2024

$5,450.00

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 Lease deficiency

Official Form 106E/F Schedule E/F: Creditors Who Have Unsecured Claims page 18 of 20

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Case 24-42332-mxm13 Doc 18 Filed 07/30/24 Entered 07/30/24 20:04:02 Desc Main

Document Page 36 of 51
Debtor 1 Jose Miguel Mendez Collazo

Debtor 2 Cynthia Aixa Rodriguez Rivera

First Name Middle Name Last Name

Case number (if known) 24-42332-MXM-13

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

4.35 US Small Business Administration

Nonpriority Creditor’s Name

409 3rd St., SW

Number Street

Washington, DC 20416

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 1 7 0

When was the debt incurred? 11/10/2017

$3,806.00

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 GovernmentMiscellaneousDebt

4.36 Vladimir Pozdynakov

Nonpriority Creditor’s Name

120 Precinct Line Road

Number Street

Hurst, TX 76053

City State ZIP Code

Who incurred the debt? Check one.

Debtor 1 only

Debtor 2 only

Debtor 1 and Debtor 2 only

At least one of the debtors and another

Check if this claim is for a community debt

Is the claim subject to offset?

No

Yes

Last 4 digits of account number

When was the debt incurred?

$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 19 of 20

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Case 24-42332-mxm13 Doc 18 Filed 07/30/24 Entered 07/30/24 20:04:02 Desc Main

Document Page 37 of 51
Debtor 1 Jose Miguel Mendez Collazo

Debtor 2 Cynthia Aixa Rodriguez Rivera

First Name Middle Name Last Name

Case number (if known) 24-42332-MXM-13

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. $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. + $4,008.00

6e. Total. Add lines 6a through 6d. 6e. $4,008.00

Total claim

Total claims

from Part 2

6f. Student loans 6f. $78,977.00

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. + $162,602.82

6j. Total. Add lines 6f through 6i. 6j. $241,579.82

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

Case 24-42332-mxm13 Doc 18 Filed 07/30/24 Entered 07/30/24 20:04:02 Desc Main

Document Page 38 of 51
Fill in this information to identify your case:

Debtor 1 Jose Miguel Mendez Collazo

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Cynthia Aixa Rodriguez Rivera

First Name Middle Name Last Name

United States Bankruptcy Court for the: Northern District of Texas

Case number

(if known)

24-42332-MXM-13 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

Artisan Village, LP

Name

3200 Batten Circle

Number Street

Fort Worth, TX 76177

City State ZIP Code

Residential Lease

Contract to be ASSUMED

2.2

Carlos Abreu

Name

20208 SW 325 Street

Number Street

Homestead, FL 33030

City State ZIP Code

RV Rental

Contract to be ASSUMED

2.3

Name

Number Street

City State ZIP Code

2.4

Name

Number Street

City State ZIP Code

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

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Schedule G: Executory Contracts and Unexpired Leases 12/15

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Case 24-42332-mxm13 Doc 18 Filed 07/30/24 Entered 07/30/24 20:04:02 Desc Main

Document Page 39 of 51
Fill in this information to identify your case:

Debtor 1 Jose Miguel Mendez Collazo

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Cynthia Aixa Rodriguez Rivera

First Name Middle Name Last Name

United States Bankruptcy Court for the: Northern District of Texas

Case number

(if known)

24-42332-MXM-13

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

Name of your spouse, former spouse, or legal equivalent

Number Street

City State ZIP Code

3. In Column 1, list all of your codebtors. Do not include your spouse as a codebtor if your spouse is filing with you. List the person shown in line

2 again as a codebtor only if that person is a guarantor or cosigner. Make sure you have listed the creditor on Schedule D (Official Form 106D),

Schedule E/F (Official Form 106E/F), or Schedule G (Official Form 106G). Use Schedule D, Schedule E/F, or Schedule G to fill out Column 2.

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

Check all schedules that apply:

3.1

Name

Number Street

City State ZIP Code

 Schedule D, line 

 Schedule E/F, line 

 Schedule G, line 

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 1 of 1

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Case 24-42332-mxm13 Doc 18 Filed 07/30/24 Entered 07/30/24 20:04:02 Desc Main

Document Page 40 of 51
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 Jose Miguel Mendez Collazo

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Cynthia Aixa Rodriguez Rivera

First Name Middle Name Last Name

United States Bankruptcy Court for the: Northern District of Texas

Case number

(if known)

24-42332-MXM-13

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

Project Manager

MP Heavy Construction, Inc

26022 Budde Rd B202

Number Street

Spring, TX 77380

City State Zip Code

Employed Not Employed

Number Street

City State Zip Code

How long employed there? 1 year 5 months

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. $8,333.34 $0.00

3. Estimate and list monthly overtime pay. 3. + $904.00 + $0.00

4. Calculate gross income. Add line 2 + line 3. 4. $9,237.34 $0.00

Official Form 106I Schedule I: Your Income page 1

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Schedule I: Your Income 12/15

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Case 24-42332-mxm13 Doc 18 Filed 07/30/24 Entered 07/30/24 20:04:02 Desc Main

Document Page 41 of 51
Debtor 1

Debtor 2

Jose Miguel Mendez Collazo

Cynthia Aixa Rodriguez Rivera

First Name Middle Name Last Name

Case number (if known) 24-42332-MXM-13

For Debtor 1 For Debtor 2 or

non-filing spouse

Copy line 4 here....................................................................................➔ 4. $9,237.34 $0.00

5. List all payroll deductions:

5a. Tax, Medicare, and Social Security deductions 5a. $1,057.87 $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. $374.24 $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. $1,432.11 $0.00

7. Calculate total monthly take-home pay. Subtract line 6 from line 4. 7. $7,805.23 $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. $0.00 $0.00

8f. Other government assistance that you regularly receive

Include cash assistance and the value (if known) of any non-cash

assistance that you receive, such as food stamps (benefits under the

Supplemental Nutrition Assistance Program) or housing subsidies.

Specify: 8f. $0.00 $0.00

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

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

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

10. Calculate monthly income. Add line 7 + line 9.

Add the entries in line 10 for Debtor 1 and Debtor 2 or non-filing spouse 10. $7,805.23 + $0.00 = $7,805.23

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. $7,805.23

Combined

monthly income

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

 No.

 Yes. Explain: 

Official Form 106I Schedule I: Your Income page 2

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Document Page 42 of 51
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 Jose Miguel Mendez Collazo

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Cynthia Aixa Rodriguez Rivera

First Name Middle Name Last Name

United States Bankruptcy Court for the: Northern District of Texas

Case number

(if known)

24-42332-MXM-13

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. $1,505.00

If not included in line 4:

4a. Real estate taxes 4a. $0.00

4b. Property, homeowner's, or renter's insurance 4b. $0.00

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

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Debtor 1

Debtor 2

Jose Miguel Mendez Collazo

Cynthia Aixa Rodriguez Rivera

First Name Middle Name Last Name

Case number (if known) 24-42332-MXM-13

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. $80.00

6c. Telephone, cell phone, Internet, satellite, and cable services 6c. $80.00

6d. Other. Specify: Cable or Satellite Dish 6d. $80.00

7. Food and housekeeping supplies 7. $350.00

8. Childcare and children’s education costs 8. $200.00

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

10. Personal care products and services 10. $40.00

11. Medical and dental expenses 11. $0.00

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

Do not include car payments. 12. $350.00

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

14. Charitable contributions and religious donations 14. $0.00

15. Insurance.

Do not include insurance deducted from your pay or included in lines 4 or 20.

15a. Life insurance 15a. $0.00

15b. Health insurance 15b. $300.00

15c. Vehicle insurance 15c. $250.00

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: 16. $0.00

17. Installment or lease payments:

17a. Car payments for Vehicle 1 17a. $0.00

17b. Car payments for Vehicle 2 17b. $0.00

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. $350.00

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

Case 24-42332-mxm13 Doc 18 Filed 07/30/24 Entered 07/30/24 20:04:02 Desc Main

Document Page 44 of 51
Debtor 1

Debtor 2

Jose Miguel Mendez Collazo

Cynthia Aixa Rodriguez Rivera

First Name Middle Name Last Name

Case number (if known) 24-42332-MXM-13

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.

$3,885.00

$3,290.00

$7,175.00

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.

$7,805.23

– $7,175.00

$630.23

24. Do you expect an increase or decrease in your expenses within the year after you file this form?

For example, do you expect to finish paying for your car loan within the year or do you expect your

mortgage payment to increase or decrease because of a modification to the terms of your mortgage?

 No.

 Yes.

None

Official Form 106J Schedule J: Your Expenses page 3

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Document Page 45 of 51
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 but list all

other dependents of Debtor 2

regardless of whether listed as a

dependent of Debtor 1 on

Schedule J.

Only list dependents

Do not state the dependents'

names.

 No

Yes. Fill out this information

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

Dependent's relationship to

Debtor 2:

Dependent's

age

Does dependent live

with you?

Child 14 Years No. Yes.

Child 5 Years No. Yes.

 No. Yes.

 No. Yes.

 No. Yes.

Fill in this information to identify your case:

Debtor 1 Jose Miguel Mendez Collazo

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Cynthia Aixa Rodriguez Rivera

First Name Middle Name Last Name

United States Bankruptcy Court for the: Northern District of Texas

Case number

(if known)

24-42332-MXM-13

Official Form 106J-2

Use this form for Debtor 2’s separate household expenses ONLY IF Debtor 1 and Debtor 2 maintain separate households. If Debtor 1 and Debtor 2 have one

or more dependents in common, list the dependents on both Schedule J and this form. Answer the questions on this form only with respect to expenses for

Debtor 2 that are not reported on Schedule J. Be as complete and accurate as possible. 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. Do not complete this form.

 Yes

2.

3. Do your expenses include

expenses of people other than

yourself, your dependents, and

Debtor 1?

 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.

Include expenses paid for with non-cash government assistance if you know the value of

such assistance and have included it on Schedule I: Your Income (Official Form 106I.)

Your expenses

4. The rental or home ownership expenses for your residence. Include first mortgage payments and any rent

for the ground or lot.

If not included in line 4:

4a. Real estate taxes

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

4c. Home maintenance, repair, and upkeep expenses

4d. Homeowner's association or condominium dues

4.

4a.

4b.

4c.

4d.

$1,300.00

$0.00

$0.00

$0.00

$0.00

Official Form 106J-2 Schedule J-2: Expenses for Separate Household of Debtor 2 page 1

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Schedule J-2: Expenses for Separate Household of Debtor 2 12/15

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Debtor 1

Debtor 2

Jose Miguel Mendez Collazo

Cynthia Aixa Rodriguez Rivera

First Name Middle Name Last Name

Case number (if known) 24-42332-MXM-13

Your expenses

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

6. Utilities:

6a. Electricity, heat, natural gas

6b. Water, sewer, garbage collection

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

6d. Other. Specify: Cable or Satellite Dish

6a.

6b.

6c.

6d.

$200.00

$80.00

$80.00

$80.00

7. Food and housekeeping supplies 7. $450.00

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

9. Clothing, laundry, and dry cleaning 9. $0.00

10. Personal care products and services 10. $150.00

11. Medical and dental expenses 11. $0.00

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

Do not include car payments. 12. $350.00

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

14. Charitable contributions and religious donations 14. $0.00

15. Insurance.

Do not include insurance deducted from your pay or included in lines 4 or 20.

15a. Life insurance

15b. Health insurance

15c. Vehicle insurance

15d. Other insurance. Specify: 

15a.

15b.

15c.

15d.

$0.00

$300.00

$300.00

$0.00

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

Specify: 16. $0.00

17. Installment or lease payments:

17a. Car payments for Vehicle 1

17b. Car payments for Vehicle 2

17c. Other. Specify: 

17d. Other. Specify: 

17a.

17b.

17c.

17d.

18. Your payments of alimony, maintenance, and support that you did not report as deducted

from your pay on line 5, Schedule I, Your Income (Official Form 106I). 18. $0.00

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

Specify: 19. $0.00

20. Other real property expenses not included in lines 4 or 5 of this form or on Schedule I: Your Income

20a. Mortgages on other property

20b. Real estate taxes

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

20d. Maintenance, repair, and upkeep expenses

20a.

20b.

20c.

20d.

$0.00

$0.00

$0.00

$0.00

Official Form 106J-2 Schedule J-2: Expenses for Separate Household of Debtor 2 page 2

Case 24-42332-mxm13 Doc 18 Filed 07/30/24 Entered 07/30/24 20:04:02 Desc Main

Document Page 47 of 51
20e. Homeowner’s association or condominium dues 20e. $0.00

Debtor 1

Debtor 2

Jose Miguel Mendez Collazo

Cynthia Aixa Rodriguez Rivera

First Name Middle Name Last Name

Case number (if known) 24-42332-MXM-13

21. Other. Specify: 21. + $0.00

22. Your monthly expenses. Add lines 4 through 21.

The result is the monthly expenses of Debtor 2. Copy the result to line 22b of Schedule J to calculate the

total expenses for Debtor 1 and Debtor 2.

22.

$3,290.00

23. Line not used on this form.

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-2 Schedule J-2: Expenses for Separate Household of Debtor 2 page 3

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Case 24-42332-mxm13 Doc 18 Filed 07/30/24 Entered 07/30/24 20:04:02 Desc Main

Document Page 48 of 51
Fill in this information to identify your case:

Debtor 1 Jose Miguel Mendez Collazo

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Cynthia Aixa Rodriguez Rivera

First Name Middle Name Last Name

United States Bankruptcy Court for the: Northern District of Texas

Case number

(if known)

24-42332-MXM-13 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

$75,888.94

$75,888.94

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....... $65,608.00

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

$4,008.00

+ $241,579.82

Your total liabilities $311,195.82

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.......................................................................................... $7,805.23

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

Copy your monthly expenses from line 22c of Schedule J.................................................................................. $7,175.00

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

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Summary of Your Assets and Liabilities and Certain Statistical

Information 12/15

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Debtor 1

Debtor 2

Jose Miguel Mendez Collazo

Cynthia Aixa Rodriguez Rivera

First Name Middle Name Last Name

Case number (if known) 24-42332-MXM-13

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. $9,123.34

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.) $0.00

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

9d. Student loans. (Copy line 6f.) $78,977.00

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. $78,977.00

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

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Document Page 50 of 51
Fill in this information to identify your case:

Debtor 1 Jose Miguel Mendez Collazo

First Name Middle Name Last Name

Debtor 2

(Spouse, if filing)

Cynthia Aixa Rodriguez Rivera

First Name Middle Name Last Name

United States Bankruptcy Court for the: Northern District of Texas

Case number

(if known)

24-42332-MXM-13 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/ Jose Miguel Mendez Collazo

Jose Miguel Mendez Collazo, Debtor 1

Date 07/30/2024

MM/ DD/ YYYY

✘ /s/ Cynthia Aixa Rodriguez Rivera

Cynthia Aixa Rodriguez Rivera, Debtor 2

Date 07/30/2024

MM/ DD/ YYYY

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

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Declaration About an Individual Debtor's Schedules 12/15

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