© 1993-2009 EZ-Filing, Inc. [1-800-998-2424] - Forms Software Only

United States Bankruptcy Court

IN RE: Case No.

Debtor(s) Chapter

1. Pursuant to 11 U.S.C. § 329(a) and Bankruptcy Rule 2016(b), I certify that I am the attorney for the above-named debtor(s) and that compensation paid to me within one year before the filing of the petition in bankruptcy, or agreed to be paid to me, for services rendered or to be rendered on behalf of the debtor(s) in contemplation of or in connection with the bankruptcy case is as follows: For legal services, I have agreed to accept . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ Prior to the filing of this statement I have received . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ Balance Due . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 2. The source of the compensation paid to me was: Debtor Other (specify): 3. The source of compensation to be paid to me is: Debtor Other (specify): 4. I have not agreed to share the above-disclosed compensation with any other person unless they are members and associates of my law firm. I have agreed to share the above-disclosed compensation with a person or persons who are not members or associates of my law firm. A copy of the agreement, together with a list of the names of the people sharing in the compensation, is attached. 5. In return for the above-disclosed fee, I have agreed to render legal service for all aspects of the bankruptcy case, including: a. Analysis of the debtor's financial situation, and rendering advice to the debtor in determining whether to file a petition in bankruptcy; b. Preparation and filing of any petition, schedules, statement of affairs and plan which may be required; c. Representation of the debtor at the meeting of creditors and confirmation hearing, and any adjourned hearings thereof; d. Representation of the debtor in adversary proceedings and other contested bankruptcy matters; e. [Other provisions as needed]

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

CERTIFICATION I certify that the foregoing is a complete statement of any agreement or arrangement for payment to me for representation of the debtor(s) in this bankruptcy proceeding.

Date

Northern District of Illinois

DISCLOSURE OF COMPENSATION OF ATTORNEY FOR DEBTOR

Ortiz, Robert Brian 7

 900.00

 900.00

 0.00  ̧ Debtor's mother

 ̧

January 8, 2010 /s/ Gershon S. Kulek

Gershon S. Kulek 6182449

Gershon Kulek, Attorney

180 W. Washington St; 4th Floor

Chicago, IL 60602

(312) 644-1000 Fax: (312) 644-0000

gkulek@yahoo.com

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© 1993-2009 EZ-Filing, Inc. [1-800-998-2424] - Forms Software Only B201A (Form 201A) (12/09) WARNING: Effective December 1, 2009, the 15-day deadline to file schedules and certain other documents under Bankruptcy Rule 1007(c) is shortened to 14 days. For further information, see note at bottom of page 2 UNITED STATES BANKRUPTCY COURT

NOTICE TO CONSUMER DEBTOR(S) UNDER §342(b) OF THE BANKRUPTCY CODE In accordance with § 342(b) of the Bankruptcy Code, this notice to individuals with primarily consumer debts: (1) Describes briefly the services available from credit counseling services; (2) Describes briefly the purposes, benefits and costs of the four types of bankruptcy proceedings you may commence; and (3) Informs you about bankruptcy crimes and notifies you that the Attorney General may examine all information you supply in connection with a bankruptcy case. You are cautioned that bankruptcy law is complicated and not easily described. Thus, you may wish to seek the advice of an attorney to learn of your rights and responsibilities should you decide to file a petition. Court employees cannot give you legal advice. Notices from the bankruptcy court are sent to the mailing address you list on your bankruptcy petition. In order to ensure that you receive information about events concerning your case, Bankruptcy Rule 4002 requires that you notify the court of any changes in your address. If you are filing a joint case (a single bankruptcy case for two individuals married to each other), and each spouse lists the same mailing address on the bankruptcy petition, you and your spouse will generally receive a single copy of each notice mailed from the bankruptcy court in a jointly-addressed envelope, unless you file a statement with the court requesting that each spouse receive a separate copy of all notices. 1. Services Available from Credit Counseling Agencies With limited exceptions, § 109(h) of the Bankruptcy Code requires that all individual debtors who file for bankruptcy relief on or after October 17, 2005, receive a briefing that outlines the available opportunities for credit counseling and provides assistance in performing a budget analysis. The briefing must be given within 180 days before the bankruptcy filing. The briefing may be provided individually or in a group (including briefings conducted by telephone or on the Internet) and must be provided by a nonprofit budget and credit counseling agency approved by the United States trustee or bankruptcy administrator. The clerk of the bankruptcy court has a list that you may consult of the approved budget and credit counseling agencies. Each debtor in a joint case must complete the briefing. In addition, after filing a bankruptcy case, an individual debtor generally must complete a financial management instructional course before he or she can receive a discharge. The clerk also has a list of approved financial management instructional courses. Each debtor in a joint case must complete the course. 2. The Four Chapters of the Bankruptcy Code Available to Individual Consumer Debtors Chapter 7: Liquidation ($245 filing fee, $39 administrative fee, $15 trustee surcharge: Total fee $299) Chapter 7 is designed for debtors in financial difficulty who do not have the ability to pay their existing debts. Debtors whose debts are primarily consumer debts are subject to a “means test” designed to determine whether the case should be permitted to proceed under chapter 7. If your income is greater than the median income for your state of residence and family size, in some cases, the United States trustee (or bankruptcy administrator), the trustee, or creditors have the right to file a motion requesting that the court dismiss your case under § 707(b) of the Code. It is up to the court to decide whether the case should be dismissed. Under chapter 7, you may claim certain of your property as exempt under governing law. A trustee may have the right to take possession of and sell the remaining property that is not exempt and use the sale proceeds to pay your creditors.

The purpose of filing a chapter 7 case is to obtain a discharge of your existing debts. If, however, you are found to have committed certain kinds of improper conduct described in the Bankruptcy Code, the court may deny your

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© 1993-2009 EZ-Filing, Inc. [1-800-998-2424] - Forms Software Only B201A (Form 201A) (12/09) Page 2 discharge and, if it does, the purpose for which you filed the bankruptcy petition will be defeated. Even if you receive a general discharge, some particular debts are not discharged under the law. Therefore, you may still be responsible for most taxes and student loans; debts incurred to pay nondischargeable taxes; domestic support and property settlement obligations; most fines, penalties, forfeitures, and criminal restitution obligations; certain debts which are not properly listed in your bankruptcy papers; and debts for death or personal injury caused by operating a motor vehicle, vessel, or aircraft while intoxicated from alcohol or drugs. Also, if a creditor can prove that a debt arose from fraud, breach of fiduciary duty, or theft, or from a willful and malicious injury, the bankruptcy court may determine that the debt is not discharged. Chapter 13: Repayment of All or Part of the Debts of an Individual with Regular Income ($235 filing fee, $39 administrative fee: Total fee $274) Chapter 13 is designed for individuals with regular income who would like to pay all or part of their debts in installments over a period of time. You are only eligible for chapter 13 if your debts do not exceed certain dollar amounts set forth in the Bankruptcy Code. Under chapter 13, you must file with the court a plan to repay your creditors all or part of the money that you owe them, using your future earnings. The period allowed by the court to repay your debts may be three years or five years, depending upon your income and other factors. The court must approve your plan before it can take effect. After completing the payments under your plan, your debts are generally discharged except for domestic support obligations; most student loans; certain taxes; most criminal fines and restitution obligations; certain debts which are not properly listed in your bankruptcy papers; certain debts for acts that caused death or personal injury; and certain long term secured obligations. Chapter 11: Reorganization ($1000 filing fee, $39 administrative fee: Total fee $1039) Chapter 11 is designed for the reorganization of a business but is also available to consumer debtors. Its provisions are quite complicated, and any decision by an individual to file a chapter 11 petition should be reviewed with an attorney.

Chapter 12: Family Farmer or Fisherman ($200 filing fee, $39 administrative fee: Total fee $239) Chapter 12 is designed to permit family farmers and fishermen to repay their debts over a period of time from future earnings and is similar to chapter 13. The eligibility requirements are restrictive, limiting its use to those whose income arises primarily from a family-owned farm or commercial fishing operation. 3. Bankruptcy Crimes and Availability of Bankruptcy Papers to Law Enforcement Officials A person who knowingly and fraudulently conceals assets or makes a false oath or statement under penalty of perjury, either orally or in writing, in connection with a bankruptcy case is subject to a fine, imprisonment, or both. All information supplied by a debtor in connection with a bankruptcy case is subject to examination by the Attorney General acting through the Office of the United States Trustee, the Office of the United States Attorney, and other components and employees of the Department of Justice. WARNING: Section 521(a)(1) of the Bankruptcy Code requires that you promptly file detailed information regarding your creditors, assets, liabilities, income, expenses and general financial condition. Your bankruptcy case may be dismissed if this information is not filed with the court within the time deadlines set by the Bankruptcy Code, the Bankruptcy Rules, and the local rules of the court. The documents and the deadlines for filing them are listed on Form B200, which is posted at http://www.uscourts.gov/bkforms/bankruptcy_forms.html#procedure. Many filing deadlines change on December 1, 2009. Of special note, 12 rules that set 15 days to act are amended to require action within 14 days, including Rule 1007(c), filing the initial case papers; Rule 3015(b), filing a chapter 13 plan; Rule 8009(a), filing appellate briefs; and Rules 1019, 1020, 2015, 2015.1, 2016, 4001, 4002, 6004, and 6007.

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© 1993-2009 EZ-Filing, Inc. [1-800-998-2424] - Forms Software Only B201B (Form 201B) (12/09)

IN RE: Case No.

Debtor(s) Chapter

UNDER § 342(b) OF THE BANKRUPTCY CODE

Certificate of [Non-Attorney] Bankruptcy Petition Preparer I, the [non-attorney] bankruptcy petition preparer signing the debtor’s petition, hereby certify that I delivered to the debtor the attached notice, as required by § 342(b) of the Bankruptcy Code.

Printed Name and title, if any, of Bankruptcy Petition Preparer Address:

X

Signature of Bankruptcy Petition Preparer of officer, principal, responsible person, or partner whose Social Security number is provided above.

Social Security number (If the bankruptcy petition preparer is not an individual, state the Social Security number of the officer, principal, responsible person, or partner of the bankruptcy petition preparer.) (Required by 11 U.S.C. § 110.)

Certificate of the Debtor I (We), the debtor(s), affirm that I (we) have received and read the attached notice, as required by § 342(b) of the Bankruptcy Code.

Printed Name(s) of Debtor(s) X

Signature of Debtor Date

Case No. (if known) X

Signature of Joint Debtor (if any) Date

Instructions: Attach a copy of Form B 201A, Notice to Consumer Debtor(s) Under § 342(b) of the Bankruptcy Code. Use this form to certify that the debtor has received the notice required by 11 U.S.C. § 342(b) only if the certification has NOT been made on the Voluntary Petition, Official Form B1. Exhibit B on page 2 of Form B1 contains a certification by the debtor’s attorney that the attorney has given the notice to the debtor. The Declarations made by debtors and bankruptcy petition preparers on page 3 of Form B1 also include this certification.

United States Bankruptcy Court

Northern District of Illinois

CERTIFICATION OF NOTICE TO CONSUMER DEBTOR(S)

Ortiz, Robert Brian 7

Ortiz, Robert Brian /s/ Robert Brian Ortiz 1/08/2010

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© 1993-2009 EZ-Filing, Inc. [1-800-998-2424] - Forms Software Only B1 (Official Form 1) (1/08)

Name of Debtor (if individual, enter Last, First, Middle): Name of Joint Debtor (Spouse) (Last, First, Middle): All Other Names used by the Debtor in the last 8 years (include married, maiden, and trade names): All Other Names used by the Joint Debtor in the last 8 years (include married, maiden, and trade names):

Last four digits of Soc. Sec. or Individual-Taxpayer I.D. (ITIN) No./Complete EIN (if more than one, state all): Last four digits of Soc. Sec. or Individual-Taxpayer I.D. (ITIN) No./Complete EIN (if more than one, state all): Street Address of Debtor (No. & Street, City, State & Zip Code): Street Address of Joint Debtor (No. & Street, City, State & Zip Code):

ZIPCODE ZIPCODE County of Residence or of the Principal Place of Business: County of Residence or of the Principal Place of Business: Mailing Address of Debtor (if different from street address) Mailing Address of Joint Debtor (if different from street address):

ZIPCODE ZIPCODE Location of Principal Assets of Business Debtor (if different from street address above): ZIPCODE Type of Debtor (Form of Organization) (Check one box.) Individual (includes Joint Debtors) See Exhibit D on page 2 of this form. Corporation (includes LLC and LLP) Partnership Other (If debtor is not one of the above entities, check this box and state type of entity below.)

Nature of Business (Check one box.) Health Care Business Single Asset Real Estate as defined in 11 U.S.C. § 101(51B) Railroad Stockbroker Commodity Broker Clearing Bank Other

Tax-Exempt Entity (Check box, if applicable.) Debtor is a tax-exempt organization under Title 26 of the United States Code (the Internal Revenue Code).

Chapter of Bankruptcy Code Under Which the Petition is Filed (Check one box.) Chapter 7 Chapter 15 Petition for Chapter 9 Recognition of a Foreign Chapter 11 Main Proceeding Chapter 12 Chapter 15 Petition for Chapter 13 Recognition of a Foreign Nonmain Proceeding Nature of Debts (Check one box.) Debts are primarily consumer Debts are primarily debts, defined in 11 U.S.C. business debts. § 101(8) as “incurred by an individual primarily for a personal, family, or house- hold purpose.” Filing Fee (Check one box) Full Filing Fee attached Filing Fee to be paid in installments (Applicable to individuals only). Must attach signed application for the court’s consideration certifying that the debtor is unable to pay fee except in installments. Rule 1006(b). See Official Form 3A.

Filing Fee waiver requested (Applicable to chapter 7 individuals only). Must attach signed application for the court’s consideration. See Official Form 3B.

Chapter 11 Debtors Check one box: Debtor is a small business debtor as defined in 11 U.S.C. § 101(51D). Debtor is not a small business debtor as defined in 11 U.S.C. § 101(51D). Check if: Debtor’s aggregate noncontingent liquidated debts owed to non-insiders or affiliates are less than $2,190,000. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Check all applicable boxes: A plan is being filed with this petition Acceptances of the plan were solicited prepetition from one or more classes of creditors, in accordance with 11 U.S.C. § 1126(b). Statistical/Administrative Information Debtor estimates that funds will be available for distribution to unsecured creditors. Debtor estimates that, after any exempt property is excluded and administrative expenses paid, there will be no funds available for distribution to unsecured creditors.

THIS SPACE IS FOR COURT USE ONLY

Estimated Number of Creditors 1-49 50-99 100-199 200-999 1,000- 5,000 5,001- 10,000 10,001- 25,000 25,001- 50,000 50,001- 100,000 Over 100,000 Estimated Assets $0 to $50,000 $50,001 to $100,000 $100,001 to $500,000 $500,001 to $1 million $1,000,001 to $10 million $10,000,001 to $50 million $50,000,001 to $100 million $100,000,001 to $500 million $500,000,001 to $1 billion More than $1 billion Estimated Liabilities $0 to $50,000 $50,001 to $100,000 $100,001 to $500,000 $500,001 to $1 million $1,000,001 to $10 million $10,000,001 to $50 million $50,000,001 to $100 million $100,000,001 to $500 million $500,000,001 to $1 billion More than $1 billion

United States Bankruptcy Court

Northern District of Illinois Voluntary Petition

Ortiz, Robert Brian

Brian Ortiz

2623

4620 N. Beacon

#1N

Chicago, IL 60640 Cook

 ̧  ̧

 ̧

 ̧

 ̧

 ̧

 ̧

 ̧

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© 1993-2009 EZ-Filing, Inc. [1-800-998-2424] - Forms Software Only B1 (Official Form 1) (1/08) Page 2

(This page must be completed and filed in every case) Name of Debtor(s):

Prior Bankruptcy Case Filed Within Last 8 Years (If more than two, attach additional sheet) Location Where Filed: Case Number: Date Filed: Location Where Filed: Case Number: Date Filed: Pending Bankruptcy Case Filed by any Spouse, Partner or Affiliate of this Debtor (If more than one, attach additional sheet) Name of Debtor: Case Number: Date Filed: District: Relationship: Judge:

Exhibit A (To be completed if debtor isrequired to file periodic reports(e.g., forms 10K and 10Q) with the Securities and Exchange Commission pursuant to Section 13 or 15(d) of the Securities Exchange Act of 1934 and is requesting relief under chapter 11.) Exhibit A is attached and made a part of this petition.

Exhibit B (To be completed if debtor is an individual whose debts are primarily consumer debts.) I, the attorney for the petitioner named in the foregoing petition, declare that I have informed the petitioner that [he or she] may proceed under chapter 7, 11, 12, or 13 of title 11, United States Code, and have explained the relief available under each such chapter. I further certify that I delivered to the debtor the notice required by § 342(b) of the Bankruptcy Code. X Signature of Attorney for Debtor(s) Date Exhibit C Does the debtor own or have possession of any property that poses or is alleged to pose a threat of imminent and identifiable harm to public health or safety? Yes, and Exhibit C is attached and made a part of this petition. No Exhibit D (To be completed by every individual debtor. If a joint petition is filed, each spouse must complete and attach a separate Exhibit D.) Exhibit D completed and signed by the debtor is attached and made a part of this petition. If this is a joint petition: Exhibit D also completed and signed by the joint debtor is attached a made a part of this petition. Information Regarding the Debtor - Venue (Check any applicable box.) Debtor has been domiciled or has had a residence, principal place of business, or principal assetsin this District for 180 daysimmediately preceding the date of this petition or for a longer part of such 180 days than in any other District. There is a bankruptcy case concerning debtor’s affiliate, general partner, or partnership pending in this District. Debtor is a debtor in a foreign proceeding and has its principal place of business or principal assets in the United States in this District, or has no principal place of business or assets in the United States but is a defendant in an action or proceeding [in a federal or state court] in this District, or the interests of the parties will be served in regard to the relief sought in this District. Certification by a Debtor Who Resides as a Tenant of Residential Property (Check all applicable boxes.) Landlord has a judgment against the debtor for possession of debtor’s residence. (If box checked, complete the following.)

(Name of landlord or lessor that obtained judgment) (Address of landlord or lessor) Debtor claims that under applicable nonbankruptcy law, there are circumstances under which the debtor would be permitted to cure the entire monetary default that gave rise to the judgment for possession, after the judgment for possession was entered, and Debtor has included in this petition the deposit with the court of any rent that would become due during the 30-day period after the filing of the petition. Debtor certifies that he/she has served the Landlord with this certification. (11 U.S.C. § 362(l)).

Voluntary Petition Ortiz, Robert Brian

None

None

/s/ Gershon S. Kulek 1/08/10

 ̧

 ̧

 ̧

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© 1993-2009 EZ-Filing, Inc. [1-800-998-2424] - Forms Software Only B1 (Official Form 1) (1/08) Page 3

(This page must be completed and filed in every case) Name of Debtor(s):

Signatures Signature(s) of Debtor(s) (Individual/Joint) I declare under penalty of perjury that the information provided in this petition is true and correct. [If petitioner is an individual whose debts are primarily consumer debts and has chosen to file under Chapter 7] I am aware that I may proceed under chapter 7, 11, 12 or 13 of title 11, United State Code, understand the relief available under each such chapter, and choose to proceed under chapter 7. [If no attorney represents me and no bankruptcy petition preparer signs the petition] I have obtained and read the notice required by 11 U.S.C. § 342(b). I request relief in accordance with the chapter of title 11, United States Code, specified in this petition. X Signature of Debtor X Signature of Joint Debtor Telephone Number (If not represented by attorney) Date

Signature of a Foreign Representative I declare under penalty of perjury that the information provided in this petition istrue and correct, that I amthe foreign representative of a debtor in a foreign proceeding, and that I am authorized to file this petition. (Check only one box.) I request relief in accordance with chapter 15 of title 11, United States Code. Certified copies ofthe documentsrequired by 11 U.S.C. § 1515 are attached. Pursuant to 11 U.S.C. § 1511, I request relief in accordance with the chapter of title 11 specified in this petition. A certified copy of the order granting recognition ofthe foreign main proceedingis attached. X Signature of Foreign Representative Printed Name of Foreign Representative Date

Signature of Attorney* X Signature of Attorney for Debtor(s)

Date *In a case in which § 707(b)(4)(D) applies, this signature also constitutes a certification that the attorney has no knowledge after an inquiry that the information in the schedules is incorrect.

Signature of Non-Attorney Petition Preparer I declare under penalty of perjury that: 1) I am a bankruptcy petition preparer as defined in 11 U.S.C. § 110; 2) I prepared this document for compensation and have provided the debtor with a copy of this document and the notices and information required under 11 U.S.C. §§ 110(b), 110(h) and 342(b); 3) if rules or guidelines have been promulgated pursuant to 11 U.S.C. § 110(h) setting a maximum fee for services chargeable by bankruptcy petition preparers, I have given the debtor notice of the maximum amount before preparing any document for filing for a debtor or accepting any fee from the debtor, as required in that section. Official Form 19 is attached. Printed Name and title, if any, of Bankruptcy Petition Preparer Social Security Number (If the bankruptcy petition preparer is not an individual, state the Social Security number of the officer, principal, responsible person or partner of the bankruptcy petition preparer.) (Required by 11 U.S.C. § 110.) Address

X Signature of Bankruptcy Petition Preparer or officer, principal, responsible person, or partner whose social security number is provided above. Date Names and Social Security numbers of all other individuals who prepared or assisted in preparing this document unless the bankruptcy petition preparer is not an individual:

If more than one person prepared this document, attach additional sheets conforming to the appropriate official form for each person. A bankruptcy petition preparer’s failure to comply with the provisions of title 11 and the Federal Rules of Bankruptcy Procedure may result in fines or imprisonment or both 11 U.S.C. § 110; 18 U.S.C. § 156.

Signature of Debtor (Corporation/Partnership) I declare under penalty of perjury that the information provided in this petition is true and correct, and that I have been authorized to file this petition on behalf of the debtor. The debtor requests relief in accordance with the chapter of title 11, United States Code, specified in this petition. X Signature of Authorized Individual Printed Name of Authorized Individual Title of Authorized Individual Date

Voluntary Petition Ortiz, Robert Brian

/s/ Robert Brian Ortiz Robert Brian Ortiz

(773) 398-5121

January 8, 2010

/s/ Gershon S. Kulek

January 8, 2010

Gershon S. Kulek 6182449

Gershon Kulek, Attorney

180 W. Washington St; 4th Floor

Chicago, IL 60602

(312) 644-1000 Fax: (312) 644-0000

gkulek@yahoo.com

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© 1993-2009 EZ-Filing, Inc. [1-800-998-2424] - Forms Software Only B1D (Official Form 1, Exhibit D) (12/09)

IN RE: Case No.

Debtor(s) Chapter

CREDIT COUNSELING REQUIREMENT Warning: You must be able to check truthfully one of the five statements regarding credit counseling listed below. If you cannot do so, you are not eligible to file a bankruptcy case, and the court can dismiss any case you do file. If that happens, you will lose whatever filing fee you paid, and your creditors will be able to resume collection activities against you. If your case is dismissed and you file another bankruptcy case later, you may be required to pay a second filing fee and you may have to take extra steps to stop creditors’ collection activities. Every individual debtor must file this Exhibit D. If a joint petition is filed, each spouse must complete and file a separate Exhibit D. Check one of the five statements below and attach any documents as directed. 1. Within the 180 days before the filing of my bankruptcy case, I received a briefing from a credit counseling agency approved by the United States trustee or bankruptcy administrator that outlined the opportunities for available credit counseling and assisted me in performing a related budget analysis, and I have a certificate from the agency describing the services provided to me. Attach a copy of the certificate and a copy of any debt repayment plan developed through the agency. 2. Within the 180 days before the filing of my bankruptcy case, I received a briefing from a credit counseling agency approved by the United States trustee or bankruptcy administrator that outlined the opportunities for available credit counseling and assisted me in performing a related budget analysis, but I do not have a certificate from the agency describing the services provided to me. You must file a copy of a certificate from the agency describing the services provided to you and a copy of any debt repayment plan developed through the agency no later than 14 days after your bankruptcy case is filed. 3. I certify that I requested credit counseling services from an approved agency but was unable to obtain the services during the seven days from the time I made my request, and the following exigent circumstances merit a temporary waiver of the credit counseling requirement so I can file my bankruptcy case now. [Summarize exigent circumstances here.]

If your certification is satisfactory to the court, you must still obtain the credit counseling briefing within the first 30 days after you file your bankruptcy petition and promptly file a certificate fromthe agency that provided the counseling,together with a copy of any debt management plan developed through the agency. Failure to fulfill these requirements may result in dismissal of your case. Any extension of the 30-day deadline can be granted only for cause and is limited to a maximum of 15 days. Your case may also be dismissed if the court is not satisfied with your reasons for filing your bankruptcy case without first receiving a credit counseling briefing. 4. I am not required to receive a credit counseling briefing because of: [Check the applicable statement.] [Must be accompanied by a motion for determination by the court.] Incapacity. (Defined in 11 U.S.C. § 109(h)(4) as impaired by reason of mental illness or mental deficiency so as to be incapable of realizing and making rational decisions with respect to financial responsibilities.); Disability. (Defined in 11 U.S.C. § 109(h)(4) as physically impaired to the extent of being unable, after reasonable effort, to participate in a credit counseling briefing in person, by telephone, or through the Internet.); Active military duty in a military combat zone. 5. The United States trustee or bankruptcy administrator has determined that the credit counseling requirement of 11 U.S.C. § 109(h) does not apply in this district. I certify under penalty of perjury that the information provided above is true and correct.

Signature of Debtor: Date:

United States Bankruptcy Court

Northern District of Illinois

EXHIBIT D - INDIVIDUAL DEBTOR'S STATEMENT OF COMPLIANCE

Ortiz, Robert Brian 7

 ̧

/s/ Robert Brian Ortiz January 8, 2010

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© 1993-2009 EZ-Filing, Inc. [1-800-998-2424] - Forms Software Only B6 Summary (Form 6 - Summary) (12/07)

IN RE: Case No.

Debtor(s) Chapter

Indicate as to each schedule whether that schedule is attached and state the number of pages in each. Report the totals from Schedules A, B, D, E, F, I, and J in the boxes provided. Add the amounts from Schedules A and B to determine the total amount of the debtor’s assets. Add the amounts of all claims from Schedules D, E, and F to determine the total amount of the debtor’s liabilities. Individual debtors also must complete the “Statistical Summary of Certain Liabilities and Related Data” if they file a case under chapter 7, 11, or 13. NAME OF SCHEDULE ATTACHED (YES/NO) NUMBER OF SHEETS ASSETS LIABILITIES OTHER

A - Real Property $

B - Personal Property $

C - Property Claimed as Exempt

D - Creditors Holding Secured Claims $

E - Creditors Holding Unsecured Priority Claims (Total of Claims on Schedule E) $

F - Creditors Holding Unsecured Nonpriority Claims $

G - Executory Contracts and Unexpired Leases

H - Codebtors

I - Current Income of Individual Debtor(s) $

J - Current Expenditures of Individual Debtor(s) $

TOTAL $ $

United States Bankruptcy Court

Northern District of Illinois

SUMMARY OF SCHEDULES

Ortiz, Robert Brian 7

Yes 1 360,000.00

Yes 3 8,135.00

Yes 1

Yes 1 354,260.00

Yes 2 14,159.00

Yes 2 68,672.90

Yes 1

Yes 1

Yes 1 2,176.61

Yes 2 3,909.44

 15 368,135.00 437,091.90

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© 1993-2009 EZ-Filing, Inc. [1-800-998-2424] - Forms Software Only Form 6 - Statistical Summary (12/07)

IN RE: Case No.

Debtor(s) Chapter

If you are an individual debtor whose debts are primarily consumer debts, as defined in § 101(8) of the Bankruptcy Code (11 U.S.C. § 101(8)), filing a case under chapter 7, 11 or 13, you must report all information requested below. Check this box if you are an individual debtor whose debts are NOT primarily consumer debts. You are not required to report any information here. This information is for statistical purposes only under 28 U.S.C. § 159. Summarize the following types of liabilities, as reported in the Schedules, and total them.

Type of Liability Amount Domestic Support Obligations (from Schedule E) $ Taxes and Certain Other Debts Owed to Governmental Units (from Schedule E) $ Claims for Death or Personal Injury While Debtor Was Intoxicated (from Schedule E) (whether disputed or undisputed) $ Student Loan Obligations (from Schedule F) $ Domestic Support, Separation Agreement, and Divorce Decree Obligations Not Reported on Schedule E $ Obligations to Pension or Profit-Sharing, and Other Similar Obligations (from Schedule F) $ TOTAL $

State the following: Average Income (from Schedule I, Line 16) $ Average Expenses (from Schedule J, Line 18) $ Current Monthly Income (from Form 22A Line 12; OR, Form 22B Line 11; OR, Form 22C Line 20 ) $

State the following: 1. Total from Schedule D, “UNSECURED PORTION, IF ANY” column $ 2. Total from Schedule E, “AMOUNT ENTITLED TO PRIORITY” column. $ 3. Total from Schedule E, “AMOUNT NOT ENTITLED TO PRIORITY, IF ANY” column $ 4. Total from Schedule F $ 5. Total of non-priority unsecured debt (sum of 1, 3, and 4) $

United States Bankruptcy Court

Northern District of Illinois

STATISTICAL SUMMARY OF CERTAIN LIABILITIES AND RELATED DATA (28 U.S.C. § 159)

Ortiz, Robert Brian 7

 0.00

 14,159.00

 0.00

 0.00

 0.00

 0.00

 14,159.00

 2,176.61

 3,909.44

 1,322.90

 0.00 14,159.00 0.00

 68,672.90

 68,672.90

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© 1993-2009 EZ-Filing, Inc. [1-800-998-2424] - Forms Software Only B6A (Official Form 6A) (12/07) IN RE Debtor(s) Case No. (If known)

Except as directed below, list all real property in which the debtor has any legal, equitable, or future interest, including all property owned as a cotenant, community property, or in which the debtor has a life estate. Include any property in which the debtor holds rights and powers exercisable for the debtor’s own benefit. If the debtor is married, state whether the husband, wife, both, or the marital community own the property by placing an “H,” “W,” “J,” or “C” in the column labeled “Husband, Wife, Joint, or Community.” If the debtor holds no interest in real property, write “None” under “Description and Location of Property.” Do not include interests in executory contracts and unexpired leases on this schedule. List them in Schedule G - Executory Contracts and Unexpired Leases. If an entity claims to have a lien or hold a secured interest in any property, state the amount of the secured claim. See Schedule D. If no entity claims to hold a secured interest in the property, write “None” in the column labeled “Amount of Secured Claim.” If the debtor is an individual or if a joint petition is filed, state the amount of any exemption claimed in the property only in Schedule C - Property Claimed as Exempt.

DESCRIPTION AND LOCATION OF PROPERTY NATURE OF DEBTOR'S INTEREST IN PROPERTY

HUSBAND, WIFE, JOINT, OR COMMUNITY

CURRENT VALUE OF DEBTOR'S INTEREST IN PROPERTY WITHOUT DEDUCTING ANY SECURED CLAIM OR EXEMPTION AMOUNT OF SECURED CLAIM

TOTAL

(Report also on Summary of Schedules)

SCHEDULE A - REAL PROPERTY

 360,000.00

Ortiz, Robert Brian

Residential condominium-4620 N. Beacon Street; #1N, Fee Simple 360,000.00 354,260.00 Chicago, IL 60640

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© 1993-2009 EZ-Filing, Inc. [1-800-998-2424] - Forms Software Only B6B (Official Form 6B) (12/07) IN RE Debtor(s) Case No. (If known)

Except as directed below, list all personal property of the debtor of whatever kind. If the debtor has no property in one or more of the categories, place an “x” in the appropriate position in the column labeled “None.” If additional space is needed in any category, attach a separate sheet properly identified with the case name, case number, and the number of the category. If the debtor is married, state whether the husband, wife, both, or the marital community own the property by placing an “H,” “W,” “J,” or “C” in the column labeled “Husband, Wife, Joint, or Community.” If the debtor is an individual or a joint petition is filed, state the amount of any exemptions claimed only in Schedule C - Property Claimed as Exempt. Do not list interests in executory contracts and unexpired leases on this schedule. List them in Schedule G - Executory Contracts and Unexpired Leases. If the property is being held for the debtor by someone else, state that person’s name and address under “Description and Location of Property.” If the property is being held for a minor child, simply state the child's initials and the name and address of the child's parent or guardian, such as "A.B., a minor child, by John Doe, guardian." Do not disclose the child's name. See, 11 U.S.C. §112 and Fed. R. Bankr. P. 1007(m).

TYPE OF PROPERTY N

O

N

E DESCRIPTION AND LOCATION OF PROPERTY

HUSBAND, WIFE, JOINT, OR COMMUNITY

CURRENT VALUE OF DEBTOR'S INTEREST IN PROPERTY WITHOUT DEDUCTING ANY SECURED CLAIM OR EXEMPTION

SCHEDULE B - PERSONAL PROPERTY

Ortiz, Robert Brian

1. Cash on hand. Pocket cash 35.00 2. Checking, savings or other financial accounts, certificates of deposit or shares in banks, savings and loan, thrift, building and loan, and homestead associations, or credit unions, brokerage houses, or cooperatives.

Checking account 100.00

3. Security deposits with public utilities, telephone companies, landlords, and others. X

4. Household goods and furnishings, include audio, video, and computer equipment. Lap top computer 1,500.00 Living room, dining room and bedroom furniture 500.00 5. Books, pictures and other art objects, antiques, stamp, coin, record, tape, compact disc, and other collections or collectibles.

X

6. Wearing apparel. Normal clothing 500.00 7. Furs and jewelry. Watch 25.00 8. Firearms and sports, photographic, and other hobby equipment. X 9. Interest in insurance policies. Name insurance company of each policy and itemize surrender or refund value of each.

X

10. Annuities. Itemize and name each issue. X 11. Interests in an education IRA as defined in 26 U.S.C. § 530(b)(1) or under a qualified State tuition plan as defined in 26 U.S.C. § 529(b)(1). Give particulars. (File separately the record(s) of any such interest(s). 11 U.S.C. § 521(c).)

X

12. Interests in IRA, ERISA, Keogh, or other pension or profit sharing plans. Give particulars. X

13. Stock and interests in incorporated and unincorporated businesses. Itemize. X

14. Interests in partnerships or joint ventures. Itemize. X

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Ortiz, Robert Brian

15. Government and corporate bonds and other negotiable and non-negotiable instruments. X

16. Accounts receivable. X 17. Alimony, maintenance, support, and property settlements in which the debtor is or may be entitled. Give particulars.

X

18. Other liquidated debts owed to debtor including tax refunds. Give particulars. X

19. Equitable or future interest, life estates, and rights or powers exercisable for the benefit of the debtor other than those listed in Schedule A - Real Property.

X

20. Contingent and noncontingent interests in estate of a decedent, death benefit plan, life insurance policy, or trust.

X

21. Other contingent and unliquidated claims of every nature, including tax refunds, counterclaims of the debtor, and rights to setoff claims. Give estimated value of each.

X

22. Patents, copyrights, and other intellectual property. Give particulars. X 23. Licenses, franchises, and other general intangibles. Give particulars. X 24. Customer lists or other compilations containing personally identifiable information (as defined in 11 U.S.C. § 101(41A)) provided to the debtor by individuals in connection with obtaining a product or service from the debtor primarily for personal, family, or household purposes.

X

25. Automobiles, trucks, trailers, and other vehicles and accessories. 2002 Ford Escape 5,475.00 26. Boats, motors, and accessories. X 27. Aircraft and accessories. X 28. Office equipment, furnishings, and supplies. X 29. Machinery, fixtures, equipment, and supplies used in business. X 30. Inventory. X 31. Animals. X 32. Crops - growing or harvested. Give particulars. X 33. Farming equipment and implements. X 34. Farm supplies, chemicals, and feed. X

B6B (Official Form 6B) (12/07) - Cont. IN RE Debtor(s) Case No. (If known)

(Continuation Sheet)

TYPE OF PROPERTY N

O

N

E DESCRIPTION AND LOCATION OF PROPERTY

HUSBAND, WIFE, JOINT, OR COMMUNITY

CURRENT VALUE OF DEBTOR'S INTEREST IN PROPERTY WITHOUT DEDUCTING ANY SECURED CLAIM OR EXEMPTION

SCHEDULE B - PERSONAL PROPERTY

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Ortiz, Robert Brian

35. Other personal property of any kind not already listed. Itemize. X

B6B (Official Form 6B) (12/07) - Cont. IN RE Debtor(s) Case No. (If known)

(Continuation Sheet)

TYPE OF PROPERTY N

O

N

E DESCRIPTION AND LOCATION OF PROPERTY

HUSBAND, WIFE, JOINT, OR COMMUNITY

CURRENT VALUE OF DEBTOR'S INTEREST IN PROPERTY WITHOUT DEDUCTING ANY SECURED CLAIM OR EXEMPTION

TOTAL (Include amounts from any continuation sheets attached. continuation sheets attached Report total also on Summary of Schedules.)

SCHEDULE B - PERSONAL PROPERTY

 8,135.00 0

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© 1993-2009 EZ-Filing, Inc. [1-800-998-2424] - Forms Software Only B6C (Official Form 6C) (12/07) IN RE Debtor(s) Case No. (If known)

Debtor elects the exemptions to which debtor is entitled under: Check if debtor claims a homestead exemption that exceeds $136,875. (Check one box) 11 U.S.C. § 522(b)(2) 11 U.S.C. § 522(b)(3)

DESCRIPTION OF PROPERTY SPECIFY LAW PROVIDING EACH EXEMPTION VALUE OF CLAIMED EXEMPTION CURRENT VALUE OF PROPERTY WITHOUT DEDUCTING EXEMPTIONS

SCHEDULE C - PROPERTY CLAIMED AS EXEMPT

 ̧

Ortiz, Robert Brian

SCHEDULE A - REAL PROPERTY

Residential condominium-4620 N. Beacon 735 ILCS 5 §12-901 15,000.00 360,000.00 Street; #1N, Chicago, IL 60640

SCHEDULE B - PERSONAL PROPERTY

Pocket cash 735 ILCS 5 §12-1001(b) 35.00 35.00 Checking account 735 ILCS 5 §12-1001(b) 100.00 100.00 Lap top computer 735 ILCS 5 §12-1001(b) 1,500.00 1,500.00 Living room, dining room and bedroom 735 ILCS 5 §12-1001(b) 500.00 500.00 furniture

Normal clothing 735 ILCS 5 §12-1001(a) 500.00 500.00 Watch 735 ILCS 5 §12-1001(b) 25.00 25.00 2002 Ford Escape 735 ILCS 5 §12-1001(c) 2,400.00 5,475.00

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© 1993-2009 EZ-Filing, Inc. [1-800-998-2424] - Forms Software Only B6D (Official Form 6D) (12/07) IN RE Debtor(s) Case No. (If known)

State the name, mailing address, including zip code, and last four digits of any account number of all entities holding claims secured by property of the debtor as of the date of filing of the petition. The complete account number of any account the debtor has with the creditor is useful to the trustee and the creditor and may be provided if the debtor chooses to do so. List creditors holding all types of secured interests such as judgment liens, garnishments, statutory liens, mortgages, deeds of trust, and other security interests. List creditors in alphabetical order to the extent practicable. If a minor child is the creditor, state the child's initials and the name and address of the child's parent or guardian, such as "A.B., a minor child, by John Doe, guardian." Do not disclose the child's name. See, 11 U.S.C. §112 and Fed. R. Bankr. P. 1007(m). If allsecured creditors will not fit on this page, use the continuation sheet provided. If any entity other than a spouse in a joint case may be jointly liable on a claim, place an “X” in the column labeled “Codebtor,” include the entity on the appropriate schedule of creditors, and complete Schedule H – Codebtors. If a joint petition is filed, state whether the husband, wife, both of them, or the marital community may be liable on each claim by placing an “H,” “W,” “J,” or “C” in the column labeled “Husband, Wife, Joint, or Community.” If the claim is contingent, place an “X” in the column labeled “Contingent.” If the claim is unliquidated, place an “X” in the column labeled “Unliquidated.” If the claim is disputed, place an “X” in the column labeled “Disputed.” (You may need to place an “X” in more than one of these three columns.) Total the columns labeled “Amount of Claim Without Deducting Value of Collateral” and “Unsecured Portion, if Any” in the boxes labeled “Total(s)” on the last sheet of the completed schedule. Report the total from the column labeled “Amount of Claim Without Deducting Value of Collateral” also on the Summary of Schedules and, if the debtor is an individual with primarily consumer debts, report the total from the column labeled “Unsecured Portion, if Any” on the Statistical Summary of Certain Liabilities and Related Data. Check this box if debtor has no creditors holding secured claims to report on this Schedule D.

CREDITOR'S NAME AND MAILING ADDRESS INCLUDING ZIP CODE AND ACCOUNT NUMBER. (See Instructions Above.) CODEBTOR HUSBAND, WIFE, JOINT, OR COMMUNITYDATE CLAIM WAS INCURRED, NATURE OF LIEN, AND DESCRIPTION AND VALUE OF PROPERTY SUBJECT TO LIEN CONTINGENT UNLIQUIDATED DISPUTED

AMOUNT OF CLAIM WITHOUT DEDUCTING VALUE OF COLLATERAL UNSECURED PORTION, IF ANY

ACCOUNT NO.

ACCOUNT NO.

ACCOUNT NO.

ACCOUNT NO.

continuation sheets attached Subtotal (Total of this page) $ $ Total (Use only on last page) $ $ (Report also on Summary of Schedules.) (If applicable, report also on Statistical Summary of Certain Liabilities and Related Data.)

SCHEDULE D - CREDITORS HOLDING SECURED CLAIMS

Ortiz, Robert Brian

1642023913 189,260.00

360,000.00

Chase Manhattan Mortgage

3415 Vision Dr.

Columbus, OH 43219

August 2003; mortgage for residential

condominium

VALUE $ 165,000.00

360,000.00

Robert & Sandra Ortiz

3747 N.E. Crystal Waters Lane

Grand Rapids, MI 49525

2001; Loan for downpayment for

residential condominium

VALUE $

VALUE $

VALUE $ 0 354,260.00

354,260.00

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Ortiz, Robert Brian B6E (Official Form 6E) (12/07) IN RE Debtor(s) Case No. (If known)

A complete list of claims entitled to priority, listed separately by type of priority, is to be set forth on the sheets provided. Only holders of unsecured claims entitled to priority should be listed in this schedule. In the boxes provided on the attached sheets, state the name, mailing address, including zip code, and last four digits of the account number, if any, of all entities holding priority claims against the debtor or the property of the debtor, as of the date of the filing of the petition. Use a separate continuation sheet for each type of priority and label each with the type of priority. The complete account number of any account the debtor has with the creditor is useful to the trustee and the creditor and may be provided if the debtor chooses to do so. If a minor child is a creditor, state the child's initials and the name and address of the child's parent or guardian, such as "A.B., a minor child, by John Doe, guardian." Do not disclose the child's name. See, 11 U.S.C. §112 and Fed. R. Bankr. P. 1007(m). If any entity other than a spouse in a joint case may be jointly liable on a claim, place an "X" in the column labeled "Codebtor," include the entity on the appropriate schedule of creditors, and complete Schedule H-Codebtors. If a joint petition is filed, state whether the husband, wife, both of them, or the marital community may be liable on each claim by placing an "H," "W," "J," or "C" in the column labeled "Husband, Wife, Joint, or Community." If the claim is contingent, place an "X" in the column labeled "Contingent." If the claim is unliquidated, place an "X" in the column labeled "Unliquidated." If the claim is disputed, place an "X" in the column labeled "Disputed." (You may need to place an "X" in more than one of these three columns.) Report the total of claims listed on each sheet in the box labeled "Subtotals" on each sheet. Report the total of all claims listed on this Schedule E in the box labeled “Total” on the last sheet of the completed schedule. Report this total also on the Summary of Schedules. Report the total of amounts entitled to priority listed on each sheet in the box labeled "Subtotals" on each sheet. Report the total of all amounts entitled to priority listed on this Schedule E in the box labeled “Totals” on the last sheet of the completed schedule. Individual debtors with primarily consumer debts report this total also on the Statistical Summary of Certain Liabilities and Related Data. Report the total of amounts not entitled to priority listed on each sheet in the box labeled “Subtotals” on each sheet. Report the total of all amounts not entitled to priority listed on this Schedule E in the box labeled “Totals” on the last sheet of the completed schedule. Individual debtors with primarily consumer debts report this total also on the Statistical Summary of Certain Liabilities and Related Data. Check this box if debtor has no creditors holding unsecured priority claims to report on this Schedule E. TYPES OF PRIORITY CLAIMS (Check the appropriate box(es) below if claims in that category are listed on the attached sheets) Domestic Support Obligations Claims for domestic support that are owed to or recoverable by a spouse, former spouse, or child of the debtor, or the parent, legal guardian, or responsible relative of such a child, or a governmental unit to whom such a domestic support claim has been assigned to the extent provided in 11 U.S.C. § 507(a)(1). Extensions of credit in an involuntary case Claims arising in the ordinary course of the debtor's business or financial affairs after the commencement of the case but before the earlier of the appointment of a trustee or the order for relief. 11 U.S.C. § 507(a)(3). Wages, salaries, and commissions Wages, salaries, and commissions, including vacation, severance, and sick leave pay owing to employees and commissions owing to qualifying independent sales representatives up to $10,950* per person earned within 180 days immediately preceding the filing of the original petition, or the cessation of business, whichever occurred first, to the extent provided in 11 U.S.C. § 507(a)(4). Contributions to employee benefit plans Money owed to employee benefit plans for services rendered within 180 days immediately preceding the filing of the original petition, or the cessation of business, whichever occurred first, to the extent provided in 11 U.S.C. § 507(a)(5). Certain farmers and fishermen Claims of certain farmers and fishermen, up to $5,400* per farmer or fisherman, against the debtor, as provided in 11 U.S.C. § 507(a)(6). Deposits by individuals Claims of individuals up to $2,425* for deposits for the purchase, lease, or rental of property or services for personal, family, or household use, that were not delivered or provided. 11 U.S.C. § 507(a)(7). Taxes and Certain Other Debts Owed to Governmental Units Taxes, customs duties, and penalties owing to federal, state, and local governmental units as set forth in 11 U.S.C. § 507(a)(8). Commitments to Maintain the Capital of an Insured Depository Institution Claims based on commitments to the FDIC, RTC, Director of the Office of Thrift Supervision, Comptroller of the Currency, or Board of Governors ofthe FederalReserve System, or their predecessors orsuccessors, to maintain the capital of an insured depository institution. 11 U.S.C. § 507 (a)(9). Claims for Death or Personal Injury While Debtor Was Intoxicated Claims for death or personal injury resulting from the operation of a motor vehicle or vessel while the debtor was intoxicated from using alcohol, a drug, or another substance. 11 U.S.C. § 507(a)(10). * Amounts are subject to adjustment on April 1, 2010, and every three years thereafter with respect to cases commenced on or after the date of adjustment. continuation sheets attached

SCHEDULE E - CREDITORS HOLDING UNSECURED PRIORITY CLAIMS

 ̧

 1

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© 1993-2009 EZ-Filing, Inc. [1-800-998-2424] - Forms Software Only

Ortiz, Robert Brian B6E (Official Form 6E) (12/07) - Cont. IN RE Debtor(s) Case No. (If known)

(Continuation Sheet)

(Type of Priority for Claims Listed on This Sheet)

CREDITOR'S NAME, MAILING ADDRESS INCLUDING ZIP CODE AND ACCOUNT NUMBER. (See Instructions above.) CODEBTOR HUSBAND, WIFE, JOINT, OR COMMUNITY

DATE CLAIM WAS INCURRED AND CONSIDERATION FOR CLAIM CONTINGENT UNLIQUIDATED DISPUTED

AMOUNT OF CLAIM AMOUNT ENTITLED TO PRIORITY

AMOUNT NOT ENTITLED TO PRIORITY, IF ANY

ACCOUNT NO.

ACCOUNT NO.

ACCOUNT NO.

ACCOUNT NO.

ACCOUNT NO.

ACCOUNT NO.

Sheet no. of continuation sheets attached to Subtotal Schedule of Creditors Holding Unsecured Priority Claims (Totals of this page) $ $ $ Total (Use only on last page of the completed Schedule E. Report also on the Summary of Schedules.) $ Total (Use only on last page of the completed Schedule E. If applicable, report also on the Statistical Summary of Certain Liabilities and Related Data.) $ $

SCHEDULE E - CREDITORS HOLDING UNSECURED PRIORITY CLAIMS

Taxes and Other Certain Debts Owed to Governmental Units

xxx-xx-2623

1,502.83 1,502.83

Illinois Department Of Revenue

101 W. Jefferson St.

Springfield, IL 62702

2006-2009; income taxes and

penalties

VN082231730

41.60 41.60

Illinois Tollway

P.O. Box 5201

Lisle, IL 60532-5201

10/2/2008; fine

xxx-xx-2623

12,614.57 12,614.57

Internal Revenue Service

U.S. Dept. Of The Treasury

Cincinnati, OH 45999-0030

2006-2009; income taxes and

penalties owed

 1 1 14,159.00 14,159.00 14,159.00

14,159.00

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© 1993-2009 EZ-Filing, Inc. [1-800-998-2424] - Forms Software Only B6F (Official Form 6F) (12/07) IN RE Debtor(s) Case No. (If known)

State the name, mailing address, including zip code, and last four digits of any account number, of all entities holding unsecured claims without priority against the debtor or the property of the debtor, as of the date of filing of the petition. The complete account number of any account the debtor has with the creditor is useful to the trustee and the creditor and may be provided if the debtor chooses to do so. If a minor child is a creditor, state the child's initials and the name and address of the child's parent or guardian, such as "A.B., a minor child, by John Doe, guardian." Do not disclose the child's name. See, 11 U.S.C. §112 and Fed. R. Bankr. P. 1007(m). Do not include claims listed in Schedules D and E. If all creditors will not fit on this page, use the continuation sheet provided. If any entity other than a spouse in a joint case may be jointly liable on a claim, place an “X” in the column labeled “Codebtor,” include the entity on the appropriate schedule of creditors, and complete Schedule H - Codebtors. If a joint petition is filed, state whether the husband, wife, both of them, or the marital community may be liable on each claim by placing an “H,” “W,” “J,” or “C” in the column labeled “Husband, Wife, Joint, or Community.” If the claim is contingent, place an “X” in the column labeled “Contingent.” If the claim is unliquidated, place an “X” in the column labeled “Unliquidated.” If the claim is disputed, place an “X” in the column labeled “Disputed.” (You may need to place an “X” in more than one of these three columns.) Report the total of all claims listed on this schedule in the box labeled “Total” on the last sheet of the completed schedule. Report this total also on the Summary of Schedules and, if the debtor is an individual with primarily consumer debts, report this total also on the Statistical Summary of Certain Liabilities and Related Data. Check this box if debtor has no creditors holding unsecured nonpriority claims to report on this Schedule F.

CREDITOR'S NAME, MAILING ADDRESS INCLUDING ZIP CODE, AND ACCOUNT NUMBER. (See Instructions Above.) CODEBTOR HUSBAND, WIFE, JOINT, OR COMMUNITYDATE CLAIM WAS INCURRED AND CONSIDERATION FOR CLAIM. IF CLAIM IS SUBJECT TO SETOFF, SO STATE CONTINGENT UNLIQUIDATED DISPUTEDAMOUNT OF CLAIM

ACCOUNT NO.

ACCOUNT NO.

ACCOUNT NO.

ACCOUNT NO.

continuation sheets attached Subtotal (Total of this page) $ Total (Use only on last page of the completed Schedule F. Report also on the Summary of Schedules and, if applicable, on the Statistical Summary of Certain Liabilities and Related Data.) $

SCHEDULE F - CREDITORS HOLDING UNSECURED NONPRIORITY CLAIMS

Ortiz, Robert Brian

46136125981.....

17,552.00

1st National Bank Of Omaha

P.O. Box 3412

Omaha, NE 68103

June 1994; credit card

Several accounts

16,501.00

Bank Of America

P.O. Box 17054

Wilmington, DE 19850

April 2001; credit cards

4418-4091-1938-1946

19,443.78

First National Bank Of Omaha

P.O. Box 3331

Omaha, NE 68103-0331

Credit card;

William H. Hunter, Attorney At Law

29 S. LaSalle St.; Suite 950

Chicago, IL 60603

Assignee or other notification for:

First National Bank Of Omaha

 1 53,496.78

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© 1993-2009 EZ-Filing, Inc. [1-800-998-2424] - Forms Software Only

Ortiz, Robert Brian B6F (Official Form 6F) (12/07) - Cont. IN RE Debtor(s) Case No. (If known)

(Continuation Sheet)

CREDITOR'S NAME, MAILING ADDRESS INCLUDING ZIP CODE, AND ACCOUNT NUMBER. (See Instructions Above.) CODEBTOR HUSBAND, WIFE, JOINT, OR COMMUNITY

DATE CLAIM WAS INCURRED AND CONSIDERATION FOR CLAIM. IF CLAIM IS SUBJECT TO SETOFF, SO STATE CONTINGENT UNLIQUIDATED DISPUTEDAMOUNT OF CLAIM

ACCOUNT NO.

ACCOUNT NO.

ACCOUNT NO.

ACCOUNT NO.

ACCOUNT NO.

ACCOUNT NO.

ACCOUNT NO.

Sheet no. of continuation sheets attached to Schedule of Creditors Holding Unsecured Nonpriority Claims Subtotal (Total of this page) $ Total (Use only on last page of the completed Schedule F. Report also on the Summary of Schedules, and if applicable, on the Statistical Summary of Certain Liabilities and Related Data.) $

SCHEDULE F - CREDITORS HOLDING UNSECURED NONPRIORITY CLAIMS

823215

39.99

Landvoice

P.O. Box 511140

SLC, UT 84151-1140

October 2008; services rendered

290194729-PU

1,344.25

Principal Life Insurance Co.

C/O Receivable Management Services

55 Shuman Rd.; P.O. Box 3100

Naperville, IL 60566-7099

9/27/2006; insurance premiums

4177348655

279.70

Quest Diagnostics, Inc.

C/O American Medical Collection Agency

2269 S. Saw Mill River Rd.; Building 3

Elmsford, NY 10523

9/25/06; medical services

71534

157.00

Rush University Medical Group

75 Remittance Drive; Dept. 1620

Chicago, IL 60675-1620

September 2006; medical services

12,973.18

Stephen M. Komie

Komie & Associates

1 N. LaSalle St.; #4200

Chicago, IL 60602

2006-2009; attorney's fees and costs for divorce

case

V71534

157.00

Vyridian Revenue Management

Nationwide Credit & Collection, Inc.

9919 Roosevelt Rd.

Westchester, IL 60154

August 2007; medical services

13987

225.00

Zabrin Inan, M.D.

1000 Lake Shore Dr.; Suite 308

Chicago, IL 60611-1311

December 2007; medical services

 1 1 15,176.12

68,672.90

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© 1993-2009 EZ-Filing, Inc. [1-800-998-2424] - Forms Software Only B6G (Official Form 6G) (12/07) IN RE Debtor(s) Case No. (If known)

Describe all executory contracts of any nature and all unexpired leases of real or personal property. Include any timeshare interests. State nature of debtor’s interest in contract, i.e., “Purchaser,” “Agent,” etc. State whether debtor is the lessor or lessee of a lease. Provide the names and complete mailing addresses of all other parties to each lease or contract described. If a minor child is a party to one of the leases or contracts, state the child's initials and the name and address of the child's parent or guardian, such as "A.B., a minor child, by John Doe, guardian." Do not disclose the child's name. See, 11 U.S.C. §112 and Fed. R. Bankr. P. 1007(m). Check this box if debtor has no executory contracts or unexpired leases. NAME AND MAILING ADDRESS, INCLUDING ZIP CODE OF OTHER PARTIES TO LEASE OR CONTRACT DESCRIPTION OF CONTRACT OR LEASE AND NATURE OF DEBTOR’S INTEREST. STATE WHETHER LEASE IS FOR NONRESIDENTIAL REAL PROPERTY. STATE CONTRACT NUMBER OF ANY GOVERNMENT CONTRACT.

SCHEDULE G - EXECUTORY CONTRACTS AND UNEXPIRED LEASES

 ̧

Ortiz, Robert Brian

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© 1993-2009 EZ-Filing, Inc. [1-800-998-2424] - Forms Software Only B6H (Official Form 6H) (12/07) IN RE Debtor(s) Case No. (If known)

Provide the information requested concerning any person or entity, other than a spouse in a joint case, that is also liable on any debts listed by the debtor in the schedules of creditors. Include all guarantors and co-signers. If the debtor resides or resided in a community property state, commonwealth, or territory (including Alaska, Arizona, California, Idaho, Louisiana, Nevada, New Mexico, Puerto Rico, Texas, Washington, or Wisconsin) within the eight-year period immediately preceding the commencement of the case, identify the name of the debtor’s spouse and of any former spouse who resides or resided with the debtor in the community property state, commonwealth, or territory. Include all names used by the nondebtor spouse during the eight years immediately preceding the commencement of this case. If a minor child is a codebtor or a creditor, state the child's initials and the name and address of the child's parent or guardian, such as "A.B., a minor child, by John Doe, guardian." Do not disclose the child's name. See, 11 U.S.C. §112 and Fed. R. Bankr. P. 1007(m). Check this box if debtor has no codebtors.

NAME AND ADDRESS OF CODEBTOR NAME AND ADDRESS OF CREDITOR

SCHEDULE H - CODEBTORS

 ̧

Ortiz, Robert Brian

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Ortiz, Robert Brian

Daughter 9

B6I (Official Form 6I) (12/07) IN RE Debtor(s) Case No. (If known)

The column labeled “Spouse” must be completed in all cases filed by joint debtors and by every married debtor, whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed. Do not state the name of any minor child. The average monthly income calculated on this form may differ from the current monthly income calculated on From 22A, 22B, or 22C. Debtor's Marital Status DEPENDENTS OF DEBTOR AND SPOUSE RELATIONSHIP(S): AGE(S):

EMPLOYMENT: DEBTOR SPOUSE Occupation Name of Employer How long employed Address of Employer

INCOME: (Estimate of average or projected monthly income at time case filed) DEBTOR SPOUSE 1. Current monthly gross wages, salary, and commissions (prorate if not paid monthly) $ $ 2. Estimated monthly overtime $ $ 3. SUBTOTAL $ $ 4. LESS PAYROLL DEDUCTIONS a. Payroll taxes and Social Security $ $ b. Insurance $ $ c. Union dues $ $ d. Other (specify) $ $ $ $ 5. SUBTOTAL OF PAYROLL DEDUCTIONS $ $ 6. TOTAL NET MONTHLY TAKE HOME PAY $ $ 7. Regular income from operation of business or profession or farm (attach detailed statement) $ $ 8. Income from real property $ $ 9. Interest and dividends $ $ 10. Alimony, maintenance or support payments payable to the debtor for the debtor’s use or that of dependents listed above $ $ 11. Social Security or other government assistance (Specify) $ $ $ $ 12. Pension or retirement income $ $ 13. Other monthly income (Specify) $ $ $ $ $ $ 14. SUBTOTAL OF LINES 7 THROUGH 13 $ $ 15. AVERAGE MONTHLY INCOME (Add amounts shown on lines 6 and 14) $ $ 16. COMBINED AVERAGE MONTHLY INCOME: (Combine column totals from line 15; if there is only one debtor repeat total reported on line 15) $ (Report also on Summary of Schedules and, if applicable, on Statistical Summary of Certain Liabilities and Related Data) 17. Describe any increase or decrease in income reasonably anticipated to occur within the year following the filing of this document:

SCHEDULE I - CURRENT INCOME OF INDIVIDUAL DEBTOR(S)

Married

 0.00

 0.00

 0.00

 2,176.61

 2,176.61

 2,176.61

 2,176.61

None

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Ortiz, Robert Brian B6J (Official Form 6J) (12/07) IN RE Debtor(s) Case No. (If known)

Complete thisschedule by estimating the average or projected monthly expenses of the debtor and the debtor’s family at time case filed. Prorate any payments made biweekly, quarterly, semi-annually, or annually to show monthly rate. The average monthly expenses calculated on this form may differ from the deductions from income allowed on Form22A or 22C. Check this box if a joint petition is filed and debtor’s spouse maintains a separate household. Complete a separate schedule of expenditures labeled “Spouse.” 1. Rent or home mortgage payment (include lot rented for mobile home) $ a. Are real estate taxes included? Yes No b. Is property insurance included? Yes No 2. Utilities: a. Electricity and heating fuel $ b. Water and sewer $ c. Telephone $ d. Other $

$ 3. Home maintenance (repairs and upkeep) $ 4. Food $ 5. Clothing $ 6. Laundry and dry cleaning $ 7. Medical and dental expenses $ 8. Transportation (not including car payments) $ 9. Recreation, clubs and entertainment, newspapers, magazines, etc. $ 10. Charitable contributions $ 11. Insurance (not deducted from wages or included in home mortgage payments) a. Homeowner’s or renter’s $ b. Life $ c. Health $ d. Auto $ e. Other $

$ 12. Taxes (not deducted from wages or included in home mortgage payments) (Specify) $

$ 13. Installment payments: (in chapter 11, 12 and 13 cases, do not list payments to be included in the plan) a. Auto $ b. Other $

$ 14. Alimony, maintenance, and support paid to others $ 15. Payments for support of additional dependents not living at your home $ 16. Regular expenses from operation of business, profession, or farm (attach detailed statement) $ 17. Other $

$

$ 18. AVERAGE MONTHLY EXPENSES (Total lines 1-17. Report also on Summary of Schedules and, if applicable, on the Statistical Summary of Certain Liabilities and Related Data. $ 19. Describe any increase or decrease in expenditures anticipated to occur within the year following the filing of this document:

20. STATEMENT OF MONTHLY NET INCOME a. Average monthly income from Line 15 of Schedule I $ b. Average monthly expenses from Line 18 above $ c. Monthly net income (a. minus b.) $

SCHEDULE J - CURRENT EXPENDITURES OF INDIVIDUAL DEBTOR(S)

 ̧

 1,547.88  ̧

 ̧ 100.00

 135.00

 400.00

 25.00

 200.00

 120.00

 942.56 Day Care 275.00 Condominium Monthly Assessment 164.00

 3,909.44

None

 2,176.61

 3,909.44

 -1,732.83

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Ortiz, Robert Brian B6J (Official Form 6J) (12/07) IN RE Debtor(s) Case No. (If known)

Complete thisschedule by estimating the average or projected monthly expenses of the debtor and the debtor’s family at time case filed. Prorate any payments made biweekly, quarterly, semi-annually, or annually to show monthly rate. The average monthly expenses calculated on this form may differ from the deductions from income allowed on Form22A or 22C. Check this box if a joint petition is filed and debtor’s spouse maintains a separate household. Complete a separate schedule of expenditures labeled “Spouse.” 1. Rent or home mortgage payment (include lot rented for mobile home) $ a. Are real estate taxes included? Yes No b. Is property insurance included? Yes No 2. Utilities: a. Electricity and heating fuel $ b. Water and sewer $ c. Telephone $ d. Other $

$ 3. Home maintenance (repairs and upkeep) $ 4. Food $ 5. Clothing $ 6. Laundry and dry cleaning $ 7. Medical and dental expenses $ 8. Transportation (not including car payments) $ 9. Recreation, clubs and entertainment, newspapers, magazines, etc. $ 10. Charitable contributions $ 11. Insurance (not deducted from wages or included in home mortgage payments) a. Homeowner’s or renter’s $ b. Life $ c. Health $ d. Auto $ e. Other $

$ 12. Taxes (not deducted from wages or included in home mortgage payments) (Specify) $

$ 13. Installment payments: (in chapter 11, 12 and 13 cases, do not list payments to be included in the plan) a. Auto $ b. Other $

$ 14. Alimony, maintenance, and support paid to others $ 15. Payments for support of additional dependents not living at your home $ 16. Regular expenses from operation of business, profession, or farm (attach detailed statement) $ 17. Other $

$

$ 18. AVERAGE MONTHLY EXPENSES (Total lines 1-17. Report also on Summary of Schedules and, if applicable, on the Statistical Summary of Certain Liabilities and Related Data. $ 19. Describe any increase or decrease in expenditures anticipated to occur within the year following the filing of this document:

20. STATEMENT OF MONTHLY NET INCOME a. Average monthly income from Line 15 of Schedule I $ b. Average monthly expenses from Line 18 above $ c. Monthly net income (a. minus b.) $

SCHEDULE J - CURRENT EXPENDITURES OF INDIVIDUAL DEBTOR(S)

SPOUSE

 ̧

 ̧

None

 0.00

 0.00

 0.00

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Ortiz, Robert Brian B6 Declaration (Official Form 6 - Declaration) (12/07) IN RE Debtor(s) Case No. (If known)

DECLARATION UNDER PENALTY OF PERJURY BY INDIVIDUAL DEBTOR I declare under penalty of perjury that I have read the foregoing summary and schedules, consisting of sheets, and that they are true and correct to the best of my knowledge, information, and belief.

Date: Signature: Debtor Date: Signature: (Joint Debtor, if any) [If joint case, both spouses must sign.]

DECLARATION AND SIGNATURE OF NON-ATTORNEY BANKRUPTCY PETITION PREPARER (See 11 U.S.C. § 110) I declare under penalty of perjury that: (1) I am a bankruptcy petition preparer as defined in 11 U.S.C. § 110; (2) I prepared this document for compensation and have provided the debtor with a copy of this document and the notices and information required under 11 U.S.C. §§ 110(b), 110(h), and 342 (b); and, (3) if rules or guidelines have been promulgated pursuant to 11 U.S.C. § 110(h) setting a maximum fee for services chargeable by bankruptcy petition preparers, I have given the debtor notice of the maximum amount before preparing any document for filing for a debtor or accepting any fee from the debtor, as required by that section. Printed or Typed Name and Title, if any, of Bankruptcy Petition Preparer Social Security No. (Required by 11 U.S.C. § 110.) If the bankruptcy petition preparer is not an individual, state the name, title (if any), address, and social security number of the officer, principal, responsible person, or partner who signs the document.

Address

Signature of Bankruptcy Petition Preparer Date Names and Social Security numbers of all other individuals who prepared or assisted in preparing this document, unless the bankruptcy petition preparer is not an individual:

If more than one person prepared this document, attach additional signed sheets conforming to the appropriate Official Form for each person. A bankruptcy petition preparer's failure to comply with the provision of title 11 and the Federal Rules of Bankruptcy Procedure may result in fines or imprisonment or both. 11 U.S.C. § 110; 18 U.S.C. § 156.

DECLARATION UNDER PENALTY OF PERJURY ON BEHALF OF CORPORATION OR PARTNERSHIP I, the (the president or other officer or an authorized agent of the corporation or a member or an authorized agent of the partnership) of the (corporation or partnership) named as debtor in this case, declare under penalty of perjury that I have read the foregoing summary and schedules, consisting of sheets (total shown on summary page plus 1), and that they are true and correct to the best of my knowledge, information, and belief.

Date: Signature:

(Print or type name of individual signing on behalf of debtor) [An individual signing on behalf of a partnership or corporation must indicate position or relationship to debtor.] Penalty for making a false statement or concealing property: Fine of up to $500,000 or imprisonment for up to 5 years or both. 18 U.S.C. §§ 152 and 3571.

DECLARATION CONCERNING DEBTOR'S SCHEDULES

 17

January 8, 2010 /s/ Robert Brian Ortiz

Robert Brian Ortiz

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ReMax Desk Fees 622.98 ReMax Broker Fees 21.78 ReMax Invoice Fees 297.80

United States Bankruptcy Court

IN RE: Case No.

Debtor(s) Chapter

FINANCIAL REVIEW OF THE DEBTOR’S BUSINESS (Note: ONLY INCLUDE information directly related to the business operation.) PART A - GROSS BUSINESS INCOME FOR THE PREVIOUS 12 MONTHS: 1. Gross Income For 12 Months Prior to Filing: PART B - ESTIMATED AVERAGE FUTURE GROSS MONTHLY INCOME: 2. Gross Monthly Income: PART C - ESTIMATED FUTURE MONTHLY EXPENSES: 3. Net Employee Payroll (Other Than Debtor) 4. Payroll Taxes 5. Unemployment Taxes 6. Worker’s Compensation 7. Other Taxes 8. Inventory Purchases (Including raw materials) 9. Purchase of Feed/Fertilizer/Seed/Spray 10. Rent (Other than debtor’s principal residence) 11. Utilities 12. Office Expenses and Supplies 13. Repairs and Maintenance 14. Vehicle Expenses 15. Travel and Entertainment 16. Equipment Rental and Leases 17. Legal/Accounting/Other Professional Fees 18. Insurance 19. Employee Benefits (e.g., pension, medical, etc.) 20. Payments to be Made Directly by Debtor to Secured Creditors for Pre-Petition Business Debts (Specify):

21. Other (Specify):

22. Total Monthly Expenses (Add items 3-21) PART D - ESTIMATED AVERAGE NET MONTHLY INCOME 23. AVERAGE NET MONTHLY INCOME (Subtract Item 22 from Item 2)

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

Northern District of Illinois

BUSINESS INCOME AND EXPENSES

Ortiz, Robert Brian 7

 21,766.05

 2,176.61

 942.56

 942.56

 1,234.05

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© 1993-2009 EZ-Filing, Inc. [1-800-998-2424] - Forms Software Only B7 (Official Form 7) (12/07)

IN RE: Case No.

Debtor(s) Chapter

Thisstatement is to be completed by every debtor. Spousesfiling a joint petition may file a single statement on which the information for both spouses is combined. Ifthe case is filed under chapter 12 or chapter 13, a married debtor must furnish information for both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed. An individual debtor engaged in business as a sole proprietor, partner, family farmer, orself-employed professional,should provide the information requested on this statement concerning allsuch activities as well asthe individual's personal affairs. To indicate payments, transfers and the like to minor children, state the child's initials and the name and address of the child's parent or guardian,such as "A.B., a minor child, by John Doe, guardian." Do not disclose the child's name. See, 11 U.S.C. §112 and Fed. R. Bankr. P. 1007(m). Questions 1 - 18 are to be completed by all debtors. Debtors that are or have been in business, as defined below, also must complete Questions 19 - 25. If the answer to an applicable question is "None," mark the box labeled "None." If additional space is needed for the answer to any question, use and attach a separate sheet properly identified with the case name, case number (if known), and the number of the question. DEFINITIONS "In business." A debtor is "in business" for the purpose of this form if the debtor is a corporation or partnership. An individual debtor is "in business" for the purpose of this form if the debtor is or has been, within six years immediately preceding the filing of this bankruptcy case, any of the following: an officer, director, managing executive, or owner of 5 percent or more of the voting or equity securities of a corporation; a partner, other than a limited partner, of a partnership; a sole proprietor or self-employed full-time or part-time. An individual debtor also may be “in business” for the purpose of this formifthe debtor engages in a trade, business, or other activity, other than as an employee, to supplement income from the debtor’s primary employment. "Insider." The term "insider" includes but is not limited to: relatives of the debtor; general partners of the debtor and their relatives; corporations of which the debtor is an officer, director, or person in control; officers, directors, and any owner of 5 percent or more of the voting or equity securities of a corporate debtor and their relatives; affiliates of the debtor and insiders of such affiliates; any managing agent of the debtor. 11 U.S.C. § 101.

United States Bankruptcy Court

Northern District of Illinois

STATEMENT OF FINANCIAL AFFAIRS

Ortiz, Robert Brian 7

1. Income from employment or operation of business None State the gross amount of income the debtor has received from employment, trade, or profession, or from operation of the debtor's business, including part-time activities either as an employee or in independent trade or business, from the beginning of this calendar year to the date this case was commenced. State also the gross amounts received during the two years immediately preceding this calendar year. (A debtor that maintains, or has maintained, financial records on the basis of a fiscal rather than a calendar year may report fiscal year income. Identify the beginning and ending dates of the debtor's fiscal year.) If a joint petition is filed, state income for each spouse separately. (Married debtors filing under chapter 12 or chapter 13 must state income of both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.) AMOUNT SOURCE 31,184.00 Real estate agent-2007 26,062.00 Real estate agent-2008 2. Income other than from employment or operation of business None State the amount of income received by the debtor other than from employment, trade, profession, operation of the debtor’s business during the two years immediately preceding the commencement of this case. Give particulars. If a joint petition is filed, state income for each spouse separately. (Married debtors filing under chapter 12 or chapter 13 must state income for each spouse whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.)  ̧

3. Payments to creditors Complete a. or b., as appropriate, and c. None a. Individual or joint debtor(s) with primarily consumer debts: List all payments on loans, installment purchases of goods or services, and other debts to any creditor made within 90 days immediately preceding the commencement of this case unless the aggregate value of all property that constitutes or is affected by such transfer is less than $600. Indicate with an asterisk (*) any payments that were made to a creditor on account of a domestic support obligation or as part of an alternative repayment schedule under a plan by an approved nonprofit budgeting and credit counseling agency. (Married debtorsfiling under chapter 12 or chapter 13 must include payments by either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.)

 ̧

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© 1993-2009 EZ-Filing, Inc. [1-800-998-2424] - Forms Software Only None b. Debtor whose debts are not primarily consumer debts: List each payment or other transfer to any creditor made within 90 days immediately preceding the commencement of the case unless the aggregate value of all property that constitutes or is affected by such transfer is less than $5,475. If the debtor is an individual, indicate with an asterisk (*) any payments that were made to a creditor on account of a domestic support obligation or as part of an alternative repaymentschedule under a plan by an approved nonprofit budgeting and credit counseling agency. (Married debtors filing under chapter 12 or chapter 13 must include payments and other transfers by either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.)

 ̧

None c. All debtors: List all payments made within one year immediately preceding the commencement of this case to or for the benefit of creditors who are or were insiders. (Married debtors filing under chapter 12 or chapter 13 must include payments by either or both spouses whether or not  ̧ a joint petition is filed, unless the spouses are separated and a joint petition is not filed.) 4. Suits and administrative proceedings, executions, garnishments and attachments None a. List all suits and administrative proceedings to which the debtor is or was a party within one year immediately preceding the filing of this bankruptcy case. (Married debtors filing under chapter 12 or chapter 13 must include information concerning either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.) CAPTION OF SUIT COURT OR AGENCY STATUS OR AND CASE NUMBER NATURE OF PROCEEDING AND LOCATION DISPOSITION First National Bank of Omaha V. Collection Daley Center Chicago, IL Judgment entered Robert Brian Ortiz 08 M1 against me May 5, 2009 180180

Carolina Ortiz V. Robert Brian Divorce case Daley Center/ 50 W. Washington Pending Ortiz 06 D 269 St.; Chicago, IL Debtor and his wife have been separated since October 2005 and are living in separate households.

None b. Describe all property that has been attached, garnished or seized under any legal or equitable process within one year immediately preceding the commencement of this case. (Married debtors filing under chapter 12 or chapter 13 must include information concerning property of either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.)  ̧

5. Repossessions, foreclosures and returns None List all property that has been repossessed by a creditor, sold at a foreclosure sale, transferred through a deed in lieu of foreclosure or returned to the seller, within one year immediately preceding the commencement of this case. (Married debtors filing under chapter 12 or chapter 13 must include information concerning property of either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.)  ̧

6. Assignments and receiverships None a. Describe any assignment of property for the benefit of creditors made within 120 days immediately preceding the commencement of this case. (Married debtorsfiling under chapter 12 or chapter 13 must include any assignment by either or both spouses whether or not a joint petition isfiled, unless the spouses are separated and joint petition is not filed.)  ̧

None b. List all property which has been in the hands of a custodian, receiver, or court-appointed official within one year immediately preceding the commencement ofthis case. (Married debtorsfiling under chapter 12 or chapter 13 must include information concerning property of either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.)  ̧

7. Gifts None List all gifts or charitable contributions made within one year immediately preceding the commencement of this case except ordinary and usual gifts to family members aggregating lessthan $200 in value per individual family member and charitable contributions aggregating less than $100 per recipient. (Married debtors filing under chapter 12 or chapter 13 must include gifts or contributions by either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.)  ̧

8. Losses None List all losses from fire, theft, other casualty or gambling within one year immediately preceding the commencement of this case or since the commencement of this case. (Married debtors filing under chapter 12 or chapter 13 must include losses by either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.)  ̧

9. Payments related to debt counseling or bankruptcy None List all payments made or property transferred by or on behalf of the debtor to any persons, including attorneys, for consultation concerning debt consolidation, relief under bankruptcy law or preparation of a petition in bankruptcy within one year immediately preceding the commencement of this case. DATE OF PAYMENT, NAME OF AMOUNT OF MONEY OR DESCRIPTION NAME AND ADDRESS OF PAYEE PAYOR IF OTHER THAN DEBTOR AND VALUE OF PROPERTY Gershon S. Kulek October 2009 900.00

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Chicago, IL 60602

Attorney's fees for this case

10. Other transfers None a. List all other property, other than property transferred in the ordinary course of the business or financial affairs of the debtor, transferred either absolutely or as security within two years immediately preceding the commencement of this case. (Married debtors filing under chapter 12 or chapter 13 must include transfers by either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.)  ̧

None b. List all property transferred by the debtor within ten yearsimmediately preceding the commencement ofthis case to a self-settled trust orsimilar  ̧ device of which the debtor is a beneficiary. 11. Closed financial accounts None List all financial accounts and instruments held in the name of the debtor or for the benefit of the debtor which were closed, sold, or otherwise transferred within one year immediately preceding the commencement of this case. Include checking, savings, or other financial accounts, certificates of deposit, or other instruments; shares and share accounts held in banks, credit unions, pension funds, cooperatives, associations, brokerage houses and other financial institutions. (Married debtors filing under chapter 12 or chapter 13 must include information concerning accounts or instruments held by or for either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.)

 ̧

12. Safe deposit boxes None List each safe deposit or other box or depository in which the debtor has or had securities, cash, or other valuables within one year immediately preceding the commencement of this case. (Married debtors filing under chapter 12 or chapter 13 must include boxes or depositories of either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.) DATE OF NAMES AND ADDRESS TRANSFER OR NAME AND ADDRESS OF BANK OF THOSE WITH ACCESS DESCRIPTION OF SURRENDER, IF OR OTHER DEPOSITORY TO BOX OR DEPOSITORY CONTENTS ANY Chase Bank Nothing in it 1825 W. Lawrence Ave.

Chicago, IL 60640

Received this for free from Chase Bank. I never put anything it.

13. Setoffs None List all setoffs made by any creditor, including a bank, against a debt or deposit of the debtor within 90 days preceding the commencement of this case. (Married debtors filing under chapter 12 or chapter 13 must include information concerning either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.)  ̧

14. Property held for another person None List all property owned by another person that the debtor holds or controls.  ̧

15. Prior address of debtor None If debtor has moved within three yearsimmediately preceding the commencement of this case, list all premises which the debtor occupied during  ̧ that period and vacated prior to the commencement of this case. If a joint petition is filed, report also any separate address of either spouse. 16. Spouses and Former Spouses None Ifthe debtorresides orresided in a communitypropertystate, commonwealth, orterritory (includingAlaska, Arizona,California,Idaho, Louisiana, Nevada, New Mexico, Puerto Rico, Texas, Washington, or Wisconsin) within eight yearsimmediately preceding the commencement of the case,  ̧ identify the name of the debtor’s spouse and of any former spouse who resides or resided with the debtor in the community property state.

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© 1993-2009 EZ-Filing, Inc. [1-800-998-2424] - Forms Software Only 17. Environmental Information For the purpose of this question, the following definitions apply: “EnvironmentalLaw”means any federal,state, orlocalstatute orregulation regulating pollution, contamination,releases of hazardous ortoxic substances, wastes or material into the air, land, soil, surface water, groundwater, or other medium, including, but not limited to, statutes or regulations regulating the cleanup of these substances, wastes or material. “Site” means any location, facility, or property as defined under any Environmental Law, whether or not presently or formerly owned or operated by the debtor, including, but not limited to, disposal sites. “Hazardous Material” means anything defined as a hazardous waste, hazardoussubstance, toxic substance, hazardous material, pollutant, or contaminant or similar term under an Environmental Law. None a. List the name and address of every site for which the debtor has received notice in writing by a governmental unit that it may be liable or potentially liable under or in violation of an Environmental Law. Indicate the governmental unit, the date of the notice, and, if known, the Environmental Law.  ̧

None b. List the name and address of every site for which the debtor provided notice to a governmental unit of a release of Hazardous Material. Indicate  ̧ the governmental unit to which the notice was sent and the date of the notice. None c. List all judicial or administrative proceedings, including settlements or orders, under any Environmental Law with respect to which the debtor  ̧ is or was a party. Indicate the name and address of the governmental unit that is or was a party to the proceeding, and the docket number. 18. Nature, location and name of business None a. If the debtoris an individual, list the names, addresses, taxpayer identification numbers, nature ofthe businesses, and beginning and ending dates of all businesses in which the debtor was an officer, director, partner, or managing executive of a corporation, partner in a partnership, sole proprietor, or was self-employed in a trade, profession, or other activity either full- or part-time within six years immediately preceding the commencement of this case, or in which the debtor owned 5 percent or more of the voting or equity securities within six years immediately preceding the commencement of this case. If the debtoris a partnership, list the names, addresses, taxpayer identification numbers, nature of the businesses, and beginning and ending dates of all businesses in which the debtor was a partner or owned 5 percent or more of the voting or equity securities, within six years immediately preceding the commencement of this case. If the debtor is a corporation, list the names, addresses, taxpayer identification numbers, nature of the businesses, and beginning and ending dates of all businesses in which the debtor was a partner or owned 5 percent or more of the voting or equity securities within six years immediately preceding the commencement of this case.

 ̧

None b. Identify any business listed in response to subdivision a., above, that is “single asset real estate” as defined in 11 U.S.C. § 101.  ̧

[If completed by an individual or individual and spouse] I declare under penalty of perjury that I have read the answers contained in the foregoing statement of financial affairs and any attachments thereto and that they are true and correct.

Date: Signature of Debtor Date: Signature of Joint Debtor (if any)

January 8, 2010 /s/ Robert Brian Ortiz Robert Brian Ortiz

continuation pages attached

Penalty for making a false statement: Fine of up to $500,000 or imprisonment for up to 5 years or both. 18 U.S.C. § 152 and 3571.

 0

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© 1993-2009 EZ-Filing, Inc. [1-800-998-2424] - Forms Software Only B8 (Official Form 8) (12/08)

IN RE: Case No.

Debtor(s) Chapter

PART A – Debts secured by property of the estate. (Part A must be fully completed for EACH debt which is secured by property of the estate. Attach additional pages if necessary.) Property No. 1 Creditor’s Name: Describe Property Securing Debt:

Property will be (check one): Surrendered Retained If retaining the property, I intend to (check at least one): Redeem the property Reaffirm the debt Other. Explain (for example, avoid lien using 11 U.S.C. § 522(f)). Property is (check one): Claimed as exempt Not claimed as exempt Property No. 2 (if necessary) Creditor’s Name: Describe Property Securing Debt:

Property will be (check one): Surrendered Retained If retaining the property, I intend to (check at least one): Redeem the property Reaffirm the debt Other. Explain (for example, avoid lien using 11 U.S.C. § 522(f)). Property is (check one): Claimed as exempt Not claimed as exempt PART B – Personal property subject to unexpired leases. (All three columns of Part B must be completed for each unexpired lease. Attach additional pages if necessary.) Property No. 1 Lessor’s Name: Describe Leased Property: Lease will be assumed pursuant to 11 U.S.C. § 365(p)(2): Yes No Property No. 2 (if necessary) Lessor’s Name: Describe Leased Property: Lease will be assumed pursuant to 11 U.S.C. § 365(p)(2): Yes No continuation sheets attached (if any) I declare under penalty of perjury that the above indicates my intention as to any property of my estate securing a debt and/or personal property subject to an unexpired lease. Date: Signature of Debtor

Signature of Joint Debtor

United States Bankruptcy Court

Northern District of Illinois

CHAPTER 7 INDIVIDUAL DEBTOR'S STATEMENT OF INTENTION

Ortiz, Robert Brian 7

Chase Manhattan Mortgage Residential condominium-4620 N. Beacon Street; #1N, Chicago, IL

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Robert & Sandra Ortiz Residential condominium-4620 N. Beacon Street; #1N, Chicago, IL

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January 8, 2010 /s/ Robert Brian Ortiz

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© 1993-2009 EZ-Filing, Inc. [1-800-998-2424] - Forms Software Only

United States Bankruptcy Court

IN RE: Case No.

Debtor(s) Chapter

Number of Creditors The above-named Debtor(s) hereby verifies that the list of creditors is true and correct to the best of my (our) knowledge.

Date: Debtor

Joint Debtor

Northern District of Illinois

VERIFICATION OF CREDITOR MATRIX

Ortiz, Robert Brian 7

 16

January 8, 2010 /s/ Robert Brian Ortiz

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Ortiz, Robert Brian

4620 N. Beacon

#1N

Chicago, IL 60640

Gershon Kulek, Attorney

180 W. Washington St; 4th Floor

Chicago, IL 60602

1st National Bank Of Omaha

P.O. Box 3412

Omaha, NE 68103

Bank Of America

P.O. Box 17054

Wilmington, DE 19850

Chase Manhattan Mortgage

3415 Vision Dr.

Columbus, OH 43219

First National Bank Of Omaha

P.O. Box 3331

Omaha, NE 68103-0331

Illinois Department Of Revenue

101 W. Jefferson St.

Springfield, IL 62702

Illinois Tollway

P.O. Box 5201

Lisle, IL 60532-5201

Internal Revenue Service

U.S. Dept. Of The Treasury

Cincinnati, OH 45999-0030

Landvoice

P.O. Box 511140

SLC, UT 84151-1140

Principal Life Insurance Co.

C/O Receivable Management Services

55 Shuman Rd.; P.O. Box 3100

Naperville, IL 60566-7099

Quest Diagnostics, Inc.

C/O American Medical Collection Agency

2269 S. Saw Mill River Rd.; Building 3

Elmsford, NY 10523

Robert & Sandra Ortiz

3747 N.E. Crystal Waters Lane

Grand Rapids, MI 49525

Rush University Medical Group

75 Remittance Drive; Dept. 1620

Chicago, IL 60675-1620

Stephen M. Komie

Komie & Associates

1 N. LaSalle St.; #4200

Chicago, IL 60602

Vyridian Revenue Management

Nationwide Credit & Collection, Inc.

9919 Roosevelt Rd.

Westchester, IL 60154

William H. Hunter, Attorney At Law

29 S. LaSalle St.; Suite 950

Chicago, IL 60603

Zabrin Inan, M.D.

1000 Lake Shore Dr.; Suite 308

Chicago, IL 60611-1311

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