Official Form 1 (1/08) Case #: 10 B 

United States Bankruptcy Court Voluntary Petition

NORTHERN DISTRICT OF ILLINOIS

Name of Debtor (if individual, enter Last, First, Middle):

All Other Names used by the Debtor in the last 8 years

(include married, maiden, and trade names):

NONE

Last four digits of Soc. Sec. or Indvidual-Taxpayer I.D. (ITIN) No./Complete EIN

(if more than one, state all): 6213

Street Address of Debtor (No. & Street, City, and State):

3711 Harms Road

Joliet IL

County of Residence or of the

Principal Place of Business: Will

Mailing Address of Debtor (if different from street address):

Location of Principal Assets of Business Debtor

(if different from street address above):

Name of Joint Debtor (Spouse)(Last, First, Middle):

All Other Names used by the Joint Debtor in the last 8 years

Last four digits of Soc. Sec. or Indvidual-Taxpayer I.D. (ITIN) No./Complete EIN

Street Address of Joint Debtor

Mailing Address of Joint Debtor

(include married, maiden, and trade names):

(if more than one, state all):

(No. & Street, City, and State):

County of Residence or of the

Principal Place of Business:

(if different from street address):

SAME

NOT APPLICABLE

Smith, Joanne 

ZIPCODE

ZIPCODE

60435

ZIPCODE

ZIPCODE

ZIPCODE

Railroad

Stockbroker

Commodity Broker

Other (if debtor is not one of the above

Partnership Chapter 13

Chapter 12 Chapter 15 Petition for Recognition

Chapter 9

Chapter 11

Chapter 7

Chapter of Bankruptcy Code Under Which 

the Petition is Filed (Check one box)

Nature of Debts

Filing Fee (Check one box)

(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.

Chapter 11 Debtors:

Check one box:

Debtor is not a small business debtor as defined in 11 U.S.C. § 101(51D).

Debtor is a small business as defined in 11 U.S.C. § 101(51D).

Debtor’s aggregate noncontingent liquidated debts (excluding debts

owed to insiders or affiliates) are less than $2,190,000.

Clearing Bank

entities, check this box and state type of

entity below

of a Foreign Nonmain Proceeding

Filing Fee waiver requested (applicable to chapter 7 individuals only). Must

attach signed application for the court's consideration. See Offi cial Form 3B.

Nature of Business

(Check

Health Care Business

Single Asset Real Estate as defined

in 11 U.S.C. § 101 (51B)

(Form of organization)

Corporation (includes LLC and LLP)

Individual (includes Joint Debtors)

Type of Debtor

(Check

Chapter 15 Petition for Recognition

of a Foreign Main Proceeding

Check if:

 one box.)

 one box.)

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).

Debts are primarily consumer debts, defined

in 11 U.S.C. § 101(8) as "incurred by an

individual primarily for a personal, family,

Debts are primarily

business debts.

or household purpose"

See Exhibit D on page 2 of this form.

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).

-- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --

Statistical/Administrative Information THIS SPACE IS FOR COURT USE ONLY

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.

Estimated Number of Creditors

Estimated Assets

Estimated Liabilities

100,000

100-199

5,000

200-999

10,000 25,000 50,000 100,000

1-49 50-99 1,000- 5,001- 10,001- 25,001- 50,001- Over

$1,000,001

to $10

million

$500,001

to $1

million

$0 to

$50,000

$50,001 to

$100,000

$100,001 to

$500,000

$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

$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

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Joanne Smith

FORM B6A (Official Form 6A) (12/07)

In re

Debtor(s)

Case No. 10 B 

(if known)

SCHEDULE A-REAL PROPERTY

,

Do not include interests in executory contracts and unexpired leases on this schedule. List them in Schedule G-Executory

Contracts and Unexpired Leases.

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.”

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--H

Wife--W

Joint--J

Community--C

Current

Value

of Debtor's Interest,

in Property Without

Deducting any

Secured Claim or

Exemption

Amount of

Secured Claim

Residence

3711 Harms Road

Joliet, IL 60435

Fee Simple $ 163,000.00 $ 163,000.00

No continuation sheets attached TOTAL $

(Report also on Summary of Schedules.)

163,000.00

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B6B (Official Form 6B) (12/07)

In re Joanne Smith

Debtor(s)

SCHEDULE B-PERSONAL PROPERTY

Case No.

(if known)

10 B ,

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.

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).

Do not list interests in executory contracts and unexpired leases on this schedule. List them in Schedule G-Executory Contracts

and Unexpired Leases.

Description and Location of Property

Husband--H

Wife--W

Joint--J

Community--C

Type of Property

Current

Value

of Debtor's Interest,

in Property Without

Deducting any

Exemption

Secured Claim or

N

o

n

e

1. Cash on hand. X

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 - National City Bank

Location: In debtor's possession

$ 800.00

3. Security deposits with public utilities,

telephone companies, landlords, and

others.

X

4. Household goods and furnishings,

including audio, video, and computer

equipment.

Miscellaneous Household Furnishings

Location: In debtor's possession

$ 1,500.00

5. Books, pictures and other art objects,

antiques, stamp, coin, record, tape,

compact disc, and other collections or

collectibles.

X

6. Wearing apparel. Miscellaneous Wearing Apparel

Location: In debtor's possession

$ 800.00

7. Furs and jewelry. X

8. Firearms and sports, photographic, and

other hobby equipment.

X

9. Interests in insurance policies. Name

insurance company of each policy and

itemize surrender or refund value of each.

Life Insurance - through employment

Location: In debtor's possession

NO SURRENDER

VALUE

10. Annuities. Itemize and name each issuer. X

11. Interest 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

Page 1 of 3

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B6B (Official Form 6B) (12/07)

In re Joanne Smith

Debtor(s)

SCHEDULE B-PERSONAL PROPERTY

Case No.

(if known)

10 B ,

(Continuation Sheet)

Description and Location of Property

Husband--H

Wife--W

Joint--J

Community--C

Type of Property

Current

Value

of Debtor's Interest,

in Property Without

Deducting any

Exemption

Secured Claim or

N

o

n

e

12. Interests in IRA, ERISA, Keogh, or other

pension or profit sharing plans. Give

particulars.

IMRF Pension

Location: In debtor's employer's possession

$ 1,000.00

13. Stock and interests in incorporated and

unincorporated businesses. Itemize.

X

14. Interests in partnerships or joint ventures.

Itemize.

X

15. Government and corporate bonds and

other negotiable and non-negotiable

instruments.

X

16. Accounts Receivable. X

17. Alimony, maintenance, support, and

property settlements to 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 interests, life estates,

and rights or powers exercisable for the

benefit of the debtor other than those

listed in Schedule of Real Property.

X

20. Contingent and non-contingent 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 described 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.

2005 Hyundai Tucson

Location: In debtor's possession

$ 7,000.00

26. Boats, motors, and accessories. X

27. Aircraft and accessories. X

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B6B (Official Form 6B) (12/07)

In re Joanne Smith

Debtor(s)

SCHEDULE B-PERSONAL PROPERTY

Case No.

(if known)

10 B ,

(Continuation Sheet)

Description and Location of Property

Husband--H

Wife--W

Joint--J

Community--C

Type of Property

Current

Value

of Debtor's Interest,

in Property Without

Deducting any

Exemption

Secured Claim or

N

o

n

e

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

35. Other personal property of any kind not

already listed. Itemize.

X

Page 3 of 3

(Report total also on Summary of Schedules.)

Total $ 11,100.00

Include amounts from any continuation sheets attached.

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B6C (Official Form 6C) (12/07)

In re

Joanne Smith

Debtor(s)

SCHEDULE C-PROPERTY CLAIMED AS EXEMPT

Case No.

(if known)

10 B ,

Debtor claims the exemptions to which debtor is entitled under:

(Check one box)

11 U.S.C. § 522(b) (2)

11 U.S.C. § 522(b) (3)

Check if debtor claims a homestead exemption that exceeds $136,875.

Description of Property Providing each

Current

Value of Property

Exemption

Specify Law

Without Deducting

Exemptions

Value of

Claimed

Exemption

Residence 735 ILCS 5/12-901 $ 15,000.00 $ 163,000.00

Checking Account 735 ILCS 5/12-1001(b) $ 800.00 $ 800.00

Miscellaneous Household

Furnishings

735 ILCS 5/12-1001(b) $ 1,500.00 $ 1,500.00

Miscellaneous Wearing Apparel 735 ILCS 5/12-1001(a) $ 800.00 $ 800.00

Life Insurance 735 ILCS 5/12-1001(f) NO SURRENDER

VALUE

100%

IMRF Pension 735 ILCS 5/12-1006 $ 1,000.00 $ 1,000.00

2005 Hyundai Tucson 735 ILCS 5/12-1001(c) $ 2,400.00 $ 7,000.00

Page No. 1 of 1

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Case No. 10 B 

(if known)

SCHEDULE D - CREDITORS HOLDING SECURED CLAIMS

In reJoanne Smith ,

B6D (Official Form 6D) (12/07)

Debtor(s)

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 all secured 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

Check this box if debtor has no creditors holding secured claims to report on this Schedule D.

Creditor's Name and

Mailing Address

H--Husband

W--Wife

J--Joint

C--Community

Date Claim was Incurred, Nature

of Lien, and Description and Market

Value of Property Subject to Lien

Amount of Claim

Without

Deducting Value

of Collateral

Unsecured

Portion, If Any

Including ZIP Code and

Account Number

(See Instructions Above.)

Co-DebtorContingentUnliquidatedDisputed

2005 Hyundai Tucson

Account No:

Creditor # :

Value:

1 Auto Loan

$ 7,000.00

20041001496026 $ 9,045.00 $ 2,045.00

Hyundai Motor Finance Co.

PO Box 20829

Fountain Valley CA 92728-0829

Account No:

Creditor # :

Value:

2 Notice Only

$ 163,000.00

3002557704 $ 0.00 $ 0.00

IndyMac Mortgage

PO Box 78821

Phoenix AZ 85062-8826

Account No:

Creditor # :

Value:

3 First Mortgage

$ 163,000.00

09 CH 3619 $ 183,000.00 $ 20,000.00

One West Bank, FSB

c/o Codilis & Assoc

15W030 W Frontage Rd, Ste 100

Burr Ridge IL 60527

No continuation sheets attached

(Use only on last page)

Total $

(Total of this page)

Subtotal $ $ 192,045.00

$ 192,045.00

$ 22,045.00

$ 22,045.00

(Report also on Summary of

Schedules.)

(If applicable, report also on

Statistical Summary of

Certain Liabilities and

Related Data)

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B6E (Official Form 6E) (12/07)

Case No. 10 B 

(if known)

SCHEDULE E - CREDITORS HOLDING UNSECURED PRIORITY CLAIMS

In re Joanne Smith ,

Debtor(s)

 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 "Total" 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, 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).

Wages, salaries, and commissions

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 FDIC, RTC, Director of the Office of Thrift Supervision, Comptroller of the Currency, or Board of Governors of

the Federal Reserve System, or their predecessors or successors, 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.

No continuation sheets attached

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Case No. 10 B 

(if known)

SCHEDULE F - CREDITORS HOLDING UNSECURED NONPRIORITY CLAIMS 

In re Joanne Smith ,

B6F (Official Form 6F) (12/07) 

Debtor(s)

 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 total of all claims listed on this schedule in the box labeled "Total" on the last sheet of the completed schedules. Report this total also on

Check this box if debtor has no creditors holding unsecured claims to report on this Schedule F.

Creditor's Name, Mailing Address

including Zip Code,

H--Husband

W--Wife

J--Joint

C--Community

Date Claim was Incurred,

and Consideration for Claim.

If Claim is Subject to Setoff, so State.

Amount of Claim

And Account Number

(See instructions above.)

Co-Debtor

ContingentUnliquidatedDisputed

Account No:

Creditor # : 1

AT & T

c/o CCA

700 Longwater Drive

Norwell MA 02061

Telephone Bill

XX3585 $ 156.00

Account No:

Creditor # : 2

Capital One Bank

PO Box 85520

Richmond VA 23285

Credit Card Purchases

5178-0525-0715-3803 $ 1,768.00

Account No:

Creditor # : 3

Car Max Auto Finance

225 Chastain Meadows Court

Kennesaw GA 30144

Deficiency Amount

XX1661 $ 900.00

Account No:

Creditor # : 4

Citgo Mastercard

PO Box 142319

Irving TX 75014-2319

Credit Card Purchases

5419-3100-2159-9938 $ 370.00

2 continuation sheets attached

(Use only on last page of the completed Schedule F. Report also on Summary of

Schedules and, if applicable, on the Statistical Summary of Certain Liabilities and Related

Total $

Subtotal $ $ 3,194.00

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 Document Page 16 of 31
Case No. 10 B 

(if known)

SCHEDULE F - CREDITORS HOLDING UNSECURED NONPRIORITY CLAIMS 

In re Joanne Smith ,

B6F (Official Form 6F) (12/07) - Cont.

Debtor(s)

(Continuation Sheet)

Creditor's Name, Mailing Address

including Zip Code,

H--Husband

W--Wife

J--Joint

C--Community

Date Claim was Incurred,

and Consideration for Claim.

If Claim is Subject to Setoff, so State.

Amount of Claim

And Account Number

(See instructions above.)

Co-Debtor

ContingentUnliquidatedDisputed

Account No:

Creditor # : 5

Dress Barn

c/o WFNNB

PO Box 182273

Columbus OH 43218

Credit Card Purchases

5856-3724-3001-8173 $ 30.00

Account No:

Creditor # : 6

GEMB/ASA

PO Box 981439

El Paso TX 79998

Credit Card Purchases

6019-1800-3642-4535 $ 405.00

Account No:

Creditor # : 7

Goodyear

PO Box 6497

Sioux Falls SD 57117

Credit Card Purchases

6035-5101-2900-8227 $ 65.00

Account No:

Creditor # : 8

ITT Education Services

c/o NCO Financial

PO Box 15636

Wilmington DE 19850

Tuition Bill

8B1QK3 $ 3,868.00

Account No:

Creditor # : 9

JC Penny's

PO Box 981131

El Paso TX 79998

Credit Card Purchases

249-013-195-6 $ 150.00

Account No:

Creditor # : 10

Menards

c/o HSBC

PO Box 15521

Wilmington DE 19850-5521

Credit Card Purchases

6004-3001-0902-7976 $ 1,939.00

1

Creditors Holding Unsecured Nonpriority Claims

Sheet No. of 2 continuation sheets attached to Schedule of 

(Use only on last page of the completed Schedule F. Report also on Summary of

Schedules and, if applicable, on the Statistical Summary of Certain Liabilities and Related

Total $

Subtotal $ $ 6,457.00

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 Document Page 17 of 31
Case No. 10 B 

(if known)

SCHEDULE F - CREDITORS HOLDING UNSECURED NONPRIORITY CLAIMS 

In re Joanne Smith ,

B6F (Official Form 6F) (12/07) - Cont.

Debtor(s)

(Continuation Sheet)

Creditor's Name, Mailing Address

including Zip Code,

H--Husband

W--Wife

J--Joint

C--Community

Date Claim was Incurred,

and Consideration for Claim.

If Claim is Subject to Setoff, so State.

Amount of Claim

And Account Number

(See instructions above.)

Co-Debtor

ContingentUnliquidatedDisputed

Account No:

Creditor # : 11

Sallie Mae

PO Box 9500

Wilkes Barre PA 18773

Student Loan

9744269556-1 $ 11,244.00

Account No:

Creditor # : 12

Sallie Mae

PO Box 9500

Wilkes Barre PA 18773

Student Loan

XXX0905 $ 8,474.00

Account No:

Creditor # : 13

Sears Credit Card

PO Box 6283

Sioux Falls SD 57117-6283

Credit Card Purchases

5049-9401-3107-0806 $ 20.00

Account No:

Creditor # : 14

Sears/CBSD

701 E 60th Street, N

Sioux Falls SD 57117

Credit Card Purchases

5049-9410-4755-6003 $ 475.00

Account No:

Creditor # : 15

Target NB

PO Box 59317

Minneapolis MN 55359-0317

Credit Card Purchases

XXX4968 $ 693.00

Account No:

Creditor # : 16

The Home Depot

PO Box 6891000

Des Moines IA 50368-9100

Credit Card Purchases

6035-3202-5075-4999 $ 162.00

$ 30,719.00

2

Creditors Holding Unsecured Nonpriority Claims

Sheet No. of 2 continuation sheets attached to Schedule of 

(Use only on last page of the completed Schedule F. Report also on Summary of

Schedules and, if applicable, on the Statistical Summary of Certain Liabilities and Related

Total $

Subtotal $ $ 21,068.00

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 Document Page 18 of 31
B6G (Official Form 6G) (12/07)

In re Joanne Smith / Debtor

SCHEDULE G-EXECUTORY CONTRACTS AND UNEXPIRED LEASES

Case No.

(if known)

10 B 

Describe all executory contracts of any nature and all unexpired leases of real or personal property. Include any timeshare interests. State the nature of

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, 

Check this box if the debtor has no executory contracts or unexpired leases.

debtor's interests 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

11 U.S.C. §112 and Fed. R. Bankr. P. 1007(m).

Including Zip Code, of

Description of Contract or Lease and

Nature of Debtor's Interest.

Other Parties to Lease

Name and Mailing Address,

State whether Lease is for Nonresidential Real Property.

or Contract. State Contract Number of any Government Contract.

Page 1 of 1

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 Document Page 19 of 31
B6H (Official Form 6H) (12/07)

In re Joanne Smith / Debtor

SCHEDULE H-CODEBTORS

Case No.

(if known)

10 B 

Check this box if the debtor has no codebtors.

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 preeceding the commencement of the case, identify the name of the debtors 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).

Name and Address of Codebtor Name and Address of Creditor

Page 1 of 1

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 Document Page 20 of 31
B6I (Official Form 6I) (12/07)

In re Joanne Smith , Case No. 10 B 

Debtor(s) (if known)

SCHEDULE I - CURRENT INCOME OF INDIVIDUAL DEBTOR(S)

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 Form 22A, 22B, or 22C.

Debtor's Marital 

Status:

DEPENDENTS OF DEBTOR AND SPOUSE

RELATIONSHIP(S): AGE(S):

Single

EMPLOYMENT: DEBTOR SPOUSE

Occupation

Name of Employer

How Long Employed

Address of Employer

6 months

Will County

Administrative Work

302 N. Chicago St.

Joliet IL 60432

INCOME: (Estimate of average or projected monthly income at time case filed) DEBTOR SPOUSE

3,242.00

1. Monthly gross wages, salary, and commissions (Prorate if not paid monthly) $

2. Estimate monthly overtime

3. SUBTOTAL

$

$ $

$

$

4. LESS PAYROLL DEDUCTIONS

a. Payroll taxes and social security

b. Insurance

c. Union dues

$

$

$

$

$

$

3,242.00

0.00

0.00

0.00

0.00

547.00

33.00

39.00

0.00

0.00

0.00

d. Other (Specify): IMRF $ 146.00 $ 0.00

5. SUBTOTAL OF PAYROLL DEDUCTIONS

6. TOTAL NET MONTHLY TAKE HOME PAY

$

$

$

$

765.00

2,477.00 0.00

0.00

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 government assistance

$

$

$

$

$

$

$ $

(Specify): $ $

12. Pension or retirement income

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

0.00 0.00

$ 0.00 $ 0.00

(Specify): $ 0.00 $ 0.00

13. Other monthly income

16. COMBINED AVERAGE MONTHLY INCOME:

(Report also on Summary of Schedules and, if applicable, on

Statistical Summary of Certain Liabilities and Related Data)

15. AVERAGE MONTHLY INCOME 

2,477.00

(Add amounts shown on lines 6 and 14) $ 2,477.00 $ 0.00

14. SUBTOTAL OF LINES 7 THROUGH 13 $ 0.00 $ 0.00

(Combine column totals

from line 15; if there is only one debtor repeat total reported on line 15)

$

17. Describe any increase or decrease in income reasonably anticipated to occur within the year following the filing of this document:

Page No. 1 of 1

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 Document Page 21 of 31
B6J(Official Form 6J)(12/07)

Case No.

(if known)

SCHEDULE J-CURRENT EXPENDITURES OF INDIVIDUAL DEBTOR

In re Joanne Smith , 10 B 

Debtor(s)

 Complete this schedule by estimating the average or projected monthly expenses of the debtor and the debtor's family. Prorate any payments

made bi-weekly, 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 Form 22 A 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?

b. Is property insurance included?

$

$

2. Utilities: a. Electricity and heating fuel

b. Water and sewer

c. Telephone

d. Other

$

$

$

957.00

150.00

50.00

100.00

0.00

$ 0.00

Yes

Yes

No

No

 Other

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

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

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

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

3. Home maintenance (repairs and upkeep)

4. Food

5. Clothing

7. Medical and dental expenses

6. Laundry and dry cleaning

9. Recreation, clubs and entertainment, newspapers, magazines, etc. 

8. Transportation (not including car payments)

10. Charitable contributions

a. Homeowner's or renter's

11. Insurance (not deducted from wages or included in home mortgage payments)

b. Life

c. Health

d. Auto

e. Other

 Other

$ 0.00

$ 250.00

$

$ 10.00

50.00

$ 30.00

$

$ 0.00

120.00

$ 0.00

$ 0.00

$ 0.00

80.00

$ 0.00

$

$ 0.00

$ 0.00

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

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

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

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

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

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

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

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

(Specify) $

13. Installment payments: (In chapter 11, 12, and 13 cases, do not list payments to be included in the plan)

a. Auto $

$

$

316.00

0.00

15.00

0.00

b. Other: Association Dues

c. Other:

Real Estate Taxes

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

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

$ 0.00

$ 0.00

$ 0.00

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:

Other:

$

$

0.00

0.00

0.00

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

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

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

18. AVERAGE MONTHLY EXPENSES Total lines 1-17. Report also on Summary of Schedules $ 2,128.00

19. Describe any increase or decrease in expenditures reasonably anticipated to occur within the year following the filing of this document:

and, if applicable, on the Statistical Summary of Certain Liabilities and Related Data.)

a. Average monthly income from Line 16 of Schedule I

b. Average monthly expenses from Line 18 above

c. Monthly net income (a. minus b.)

20. STATEMENT OF MONTHLY NET INCOME

$ 2,477.00

$

$

2,128.00

349.00

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 Document Page 22 of 31
B6 Declaration (Official Form 6 - Declaration) (12/07) 

Case No.

UNITED STATES BANKRUPTCY COURT

In re

/ Debtor

Joanne Smith 10 B 

NORTHERN DISTRICT OF ILLINOIS

EASTERN DIVISION

Chapter 13

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 must also complete the "Statistical Summary of Certain Liabilities and Related Data"if they

file a case under chapter 7, 11, or 13.

SUMMARY OF SCHEDULES

NAME OF SCHEDULE

Attached

(Yes/No)

No. of

Sheets ASSETS LIABILITIES OTHER

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

1

3

1

1

1

3

1

1

1

1

A-Real Property

B-Personal Property

C-Property Claimed as

Exempt

D-Creditors Holding Secured

Claims

E-Creditors Holding

Unsecured Priority Claims

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)

$ 163,000.00

$ 11,100.00

$ 192,045.00

$ 0.00

$ 30,719.00

$ 2,477.00

$ 2,128.00

(Total of Claims on Schedule E)

TOTAL 14 $ 174,100.00 $ 222,764.00

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 Document Page 23 of 31
B6 Declaration (Official Form 6 - Declaration) (12/07)

NORTHERN DISTRICT OF ILLINOIS

UNITED STATES BANKRUPTCY COURT

In re

/ Debtor

Joanne Smith

Chapter 13

Case No. 10 B 

EASTERN DIVISION

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

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

Type of Liability

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

Amount

$

$

$

$

$

$

0.00

0.00

19,718.00

0.00

0.00

19,718.00

0.00

This information is for statistical purposes only under 28 U.S.C. § 159.

$

chapter 7, 11, or 13, you must report all information requested below.

Summarize the following types of liabilities, as reported in the Schedules, and total them.

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)

$

$

$

2,477.00

2,128.00

3,242.00

1. Total from Schedule D, "UNSECURED PORTION, IF ANY" column $ 22,045.00

State the following:

2. Total from Schedule E, "AMOUNT ENTITLED TO PRIORITY" column $ 0.00

3. Total from Schedule E, "AMOUNT NOT ENTITLED TO PRIORITY, IF ANY" column $ 0.00

4. Total from Schedule F $ 30,719.00

5. Total of non-priority unsecured debt (sum of 1, 3, and 4) $ 52,764.00

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.

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Case 10-01363 Doc 1 Filed 01/15/10 Entered 01/15/10 10:08:12 Desc Main

 Document Page 25 of 31
Form 7 (12/07)

Joanne Smith Case No.

EASTERN DIVISION

NORTHERN DISTRICT OF ILLINOIS

UNITED STATES BANKRUPTCY COURT

In re: 10 B 

STATEMENT OF FINANCIAL AFFAIRS

This statement is to be completed by every debtor. Spouses filing a joint petition may file a single statement on which the information for

both spouses is combined. If the 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, or self-employed professional, should provide the information requested on this statement concerning all such

activities as well as the 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 diclose 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 the 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 my also be "in

business" for the purpose of this form if the 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 corporation debtor and their relatives; affiliates of the debtor and insiders of such affiliates; any managing agent of the

debtor. 11 U.S.C. §101.

1. Income from employment or operation of business

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.)

None

 AMOUNT SOURCE

Year to date: $10,000.00

 Last Year: $32,192.00

Year before: $28,800.00

Gross income from Debtor's employment.

Gross income from Debtor's employment.

Gross income from Debtor's employment.

2. Income other than from employment or operation of business

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.)

None

AMOUNT SOURCE 

Debtor was receiving $311.00 from unemployment up to Aug.

11, 2009.

Statement of Affairs - Page 1

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Form 7 (12/07)

3. Payments to creditors

Complete a. or b., as appropriate, and c.

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 creditor counseling agency. (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.)

None

NAME AND ADDRESS OF CREDITOR DATES OF

PAYMENTS AMOUNT PAID

AMOUNT

STILL OWING

Normal minimal monthly payments

when able.

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 this 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

repayment schedule under a plan by an approved nonprofit budgeting and creditor counseling agency. (Married debtors filingunder 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.)

None

4. Suits and administrative proceedings, executions, garnishments and attachments

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.)

None

CAPTION OF SUIT

AND CASE NUMBER NATURE OF PROCEEDING AND LOCATION STATUS OR DISPOSITION

COURT OR AGENCY 

One West Bank, FSB

v. Joanne Smith, 09

CH 3619

Foreclosure Twelfth Judicial

Circuit, 09 CH 3619

Pending

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.)

None

5. Repossessions, foreclosures and returns

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.)

None

6. Assignments and receiverships

a. Describe any assignment of property for the benefit of creditors made within 120 days immediately preceding the commencement of this case. (Married

debtors filing under chapter 12 or chapter 13 must include any assignment by either or both spouses whether or not a joint petition is filed, unless the

None

Statement of Affairs - Page 2

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Form 7 (12/07)

spouses are separated and a joint petition is not filed.)

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 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.)

None

7. Gifts

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 less than $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.)

None

8. Losses

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.)

None

9. Payments related to debt counseling or bankruptcy

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 the bankruptcy law or preparation of a petition in bankruptcy within one year immediately preceding the commencement of

 this case.

None

NAME AND ADDRESS OF PAYEE

DATE OF PAYMENT,

NAME OF PAYER IF OTHER THAN DEBTOR

AMOUNT OF MONEY OR 

DESCRIPTION AND VALUE OF PROPERTY

Payee: Thomas M. Britt

Address:

7601 W. 191st Street

Suite 1W

Tinley Park, IL 60487

Date of Payment: Oct., 2009

Payor: Joanne Smith

$800.00

Payee: Chestnut Health

Systems

Address: 1003 Martin Luther

King Drive, Bloomington, IL

61701

Date of Payment: Oct., 2009

Payor: Debtor

$45.00

10. Other transfers

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 years immediately preceding the commencement of this case to a self-settled trust or similar device

of which the debtor is a benificiary.

None

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Form 7 (12/07)

11. Closed financial accounts

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.)

None

12. Safe deposit boxes

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.)

None

13. Setoffs

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.)

None

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

If the debtor has moved within three years immediately 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.

None

16. Spouses and Former Spouses

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 eight years 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.

None

17. Environmental Information

For the purpose of this question, the following definitions apply:

"Environmental Law" means any federal, state, or local statute or regulation regulating pollution, contamination, releases of hazardous or toxic 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 hazardous waste, hazardous substance, toxic substance, hazardous material, pollutant, or contaminant or

similar termunder an Environmental Law:

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

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