United States Bankruptcy Court

 Northern District of Illinois

 Name of Individual Debtor: (enter Last, First, Middle): Name of Individual Debtor: (Spouse)( Last, First, Middle): 

 MASSEY, CLAUDIA E.

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

 (include married, maiden, and trade names) (include married, maiden, and trade names) 

CLAUDIA E. DeCICCO, CLAUDIA E. KLINE

,

 Last four digits of Soc. Sec. Complete EIN or other Tax I.D. No. (if Last four digits of Soc. Sec. Complete EIN or other Tax I.D. No. (if 

 more than one , state all): more than one, state all):

8618

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

 626 Justina, Hinsdale, Illinois 60521 

 

 County of Residence or of the Principal Place of Business: DuPage County of Residence or of the Principal Place of Business: 

 

 Mailing Address of debtor if different from street address: 

location of Principal Assets of Business Debtor (if different from street address above):

 Type of Debtor (Form of Organization) Nature of Business Chapter of Bankruptcy Code Under Which

 (Check one box) (Check one box) the Petition is Filed (Check one box)

 [X] Individual (includes joint debtor) [ ] Health Care Business

 [ ] Corporation (includes LLC and LLP) [ ] Single Asset Real Estate as defined in: [X] Chapter 7 [ ] Chapter 11 [ ] Chapter 15 Petition for Recognition

 [ ] Partnership 11 U.S.C. § 101 (51B) [ ] Chapter 9 [ ] Chapter 12 of a Foreign Main Proceeding

 [ ] Other (If debtor is not one of the above [ ] Railroad [ ] Chapter 13 [ ] Chapter 15 Petition for Recognition 

 entities, check this box and provide the [ ] Stockbroker

 information requested below.) [ ] Commodity Broker Nature of Debts (Check one box) 

 [ ]Clearing Bank

 [ ] Other [X] Debts are primarily consumer [ ] Debts are primarily

 debts, defined in 11 U.S.C. business debts.

Tax-Exempt Entity § 101(8) as “incurred by an

[ ] Debtor is a tax-exempt organization individual primarily for a

under Title 26 of the United States personal, family, or houseCode (the Internal Revenue Code hold purpose”

 Filing Fee (Check one box) Chapter 11 Debtors

 [X] Full Filing Fee attached Check one box:

 [ ] Filing Fee to be paid in installments (Applicable to individuals only) [ ] Debtor is a small business debtor as defined in 11 U.S.C. § 101(51D).

 Must attach signed application for the court’s consideration certifying that the debtor is [ ] Debtor is not a small business debtor as defined in 11USC § 101(51D).

 unable to pay fee except in installments. Rule 1006(b). See Official Form 3A. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

 Check if:

 [ ] Filing Fee waiver requested (Applicable to Chapter 7 individuals only). Must attach [ ] Debtor’s aggregate noncontingent liquidated debts owed to 

 signed application for court’s consideration. See Official Form 3B. non-insiders or affiliates are less than $2 million.

 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 THIS SPACE FOR COURT USE ONLY

 [ ] Debtor estimates that funds will be available for distribution to unsecured creditors.

 [X] 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

 1- 50- 100- 200- 1,000- 5,001- 10,001- 25,001- 50,001- OVER

49 99 199 999 5,000 10,000 25,000 50,000 100,000 100,000

[x ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ]

 Estimated Assets

 $0 to $50,001 to $100,001 to $500,001 to $1,000.001 to $10,000,001 to $50,000,001 More than

 $50,000 $100,000 $500,000 $1 million $10 million $50 million $100 million $100 million

 [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ]

 Estimated Debts

 $0 to $50,001 to $100,001 to $500,001 to $1,000.001 to $10,000,001 to $50,000,001 More than

 $50,000 $100,000 $500,000 $1 million $10 million $50 million $100 million $100 million

 [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ]

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 Document Page 1 of 37
Voluntary Petition Name of Debtor(s)

All Prior Bankruptcy Cases Filed Within Last 8 Years (If more than one, attach additional sheet)

Location Case Number: Date Filed:

Where 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 Exhibit B

 (To be completed if debtor is required to file periodic reports (e.g., forms (To be completed if debtor is an individual

 10K and 10Q) with the Securities and Exchange Commission pursuant to whose debts are primarily consumer debts.)

 Section 13 or 15(d) of the Securities Exchange Act of 1934 and is requesting 

 Relief under Chapter 11.) I, the attorney for the petitioner named in the forgoing 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/

[ ] Exhibit A is attached and made a part of this petition.. /s/ Paul C. Sheils

 Paul C. Sheils, Attorney for Debtor(s) Date

Exhibit C

 Does 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 part of this petition 

 

 [X] 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)

[X] Exhibit D completed and signed by the debtor is attached and made a part of this petition.

 If this is a joint petition:

[X] Exhibit D also completed and signed by the joint debtor is attached and made a part of this petition.

Information Regarding the Debtor-Venue

( Check any applicable box)

[X] Debtor has been domiciled or has had a residence, principal place of business, or principal assets in this district for 180 

days immediately 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.

Statement 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 that obtained judgment)

(Address of landlord)

[ ] 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 this petition.

 

 

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 Voluntary Petition 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 States code, understand the relief available under 

each such chapter, and choose to proceed under Chapter 7.

I request relief in accordance with the chapter of Title 11, United states Code, 

Specified in this petition.

/s/ MASSEY, CLAUDIA E.

Signature of Debtor 

Signature of Joint Debtor

Date

 Signature of Attorney

/s/

Signature of Attorney for Debtor

PAUL C. SHEILS

Printed Name of Attorney for Debtor(s)

PAUL C. SHEILS, ATTORNEY

Firm Name

15 SALT CREEK LANE, SUITE 122

Address

HINSDALE, ILLINOIS 60521

(630) 655-1204

Telephone Number

Date

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UNITED STATES BANKRUPTCY COURT

Northern District of Illinois

In re MASSEY, CLAUDIA E. Case No. 

Debtor(s) (if known)

EXHIBIT D – INDIVIDUAL DEBTOR’S STATEMENT OF COMPLIANCE WITH CREDIT COUNSELING REQUIREMENT

Warning: You must be able to check truthfully one of the five statements regarding credit counseling listed below. If you can not 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 person 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.

[X]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 15 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 five days from the time I made my request, and that following exigent circumstances 

merit a temporary waiver of the credit counseling requirement so I can file my bankruptcy case now. [Must be 

accompanied by a motion for determination by the court.] [Summarize exigent circumstances here.] 

If the court is satisfied with the reasons stated in your motion, it will send you an order approving your 

request. You must still obtain the credit counseling briefing within the first 30 days after you file your 

bankruptcy case and promptly file a certificate from the agency that provided the briefing, together with 

a copy of any debt management plan developed through the agency. Any extension of the 30-day deadline 

can be granted only for cause and is limited to a maximum of 15 days. A motion for extension must be 

filed within the 30-day period. Failure to fulfill these requirements may result in a dismissal of your case. 

If the court is not satisfied with your reasons for filing your bankruptcy case without first receiving a 

credit counseling briefing, your case may be dismissed.

[ ]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.]

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[ ]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 

unreasonable 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: /s/ MASSEY, CLAUDIA E.

Signature of Codebtor: 

Date: 

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UNITED STATES BANKRUPTCY COURT

NORTHERN DISTRICT OF ILLINOIS

In re MASSEY, CLAUDIA E. Case No. 

Chapter 

SUMMARY OF SCHEDULES

AMOUNTS SCHEDULED

NAME OF SCHEDULE ATTACHED 

YES/NO

NO. OF 

SHEETS

ASSETS DEBTS OTHER

A - Real Property Yes 1 $0.00

B - Personal Property Yes 3 $5,200.00

C - Property Claimed as Exempt Yes 1 $3,300.00

D - Creditors Holding Secured Claims Yes 1 $0 $0.00

E - Unsecured Priority Claims Yes 1 0 $114,522.00

F - Unsecured Nonpriority Claims Yes 1 0 $70,141.00

G - Executory Claims/ Unexpired Leases Yes 1 0 0

H - Codebtors Yes 1 0 0

I - Debtor’s Current Income Yes 1 0 0 $1,546.00

J - Debtor’s Current Expenses Yes 1 0 0 $1,611.00

12 0 0

$5,200.00 0

$184,663.00

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UNITED STATES BANKRUPTCY COURT

NORTHERN DISTRICT OF ILLINOIS

In re MASSEY, CLAUDIA E. Case No. 

Chapter 

STATISTICAL SUMMARY OF CERTIAN 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 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 stastical 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) $0.00

Taxes and Certain Other Debts Owed to Governmental Units 

(from Schedule E)

$114,522.54

Claims for Death or Personal Injury While Debtor Was 

Intoxicated (from Schedule E)

$0.00

Student Loan Obligations (from Schedule F) $0.00

Domestic Support, Separation Agreement, and Divorce Decree 

Obligations Not Reported on Schedule E

$0.00

Obligations to Pension or Profit Sharing, and Other Similar 

Obligations (from Schedule F)

$0.00

 TOTAL $114,522.54

State the following:

Average income (from Schedule I, Line 16) $1,546.81

Average Expenses (from Schedule J, Line 18) $1,611.00

Current Monthly Income (from Form 22A, Line 12; OR, Form

22B Line 11; OR, Form 22C, Line 20)

$1,730.00

State the following:

1. Total from Schedule D, “UNSECURED PORTION, IF

ANY” column.

$0.00

2. Total from Schedule E, “ÁMOUNT ENTITLED TO 

PRIORITY, IF ANY” column.

$ $114,522.00

3. Total from Schedule E, “AMOUNT NOT ENTITLED TO 

PRIORITY, IF ANY” column.

$0.00

4. Total from Schedule F. $70,141.00

5. Total of non-priority unsecured debt (sum of 1, 2, and 4. $184,663.00

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In re: MASSEY, CLAUDIA E. Case No. 

SCHEDULE A- REAL PROPERTY

Except as directed below, list all real property in which the debtor has any legal, equitable, or future interest, including all property owned as co tenant, 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 husband, wife, or both 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 DEBTORS 

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

$0.00 $0.00

 Total $0.00 $0.00

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In re MASSEY, CLAUDIA E. Case No. 

SCHEDULE B - PERSONAL PROPERTY

Except as directed below, list all personal property of the debtor of whatever kind. If the debtor has no personal 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 husband, wife, or both 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.” In providing the 

information requested in this schedule, do not include the name or address of a minor child. Simply state “a minor child.”

 

 TYPE OF PROPERTY

N

O

N

E

 DESCRIPTION AND 

LOCATION OF PROPERTY

H USBAND, WIFE, JOINT OR COMMUNITY 

CURRENT MARKET VALUE 

OF DEBTOR’S INTEREST IN 

PROPERTY, WITHOUT 

DEDUCTING ANY SECURED 

CLAIM OR EXEMPTION

1. Cash on hand.

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.

3. Security deposits with public utilities, 

telephone companies, landlords, and 

others.

4. Household goods and furnishings, 

including audio, video, and computer 

equipment.

5. Books, pictures and other art objects, 

antiques, stamp, coin, record, tape, 

compact disc, and other collections or 

collectibles.

6. Wearing apparel.

7. Furs and jewelry.

8. Firearms and sports, photographic, and 

other hobby equipment.

9. Interests in insurance policies. Name 

insurance company of each policy and 

itemize surrender or refund value of each.

10. Annuities. Itemize and name each issuer.

11. Interests in education IRA as defined in 26 

USC S 529(b)(1). Give particulars. (File 

separately the records of any such 

interests. 11USC s 521(c) Rule 1007(b).

X

X

X

X

X

X

X

X

626 Justina, Hinsdale, 

Illinois 60521

Chase Bank

626 Justina, Hinsdale, 

Illinois 60521

626 Justina, Hinsdale, 

Illinois 60521

$100.00

$100.00

$500.00

$200.00

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In re MASSEY, CLAUDIA E. Case No. 

SCHEDULE B - PERSONAL PROPERTY

(Continuation Sheet)

 

 TYPE OF PROPERTY

N

O

N

E

 DESCRIPTION AND 

LOCATION OF PROPERTY

H USBAND, WIFE, JOINT OR COMMUNITY 

CURRENT MARKET VALUE 

OF DEBTOR’S INTEREST IN 

PROPERTY, WITHOUT 

DEDUCTING ANY SECURED 

CLAIM OR EXEMPTION

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

pension or profit sharing plans.

Give particulars.

13. Stock and interests in incorporated and 

unincorporated businesses.

Itemize

14. Interests in partnerships or joint ventures. 

Itemize.

15. Government and corporate bonds and other 

negotiable and non negotiable instruments.

16. Accounts receivable.

17. Alimony, maintenance, support,, and 

property settlements to which the debtor is or 

may be entitled. Give particulars.

18. Other liquidated debts owed to debtor 

including tax refunds.

Give particulars.

19. Equitable or future interests, life estates, 

and rights or powers exercisable for the benefit 

of the debtor other than those listed in Schedule 

A – Real Property.

20. Contingent and noncontingent interests of a 

decedent, death benefit plan, life insurance 

policy, or trust.

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

X

X

X

X

X

X

X

X

X

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In re MASSEY, CLAUDIA E. Case No. 

SCHEDULE B - PERSONAL PROPERTY

(Continuation Sheet)

 

 TYPE OF PROPERTY

N

O

N

E

 DESCRIPTION AND 

LOCATION OF PROPERTY

H USBAND, WIFE, JOINT OR COMMUNITY 

CURRENT MARKET VALUE 

OF DEBTOR’S INTEREST IN 

PROPERTY, WITHOUT 

DEDUCTING ANY SECURED 

CLAIM OR EXEMPTION

22. Patents, copyrights, and other 

intellectual property.

Give particulars.

23. Licenses, franchises, and other general 

intangibles. Give particulars.

24. Customer lists or other compilations 

containing personally identifiable 

information (as defined in 11 USC s 

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.

25. Automobiles, trucks, trailers, and other 

vehicles and accessories.

26. Boats, motors and accessories.

27. Aircraft and accessories.

28. Office equipment, furnishings and 

supplies.

29. Machinery, fixtures, equipment and 

supplies used in business.

30. Inventory.

31. Animals.

32. Crops – growing or harvested.

Give particulars.

33. Farming equipment and implements.

34. Farm supplies, chemicals and feed.

35. Other personal property of any kind 

not already listed. Itemize. 

X

X

X

X

X

X

X

X

X

X

X

X

X

2000 Jeep Pathfinder 

626 Justina, Hinsdale, 

Illinois 60521

$4,000.00

 Total personal property from 

page 1 $1,200.00

 Total personal property $5,200.00

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In re MASSEY, CLAUDIA E. Case No. 

SCHEDULE C - PROPERTY CLAIMED AS EXEMPT

Debtor claims the exemptions to which debtor is entitled under [ ] Check if debtor claims an exemption that exceeds 

(check one box) $125,000.

[ ] 11 U. S. C. § 522 (b)(2):

[X] 11 U. S. C § 522 (b)(3):

DESCRIPTION OF PROPERTY SPECIFY LAW PROVIDING EACH 

EXEMPTION

VALUE OF CLAIMED 

EXEMPTION

CURRENT MARKET 

VALUE OF PROPERTY 

WITHOUT DEDUCTING 

EXEMPTION

Cash on hand

Chase Bank

Household Good

Wearing Apparel

2000 Jeep Pathfinder

735 IL COM STATS

Sec 5/12-1001(b)

735 IL COM STATS

Sec 5/12-1001(b)

735 IL COM STATS

Sec 5/12-1001(b)

733 IL COM STATS

Sec 5/12-1001(a)

735 IL COM STATS

Sec 5/12-1001(c)

$ 100.00

$ 100.00

$ 500.00

$ 200.00

$ 2,400.00

$ 100.00

$ 100.00

$ 500.00

$ 200.00

$ 4,000.00

Total exemptions $3,300.00 $4,900.00

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In re ________MASSEY, CLAUDIA E.__ Case No. ____________________

SCHEDULE D - CREDITORS HOLDING SECURED CLAIMS

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 a creditor, indicate by stating “a minor child” and do not disclose 

the child’s name. See 11 U.S.C. § 112. If a “minor child” is stated, also include the name, address, and legal relationship to the minor child of a person 

described in 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 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 is 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 COMMUNITY

DATE CLAIM WAS 

INCURRED, NATURE 

OF LIEN, AND 

DESCRIPTION AND 

VALUE OF 

PROPERTY SUBJECT 

TO LIEN

CONTINGENTUNLIQUIDATED DISPUTED

AMOUNT OF CLAIM 

WITHOUT DEDUCTING 

VALUE OF 

COLLATERAL

UNSECURED 

PORTION, IF ANY

Total secured 0.00 0.00

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In re ______MASSEY, CLAUDIA E.___ Case No. ____________________

SCHEDULE E - CREDITORS HOLDING UNSECURED PRIORITY CLAIMS

A complete list of claims 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 on this schedule. In the boxes provided on the attached sheets, state the name and 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, indicate that by stating “a minor child” and do not disclose the child’s name. See 11 U.S.C. § 112. If a 

“minor child” is stated, also include the name, address, and legal relationship to the minor child of a person described in 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 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 unadjudicated, 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 “Subtotal” 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 “Subtotal” on each sheet. Report the total of all amounts entitled to 

priority listed of this Schedule E in the box labeled “Totals” on the last sheet of the completed schedule. Individuals debtors with primarily consumer debts who file a 

case under chapter 7 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 

who file a case under chapter 7 report this total also on the Statistical Summary of Certain Liabilities and Related Data. 

[X] 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 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 $10,000* per person earned within 90 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).

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In re MASSEY, CLAUDIA E. Case No. 

[ ] Certain farmers and fishermen

Claims of certain farmers and fishermen, up to a maximum of $4,925* per farmer or fisherman, against debtor, as provided in 11 U. S. C. § 

507(a)(6).

[ ] Deposits by individuals

Claims of individuals up to a maximum of $2,225* for deposits for the purchase, lease, or rental of property or services for personal, family, or 

household use, that were not delivered or provided, as provided in 11 U. S. C. § 507(a)(7).

[ ] Taxes and Certain Other Debts Owed to Governmental Units

Taxes, custom 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 FCIC, 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 as provided in 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, 2007, and every three years thereafter with resect to cases commenced on or after the date of adjustment,

_____ continuation sheets attached

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In re MASSEY, CLAUDIA E. Case No. 

SCHEDULE E - CREDITORS HOLDING UNSECURED PRIORITY CLAIMS

(Continuation Sheet)

TYPE OF PRIORITY

CREDITOR’S NAME AND 

MAILING ADDRESS 

INCLUDING ZIP CODE 

AND ACCOUNT NUMBER

(See instructions above)

 CODEBTOR HUSBAND, WIFE, JOINT OR COMMUNITY

DATE CLAIM WAS 

INCURRED, NATURE 

OF LIEN, AND 

DESCRIPTION AND 

VALUE OF 

PROPERTY SUBJECT 

TO LIEN

CONTINGENTUNLIQUIDATED DISPUTED

AMOUNT OF CLAIM 

WITHOUT DEDUCTING 

VALUE OF 

COLLATERAL

 AMOUNT

ENTITLED TO 

 PRIORITY

XXXX-8618

Internal Revenue Serv

Kansas City, MO 64999-

0010

Tax year 2002 $8,903.30 $8,903.30

XXXX-8618

Internal Revenue Serv

Kansas City, MO 64999-

0010

Tax year 2003 $15,111.07 $15,111.07

XXXX-8618

Internal Revenue Serv

Kansas City, MO 64999-

0010

Tax year 2004 $25,186.94 $25,186.94

XXXX-8618

Internal Revenue Serv

Kansas City, MO 64999-

0010

Tax year 2005 $37,547.87 $37,547.87

XXXX-8618

Internal Revenue Serv

Kansas City, MO 64999-

0010

Tax year 2006 $27,773.36 $27,773.36

Total priority claims $114,522.54 $114,522.54

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In re MASSEY, CLAUDIA E. Case No. 

SCHEDULE F - CREDITORS HOLDING UNSECURED NONPRIORITY CLAIMS

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 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, indicate that by stating “a 

minor child” and do not disclose the child’s name. See 11 U.S.C. § 112. If a “minor child” is stated, also include the name, address, and legal relationship to 

the minor child of a person described in 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 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 filing a case under chapter 7, report this total also on the Statistical Summary of 

Certain Liabilities and Related Data.

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

 CREDITOR’S NAME AND 

 MAILING ADDRESS 

 INCLUDING ZIP CODE 

 AND ACCOUNT NUMBER

 (See instructions above)

 CODEBTORHUSBAND, WIFE, JOINT OR COMMUNITY

DATE CLAIM WAS 

INCURRED, AND 

CONSIDERATION FOR 

CLAIM. 

IF CLAIM IS SUBJECT TO 

SETORR, SO STATE

CONTINGENTUNLIQUIDATEDDISPUTED

AMOUNT OF CLAIM

XXXX-1491

Target Visa

P.O. Box 59317

Minneapolis, MN 55459

Unknown

Credit Card

$10,000.00

XXXX-7565

Capital One Master Card

P.O. Box 85617

Richmond, VA 23285

Unknown

Credit Card

$8,915.00

XXXX-9227

Capital One Visa

P.O. Box 85617

Richmond, VA 23285

Unknown

Credit Card

$11,023.00

XXXX-9318

Capital One Visa

P.O. box 85617

Richmond, VA 23285

Unknown

Credit Card

$9,187.00

XXXX-7711

Capital One Visa

P.O. box 85617

Richmond, VA 23285

Unknown

Credit Card

$8,615.00

Total page 1 $47,740.00

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In re MASSEY, CLAUDIA E. Case No. 

SCHEDULE F - CREDITORS HOLDING UNSECURED NONPRIORITY CLAIMS

(Continuation Sheet)

CREDITOR’S NAME AND 

MAILING ADDRESS 

INCLUDING ZIP CODE AND 

ACCOUNT NUMBER

(See instructions above)

 CODEBTORHUSBAND, WIFE, JOINT OR COMMUNITY

 DATE CLAIM WAS 

INCURRED, AND 

CONSIDERATION FOR 

CLAIM. 

IF CLAIM IS SUBJECT TO 

SETOFF SO STATE

CONTINGENTUNLIQUIDATEDDISPUTED

AMOUNT OF CLAIM

XXXX-7117

TJX Visa

P.O. Box 26074

Richmond, VA 23260

Unknown

Credit Card

$11,401.00

XXXX-9069

Chase Visa

P.O. Box 15153

Wilmington, DE 19886

Unknown

Credit Card

$11,000.00

Total unsecured from page 1 $47,740.00

Total unsecured $70,141.00

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In re MASSEY, CLAUDIA E. Case No. 

SCHEDULE G - EXECUTORY CONTRACTS AND UNEXPIRED LEASES

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 creditor, 

 indicate that by stating “a minor child” and do not disclose the child’s name. See 11 U.S.C. § 112; 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 

NONRESIDEDTIAL REAL PROPERTY. STATE CONTRACT 

NUMBER OF ANY GOVERNMENTAL CONTRACT.

Deborah Winkleman

626 Justina

Hinsdale, IL 60521

Residential Lease

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In re _____MASSEY, CLAUDIA E.__ Case No. ____________________

SCHEDULE H - CODEBTORS

Provide information requested concerning any person or entity, other than a spouse in a joint case, that is also liable on any 

debts listed by debtor in the schedules of creditors. Include all guarantors and co-signors. If debtor resides or resided in a community 

property state, commonwealth, or territory (including Alaska, 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 creditor, indicate that by stating “a minor child” and do not disclose the child’s name. See 11 U.S.C. § 112; 

Fed. R. Bankr. P. 1007(m).

[X ] Check this box if debtor has no codebtors.

NAME AND ADDRESS OF CODEBTOR NAME AND ADDRESS OF CREDITOR

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In re MASSEY, CLAUDIA E. Case No. 

SCHEDULE I – CURRENT INCOME OF INDIVIDUAL DEBTOR(S)

The column labeled “Spouse” must be completed in all cases filed by joint debtors and by a married debtor in a chapter 7, 11, 12 or 13 case 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.

Debtor’s Marital DEPENDENTS OF DEBTOR AND SPOUSE

Status:

Single

RELATIONSHIP(S)

Daughter

Daughter

AGE(S)

16

10

Employment: DEBTOR SPOUSE

Occupation Florist 

Name of Employer Dominicks Finer Foods

How long employed 3years

Address of Employer 20427 W. 27th Avenue

 Phoenix, AZ 85027-3241

INCOME: (Estimate of average monthly income) DEBTOR SPOUSE

1. Current monthly gross wages, salary, and commissions

(pro rate if not paid monthly) . . . . . . . . . . . . . . . . . . . $ 1,530.52 $ 0.00

2. Estimated monthly overtime . . . . . . . . . . . . . . . . . . . .. . . $ 0.00 $ 0.00

 

3. SUBTOTAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,530.52 $ 0.00

4. LESS PAYROLL DEDUCTIONS

a. Payroll taxes and social security . . . . . . . . . . . . . $ 57.99 $ 0.00

b. Insurance . . . . . . . . . . . . . . . . . . . . . . . . . $ 70.45 $ 0.00

c. Union dues . . . . . . . . . . . . . . . . . . . . . . . . $ 32.92 $ 0.00

d. Other (Specify):.IRS Tax levy . . . . . . . . . . . . . . $ 22.35 $ 0.00

5. SUBTOTAL OF PAYROLL DEDUCTIONS . . . . . . . . . . $ 183.71 $ 0.00

6. TOTAL NET MONTHLY TAKE HOME PAY . . . . . . . . . . . . . . $ 1,346.81 $ 0.00

7. Regular income from operation of business or profession or farm

(attach detailed statement) . . . . . . . . . . . . . . . . . . . . . . . . . . $ 0.00 $ 0.00

8. Income from real property . . . . . . . . . . . . . . . . . . . . . . . . $ 0.00 $ 0.00

9. Interest and dividends . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 0.00 $ 0.00

10. Alimony, maintenance or support payments payable to the debtor for the 

debtor’s use or that of dependents listed above . . . . . . . . . . . . . . . $ 200.00 $ 0.00

11. Social security or other government assistance

(Specify) . . . . . . . . . . . . $ 0.00 $ 0.00

12. Pension or retirement income . . . . . . . . . . . . . . . . . . . . . . $ 0.00 $ 0.00

13. Other monthly income

(Specify) . . . . . . . . . . . $ 0.00 $ 0.00

14. SUBTOTAL OF LINES 7 THROUGH 13 $ 200.00 $ 0.00 

 

15. AVERAGE MONTHLY INCOME . . . . . . . . . . . . . . . . . . . $ 1,546.81 $ 0.00

16. COMBINED AVERAGE MONTHLY INCOME $ 1,546.81 (Report also on Summary of Schedules)

17. Describe any increase or decrease reasonably anticipated to occur within the year following the filing of this document: None

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In re: MASSEY, CLAUDIA E. Case No. 

SCHEDULE J- CURRENT EXPENDITURES OF INDIVIDUAL DEBTORS

Complete this schedule by estimating the average monthly expenses of the debtor and the debtor’s family. Pro rate any payments made bi-weekly, quarterly, 

semi-annually, or annually to show monthly rate.

[] Check this box if a joint petition is filed and debtor’s spouse maintains a separate household. If box is checked, complete a separate 

 schedule of expenditures labeled “Spouse.”

1. Rent or home mortgage payment (include lot rented for mobile home) . . . . . . . . . . . . . . . . . . . . . $ 0.00

 a. Are real estate taxes included? Yes X No X

 b. Is property insurance included? Yes X No X

2. Utilities: a. Electricity and heating fuel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 200.00

b. Water and sewer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 50.00

c. Telephone. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 75.00

d. Other . . . . $ 125.00

3. Home maintenance (repairs and upkeep) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 0.00

4. Food. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 650.00

5. Clothing. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 200.00

6. Laundry and dry cleaning. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 0.00

7. Medical and dental expense. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 35.00

8. Transportation (not including car payments) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 175.00

9. Recreation, clubs and entertainment, newspapers, magazines, etc. . . . . . . . . . . . . . . . . . . . . . . . $ 0.00

10. Charitable contributions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 0.00

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

a. Homeowner’s or renter’s. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 0.00

b. Life. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 0.00

c. Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 0.00

d. Auto. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 58.00

10.Other . . . . $ 0.00

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

(Specify) . . . . $ 0.00

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

a. Auto. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 0.00

b. Other . . . . . $ 0.00

c. Other . . . . . $ 0.00

d. Other . . . . . $ 0.00

14. Alimony, maintenance, and support to others. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 0.00

15. Payments for support of additional dependents not living at your home. . . . . . . . . . . . . . . . . . . . $ 0.00

16. Regular expenses form operation of business, profession, or farm (attach detailed statement) . . . . . . . . . $ 0.00

17. Other Cell Phone . . . . . $ 43.00

 Other . . . . $ 0.00

18. TOTAL MONTHLY EXPENSES (Report also on Summary of Schedules) . . . . . . . . . . . . . . . . . $ 1,611.00

19. Describe any increase or decrease in expenditures reasonably anticipated to occur within the year

 following the filing of this document.

x

20. STATEMENT OF MONHLY NET INCOME

a. Total monthly income from Line 16 of Schedule I . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,546.81

b. Total projected monthly expenses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1,611.00

c. Monthly net income (a. minus b.). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ (-64.19) 

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United States Bankruptcy Court

Northern District of Illinois

In Re MASSEY, CLAUDIA E. Case No. 

DECLARATION CONCERNING DEBTOR’S SCHEDULES

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 19

 sheets [total shown on summary page plus 2], and that they are true and correct to the best of my knowledge, 

information and belief.

Date Signature /s/MASSEY, CLAUDIA E.

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.

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UNITED STATES BANKRUPTCY COURT, NORTHERN DISTRICT OF ILLINOIS

In re MASSEY, CLAUDIA E. Case No. 

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. Do not include 

the name or address of a minor child in this statement. Indicate payments, transfers and the like to minor children by stating ‘a minor

 child.” See 11 U.S.C. § 112; 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 to answer 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 proprietorship or self 

employed full-time or part-time. An individual debtor also may be “in business” for the purpose of this form if the debtor engages in 

trade, business, or other activity, other than as an employee, to supplement income from 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. 11U.S.C. § 101.

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 

[X] business, including part-time activities either as an employee or in independent trade or business, from the beginning of the

 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 year 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.)

 

DEBTOR:

YEAR AMOUNT SOURCE 

2007 $ 0.00

2008 $ 0.00

Y-T-D $ 0.00

SPOUSE:

YEAR AMOUNT SOURCE

2007 $ 0.00

2008 $ 0.00

Y-T-D $ 0.00

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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

[X] 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.)

YEAR AMOUNT SOURCE

2007 $ 0.00

2008 $ 0.00

Y-T-D $ 0.00

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

[X] services, and other debts to any creditor made within 90 days immediately preceding the commencement of this case if the

aggregate value of all property that constitutes or is affected by such transfer is not 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 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.)

NAME AND ADDRESS DATES OF AMOUNT AMOUNT

OF CREDITOR PAYMENTS PAID STILL OWING

None b. Debtor whose debts are not primarily consumer debts: List each payment or other transfer to any creditor made

[X] within 90 days immediately preceding the commencement of the case if the aggregate of all property that constitutes or is

affected by such transfer is not less than $5,000. (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.)

NAME AND ADDRESS DATES OF AMOUNT AMOUNT

OF CREDITOR PAYMENTS/ PAID OR STILL OWING

TRANSFERS VALUE OF 

TRANSFERS

None c. All debtors: List all payments made within one year immediately preceding the commencement of this case to or for the 

[X] benefit of creditors who are or were insiders. (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.)

NAME AND ADDRESS DATE OF AMOUNT AMOUNT

OF CREDITORS AND PAYMENT PAID STILL OWING

RELATIONSHIP TO DEBTOR

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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

[X] the filing of this bankruptcy case. (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.)

CAPTION OF SUIT NATURE OF COURT STATUS OR

AND CASE NO. PROCEEDING AND DISPOSITION

Steven Massey Divorce LOCATION Pending

VS Circuit Court

Claudia Massey Cook County

06 D 1539

Chase Bank Collection Circuit Court Settled

VS Cook County

Claudia Massey

07 M1 148823

Capital One Collection Circuit Court Judgment

VS Cook County

Claudia Massey

08 SC 7537

Capital One Collection Circuit Court Judgment

VS Cook County

Claudia Massey

08 M1 179170

Capital One Collection Circuit Court Dismissed

VS Cook County

Claudia Massey

08 M1160294

Federal Insurance Insurance Circuit Court Pending

VS Liability Cook County

Claudia Massey

08 L 7275

Capital One Collection Circuit Court Dismissed

VS Cook County

Claudia Massey

09 M1 106479

Capital One Collection Circuit Court Pending

VS Cook County

Claudia Massey

09 M1 143549

None b. Describe all property that has been attached, garnished or seized under any legal or equitable process within one year

[X] immediately preceding the commencement of this case. (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.)

NAME AND ADDRESS DATE OF DESCRIPTION AND

OF PERSON FOR WHOSE SEIZURE VALUE OF PROPERTY

BENEFIT PROPERTY 

WAS SEIZED

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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

[X] 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 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.)

NAME AND ADDRESS OF DATE OF REPOSESSION, DESCRIPTION AND

CREDITOR OR SELLER FORECLOSURE SALE, VALUE OF PROPERTY

TRANSFER OR RETURN

6. Assignments and receiverships:

None a. Describe any assignment of property for the benefit of creditors made within 120 days preceding the commencement of

[X] this case. (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.)

 NAME AND ADDRESS DATE OF TERMS OF ASSIGNMENT

OF ASSIGNEE ASSIGNMENT OR SETTLEMENT

None b. List all property which has been in the hands of a custodian, receiver or court-appointed official within one year 

[X] immediately preceding the commencement of this case. (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.)

NAME AND ADDRESS NAME AND LOCATION DATE OF DESCRIPTION

OF CUSTODIAN OF COURT CASE ORDER & VALUE OF

TITLE & NUMBER PROPERTY

7. Gifts

None list all gifts or charitable contributions made within one year immediately preceding the commencement of this case except

[X] ordinary and usual gifts to family members aggregating less than $200 in value per family member and charitable

contributions aggregating less than $100 per recipient. (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.)

NAME AND ADDRESS RELATIONSHIP TO DATE OF DESCRIPTION AND

OF PERSON OR DEBTOR, IF ANY GIFT VALUE OF GIFT

ORGANIZATION

8. Losses

None List all losses from fire, theft, other calamity or gambling within one year immediately preceding the commencement of this

[X] case or since the commencement of this case. (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.)

DESCRIPTION AND DESCRIPTION OF CIRCUMSTANCES AND, DATE

VALUE OF PROPERTY IF LOSS WAS COVERED IN WHOLE OR IN OF LOSS

PART BY INSURANCE, GIVE PARTICULARS

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9. Payment related to debt counseling or bankruptcy within one (1) year of filing:

NAME AND ADDRESS DATE OF PAYMENT, NAME OF AMOUNT OF MONEY OR

OF PAYEE PAYOR IF OTHER THAN DEBTOR DESCRIPTION AND VALUE 

OF PROPERTY

Paul C. Sheils, Attorney

15 Salt Creek Lane, Suite 122 12/29/09 $1,201.00

Hinsdale, IL 60521

10. Other transfers

None a. List all other property, other than property transferred in the ordinary course of business or financial affairs of the debtor,

[X] 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 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.)

NAME AND ADDRESS OF DATE DESCRIBE PROPERTY

TRANSFEREE, RELATIONSHIP TRANSFERRED AND

TO DEBTOR VALUE RECEIVED

None b. List all property transferred by the debtor within ten years immediately preceding the commencement of this case to a self

[X] settled trust or similar device of which the debtor is a beneficiary.

NAME OF TRUST OR DATE(S) OF AMOUNT OF MONEY OR DESCRIPTION

OTHER DEVICE TRANSFER(S) AND VALUE OF PROPERTY OR DEBTOR’S

INTEREST IN PROPERTY

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,

[X] 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 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.)

NAME AND ADDRESS TYPE AND NUMBER OF ACCOUNT AMOUNT AND DATE OF

OF INSTITUTION AND AMOUNT OF FINAL BALANCE SALE OR CLOSING

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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

[X] year immediately preceding the commencement of this case. (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.)

NAME AND ADDRESS OF BANK NAMES AND ADDRESSES OF DESCRIPTION DATE OF

OR OTHER DEPOSITORY THOSE WITH ACCESS TO OF CONTENTS TRANSFER OR

BOX OR DEPOSITORY SURRENDER

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

[X] commencement of this case. (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.)

NAMES AND ADDRESS DATE OF SETOFF AMOUNT OF

OF CREDITOR SETOFF

14. Property held for another person

None List all property owned by another person that the debtor holds or controls.

[X]

NAME AND ADDRESS DESCRIPTION AND LOCATION OF 

OF OWNER VALUE OF PROPERTY PROPERTY

15. Prior address of debtor 

None If a debtor has moved within three years immediately preceding the commencement of this case, list all premises which the

[X] debtor has 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.

ADDRESS NAME USED DATES OF

OCCUPANCY

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______________________________________________________________________________________

16. Spouses or Former Spouses

None If the debtor resides or resided in a community property state, commonwealth, or territory (including Alaska, 

[X] 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 

debtor’s spouse and of any former spouse who resides or resided with the debtor in the community property state.

 NAME OF SPOUSE OR FORMER SPOUSE

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 a hazardous waste, hazardous substance, toxic substance, hazardous

material, pollutant, or contaminant or other 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

[X] 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.

 SITE NAME NAME AND ADDRESS DATE OF ENVIRONMENTAL

 AND ADDRESS OF GOVERMENTAL UNIT NOTICE LAW

 

None b. List the name and address of every site for which the debtor provided notice to a governmental 

[X] unit of a release of Hazardous Material. Indicate the governmental unit to which the notice was

 sent and the date of notice.

 SITE NAME NAME AND ADDRESS DATE OF ENVIRONMENTAL

 AND ADDRESS OF GOVERMENTAL UNIT NOTICE LAW

None c. List all judicial or administrative proceedings, including settlements or orders, under my

[X] Environmental Law with respect to which the debtor is or was a party. Indicate the name and 

address of the Governmental Unit that was a party to the proceeding, and the docket number.

 NAME AND ADDRESS DOCKET NUMBER STATUS OR 

 OF GOVERMENTAL UNIT DISPOSITION

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________________________________________________________________________________________

18 Nature, location and name of business

None a. If the debtor is an individual, list the names, addresses, taxpayer identification numbers, nature of the businesses and

[X] 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 corporation, sole proprietor or was self-employed in a trade, profession, or other activity either fullor 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 debtor is a partnership, list the names, addresses, taxpayer identification numbers, nature of the businesses and the

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 filing of this case.

If the debtor is a corporation, list the names, addresses, taxpayer identification numbers, nature of the businesses and the

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 filing of this case.

 NAME LAST FOUR DIGITS ADDRESS NATURE OF BUSINESS BEGINNING AND

OF SOC. SEC. NO./ ENDING DATES

COMPLETE EIN OR

OTHER TAXPAYER

I.D. NO.

______________________________________________________________________________________

None b. Identify any business listed in 18a that is a “single asset real estate” as defined in 11 U.S.C. § 101.

[X] 

 NAME ADDRESS

_______________________________________________________________________________________ 

The following questions are to be completed by every debtor that is a corporation or partnership and by any individual debtor who is 

or has been, within six years immediately preceding the commencement of this case, any of the following: an officer, director, 

managing executive or owner of more than 5 percent 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 in a trade, profession or other activity, either full- or part-time.

(An individual or joint debtor should complete this portion of the statement only if the debtor is or has been in business, as 

described above, within six years immediately preceding the commencement of this case. A debtor who has not been in business within 

those six years should go directly to the signature page.)

 

19. Books, records and financial statements

 None a. List all bookkeepers and accountants who within two years immediately preceding the filing of this bankruptcy case

[X] kept or supervised the keeping of books of account and records of the debtor.

 NAME AND ADDRESS DATES SERVICES RENDERED

None b. List all firms or individuals who within the two years immediately preceding the filing of this 

[X] bankruptcy case have audited the books of account and records, or prepared a financial statement

 of the debtor.

 NAME ADDRESS DATES SERVICES RENDERED

None c. List all firms or individuals who at the time of the commencement of this case were in possession

[X] of the books of account and records of the debtor. If any of the books of account and records are not available, explain.

 NAME ADDRESS

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None d. List all financial institutions, creditors and other parties, including mercantile and trade agencies, to 

[X] whom a financial statement was issued within the two years immediately preceding the commencement 

 of this case.

 NAME AND ADDRESS DATE ISSUED

________________________________________________________________________________________

20. Inventories

None a. List the dates of the last two inventories taken of your property, the name of the person who supervised the taking of each

[X] inventory, and the dollar amount and basis of each inventory.

 

DATE OF INVENTORY INVENTORY DOLLAR AMOUNT 

 SUPERVISOR OF INVENTORY

______________________________________________________________________________________

None b. Name of person having possession of inventories.

[X]

 DATE OF INVENTORY NAME AND ADDRESS OF CUSTODIAN

 OF INVENTORY RECORDS

_______________________________________________________________________________________

21. Current Partners, Officers, Directors and Shareholders

None a. If the debtor is a partnership, list the nature and the percentage of partnership interest of each member

[X] of the partnership

 NAME AND ADDRESS NATURE OF INTEREST PERCENTAGE OF INTEREST 

None b. If the debtor is a corporation, list all officers and directors of the corporation, and each stockholder who

[X] directly or indirectly owns, controls or holds 5 percent or more of the voting or equity securities of the 

corporation. 

 NAME AND ADDRESS TITLE NATURE AND PERCENTAGE

 OF STOCK OWNERSHIP

22. Former partners, officers, directors and shareholders 

None a. If the debtor is a partnership, list each member who withdrew from the partnership within one year immediately preceding 

[X] the commencement of this case.

 

NAME ADDRESS DATE OF WITHDRAWL

 

None b. If the debtor is a corporation, list all officers, or directors whose relationship with the corporation terminated within one 

[X] year immediately preceding the commencement of this case.

NAME AND ADDRESS TITLE DATE OF WITHDRAWAL

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_______________________________________________________________________________________

23. Withdrawals from a partnership or distribution by a corporation

None If the debtor is a partnership or corporation, list all withdrawals or distributions credited or given to an insider, including

[X] compensation in any form, bonuses, loans, stock redemptions, options exercised and any other perquisite during one year

immediately preceding the commencement of this case.

 NAME & ADDRESS DATE OF PURPOSE AMOUNT OF MONEY OR 

 OF RECIPIENT, OF WITHDRAWL DESCRIPTION AND VALUE 

 RELATIONSHIP TO DEBTOR OF PROPERTY

 

_____________________________________________________________________________________

24. Tax Consolidation Group 

None If the debtor is a corporation, list the name and federal taxpayer identification number of the parent corporation of any

[X] consolidated group for tax purposes of which the debtor has been a member at any time within six years immediately 

preceding the commencement of this case.

 NAME OF PARENT CORPORATION LAST FOUR DIGITS OF TAXPAYER IDENTIFICATION # 

______________________________________________________________________________________

25. Pension Funds.

None If the debtor is not an individual, list the name and federal taxpayer identification number of any pension fund to which the

[X] debtor, as an employer, has been responsible for contributing at any time within six years immediately preceding the

commencement of this case.

 NAME OF PENSION FUND LAST FOUR DIGITS OF TAXPAYER IDENTIFICATION #

______________________________________________________________________________________

DECLARATION CONCERNING DEBTOR’S

 STATEMENT OF FINANCIAL AFFAIRS

I declare under penalty of perjury that I have read the answers contained in the foregoing statement of financial affairs and 

any attachments thereto, consisting of a total of 10 sheets, and that they are true and correct.

Date signature: /s/ MASSEY, CLAUDIA E.

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United States Bankruptcy Court

Northern District of Illinois

In re ______MASSEY, CLAUDIA E.___ Case No. ____________________

CHAPTER 7 INDIVIDUAL DEBTOR’S STATEMENT OF INTENTION

[X] I have filed a schedule of assets and liabilities which includes consumer debts secured by property of the estate.

[ ] I have filed a schedule of executory contracts and unexpired leases which includes personal property subject to and unexpired lease.

[X] I intend to do the following with respect to the property of the estate which secures those consumer debts.

 Description of Secured Creditor’s Property will Property is Property will be Debt will be

 Property Name be surrendered claimed as redeemed reaffirmed

 exempt 11 USC § 722 11 USC §524 (c)

Description of Leased Lessor’s Lease will be assumed 

Property Name 11 USC § 362(h)(1)(A)

signature: /s/ MASSEY, CLAUDIA E.

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United States Bankruptcy Court

Northern District of Illinois

In re ______MASSEY, CLAUDIA E.___ Case No. ____________________

DISCLOSURE OF COMPENSATION OF ATTORNEY FOR DEBTOR

1. Pursuant to 11 U.S.C. Section 329(a) and Bankruptcy rule 2016(b). I certify that I am the attorney for the above-named debtor(s) and that the 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 this bankruptcy case is as follows:

For legal services, I have agreed to accept........................................................... $ 1,500.00

Prior to the filing of this statement I have received................................................. $ 1,500.00

 

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

 

2. $ 299 of the filing fee has been paid.

3. The source of the compensation paid to me was:

[X] Debtor [ ] Other (specify)

4. The source of the compensation to be paid to me is:

[X] Debtor [ ] Other (specify) 

5. [X] I have not agreed to share the above compensation with any other person unless they are members or associates of my law firm:

 [ ] I have agreed to share the above-disclosed compensation with a person or persons who are not members 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.

6. In return for the above-disclosed fee, I have agreed to render legal service for all aspects of the bankruptcy case, including:

a. Analysis of the debtor’s financial situation, and rendering advice to the debtor in determining whether to file a petition in bankruptcy;

b. Preparation and filing of any petition, schedules, statements, 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. (other provisions as needed)

7. By agreement with the debtor(s), the above-disclosed fee does not include the following services: Representation of the debtor(s) in any 

dischargeability actions, judicial lien avoidances, relief from stay actions or any other adversary proceeding. Any post petition motions including 

the preparing, filing, arguing and appearing. 

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: /s/ Paul C. Sheils

Paul C. Sheils, Attorney

15 SALT CREEK LANE, SUITE 122

HINSDALE, ILLINOIS 60521

(630) 655-1204

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UNITED STATES BANKRUPTCY COURT

NORTHERN DISTRICT OF ILLINOIS

NOTICE TO INDIVIDUAL CONSUMER DEBTOR UNDER § 342 (b)

OF THE BANKRUPTCY CODE

In accordance with § 342 (b) of the Bankruptcy Code, this notice: (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 can not give you legal advice.

1. Services Available from Credit Counseling Agencies

With limited exceptions, § 109(h) of the Bankruptcy Code requires that all individuals 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.

In addition, after filing a bankruptcy case, an individual debtor must complete a financial management instructional 

course before he or she can receive a discharge. The clerk also has a list of financial management instructional courses.

2. The Four Chapters of the Bankruptcy Code Available to Individual Consumer Debtors 

Chapter 7: Liquidation ($220 filing fee, $39 administrative fee, $15 trustee surcharge: Total Fee $274)

1. 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, 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.

2. 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.

3. 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 types of improper conduct described in the Bankruptcy Code, the court may deny your discharge and, if it does, 

the purpose for which you filed the bankruptcy petition will be defeated.

4. 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 ($150 filing fee, $39 

administrative fee: Total fee $189)

1. 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 eligible for chapter 13 if your debts do not exceed certain dollar amounts set forth in the Bankruptcy 

Code.

2. 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.

3. After completion 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.

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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 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 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.

Certificate of Attorney

I hereby certify that I delivered this notice required by § 342(b) of the Bankruptcy Code.

Paul C. Sheils /s/ Paul C. Sheils

Printed Name of Attorney Signature of Attorney Date

Address:

15 SALT CREEK LANE, SUITE 122

HINSDALE, ILLINOIS 60521

(630) 655-1204

Certificate of Debtor(s)

I (We), the debtor(s), affirm that I(we) have received and read this notice.

/s/ MASSEY, CLAUDIA E.

Printed Name(s) of Debtor(s) Signature of Debtor Date

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