UNITED STATES BANKRUPTCY COURT

NORTHERN DISTRICT OF ILLINOIS

EASTERN DIVISION

IN RE:

Debtor(s)

Chapter

Steven G. Pometta

)

)

)

)

) Phyllis A. Pometta

Bankruptcy Case No.

7

DECLARATION REGARDING ELECTRONIC FILING

Signed by Debtor(s) or Corporate Representative and Attorney

To Be Used When Submitting Petition on Diskette

PART I - DECLARATION OF PETITIONER Date:

A. To be completed in all cases.

 We Steven G. Pometta and Phyllis A. Pometta, the undersigned debtor(s), corporate officer, partner, or 

member, hereby declare under penalty of perjury that the information I(we) have given my (our)attorney, including 

correct social security number(s) and the information provided in the electronically filed petition, statements, 

schedules, and if applicable, application to pay filing fee in installments, and Application for Waiver of the Chapter 7 

Filing Fee, is true and correct. I(we) consent to my(our) attorney sending the petition, statements, schedules, and this 

DECLARATION to the United States Bankruptcy Court. I(we) understand that this DECLARATION must be filed with 

the Clerk in addition to the petition. I(we) understand that failure to file this DECLARATION will cause this case to be 

dismissed pursuant to 11U.S.C. sections 707(a) and 105.

B. To be checked and applicable only if the petitioner is an individual (or individuals) whose debts are 

primarily consumer debts and who has (or have) chosen to file under chapter 7.

 I(we) am(are) aware that I(we) may proceed under chapter 7, 11, 12, or 13 of Title 11 United States

Code; I(we) understand the relief available under each such chapter; I(we) choose to proceed under

chapter 7; and I(we) request relief in accordance with chapter 7.

C. To be checked and applicable only if the petition is a corporation, partnership, or limited liability entity.

 I declare under penalty of perjury that the information provided in this petition is true and correct and

that I have been authorized to file this petition on behalf of the debtor. The debtor requests relief in

accordance with the chapter specified in the petition.

Signature:s/ Steven G. Pometta Signature: s/ Phyllis A. Pometta

(Debtor or Corporate Officer, Partner or Member) (Joint Debtor)

Steven G. Pometta Phyllis A. Pometta

PART II - DECLARATION OF ATTORNEY

I declare under penalty of perjury that I have reviewed the above debtor's(s’) petition and that the information is 

complete and correct to the best of my knowledge. The debtor(s) will have signed this form before I submit the 

petition, schedules, and statements. I will give the debtor(s) a copy of all forms and information to be filed with the 

United States Bankruptcy Court. If an individual, I further declare that I have informed the petitioner(s) that they 

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. This declaration is based on all information of which I have knowledge.

Signature of Attorney: 

Typed or Printed Name of Attorney: 

s/AndrewMCarter

Andrew M. Carter

01/08

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 1 of 75
UNITED STATES BANKRUPTCY COURT

NORTHERN DISTRICT OF ILLINOIS

EASTERN DIVISION

IN RE

Debtor(s)

Chapter

Steven G. Pometta

)

)

)

)

)

Phyllis A. Pometta

Bankruptcy Case No.

7

DECLARATION REGARDING ELECTRONIC FILING

Signed by Debtor(s) or Corporate Representative

To Be Used When Filing over the Internet

PART I - DECLARATION OF PETITIONER Date:

A. To be completed in all cases.

 I(We) Steven G. Pometta and Phyllis A. Pometta, the undersigned debtor, corporate officer, partner, or 

member, hereby declare under penalty of perjury that the information I have given my attorney, including correct social 

security number and the information provided in the electronically filed petition, statements, schedules, and if applicable, 

application to pay filing fee in installments, and Application for Waiver of the Chapter 7 Filing Fee, is true and correct. I 

consent to my attorney sending the petition, statements, schedules, and this DECLARATION to the United States 

Bankruptcy Court. I understand that this DECLARATION must be filed with the Clerk in addition to the petition. I 

understand that failure to file this DECLARATION will cause this case to be dismissed pursuant to 11 U.S.C. sections 

707(a) and 105.

B. To be checked and applicable only if the petitioner is an individual (or individuals) whose debts are primarily 

consumer debts and who has (or have) chosen to file under chapter 7.

 I(we) am(are) aware that I(we) may proceed under chapter 7, 11, 12, or 13 of Title 11 United States Code; 

I(we) understand the relief available under each such chapter; I(we) choose to proceed under chapter 7; and 

I(we) request relief in accordance with chapter 7.

C. To be checked and applicable only if the petition is a corporation, partnership, or limited liability entity.

 I declare under penalty of perjury that the information provided in this petition is true and correct and that I

have been authorized to file this petition on behalf of the debtor. The debtor requests relief in accordance

with the chapter specified in the petition.

Signature:s/ Steven G. Pometta Signature: s/ Phyllis A. Pometta

(Debtor or Corporate Officer, Partner or Member) (Joint Debtor)

Steven G. Pometta Phyllis A. Pometta

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 2 of 75
American Express

P.O. Box 0001

Los Angeles, CA 90096

AT & T c/o CCA

P.O. Box 806

Norwell, MA 02061

Capital One

P.O. BO6492

Carol Stream, IL 60197

CapitalOne

c/o MRS Associates

P.O. Box 1930

Cherry Hill, NJ 08003

Chase

Cardmember Services

P.O. Box 15153

Wilmington, DE 19886

Chase

Cardmember Services

P.O. Box 15153

Wilmington, DE 19886

Chase

Cardmember Services

PO Box 15153

Wilmington, DE 19886

Chase-BP

Cardmember Services

PO Box 15325

Wilmington, DE 19886

Citi Mortgage

P.O. Box 183040

Columbus, OH 43218-3040

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 3 of 75
Doctors Center for Wellness

1045 Burlington Ave

Lisle, IL 60532

Edward Hospital

P.O. Box 4207

Carol Stream, IL 60197

Edward Hospital

c/o Miramed Revenue Group

Dept 77304

P.O. Box 77000

Detroit, MI 48277

Exxon-Mobil

Processing Center

Des Moines, IA 50361

First Source Advantage c/o HSBC Retail

P.O. Box 628

Buffolo, NY 14240

Generations Family Medical

2940 Rollingridge Drive

Naperville, IL 60564

Harris, N.A.

P.O. Box 6201

Carol Stream, IL 60197-6201

Kohls

P.O. Box 2983

Milwaukee, WI 53201

Menards

c/o HSBC Retail SRV

P.O. Box 17602

Baltimore, MD 21297

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 4 of 75
Meyer Platinum

P.O. Box 960015

Orlando, FL 32896

Michael Reicherts, MD.

P.O. Box 393

Bedford Park, IL 60499

Midwest Center for Advanced Imaging

4355 Montgomery Rd.

Naperville, IL 60564

Ralph & Carol Mautoni

8439 Sandalwood

Darien, IL 60561

Reward Zone

P.O. Box 80045

Salinas, CA 93912

Shell

Processing Center

P.O. Box 183018

Columbus, OH 43218

Target National Bank

P.O. Box 59317

Minneapolis, MN 55459

Wells Fargo

P.O. Box 98752

Las Vegas, NV 89193

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 5 of 75
UNITED STATES BANKRUPTCY COURT

NORTHERN DISTRICT OF ILLINOIS

EASTERN DIVISION

In Re: Bankruptcy Case Number:

Steven G. Pometta

Phyllis A. Pometta

VERIFICATION OF CREDITOR MATRIX

Number of Creditors:

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

knowledge.

s/ Steven G. Pometta

Steven G. Pometta

Dated: 

Debtor

1/14/2010

s/ Phyllis A. Pometta

Joint Debtor

Phyllis A. Pometta

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 6 of 75
B 1 (Official Form 1) (1/08)

Pometta, Steven, G.

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

Pometta, Phyllis, A.

Voluntary Petition

Eastern Division

Northern District of Illinois United States Bankruptcy Court

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):

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

more than one, state all): 6205 2561

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

than one, state all):

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

2819 Twin Falls Drive

Plainfield, IL 

2819 Twin Falls Drive

Plainfield, IL 

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

ZIP CODE 60586 60586 ZIP CODE

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

Will

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

 

ZIP CODE ZIP CODE

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

ZIP CODE





Chapter 13

Chapter 12

Chapter 9

Chapter 11

Chapter 7

Chapter 15 Petition for 

Recognition of a Foreign 

Nonmain Proceeding

Chapter 15 Petition for

Recognition of a Foreign 

Main Proceeding

Chapter of Bankruptcy Code Under Which

the Petition is Filed (Check one box)

Nature of Business

(Check one box)













Other

Health Care Business

Single Asset Real Estate as defined in 11 

U.S.C. § 101(51B)

Clearing Bank

Commodity Broker

Stockbroker

Railroad



Type of Debtor









See Exhibit D on page 2 of this form.

Other (If debtor is not one of the above entities, 

check this box and state type of entity below.) 

_____________________ 

Partnership

Corporation (includes LLC and LLP)

 Individual (includes Joint Debtors) 

(Check one box.)

(Form of Organization)











Nature of Debts

(Check one box)



Tax-Exempt Entity

(Check box, if applicable)

Debts are primarily 

business debts.

 Debts are primarily consumer

debts, defined in 11 U.S.C.

§ 101(8) as “incurred by an

individual primarily for a

personal, family, or household purpose.”

Debtor is a tax-exempt organization 

under Title 26 of the United States 

Code (the Internal Revenue Code.)

 













Filing Fee (Check one box)

Full Filing Fee attached

Filing Fee to be paid in installments (applicable to individuals only). Must attach

signed application for the court's consideration certifying that the debtor is

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

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

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

Check one box:

Check if:

Debtor's aggregate noncontingent liquidated debts (excluding debts owed to

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

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

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

Chapter 11 Debtors

Check all applicable boxes

A plan is being filed with this petition

Acceptances of the plan were solicited prepetition from one or more classes

of creditors, in accordance with 11 U.S.C. § 1126(b).





Statistical/Administrative Information 



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

Debtor estimates that, after any exempt property is excluded and administrative 

 THIS SPACE IS FOR 

COURT USE ONLY

expenses paid, there will be no funds available for distribution to unsecured creditors.





$50,001 to 

$100,000

$0 to

$50,000

  

$100,001 to 

$500,000



$500,001 to

$1

million



$1,000,001 

to $10 

million 

  

$10,000,001 

to $50 

million 

$50,000,001 

to $100 

million 

$100,000,001 

to $500 

million 

$500,000,001 

to $1 billion 

More than $1 

billion 

Estimated Liabilities



$50,001 to 

$100,000

$50,000,001 

to $100 

million 

$100,000,001 

to $500 

million 

$0 to

$50,000

Estimated Assets

        

         

Over

100,000

50,001-

100,000

25,001-

50,000

10,001-

25,000

5,001-

10,000

1,000-

5,000

200-

999

100-

199

50-

99

1-

49

$100,001 to 

$500,000

$1,000,001 

to $10 

million 

$500,001 to

$1

million

$10,000,001 

to $50 

million 

$500,000,001 

to $1 billion 

More than $1 

billion 

Estimated Number of Creditors

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 7 of 75
B 1 (Official Form 1) (1/08) FORM B1, Page 2

Voluntary Petition Name of Debtor(s):

(This page must be completed and filed in every case) Steven G. Pometta, Phyllis A. Pometta

NONE

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

Location Case Number: Date Filed:

Where Filed:

Location

Where Filed:

Case Number: Date Filed:

NONE

Pending Bankruptcy Case Filed by any Spouse, Partner or Affiliate of this Debtor (If more than one, attach additional sheet)

Judge:

Name of Debtor: Case Number: Date Filed:

District: Relationship:



Exhibit A

Exhibit A is attached and made a part of this petition.

(To be completed if debtor is required to file periodic reports (e.g., forms 10K and

10Q) with the Securities and Exchange Commission pursuant to Section 13 or 15(d)

of the Securities Exchange Act of 1934 and is requesting relief under chapter 11.)

s/AndrewMCarter

have informed the petitioner that [he or she] may proceed under chapter 7, 11,

I, the attorney for the petitioner named in the foregoing petition, declare that I

whose debts are primarily consumer debts)

(To be completed if debtor is an individual

Exhibit B

1/14/2010

available under each such chapter. I further certify that I have delivered to the

12, or 13 of title 11, United States Code, and have explained the relief

X

debtor the notice required by 11 U.S.C. § 342(b).

Signature of Attorney for Debtor(s) Date

Andrew M. Carter 0404578



Yes, and Exhibit C is attached and made a part of this petition.

No





Does the debtor own or have possession of any property that poses or is alleged to pose a threat of imminent and identifiable harm to public health or safety?

Exhibit C

Exhibit D

(To be completed by every individual debtor. If a joint petition is filed, each spouse must complete and attach a separate Exhibit D.)

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

If this is a joint petition:

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













Landlord has a judgment against the debtor for possession of debtor's residence. (If box checked, complete the following).

Certification by a Debtor Who Resides as a Tenant of Residential Property 

(Check all applicable boxes.) 

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.

There is a bankruptcy case concerning debtor's affiliate. general partner, or partnership pending in this District.

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.

(Check any applicable box)

Information Regarding the Debtor - Venue

(Name of landlord that obtained judgment)

Debtor has included in this petition the deposit with the court of any rent that would become due during the 30-day period after the 

filing of the petition.

Debtor 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

(Address of landlord)





 Debtor certifies that he/she has served the Landlord with this certification. (11 U.S.C. § 362(l)). 

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 8 of 75
B 1 (Official Form 1) (1/08) FORM B1, Page 3

Voluntary Petition Name of Debtor(s):

Steven G. Pometta, Phyllis A. Pometta (This page must be completed and filed in every case)





X Not Applicable

Pursuant to 11 U.S.C. § 1511, I request relief in accordance with the 

Chapter of title 11 specified in the petition. A certified copy of the 

order granting recognition of the foreign main proceeding is attached.

(Check only one box.)

I request relief in accordance with chapter 15 of Title 11, United States Code.

Certified Copies of the documents required by § 1515 of title 11 are attached. [If no attorney represents me and no bankruptcy petition preparer signs the petition] I

have obtained and read the notice required by 11 U.S.C. § 342(b).

X s/ Steven G. Pometta

I request relief in accordance with the chapter of title 11, United States Code, specified 

in this petition.

[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 declare under penalty of perjury that the information provided in this petition is true

and correct.

Signature(s) of Debtor(s) (Individual/Joint)

Signatures

Signature of a Foreign Representative

I declare under penalty of perjury that the information provided in this petition is true

and correct, that I am the foreign representative of a debtor in a foreign proceeding, 

and that I am authorized to file this petition. 

X s/ Phyllis A. Pometta

Signature of Debtor (Signature of Foreign Representative) Steven G. Pometta

Signature of Joint Debtor Phyllis A. Pometta (Printed Name of Foreign Representative)

Telephone Number (If not represented by attorney)

Date

1/14/2010 Date

Law Office of Andrew M. Carter

127 W. Willow Avenue Wheaton, IL 60187

Andrew M. Carter Bar No. 0404578 

I declare under penalty of perjury that: (1) I am a bankruptcy petition preparer as defined 

in 11 U.S.C. § 110; (2) I prepared this document for compensation and have provided the 

debtor with a copy of this document and the notices and information required under 11 

U.S.C. §§ 110(b), 110(h), and 342(b); and, (3) if rules or guidelines have been 

promulgated pursuant to 11 U.S.C. § 110(h) setting a maximum fee for services chargeable 

by bankruptcy petition preparers, I have given the debtor notice of the maximum amount 

before preparing any document for filing for a debtor or accepting any fee from the debtor, 

as required in that section. Official Form 19 is attached. 

Signature of Non-Attorney Petition Preparer

Firm Name

Printed Name of Attorney for Debtor(s) / Bar No.

Signature of Attorney for Debtor(s)

X

Signature of Attorney

s/AndrewMCarter

630-462-8071 630-462-0342

1/14/2010

Telephone Number

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

Address Not Applicable

Social-Security number (If the bankruptcy petition preparer is not an individual, state 

the Social-Security number of the officer, principal, responsible person or partner of 

the bankruptcy petition preparer.) (Required by 11 U.S.C. § 110.) 

*In a case in which § 707(b)(4)(D) applies, this signature also constitutes a 

certification that the attorney has no knowledge after an inquiry that the 

information in the schedules is incorrect. 

Date 

Address

I declare under penalty of perjury that the information provided in this petition is true

and correct, and that I have been authorized to file this petition on behalf of the

debtor.

Signature of Debtor (Corporation/Partnership) X Not Applicable

If more than one person prepared this document, attach to the appropriate official form 

for each person. 

Not Applicable

The debtor requests the relief in accordance with the chapter of title 11, United States

Code, specified in this petition.

X

Signature of Authorized Individual

Printed Name of Authorized Individual

Title of Authorized Individual

Date

Names and Social-Security numbers of all other individuals who prepared or assisted 

in preparing this document unless the bankruptcy petition preparer is not an 

individual. 

A bankruptcy petition preparer’s failure to comply with the provisions of title 11 and 

the Federal Rules of Bankruptcy Procedure may result in fines or imprisonment or 

both. 11 U.S.C. § 110; 18 U.S.C. § 156. 

Date

Signature of bankruptcy petition preparer or officer, principal, responsible person, or 

partner whose Social-Security number is provided above. 

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 9 of 75
B 1D (Official Form 1, Exhibit D) (12/08)

UNITED STATES BANKRUPTCY COURT

Northern District of Illinois

Eastern Division

In re Steven G. Pometta Phyllis A. Pometta 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 cannot do so, you are not eligible to file a bankruptcy case, and the court can 

dismiss any case you do file. If that happens, you will lose whatever filing fee you paid, and your creditors 

will be able to resume collection activities against you. If your case is dismissed and you file another 

bankruptcy case later, you may be required to pay a second filing fee and you may have to take extra steps 

to stop creditors' collection activities.

 Every individual debtor must file this Exhibit D. If a joint petition is filed, each spouse must complete and file 

a separate Exhibit D. Check one of the five statements below and attach any documents as directed.

 1. Within the 180 days before the filing of my bankruptcy case, I received a briefing from a credit 

counseling agency approved by the United States trustee or bankruptcy administrator that outlined the opportunities 

for available credit counseling and assisted me in performing a related budget analysis, and I have a certificate 

from the agency describing the services provided to me. Attach a copy of the certificate and a copy of any debt 

repayment plan developed through the agency.



 2. Within the 180 days before the filing of my bankruptcy case, I received a briefing from a credit 

counseling agency approved by the United States trustee or bankruptcy administrator that outlined the opportunities 

for available credit counseling and assisted me in performing a related budget analysis, but I do not have a 

certificate from the agency describing the services provided to me. You must file a copy of a certificate from the 

agency describing the services provided to you and a copy of any debt repayment plan developed through the 

agency no later than 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 the following exigent circumstances 

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

exigent circumstances here.]



 If your certification is satisfactory to the court, you must still obtain the credit counseling briefing 

within the first 30 days after you file your bankruptcy petition and promptly file a certificate from the 

agency that provided the counseling, together with a copy of any debt management plan developed 

through the agency. Failure to fulfill these requirements may result in dismissal of your case. Any 

extension of the 30-day deadline can be granted only for cause and is limited to a maximum of 15 days. 

Your case may also be dismissed if the court is not satisfied with your reasons for filing your bankruptcy 

case without first receiving a credit counseling briefing.

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 10 of 75
B 1D (Official Form 1, Exh. D) (12/08) – Cont.





 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.);

 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.]

 Disability. (Defined in 11 U.S.C. § 109(h)(4) as physically impaired to the extent of being 

unable, after reasonable effort, to participate in a credit counseling briefing in person, by telephone, or 

through the Internet.);

 Active military duty in a military combat zone.





 5. The United States trustee or bankruptcy administrator has determined that the credit counseling 

requirement of 11 U.S.C. ' 109(h) does not apply in this district.



 I certify under penalty of perjury that the information provided above is true and correct.

Signature of Debtor:

Steven G. Pometta

s/ Steven G. Pometta

Date: 1/14/2010

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 11 of 75
B 1D (Official Form 1, Exhibit D) (12/08)

UNITED STATES BANKRUPTCY COURT

Northern District of Illinois

Eastern Division

In re Steven G. Pometta Phyllis A. Pometta 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 cannot do so, you are not eligible to file a bankruptcy case, and the court can 

dismiss any case you do file. If that happens, you will lose whatever filing fee you paid, and your creditors 

will be able to resume collection activities against you. If your case is dismissed and you file another 

bankruptcy case later, you may be required to pay a second filing fee and you may have to take extra steps 

to stop creditors' collection activities.

 Every individual debtor must file this Exhibit D. If a joint petition is filed, each spouse must complete and file 

a separate Exhibit D. Check one of the five statements below and attach any documents as directed.

 1. Within the 180 days before the filing of my bankruptcy case, I received a briefing from a credit 

counseling agency approved by the United States trustee or bankruptcy administrator that outlined the opportunities 

for available credit counseling and assisted me in performing a related budget analysis, and I have a certificate 

from the agency describing the services provided to me. Attach a copy of the certificate and a copy of any debt 

repayment plan developed through the agency.



 2. Within the 180 days before the filing of my bankruptcy case, I received a briefing from a credit 

counseling agency approved by the United States trustee or bankruptcy administrator that outlined the opportunities 

for available credit counseling and assisted me in performing a related budget analysis, but I do not have a 

certificate from the agency describing the services provided to me. You must file a copy of a certificate from the 

agency describing the services provided to you and a copy of any debt repayment plan developed through the 

agency no later than 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 the following exigent circumstances 

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

exigent circumstances here.]



 If your certification is satisfactory to the court, you must still obtain the credit counseling briefing 

within the first 30 days after you file your bankruptcy petition and promptly file a certificate from the 

agency that provided the counseling, together with a copy of any debt management plan developed 

through the agency. Failure to fulfill these requirements may result in dismissal of your case. Any 

extension of the 30-day deadline can be granted only for cause and is limited to a maximum of 15 days. 

Your case may also be dismissed if the court is not satisfied with your reasons for filing your bankruptcy 

case without first receiving a credit counseling briefing.

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 12 of 75
B 1D (Official Form 1, Exh. D) (12/08) – Cont.





 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.);

 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.]

 Disability. (Defined in 11 U.S.C. § 109(h)(4) as physically impaired to the extent of being 

unable, after reasonable effort, to participate in a credit counseling briefing in person, by telephone, or 

through the Internet.);

 Active military duty in a military combat zone.





 5. The United States trustee or bankruptcy administrator has determined that the credit counseling 

requirement of 11 U.S.C. ' 109(h) does not apply in this district.



 I certify under penalty of perjury that the information provided above is true and correct.

Signature of Debtor: s/ Phyllis A. Pometta

Phyllis A. Pometta

Date: 1/14/2010

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 13 of 75
B6A (Official Form 6A) (12/07)

, In re: Case No.

(If known)

Steven G. Pometta Phyllis A. Pometta

Debtors

SCHEDULE A - REAL PROPERTY

DESCRIPTION AND

LOCATION OF

PROPERTY

NATURE OF DEBTOR'S

INTEREST IN PROPERTY

AMOUNT OF

SECURED

CLAIM

CURRENT VALUE

OF DEBTOR'S

INTEREST IN

PROPERTY, WITHOUT

DEDUCTING ANY

SECURED CLAIM 

 OR EXEMPTION

HUSBAND, WIFE, JOINT

OR COMMUNITY

2819 Twin Falls Drive, Plainfiled, IL J

60586

Fee Owner $ 180,000.00 $ 206,000.00

Total  $ 180,000.00

(Report also on Summary of Schedules.)

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 14 of 75
B6B (Official Form 6B) (12/07)

, In re Case No.

(If known)

Steven G. Pometta Phyllis A. Pometta

Debtors

SCHEDULE B - PERSONAL PROPERTY

TYPE OF PROPERTY

CURRENT VALUE OF

DEBTOR'S INTEREST

IN PROPERTY, WITHOUT DEDUCTING ANY

SECURED CLAIM

OR EXEMPTION

DESCRIPTION AND LOCATION

NONE

OF PROPERTY

HUSBAND, WIFE, JOINT

OR COMMUNITY

1. Cash on hand 0.00

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.

2. Account at National City H 2.00

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 at Harris N.A. W 200.00

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 at Harris N.A. in Plainfield, IL J 75.00

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 at National City Bank in 

Plainfield, IL

W 100.00

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.

PayPal Account W 20.00

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.

Pro Pay Credit Account W 30.00

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.

Savings Account at National City Bank in 

Plainfield, IL

W 70.00

Security deposits with public utilities, 

telephone companies, landlords, and 

others.

3. H 0.00

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 15 of 75
B6B (Official Form 6B) (12/07) -- Cont.

, In re Case No.

(If known)

Steven G. Pometta Phyllis A. Pometta

Debtors

(Continuation Sheet)

SCHEDULE B - PERSONAL PROPERTY

TYPE OF PROPERTY

CURRENT VALUE OF

DEBTOR'S INTEREST

IN PROPERTY, WITHOUT DEDUCTING ANY

SECURED CLAIM

OR EXEMPTION

DESCRIPTION AND LOCATION

NONE

OF PROPERTY

HUSBAND, WIFE, JOINT

OR COMMUNITY

Household goods and furnishings, 

including audio, video, and computer 

equipment.

4. 2 end tables and 1 coffee table (150.00); 42" TV 

(400.0); Entertainment Unit (300.00); Dining room 

table, 4 chairs and buffet (75.00); 2 end tables and 

1 coffee table (35.00); Bedroom Set #1 (2 child size 

dressors, 1 mirror, and Queen Headbord---100.00); 

Bedroom Set #2 (child size dressers/changing 

station and desk---50.00); Bedroom Set #3 (2 

childsize dressers/hutch---50.00); Master Bedroom 

Set (K headboard, 2 dressers, armoire---500.00); 

Washer/Dryer (100.00); Shed (500.00); Pool 

(1000.00)

J 3,260.00

Household goods and furnishings, 

including audio, video, and computer 

equipment.

Kitchen Table and 6 chairs (100.00); Hutch 

($50.00); 2 Bar Stools (20.00); Refreigerator 

(200.00); Oven ($100.00); Microwave ($25.00); 

Dishwasher ($50.00); Loveseat (100.00); Couch 

(200.00); Chair and Ottoman (75.00)

J 920.00

Books, pictures and other art objects, 

antiques, stamp, coin, record, tape, 

compact disc, and other collections or 

collectibles.

5. J 0.00

6. Wearing apparel. Normal Wearing Apparel at 2819 Twin Falls Drive, 

Plainfield, IL

J 200.00

7. Furs and jewelry. J 0.00

Firearms and sports, photographic, and 

other hobby equipment.

8. W 0.00

Interests in insurance policies. Name 

insurance company of each policy and 

itemize surrender or refund value of 

each.

9. Term Life Insurance Policy with Northwestern 

Mutual

W 0.00

Interests in insurance policies. Name 

insurance company of each policy and 

itemize surrender or refund value of 

each.

Term Life Insurance Policy with Northwestern 

Mutual

H 0.00

Annuities. Itemize and name each 

issuer.

10. W 0.00

Interests in an education IRA as defined 

in 26 U.S.C. § 530(b)(1) or under a 

qualified State tuition plan as defined in 

26 U.S.C. § 529(b)(1). Give particulars. 

(File separately the record(s) of any such 

interest(s). 11 U.S.C. § 521(c).)

11. H 0.00

Interests in IRA, ERISA, Keogh, or other 

pension or profit sharing plans. Give 

particulars.

12. IRA with Putnam; Boston, MA 02266-8383 W 14,000.00

Interests in IRA, ERISA, Keogh, or other 

pension or profit sharing plans. Give 

particulars.

Pension with Painters Local 97 District 30 H 24,000.00

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 16 of 75
B6B (Official Form 6B) (12/07) -- Cont.

, In re Case No.

(If known)

Steven G. Pometta Phyllis A. Pometta

Debtors

(Continuation Sheet)

SCHEDULE B - PERSONAL PROPERTY

TYPE OF PROPERTY

CURRENT VALUE OF

DEBTOR'S INTEREST

IN PROPERTY, WITHOUT DEDUCTING ANY

SECURED CLAIM

OR EXEMPTION

DESCRIPTION AND LOCATION

NONE

OF PROPERTY

HUSBAND, WIFE, JOINT

OR COMMUNITY

Stock and interests in incorporated and 

unincorporated businesses. Itemize.

13. H 0.00

Interests in partnerships or joint 

ventures. Itemize.

14. H 0.00

Government and corporate bonds and 

other negotiable and nonnegotiable 

instruments.

15. H 0.00

16. Accounts receivable. H 0.00

Alimony, maintenance, support, and 

property settlements to which the debtor 

is or may be entitled. Give particulars.

17. H 0.00

Other liquidated debts owed to debtor 

including tax refunds. Give particulars.

18. H 0.00

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.

19. H 0.00

Contingent and noncontingent interests 

in estate of a decedent, death benefit 

plan, life insurance policy, or trust.

20. H 0.00

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.

21. H 0.00

Patents, copyrights, and other 

intellectual property. Give particulars.

22. H 0.00

Licenses, franchises, and other general 

intangibles. Give particulars.

23. H 0.00

24.Customer lists or other compilations J 0.00

containing personally identifiable 

information (as defined in 11 U.S.C. § 

101(41A)) provided to the debtor by 

individuals in connection with obtaining a 

product or service from the debtor primarily 

for personal, family, or household 

purposes.

Automobiles, trucks, trailers, and other 

vehicles and accessories.

25. 2004 Kia Sodona J 5,000.00

Automobiles, trucks, trailers, and other 

vehicles and accessories.

2004 Nissan Frontier J 9,700.00

26. Boats, motors, and accessories. J 0.00

27. Aircraft and accessories. J 0.00

Office equipment, furnishings, and 

supplies.

28. Computer ($600.00), Desk and Shelving (10.00), 

Fax/Copier ($10.00)

W 620.00

Machinery, fixtures, equipment and 

supplies used in business.

29. W 0.00

30. Inventory. W 0.00

31. Animals. X

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 17 of 75
B6B (Official Form 6B) (12/07) -- Cont.

, In re Case No.

(If known)

Steven G. Pometta Phyllis A. Pometta

Debtors

(Continuation Sheet)

SCHEDULE B - PERSONAL PROPERTY

TYPE OF PROPERTY

CURRENT VALUE OF

DEBTOR'S INTEREST

IN PROPERTY, WITHOUT DEDUCTING ANY

SECURED CLAIM

OR EXEMPTION

DESCRIPTION AND LOCATION

NONE

OF PROPERTY

HUSBAND, WIFE, JOINT

OR COMMUNITY

Crops - growing or harvested. Give 

particulars.

32. W 0.00

33. Farming equipment and implements. W 0.00

34. Farm supplies, chemicals, and feed. W 0.00

Other personal property of any kind not 

already listed. Itemize.

35. Dry Wall tools H 1,100.00

Total  $ 59,297.00

(Include amounts from any continuation sheets 

attached. Report total also on Summary of 

Schedules.)

3 continuation sheets attached

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 18 of 75
, In re Case No.

Debtors (If known)

Steven G. Pometta Phyllis A. Pometta

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

SCHEDULE C - PROPERTY CLAIMED AS EXEMPT

11 U.S.C. § 522(b)(2) 

(Check one box)

Debtor claims the exemptions to which debtor is entitled under:

 11 U.S.C. § 522(b)(3) 

Check if debtor claims a homestead exemption that exceeds

$136,875

 





DESCRIPTION OF PROPERTY

SPECIFY LAW

PROVIDING EACH

EXEMPTION

VALUE OF

CLAIMED

EXEMPTION

CURRENT

VALUE OF PROPERTY

WITHOUT DEDUCTING

EXEMPTION

2004 Kia Sodona 735 ILCS 5/12-1001(c) 2,400.00 5,000.00

735 ILCS 5/12-1001(b) 1,000.00

2004 Nissan Frontier 735 ILCS 5/12-1001(c) 2,400.00 9,700.00

735 ILCS 5/12-1001(b) 6,350.00

2819 Twin Falls Drive, 

Plainfiled, IL 60586

735 ILCS 5/12-901 30,000.00 180,000.00

Checking Account at Harris 

N.A.

735 ILCS 5/12-1001(b) 200.00 200.00

Checking Account at Harris 

N.A. in Plainfield, IL

735 ILCS 5/12-1001(b) 75.00 75.00

Checking Account at National 

City Bank in Plainfield, IL

735 ILCS 5/12-1001(b) 100.00 100.00

IRA with Putnam; Boston, MA 

02266-8383

735 ILCS 5/12-1006 14,000.00 14,000.00

Normal Wearing Apparel at 

2819 Twin Falls Drive, 

Plainfield, IL

735 ILCS 5/12-1001(a),(e) 200.00 200.00

Pension with Painters Local 97 

District 30

735 ILCS 5/12-1006 24,000.00 24,000.00

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 19 of 75
B6D (Official Form 6D) (12/07)

, In re Case No.

(If known)

Steven G. Pometta Phyllis A. Pometta

Debtors

SCHEDULE D - CREDITORS HOLDING SECURED CLAIMS

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

DATE CLAIM WAS

INCURRED, NATURE

OF LIEN, AND

DESCRIPTION AND 

VALUE OF PROPERTY

SUBJECT TO LIEN

AMOUNT OF 

CLAIM WITHOUT

DEDUCTING

VALUE OF

COLLATERAL

UNSECURED

PORTION, IF

ANY

DISPUTED

UNLIQUIDATED

HUSBAND, WIFE, JOINT

OR COMMUNITY

CREDITOR'S NAME AND

MAILING ADDRESS

INCLUDING ZIP CODE AND

AN ACCOUNT NUMBER

(See Instructions, Above.)

CODEBTOR

ACCOUNT NO. 2001469570-2 J 183,000.00 Mortgage

2819 Twin Falls Drive, Plainfiled, 

IL 60586

__________________________

VALUE $180,000.00

Citi Mortgage

P.O. Box 183040

Columbus, OH 43218-3040

0.00

ACCOUNT NO. 00000610023751 J 23,000.00 Second Lien on Residence

2819 Twin Falls Drive, Plainfiled, 

IL 60586

__________________________

VALUE $180,000.00

Harris, N.A.

P.O. Box 6201

Carol Stream, IL 60197-6201

157,000.00

0

attached

continuation sheets

$ $ 157,000.00 (Total of this page)

Subtotal  206,000.00

$ 157,000.00 $

(Use only on last page)

Total  206,000.00

(If applicable, report 

also on Statistical 

Summary of Certain 

Liabilities and 

Related Data.)

(Report also on Summary of 

Schedules)

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 20 of 75
B6E (Official Form 6E) (12/07)

, Case No. In re

(If known) Debtors

Steven G. Pometta Phyllis A. Pometta

SCHEDULE E - CREDITORS HOLDING UNSECURED PRIORITY CLAIMS

 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.)

 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).

 Domestic Support Obligations

 Extensions of credit in an involuntary case

 Claims arising in the ordinary course of the debtor's business or financial affairs after the commencement of the case but before the earlier of the 

appointment of a trustee or the order for relief. 11 U.S.C. § 507(a)(3).



 Wages, salaries, and commissions

 Wages, salaries, and commissions, including vacation, severance, and sick leave pay owing to employees and commissions owing to qualifying

independent sales representatives up to $10,950* per person earned within 180 days immediately preceding the filing of the original petition, or the

cessation of business, whichever occurred first, to the extent provided in 11 U.S.C. § 507(a)(4).



 Contributions to employee benefit plans

 Money owed to employee benefit plans for services rendered within 180 days immediately preceding the filing of the original petition, or the

cessation of business, whichever occurred first, to the extent provided in 11 U.S.C. § 507(a)(5).



 Certain farmers and fishermen

 Claims of certain farmers and fishermen, up to $5,400* per farmer or fisherman, against the debtor, as provided in 11 U.S.C. § 507(a)(6).





 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).

 Deposits by individuals

 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).

1 continuation sheets attached

 Claims based on commitments to the 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).

 Commitments to Maintain the Capital of an Insured Depository Institution

 * 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.

 

 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).

Claims for Death or Personal Injury While Debtor Was Intoxicated

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 21 of 75
B6E (Official Form 6E) (12/07) – Cont.

, In re Case No.

(If known) Steven G. Pometta Phyllis A. Pometta

Debtors

SCHEDULE E - CREDITORS HOLDING UNSECURED PRIORITY CLAIMS

(Continuation Sheet)

CODEBTOR

HUSBAND, WIFE, JOINT

OR COMMUNITY

CONTINGENT

UNLIQUIDATED

DISPUTED

 AMOUNT 

OF CLAIM

AMOUNT

ENTITLED TO

PRIORITY

CREDITOR'S NAME,

MAILING ADDRESS

INCLUDING ZIP CODE,

AND ACCOUNT NUMBER

(See instructions above.)

DATE CLAIM WAS 

INCURRED AND 

CONSIDERATION 

FOR CLAIM

AMOUNT

NOT

ENTITLED TO

PRIORITY, IF

ANY

ACCOUNT NO. $0.00

Sheet no. 1 of 1 continuation sheets attached to Schedule of $

Creditors Holding Priority Claims

Subtotals

(Totals of this page)

 $ 0.00 0.00$ 0.00

Total

(Use only on last page of the completed 

Schedule E. Report also on the Summary of 

Schedules.)



0.00

0.00

Total

(Use only on last page of the completed 

Schedule E. If applicable, report also on the 

Statistical Summary of Certain Liabilities 

and Related Data. )



0.00

$

$ $

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 22 of 75
,

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

In re Case No.

(If known)

Steven G. Pometta Phyllis A. Pometta

Debtors

SCHEDULE F - CREDITORS HOLDING UNSECURED NONPRIORITY CLAIMS

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

DATE CLAIM WAS 

INCURRED AND 

CONSIDERATION FOR 

CLAIM.

 IF CLAIM IS SUBJECT TO

SETOFF, SO STATE

CREDITOR'S NAME,

MAILING ADDRESS

INCLUDING ZIP CODE,

AND ACCOUNT NUMBER

(See instructions above.)

AMOUNT OF 

CLAIM

CODEBTOR

HUSBAND, WIFE, JOINT

OR COMMUNITY

CONTINGENT

UNLIQUIDATED

DISPUTED

ACCOUNT NO. 3717-342673-42009 J 2,330.82

American Express

P.O. Box 0001

Los Angeles, CA 90096

Credit Card

ACCOUNT NO. 15-11836874 J 138.45

AT & T c/o CCA

P.O. Box 806

Norwell, MA 02061

Telephone Land Line

ACCOUNT NO. 4802-1325-3933-1671 J 2,316.15

Capital One

P.O. BO6492

Carol Stream, IL 60197

Credit Card

ACCOUNT NO. 373352 J 18171.66.00

CapitalOne

c/o MRS Associates

P.O. Box 1930

Cherry Hill, NJ 08003

Credit Card

ACCOUNT NO. 4185-5625-0021-1865 J 1,223.43

Chase

Cardmember Services

P.O. Box 15153

Wilmington, DE 19886

Credit Card

4 Continuation sheets attached

Subtotal  $ 6,008.85

Total 

$

(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 Data.)

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 23 of 75
B6F (Official Form 6F) (12/07) - Cont.

, In re Case No.

(If known)

Steven G. Pometta Phyllis A. Pometta

Debtors

SCHEDULE F - CREDITORS HOLDING UNSECURED NONPRIORITY CLAIMS

(Continuation Sheet)

DATE CLAIM WAS 

INCURRED AND 

CONSIDERATION FOR 

CLAIM.

 IF CLAIM IS SUBJECT TO

SETOFF, SO STATE

CREDITOR'S NAME,

MAILING ADDRESS

INCLUDING ZIP CODE,

AND ACCOUNT NUMBER

(See instructions above.)

AMOUNT OF 

CLAIM

CODEBTOR

HUSBAND, WIFE, JOINT

OR COMMUNITY

CONTINGENT

UNLIQUIDATED

DISPUTED

ACCOUNT NO. 4266-9020-2388-3075 J 6,328.51

Chase

Cardmember Services

P.O. Box 15153

Wilmington, DE 19886

Credit Card

ACCOUNT NO. 5222-7730-1025-3790 J 6,282.23

Chase

Cardmember Services

PO Box 15153

Wilmington, DE 19886

Credit Card

ACCOUNT NO. 4227-6510-2169-5027 J 1,197.39

Chase-BP

Cardmember Services

PO Box 15325

Wilmington, DE 19886

Credit Card

ACCOUNT NO. DC60604 J 139.26

Doctors Center for Wellness

1045 Burlington Ave

Lisle, IL 60532

Chiropractic Care for Phyllis in 2009

ACCOUNT NO. E048503569 H 04/2009 75.63

Edward Hospital

c/o Miramed Revenue Group

Dept 77304

P.O. Box 77000

Detroit, MI 48277

Medical Care for Steve

Subtotal  14,023.02 Sheet no. 1 of 4 continuation sheets attached to Schedule of Creditors 

Holding Unsecured

Nonpriority Claims

$

Total 

$

(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 Data.)

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 24 of 75
B6F (Official Form 6F) (12/07) - Cont.

, In re Case No.

(If known)

Steven G. Pometta Phyllis A. Pometta

Debtors

SCHEDULE F - CREDITORS HOLDING UNSECURED NONPRIORITY CLAIMS

(Continuation Sheet)

DATE CLAIM WAS 

INCURRED AND 

CONSIDERATION FOR 

CLAIM.

 IF CLAIM IS SUBJECT TO

SETOFF, SO STATE

CREDITOR'S NAME,

MAILING ADDRESS

INCLUDING ZIP CODE,

AND ACCOUNT NUMBER

(See instructions above.)

AMOUNT OF 

CLAIM

CODEBTOR

HUSBAND, WIFE, JOINT

OR COMMUNITY

CONTINGENT

UNLIQUIDATED

DISPUTED

ACCOUNT NO. E05032630 J 602.99

Edward Hospital

P.O. Box 4207

Carol Stream, IL 60197

Nursemaid's Elbow Meidcal Care for 

Gianna on 9/25/09

ACCOUNT NO. 7302-8262-4357-3134 J 1,000.25

Exxon-Mobil

Processing Center

Des Moines, IA 50361

Credit Card

ACCOUNT NO. 14432022 J 1,640.55

First Source Advantage c/o HSBC Retail

P.O. Box 628

Buffolo, NY 14240

Credit Card

ACCOUNT NO. POMSTE0001 J 43.60

Generations Family Medical

2940 Rollingridge Drive

Naperville, IL 60564

10/19, 10/26, and 11/9 Physicals 

ACCOUNT NO. 020-0161-693 J 3,262.98

Kohls

P.O. Box 2983

Milwaukee, WI 53201

Credit Card

Subtotal  6,550.37 Sheet no. 2 of 4 continuation sheets attached to Schedule of Creditors 

Holding Unsecured

Nonpriority Claims

$

Total 

$

(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 Data.)

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 25 of 75
B6F (Official Form 6F) (12/07) - Cont.

, In re Case No.

(If known)

Steven G. Pometta Phyllis A. Pometta

Debtors

SCHEDULE F - CREDITORS HOLDING UNSECURED NONPRIORITY CLAIMS

(Continuation Sheet)

DATE CLAIM WAS 

INCURRED AND 

CONSIDERATION FOR 

CLAIM.

 IF CLAIM IS SUBJECT TO

SETOFF, SO STATE

CREDITOR'S NAME,

MAILING ADDRESS

INCLUDING ZIP CODE,

AND ACCOUNT NUMBER

(See instructions above.)

AMOUNT OF 

CLAIM

CODEBTOR

HUSBAND, WIFE, JOINT

OR COMMUNITY

CONTINGENT

UNLIQUIDATED

DISPUTED

ACCOUNT NO. 6004-3009-0804-8652 J 1,344.74

Menards

c/o HSBC Retail SRV

P.O. Box 17602

Baltimore, MD 21297

Credit Card

ACCOUNT NO. 5148-6550-0371-0954 J 401.80

Meyer Platinum

P.O. Box 960015

Orlando, FL 32896

Credit Card

ACCOUNT NO. POMST000 J 08/2009 56.10

Michael Reicherts, MD.

P.O. Box 393

Bedford Park, IL 60499

Allergic Reaction Care for Alyssa; well 

check for all

ACCOUNT NO. 2030718 W 10/2009 385.00

Midwest Center for Advanced Imaging

4355 Montgomery Rd.

Naperville, IL 60564

Mammogram and Neck x-ray 

ACCOUNT NO. J 4,500.00

Ralph & Carol Mautoni

8439 Sandalwood

Darien, IL 60561

Money Lent for 2009 to cover Mortgage 

Payments

Subtotal  6,687.64 Sheet no. 3 of 4 continuation sheets attached to Schedule of Creditors 

Holding Unsecured

Nonpriority Claims

$

Total 

$

(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 Data.)

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 26 of 75
B6F (Official Form 6F) (12/07) - Cont.

, In re Case No.

(If known)

Steven G. Pometta Phyllis A. Pometta

Debtors

SCHEDULE F - CREDITORS HOLDING UNSECURED NONPRIORITY CLAIMS

(Continuation Sheet)

DATE CLAIM WAS 

INCURRED AND 

CONSIDERATION FOR 

CLAIM.

 IF CLAIM IS SUBJECT TO

SETOFF, SO STATE

CREDITOR'S NAME,

MAILING ADDRESS

INCLUDING ZIP CODE,

AND ACCOUNT NUMBER

(See instructions above.)

AMOUNT OF 

CLAIM

CODEBTOR

HUSBAND, WIFE, JOINT

OR COMMUNITY

CONTINGENT

UNLIQUIDATED

DISPUTED

ACCOUNT NO. 5156-2500-0527-1566 J 1,996.32

Reward Zone

P.O. Box 80045

Salinas, CA 93912

Credit Card

ACCOUNT NO. 148-404-924 J 1,611.77

Shell

Processing Center

P.O. Box 183018

Columbus, OH 43218

Credit Card

ACCOUNT NO. 4352-3750-2683-8062 J 3,515.47

Target National Bank

P.O. Box 59317

Minneapolis, MN 55459

Credit Card

ACCOUNT NO. 5774-4212-2000-7083 J 3,105.99

Wells Fargo

P.O. Box 98752

Las Vegas, NV 89193

Credit Card

Subtotal  10,229.55 Sheet no. 4 of 4 continuation sheets attached to Schedule of Creditors 

Holding Unsecured

Nonpriority Claims

$

Total

43,499.43 

$

(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 Data.)

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 27 of 75
Andrew M. Carter 0404578

Attorney for the Petitioner(s)

UNITED STATES BANKRUPTCY COURT

In Re:

Debtor: Steven G. Pometta

Social Security Number: 6205

Case No: 

Joint Debtor: Phyllis A. Pometta

Social Security Number: 2561 Numbered Listing of Creditors

Chapter 7

Law Office of Andrew M. Carter

127 W. Willow Avenue

Wheaton, IL 60187

630-462-8071

Northern District of Illinois

Eastern Division

Creditor name and mailing address Category of Claim Amount of Claim

1 . American Express Unsecured Claims

P.O. Box 0001

Los Angeles, CA 90096

$ 2,330.82

2 . AT & T c/o CCA Unsecured Claims

P.O. Box 806

Norwell, MA 02061

$ 138.45

3 . Capital One Unsecured Claims

P.O. BO6492

Carol Stream, IL 60197

$ 2,316.15

4 . CapitalOne Unsecured Claims

c/o MRS Associates

P.O. Box 1930

Cherry Hill, NJ 08003

$ 0.00

5 . Chase Unsecured Claims

Cardmember Services

P.O. Box 15153

Wilmington, DE 19886

$ 1,223.43

Numbered Listing of Creditors - Page 1

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 28 of 75
In re: Steven G. Pometta Case No. _____________________

Phyllis A. Pometta

6 . Chase Unsecured Claims

Cardmember Services

P.O. Box 15153

Wilmington, DE 19886

$ 6,328.51

7 . Chase Unsecured Claims

Cardmember Services

PO Box 15153

Wilmington, DE 19886

$ 6,282.23

8 . Chase-BP Unsecured Claims

Cardmember Services

PO Box 15325

Wilmington, DE 19886

$ 1,197.39

9 . Citi Mortgage Secured Claims

P.O. Box 183040

Columbus, OH 43218-3040

$ 183,000.00

10 . Doctors Center for Wellness Unsecured Claims

1045 Burlington Ave

Lisle, IL 60532

$ 139.26

11 . Edward Hospital Unsecured Claims

P.O. Box 4207

Carol Stream, IL 60197

$ 602.99

12 . Edward Hospital Unsecured Claims

c/o Miramed Revenue Group

Dept 77304

P.O. Box 77000

Detroit, MI 48277

$ 75.63

13 . Exxon-Mobil Unsecured Claims

Processing Center

Des Moines, IA 50361

$ 1,000.25

14 . First Source Advantage c/o HSBC Retail Unsecured Claims

P.O. Box 628

Buffolo, NY 14240

$ 1,640.55

Numbered Listing of Creditors - Page 2

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 29 of 75
In re: Steven G. Pometta Case No. _____________________

Phyllis A. Pometta

15 . Generations Family Medical Unsecured Claims

2940 Rollingridge Drive

Naperville, IL 60564

$ 43.60

16 . Harris, N.A. Secured Claims

P.O. Box 6201

Carol Stream, IL 60197-6201

$ 23,000.00

17 . Kohls Unsecured Claims

P.O. Box 2983

Milwaukee, WI 53201

$ 3,262.98

18 . Menards Unsecured Claims

c/o HSBC Retail SRV

P.O. Box 17602

Baltimore, MD 21297

$ 1,344.74

19 . Meyer Platinum Unsecured Claims

P.O. Box 960015

Orlando, FL 32896

$ 401.80

20 . Michael Reicherts, MD. Unsecured Claims

P.O. Box 393

Bedford Park, IL 60499

$ 56.10

21 . Midwest Center for Advanced Imaging Unsecured Claims

4355 Montgomery Rd.

Naperville, IL 60564

$ 385.00

22 . Ralph & Carol Mautoni Unsecured Claims

8439 Sandalwood

Darien, IL 60561

$ 4,500.00

23 . Reward Zone Unsecured Claims

P.O. Box 80045

Salinas, CA 93912

$ 1,996.32

Numbered Listing of Creditors - Page 3

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 30 of 75
In re: Steven G. Pometta Case No. _____________________

Phyllis A. Pometta

24 . Shell Unsecured Claims

Processing Center

P.O. Box 183018

Columbus, OH 43218

$ 1,611.77

25 . Target National Bank Unsecured Claims

P.O. Box 59317

Minneapolis, MN 55459

$ 3,515.47

26 . Wells Fargo Unsecured Claims

P.O. Box 98752

Las Vegas, NV 89193

$ 3,105.99

Numbered Listing of Creditors - Page 4

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 31 of 75
In re: Steven G. Pometta Case No. _____________________

Phyllis A. Pometta

(The penalty for making a false statement or concealing property is a fine up to $500,000 or 

imprisonment for up to 5 years or both. 18 U.S.C. secs. 152 and 3571.)

DECLARATION

I, Steven G. Pometta, and I, Phyllis A. Pometta, named as debtors in this case, declare under penalty of perjury that we have 

read the foregoing Numbered Listing of Creditors, consisting of 4 sheets (not including this declaration), and that it is true and 

correct to the best of our information and belief.

Signature:

Dated: 1/14/2010

s/ Phyllis A. Pometta

Signature: s/ Steven G. Pometta

Steven G. Pometta

Dated: 1/14/2010

Phyllis A. Pometta

Numbered Listing of Creditors - Page 5

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 32 of 75
, Case No. In re:

B6G (Official Form 6G) (12/07)

(If known)

Steven G. Pometta Phyllis A. Pometta

Debtors

SCHEDULE G - EXECUTORY CONTRACTS AND UNEXPIRED LEASES

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

NAME AND MAILING ADDRESS, INCLUDING ZIP CODE,

OF OTHER PARTIES TO LEASE OR CONTRACT.

DESCRIPTION OF CONTRACT OR LEASE AND NATURE OF

DEBTOR'S INTEREST, STATE WHETHER LEASE IS FOR

NONRESIDENTIAL REAL PROPERTY. STATE CONTRACT

NUMBER OF ANY GOVERNMENT CONTRACT.

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 33 of 75
B6H (Official Form 6H) (12/07)

In re: Case No. , (If known)

Steven G. Pometta Phyllis A. Pometta

Debtors

SCHEDULE H - CODEBTORS

 Check this box if debtor has no codebtors.

NAME AND ADDRESS OF CODEBTOR NAME AND ADDRESS OF CREDITOR

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 34 of 75
B6I (Official Form 6I) (12/07)

In re Case No. , Steven G. Pometta Phyllis A. Pometta

Debtors (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

Married

RELATIONSHIP(S): AGE(S):

Daughter 11

Son 8

Daughter 5

DEBTOR SPOUSE

Occupation 

How long employed

Address of Employer

Dry Wall Finisher Marketing

2819 Twin Falls Drive

Plainfield, IL 60586

Name of Employer None None

Employment:

INCOME: (Estimate of average or projected monthly income at time

 case filed) DEBTOR SPOUSE

3. SUBTOTAL

4. LESS PAYROLL DEDUCTIONS

 b. Insurance 0.00 0.00

 c. Union dues $ 0.00 $ 0.00

$ $

 a. Payroll taxes and social security $ $ 0.00 0.00

2. Estimate monthly overtime 0.00 $ 0.00

$ 0.00 $ 0.00

 (Prorate if not paid monthly.)

$ 0.00 $ 0.00

1. Monthly gross wages, salary, and commissions

$

 d. Other (Specify) $ $ 0.00 0.00

5. SUBTOTAL OF PAYROLL DEDUCTIONS

Unemployment: 

11. Social security or other government assistance

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

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

$ $

8. Income from real property $ $

 (Attach detailed statement) $ $

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

6. TOTAL NET MONTHLY TAKE HOME PAY $ $

$ $

(Specify) $ $

9. Interest and dividends

0.00 0.00

0.00 0.00

0.00

0.00

0.00

0.00

2,236.00

29.00

0.00

0.00

0.00

0.00

$ $ 12. Pension or retirement income 0.00 0.00

Food Stamps $ $ 230.00 0.00 (Specify)

13. Other monthly income

15. AVERAGE MONTHLY INCOME (Add amounts shown on lines 6 and 14) $ 2,466.00 $ 29.00

$ 2,466.00 $ 29.00

16. COMBINED AVERAGE MONTHLY INCOME: (Combine column

totals from line 15)

$ 2,495.00

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

Statistical Summary of Certain Liabilities and Related Data)

14. SUBTOTAL OF LINES 7 THROUGH 13

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

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 35 of 75
B6I (Official Form 6I) (12/07) - Cont.

In re Case No. , Steven G. Pometta Phyllis A. Pometta

Debtors (If known)

SCHEDULE I - CURRENT INCOME OF INDIVIDUAL DEBTOR(S)

NONE

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 36 of 75
B6J (Official Form 6J) (12/07)

Debtors (If known)

Steven G. Pometta Phyllis A. Pometta Case No. In re ,

SCHEDULE J - CURRENT EXPENDITURES OF INDIVIDUAL DEBTOR(S)

 Complete this schedule by estimating the average or projected monthly expenses of the debtor and the debtor’s family at time case filed. Prorate 

any payments made biweekly, quarterly, semi-annually, or annually to show monthly rate. The average monthly expenses calculated on this form may 

differ from the deductions from income allowed on Form22A or 22C.

 Check this box if a joint petition is filed and debtor's spouse maintains a separate household. Complete a separate schedule of

 expenditures labeled "Spouse."

 a. Are real estate taxes included?

 b. Is property insurance included?

2. Utilities:

70.00

65.00

169.00

2,093.00

No

Yes No

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

Yes 



 a. Electricity and heating fuel $

 b. Water and sewer $

 c. Telephone $

d. Other Cable ($100.00); Cell Phones ($180.00) $ 280.00

146.00

0.00

63.00

0.00

25.00

0.00

320.00

125.00

0.00

100.00

500.00

20.00

b. Life

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

10. Charitable contributions $

d. Auto

c. Health

$

a. Homeowner’s or renter’s $

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

8. Transportation (not including car payments) $

7. Medical and dental expenses $

$

$

6. Laundry and dry cleaning $

4. Food $

3. Home maintenance (repairs and upkeep) $

5. Clothing $

e. Other $ 0.00

0.00

0.00

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

a. Auto

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

(Specify) $

$

b. Other $ 0.00

0.00

0.00

0.00

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) $

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

17. Other Union Dues ($30.00), Homeowner's Association (21.0 $ 51.00

$ 4,027.00 18. AVERAGE MONTHLY EXPENSES (Total lines 1-17. Report also on Summary of Schedules and,

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

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

20. STATEMENT OF MONTHLY NET INCOME

a. Average monthly income from Line 15 of Schedule I $

b. Average monthly expenses from Line 18 above

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

$

$ -1,532.00

4,027.00

2,495.00

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 37 of 75
Form 6 - Statistical Summary (12/07)

United States Bankruptcy Court

Northern District of Illinois

Eastern Division

In re Case No. ,

Chapter 7

Steven G. Pometta Phyllis A. Pometta

Debtors

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

 Check this box if you are an individual debtor whose debts are NOT primarily consumer debts. You are not required to report any

information here.



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

$

$

$

$

$

$

Amount

TOTAL

Obligations to Pension or Profit-Sharing, and Other Similar Obligations 

(from Schedule F)

Domestic Support, Separation Agreement, and Divorce Decree 

Obligations Not Reported on Schedule E.

Student Loan Obligations (from Schedule F)

Claims for Death or Personal Injury While Debtor Was

Intoxicated (from Schedule E) (whether disputed or undisputed)

Domestic Support Obligations (from Schedule E)

Taxes and Certain Other Debts Owed to Governmental Units (from 

Schedule E) 

Type of Liability

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

$

0.00

0.00

0.00

0.00

0.00

0.00

0.00

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

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

Average Expenses (from Schedule J, Line 18)

$

$

Average Income (from Schedule I, Line 16) $

State the following:

2,495.00

4,027.00

2,577.00

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 38 of 75
United States Bankruptcy Court

Northern District of Illinois

Eastern Division

In re Case No. ,

Chapter 7

Steven G. Pometta Phyllis A. Pometta

Debtors

State the following:

1. Total from Schedule D, “UNSECURED PORTION, IF ANY” column

2. Total from Schedule E, “AMOUNT ENTITLED TO PRIORITY” 

column.

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

IF ANY” column

4. Total from Schedule F

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

$

$

$

$

$

157,000.00

0.00

0.00

43,499.43

200,499.43

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 39 of 75
UNITED STATES BANKRUPTCY COURT

Northern District of Illinois

Eastern Division

In re: Steven G. Pometta Phyllis A. Pometta Case No.

Chapter 7

BUSINESS INCOME AND EXPENSES

0.00

0.00

operation.)

PART A - GROSS BUSINESS INCOME FOR PREVIOUS 12 MONTHS:

 1. Gross Income For 12 Months Prior to Filing:

PART B - ESTIMATED AVERAGE FUTURE GROSS MONTHLY INCOME: 

 2. Gross Monthly Income:

$

$

PART C - ESTIMATED FUTURE MONTHLY EXPENSES:

 3. Net Employee Payroll (Other Than Debtor) $

 4. Payroll Taxes

 5. Unemployment Taxes

 6. Worker's Compensation

 7. Other Taxes

 8. Inventory Purchases (Including raw materials)

 9. Purchase of Feed/Fertilizer/Seed/Spray

 10. Rent (Other than debtor's principal residence)

 11. Utilities

 12. Office Expenses and Supplies

 13. Repairs and Maintenance

 14. Vehicle Expenses 

 15. Travel and Entertainment

 16. Equipment Rental and Leases

 17. Legal/Accounting/Other Professional Fees

 18. Insurance

 19. Employee Benefits (e.g., pension, medical, etc.)

FINANCIAL REVIEW OF THE DEBTOR'S BUSINESS (NOTE: ONLY INCLUDE information directly related to the business

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

 20. Payments to Be Made Directly By Debtor to Secured Creditors For

Pre-Petition Business Debts (Specify):

None

 21. Other (Specify):

None

 22. Total Monthly Expenses (Add items 3 - 21) $ 0.00

 23. AVERAGE NET MONTHLY INCOME (Subtract Item 22 from Item 2) $

PART D - ESTIMATED AVERAGE NET MONTHLY INCOME:

0.00

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 40 of 75
B6 Summary (Official Form 6 - Summary) (12/07)

United States Bankruptcy Court

Northern District of Illinois

Eastern Division

Case No. 

Debtors

Chapter 7

, In re Steven G. Pometta Phyllis A. Pometta

SUMMARY OF SCHEDULES

Indicate as to each schedule whether that schedule is attached and state the number of pages in each. Report the totals from Schedules A, B, D, E, F, I,

and J in the boxes provided. Add the amounts from Schedules A and B to determine the total amount of the debtor’s assets. Add the amounts of all claims from 

Schedules D, E, and F to determine the total amount of the debtor’s liabilities. Individual debtors also must complete the “Statistical Summary of Certain Liabilities 

and Related Data” if they file a case under chapter 7, 11, or 13.

NAME OF SCHEDULE ATTACHED

(YES/NO)

NO. OF SHEETS ASSETS LIABILITIES OTHER

Real Property

Personal Property

Property Claimed

as Exempt

Creditors Holding

Secured Claims

Creditors Holding Unsecured

Priority Claims

(Total of Claims on Schedule E)

Creditors Holding Unsecured

Nonpriority Claims

Executory Contracts and

Unexpired Leases

Codebtors

Current Expenditures of 

Individual Debtor(s)

TOTAL

$ 

$

$

$

$

$

$

$ $

YES

YES

YES

YES

YES

YES

YES

YES

YES

YES

A -

B -

C -

D -

E -

F -

G -

H -

I -

J -

Current Income of

Individual Debtor(s)

1

4

1

1

2

5

1

1

2

2

239,297.00 249,499.43

180,000.00

59,297.00

206,000.00

0.00

43,499.43

2,495.00

4,027.00

20

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 41 of 75
, In re Case No.

(If known)

Steven G. Pometta Phyllis A. Pometta

Debtors

B6 Declaration (Official Form 6 - Declaration) (12/07)

DECLARATION CONCERNING DEBTOR'S SCHEDULES

DECLARATION UNDER PENALTY OF PERJURY BY INDIVIDUAL DEBTOR

sheets, and that they are true and correct to the best of my knowledge, information, and belief.

 I declare under penalty of perjury that I have read the foregoing summary and schedules, consisting of 22

Date: Signature:

Steven G. Pometta

1/14/2010 s/ Steven G. Pometta

Debtor

Phyllis A. Pometta

Date: 1/14/2010 Signature:

(Joint Debtor, if any)

s/ Phyllis A. Pometta

[If joint case, both spouses must sign]

DECLARATION UNDER PENALTY OF PERJURY ON BEHALF OF CORPORATION OR PARTNERSHIP

(NOT APPLICABLE)

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.

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 42 of 75
B7 (Official Form 7) (12/07)

UNITED STATES BANKRUPTCY COURT

Northern District of Illinois

Eastern Division

Case No. In re: , (If known)

Steven G. Pometta Phyllis A. Pometta

Debtors

STATEMENT OF FINANCIAL AFFAIRS

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 FISCAL YEAR PERIOD

Leopardo Companies, Inc

5200 Prairie Stone Pkwy

Hoffman Estates, IL 60192

73,000.00 2008

5,000.00 Babyswags (self-employed) 2008

Leopardo Companies, Inc.

5200 Prairie Stone Pkwy

Hoffman Estates, IL 60192

59,000.00 2007

Leopardo Companies, Inc.

5200 Prairie Stone Pkwy

Hoffman Estates, IL 60192

31,790.00 01/01/09-07/05/09

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 FISCAL YEAR PERIOD

10,000.00 Illinois Department of Employment Security 08/15/09-12/19/09

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 43 of 75
2

3. Payments to creditors

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

None

NAME AND ADDRESS OF 

CREDITOR

DATES OF

PAYMENTS

AMOUNT

PAID

AMOUNT

STILL OWING



a. Individual or joint debtor(s) with primarily consumer debts: List all payments on loans, installment purchases of goods or 

services, and other debts to any creditor made within 90 days immediately preceding the commencement of this case unless 

the aggregate value of all property that constitutes or is affected by such transfer is less than $600. Indicate with an asterisk 

(*) any payments that were made to a creditor on account of a domestic support obligation or as part of an alternative 

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

Citi Mortgage

P.O. Box 183040

Columbus, OH 43218-3040

10/11/09; 11/10/09; 12/09/09 5,400.00 184,000.00

Harris, N.A.

P.O. Box 6201

Carol Stream, IL 60197-6201

10/11/09; 11/10/09; 12/09/09 1,029.00 24,000.00



None b. Debtor whose debts are not primarily consumer debts: List each payment or other transfer to any creditor made within 90

days immediately preceding the commencement of the case unless the aggregate value of all property that constitutes or is

affected by such transfer is less than $5,475. If the debtor is an individual, indicate with an asterisk (*) any payments that

were made to a creditor on account of a domestic support obligation or as part of an alternative repayment schedule under

a plan by an approved nonprofit budgeting and credit counseling agency. (Married debtors filing under chapter 12 or chapter

13 must include payments and other transfers by either or both spouses whether or not a joint petition is filed, unless the

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

NAME AND ADDRESS OF CREDITOR DATES OF

PAYMENTS/

TRANSFERS

AMOUNT

PAID OR

VALUE OF

TRANSFERS

AMOUNT

STILL

OWING

None

NAME AND ADDRESS OF CREDITOR

AND RELATIONSHIP TO DEBTOR

DATE OF

PAYMENT

AMOUNT AMOUNT

PAID STILL OWING



c. All debtors: List all payments made within one year immediately preceding the commencement of this case to or for the 

benefit of creditors who are or were insiders. (Married debtors filing under chapter 12 or chapter 13 must include payments 

by either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is 

not filed.)

 

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



None a. List all suits and administrative proceedings to which the debtor is or was a party within one year immediately preceding 

the filing of this bankruptcy case. (Married debtors filing under chapter 12 or chapter 13 must include information concerning 

either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is 

not filed.)

CAPTION OF SUIT

AND CASE NUMBER NATURE OF PROCEEDING

COURT OR AGENCY

AND LOCATIO

STATUS OR

DISPOSITION

 

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 44 of 75
3

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

immediately preceding the commencement of this case. (Married debtors filing under chapter 12 or chapter 13 must include 

information concerning property of either or both spouses whether or not a joint petition is filed, unless the spouses are 

separated and a joint petition is not filed.)



NAME AND ADDRESS DESCRIPTION

OF PERSON FOR WHOSE DATE OF AND VALUE OF 

BENEFIT PROPERTY WAS SEIZED SEIZURE PROPERTY

5. Repossessions, foreclosures and returns

None List all property that has been repossessed by a creditor, sold at a foreclosure sale, transferred through a deed in lieu of 

foreclosure or returned to the seller, within one year immediately preceding the commencement of this case. (Married 

debtors filing under chapter 12 or chapter 13 must include information concerning property of either or both spouses 

whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.)



DATE OF REPOSSESSION, DESCRIPTION

NAME AND ADDRESS FORECLOSURE SALE, AND VALUE OF

OF CREDITOR OR SELLER TRANSFER OR RETURN PROPERTY

6. Assignments and receiverships

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

commencement of this case. (Married 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 spouses are separated and a joint petition is not

filed.)



TERMS OF

NAME AND ADDRESS DATE OF ASSIGNMENT

OF ASSIGNEE ASSIGNMENT OR SETTLEMENT

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



NAME AND ADDRESS DESCRIPTION

NAME AND ADDRESS OF COURT DATE OF AND VALUE OF

OF CUSTODIAN CASE TITLE & NUMBER ORDER PROPERTY

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.)

NAME AND ADDRESS RELATIONSHIP DESCRIPTION

OF PERSON TO DEBTOR, DATE AND VALUE OF

OR ORGANIZATION IF ANY OF GIFT GIFT

None



Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 45 of 75
4

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.)

DESCRIPTION DESCRIPTION OF CIRCUMSTANCES AND, IF

AND VALUE OF LOSS WAS COVERED IN WHOLE OR IN PART DATE OF

PROPERTY BY INSURANCE, GIVE PARTICULARS LOSS

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.

NAME AND ADDRESS DATE OF PAYMENT, AMOUNT OF MONEY OR

OF PAYEE NAME OF PAYOR IF DESCRIPTION AND VALUE

OTHER THAN DEBTOR OF PROPERTY

None



Andrew M. Carter

127 W. Willow Ave

Wheaton, IL 60187

01/11/2010 $750.00

10. Other transfers

DESCRIBE PROPERTY 

NAME AND ADDRESS OF TRANSFEREE, TRANSFERRED

RELATIONSHIP TO DEBTOR DATE AND VALUE RECEIVED

None



a. List all other property, other than property transferred in the ordinary course of the business or financial affairs of the 

debtor, transferred either absolutely or as security within two years immediately preceding the commencement of this case. 

(Married debtors filing under chapter 12 or chapter 13 must include transfers by either or both spouses whether or not a joint 

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

 



None

DEVICE TRANSFER(S)

DATE(S) OF

INTEREST IN PROPERTY

NAME OF TRUST OR OTHER

AND VALUE OF PROPERTY OR DEBTOR

AMOUNT OF MONEY OR DESCRIPTION

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 beneficiary.

11. Closed financial accounts



None List all financial accounts and instruments held in the name of the debtor or for the benefit of the debtor which were closed, 

sold, or otherwise transferred within one year immediately preceding the commencement of this case. Include checking, 

savings, or other financial accounts, certificates of deposit, or other instruments; shares and share accounts held in banks, 

credit unions, pension funds, cooperatives, associations, brokerage houses and other financial institutions. (Married debtors 

filing under chapter 12 or chapter 13 must include information concerning accounts or instruments held by or for either or 

both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.)

OF INSTITUTION AND AMOUNT OF FINAL BALANCE OR CLOSING

NAME AND ADDRESS DIGITS OF ACCOUNT NUMBER, DATE OF SALE

TYPE OF ACCOUNT, LAST FOUR AMOUNT AND

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 46 of 75
5

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.)

NAME AND ADDRESS NAMES AND ADDRESSES DESCRIPTION DATE OF TRANSFER

OF BANK OR OF THOSE WITH ACCESS OF OR SURRENDER,

OTHER DEPOSITORY TO BOX OR DEPOSITOR CONTENTS IF ANY

None



Harris, N.A. (Plainfield, IL) Phyllis A. Pomette and 

Steven G. Pometta

Marriage Certificates and 

Birth Certificates

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.)

DATE OF AMOUNT OF

NAME AND ADDRESS OF CREDITOR SETOFF SETOFF

None



14. Property held for another person

List all property owned by another person that the debtor holds or controls.

NAME AND ADDRESS DESCRIPTION AND VALUE

OF OWNER OF PROPERTY LOCATION OF PROPERTY

None



Alyssa Pometta

2819 Twin Falls Drive

Plainfield, IL 60586

Savings Account ($1,000.00) Harris, N.A. (Plainfield, IL)

Alyssa Pometta

2819 Twin Falls Drive

Plainfield, IL 60586

Putnam Account ($1,900.00) Putnam Investments (Boston, 

MA)

Gianna Pometta

2819 Twin Falls Drive

Plainfield, IL 60586

Savings Account ($1,000.00) Harris, N.A. (Plainfield, IL)

Scott Pometta

2819 Twin Falls Drive

Plainfield, IL 60586

Savings Account ($1,000.00) Harris, N.A. (Plainfield, IL)

15. Prior address of debtor

If 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.

ADDRESS NAME USED DATES OF OCCUPANCY

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



NAME 

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 47 of 75
6

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 similar term under 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



SITE NAME AND NAME AND ADDRESS DATE OF ENVIRONMENTAL 

ADDRESS OF GOVERNMENTAL UNIT NOTICE LAW 

b. List the name and address of every site for which the debtor provided notice to a governmental unit of a release of 

Hazardous Material. Indicate the governmental unit to which the notice was sent and the date of the notice. 

None



SITE NAME AND NAME AND ADDRESS DATE OF ENVIRONMENTAL 

ADDRESS OF GOVERNMENTAL UNIT NOTICE LAW 

c. List all judicial or administrative proceedings, including settlements or orders, under any Environmental Law with 

respect to which the debtor is or was a party. Indicate the name and address of the governmental unit that is or was a party 

to the proceeding, and the docket number. 

None



NAME AND ADDRESS DOCKET NUMBER STATUS OR 

OF GOVERNMENTAL UNIT DISPOSITION 

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 48 of 75
7

18. Nature, location and name of business

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

beginning and ending dates of all businesses in which the debtor was a partner or owned 5 percent or more of the voting or 

equity securities within the 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 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 the six years immediately preceding the commencement of this case.

a. If the debtor is an individual, list the names, addresses, taxpayer identification numbers, nature of the businesses,

and beginning and ending dates of all businesses in which the debtor was an officer, director, partner, or managing

executive of a corporation, partner in a partnership, sole proprietor, or was self-employed in a trade, profession, or

other activity either full- or part-time within the 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 the six years immediately

preceding the commencement of this case.

None



LAST FOUR DIGITS

OF SOCIAL SECURITY

OR OTHER INDIVIDUAL

TAXPAYER-I.D. NO.

(ITIN)/ COMPLETE EIN

ADDRESS BEGINNING AND ENDING 

DATES 

NAME NATURE OF 

BUSINESS

Marketing of 

Maternity and 

Juvenile Products

Babyswags 2819 Twin Falls Drive 09/01/2006

Plainfield, IL 60586

2561

b. Identify any business listed in response to subdivision a., above, that is "single asset real estate" as defined in 11 

U.S.C. § 101.

None

NAME ADDRESS



* * * * * *

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

1/14/2010 s/ Steven G. Pometta

of financial affairs and any attachments thereto and that they are true and correct.

Date Signature

of Debtor Steven G. Pometta

[if completed by an individual or individual and spouse]

Phyllis A. Pometta

Signature

of Joint Debtor

(if any)

Date 1/14/2010 s/ Phyllis A. Pometta

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 49 of 75
B 8 (Official Form 8) (12/08)

UNITED STATES BANKRUPTCY COURT

Northern District of Illinois

Eastern Division

Debtors

In re Steven G. Pometta Phyllis A. Pometta , Case No.

Chapter 7

CHAPTER 7 INDIVIDUAL DEBTOR'S STATEMENT OF INTENTION

PART A – Debts secured by property of the estate. (Part A must be fully completed for EACH debt which is secured 

by property of the estate. Attach additional pages if necessary.)

Citi Mortgage 2819 Twin Falls Drive, Plainfiled, IL 60586

Property No. 1

Creditor's Name: Describe Property Securing Debt:

 Other. Explain ___________________________ (for example, avoid lien using 11 U.S.C. § 522(f))

 Reaffirm the debt

 Redeem the property

If retaining the property, I intend to (check at least one):

 Surrendered  Retained

Property will be (check one):

Property is (check one):

   Claimed as exempt Not claimed as exempt

Harris, N.A. 2819 Twin Falls Drive, Plainfiled, IL 60586

Property No. 2

Creditor's Name: Describe Property Securing Debt:

 Other. Explain ___________________________ (for example, avoid lien using 11 U.S.C. § 522(f))

 Reaffirm the debt

 Redeem the property

If retaining the property, I intend to (check at least one):

 Surrendered  Retained

Property will be (check one):

Property is (check one):

   Claimed as exempt Not claimed as exempt

PART B – Personal property subject to unexpired leases. (All three columns of Part B must be completed for

each unexpired lease. Attach additional pages if necessary.)

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 50 of 75
B 8 (Official Form 8) (12/08) Page 2

Property No. 1

Lessor's Name: Describe Leased Property: Lease will be Assumed pursuant

to 11 U.S.C. § 365(p)(2):

 YES  NO

None

0 continuation sheets attached (if any)

I declare under penalty of perjury that the above indicates my intention as to any property of my estate 

securing a debt and/or personal property subject to an unexpired lease.

Date: 1/14/2010 s/ Steven G. Pometta

Steven G. Pometta

Signature of Debtor

s/ Phyllis A. Pometta

Phyllis A. Pometta

Signature of Joint Debtor (if any)

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 51 of 75
Form B1, Exhibit C

(9/01)

UNITED STATES BANKRUPTCY COURT

Northern District of Illinois

Eastern Division

Exhibit "C"

[If, to the best of the debtor's knowledge, the debtor owns or has possession of property 

 that poses or is alleged to pose a threat of imminent and identifiable harm to the public health or

safety, attach this Exhibit "C" to the petition.]

In re: Case No.: 

Chapter:

Steven G. Pometta

Phyllis A. Pometta 7

Debtor(s)

Exhibit "C" to Voluntary Petition

1. Identify and briefly describe all real or personal property owned by or in possession of 

the debtor that, to the best of the debtor's knowledge, poses or is alleged to pose a threat of

imminent and identifiable harm to the public health or safety (attach additional sheets if necessary):

N/A

2. With respect to each parcel of real property or item of personal property identified in 

question 1, describe the nature and location of the dangerous condition, whether environmental

or otherwise, that poses or is alleged to pose a threat of imminent and identifiable harm to the 

public health or safety (attach additional sheets if necessary):

N/A

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 52 of 75
B22A (Official Form 22A) (Chapter 7) (12/08)

In re Steven G. Pometta, Phyllis A. Pometta

According to the information required to be entered on this 

statement (check one box as directed in Part I, III, or VI of this 

statement):

Case Number:

(If known)

The presumption does not arise

Debtor(s)  The presumption arises



 The presumption is temporarily inapplicable.

CHAPTER 7 STATEMENT OF CURRENT MONTHLY INCOME

AND MEANS-TEST CALCULATION

In addition to Schedules I and J, this statement must be completed by every individual chapter 7 debtor, whether or not filing jointly. 

Unless the exclusion in Line 1C applies, joint debtors may complete a single statement. If the exclusion in Line 1C applies, each joint 

filer must complete a separate statement.

 

Part I. MILITARY AND NON-CONSUMER DEBTORS

Disabled Veterans. If you are a disabled veteran described in the Declaration in this Part IA, (1) check the box at the 

beginning of the Declaration, (2) check the box for “The presumption does not arise” at the top of this statement, and (3) 

complete the verification in Part VIII. Do not complete any of the remaining parts of this statement.

 Declaration of Disabled Veteran. By checking this box, I declare under penalty of perjury that I am a disabled 

veteran (as defined in 38 U.S.C. § 3741(1)) whose indebtedness occurred primarily during a period in which I was on active 

duty (as defined in 10 U.S.C. § 101(d)(1)) or while I was performing a homeland defense activity (as defined in 32 U.S.C. 

§901(1)).

1A

Non-consumer Debtors. If your debts are not primarily consumer debts, check the box below and complete the 

verification in Part VIII. Do not complete any of the remaining parts of this statement.

Declaration of non-consumer debts. By checking this box, I declare that my debts are not primarily consumer debts.

1B

 

1C

Reservists and National Guard Members; active duty or homeland defense activity. Members of a reserve 

component of the Armed Forces and members of the National Guard who were called to active duty (as defined in 10 

U.S.C. § 101(d)(1)) after September 11, 2001, for a period of at least 90 days, or who have performed homeland defense 

activity (as defined in 32 U.S.C. § 901(1)) for a period of at least 90 days, are excluded from all forms of means testing 

during the time of active duty or homeland defense activity and for 540 days thereafter (the “exclusion period”). If you 

qualify for this temporary exclusion, (1) check the appropriate boxes and complete any required information in the 

Declaration of Reservists and National Guard Members below, (2) check the box for “The presumption is temporarily 

inapplicable” at the top of this statement, and (3) complete the verification in Part VIII. During your exclusion period 

you are not required to complete the balance of this form, but you must complete the form no later than 14 days 

after the date on which your exclusion period ends, unless the time for filing a motion raising the means test 

presumption expires in your case before your exclusion period ends.

 Declaration of Reservists and National Guard Members. By checking this box and making the appropriate entries 

below, I declare that I am eligible for a temporary exclusion from means testing because, as a member of a reserve 

component of the Armed Forces or the National Guard

 

a. 









b.

I was called to active duty after September 11, 2001, for a period of at least 90 days and

I remain on active duty /or/

I was released from active duty on ________________, which is less than 540 days before this 

bankruptcy case was filed;

OR

I am performing homeland defense activity for a period of at least 90 days /or/

I performed homeland defense activity for a period of at least 90 days, terminating on 

_______________, which is less than 540 days before this bankruptcy case was filed.

 

 

 

 

 

Part II. CALCULATION OF MONTHLY INCOME FOR § 707(b)(7) EXCLUSION

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 53 of 75
B22A (Official Form 22A) (Chapter 7) (12/08) 2

Marital/filing status. Check the box that applies and complete the balance of this part of this statement as directed.

b. Married, not filing jointly, with declaration of separate households. By checking this box, debtor declares under 

 penalty of perjury: "My spouse and I are legally separated under applicable non-bankruptcy law or my spouse 

 and I are living apart other than for the purpose of evading the requirements of § 707(b)(2)(A) of the Bankruptcy 

 Code." Complete only Column A ("Debtor's Income") for Lines 3-11.

c. Married, not filing jointly, without the declaration of separate households set out in line 2.b above. Complete 

 both Column A ("Debtor's Income") and Column B ("Spouse's Income") for Lines 3-11.

a. Unmarried. Complete only Column A ("Debtor's Income") for Lines 3-11.

d. Married, filing jointly. Complete both Column A ("Debtor's Income") and Column B ("Spouse's Income") 

for Lines 3-11.

2

 

 

 



Column B

Spouse's

Income

Column A

Debtor's

Income

All figures must reflect average monthly income received from all sources, derived during the 

six calendar months prior to filing the bankruptcy case, ending on the last day of the month 

before the filing. If the amount of monthly income varied during the six months, you must 

divide the six-month total by six, and enter the result on the appropriate line.

3 Gross wages, salary, tips, bonuses, overtime, commissions. $ $ 0.00 0.00

4

Income from the operation of a business, profession or farm. Subtract Line b from

Line a and enter the difference in the appropriate column(s) of Line 4. If you operate more 

than one business, profession or farm, enter aggregate numbers and provide details on an 

attachment. Do not enter a number less than zero. Do not include any part of the business 

expenses entered on Line b as a deduction in Part V.

1,929.00

2,040.00

$

$

$0.00 $111.00

b.

a.

c.

Gross Receipts

Ordinary and necessary business expenses

Business income Subtract Line b from Line a

Rent and other real property income. Subtract Line b from Line a and enter the difference 

in the appropriate column(s) of Line 5. Do not enter a number less than zero. Do not 

include any part of the operating expenses entered on Line b as a deduction in Part V.

a.

b.

c.

Gross Receipts

Ordinary and necessary operating expenses

Rent and other real property income Subtract Line b from Line a $ $ 0.00 0.00

$

$

0.00

0.00

5

6 Interest, dividends, and royalties. $ $ 0.00 0.00

7 Pension and retirement income. $0.00 0.00 $

$ $ 230.00 0.00 8 Any amounts paid by another person or entity, on a regular basis, for the household

expenses of the debtor or the debtor’s dependents, including child support paid for

that purpose. Do not include alimony or separate maintenance payments or amounts paid 

by your spouse if Column B is completed.

Unemployment compensation claimed to

be a benefit under the Social Security Act Debtor Spouse $2,236.00 0.00 $ $ $

Unemployment compensation. Enter the amount in the appropriate column(s) of Line 9. 

However, if you contend that unemployment compensation received by you or your spouse 

was a benefit under the Social Security Act, do not list the amount of such compensation in 

9 Column A or B, but instead state the amount in the space below:

Income from all other sources. Specify source and amount. If necessary, list additional

sources on a separate page. Do not include alimony or separate maintenance payments

paid by your spouse if Column B is completed, but include all other payments of

alimony or separate maintenance. Do not include any benefits received under the Social

Security Act or payments received as a victim of a war crime, crime against humanity, or as

a victim of international or domestic terrorism.

10

a. $

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 54 of 75
B22A (Official Form 22A) (Chapter 7) (12/08) 3

Total and enter on Line 10. $0.00 $0.00

11 $2,466.00 $111.00 Subtotal of Current Monthly Income for § 707(b)(7). Add Lines 3 thru 10 in Column A, 

and, if Column B is completed, add Lines 3 thru 10 in Column B. Enter the total(s).

$ 2,577.00 12

Total Current Monthly Income for § 707(b)(7). If Column B has been completed, add Line 

11, Column A to Line 11, Column B, and enter the total. If Column B has not been 

completed, enter the amount from Line 11, Column A.

Part III. APPLICATION OF § 707(b)(7) EXCLUSION

Annualized Current Monthly Income for § 707(b)(7). Multiply the amount from Line 12 by the number 12 and enter

the result.

Applicable median family income. Enter the median family income for the applicable state and household size. (This

information is available by family size at www.usdoj.gov/ust/ or from the clerk of the bankruptcy court.)

Application of Section 707(b)(7). Check the applicable box and proceed as directed.

The amount on Line 13 is less than or equal to the amount on Line 14. Check the box for “The presumption does not

arise” at the top of page 1 of this statement, and complete Part VIII; do not complete Parts IV, V, VI or VII.

The amount on Line 13 is more than the amount on Line 14. Complete the remaining parts of this statement.

13

14

15

30,924.00

88,365.00

$

$ a. Enter debtor’s state of residence: IL 5 b. Enter debtor’s household size:

 



Complete Parts IV, V, VI, and VII of this statement only if required. (See Line 15).

a. $

$

17

16

Marital adjustment. If you checked the box at Line 2.c, enter on Line 17 the total of any income listed in

Line 11, Column B that was NOT paid on a regular basis for the household expenses of the debtor or the

debtor’s dependents. Specify in the lines below the basis for excluding the Column B income (such as

payment of the spouse’s tax liability or the spouse’s support of persons other than the debtor or the debtor’s 

dependents) and the amount of income devoted to each purpose. If necessary, list additional adjustments 

on a separate page. If you did not check box at Line 2.c, enter zero.

Enter the amount from Line 12.

Part IV. CALCULATION OF CURRENT MONTHLY INCOME FOR § 707(b)(2)

Total and enter on Line 17 . $

18 Current monthly income for § 707(b)(2). Subtract Line 17 from Line 16 and enter the result. $

Subpart A: Deductions under Standards of the Internal Revenue Service (IRS)

Part V. CALCULATION OF DEDUCTIONS FROM INCOME

19A

National Standards: food, clothing and other items. Enter in Line 19A the “Total” amount from IRS

National Standards for Food, Clothing and Other Items for the applicable household size. (This information

is available at www.usdoj.gov/ust/ or from the clerk of the bankruptcy court.) $

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 55 of 75
B22A (Official Form 22A) (Chapter 7) (12/08) 4

19B National Standards: health care. Enter in Line a1 below the amount from IRS National Standards for

Out-of-Pocket Health Care for persons under 65 years of age, and in Line a2 the IRS National Standards for

Out-of-Pocket Health Care for persons 65 years of age or older. (This information is available at

www.usdoj.gov/ust/ or from the clerk of the bankruptcy court.) Enter in Line b1 the number of members of

your household who are under 65 years of age, and enter in Line b2 the number of members of your

household who are 65 years of age or older. (The total number of household members must be the same as

the number stated in Line 14b.) Multiply Line a1 by Line b1 to obtain a total amount for household members

under 65, and enter the result in Line c1. Multiply Line a2 by Line b2 to obtain a total amount for household

members 65 and older, and enter the result in Line c2. Add Lines c1 and c2 to obtain a total health care

amount, and enter the result in Line 19B.

Household members under 65 years of age Household members 65 years of age or older

c2.

b2.

a2.

c1.

b1.

a1.

$

Allowance per member

Number of members

Subtotal

Allowance per member

Number of members

Subtotal

20A

Local Standards: housing and utilities; non-mortgage expenses. Enter the amount of the IRS Housing 

and Utilities Standards; non-mortgage expenses for the applicable county and household size. (This 

information is available at www.usdoj.gov/ust/ or from the clerk of the bankruptcy court). $

$

Local Standards: housing and utilities; mortgage/rent expense. Enter, in Line a below, the amount of 

the IRS Housing and Utilities Standards; mortgage/rent expense for your county and household size (this 

information is available at www.usdoj.gov/ust/ or from the clerk of the bankruptcy court); enter on Line b the

total of the Average Monthly Payments for any debts secured by your home, as stated in Line 42; subtract 

Line b from Line a and enter the result in Line 20B. Do not enter an amount less than zero.

20B

a. IRS Housing and Utilities Standards; mortgage/rental expense

$

$ b.

c.

Average Monthly Payment for any debts secured by home, if 

any, as stated in Line 42.

Net mortgage/rental expense Subtract Line b from Line a

21

Local Standards: housing and utilities; adjustment. If you contend that the process set out in Lines 20A

and 20B does not accurately compute the allowance to which you are entitled under the IRS Housing and

Utilities Standards, enter any additional amount to which you contend you are entitled, and state the basis

for your contention in the space below:

$

$

22A

Local Standards: transportation; vehicle operation/public transportation expense. You are entitled to 

an expense allowance in this category regardless of whether you pay the expenses of operating a vehicle 

and regardless of whether you use public transportation.

Check the number of vehicles for which you pay the operating expenses or for which the operating expenses 

are included as a contribution to your household expenses in Line 8.  0  1  2 or more.

If you checked 0, enter on Line 22A the “Public Transportation” amount from IRS Local Standards:

Transportation. If you checked 1 or 2 or more, enter on Line 22A the “Operating Costs” amount from IRS

Local Standards: Transportation for the applicable number of vehicles in the applicable Metropolitan

Statistical Area or Census Region. (These amounts are available at www.usdoj.gov/ust/ or from the clerk of

the bankruptcy court.)

$

22B

Local Standards: transportation; additional public transportation expense. If you pay the operating 

expenses for a vehicle and also use public transportation, and you contend that you are entitled to an 

additional deduction for your public transportation expenses, enter on Line 22B the “Public Transportation”

amount from IRS Local Standards: Transportation. (This amount is available at www.usdoj.gov/ust/ or from

the clerk of the bankruptcy court.)

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 56 of 75
B22A (Official Form 22A) (Chapter 7) (12/08) 5

Local Standards: transportation ownership/lease expense; Vehicle 1. Check the number of vehicles for

which you claim an ownership/lease expense. (You may not claim an ownership/lease expense for more

than two vehicles.)

$

$

$

1 2 or more.

23

a.

b.

c.

Average Monthly Payment for any debts secured by Vehicle 1,

as stated in Line 42.

Net ownership/lease expense for Vehicle 1 Subtract Line b from Line a

Enter, in Line a below, the “Ownership Costs” for “One Car” from the IRS Local Standards: Transportation

(available at www.usdoj.gov/ust/ or from the clerk of the bankruptcy court); enter in Line b the total of the

Average Monthly Payments for any debts secured by Vehicle 1, as stated in Line 42; subtract Line b from 

Line a and enter the result in Line 23. Do not enter an amount less than zero.

IRS Transportation Standards, Ownership Costs

  

25

Other Necessary Expenses: taxes. Enter the total average monthly expense that you actually incur for all

federal, state and local taxes, other than real estate and sales taxes, such as income taxes, self employment

taxes, social security taxes, and Medicare taxes. Do not include real estate or sales taxes.

Net ownership/lease expense for Vehicle 2 Subtract Line b from Line a

Average Monthly Payment for any debts secured by Vehicle 2,

as stated in Line 42

c.

b.

a.

24

Local Standards: transportation ownership/lease expense; Vehicle 2. Complete this Line only if you checked

the “2 or more” Box in Line 23.

$

$

$

$

Enter, in Line a below, the “Ownership Costs” for “One Car” from the IRS Local Standards: Transportation

(available at www.usdoj.gov/ust/ or from the clerk of the bankruptcy court); enter in Line b the total of the

Average Monthly Payments for any debts secured by Vehicle 2, as stated in Line 42; subtract Line b from 

Line a and enter the result in Line 24. Do not enter an amount less than zero.

IRS Transportation Standards, Ownership Costs

26 $

Other Necessary Expenses: involuntary deductions for employment. Enter the total average monthly

payroll deductions that are required for your employment, such as retirement contributions, union dues, and

uniform costs. Do not include discretionary amounts, such as voluntary 401(k) contributions.

$ 27

Other Necessary Expenses: life insurance. Enter total average monthly premiums that you actually 

pay for term life insurance for yourself. Do not include premiums for insurance on your dependents, for

whole life or for any other form of insurance.

28 $

Other Necessary Expenses: court-ordered payments. Enter the total monthly amount that you are

required to pay pursuant to the order of a court or administrative agency, such as spousal or child support

payments. Do not include payments on past due obligations included in Line 44.

29

$

Other Necessary Expenses: education for employment or for a physically or mentally challenged

child. Enter the total average monthly amount that you actually expend for education that is a condition of

employment and for education that is required for a physically or mentally challenged dependent child for

whom no public education providing similar services is available.

30 $

Other Necessary Expenses: childcare. Enter the total average monthly amount that you actually expend on

childcare—such as baby-sitting, day care, nursery and preschool. Do not include other educational

payments.

31

$

Other Necessary Expenses: health care. Enter the total average monthly amount that you actually expend

on health care that is required for the health and welfare of yourself or your dependents, that is not 

reimbursed by insurance or paid by a health savings account, and that is in excess of the amount entered in 

Line 19B. Do not include payments for health insurance or health savings accounts listed in Line 34.

Other Necessary Expenses: telecommunication services. Enter the total average monthly amount that 

you actually pay for telecommunication services other than your basic home telephone and cell phone 

service— such as pagers, call waiting, caller id, special long distance, or internet service—to the extent 

necessary for your health and welfare or that of your dependents. Do not include any amount previously 

deducted. $

32

33 Total Expenses Allowed under IRS Standards. Enter the total of Lines 19 through 32. $

Note: Do not include any expenses that you have listed in Lines 19-32

Subpart B: Additional Living Expense Deductions

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 57 of 75
B22A (Official Form 22A) (Chapter 7) (12/08) 6

34

Health Savings Account

Disability Insurance

Health Insurance

c.

b.

a.

Health Insurance, Disability Insurance, and Health Savings Account Expenses. List the monthly

expenses in the categories set out in lines a-c below that are reasonably necessary for yourself, your 

spouse, or your dependents.

$

$

$

$

Total and enter on Line 34

If you do not actually expend this total amount, state your actual total average monthly expenditures in

the space below:

$

35 $

Continued contributions to the care of household or family members. Enter the total average actual 

monthly expenses that you will continue to pay for the reasonable and necessary care and support of an 

elderly, chronically ill, or disabled member of your household or member of your immediate family who is 

unable to pay for such expenses.

36 $

Protection against family violence. Enter the total average reasonably necessary monthly expenses that 

you actually incurred to maintain the safety of your family under the Family Violence Prevention and 

Services Act or other applicable federal law. The nature of these expenses is required to be kept confidential 

by the court.

37 $

Home energy costs. Enter the total average monthly amount, in excess of the allowance specified by IRS

Local Standards for Housing and Utilities, that you actually expend for home energy costs. You must 

provide your case trustee with documentation of your actual expenses, and you must demonstrate 

that the additional amount claimed is reasonable and necessary.

38

$

Education expenses for dependent children less than 18. Enter the total average monthly expenses that 

you actually incur, not to exceed $137.50 per child, for attendance at a private or public elementary or 

secondary school by your dependent children less than 18 years of age. You must provide your case 

trustee with documentation of your actual expenses, and you must explain why the amount claimed 

is reasonable and necessary and not already accounted for in the IRS Standards.

Additional food and clothing expense. Enter the total average monthly amount by which your food and

clothing expenses exceed the combined allowances for food and clothing (apparel and services) in the IRS

National Standards, not to exceed 5% of those combined allowances. (This information is available at

www.usdoj.gov/ust/ or from the clerk of the bankruptcy court.) You must demonstrate that the additional

amount claimed is reasonable and necessary.

$

$

39

Continued charitable contributions. Enter the amount that you will continue to contribute in the form of cash or

financial instruments to a charitable organization as defined in 26 U.S.C. § 170(c)(1)-(2). 40

Total Additional Expense Deductions under § 707(b). $ 41 Enter the total of Lines 34 through 40.

Subpart C: Deductions for Debt Payment

42

Name of Property Securing the Debt CreditorAverage

Monthly

Payment

Does payment

include taxes

or insurance?

a. $   yes no

Future payments on secured claims. For each of your debts that is secured by an interest in property that

you own, list the name of the creditor, identify the property securing the debt, state the Average Monthly

Payment, and check whether the payment includes taxes or insurance. The Average Monthly Payment is the

total of all amounts scheduled as contractually due to each Secured Creditor in the 60 months following the

filing of the bankruptcy case, divided by 60. If necessary, list additional entries on a separate page. Enter

the total of the Average Monthly Payments on Line 42.

Total: Add Lines a, b and c $

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 58 of 75
B22A (Official Form 22A) (Chapter 7) (12/08) 7

43

Name of Creditor Property Securing the Debt 1/60th of the Cure Amount

Other payments on secured claims. If any of debts listed in Line 42 are secured by your primary

residence, a motor vehicle, or other property necessary for your support or the support of your dependents,

you may include in your deduction 1/60th of any amount (the “cure amount”) that you must pay the creditor

in addition to the payments listed in Line 42, in order to maintain possession of the property. The cure

amount would include any sums in default that must be paid in order to avoid repossession or foreclosure.

List and total any such amounts in the following chart. If necessary, list additional entries on a separate

page.

Total: Add Lines a, b and c $

44 $

Payments on prepetition priority claims. Enter the total amount, divided by 60, of all priority claims, such

as priority tax, child support and alimony claims, for which you were liable at the time of your bankruptcy

filing. Do not include current obligations, such as those set out in Line 28.

45

Average monthly administrative expense of Chapter 13 case

 x

Current multiplier for your district as determined under schedules issued 

by the Executive Office for United States Trustees. (This information is 

available at www.usdoj.gov/ust/ or from the clerk of the bankruptcy 

court.)

Total: Multiply Lines a and b

Projected average monthly Chapter 13 plan payment.

c.

b.

a.

Chapter 13 administrative expenses. If you are eligible to file a case under Chapter 13, complete the 

following chart, multiply the amount in line a by the amount in line b, and enter the resulting administrative 

expense.

$

$

46 Total Deductions for Debt Payment. Enter the total of Lines 42 through 45. $

47

Subpart D: Total Deductions from Income

Total of all deductions allowed under § 707(b)(2). Enter the total of Lines 33, 41, and 46. $

55

53

52

The amount on Line 51 is equal to or greater than the amount on Line 54. Check the box for “The presumption arises” at 

the top of page 1 of this statement, and complete the verification in Part VIII. You may also complete Part VII.

The amount on Line 51 is less than the amount on Line 54. Check the box for “The presumption does not arise” at the top of 

page 1 of this statement, and complete the verification in Part VIII.

Secondary presumption determination. Check the applicable box and proceed as directed.

54 Threshold debt payment amount. Multiply the amount in Line 53 by the number 0.25 and enter the result.

Enter the amount of your total non-priority unsecured debt

The amount on Line 51 is at least $6,575, but not more than $10,950. Complete the remainder of Part VI (Lines 53 through

55).

The amount set forth on Line 51 is more than $10,950. Check the box for “The presumption arises” at the top of page 1 of this 

statement, and complete the verification in Part VIII. You may also complete Part VII. Do not complete the remainder of Part VI.

The amount on Line 51 is less than $6,575 Check the box for “The presumption does not arise” at the top of page 1 of this 

statement, and complete the verification in Part VIII. Do not complete the remainder of Part VI.

51

Initial presumption determination. Check the applicable box and proceed as directed.

60-month disposable income under § 707(b)(2). Multiply the amount in Line 50 by the number 60 and enter the

result.

50

49

48

Monthly disposable income under § 707(b)(2). Subtract Line 49 from Line 48 and enter the result

Enter the amount from Line 47 (Total of all deductions allowed under § 707(b)(2))

Enter the amount from Line 18 (Current monthly income for § 707(b)(2))

Part VI. DETERMINATION OF § 707(b)(2) PRESUMPTION

$

$

$

$

$

$

 

 

 

 

 

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 59 of 75
B22A (Official Form 22A) (Chapter 7) (12/08) 8

Other Expenses. List and describe any monthly expenses, not otherwise stated in this form, that are required for the 

health and welfare of you and your family and that you contend should be an additional deduction from your current 

monthly income under § 707(b)(2)(A)(ii)(I). If necessary, list additional sources on a separate page. All figures should 

reflect your average monthly expense for each item. Total the expenses.

Part VII. ADDITIONAL EXPENSE CLAIMS

Expense Description Monthly Amount

56

Total: Add Lines a, b, and c $

Date:

I declare under penalty of perjury that the information provided in this statement is true and correct. (If this a joint case, 

both debtors must sign.)

Part VIII: VERIFICATION

Signature:

Steven G. Pometta, (Debtor)

1/14/2010 s/ Steven G. Pometta 57

Date: Signature: 1/14/2010

Phyllis A. Pometta, (Joint Debtor, if any)

s/ Phyllis A. Pometta

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 60 of 75
B23 (Official Form 23) (12/08)

UNITED STATES BANKRUPTCY COURT

Northern District of Illinois

Eastern Division

Steven G. Pometta Phyllis A. Pometta In re , Case No.

Debtors Chapter 7

DEBTOR’S CERTIFICATION OF COMPLETION OF POSTPETITION INSTRUCTIONAL

COURSE CONCERNING PERSONAL FINANCIAL MANAGEMENT

 Every individual debtor in a chapter 7, chapter 11 in which § 1141(d)(3) applies, or chapter 13 case must 

file this certification. If a joint petition is filed, each spouse must complete and file a separate certification. Complete 

one of the following statements and file by the deadline stated below:

 I, , the debtor in the above-styled

financial management provided by

case, hereby certify that on (Date), I completed an instructional course in personal 

(Printed Name of Debtor)

an approved personal financial management provider.

(Name of Provider)

Certificate No. (if any):

 I, , the debtor in the above-styled case,

(Printed Name of Debtor)

hereby certify that no personal financial management course is required, because of [Check the appropriate box.]:

Incapacity or disability, as defined in 11 U.S.C. § 109(h)

Active military duty in a military combat zone; or

Residence in a district in which the United States trustee (or bankruptcy administrator) has 

determined that the approved instructional courses are not adequate at this time to serve the 

additional individuals who would otherwise be required to complete such courses.







Signature of Debtor:

Date:

s/ Steven G. Pometta

Steven G. Pometta

1/14/2010

 Instructions: Use this form only to certify whether you completed a course in personal financial management. 

(Fed. R. Bankr. P. 1007(b)(7).) Do NOT use this form to file the certificate given to you by your prepetition credit 

counseling provider and do NOT include with the petition when filing your case.

 Filing Deadlines: In a chapter 7 case, file within 45 days of the first date set for the meeting of creditors under § 

341 of the Bankruptcy Code. In a chapter 11 or 13 case, file no later than the last payment made by the debtor as 

required by the plan or the filing of a motion for a discharge under § 1141(d)(5)(B) or § 1328(b) of the Code. (See 

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

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 61 of 75
B23 (Official Form 23) (12/08)

UNITED STATES BANKRUPTCY COURT

Northern District of Illinois

Eastern Division

Steven G. Pometta Phyllis A. Pometta In re , Case No.

Debtors Chapter 7

DEBTOR’S CERTIFICATION OF COMPLETION OF POSTPETITION INSTRUCTIONAL

COURSE CONCERNING PERSONAL FINANCIAL MANAGEMENT

 Every individual debtor in a chapter 7, chapter 11 in which § 1141(d)(3) applies, or chapter 13 case must 

file this certification. If a joint petition is filed, each spouse must complete and file a separate certification. Complete 

one of the following statements and file by the deadline stated below:

 I, , the debtor in the above-styled

financial management provided by

case, hereby certify that on (Date), I completed an instructional course in personal 

(Printed Name of Debtor)

an approved personal financial management provider.

(Name of Provider)

Certificate No. (if any):

 I, , the debtor in the above-styled case,

(Printed Name of Debtor)

hereby certify that no personal financial management course is required, because of [Check the appropriate box.]:

Incapacity or disability, as defined in 11 U.S.C. § 109(h)

Active military duty in a military combat zone; or

Residence in a district in which the United States trustee (or bankruptcy administrator) has 

determined that the approved instructional courses are not adequate at this time to serve the 

additional individuals who would otherwise be required to complete such courses.







Signature of Debtor:

Date: 1/14/2010

Phyllis A. Pometta

s/ Phyllis A. Pometta

 Instructions: Use this form only to certify whether you completed a course in personal financial management. 

(Fed. R. Bankr. P. 1007(b)(7).) Do NOT use this form to file the certificate given to you by your prepetition credit 

counseling provider and do NOT include with the petition when filing your case.

 Filing Deadlines: In a chapter 7 case, file within 45 days of the first date set for the meeting of creditors under § 

341 of the Bankruptcy Code. In a chapter 11 or 13 case, file no later than the last payment made by the debtor as 

required by the plan or the filing of a motion for a discharge under § 1141(d)(5)(B) or § 1328(b) of the Code. (See 

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

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 62 of 75
B24 (Official Form 24) (12/07)

Northern District of Illinois

UNITED STATES BANKRUPTCY COURT

Eastern Division

In re Steven G. Pometta Phyllis A. Pometta , Case No.

Debtors Chapter 7

CERTIFICATION TO COURT OF APPEALS

BY ALL PARTIES

 A notice of appeal having been filed in the above-styled matter on _____________, 

________________________,________________________, and ________________________, [Names of all the appellants and 

all the appellees, if any], who are all the appellants [and all the appellees] hereby certify to the court under 28 U.S.C. § 158(d)(2)(A) 

that a circumstance specified in 28 U.S.C. § 158(d)(2) exists as stated below.

 Leave to appeal in this matter is is not required under 28 U.S.C. § 158(a).  

[If from a final judgment, order, or decree] This certification arises in an appeal from a final judgment, order, or decree of

the United States Bankruptcy Court for the Northern District of Illinois entered on ___________[Date]..

[If from an interlocutory order or decree] This certification arises in an appeal from an interlocutory order or decree, and the

parties hereby request leave to appeal as required by 28 U.S.C. § 158(a).

 [The certification shall contain one or more of the following statements, as is appropriate to the circumstances.]

 The judgment, order, or decree involves a question of law as to which there is no controlling decision of the court of

appeals for this circuit or of the Supreme Court of the United States, or involves a matter of public importance.

Or

 The judgment, order, or decree involves a question of law requiring resolution of conflicting decisions.

Or

 An immediate appeal from the judgment, order, or decree may materially advance the progress of the case or proceeding

in which the appeal is taken.

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 63 of 75
B24 (Official Form 24) (12/07) - Cont. Page 2

 [The parties may include or attach the information specified in Rule 8003(f)(3)(C).]

Signed: [If there are more than two signatories, all must sign and provide the information requested below. Attach additional signed

sheets if needed.]

Attorney for Appellant (or Appellant,

if not represented by an attorney)

s/AndrewMCarter

Printed Name of Signer

Andrew M. Carter

127 W. Willow Avenue

Wheaton, IL 60187

Attorney for Appellant (or Appellant,

if not represented by an attorney)

Printed Name of Signer

630-462-8071

Address Address

Telephone No.

1/14/2010

Telephone No.

1/14/2010

Date Date

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 64 of 75
B202 (Form 202) (08/07)

Eastern Division

Northern District of Illinois

United States Bankruptcy Court

In re Steven G. Pometta Phyllis A. Pometta Case Number

Chapter 7

STATEMENT OF MILITARY SERVICE

 The Servicemembers’ Civil Relief Act of 2003, Pub. L. No. 108-189, provides for the temporary suspension of 

certain judicial proceedings or transactions that may adversely affect military servicemembers, their dependents, and 

others. Each party to a bankruptcy case who might be eligible for relief under the act should complete this form and file it 

with the Bankruptcy Court.

IDENTIFICATION OF SERVICEMEMBER

 Self (Debtor, Codebtor, Creditor, Other)

 Non-Filing Spouse of Debtor (name)

 Other (Name of servicemember)

(Relationship of filer to servicemember)

(Type of liability)

U.S. Armed Forces (Army, Navy, Air Force, Marine Corps, or Coast Guard) or commissioned officer of the Public 

Health Service or the National Oceanic and Atmospheric Administration (specify type of service)

TYPE OF MILITARY SERVICE

 Active Service since (date)

 Inductee - ordered to report on (date)

 Retired / Discharged (date)

 Active Service since

U.S. Military Reserves and National Guard

(date)

 Impending Active Service - orders postmarked (date)

Ordered to report on (date)

 Retired / Discharged (date)

U.S. Citizen Serving with U.S. ally in war or military action (specify ally and war or action)

 Active Service since (date)

 Retired / Discharged (date)

 Servicemember deployed overseas on

DEPLOYMENT

(date)

Anticipated completion of overseas tour-of-duty (date)

SIGNATURE

Date

s/ Steven G. Pometta 1/14/2010

Steven G. Pometta

(print name)

This statement is for information use only. Filing this statement with the Bankruptcy Court does not constitute an application for or invoke 

the benefits and relief available under the Servicemembers’ Civil Relief Act of 2003.

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 65 of 75
B202 (Form 202) (08/07)

Eastern Division

Northern District of Illinois

United States Bankruptcy Court

In re Steven G. Pometta Phyllis A. Pometta Case Number

Chapter 7

STATEMENT OF MILITARY SERVICE

 The Servicemembers’ Civil Relief Act of 2003, Pub. L. No. 108-189, provides for the temporary suspension 

of certain judicial proceedings or transactions that may adversely affect military servicemembers, their dependents, 

and others. Each party to a bankruptcy case who might be eligible for relief under the act should complete this form 

and file it with the Bankruptcy Court.

IDENTIFICATION OF SERVICEMEMBER

 Self (Debtor, Codebtor, Creditor, Other)

 Non-Filing Spouse of Debtor (name)

 Other (Name of servicemember)

(Relationship of filer to servicemember)

(Type of liability)

U.S. Armed Forces (Army, Navy, Air Force, Marine Corps, or Coast Guard) or commissioned officer of the Public 

Health Service or the National Oceanic and Atmospheric Administration (specify type of service)

TYPE OF MILITARY SERVICE

 Active Service since (date)

 Inductee - ordered to report on (date)

 Retired / Discharged (date)

 Active Service since

U.S. Military Reserves and National Guard

(date)

 Impending Active Service - orders postmarked (date)

Ordered to report on (date)

 Retired / Discharged (date)

U.S. Citizen Serving with U.S. ally in war or military action (specify ally and war or action)

 Active Service since (date)

 Retired / Discharged (date)

 Servicemember deployed overseas on

DEPLOYMENT

(date)

Anticipated completion of overseas tour-of-duty (date)

SIGNATURE

Date

s/ Phyllis A. Pometta 1/14/2010

Phyllis A. Pometta

(print name)

This statement is for information use only. Filing this statement with the Bankruptcy Court does not constitute an application for

or invoke the benefits and relief available under the Servicemembers’ Civil Relief Act of 2003.

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 66 of 75
UNITED STATES BANKRUPTCY COURT

DISTRICT OF COLUMBIA

Steven G. Pometta

Chapter

Case No.

Debtors.

In re

7

Phyllis A. Pometta

Debtor’s Statement of Special Circumstances

Amended - Debtor’s Statement of Special Circumstances

 I hereby certify under penalty of perjury that the Debtor’s Statement of Special Circumstances is true, correct 

and complete to the best of my knowledge.

Dated:

Dated:

Page 1 of 1

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 67 of 75
UNITED STATES BANKRUPTCY COURT

Northern District of Illinois

Eastern Division

Phyllis A. Pometta

7

In re

Debtors.

Case No.

Chapter

Steven G. Pometta

Notice to Trustee of Special Circumstances 

Dear

 Please be advised that I represent Steven G. Pometta Phyllis A. Pometta. According to the calculations 

required by the Statement of Current Monthly Income and Means Test Calculation, the debtor checked the box on 

page 1 of the form indicating that a presumption of abuse arises in this matter. To rebut this presumption, I am 

writing to provide you with information supporting the debtor’s claim of special circumstances that justify additional 

expenses and/or adjustments of current monthly income, and/or to provide documentation for expense items that 

should be deducted from my client’s current monthly income pursuant to § 707(b)(2)(A)(ii)(I). 

 On Line 12 of Official Form B22A, the debtor stated that his current monthly income is $2,577.00, based on 

the definition provided in section 101(10A) of the Code. However, this amount includes income that the debtor did 

not actually have at the time his petition was filed, and which the debtor does not currently have. I am enclosing the 

Debtor’s Statement of Special Circumstances which demonstrates that the debtor’s actual monthly income is $ . I 

am also enclosing copies of my client’s recent payment advices showing his actual income. 

Adjustments of Current Monthly Income 

Additional Expenses 

 On Line of Official Form B22A, the debtor listed an expense amount of $ based on the Internal Revenue 

Service National or Local Standard for . 

I am enclosing the Debtor’s Statement of Special Circumstances which demonstrates that the debtor’s actual 

monthly expense for this item is $ , and that this expense is necessary and reasonable. I am also enclosing 

documentation for this expense. 

 In Part VII of Official Form B22A, the debtor listed the following additional expenses: . 

The debtor listed these items as a monthly expense amount of $0.00, though this amount was not deducted from 

his current monthly income for purposes of determining the § 707(b)(2) presumption. I am enclosing the Debtor’s 

Statement of Special Circumstances which demonstrates that these monthly expenses are required for the health 

and welfare of the debtor and the debtor’s family or for the production of the debtor’s income. I am also enclosing 

documentation for these expense items. 

 If the additional expenses or adjustments to income referred to above are considered in applying the means 

test, a presumption of abuse no longer arises in this case. Accordingly, my client requests that in lieu of filing a 

motion to dismiss or convert this chapter 7 case under § 707(b), you file a statement with the court, for the reasons 

set forth above, that such a motion is not appropriate. If you are in need of any additional information or 

documentation, please contact me. 

Attorney for Debtor(s)

Andrew M. Carter

s/AndrewMCarter

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 68 of 75
B 203

(12/94)

UNITED STATES BANKRUPTCY COURT

Northern District of Illinois

Eastern Division

Chapter

Case No.

 7

In re: Steven G. Pometta Phyllis A. Pometta

Debtors

DISCLOSURE OF COMPENSATION OF ATTORNEY 

FOR DEBTOR

1. Pursuant to 11 U.S.C. § 329(a) and Bankruptcy Rule 2016(b), I certify that I am the attorney for the above-named debtor(s) 

 and that compensation paid to me within one year before the filing of the petition in bankruptcy, or agreed to be 

 paid to me, for services rendered or to be rendered on behalf of the debtor(s) in contemplation of or in 

 connection with the bankruptcy case is as follows:

 Debtor  Other (specify)

 Balance Due $

 Prior to the filing of this statement I have received $

 For legal services, I have agreed to accept $

 750.00

2. The source of compensation paid to me was:

 1,200.00

 450.00

3. The source of compensation to be paid to me is:

  Debtor Other (specify)

4. I have not agreed to share the above-disclosed compensation with any other person unless they are members and associates 

of my law firm.

I have agreed to share the above-disclosed compensation with a person or persons who are not members or associates of

my law firm. A copy of the agreement, together with a list of the names of the people sharing in the compensation, is 





attached.

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

 including:

Analysis of the debtor's financial situation, and rendering advice to the debtor in determining whether to file 

a petition in bankruptcy;

a) 

b) Preparation and filing of any petition, schedules, statement of affairs, and plan which may be required;

c) Representation of the debtor at the meeting of creditors and confirmation hearing, and any adjourned hearings thereof;

d) [Other provisions as needed]

None

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

Representation of Debtor in Adversary Proceedings and other contested Bankruptcy Matters and Reaffirmation 

Hearings

Andrew M. Carter, Bar No. 0404578

Dated:

representation of the debtor(s) in this bankruptcy proceeding.

 I certify that the foregoing is a complete statement of any agreement or arrangement for payment to me for 

CERTIFICATION

Attorney for Debtor(s)

Law Office of Andrew M. Carter

s/AndrewMCarter

1/14/2010

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 69 of 75
B 201 (12/08) 

UNITED STATES BANKRUPTCY COURT

NORTHERN DISTRICT OF ILLINOIS

EASTERN DIVISION

NOTICE TO CONSUMER DEBTOR(S) UNDER § 342(b)

OF THE BANKRUPTCY CODE

 In accordance with § 342(b) of the Bankruptcy Code, this notice to individuals with primarily consumer debts: (1) 

Describes briefly the services available from credit counseling services; (2) Describes briefly the purposes, benefits and 

costs of the four types of bankruptcy proceedings you may commence; and (3) Informs you about bankruptcy crimes and 

notifies you that the Attorney General may examine all information you supply in connection with a bankruptcy case.

 You are cautioned that bankruptcy law is complicated and not easily described. Thus, you may wish to seek the 

advice of an attorney to learn of your rights and responsibilities should you decide to file a petition. Court employees cannot 

give you legal advice.

 Notices from the bankruptcy court are sent to the mailing address you list on your bankruptcy petition. In order to 

ensure that you receive information about events concerning your case, Bankruptcy Rule 4002 requires that you notify the 

court of any changes in your address. If you are filing a joint case (a single bankruptcy case for two individuals married to 

each other), and each spouse lists the same mailing address on the bankruptcy petition, you and your spouse will generally 

receive a single copy of each notice mailed from the bankruptcy court in a jointly-addressed envelope, unless you file a 

statement with the court requesting that each spouse receive a separate copy of all notices.

1. Services Available from Credit Counseling Agencies

 With limited exceptions, § 109(h) of the Bankruptcy Code requires that all individual debtors who file for 

bankruptcy relief on or after October 17, 2005, receive a briefing that outlines the available opportunities for credit 

counseling and provides assistance in performing a budget analysis. The briefing must be given within 180 days 

before the bankruptcy filing. The briefing may be provided individually or in a group (including briefings conducted by 

telephone or on the Internet) and must be provided by a nonprofit budget and credit counseling agency approved by the 

United States trustee or bankruptcy administrator. The clerk of the bankruptcy court has a list that you may consult of the 

approved budget and credit counseling agencies. Each debtor in a joint case must complete the briefing.

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

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

financial management instructional courses. Each debtor in a joint case must complete the course.

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

 Chapter 7: Liquidation ($245 filing fee, $39 administrative fee, $15 trustee surcharge: Total fee $299)

 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 kinds 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 ($235 filing fee, $39 

administrative fee: Total fee $274)

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 70 of 75
B 201 Page 2

 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 only 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 completing the payments under your plan, your debts are generally discharged except for domestic support 

obligations; most student loans; certain taxes; most criminal fines and restitution obligations; certain debts which are not 

properly listed in your bankruptcy papers; certain debts for acts that caused death or personal injury; and certain long term 

secured obligations. 

 Chapter 11: Reorganization ($1000 filing fee, $39 administrative fee: Total fee $1039)

 Chapter 11 is designed for the reorganization of a business but is also available to consumer debtors. Its provisions 

are quite complicated, and any decision by an individual to file a chapter 11 petition should be reviewed with an attorney. 

 Chapter 12: Family Farmer or Fisherman ($200 filing fee, $39 administrative fee: Total fee $239)

 Chapter 12 is designed to permit family farmers and fishermen to repay their debts over a period of time from 

future earnings and is similar to chapter 13. The eligibility requirements are restrictive, limiting its use to those whose 

income arises primarily from a family-owned farm or commercial fishing operation. 

3. Bankruptcy Crimes and Availability of Bankruptcy Papers to Law Enforcement Officials

 A person who knowingly and fraudulently conceals assets or makes a false oath or statement under penalty of 

perjury, either orally or in writing, in connection with a bankruptcy case is subject to a fine, imprisonment, or both. All 

information supplied by a debtor in connection with a bankruptcy case is subject to examination by the Attorney General 

acting through the Office of the United States Trustee, the Office of the United States Attorney, and other components and 

employees of the Department of Justice. 

WARNING: Section 521(a)(1) of the Bankruptcy Code requires that you promptly file detailed information regarding your 

creditors, assets, liabilities, income, expenses and general financial condition. Your bankruptcy case may be dismissed if 

this information is not filed with the court within the time deadlines set by the Bankruptcy Code, the Bankruptcy Rules, and 

the local rules of the court. 

Certificate of the Debtor

We, the debtors, affirm that we have received and read this notice.

Phyllis A. Pometta

Signature of Joint Debtor Date

Case No. (if known)

s/ Phyllis A. Pometta 1/14/2010 Printed Name(s) of Debtor(s)

1/14/2010

Signature of Debtor Date

s/ Steven G. Pometta

Steven G. Pometta

Steven G. Pometta

Phyllis A. Pometta

X

X

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 71 of 75
EASTERN DIVISION

NORTHERN DISTRICT OF ILLINOIS

UNITED STATES BANKRUPTCY COURT

Steven G. Pometta

Chapter

Case No.

Debtors.

In re

7

Phyllis A. Pometta

STATEMENT OF MONTHLY GROSS INCOME

2,249.66 -852.67

13,497.97 -5,116.00

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

Income from other sources

Last month 

Two months ago 

Three months ago 

Four months ago 

Five months ago 

Six months ago 

Income: Debtor Joint Debtor 

The undersigned certifies the following is the debtor's monthly income . 

3,470.97

0.00

0.00

0.00

0.00

0.00

10,027.00

2,996.00

-724.00

533.00

-2,910.00

-4,624.00

-387.00

0.00

Total gross income for six 

months preceding filing

Average Monthly Gross 

Income

Average Monthly Net Income $ 2,466.00 29.00 $

 Attached are all payment advices received by the undersigned debtor prior to the petition date, we declare 

under penalty of perjury that we have read the foregoing statement and that it is true and correct to the best of our 

knowledge, information, and belief.

Joint Debtor 

Debtor 

Dated: 1/14/2010

Phyllis A. Pometta

Steven G. Pometta

s/ Phyllis A. Pometta

s/ Steven G. Pometta

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 72 of 75
 B10 (Official Form 10) (12/08)

Name of Debtor: Case Number:

UNITED STATES BANKRUPTCY COURT PROOF OF CLAIM

This form should not be used to make a claim for an administrative expense arising after the commencement of the case. A request for payment of an

administrative expense may be filed pursuant to 11 U.S.C. § 503. NOTE:

Filed on:

Telephone number:

Court Claim Number:

(If known)

Check this box to indicate that this claim 

amends a previously filed claim. Name and address where notices should be sent:

 Name of Creditor (the person or other entity to whom the debtor owes money or property):

Check this box if you are the debtor

Telephone number: or trustee in this case.

Check this box if you are aware that anyone else 

has filed a proof of claim relating to your claim. 

Attach copy of statement giving particulars.





Name and address where payment should be sent (if different from above):

Specify the priority of the claim.

Amount of Claim Entitled to Priority under 11 

U.S.C. §507(a). If any portion of your claim 

falls in one of the following categories, check 

the box and state the amount.

5. 

Check this box if claim includes interest or other charges in addition to the principal amount of claim. 

Attach itemized statement of interest or charges.

If all or part of your claim is entitled to priority, complete item 5.

If all or part of your claim is secured, complete item 4 below; however, if all of your claim is unsecured, do not 

complete item 4.

1. Amount of Claim as of Date Case Filed: $



2. Basis for Claim:

(See instruction #2 on reverse side.) Domestic support obligations under

11 U.S.C. §507(a)(1)(A) or (a)(1)(B).



Wages, salaries, or commissions (up to $10,950*) 

earned within 180 days before filing of the 

bankruptcy petition or cessation of the debtor’s 

business, whichever is earlier – 11 U.S.C. §507 

(a)(4).

3. Last four digits of any number by which creditor identifies debtor: 

(See instruction #3a on reverse side.)

3a. Debtor may have scheduled account as:

Up to $2,425* of deposits toward

purchase, lease, or rental of property

or services for personal, family, or household use – 

11 U.S.C. §507 (a)(7).



Contributions to an employee benefit

plan – 11 U.S.C. §507 (a)(5). 4. Secured Claim (See instruction #4 on reverse side.) 

Check the appropriate box if your claim is secured by a lien on property or a right of setoff and provide the requested 

information.

Nature of property or right of setoff: Real Estate Motor Vehicle Other

Describe:

  

if any: $ Basis for perfection:

Amount of arrearage and other charges as of time case filed included in secured claim,

Value of Property:$__________ Annual Interest Rate __________ %  Taxes or penalties owed to governmental units – 11 

U.S.C. §507(a)(8).

 Other – Specify applicable paragraph

of 11 U.S.C. §507 (a)().

Amount of Secured Claim: $ Amount of Unsecured: $

If the documents are not available, please explain:

DO NOT SEND ORIGINAL DOCUMENTS. ATTACHED DOCUMENTS MAY BE DESTROYED AFTER

SCANNING.

7. Documents: Attach redacted copies of any documents that support the claim, such as promissory notes, 

purchase orders, invoices, itemized statements of running accounts, contracts, judgments, mortgages, and security 

agreements. You may also attach a summary. Attach redacted copies of documents providing evidence of 

perfection of a security interest. You may also attach a summary. (See instruction 7 and definition of “redacted” on 

reverse side.)

6. Credits: The amount of all payments on this claim has been credited for the purpose of making this proof of 

claim.

Amount entitled to priority

$

 *Amounts are subject to adjustment on 4/1/10 and every 3 

years thereafter with respect to cases commenced on or 

after the date of adjustment. 

Date: Signature: The person filing this claim must sign it. Sign and print name and title, if any, of the 

creditor or other person authorized to file this claim and state address and telephone number if 

different from the notice address above. Attach copy of power of attorney, if any.

FOR COURT USE ONLY

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 73 of 75
Penalty for presenting fraudulent claim: Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main Fine of up to $500,000 or imprisonment for up to 5 years, or both. 18 U.S.C. §§ 152 and 3571.

 Document Page 74 of 75
B10 (Official Form 10) (12/08)- Cont.

INSTRUCTIONS FOR PROOF OF CLAIM FORM

The instructions and definitions below are general explanations of the law. In certain circumstances, such as bankruptcy cases not filed voluntarily by the debtor, 

there may be exceptions to these general rules.

Items to be completed in Proof of Claim form

Court, Name of Debtor, and Case Number:

Fill in the federal judicial district where the bankruptcy case was filed (for 

example, Central District of California), the bankruptcy debtor’s name, and 

the bankruptcy case number. If the creditor received a notice of the case 

from the bankruptcy court, all of this information is located at the top of 

the notice.

Creditor’s Name and Address:

Fill in the name of the person or entity asserting a claim and the name and 

address of the person who should receive notices issued during the 

bankruptcy case. A separate space is provided for the payment address if it 

differs from the notice address. The creditor has a continuing obligation to 

keep the court informed of its current address. See Federal Rule of 

Bankruptcy Procedure (FRBP) 2002(g).

1. Amount of Claim as of Date Case Filed:

State the total amount owed to the creditor on the date of the Bankruptcy 

filing. Follow the instructions concerning whether to complete items 4 and 

5. Check the box if interest or other charges are included in the claim.

2. Basis for Claim:

State the type of debt or how it was incurred. Examples include goods sold, 

money loaned, services performed, personal injury/wrongful death, car 

loan, mortgage note, and credit card. If the claim is based on the delivery of 

health care goods or services, limit the disclosure of the goods or services 

so as to avoid embarrassment or the disclosure of confidential health care 

information. You may be required to provide additional disclosure if the 

trustee or another party in interest files an objection to your claim.

3. Last Four Digits of Any Number by Which Creditor Identifies

Debtor:

State only the last four digits of the debtor’s account or other number used by the 

creditor to identify the debtor.

3a. Debtor May Have Scheduled Account As:

Use this space to report a change in the creditor’s name, a transferred claim, or any 

other information that clarifies a difference between this proof of claim and the 

claim as scheduled by the debtor.

4. Secured Claim:

Check the appropriate box and provide the requested information if

the claim is fully or partially secured. Skip this section if the claim is

entirely unsecured. (See DEFINITIONS, below.) State the type and

the value of property that secures the claim, attach copies of lien 

documentation, and state annual interest rate and the amount past due

on the claim as of the date of the bankruptcy filing.

5. Amount of Claim Entitled to Priority Under 11 U.S.C. §507(a).

If any portion of your claim falls in one or more of the listed categories, check the 

appropriate box(es) and state the amount entitled to priority. (See DEFINITIONS, below.) 

A claim may be partly priority and partly non-priority. For example, in some of the 

categories, the law limits the amount entitled to priority.

6. Credits:

An authorized signature on this proof of claim serves as an acknowledgment that when 

calculating the amount of the claim, the creditor gave the debtor credit for any payments 

received toward the debt.

7. Documents:

Attach to this proof of claim form redacted copies documenting the existence of the debt and 

of any lien securing the debt. You may also attach a summary. You must also attach copies 

of documents that evidence perfection of any security interest. You may also attach a 

summary. FRBP 3001(c) and (d). If the claim is based on the delivery of health care goods 

or services, see instruction 2. Do not send original documents, as attachments may be 

destroyed after scanning.

Date and Signature:

The person filing this proof of claim must sign and date it. FRBP 9011. If the claim is filed 

electronically, FRBP 5005(a)(2), authorizes courts to establish local rules specifying what 

constitutes a signature. Print the name and title, if any, of the creditor or other person 

authorized to file this claim. State the filer’s address and telephone number if it differs from 

the address given on the top of the form for purposes of receiving notices. Attach a complete 

copy of any power of attorney. Criminal penalties apply for making a false statement on a 

proof of claim.

To receive acknowledgment of your filing, you may either 

enclose a stamped self-addressed envelope and a copy of 

this proof of claim or you may access the court’s PACER 

system (www.pacer.psc.uscourts.gov) for a small fee to 

Unsecured Claim view your filed proof of claim.

Claim

A creditor is a person, corporation, or other entity owed a

debt by the debtor that arose on or before the date of the

bankruptcy filing. See 11 U.S.C. §101 (10) 

An unsecured claim is one that does not meet the

requirements of a secured claim. A claim may be partly unsecured 

if the amount of the claim exceeds the value

of the property on which the creditor has a lien.

A lien may be voluntarily granted by a debtor or may be obtained 

through a court proceeding. In some states, a court judgment is a 

lien. A claim also may be secured if the creditor owes the debtor 

money (has a right to setoff). Creditor

A debtor is the person, corporation, or other entity that has filed 

a bankruptcy case.

Debtor 

Claim Entitled to Priority Under 11 U.S.C. §507(a)

A secured claim is one backed by a lien on property of the 

debtor. The claim is secured so long as the creditor has the right 

to be paid from the property prior to other creditors. The 

amount of the secured claim cannot exceed the value of the 

property. Any amount owed to the creditor in excess of the 

value of the property is an unsecured claim. Examples of liens 

on property include a mortgage on real estate or a security 

interest in a car.

Secured Claim Under 11 U.S.C. §506(a)

A claim is the creditor’s right to receive payment on a

debt owed by the debtor that arose on the date of the

bankruptcy filing. See 11 U.S.C. §101 (5). A claim may

be secured or unsecured. 

A proof of claim is a form used by the creditor to indicate the 

amount of the debt owed by the debtor on the date of the 

bankruptcy filing. The creditor must file the form with the 

clerk of the same bankruptcy court in which the bankruptcy 

case was filed.

Proof of Claim

Priority claims are certain categories of unsecured claims that are 

paid from the available money or property in a bankruptcy case 

before other unsecured claims.

Redacted

A document A document has been redacted when the person filing it has 

masked, edited out, or otherwise deleted, certain information. A 

creditor should redact and use only the last four digits of any 

social-security, individual’s tax identification, or financial-account 

number, all but the initials of a minor’s name and only the year of 

any person’s date of birth.

Evidence of Perfection

Evidence of perfection may include a mortgage, lien, certificate 

of title, financing statement, or other document showing that 

the lien has been filed or recorded.

Acknowledgment of Filing of Claim

Offers to Purchase a Claim

Certain entities are in the business of purchasing claims 

for an amount less than the fact value of the claims. One 

or more of these entities may contact the creditor and 

offer to purchase the claim. Some of the written 

communications from these entities may easily be 

confused with official court documentation or 

communications from the debtor. These entities do not 

represent the bankruptcy court or the debtor. The creditor 

has no obligation to sell its claim. However, if the creditor 

decides to sell its claim, any transfer of such claim is 

subject to FRBP 3001(e), any applicable provisions of the 

Bankruptcy Code (11 U.S.C. § 101 et seq.), and any 

applicable orders of the bankruptcy court.

__________DEFINITIONS__________ ______INFORMATION______

Case 10-01218 Doc 1 Filed 01/14/10 Entered 01/14/10 11:25:34 Desc Main

 Document Page 75 of 75