}bk1{Form .Vluntary Peiton}bk{

B1 (Official Form 1)(1/08)

United States Bankruptcy Court Voluntary Petition

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

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

(include married, maiden, and trade names):

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

(if more than one, state all)

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

County of Residence or of the Principal Place of Business:

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

Location of Principal Assets of Business Debtor

(if different from street address above):

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

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

(include married, maiden, and trade names):

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

(if more than one, state all)

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

County of Residence or of the Principal Place of Business:

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

ZIP Code ZIP Code

ZIP Code ZIP Code

Type of Debtor

(Form of Organization)

(Check one box)

Individual (includes Joint Debtors)

See Exhibit D on page 2 of this form.

Corporation (includes LLC and LLP)

Partnership

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

check this box and state type of entity below.)

Filing Fee (Check one box)

Full Filing Fee attached

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

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

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

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

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

Nature of Business

(Check one box)

Health Care Business

Single Asset Real Estate as defined

in 11 U.S.C. § 101 (51B)

Railroad

Stockbroker

Commodity Broker

Clearing Bank

Other

Tax-Exempt Entity

(Check box, if applicable)

Debtor is a tax-exempt organization

under Title 26 of the United States

Code (the Internal Revenue Code).

Chapter of Bankruptcy Code Under Which

the Petition is Filed (Check one box)

Chapter 7

Chapter 9

Chapter 11

Chapter 12

Chapter 13

Chapter 15 Petition for Recognition

of a Foreign Main Proceeding

Chapter 15 Petition for Recognition

of a Foreign Nonmain Proceeding

Nature of Debts

(Check one box)

Debts are primarily consumer debts, Debts are primarily

defined in 11 U.S.C. § 101(8) as business debts.

"incurred by an individual primarily for

a personal, family, or household purpose."

Check one box: Chapter 11 Debtors

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

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

Check if:

Debtor’s aggregate noncontingent liquidated debts (excluding debts owed

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

Check all applicable boxes:

A plan is being filed with this petition.

Acceptances of the plan were solicited prepetition from one or more

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

Statistical/Administrative Information THIS SPACE IS FOR COURT USE ONLY

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

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

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

Estimated Number of Creditors

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

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

Estimated Assets

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

$50,000 $100,000 $500,000 to $1 to $10 to $50 to $100 to $500 to $1 billion $1 billion

million million million million million

Estimated Liabilities

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

$50,000 $100,000 $500,000 to $1 to $10 to $50 to $100 to $500 to $1 billion $1 billion

million million million million million

Northern District of Illinois

Host, Samuel E. O. Host, Evangelyn R.

xxx-xx-2844

155 South Main Street

Burlington, IL

Kane

P. O. Box 186

Burlington, IL

xxx-xx-1849

155 South Main Street

Burlington, IL

Kane

P. O. Box 186

Burlington, IL

60109

60109

60109

60109

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 Document Page 1 of 47
B1 (Official Form 1)(1/08) Page 2

Voluntary Petition

(This page must be completed and filed in every case)

Name of Debtor(s):

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

Location Case Number: Date Filed:

Where Filed:

Location Case Number: Date Filed:

Where Filed:

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

Name of Debtor: Case Number: Date Filed:

District: Relationship: Judge:

Exhibit A

(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.)

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

Exhibit C

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

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

No.

Exhibit D

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

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

If this is a joint petition:

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

Information Regarding the Debtor - Venue

(Check any applicable box)

Debtor has been domiciled or has had a residence, principal place of business, or principal assets in this District for 180

days immediately preceding the date of this petition or for a longer part of such 180 days than in any other District.

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

Debtor is a debtor in a foreign proceeding and has its principal place of business or principal assets in the United States in

this District, or has no principal place of business or assets in the United States but is a defendant in an action or

proceeding [in a federal or state court] in this District, or the interests of the parties will be served in regard to the relief

sought in this District.

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

(Check all applicable boxes)

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

(Name of landlord that obtained judgment)

(Address of landlord)

Debtor claims that under applicable nonbankruptcy law, there are circumstances under which the debtor would be permitted to cure

the entire monetary default that gave rise to the judgment for possession, after the judgment for possession was entered, and

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

after the filing of the petition.

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

Exhibit B

(To be completed if debtor is an individual whose debts are primarily consumer debts.)

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

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

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

under each such chapter. I further certify that I delivered to the debtor the notice

required by 11 U.S.C. §342(b).

X

Signature of Attorney for Debtor(s) (Date)

Host, Samuel E. O.

Host, Evangelyn R.

- None -

- None -

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 Document Page 2 of 47
B1 (Official Form 1)(1/08) Page 3

Voluntary Petition

(This page must be completed and filed in every case)

Name of Debtor(s):

Signatures

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

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

petition is true and correct.

[If petitioner is an individual whose debts are primarily consumer debts and

has chosen to file under chapter 7] I am aware that I may proceed under

chapter 7, 11, 12, or 13 of title 11, United States Code, understand the relief

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

[If no attorney represents me and no bankruptcy petition preparer signs the

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

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

specified in this petition.

X

Signature of Debtor

X

Signature of Joint Debtor

Telephone Number (If not represented by attorney)

Date

Signature of Attorney*

X

Signature of Attorney for Debtor(s)

Printed Name of Attorney for Debtor(s)

Firm Name

Address

Telephone Number

Date

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

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

information in the schedules is incorrect.

Signature of Debtor (Corporation/Partnership)

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

petition is true and correct, and that I have been authorized to file this petition

on behalf of the debtor.

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

States Code, specified in this petition.

X

Signature of Authorized Individual

Printed Name of Authorized Individual

Title of Authorized Individual

Date

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.

(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 11 U.S.C. §1515 are attached.

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

of title 11 specified in this petition. A certified copy of the order granting

recognition of the foreign main proceeding is attached.

X

Signature of Foreign Representative

Printed Name of Foreign Representative

Date

Signature of Non-Attorney Bankruptcy Petition Preparer

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

preparer as defined in 11 U.S.C. § 110; (2) I prepared this document for

compensation and have provided the debtor with a copy of this document

and the notices and information required under 11 U.S.C. §§ 110(b),

110(h), and 342(b); 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.

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

Social-Security number (If the bankrutpcy petition preparer is not

an individual, state the Social Security number of the officer,

principal, responsible person or partner of the bankruptcy petition

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

Address

X

Date

Signature of Bankruptcy Petition Preparer or officer, principal, responsible

person,or partner whose Social Security number is provided above.

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

assisted in preparing this document unless the bankruptcy petition preparer is

not an individual:

If more than one person prepared this document, attach additional sheets

conforming to the appropriate official form for each person.

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

title 11 and the Federal Rules of Bankruptcy Procedure may result in

fines or imprisonment or both 11 U.S.C. §110; 18 U.S.C. §156.

Host, Samuel E. O.

Host, Evangelyn R.

/s/ Samuel E. O. Host

Samuel E. O. Host

/s/ Evangelyn R. Host

Evangelyn R. Host

January 13, 2010

/s/ Jeffrey M. Krasner

Jeffrey M. Krasner 01524909

LAW OFFICES OF JEFFREY M. KRASNER

a Professional Corporation

407 W State St, Ste 4

Sycamore, IL 60178-1455

Email: krasnerlaw@comcast.net

815-899-8436 Fax: 815-895-1700

January 13, 2010

Case 10-01069 Doc 1 Filed 01/13/10 Entered 01/13/10 12:44:15 Desc Main

 Document Page 3 of 47
B 1D (Official Form 1, Exhibit D) (12/09)

United States Bankruptcy Court

Northern District of Illinois

In re

Samuel E. O. Host

Evangelyn R. Host Case No.

Debtor(s) Chapter 7

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 liste

so, you are not eligible to file a bankruptcy case, and the court can dismiss any case you do file. If that happens, y

fee you paid, and your creditors will be able to resume collection activities against you. If your case is dismissed a

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

activities.

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

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 

United States trustee or bankruptcy administrator that outlined the opportunities for available credit counseling and assiste

budget analysis, and I have a certificate from the agency describing the services provided to me. Attach a copy of the cert

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 

United States trustee or bankruptcy administrator that outlined the opportunities for available credit counseling and assiste

budget analysis, but I do not have a certificate from the agency describing the services provided to me. You must file a co

agency describing the services provided to you and a copy of any debt repayment plan developed through the agency no 

your bankruptcy case is filed.

 3. I certify that I requested credit counseling services from an approved agency but was unable to obtain the ser

from the time I made my request, and the following exigent circumstances merit a temporary waiver of the credit counsel

my bankruptcy case now. [Summarize exigent circumstances here.]

Software Copyright (c) 1996-2009 Best Case Solutions - Evanston, IL - (800) 492-8037 Best Case Bankruptcy

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 Document Page 4 of 47
B 1D (Official Form 1, Exhibit D) (12/09) - Cont. Page 2

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

file your bankruptcy petition and promptly file a certificate from the agency that provided the counseling, togeth

management plan developed through the agency. Failure to fulfill these requirements may result in dismissal of y

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

not satisfied with your reasons for filing your bankruptcy case without first receiving a credit counseling briefing

 4. I am not required to receive a credit counseling briefing because of: [Check the applicable statement.] [Mus

motion for determination by the court.]

 Incapacity. (Defined in 11 U.S.C. § 109(h)(4) as impaired by reason of mental illness or mental deficien

realizing and making rational decisions with respect to financial responsibilities.);

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

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 

not apply in this district.

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

Signature of Debtor: /s/ Samuel E. O. Host

Samuel E. O. Host

Date: January 13, 2010

Software Copyright (c) 1996-2009 Best Case Solutions - Evanston, IL - (800) 492-8037 Best Case Bankruptcy

Case 10-01069 Doc 1 Filed 01/13/10 Entered 01/13/10 12:44:15 Desc Main

 Document Page 5 of 47
B 1D (Official Form 1, Exhibit D) (12/09)

United States Bankruptcy Court

Northern District of Illinois

In re

Samuel E. O. Host

Evangelyn R. Host Case No.

Debtor(s) Chapter 7

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 liste

so, you are not eligible to file a bankruptcy case, and the court can dismiss any case you do file. If that happens, y

fee you paid, and your creditors will be able to resume collection activities against you. If your case is dismissed a

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

activities.

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

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 

United States trustee or bankruptcy administrator that outlined the opportunities for available credit counseling and assiste

budget analysis, and I have a certificate from the agency describing the services provided to me. Attach a copy of the cert

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 

United States trustee or bankruptcy administrator that outlined the opportunities for available credit counseling and assiste

budget analysis, but I do not have a certificate from the agency describing the services provided to me. You must file a co

agency describing the services provided to you and a copy of any debt repayment plan developed through the agency no 

your bankruptcy case is filed.

 3. I certify that I requested credit counseling services from an approved agency but was unable to obtain the ser

from the time I made my request, and the following exigent circumstances merit a temporary waiver of the credit counsel

my bankruptcy case now. [Summarize exigent circumstances here.]

Software Copyright (c) 1996-2009 Best Case Solutions - Evanston, IL - (800) 492-8037 Best Case Bankruptcy

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 Document Page 6 of 47
B 1D (Official Form 1, Exhibit D) (12/09) - Cont. Page 2

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

file your bankruptcy petition and promptly file a certificate from the agency that provided the counseling, togeth

management plan developed through the agency. Failure to fulfill these requirements may result in dismissal of y

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

not satisfied with your reasons for filing your bankruptcy case without first receiving a credit counseling briefing

 4. I am not required to receive a credit counseling briefing because of: [Check the applicable statement.] [Mus

motion for determination by the court.]

 Incapacity. (Defined in 11 U.S.C. § 109(h)(4) as impaired by reason of mental illness or mental deficien

realizing and making rational decisions with respect to financial responsibilities.);

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

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 

not apply in this district.

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

Signature of Debtor: /s/ Evangelyn R. Host

Evangelyn R. Host

Date: January 13, 2010

Software Copyright (c) 1996-2009 Best Case Solutions - Evanston, IL - (800) 492-8037 Best Case Bankruptcy

Case 10-01069 Doc 1 Filed 01/13/10 Entered 01/13/10 12:44:15 Desc Main

 Document Page 7 of 47
}bk1{Form 6.Suary ofScheduls}bk{

United States Bankruptcy Court

Northern District of Illinois

In re

,

Debtors

Case No.

Chapter 7

Samuel E. O. Host,

Evangelyn R. Host

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

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

B, D, E, F, I, and J in the boxes provided. Add the amounts from Schedules A and B to determine the total amount of the debtor’s assets.

Add the amounts of all claims from Schedules D, E, and F to determine the total amount of the debtor’s liabilities. Individual debtors must

also complete the "Statistical Summary of Certain Liabilities and Related Data" if they file a case under chapter 7, 11, or 13.

SUMMARY OF SCHEDULES

ATTACHED NO. OF NAME OF SCHEDULE ASSETS LIABILITIES OTHER

(YES/NO) SHEETS

A - Real Property

B - Personal Property

C - Property Claimed as Exempt

D - Creditors Holding Secured Claims

E - Creditors Holding Unsecured

Priority Claims

F - Creditors Holding Unsecured

Nonpriority Claims

G - Executory Contracts and

Unexpired Leases

H - Codebtors

I - Current Income of Individual

Debtor(s)

J - Current Expenditures of Individual

Debtor(s)

Total Number of Sheets of ALL Schedules

Total Assets

Total Liabilities

(Total of Claims on Schedule E)

Copyright (c) 1996-2009 - Best Case Solutions - Evanston, IL - (800) 492-8037 Best Case Bankruptcy

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

1 210,000.00

4 12,235.00

2

1 215,730.81

2 5,965.45

3 60,656.85

1

1

1 2,351.67

1 4,035.00

17

222,235.00

282,353.11

Case 10-01069 Doc 1 Filed 01/13/10 Entered 01/13/10 12:44:15 Desc Main

 Document Page 8 of 47
}bk1{Form 6.Staiscl Sumaryof CetainLbles andRlte Da}bk{

United States Bankruptcy Court

Northern District of Illinois

In re

,

Debtors

Case No.

Chapter 7

Samuel E. O. Host,

Evangelyn R. Host

Form 6 - Statistical Summary (12/07)

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.

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

Type of Liability Amount

Domestic Support Obligations (from Schedule E)

Taxes and Certain Other Debts Owed to Governmental Units

(from Schedule E)

Claims for Death or Personal Injury While Debtor Was Intoxicated

(from Schedule E) (whether disputed or undisputed)

Student Loan Obligations (from Schedule F)

Domestic Support, Separation Agreement, and Divorce Decree

Obligations Not Reported on Schedule E

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

(from Schedule F)

TOTAL

State the following:

Average Income (from Schedule I, Line 16)

Average Expenses (from Schedule J, Line 18)

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

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

State the following:

1. Total from Schedule D, "UNSECURED PORTION, IF ANY"

column

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

column

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

PRIORITY, IF ANY" column

4. Total from Schedule F

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

Copyright (c) 1996-2009 - Best Case Solutions - Evanston, IL - (800) 492-8037 Best Case Bankruptcy

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 Document Page 9 of 47
}bk1{Schedul A-ReaPropty}bk{

In re

,

Debtors

Samuel E. O. Host, Case No.

Evangelyn R. Host

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

Except as directed below, list all real property in which the debtor has any legal, equitable, or future interest, including all property owned as a

cotenant, community property, or in which the debtor has a life estate. Include any property in which the debtor holds rights and powers exercisable for

the debtor's own benefit. If the debtor is married, state whether husband, wife, both, or the marital community own the property by placing an "H," "W,"

"J," or "C" in the column labeled "Husband, Wife, Joint, or Community." If the debtor holds no interest in real property, write "None" under

"Description and Location of Property."

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

Unexpired Leases.

If an entity claims to have a lien or hold a secured interest in any property, state the amount of the secured claim. See Schedule D. If no entity

claims to hold a secured interest in the property, write "None" in the column labeled "Amount of Secured Claim." If the debtor is an individual or

if a joint petition is filed, state the amount of any exemption claimed in the property only in Schedule C - Property Claimed as Exempt.

Description and Location of Property Nature of Debtor's

Interest in Property

Husband,

Wife,

Joint, or

Community

Current Value of

Debtor's Interest in

Property, without

Deducting any Secured

Claim or Exemption

Amount of

Secured Claim

continuation sheets attached to the Schedule of Real Property

SCHEDULE A - REAL PROPERTY

Copyright (c) 1996-2009 - Best Case Solutions - Evanston, IL - (800) 492-8037 Best Case Bankruptcy

0

155 South Main Street, Burlington, IL Fee simple - 210,000.00 207,730.81

Sub-Total > 210,000.00 (Total of this page)

Total >

(Report also on Summary of Schedules)

210,000.00

Case 10-01069 Doc 1 Filed 01/13/10 Entered 01/13/10 12:44:15 Desc Main

 Document Page 10 of 47
}bk1{Schedul B-Personal Prpety}bk{

In re

,

Debtors

Samuel E. O. Host, Case No.

Evangelyn R. Host

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

Except as directed below, list all personal property of the debtor of whatever kind. If the debtor has no property in one or more of the categories, place

an "x" in the appropriate position in the column labeled "None." If additional space is needed in any category, attach a separate sheet properly identified

with the case name, case number, and the number of the category. If the debtor is married, state whether husband, wife, both, or the marital community

own the property by placing an "H," "W," "J," or "C" in the column labeled "Husband, Wife, Joint, or Community." If the debtor is an individual or a joint

petition is filed, state the amount of any exemptions claimed only in Schedule C - Property Claimed as Exempt.

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

Unexpired Leases.

If the property is being held for the debtor by someone else, state that person's name and address under "Description and Location of Property."

If the property is being held for a minor child, simply state the child's initials and the name and address of the child's parent or guardian, such as

"A.B., a minor child, by John Doe, guardian." Do not disclose the child's name. See, 11 U.S.C. §112 and Fed. R. Bankr. P. 1007(m).

Type of Property

N

O

N

E

Description and Location of Property

Husband,

Wife,

Joint, or

Community

Current Value of

Debtor's Interest in Property,

without Deducting any

Secured Claim or Exemption

continuation sheets attached to the Schedule of Personal Property

SCHEDULE B - PERSONAL PROPERTY

Copyright (c) 1996-2009 - Best Case Solutions - Evanston, IL - (800) 492-8037 Best Case Bankruptcy

3

1. Cash on hand X

2. Checking, savings or other financial

accounts, certificates of deposit, or

shares in banks, savings and loan,

thrift, building and loan, and

homestead associations, or credit

unions, brokerage houses, or

cooperatives.

X

3. Security deposits with public

utilities, telephone companies,

landlords, and others.

X

4. Household goods and furnishings,

including audio, video, and

computer equipment.

Undivided 1/2 interest used bedroom furniture, living

room set and TV.

Location: 155 South Main Street, Burlington IL

H 750.00

Undivided 1/2 interest used bedroom furniture, living

room set and TV.

Location: 155 South Main Street, Burlington IL

W 750.00

5. Books, pictures and other art

objects, antiques, stamp, coin,

record, tape, compact disc, and

other collections or collectibles.

Undivided 1/2 interest in Misc. books and pictures

Location: 155 South Main Street, Burlington IL

H 50.00

Undivided 1/2 interest in Misc. books and pictures

Location: 155 South Main Street, Burlington IL

W 0.00

6. Wearing apparel. Used clothing for 2 adults

Location: 155 South Main Street, Burlington IL

J Unknown

7. Furs and jewelry. Wedding ring and misc jewelry

Location: 155 South Main Street, Burlington IL

W 1,000.00

his Wedding ring

Location: 155 South Main Street, Burlington IL

H 150.00

8. Firearms and sports, photographic,

and other hobby equipment.

Used golf clubs

Location: 155 South Main Street, Burlington IL

H 50.00

Sub-Total >

(Total of this page)

2,750.00

Case 10-01069 Doc 1 Filed 01/13/10 Entered 01/13/10 12:44:15 Desc Main

 Document Page 11 of 47
B6B (Official Form 6B) (12/07) - Cont.

Type of Property

N

O

N

E

Description and Location of Property

Husband,

Wife,

Joint, or

Community

Current Value of

Debtor's Interest in Property,

without Deducting any

Secured Claim or Exemption

Sheet of continuation sheets attached

to the Schedule of Personal Property

SCHEDULE B - PERSONAL PROPERTY

(Continuation Sheet)

Copyright (c) 1996-2009 - Best Case Solutions - Evanston, IL - (800) 492-8037 Best Case Bankruptcy

In re

,

Debtors

Samuel E. O. Host, Case No.

Evangelyn R. Host

9. Interests in insurance policies.

Name insurance company of each

policy and itemize surrender or

refund value of each.

X

10. Annuities. Itemize and name each

issuer.

X

11. Interests in an education IRA as

defined in 26 U.S.C. § 530(b)(1) or

under a qualified State tuition plan

as defined in 26 U.S.C. § 529(b)(1).

Give particulars. (File separately the

record(s) of any such interest(s).

11 U.S.C. § 521(c).)

X

12. Interests in IRA, ERISA, Keogh, or

other pension or profit sharing

plans. Give particulars.

X

13. Stock and interests in incorporated

and unincorporated businesses.

Itemize.

Street account at Edward Jones Company, $5000.00

value subject to 51% margin loan, with net value of

H 2,450.00

14. Interests in partnerships or joint

ventures. Itemize.

X

15. Government and corporate bonds

and other negotiable and

nonnegotiable instruments.

X

16. Accounts receivable. X

17. Alimony, maintenance, support, and

property settlements to which the

debtor is or may be entitled. Give

particulars.

X

18. Other liquidated debts owed to debtor

including tax refunds. Give particulars.

X

19. Equitable or future interests, life

estates, and rights or powers

exercisable for the benefit of the

debtor other than those listed in

Schedule A - Real Property.

X

Sub-Total >

(Total of this page)

2,450.00

1 3

Case 10-01069 Doc 1 Filed 01/13/10 Entered 01/13/10 12:44:15 Desc Main

 Document Page 12 of 47
B6B (Official Form 6B) (12/07) - Cont.

Type of Property

N

O

N

E

Description and Location of Property

Husband,

Wife,

Joint, or

Community

Current Value of

Debtor's Interest in Property,

without Deducting any

Secured Claim or Exemption

Sheet of continuation sheets attached

to the Schedule of Personal Property

SCHEDULE B - PERSONAL PROPERTY

(Continuation Sheet)

Copyright (c) 1996-2009 - Best Case Solutions - Evanston, IL - (800) 492-8037 Best Case Bankruptcy

In re

,

Debtors

Samuel E. O. Host, Case No.

Evangelyn R. Host

20. Contingent and noncontingent

interests in estate of a decedent,

death benefit plan, life insurance

policy, or trust.

X

21. Other contingent and unliquidated

claims of every nature, including

tax refunds, counterclaims of the

debtor, and rights to setoff claims.

Give estimated value of each.

X

22. Patents, copyrights, and other

intellectual property. Give

particulars.

X

23. Licenses, franchises, and other

general intangibles. Give

particulars.

X

24. Customer lists or other compilations

containing personally identifiable

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

§ 101(41A)) provided to the debtor

by individuals in connection with

obtaining a product or service from

the debtor primarily for personal,

family, or household purposes.

X

25. Automobiles, trucks, trailers, and

other vehicles and accessories.

2001 Saab 9-5 with 91,000 miles

Location: 155 South Main Street, Burlington IL

Vehicle titled and loan in name of Denise R. Host,

mother of Debtor.

J 6,035.00

26. Boats, motors, and accessories. X

27. Aircraft and accessories. X

28. Office equipment, furnishings, and

supplies.

X

29. Machinery, fixtures, equipment, and

supplies used in business.

Tool of Debtor's Trade (carpenntry - 1,000.00

30. Inventory. X

31. Animals. X

32. Crops - growing or harvested. Give

particulars.

X

Sub-Total >

(Total of this page)

7,035.00

2 3

Case 10-01069 Doc 1 Filed 01/13/10 Entered 01/13/10 12:44:15 Desc Main

 Document Page 13 of 47
B6B (Official Form 6B) (12/07) - Cont.

Type of Property

N

O

N

E

Description and Location of Property

Husband,

Wife,

Joint, or

Community

Current Value of

Debtor's Interest in Property,

without Deducting any

Secured Claim or Exemption

Sheet of continuation sheets attached

to the Schedule of Personal Property

SCHEDULE B - PERSONAL PROPERTY

(Continuation Sheet)

Copyright (c) 1996-2009 - Best Case Solutions - Evanston, IL - (800) 492-8037 Best Case Bankruptcy

In re

,

Debtors

Samuel E. O. Host, Case No.

Evangelyn R. Host

33. Farming equipment and

implements.

X

34. Farm supplies, chemicals, and feed. X

35. Other personal property of any kind

not already listed. Itemize.

X

Sub-Total >

(Total of this page)

0.00

3 3

Total >

(Report also on Summary of Schedules)

12,235.00

Case 10-01069 Doc 1 Filed 01/13/10 Entered 01/13/10 12:44:15 Desc Main

 Document Page 14 of 47
}bk1{Schedul C-Propety Claimed sExpt}bk{

In re

,

Debtors

Samuel E. O. Host, Case No.

Evangelyn R. Host

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

Debtor claims the exemptions to which debtor is entitled under: Check if debtor claims a homestead exemption that exceeds

(Check one box) $136,875.

11 U.S.C. §522(b)(2)

11 U.S.C. §522(b)(3)

Description of Property Specify Law Providing

Each Exemption

Value of

Claimed

Exemption

Current Value of

Property Without

Deducting Exemption

continuation sheets attached to Schedule of Property Claimed as Exempt

SCHEDULE C - PROPERTY CLAIMED AS EXEMPT

Copyright (c) 1996-2009 - Best Case Solutions - Evanston, IL - (800) 492-8037 Best Case Bankruptcy

1

Husband's Exemptions

Real Property

155 South Main Street, Burlington, IL 735 ILCS 5/12-901 0.00 210,000.00

Household Goods and Furnishings

Undivided 1/2 interest used bedroom furniture,

living room set and TV.

Location: 155 South Main Street, Burlington IL

735 ILCS 5/12-1001(b) 500.00 750.00

Books, Pictures and Other Art Objects; Collectibles

Undivided 1/2 interest in Misc. books and

pictures

Location: 155 South Main Street, Burlington IL

735 ILCS 5/12-1001(a) 100.00 50.00

Wearing Apparel

Used clothing for 2 adults

Location: 155 South Main Street, Burlington IL

735 ILCS 5/12-1001(a) 100% Unknown

Furs and Jewelry

his Wedding ring

Location: 155 South Main Street, Burlington IL

735 ILCS 5/12-1001(b) 150.00 150.00

Firearms and Sports, Photographic and Other Hobby Equipment

Used golf clubs

Location: 155 South Main Street, Burlington IL

20 ILCS 1805/10 50.00 50.00

Stock and Interests in Businesses

Street account at Edward Jones Company,

$5000.00 value subject to 51% margin loan, with

net value of

735 ILCS 5/12-1001(b) 2,450.00 2,450.00

Automobiles, Trucks, Trailers, and Other Vehicles

2001 Saab 9-5 with 91,000 miles

Location: 155 South Main Street, Burlington IL

Vehicle titled and loan in name of Denise R. Host,

mother of Debtor.

735 ILCS 5/12-1001(c) 2,400.00 6,035.00

Machinery, Fixtures, Equipment and Supplies Used in Business

Tool of Debtor's Trade (carpenntry 735 ILCS 5/12-1001(d) 1,000.00 1,000.00

Total: 6,650.00 220,485.00

Case 10-01069 Doc 1 Filed 01/13/10 Entered 01/13/10 12:44:15 Desc Main

 Document Page 15 of 47
B6C (Official Form 6C) (12/07) -- Cont.

Description of Property Specify Law Providing

Each Exemption

Value of

Claimed

Exemption

Current Value of

Property Without

Deducting Exemption

Sheet of continuation sheets attached to the Schedule of Property Claimed as Exempt

SCHEDULE C - PROPERTY CLAIMED AS EXEMPT

(Continuation Sheet)

Copyright (c) 1996-2009 - Best Case Solutions - Evanston, IL - (800) 492-8037 Best Case Bankruptcy

In re

,

Debtors

Samuel E. O. Host, Case No.

Evangelyn R. Host

Wife's Exemptions

Household Goods and Furnishings

Undivided 1/2 interest used bedroom furniture,

living room set and TV.

Location: 155 South Main Street, Burlington IL

735 ILCS 5/12-1001(b) 500.00 750.00

Undivided 1/2 interest used bedroom furniture,

living room set and TV.

Location: 155 South Main Street, Burlington IL

735 ILCS 5/12-1001(b) 750.00 750.00

Furs and Jewelry

Wedding ring and misc jewelry

Location: 155 South Main Street, Burlington IL

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

Automobiles, Trucks, Trailers, and Other Vehicles

2001 Saab 9-5 with 91,000 miles

Location: 155 South Main Street, Burlington IL

Vehicle titled and loan in name of Denise R. Host,

mother of Debtor.

735 ILCS 5/12-1001(c) 2,400.00 6,035.00

1 1

Total: 4,650.00 8,535.00

Case 10-01069 Doc 1 Filed 01/13/10 Entered 01/13/10 12:44:15 Desc Main

 Document Page 16 of 47
}bk1{Schedul D-Creditos HldingSecurd Claims}bk{

AMOUNT OF

CLAIM

WITHOUT

DEDUCTING

VALUE OF

COLLATERAL

DATE CLAIM WAS INCURRED,

NATURE OF LIEN, AND

DESCRIPTION AND VALUE

OF PROPERTY

SUBJECT TO LIEN

C

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Husband, Wife, Joint, or Community

H

W

J

C

CREDITOR'S NAME

AND MAILING ADDRESS

INCLUDING ZIP CODE,

AND ACCOUNT NUMBER

(See instructions above.)

Account No.

Value $

Account No.

Value $

Account No.

Value $

Account No.

Value $

Subtotal

_____ continuation sheets attached (Total of this page)

UNSECURED

PORTION, IF

ANY

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

State the name, mailing address, including zip code, and last four digits of any account number of all entities holding claims secured by property of the debtor as of

the date of filing of the petition. The complete account number of any account the debtor has with the creditor is useful to the trustee and the creditor and may be provided

if the debtor chooses to do so. List creditors holding all types of secured interests such as judgment liens, garnishments, statutory liens, mortgages, deeds of trust, and

other security interests.

List creditors in alphabetical order to the extent practicable. If a minor child is a creditor, the child's initials and the name and address of the child's parent or

guardian, such as "A.B., a minor child, by John Doe, guardian." Do not disclose the child's name. See, 11 U.S.C. §112 and Fed. R. Bankr. P. 1007(m). If all secured

creditors will not fit on this page, use the continuation sheet provided.

If any entity other than a spouse in a joint case may be jointly liable on a claim, place an "X" in the column labeled "Codebtor" ,include the entity on the appropriate

schedule of creditors, and complete Schedule H - Codebtors. If a joint petition is filed, state whether the husband, wife, both of them, or the marital community may be

liable on each claim by placing an "H", "W", "J", or "C" in the column labeled "Husband, Wife, Joint, or Community".

If the claim is contingent, place an "X" in the column labeled "Contingent". If the claim is unliquidated, place an "X" in the column labeled "Unliquidated". If the

claim is disputed, place an "X" in the column labeled "Disputed". (You may need to place an "X" in more than one of these three columns.)

Total the columns labeled "Amount of Claim Without Deducting Value of Collateral" and "Unsecured Portion, if Any" in the boxes labeled "Total(s)" on the last

sheet of the completed schedule. Report the total from the column labeled "Amount of Claim" also on the Summary of Schedules and, if the debtor is an individual with

primarily consumer debts, report the total from the column labeled "Unsecured Portion" on the Statistical Summary of Certain Liabilities and Related Data.

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

SCHEDULE D - CREDITORS HOLDING SECURED CLAIMS

Copyright (c) 1996-2009 - Best Case Solutions - Evanston, IL - (800) 492-8037 Best Case Bankruptcy

In re

,

Debtors

Samuel E. O. Host, Case No.

Evangelyn R. Host

0

2001 Saab 9-5 with 91,000 miles

Location: 155 South Main Street,

Burlington IL

Vehicle titled and loan in name of Denise

R. Host, mother of Debtor.

Creditor #: 1

Chase Auto Finance

POB 901076

Fort Worth, TX 76101-2076 J

6,035.00 8,000.00 1,965.00

087556991 First Mortgage

155 South Main Street, Burlington, IL

Creditor #: 2

Countrywide Home Loans

P.O. Box 660694

Dallas, TX 75266-0694 H

210,000.00 165,615.42 0.00

087557039 Second Mortgage

155 South Main Street, Burlington, IL

Creditor #: 3

Countrywide Home Loans

P.O. Box 660694

Dallas, TX 75266-0694 H

210,000.00 42,115.39 0.00

215,730.81 1,965.00

Total 215,730.81 1,965.00

(Report on Summary of Schedules)

Case 10-01069 Doc 1 Filed 01/13/10 Entered 01/13/10 12:44:15 Desc Main

 Document Page 17 of 47
}bk1{Schedul E-Creditos HldingUsecurd PiotyClams}bk{

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

A complete list of claims entitled to priority, listed separately by type of priority, is to be set forth on the sheets provided. Only holders of unsecured claims entitled

to priority should be listed in this schedule. In the boxes provided on the attached sheets, state the name, mailing address, including zip code, and last four digits of the

account number, if any, of all entities holding priority claims against the debtor or the property of the debtor, as of the date of the filing of the petition. Use a separate

continuation sheet for each type of priority and label each with the type of priority.

The complete account number of any account the debtor has with the creditor is useful to the trustee and the creditor and may be provided if the debtor chooses to do

so. If a minor child is a creditor, state the child's initials and the name and address of the child's parent or guardian, such as "A.B., a minor child, by John Doe, guardian."

Do not disclose the child's name. See, 11 U.S.C. §112 and Fed. R. Bankr. P. 1007(m).

If any entity other than a spouse in a joint case may be jointly liable on a claim, place an "X" in the column labeled "Codebtor," include the entity on the appropriate

schedule of creditors, and complete Schedule H-Codebtors. If a joint petition is filed, state whether the husband, wife, both of them, or the marital community may be

liable on each claim by placing an "H," "W," "J," or "C" in the column labeled "Husband, Wife, Joint, or Community." If the claim is contingent, place an "X" in the

column labeled "Contingent." If the claim is unliquidated, place an "X" in the column labeled "Unliquidated." If the claim is disputed, place an "X" in the column labeled

"Disputed." (You may need to place an "X" in more than one of these three columns.)

Report the total of claims listed on each sheet in the box labeled "Subtotals" on each sheet. Report the total of all claims listed on this Schedule E in the box labeled

"Total" on the last sheet of the completed schedule. Report this total also on the Summary of Schedules.

Report the total of amounts entitled to priority listed on each sheet in the box labeled "Subtotals" on each sheet. Report the total of all amounts entitled to priority

listed on this Schedule E in the box labeled "Totals" on the last sheet of the completed schedule. Individual debtors with primarily consumer debts report this total

also on the Statistical Summary of Certain Liabilities and Related Data.

Report the total of amounts not entitled to priority listed on each sheet in the box labeled "Subtotals" on each sheet. Report the total of all amounts not entitled to

priority listed on this Schedule E in the box labeled "Totals" on the last sheet of the completed schedule. Individual debtors with primarily consumer debts report this

total also on the Statistical Summary of Certain Liabilities and Related Data.

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

TYPES OF PRIORITY CLAIMS (Check the appropriate box(es) below if claims in that category are listed on the attached sheets)

Domestic support obligations

Claims for domestic support that are owed to or recoverable by a spouse, former spouse, or child of the debtor, or the parent, legal guardian, or responsible relative

of such a child, or a governmental unit to whom such a domestic support claim has been assigned to the extent provided in 11 U.S.C. § 507(a)(1).

Extensions of credit in an involuntary case

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

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

Wages, salaries, and commissions

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

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

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

Contributions to employee benefit plans

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

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

Certain farmers and fishermen

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

Deposits by individuals

Claims of individuals up to $2,425* for deposits for the purchase, lease, or rental of property or services for personal, family, or household use, that were not

delivered or provided. 11 U.S.C. § 507(a)(7).

Taxes and certain other debts owed to governmental units

Taxes, customs duties, and penalties owing to federal, state, and local governmental units as set forth in 11 U.S.C. § 507(a)(8).

Commitments to maintain the capital of an insured depository institution

Claims based on commitments to the FDIC, RTC, Director of the Office of Thrift Supervision, Comptroller of the Currency, or Board of Governors of the Federal

Reserve System, or their predecessors or successors, to maintain the capital of an insured depository institution. 11 U.S.C. § 507 (a)(9).

Claims for death or personal injury while debtor was intoxicated

Claims for death or personal injury resulting from the operation of a motor vehicle or vessel while the debtor was intoxicated from using alcohol, a drug, or

another substance. 11 U.S.C. § 507(a)(10).

* Amounts are subject to adjustment on April 1, 2010, and every three years thereafter with respect to cases commenced on or after the date of adjustment.

continuation sheets attached

SCHEDULE E - CREDITORS HOLDING UNSECURED PRIORITY CLAIMS

Copyright (c) 1996-2009 - Best Case Solutions - Evanston, IL - (800) 492-8037 Best Case Bankruptcy

In re

,

Debtors

Samuel E. O. Host, Case No.

Evangelyn R. Host

1

Case 10-01069 Doc 1 Filed 01/13/10 Entered 01/13/10 12:44:15 Desc Main

 Document Page 18 of 47
B6E (Official Form 6E) (12/07) - Cont.

C

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Husband, Wife, Joint, or Community

H

W

J

C

CREDITOR'S NAME,

AND MAILING ADDRESS

INCLUDING ZIP CODE,

AND ACCOUNT NUMBER

(See instructions.)

DATE CLAIM WAS INCURRED AMOUNT

AND CONSIDERATION FOR CLAIM OF CLAIM

Account No.

Account No.

Account No.

Account No.

Account No.

Subtotal Sheet _____ of _____ continuation sheets attached to

Schedule of Creditors Holding Unsecured Priority Claims (Total of this page)

TYPE OF PRIORITY

AMOUNT NOT

ENTITLED TO

PRIORITY, IF ANY

AMOUNT

ENTITLED TO

PRIORITY

SCHEDULE E - CREDITORS HOLDING UNSECURED PRIORITY CLAIMS

(Continuation Sheet)

Copyright (c) 1996-2009 - Best Case Solutions - Evanston, IL - (800) 492-8037 Best Case Bankruptcy

In re

,

Debtors

Samuel E. O. Host, Case No.

Evangelyn R. Host

Taxes and Certain Other Debts

Owed to Governmental Units

498786 2003/2004/2005

taxes

Creditor #: 1

IRS

Cincinnati, OH 45999

J

5,965.45 5,965.45

0.00

5,965.45 5,965.45

1 1 0.00

5,965.45 5,965.45

Total 0.00

(Report on Summary of Schedules)

Copyright (c) 1996-2009 - Best Case Solutions - Evanston, IL - (800) 492-8037 Best Case Bankruptcy

Case 10-01069 Doc 1 Filed 01/13/10 Entered 01/13/10 12:44:15 Desc Main

 Document Page 19 of 47
}bk1{Schedul F-Creditos HldingUsecurd Nonpirty Claims}bk{

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D

Husband, Wife, Joint, or Community

H

W

J

C

CREDITOR'S NAME,

MAILING ADDRESS

INCLUDING ZIP CODE,

AND ACCOUNT NUMBER

(See instructions above.)

Account No.

Account No.

Account No.

Account No.

Subtotal

_____ continuation sheets attached (Total of this page)

DATE CLAIM WAS INCURRED AND

CONSIDERATION FOR CLAIM. IF CLAIM

IS SUBJECT TO SETOFF, SO STATE. AMOUNT OF CLAIM

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

State the name, mailing address, including zip code, and last four digits of any account number, of all entities holding unsecured claims without priority against the

debtor or the property of the debtor, as of the date of filing of the petition. The complete account number of any account the debtor has with the creditor is useful to the

trustee and the creditor and may be provided if the debtor chooses to do so. If a minor child is a creditor, state the child's initials and the name and address of the child's

parent or guardian, such as "A.B., a minor child, by John Doe, guardian." Do not disclose the child's name. See, 11 U.S.C. §112 and Fed. R. Bankr. P. 1007(m). Do not

include claims listed in Schedules D and E. If all creditors will not fit on this page, use the continuation sheet provided.

If any entity other than a spouse in a joint case may be jointly liable on a claim, place an "X" in the column labeled "Codebtor," include the entity on the appropriate

schedule of creditors, and complete Schedule H - Codebtors. If a joint petition is filed, state whether the husband, wife, both of them, or the marital community may be

liable on each claim by placing an "H," "W," "J," or "C" in the column labeled "Husband, Wife, Joint, or Community."

If the claim is contingent, place an "X" in the column labeled "Contingent." If the claim is unliquidated, place an "X" in the column labeled "Unliquidated." If the

claim is disputed, place an "X" in the column labeled "Disputed." (You may need to place an "X" in more than one of these three columns.)

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

Schedules and, if the debtor is an individual with primarily consumer debts, report this total also on the Statistical Summary of Certain Liabilities and Related Data.

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

S/N:23562-091215

SCHEDULE F - CREDITORS HOLDING UNSECURED NONPRIORITY CLAIMS

Copyright (c) 1996-2009 - Best Case Solutions - Evanston, IL - (800) 492-8037 Best Case Bankruptcy

In re

,

Debtors

Samuel E. O. Host, Case No.

Evangelyn R. Host

2

XXXX71009 2008

credit card Creditor #: 1

American Express

PO Box 981535

El Paso, TX 79998

J

4,000.00

018501-00 2007

medical Creditor #: 2

Associates for Women

915 Center St., Ste 3003

Elgin, IL 60120

J

2,179.85

xxxx6288 2008

credit card Creditor #: 3

Bank of America

PO. BOX 15726

Wilmington, DE 19886

H

12,000.00

xxxx7352 2008

credit card Creditor #: 4

Capital One Bank

PO Box 5294

Carol Stream, IL 60197

W

2,000.00

20,179.85

Case 10-01069 Doc 1 Filed 01/13/10 Entered 01/13/10 12:44:15 Desc Main

 Document Page 20 of 47
B6F (Official Form 6F) (12/07) - Cont.

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Husband, Wife, Joint, or Community

H

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CREDITOR'S NAME,

MAILING ADDRESS

INCLUDING ZIP CODE,

AND ACCOUNT NUMBER

(See instructions above.)

Account No.

Account No.

Account No.

Account No.

Account No.

Sheet no. _____ of _____ sheets attached to Schedule of Subtotal

Creditors Holding Unsecured Nonpriority Claims (Total of this page)

DATE CLAIM WAS INCURRED AND

CONSIDERATION FOR CLAIM. IF CLAIM

IS SUBJECT TO SETOFF, SO STATE. AMOUNT OF CLAIM

SCHEDULE F - CREDITORS HOLDING UNSECURED NONPRIORITY CLAIMS

(Continuation Sheet)

Copyright (c) 1996-2009 - Best Case Solutions - Evanston, IL - (800) 492-8037 Best Case Bankruptcy

In re

,

Debtors

Samuel E. O. Host, Case No.

Evangelyn R. Host

xxxx8724 2008

credit card Creditor #: 5

Cardmember Service

PO Box 15153

Wilmington, DE 19886-5153

J

8,700.00

XXXX7354 2007/2008

credit card Creditor #: 6

Citi Cards

PO Box 6000

The Lakes, NV 89163

J

9,500.00

2539391110 2009

utilities Creditor #: 7

ComEd

PO Box 6111

Carol Stream, IL 60197

J

700.00

xxxx4834 2008

credit card Creditor #: 8

DISCOVER CARD

Post Office Box 30395

Salt Lake City, UT 84130-0395

W

11,500.00

XXX7080 2007

credit card Creditor #: 9

HSBC Card Services

PO Box 17051

Baltimore, MD 21297

J

750.00

31,150.00

1 2

Case 10-01069 Doc 1 Filed 01/13/10 Entered 01/13/10 12:44:15 Desc Main

 Document Page 21 of 47
B6F (Official Form 6F) (12/07) - Cont.

C

O

D

E

B

T

O

R

C

O

N

T

I

N

G

E

N

T

U

N

L

I

Q

U

I

D

A

T

E

D

D

I

S

P

U

T

E

D

Husband, Wife, Joint, or Community

H

W

J

C

CREDITOR'S NAME,

MAILING ADDRESS

INCLUDING ZIP CODE,

AND ACCOUNT NUMBER

(See instructions above.)

Account No.

Account No.

Account No.

Account No.

Account No.

Sheet no. _____ of _____ sheets attached to Schedule of Subtotal

Creditors Holding Unsecured Nonpriority Claims (Total of this page)

DATE CLAIM WAS INCURRED AND

CONSIDERATION FOR CLAIM. IF CLAIM

IS SUBJECT TO SETOFF, SO STATE. AMOUNT OF CLAIM

SCHEDULE F - CREDITORS HOLDING UNSECURED NONPRIORITY CLAIMS

(Continuation Sheet)

Copyright (c) 1996-2009 - Best Case Solutions - Evanston, IL - (800) 492-8037 Best Case Bankruptcy

In re

,

Debtors

Samuel E. O. Host, Case No.

Evangelyn R. Host

02 21 66 7093 1 2008/09

utilities Creditor #: 10

Nicor

PO Box 0632

Aurora, IL 60507-0632

J

2,000.00

xxxx6459 2008

credit card Creditor #: 11

Washington Mutual

PO Bo 660487

Dallas, TX 75266

J

7,327.00

9,327.00

2 2

60,656.85

Total

(Report on Summary of Schedules)

Case 10-01069 Doc 1 Filed 01/13/10 Entered 01/13/10 12:44:15 Desc Main

 Document Page 22 of 47
}bk1{Schedul G-Executory Cnactsd Unexpird Leas}bk{

In re

,

Debtors

Samuel E. O. Host, Case No.

Evangelyn R. Host

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

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

of debtor's interest in contract, i.e., "Purchaser", "Agent", etc. State whether debtor is the lessor or lessee of a lease. Provide the names and

complete mailing addresses of all other parties to each lease or contract described. If a minor child is a party to one of the leases or contracts,

state the child's initials and the name and address of the child's parent or guardian, such as "A.B., a minor child, by John Doe, guardian." Do not

disclose the child's name. See, 11 U.S.C. §112 and Fed. R. Bankr. P. 1007(m).

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

Name and Mailing Address, Including Zip Code,

of Other Parties to Lease or Contract

Description of Contract or Lease and Nature of Debtor's Interest.

State whether lease is for nonresidential real property.

State contract number of any government contract.

continuation sheets attached to Schedule of Executory Contracts and Unexpired Leases

SCHEDULE G - EXECUTORY CONTRACTS AND UNEXPIRED LEASES

Copyright (c) 1996-2009 - Best Case Solutions - Evanston, IL - (800) 492-8037 Best Case Bankruptcy

0

Case 10-01069 Doc 1 Filed 01/13/10 Entered 01/13/10 12:44:15 Desc Main

 Document Page 23 of 47
}bk1{Schedul H-Codebtrs}k{

In re

,

Debtors

Samuel E. O. Host, Case No.

Evangelyn R. Host

B6H (Official Form 6H) (12/07)

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

by debtor in the schedules of creditors. Include all guarantors and co-signers. If the debtor resides or resided in a community property state,

commonwealth, or territory (including Alaska, Arizona, California, Idaho, Louisiana, Nevada, New Mexico, Puerto Rico, Texas, Washington, or

Wisconsin) within the eight year period immediately preceding the commencement of the case, identify the name of the debtor's spouse and of

any former spouse who resides or resided with the debtor in the community property state, commonwealth, or territory. Include all names used

by the nondebtor spouse during the eight years immediately preceding the commencement of this case. If a minor child is a codebtor or a creditor,

state the child's initials and the name and address of the child's parent or guardian, such as "A.B., a minor child, by John Doe, guardian." Do not

disclose the child's name. See, 11 U.S.C. §112 and Fed. R. Bankr. P. 1007(m).

Check this box if debtor has no codebtors.

NAME AND ADDRESS OF CODEBTOR NAME AND ADDRESS OF CREDITOR

continuation sheets attached to Schedule of Codebtors

SCHEDULE H - CODEBTORS

Copyright (c) 1996-2009 - Best Case Solutions - Evanston, IL - (800) 492-8037 Best Case Bankruptcy

0

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 Document Page 24 of 47
B6I (Official Form 6I) (12/07)

In re

Samuel E. O. Host

Evangelyn R. Host Case No.

Debtor(s)

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 sp

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 

Debtor's Marital Status: DEPENDENTS OF DEBTOR AND SPOUSE

Married

RELATIONSHIP(S):

None.

AGE(S):

Employment: DEBTOR SPOUSE

Occupation Carpenter Home cleaning

Name of Employer Self-employed Self-employed

How long employed 8 yrs 5 years

Address of Employer

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

1. Monthly gross wages, salary, and commissions (Prorate if not paid monthly) $ 1,485.00 $ 866.67

2. Estimate monthly overtime $ 0.00 $ 0.00

3. SUBTOTAL $ 1,485.00 $ 866.67

4. LESS PAYROLL DEDUCTIONS

a. Payroll taxes and social security $ 0.00 $ 0.00

b. Insurance $ 0.00 $ 0.00

c. Union dues $ 0.00 $ 0.00

d. Other (Specify): $ 0.00 $ 0.00

$ 0.00 $ 0.00

5. SUBTOTAL OF PAYROLL DEDUCTIONS $ 0.00 $ 0.00

6. TOTAL NET MONTHLY TAKE HOME PAY $ 1,485.00 $ 866.67

7. Regular income from operation of business or profession or farm (Attach detailed statement) $ 0.00 $ 0.00

8. Income from real property $ 0.00 $ 0.00

9. Interest and dividends $ 0.00 $ 0.00

10. Alimony, maintenance or support payments payable to the debtor for the debtor's use or that of

dependents listed above $ 0.00 $ 0.00

11. Social security or government assistance

(Specify): $ 0.00 $ 0.00

$ 0.00 $ 0.00

12. Pension or retirement income $ 0.00 $ 0.00

13. Other monthly income

(Specify): $ 0.00 $ 0.00

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 Document Page 25 of 47
B6I (Official Form 6I) (12/07)

$ 0.00 $ 0.00

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

15. AVERAGE MONTHLY INCOME (Add amounts shown on lines 6 and 14) $ 1,485.00 $ 866.67

16. COMBINED AVERAGE MONTHLY INCOME: (Combine column totals from line 15) $ 2,351.67

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

Statistical Summary of Certain Liabilities and Related Data)

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

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 Document Page 26 of 47
B6J (Official Form 6J) (12/07)

In re

Samuel E. O. Host

Evangelyn R. Host Case No.

Debtor(s)

SCHEDULE J - CURRENT EXPENDITURES OF INDIVIDUAL DEBTOR

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

quarterly, semi-annually, or annually to show monthly rate. The average monthly expenses calculated on this form may differ from the deductions f

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 la

1. Rent or home mortgage payment (include lot rented for mobile home) $ 2,400.00

 a. Are real estate taxes included? Yes X No

 b. Is property insurance included? Yes X No

2. Utilities: a. Electricity and heating fuel $ 300.00

b. Water and sewer $ 130.00

c. Telephone $ 160.00

d. Other $ 0.00

3. Home maintenance (repairs and upkeep) $ 100.00

4. Food $ 600.00

5. Clothing $ 0.00

6. Laundry and dry cleaning $ 0.00

7. Medical and dental expenses $ 50.00

8. Transportation (not including car payments) $ 0.00

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

10. Charitable contributions $ 100.00

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

a. Homeowner's or renter's $ 0.00

b. Life $ 65.00

c. Health $ 0.00

d. Auto $ 130.00

e. Other $ 0.00

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

(Specify) $ 0.00

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

plan)

a. Auto $ 0.00

b. Other $ 0.00

c. Other $ 0.00

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

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

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

17. Other $ 0.00

 Other $ 0.00

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 Document Page 27 of 47
B6J (Official Form 6J) (12/07)

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.)

$ 4,035.00

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 $ 2,351.67

b. Average monthly expenses from Line 18 above $ 4,035.00

c. Monthly net income (a. minus b.) $ -1,683.33

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 Document Page 28 of 47
B6 Declaration (Official Form 6 - Declaration). (12/07)

United States Bankruptcy Court

Northern District of Illinois

In re

Samuel E. O. Host

Evangelyn R. Host Case No.

Debtor(s) Chapter 7

DECLARATION CONCERNING DEBTOR'S SCHEDULES

DECLARATION UNDER PENALTY OF PERJURY BY INDIVIDUAL DEBTOR

I declare under penalty of perjury that I have read the foregoing summary and schedules, consisting of 19 sheets, and that the

the best of my knowledge, information, and belief.

Date January 13, 2010 Signature /s/ Samuel E. O. Host

Samuel E. O. Host

Debtor

Date January 13, 2010 Signature /s/ Evangelyn R. Host

Evangelyn R. Host

Joint Debtor

Penalty for making a false statement or concealing property: Fine of up to $500,000 or imprisonment for up to 5 years 

18 U.S.C. §§ 152 and 3571.

Software Copyright (c) 1996-2009 Best Case Solutions, Inc. - Evanston, IL - (800) 492-8037 Best Case Bankruptcy

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 Document Page 29 of 47
B7 (Official Form 7) (12/07)

United States Bankruptcy Court

Northern District of Illinois

In re

Samuel E. O. Host

Evangelyn R. Host Case No.

Debtor(s) Chapter 7

STATEMENT OF FINANCIAL AFFAIRS

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

chapter 12 or chapter 13, a married debtor must furnish information for both spouses whether or not a joint petition is filed, unless the spouses are separated and a j

debtor engaged in business as a sole proprietor, partner, family farmer, or self-employed professional, should provide the information requested on this statement c

the individual's personal affairs. To indicate payments, transfers and the like to minor children, state the child's initials and the name and address of the child's paren

child, by John Doe, guardian." Do not disclose the child's name. See, 11 U.S.C. § 112; Fed. R. Bankr. P. 1007(m).

Questions 1 - 18 are to be completed by all debtors. Debtors that are or have been in business, as defined below, also must complete Questions 19 - 25. If 

is "None," mark the box labeled "None." If additional space is needed for the answer to any question, use and attach a separate sheet properly identified with the 

and the number of the question.

DEFINITIONS

"In business." A debtor is "in business" for the purpose of this form if the debtor is a corporation or partnership. An individual debtor is "in business" for 

or has been, within six years immediately preceding the filing of this bankruptcy case, any of the following: an officer, director, managing executive, or owner of 5 p

securities of a corporation; a partner, other than a limited partner, of a partnership; a sole proprietor or self-employed full-time or part-time. An individual debtor als

of this form if the debtor engages in a trade, business, or other activity, other than as an employee, to supplement income from the debtor's primary employment.

"Insider." The term "insider" includes but is not limited to: relatives of the debtor; general partners of the debtor and their relatives; corporations of which 

person in control; officers, directors, and any owner of 5 percent or more of the voting or equity securities of a corporate debtor and their relatives; affiliates of the d

any managing agent of the debtor. 11 U.S.C. § 101.

__________________________________________

Software Copyright (c) 1996-2009 Best Case Solutions, Inc. - Evanston, IL - (800) 492-8037 Best Case Bankruptcy

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 Document Page 30 of 47
None



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.)

AMOUNT SOURCE

$25,817.00 2007 AGI from Host Builders and self employed cleaning service.

$87,869.00 2008 AGI from Host Builders, and rental real estate. $74, 800 was 1099 he received

from sheriff's sale.

None



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, or 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.)

AMOUNT SOURCE

None



3. Payments to creditors

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

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

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

all property that constitutes or is affected by such transfer is less than $600. Indicate with an (*) any payments that were made to a creditor

on account of a domestic support obligation or as part of an alternative repayment schedule under a plan by an approved nonprofit

budgeting and creditor counseling agency. (Married debtors filing under chapter 12 or chapter 13 must include payments by either or both

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

NAME AND ADDRESS

OF CREDITOR

DATES OF

PAYMENTS AMOUNT PAID

AMOUNT STILL

OWING

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 creditor counseling agency. (Married debtors filing under chapter 12 or chapter 13 must include payments by either or both spouses

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

Software Copyright (c) 1996-2009 Best Case Solutions, Inc. - Evanston, IL - (800) 492-8037 Best Case Bankruptcy

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 Document Page 31 of 47
NAME AND ADDRESS OF CREDITOR

DATES OF

PAYMENTS/

TRANSFERS

AMOUNT

PAID OR

VALUE OF

TRANSFERS

AMOUNT STILL

OWING

None



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

creditors who are or were insiders. (Married debtors filing under chapter 12 or chapter 13 must include payments by either or both spouses

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

NAME AND ADDRESS OF CREDITOR AND

RELATIONSHIP TO DEBTOR DATE OF PAYMENT AMOUNT PAID

AMOUNT STILL

OWING

None



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

a. List all suits and administrative proceedings to which the debtor is or was a party within one year immediately preceding the filing of this

bankruptcy case. (Married debtors filing under chapter 12 or chapter 13 must include information concerning either or both spouses

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

CAPTION OF SUIT

AND CASE NUMBER NATURE OF PROCEEDING

COURT OR AGENCY

AND LOCATION

STATUS OR

DISPOSITION

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 OF PERSON FOR WHOSE

BENEFIT PROPERTY WAS SEIZED DATE OF SEIZURE

DESCRIPTION AND VALUE OF

PROPERTY

None



5. Repossessions, foreclosures and returns

List all property that has been repossessed by a creditor, sold at a foreclosure sale, transferred through a deed in lieu of foreclosure or

returned to the seller, within one year immediately preceding the commencement of this case. (Married debtors filing under chapter 12 or

chapter 13 must include information concerning property of either or both spouses whether or not a joint petition is filed, unless the

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

NAME AND ADDRESS OF

CREDITOR OR SELLER

DATE OF REPOSSESSION,

FORECLOSURE SALE,

TRANSFER OR RETURN

DESCRIPTION AND VALUE OF

PROPERTY

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 Document Page 32 of 47
None



6. Assignments and receiverships

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

this case. (Married debtors filing under chapter 12 or chapter 13 must include any assignment by either or both spouses whether or not a

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

NAME AND ADDRESS OF ASSIGNEE

DATE OF

ASSIGNMENT TERMS OF ASSIGNMENT OR SETTLEMENT

None



b. List all property which has been in the hands of a custodian, receiver, or court-appointed official within one year 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

OF CUSTODIAN

NAME AND LOCATION

OF COURT

CASE TITLE & NUMBER

DATE OF

ORDER

DESCRIPTION AND VALUE OF

PROPERTY

None



7. Gifts

List all gifts or charitable contributions made within one year immediately preceding the commencement of this case except ordinary and

usual gifts to family members aggregating less than $200 in value per individual family member and charitable contributions aggregating

less than $100 per recipient. (Married debtors filing under chapter 12 or chapter 13 must include gifts or contributions by either or both

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

NAME AND ADDRESS OF

PERSON OR ORGANIZATION

RELATIONSHIP TO

DEBTOR, IF ANY DATE OF GIFT

DESCRIPTION AND

VALUE OF GIFT

None



8. Losses

List all losses from fire, theft, other casualty or gambling within one year immediately preceding the commencement of this case or since

the commencement of this case. (Married debtors filing under chapter 12 or chapter 13 must include losses by either or both spouses

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

DESCRIPTION AND VALUE

OF PROPERTY

DESCRIPTION OF CIRCUMSTANCES AND, IF

LOSS WAS COVERED IN WHOLE OR IN PART

BY INSURANCE, GIVE PARTICULARS DATE OF 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 the petition in bankruptcy within one year immediately

preceding the commencement of this case.

NAME AND ADDRESS

OF PAYEE

DATE OF PAYMENT,

NAME OF PAYOR IF OTHER

THAN DEBTOR

AMOUNT OF MONEY

OR DESCRIPTION AND VALUE

OF PROPERTY

Software Copyright (c) 1996-2009 Best Case Solutions, Inc. - Evanston, IL - (800) 492-8037 Best Case Bankruptcy

Case 10-01069 Doc 1 Filed 01/13/10 Entered 01/13/10 12:44:15 Desc Main

 Document Page 33 of 47
None



10. Other transfers

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

either absolutely or as security within two years immediately preceding the commencement of this case. (Married debtors filing under

chapter 12 or chapter 13 must include transfers by either or both spouses whether or not a joint petition is filed, unless the spouses are

separated and a joint petition is not filed.)

NAME AND ADDRESS OF TRANSFEREE,

RELATIONSHIP TO DEBTOR DATE

DESCRIBE PROPERTY TRANSFERRED

AND VALUE RECEIVED

None



b. List all property transferred by the debtor within ten years immediately preceding the commencement of this case to a self-settled trust

or similar device of which the debtor is a beneficiary.

NAME OF TRUST OR OTHER

DEVICE DATE(S) OF

TRANSFER(S)

AMOUNT OF MONEY OR DESCRIPTION AND

VALUE OF PROPERTY OR DEBTOR'S INTEREST IN

PROPERTY

None



11. Closed financial accounts

List all financial accounts and instruments held in the name of the debtor or for the benefit of the debtor which were closed, sold, or

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

accounts, certificates of deposit, or other instruments; shares and share accounts held in banks, credit unions, pension funds, cooperatives,

associations, brokerage houses and other financial institutions. (Married debtors filing under chapter 12 or chapter 13 must include

information concerning accounts or instruments held by or for either or both spouses whether or not a joint petition is filed, unless the

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

NAME AND ADDRESS OF INSTITUTION

TYPE OF ACCOUNT, LAST FOUR

DIGITS OF ACCOUNT NUMBER, AND

AMOUNT OF FINAL BALANCE

AMOUNT AND DATE OF SALE

OR CLOSING

None



12. Safe deposit boxes

List each safe deposit or other box or depository in which the debtor has or had securities, cash, or other valuables within one year

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

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

filed.)

NAME AND ADDRESS OF BANK

OR OTHER DEPOSITORY

NAMES AND ADDRESSES

OF THOSE WITH ACCESS

TO BOX OR DEPOSITORY

DESCRIPTION

OF CONTENTS

DATE OF TRANSFER OR

SURRENDER, IF ANY

None



13. Setoffs

List all setoffs made by any creditor, including a bank, against a debt or deposit of the debtor within 90 days preceding the commencement

of this case. (Married debtors filing under chapter 12 or chapter 13 must include information concerning either or both spouses whether or

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

Software Copyright (c) 1996-2009 Best Case Solutions, Inc. - Evanston, IL - (800) 492-8037 Best Case Bankruptcy

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 Document Page 34 of 47
NAME AND ADDRESS OF CREDITOR DATE OF SETOFF AMOUNT OF SETOFF

None



14. Property held for another person

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

NAME AND ADDRESS OF OWNER DESCRIPTION AND VALUE OF PROPERTY LOCATION OF PROPERTY

None



15. Prior address of debtor

If the debtor has moved within three years immediately preceding the commencement of this case, list all premises which the debtor

occupied during that period and vacated prior to the commencement of this case. If a joint petition is filed, report also any separate address

of either spouse.

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.

NAME

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

None



a. List the name and address of every site for which the debtor has received notice in writing by a governmental unit that it may be liable or

potentially liable under or in violation of an Environmental Law. Indicate the governmental unit, the date of the notice, and, if known, the

Environmental Law:

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 Document Page 35 of 47
SITE NAME AND ADDRESS

NAME AND ADDRESS OF

GOVERNMENTAL UNIT

DATE OF

NOTICE

ENVIRONMENTAL

LAW

None



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

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

SITE NAME AND ADDRESS

NAME AND ADDRESS OF

GOVERNMENTAL UNIT

DATE OF

NOTICE

ENVIRONMENTAL

LAW

None



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

debtor is or was a party. Indicate the name and address of the governmental unit that is or was a party to the proceeding, and the docket

number.

NAME AND ADDRESS OF GOVERNMENTAL

UNIT DOCKET NUMBER STATUS OR DISPOSITION

None



18 . Nature, location and name of business

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 six years

immediately preceding the commencement of this case, or in which the debtor owned 5 percent or more of the voting or equity securities

within six years immediately preceding the commencement of this case.

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

ending dates of all businesses in which the debtor was a partner or owned 5 percent or more of the voting or equity securities, within six

years immediately preceding the commencement of this case.

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

ending dates of all businesses in which the debtor was a partner or owned 5 percent or more of the voting or equity securities within six

years immediately preceding the commencement of this case.

NAME

LAST FOUR DIGITS OF

SOCIAL-SECURITY OR

OTHER INDIVIDUAL

TAXPAYER-I.D. NO.

(ITIN)/ COMPLETE EIN ADDRESS NATURE OF BUSINESS

BEGINNING AND

ENDING DATES

None



b. Identify any business listed in response to subdivision a., above, that is "single asset real estate" as defined in 11 U.S.C. § 101.

NAME ADDRESS

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DECLARATION UNDER PENALTY OF PERJURY BY INDIVIDUAL DEBTOR

I declare under penalty of perjury that I have read the answers contained in the foregoing statement of financial affairs and any attachments thereto and that they ar

Date January 13, 2010 Signature /s/ Samuel E. O. Host

Samuel E. O. Host

Debtor

Date January 13, 2010 Signature /s/ Evangelyn R. Host

Evangelyn R. Host

Joint Debtor

Penalty for making a false statement: Fine of up to $500,000 or imprisonment for up to 5 years, or both. 18 U.S.C. §§ 152 and 357

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B8 (Form 8) (12/08)

United States Bankruptcy Court

Northern District of Illinois

In re

Samuel E. O. Host

Evangelyn R. Host Case No.

Debtor(s) 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 

pages if necessary.)

Property No. 1

Creditor's Name:

Countrywide Home Loans

Describe Property Securing Debt:

155 South Main Street, Burlington, IL

Property will be (check one):

 Surrendered  Retained

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

 Redeem the property

 Reaffirm the debt

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

Property is (check one):

 Claimed as Exempt  Not claimed as exempt

PART B - Personal property subject to unexpired leases. (All three columns of Part B must be completed for each unexpired lease. Attach addition

Property No. 1

Lessor's Name:

-NONEDescribe Leased Property: Lease will be Assumed pursuant to 11

U.S.C. § 365(p)(2):

 YES  NO

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B8 (Form 8) (12/08) Page 2

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 p

lease.

Date January 13, 2010 Signature /s/ Samuel E. O. Host

Samuel E. O. Host

Debtor

Date January 13, 2010 Signature /s/ Evangelyn R. Host

Evangelyn R. Host

Joint Debtor

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United States Bankruptcy Court

Northern District of Illinois

In re

Samuel E. O. Host

Evangelyn R. Host Case No.

Debtor(s) Chapter 7

DISCLOSURE OF COMPENSATION OF ATTORNEY FOR DEBTOR(S)

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 and that compensation paid to me 

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 

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

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

Balance Due $ 1,000.00

2. $ 299.00 of the filing fee has been paid.

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

 Debtor  Other (specify):

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

 Debtor  Other (specify):

5.  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 agr

names of the people sharing in the compensation is attached.

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

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

b. Preparation and filing of any petition, schedules, statement of affairs and plan which may be required;

c. [Other provisions as needed]

exemption planning;

7. By agreement with the debtor(s), the above-disclosed fee does not include the following service:

Representation of the debtors in any dischargeability actions, judicial lien avoidances, relief from stay actions or any other ad

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In re

Samuel E. O. Host

Evangelyn R. Host Case No.

Debtor(s)

DISCLOSURE OF COMPENSATION OF ATTORNEY FOR DEBTOR(S)

(Continuation Sheet)

CERTIFICATION

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

bankruptcy proceeding.

Dated: January 13, 2010 /s/ Jeffrey M. Krasner

Jeffrey M. Krasner

LAW OFFICES OF JEFFREY M. KRASNER

a Professional Corporation

407 W State St, Ste 4

Sycamore, IL 60178-1455

815-899-8436 Fax: 815-895-1700

krasnerlaw@comcast.net

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B 201A (Form 201A) (12/09)

WARNING: Effective December 1, 2009, the 15-day deadline to file schedules and certain other documents under Bankruptcy Rule 1007

further information, see note at bottom of page 2

UNITED STATES BANKRUPTCY COURT

NORTHERN DISTRICT OF ILLINOIS

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 se

counseling services; (2) Describes briefly the purposes, benefits and costs of the four types of bankruptcy proceedings you may commence; and (3) 

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 le

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 

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 sing

individuals married to each other), and each spouse lists the same mailing address on the bankruptcy petition, you and your spouse will generally re

mailed from the bankruptcy court in a jointly-addressed envelope, unless you file a statement with the court requesting that each spouse receive a se

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 o

a briefing that outlines the available opportunities for credit counseling and provides assistance in performing a budget analysis. The brie

before the bankruptcy filing. The briefing may be provided individually or in a group (including briefings conducted by telephone or on the Interne

nonprofit budget and credit counseling agency approved by the United States trustee or bankruptcy administrator. The clerk of the bankruptcy court 

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 co

a discharge. The clerk also has a list of approved financial management instructional courses. Each debtor in a joint case must complete the course

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

Chapter 7: Liquidation ($245 filing fee, $39 administrative fee, $15 trustee surcharge: Total Fee $299)

Chapter 7 is designed for debtors in financial difficulty who do not have the ability to pay their existing debts. Debtors whose debts are pr

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 i

and family size, in some cases, the United States trustee (or bankruptcy administrator), the trustee, or creditors have the right to file a motion reques

case under § 707(b) of the Code. It is up to the court to decide whether the case should be dismissed.

Under chapter 7, you may claim certain of your property as exempt under governing law. A trustee may have the right to take possession of 

that is not exempt and use the sale proceeds to pay your creditors.

The purpose of filing a chapter 7 case is to obtain a discharge of your existing debts. If, however, you are found to have committed certain 

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 b

Even if you receive a general discharge, some particular debts are not discharged under the law. Therefore, you may still be responsible for 

incurred to pay nondischargeable taxes; domestic support and property settlement obligations; most fines, penalties, forfeitures, and criminal restitu

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Form B 201A, Notice to Consumer Debtor(s) Page 2

which are not properly listed in your bankruptcy papers; and debts for death or personal injury caused by operating a motor vehicle, vessel, or aircra

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 bankru

debt is not discharged.

Chapter 13: Repayment of All or Part of the Debts of an Individual with Regular Income ($235 filing fee, $39 administ

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 

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

Under chapter 13, you must file with the court a plan to repay your creditors all or part of the money that you owe them, using your future 

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 

After completing the payments under your plan, your debts are generally discharged except for domestic support obligations; most student 

fines and restitution obligations; certain debts which are not properly listed in your bankruptcy papers; certain debts for acts that caused death or pe

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, 

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 simila

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 w

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 

General acting through the Office of the United States Trustee, the Office of the United States Attorney, and other components and employees of th

WARNING: Section 521(a)(1) of the Bankruptcy Code requires that you promptly file detailed information regarding your creditors, assets, liabili

financial condition. Your bankruptcy case may be dismissed if this information is not filed with the court within the time deadlines set by the Bank

and the local rules of the court. The documents and the deadlines for filing them are listed on Form B200, which is posted at

http://www.uscourts.gov/bkforms/bankruptcy_forms.html#procedure.

Many filing deadlines change on December 1, 2009. Of special note, 12 rules that set 15 days to act are amended to require action within 

filing the initial case papers; Rule 3015(b), filing a chapter 13 plan; Rule 8009(a), filing appellate briefs; and Rules 1019, 1020, 2015, 2015

6007.

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B 201B (Form 201B) (12/09)

United States Bankruptcy Court

Northern District of Illinois

In re

Samuel E. O. Host

Evangelyn R. Host Case No.

Debtor(s) Chapter 7

CERTIFICATION OF NOTICE TO CONSUMER DEBTOR(S)

UNDER § 342(b) OF THE BANKRUPTCY CODE

Certification of Debtor

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

Samuel E. O. Host

Evangelyn R. Host X /s/ Samuel E. O. Host January 13, 2010

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

Case No. (if known) X /s/ Evangelyn R. Host January 13, 2010

Signature of Joint Debtor (if any) Date

Instructions: Attach a copy of Form B 201 A, Notice to Consumer Debtor(s) Under § 342(b) of the Bankruptcy Code.

Use this form to certify that the debtor has received the notice required by 11 U.S.C. § 342(b) only if the certification has NOT been made on the Voluntary Petition

2 of Form B1 contains a certification by the debtor's attorney that the attorney has given the notice to the debtor. The Declarations made by debtors and bankruptcy 

B1 also include this certification.

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United States Bankruptcy Court

Northern District of Illinois

In re

Samuel E. O. Host

Evangelyn R. Host Case No.

Debtor(s) Chapter 7

VERIFICATION OF CREDITOR MATRIX

Number of Creditors: 14

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

Date: January 13, 2010 /s/ Samuel E. O. Host

Samuel E. O. Host

Signature of Debtor

Date: January 13, 2010 /s/ Evangelyn R. Host

Evangelyn R. Host

Signature of Debtor

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}bk1{Credito AresMatix}bk{

American Express

PO Box 981535

El Paso, TX 79998

Associates for Women

915 Center St., Ste 3003

Elgin, IL 60120

Bank of America

PO. BOX 15726

Wilmington, DE 19886

Capital One Bank

PO Box 5294

Carol Stream, IL 60197

Cardmember Service

PO Box 15153

Wilmington, DE 19886-5153

Citi Cards

PO Box 6000

The Lakes, NV 89163

ComEd

PO Box 6111

Carol Stream, IL 60197

Countrywide Home Loans

P.O. Box 660694

Dallas, TX 75266-0694

Countrywide Home Loans

P.O. Box 660694

Dallas, TX 75266-0694

DISCOVER CARD

Post Office Box 30395

Salt Lake City, UT 84130-0395

HSBC Card Services

PO Box 17051

Baltimore, MD 21297

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IRS

Cincinnati, OH 45999

Nicor

PO Box 0632

Aurora, IL 60507-0632

Washington Mutual

PO Bo 660487

Dallas, TX 75266

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