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B1 (Official Form 1) (04/13)

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

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

(include married, maiden, and trade names):

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

(include married, maiden, and trade names):

Last four digits of Soc. Sec. or Individual-Taxpayer I.D. (ITIN) /Complete EIN

(if more than one, state all):

Last four digits of Soc. Sec. or Individual-Taxpayer I.D. (ITIN) /Complete EIN

(if more than one, state all):

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

ZIPCODE ZIPCODE

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

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

ZIPCODE ZIPCODE

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

ZIPCODE

Type of Debtor

(Form of Organization)

(Check one box.)

Individual (includes Joint Debtors)

See Exhibit D on page 2 of this form.

Corporation (includes LLC and LLP)

Partnership

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

check this box and state type of entity below.)

Chapter 15 Debtor

Country of debtor’s center of main interests:

__________________________________________

Each country in which a foreign proceeding by,

regarding, or against debtor is pending:

__________________________________________

Nature of Business

(Check one box.)

Health Care Business

Single Asset Real Estate as defined in 11

U.S.C. § 101(51B)

Railroad

Stockbroker

Commodity Broker

Clearing Bank

Other

Tax-Exempt Entity

(Check box, if applicable.)

Debtor is a tax-exempt organization under

Title 26 of the United States Code (the

Internal Revenue Code).

Chapter of Bankruptcy Code Under Which

the Petition is Filed (Check one box.)

 Chapter 7 Chapter 15 Petition for

 Chapter 9 Recognition of a Foreign

 Chapter 11 Main Proceeding

 Chapter 12 Chapter 15 Petition for

 Chapter 13 Recognition of a Foreign

Nonmain Proceeding

Nature of Debts

(Check one box.)

 Debts are primarily consumer Debts are primarily

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

§ 101(8) as “incurred by an

individual primarily for a

personal, family, or household purpose.”

Filing Fee (Check one box)

Full Filing Fee attached

Filing Fee to be paid in installments (Applicable to individuals

only). Must attach signed application for the court’s

consideration certifying that the debtor is unable to pay fee

except in installments. Rule 1006(b). See Official Form 3A.

Filing Fee waiver requested (Applicable to chapter 7 individuals

only). Must attach signed application for the court’s

consideration. See Official Form 3B.

Chapter 11 Debtors

Check one box:

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

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

Check if:

Debtor’s aggregate noncontingent liquidated debts (excluding debts owed to insiders or affiliates) are less

than $2,490,925 (amount subject to adjustment on 4/01/16 and every three years thereafter).

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

Check all applicable boxes:

A plan is being filed with this petition

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

accordance with 11 U.S.C. § 1126(b).

Statistical/Administrative Information

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

Debtor estimates that, after any exempt property is excluded and administrative expenses paid, there will be no funds available for

distribution to unsecured creditors.

THIS SPACE IS FOR

COURT USE ONLY

Estimated Number of Creditors

1-49 50-99 100-199 200-999 1,000-

5,000

5,001-

10,000

10,001-

25,000

25,001-

50,000

50,001-

100,000

Over

100,000

Estimated Assets

$0 to

$50,000

$50,001 to

$100,000

$100,001 to

$500,000

$500,001 to

$1 million

$1,000,001 to

$10 million

$10,000,001

to $50 million

$50,000,001 to

$100 million

$100,000,001

to $500 million

$500,000,001

to $1 billion

More than

$1 billion

Estimated Liabilities

$0 to

$50,000

$50,001 to

$100,000

$100,001 to

$500,000

$500,001 to

$1 million

$1,000,001 to

$10 million

$10,000,001

to $50 million

$50,000,001 to

$100 million

$100,000,001

to $500 million

$500,000,001

to $1 billion

More than

$1 billion

United States Bankruptcy Court

District of New Hampshire Voluntary Petition

Ash, Kalen

2112

40B Lyford Road

Pittsfield, NH

03263

Merrimack

9

9

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9

9

9

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Case: 13-11038-JMD Doc #: 1 Filed: 04/19/13 Desc: Main Document Page 1 of 41
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B1 (Official Form 1) (04/13) Page 2

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

Name of Debtor(s):

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

Location

Where Filed:

Case Number: Date Filed:

Location

Where Filed:

Case Number: Date Filed:

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

Name of Debtor: Case Number: Date Filed:

District: Relationship: Judge:

Exhibit A

(To be completed if debtor 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 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

Exhibit C

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

or safety?

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

No

Exhibit D

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

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

If this is a joint petition:

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

Information Regarding the Debtor - Venue

 (Check any applicable box.)

Debtor has been domiciled or has had a residence, principal place of business, or principal 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)).

Voluntary Petition

Ash, Kalen

None

None

/s/ Mark Cornell 4/18/13

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9

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Case: 13-11038-JMD Doc #: 1 Filed: 04/19/13 Desc: Main Document Page 2 of 41
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B1 (Official Form 1) (04/13) Page 3

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

Name of Debtor(s):

Signatures

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

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

petition is true and correct.

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

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

under chapter 7, 11, 12 or 13 of title 11, United 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 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 Attorney*

X

Signature of Attorney for Debtor(s)

Date

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

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

information in the schedules is incorrect. 

Signature of Non-Attorney Petition Preparer

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

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

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

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

110(h) and 342(b); 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 bankruptcy petition preparer is not an individual, state the

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

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

Address

X

Signature

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.

Signature of Debtor (Corporation/Partnership)

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

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

petition on behalf of the debtor.

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

United States Code, specified in this petition.

X

Signature of Authorized Individual

Printed Name of Authorized Individual

Title of Authorized Individual

Date

Voluntary Petition

Ash, Kalen

/s/ Kalen Ash

Kalen Ash

April 18, 2013

/s/ Mark Cornell

April 18, 2013

Mark Cornell 04976

Mark P. Cornell,

Attorney at Law, PLLC

2 Greenwood Ave.

Concord, NH 03301-0000

(603) 225-9900 Fax: 60-224-9100

mark.p.cornell@bankruptcynh.com

Case: 13-11038-JMD Doc #: 1 Filed: 04/19/13 Desc: Main Document Page 3 of 41
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B1D (Official Form 1, Exhibit D) (12/09)

IN RE: Case No. 

Debtor(s)

Chapter 

CREDIT COUNSELING REQUIREMENT

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

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

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

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

to stop creditors’ collection activities.

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

one of the five statements below and attach any documents as directed.

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

the United States trustee or bankruptcy administrator that outlined the opportunities for available credit counseling and assisted me in

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

certificate and a copy of any debt repayment plan developed through the agency.

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

the United States trustee or bankruptcy administrator that outlined the opportunities for available credit counseling and assisted me in

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

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

the agency no later than 14 days after your bankruptcy case is filed.

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

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

requirement so I can file my bankruptcy case now. [Summarize exigent circumstances here.]

If your certification is satisfactory to the court, you must still obtain the credit counseling briefing within the first 30 days after

you file your bankruptcy petition and promptly file a certificate fromthe agency that provided the counseling,together with a copy

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

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

also be dismissed if the court is not satisfied with your reasons for filing your bankruptcy case without first receiving a credit

counseling briefing.

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

motion for determination by the court.]

Incapacity. (Defined in 11 U.S.C. § 109(h)(4) as impaired by reason of mental illness or mental deficiency so as to be incapable

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

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

participate in a credit counseling briefing in person, by telephone, or through the Internet.);

Active military duty in a military combat zone.

5. The United States trustee or bankruptcy administrator has determined that the credit counseling requirement of 11 U.S.C. § 109(h)

does not apply in this district.

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

Signature of Debtor: 

Date: 

United States Bankruptcy Court

District of New Hampshire

EXHIBIT D - INDIVIDUAL DEBTOR'S STATEMENT OF COMPLIANCE

Ash, Kalen 7

9

/s/ Kalen Ash

April 18, 2013

Case: 13-11038-JMD Doc #: 1 Filed: 04/19/13 Desc: Main Document Page 4 of 41
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B7 (Official Form 7) (04/13)

IN RE: Case No. 

Debtor(s)

Chapter 

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

is combined. If the case is filed under chapter 12 or chapter 13, a married debtor must furnish information for both spouses whether or not a joint petition

is filed, unless the spouses are separated and a joint petition is not filed. An individual debtor engaged in business as a sole proprietor, partner, family

farmer, or self-employed professional, should provide the information requested on this statement concerning all such activities as well as the individual's

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

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

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

25. If the answer to an applicable question is "None," mark the box labeled "None." If additional space is needed for the answer to any question,

use and attach a separate sheet properly identified with the case name, case number (if known), and the number of the question.

DEFINITIONS

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

for the purpose of this form if the debtor is or has been, within six years immediately preceding the filing of this bankruptcy case, any of the following:

an officer, director, managing executive, or owner of 5 percent or more of the voting or equity securities of a corporation; a partner, other than a limited

partner, of a partnership; a sole proprietor or self-employed full-time or part-time. An individual debtor also may be “in business” for the purpose of this

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

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

which the debtor is an officer, director, or person in control; officers, directors, and any persons in control of a corporate debtor and their relatives;

affiliates of the debtor and insiders of such affiliates; any managing agent of the debtor. 11 U.S.C. § 101(2),(31).

United States Bankruptcy Court

District of New Hampshire

STATEMENT OF FINANCIAL AFFAIRS

Ash, Kalen 7

1. Income from employment or operation of business

None State the gross amount of income the debtor has received from employment, trade, or profession, or from operation of the debtor's business,

including part-time activities either as an employee or in independent trade or business, from the beginning of this calendar year to the date this

case was commenced. State also the gross amounts received during the two years immediately preceding this calendar year. (A debtor that

maintains, or has maintained, financial records on the basis of a fiscal rather than a calendar year may report fiscal year income. Identify the

beginning and ending dates of the debtor's fiscal year.) If a joint petition is filed, state income for each spouse separately. (Married debtors filing

under chapter 12 or chapter 13 must state income of both spouses whether or not a joint petition is filed, unless the spouses are separated and a

joint petition is not filed.)

AMOUNT SOURCE

38,090.00 2011 Employment Income

32,522.00 2012 Employment Income

4,739.90 2013 YTD Employment Income - (as of 4/12/13)

2. Income other than from employment or operation of business

None State the amount of income received by the debtor other than from employment, trade, profession, operation of the debtor’s business during the

two years immediately preceding the commencement of this case. Give particulars. If a joint petition is filed, state income for each spouse

separately. (Married debtors filing under chapter 12 or chapter 13 must state income for each spouse whether or not a joint petition is filed, unless

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

AMOUNT SOURCE

360.53 2012 Retirement Distribution Income

7,077.00 2012 Unemployment Income

5,118.06 2013 YTD Unemployment Income

Case: 13-11038-JMD Doc #: 1 Filed: 04/19/13 Desc: Main Document Page 5 of 41
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3. Payments to creditors

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

None a. Individual or joint debtor(s) with primarily consumer debts: List all payments on loans, installment purchases of goods or services, and other

debts to any creditor made within 90 days immediately preceding the commencement of this case unless the aggregate value of all property that

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

a domestic support obligation or as part of an alternative repayment schedule under a plan by an approved nonprofit budgeting and credit

counseling agency. (Married 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.)

AMOUNT AMOUNT

NAME AND ADDRESS OF CREDITOR DATES OF PAYMENTS PAID STILL OWING

Mark Parker 3/10/2013 1,600.00 0.00

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

preceding the commencement of the case unless the aggregate value of all property that constitutes or is affected by such transfer is less than

$6,255.* If the debtor is an individual, indicate with an asterisk (*) any payments that were made to a creditor on account of a domestic support

obligation or as part of an alternative repayment schedule under a plan by an approved nonprofit budgeting and credit counseling agency. (Married

debtors filing under chapter 12 or chapter 13 must include payments and other transfers by either or both spouses whether or not a joint petition

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

* Amount subject to adjustment on 4/01/16, and every three years thereafter with respect to cases commenced on or after the date of adjustment.

9

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 9

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

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

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

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

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

9

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.)

9

5. Repossessions, foreclosures and returns

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

the seller, within one year immediately preceding the commencement of this case. (Married debtors filing under chapter 12 or chapter 13 must

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

joint petition is not filed.)

DATE OF REPOSSESSION,

FORECLOSURE SALE, DESCRIPTION AND VALUE

NAME AND ADDRESS OF CREDITOR OR SELLER TRANSFER OR RETURN OF PROPERTY

St. Mary's Bank 9/13/2012 2012 Jeep Wrangler

48 Perimeter Road

Manchester, NH 03103-0000

6. Assignments and receiverships

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

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

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

9

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.)

9

7. Gifts

None List all gifts or charitable contributions made within one year immediately preceding the commencement of this case except ordinary and usual

gifts to family members aggregating 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.)

9

Case: 13-11038-JMD Doc #: 1 Filed: 04/19/13 Desc: Main Document Page 6 of 41
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8. Losses

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

commencement of this case. (Married debtors filing under chapter 12 or chapter 13 must include losses by either or both spouses whether or not

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

9

9. Payments related to debt counseling or bankruptcy

None List all payments made or property transferred by or on behalf of the debtor to any persons, including attorneys, for consultation concerning debt

consolidation, relief under the bankruptcy law or preparation of a petition in bankruptcy within one year immediately preceding the commencement

of this case.

DATE OF PAYMENT, NAME OF AMOUNT OF MONEY OR DESCRIPTION

NAME AND ADDRESS OF PAYEE PAYOR IF OTHER THAN DEBTOR AND VALUE OF PROPERTY

Mark P. Cornell, 1,200.00

Attorney at Law, PLLC

2 Greenwood Avenue

Concord, NH 03301-0000

10. Other transfers

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

absolutely or as security within two years immediately preceding the commencement of this case. (Married debtors filing under chapter 12 or

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

petition is not filed.)

9

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

9 device of which the debtor is a beneficiary.

11. Closed financial accounts

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

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

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

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

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

petition is not filed.)

9

12. Safe deposit boxes

None List each safe deposit or other box or depository in which the debtor has or had securities, cash, or other valuables within one year immediately

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

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

9

13. Setoffs

None List all setoffs made by any creditor, including a bank, against a debt or deposit of the debtor within 90 days preceding the commencement of this

case. (Married debtors filing under chapter 12 or chapter 13 must include information concerning either or both spouses whether or not a joint

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

9

14. Property held for another person

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

9

15. Prior address of debtor

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

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

ADDRESS NAME USED DATES OF OCCUPANCY

311 Cross Road, Rumney, NH 5/2012 - 8/2012

889 Beauty Hill Road, Barnstead, NH 2010-5/2012

16. Spouses and Former Spouses

None 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, 9

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.

Case: 13-11038-JMD Doc #: 1 Filed: 04/19/13 Desc: Main Document Page 7 of 41
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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.

9

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

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

None c. List all judicial or administrative proceedings, including settlements or orders, under any Environmental Law with respect to which the debtor

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

18. Nature, location and name of business

None a. If the 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.

9

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.

9

Case: 13-11038-JMD Doc #: 1 Filed: 04/19/13 Desc: Main Document Page 8 of 41
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[If completed by an individual or individual and spouse]

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

thereto and that they are true and correct.

Date: Signature

of Debtor

Date: Signature

of Joint Debtor

(if any)

April 18, 2013 /s/ Kalen Ash

Kalen Ash

 continuation pages attached

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

0

Case: 13-11038-JMD Doc #: 1 Filed: 04/19/13 Desc: Main Document Page 9 of 41
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B6A (Official Form 6A) (12/07)

IN RE

Debtor(s)

Case No. 

(If known)

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

property, or in which the debtor has a life estate. Include any property in which the debtor holds rights and powers exercisable for the debtor’s own benefit. If the debtor is

married, state whether the husband, wife, both, or the marital community own the property by placing an “H,” “W,” “J,” or “C” in the column labeled “Husband, Wife, Joint,

or Community.” If the debtor holds no interest in real property, write “None” under “Description and Location of Property.”

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

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

interest in the property, write “None” in the column labeled “Amount of Secured Claim.”

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

DESCRIPTION AND LOCATION OF PROPERTY NATURE OF DEBTOR'S

INTEREST IN PROPERTY

HUSBAND, WIFE, JOINT,

OR COM

MUNITY

CURRENT VALUE OF

DEBTOR'S INTEREST IN

PROPERTY WITHOUT

DEDUCTING ANY

SECURED CLAIM OR

EXEMPTION

AMOUNT OF SECURED

CLAIM

TOTAL 

(Report also on Summary of Schedules)

SCHEDULE A - REAL PROPERTY

0.00

Ash, Kalen

None

Case: 13-11038-JMD Doc #: 1 Filed: 04/19/13 Desc: Main Document Page 10 of 41
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B6B (Official Form 6B) (12/07)

IN RE

Debtor(s)

Case No. 

(If known)

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

appropriate position in the column labeled “None.” If additional space is needed in any category, attach a separate sheet properly identified with the case name, case number,

and the number of the category. If the debtor is married, state whether the husband, wife, both, or the marital community own the property by placing an “H,” “W,” “J,” or

“C” in the column labeled “Husband, Wife, Joint, or Community.” If the debtor is an individual or a joint petition is filed, state the amount of any exemptions claimed only

in Schedule C - Property Claimed as Exempt.

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

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

held for a minor child, simply state the child's initials and the name and address of the child's parent or guardian, such as "A.B., a minor child, by John Doe, guardian." Do

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

TYPE OF PROPERTY

N

O

N

E

DESCRIPTION AND LOCATION OF PROPERTY

HUSBAND, WIFE, JOINT,

OR COM

MUNITY

CURRENT VALUE OF

DEBTOR'S INTEREST IN

PROPERTY WITHOUT

DEDUCTING ANY

SECURED CLAIM OR

EXEMPTION

SCHEDULE B - PERSONAL PROPERTY

Ash, Kalen

1. Cash on hand. X

2. Checking, savings or other financial

accounts, certificates of deposit or

shares in banks, savings and loan,

thrift, building and loan, and

homestead associations, or credit

unions, brokerage houses, or

cooperatives.

Checking Account located at Bank of America 840.00

Savings Account located at Bank of America 203.00

3. Security deposits with public utilities,

telephone companies, landlords, and

others.

X

4. Household goods and furnishings,

include audio, video, and computer

equipment.

Household Goods and Furnishings 100.00

5. Books, pictures and other art objects,

antiques, stamp, coin, record, tape,

compact disc, and other collections or

collectibles.

X

6. Wearing apparel. Clothing 100.00

7. Furs and jewelry. Jewelry 150.00

8. Firearms and sports, photographic,

and other hobby equipment.

X

9. Interest in insurance policies. Name

insurance company of each policy and

itemize surrender or refund value of

each.

X

10. Annuities. Itemize and name each

issue.

X

11. Interests in an education IRA as

defined in 26 U.S.C. § 530(b)(1) or

under a qualified State tuition plan as

defined in 26 U.S.C. § 529(b)(1).

Give particulars. (File separately the

record(s) of any such interest(s). 11

U.S.C. § 521(c).)

X

12. Interests in IRA, ERISA, Keogh, or

other pension or profit sharing plans.

Give particulars.

401(k) Account 250.00

13. Stock and interests in incorporated

and unincorporated businesses.

Itemize.

X

14. Interests in partnerships or joint

ventures. Itemize.

X

Case: 13-11038-JMD Doc #: 1 Filed: 04/19/13 Desc: Main Document Page 11 of 41
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Ash, Kalen

15. Government and corporate bonds and

other negotiable and non-negotiable

instruments.

X

16. Accounts receivable. X

17. Alimony, maintenance, support, and

property settlements in which the

debtor is or may be entitled. Give

particulars.

X

18. Other liquidated debts owed to debtor

including tax refunds. Give

particulars.

X

19. Equitable or future interest, life

estates, and rights or powers

exercisable for the benefit of the

debtor other than those listed in

Schedule A - Real Property.

X

20. Contingent and noncontingent

interests in estate of a decedent, death

benefit plan, life insurance policy, or

trust.

X

21. Other contingent and unliquidated

claims of every nature, including tax

refunds, counterclaims of the debtor,

and rights to setoff claims. Give

estimated value of each.

X

22. Patents, copyrights, and other

intellectual property. Give particulars.

X

23. Licenses, franchises, and other

general intangibles. Give particulars.

X

24. Customer lists or other compilations

containing personally identifiable

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

101(41A)) provided to the debtor by

individuals in connection with

obtaining a product or service from

the debtor primarily for personal,

family, or household purposes.

X

25. Automobiles, trucks, trailers, and

other vehicles and accessories.

1996 Jeep Grand Cherokee with 147,000 miles 1,225.00

2001 Mazda Protege with 190,000 miles 1,350.00

Snowmobile 3,500.00

26. Boats, motors, and accessories. X

27. Aircraft and accessories. X

28. Office equipment, furnishings, and

supplies.

X

29. Machinery, fixtures, equipment, and

supplies used in business.

X

30. Inventory. X

31. Animals. X

32. Crops - growing or harvested. Give

particulars.

X

33. Farming equipment and implements. X

B6B (Official Form 6B) (12/07) - Cont.

IN RE

Debtor(s)

Case No. 

(If known)

(Continuation Sheet)

TYPE OF PROPERTY

N

O

N

E

DESCRIPTION AND LOCATION OF PROPERTY

HUSBAND, WIFE, JOINT,

OR COM

MUNITY

CURRENT VALUE OF

DEBTOR'S INTEREST IN

PROPERTY WITHOUT

DEDUCTING ANY

SECURED CLAIM OR

EXEMPTION

SCHEDULE B - PERSONAL PROPERTY

Case: 13-11038-JMD Doc #: 1 Filed: 04/19/13 Desc: Main Document Page 12 of 41
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Ash, Kalen

34. Farm supplies, chemicals, and feed. X

35. Other personal property of any kind

not already listed. Itemize.

X

B6B (Official Form 6B) (12/07) - Cont.

IN RE

Debtor(s)

Case No. 

(If known)

(Continuation Sheet)

TYPE OF PROPERTY

N

O

N

E

DESCRIPTION AND LOCATION OF PROPERTY

HUSBAND, WIFE, JOINT,

OR COM

MUNITY

CURRENT VALUE OF

DEBTOR'S INTEREST IN

PROPERTY WITHOUT

DEDUCTING ANY

SECURED CLAIM OR

EXEMPTION

TOTAL

(Include amounts from any continuation sheets attached.

 continuation sheets attached Report total also on Summary of Schedules.)

SCHEDULE B - PERSONAL PROPERTY

7,718.00

0

Case: 13-11038-JMD Doc #: 1 Filed: 04/19/13 Desc: Main Document Page 13 of 41
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B6C (Official Form 6C) (04/13)

IN RE

Debtor(s)

Case No. 

(If known)

Debtor elects the exemptions to which debtor is entitled under: Check if debtor claims a homestead exemption that exceeds $155,675. *

(Check one box)

 11 U.S.C. § 522(b)(2)

 11 U.S.C. § 522(b)(3)

DESCRIPTION OF PROPERTY SPECIFY LAW PROVIDING EACH EXEMPTION VALUE OF CLAIMED

EXEMPTION

CURRENT VALUE

OF PROPERTY

WITHOUT DEDUCTING

EXEMPTIONS

* Amount subject to adjustment on 4/1/16 and every three years thereafter with respect to cases commenced on or after the date of adjustment.

SCHEDULE C - PROPERTY CLAIMED AS EXEMPT

9

Ash, Kalen

SCHEDULE B - PERSONAL PROPERTY

Checking Account located at Bank of RSA § 511:2(XVIII) 840.00 840.00

America

Savings Account located at Bank of RSA § 511:2(XVIII) 203.00 203.00

America

Household Goods and Furnishings RSA § 511:2(III) 100.00 100.00

Clothing RSA § 511:2(I) 100.00 100.00

Jewelry RSA § 512:2(XVII) 150.00 150.00

401(k) Account NH RSA 511:2(XIX) 100% 250.00

1996 Jeep Grand Cherokee with 147,000 RSA § 511:2(XVIII) 1,225.00 1,225.00

miles

2001 Mazda Protege with 190,000 miles RSA § 511.2(XVI) 1,350.00 1,350.00

Case: 13-11038-JMD Doc #: 1 Filed: 04/19/13 Desc: Main Document Page 14 of 41
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B6D (Official Form 6D) (12/07)

IN RE

Debtor(s)

Case No. 

(If known)

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

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

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

security interests.

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

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

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

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

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

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

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

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

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

of the completed schedule. Report the total from the column labeled “Amount of Claim Without Deducting Value of Collateral” also on the Summary of Schedules and,

if the debtor is an individual with primarily consumer debts, report the total from the column labeled “Unsecured Portion, if Any” on the Statistical Summary of Certain

Liabilities and Related Data.

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

CREDITOR'S NAME AND MAILING ADDRESS

INCLUDING ZIP CODE AND ACCOUNT NUMBER.

(See Instructions Above.)

CODEBTOR

HUSBAND, WIFE, JOINT,

OR COM

MUNITY

DATE CLAIM WAS INCURRED,

NATURE OF LIEN, AND DESCRIPTION AND VALUE OF

PROPERTY SUBJECT TO LIEN

CONTINGENT

UNLIQUIDATED

DISPUTED

AMOUNT OF

CLAIM WITHOUT

DEDUCTING

VALUE OF

COLLATERAL

UNSECURED

PORTION, IF ANY

ACCOUNT NO.

ACCOUNT NO.

ACCOUNT NO.

ACCOUNT NO.

 continuation sheets attached

Subtotal

(Total of this page) $ $

Total

(Use only on last page) $ $

(Report also on

Summary of

Schedules.)

(If applicable, report

also on Statistical

Summary of Certain

Liabilities and Related

Data.)

SCHEDULE D - CREDITORS HOLDING SECURED CLAIMS

Ash, Kalen

...5235 X 6,628.39 3,128.39

3,500.00

Retail Services

PO Box 5893

Carol Stream, IL 60197-5893

Polaris Credit Card

VALUE $

VALUE $

VALUE $

VALUE $

0 6,628.39

6,628.39

3,128.39

3,128.39

Case: 13-11038-JMD Doc #: 1 Filed: 04/19/13 Desc: Main Document Page 15 of 41
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Ash, Kalen

B6E (Official Form 6E) (04/13)

IN RE

Debtor(s)

Case No. 

(If known)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Statistical Summary of Certain Liabilities and Related Data.

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

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

the Statistical Summary of Certain Liabilities and Related Data.

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

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

Domestic Support Obligations

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

responsible relative of such a child, or a governmental unit to whom such a domestic support claim has been assigned to the extent provided in 11

U.S.C. § 507(a)(1).

Extensions of credit in an involuntary case

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

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

Wages, salaries, and commissions

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

independent sales representatives up to $12,475* 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 $6,150* 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 $2,775* 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 4/01/16, 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

9

0

Case: 13-11038-JMD Doc #: 1 Filed: 04/19/13 Desc: Main Document Page 16 of 41
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B6F (Official Form 6F) (12/07)

IN RE

Debtor(s)

Case No. 

(If known)

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

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

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

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

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

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

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

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

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

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

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

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

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

CREDITOR'S NAME, MAILING ADDRESS

INCLUDING ZIP CODE, AND ACCOUNT NUMBER.

(See Instructions Above.)

CODEBTOR

HUSBAND, WIFE, JOINT,

OR COM

MUNITY

DATE CLAIM WAS INCURRED AND

CONSIDERATION FOR CLAIM. IF CLAIM IS

SUBJECT TO SETOFF, SO STATE

CONTINGENT

UNLIQUIDATED

DISPUTED

AMOUNT

OF

CLAIM

ACCOUNT NO.

ACCOUNT NO.

ACCOUNT NO.

ACCOUNT NO.

 continuation sheets attached

Subtotal

(Total of this page) $

Total

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

the Summary of Schedules and, if applicable, on the Statistical

Summary of Certain Liabilities and Related Data.) $

SCHEDULE F - CREDITORS HOLDING UNSECURED NONPRIORITY CLAIMS

Ash, Kalen

6,628.00

Barclays Bank

PO Box 8803

Wilmington, DE 19899-8803

Credit Card

129.00

Concord Hospital

250 Pleasant St

Concord, NH 03301-7539

Medical Bill

unknown

Dartmouth-Hitchcock Clinic

PO Box 10493

Bedford, NH 03110-0493

Medical Bill

X

unknown

Debt Recovery Solutions

900 Merchants Concourse

Westbury, NY 11590

Collectiion Account

1 6,757.00

Case: 13-11038-JMD Doc #: 1 Filed: 04/19/13 Desc: Main Document Page 17 of 41
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B6F (Official Form 6F) (12/07) - Cont.

IN RE

Debtor(s)

Case No. 

(If known)

(Continuation Sheet)

CREDITOR'S NAME, MAILING ADDRESS

INCLUDING ZIP CODE, AND ACCOUNT NUMBER.

(See Instructions Above.)

CODEBTOR

HUSBAND, WIFE, JOINT,

OR COM

MUNITY

DATE CLAIM WAS INCURRED AND

CONSIDERATION FOR CLAIM. IF CLAIM IS

SUBJECT TO SETOFF, SO STATE

CONTINGENT

UNLIQUIDATED

DISPUTED

AMOUNT

OF

CLAIM

ACCOUNT NO.

ACCOUNT NO.

ACCOUNT NO.

ACCOUNT NO.

ACCOUNT NO.

ACCOUNT NO.

ACCOUNT NO.

Sheet no. of continuation sheets attached to

Schedule of Creditors Holding Unsecured Nonpriority Claims

Subtotal

(Total of this page) $

Total

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

the Summary of Schedules, and if applicable, on the Statistical

Summary of Certain Liabilities and Related Data.) $

SCHEDULE F - CREDITORS HOLDING UNSECURED NONPRIORITY CLAIMS

...1589

6,212.05

Discover Bank

PO Box 3025

New Albany, OH 43054-3025

Credit Card

...1331

1,233.81

GE Money Bank

Attn: Bankruptcy Dept.

PO Box 103104

Roswell, GA 30076-9104

Care Credit - Credit Card

...8608

1,249.00

GE Money Bank

Attn: Bankruptcy Dept.

PO Box 103104

Roswell, GA 30076-9104

Sleepy's Credit Card

401579370

11,120.98

St. Mary's Bank

48 Perimeter Road

Manchester, NH 03103

Deficiceny on Repossessed Vehicle

1 1

19,815.84

26,572.84

Case: 13-11038-JMD Doc #: 1 Filed: 04/19/13 Desc: Main Document Page 18 of 41
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B6G (Official Form 6G) (12/07)

IN RE

Debtor(s)

Case No. 

(If known)

Describe all executory contracts of any nature and all unexpired leases of real or personal property. Include any timeshare interests. State nature of debtor’s interest in

contract, i.e., “Purchaser,” “Agent,” etc. State whether debtor is the lessor or lessee of a lease. Provide the names and complete mailing addresses of all other parties to each

lease or contract described. If a minor child is a party to one of the leases or contracts, state the child's initials and the name and address of the child's parent or guardian,

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

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

NAME AND MAILING ADDRESS, INCLUDING ZIP CODE

OF OTHER PARTIES TO LEASE OR CONTRACT

DESCRIPTION OF CONTRACT OR LEASE AND NATURE OF DEBTOR’S INTEREST.

STATE WHETHER LEASE IS FOR NONRESIDENTIAL REAL PROPERTY.

STATE CONTRACT NUMBER OF ANY GOVERNMENT CONTRACT.

SCHEDULE G - EXECUTORY CONTRACTS AND UNEXPIRED LEASES

Ash, Kalen

Harry Bealieau Residential lease

Case: 13-11038-JMD Doc #: 1 Filed: 04/19/13 Desc: Main Document Page 19 of 41
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B6H (Official Form 6H) (12/07)

IN RE

Debtor(s)

Case No. 

(If known)

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

of creditors. Include all guarantors and co-signers. If the debtor resides or resided in a community property state, commonwealth, or territory (including Alaska, Arizona,

California, Idaho, Louisiana, Nevada, New Mexico, Puerto Rico, Texas, Washington, or Wisconsin) within the eight-year period immediately preceding the commencement

of the case, identify the name of the debtor’s spouse and of any former spouse who resides or resided with the debtor in the community property state, commonwealth, or

territory. Include all names used by the nondebtor spouse during the eight years immediately preceding the commencement of this case. If a minor child is a codebtor or

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

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

 Check this box if debtor has no codebtors.

NAME AND ADDRESS OF CODEBTOR NAME AND ADDRESS OF CREDITOR

SCHEDULE H - CODEBTORS

Ash, Kalen

Duane Ash Retail Services

PO Box 5893

Carol Stream, IL 60197-5893

Case: 13-11038-JMD Doc #: 1 Filed: 04/19/13 Desc: Main Document Page 20 of 41
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Ash, Kalen

B6I (Official Form 6I) (12/07)

IN RE

Debtor(s)

Case No. 

(If known)

The column labeled “Spouse” must be completed in all cases filed by joint debtors and by every married debtor, whether or not a joint petition is filed, unless the spouses

are separated and a joint petition is not filed. Do not state the name of any minor child. The average monthly income calculated on this form may differ from the current

monthly income calculated on From 22A, 22B, or 22C.

Debtor's Marital Status DEPENDENTS OF DEBTOR AND SPOUSE

RELATIONSHIP(S): AGE(S):

EMPLOYMENT: DEBTOR SPOUSE

Occupation

Name of Employer

How long employed

Address of Employer

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

1. Current monthly gross wages, salary, and commissions (prorate if not paid monthly) $ $ 

2. Estimated monthly overtime $ $ 

3. SUBTOTAL $ $ 

4. LESS PAYROLL DEDUCTIONS

a. Payroll taxes and Social Security $ $ 

b. Insurance $ $ 

c. Union dues $ $ 

d. Other (specify) $ $ 

$ $ 

5. SUBTOTAL OF PAYROLL DEDUCTIONS $ $ 

6. TOTAL NET MONTHLY TAKE HOME PAY $ $ 

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

8. Income from real property $ $ 

9. Interest and dividends $ $ 

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

that of dependents listed above $ $ 

11. Social Security or other government assistance

(Specify) $ $ 

$ $ 

12. Pension or retirement income $ $ 

13. Other monthly income

(Specify) $ $ 

$ $ 

$ $ 

14. SUBTOTAL OF LINES 7 THROUGH 13 $ $ 

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

16. COMBINED AVERAGE MONTHLY INCOME: (Combine column totals from line 15;

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

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

Statistical Summary of Certain Liabilities and Related Data)

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

SCHEDULE I - CURRENT INCOME OF INDIVIDUAL DEBTOR(S)

Single

Assistant

Dartmouth College

4 months

Concord, NH 00000-0000

1,396.20

1,396.20

182.96

182.96

1,213.24

1,213.24

1,213.24

Unemployment ended April 2013, however debtor has filed a request for an extension of benefits.

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Ash, Kalen

B6J (Official Form 6J) (12/07)

IN RE

Debtor(s)

Case No. 

(If known)

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

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

on Form22A or 22C.

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

expenditures labeled “Spouse.”

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

a. Are real estate taxes included? Yes No 

b. Is property insurance included? Yes No 

2. Utilities:

a. Electricity and heating fuel $ 

b. Water and sewer $ 

c. Telephone $ 

d. Other $ 

$ 

3. Home maintenance (repairs and upkeep) $ 

4. Food $ 

5. Clothing $ 

6. Laundry and dry cleaning $ 

7. Medical and dental expenses $ 

8. Transportation (not including car payments) $ 

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

10. Charitable contributions $ 

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

a. Homeowner’s or renter’s $ 

b. Life $ 

c. Health $ 

d. Auto $ 

e. Other $ 

$ 

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

(Specify) $ 

$ 

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

a. Auto $ 

b. Other $ 

$ 

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

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

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

17. Other $ 

$ 

$ 

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

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

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

20. STATEMENT OF MONTHLY NET INCOME

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

b. Average monthly expenses from Line 18 above $ 

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

SCHEDULE J - CURRENT EXPENDITURES OF INDIVIDUAL DEBTOR(S)

575.00

9

9

115.00

90.00

See Schedule Attached 165.00

300.00

100.00

170.00

400.00

25.00

85.00

Snowmobile Loan 170.00

Pet Food And Care 250.00

2,445.00

None

1,213.24

2,445.00

-1,231.76

Case: 13-11038-JMD Doc #: 1 Filed: 04/19/13 Desc: Main Document Page 22 of 41
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IN RE Ash, Kalen

Debtor(s)

Case No. 

SCHEDULE J - CURRENT EXPENDITURES OF INDIVIDUAL DEBTOR(S)

Continuation Sheet - Page 1 of 1

Other Utilities

Trash Collection 25.00

Cable 140.00

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Ash, Kalen

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

IN RE

Debtor(s)

Case No. 

(If known)

DECLARATION UNDER PENALTY OF PERJURY BY INDIVIDUAL DEBTOR

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

true and correct to the best of my knowledge, information, and belief.

Date: Signature:

Debtor

Date: Signature:

(Joint Debtor, if any)

[If joint case, both spouses must sign.]

DECLARATION AND SIGNATURE OF NON-ATTORNEY BANKRUPTCY PETITION PREPARER (See 11 U.S.C. § 110)

I declare under penalty of perjury that: (1) I am a bankruptcy petition preparer as defined in 11 U.S.C. § 110; (2) I prepared this document for

compensation and have provided the debtor with a copy of this document and the notices and information required under 11 U.S.C. §§ 110(b), 110(h),

and 342 (b); and, (3) if rules or guidelines have been promulgated pursuant to 11 U.S.C. § 110(h) setting a maximum fee for services chargeable by

bankruptcy petition preparers, I have given the debtor notice of the maximum amount before preparing any document for filing for a debtor or accepting

any fee from the debtor, as required by that section.

Printed or Typed Name and Title, if any, of Bankruptcy Petition Preparer Social Security No. (Required by 11 U.S.C. § 110.)

If the bankruptcy petition preparer is not an individual, state the name, title (if any), address, and social security number of the officer, principal,

responsible person, or partner who signs the document.

Address

Signature of Bankruptcy Petition Preparer Date

Names and Social Security numbers of all other individuals who prepared or assisted in preparing this document, unless the bankruptcy petition preparer

is not an individual:

If more than one person prepared this document, attach additional signed sheets conforming to the appropriate Official Form for each person.

A bankruptcy petition preparer's failure to comply with the provision of title 11 and the Federal Rules of Bankruptcy Procedure may result in fines or

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

DECLARATION UNDER PENALTY OF PERJURY ON BEHALF OF CORPORATION OR PARTNERSHIP

I, the (the president or other officer or an authorized agent of the corporation or a

member or an authorized agent of the partnership) of the 

(corporation or partnership) named as debtor in this case, declare under penalty of perjury that I have read the foregoing summary and

schedules, consisting of sheets (total shown on summary page plus 1), and that they are true and correct to the best of my

knowledge, information, and belief.

Date: Signature:

(Print or type name of individual signing on behalf of debtor)

[An individual signing on behalf of a partnership or corporation must indicate position or relationship to debtor.]

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

DECLARATION CONCERNING DEBTOR'S SCHEDULES

16

April 18, 2013 /s/ Kalen Ash

Kalen Ash

Case: 13-11038-JMD Doc #: 1 Filed: 04/19/13 Desc: Main Document Page 24 of 41
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B201A (Form 201A) (11/12)

UNITED STATES BANKRUPTCY COURT 

NOTICE TO CONSUMER DEBTOR(S) UNDER §342(b) 

OF THE BANKRUPTCY CODE 

In accordance with § 342(b) of the Bankruptcy Code, this notice to individuals with primarily consumer debts: (1)

Describes briefly the services available from credit counseling services; (2) Describes briefly the purposes, benefits and

costs of the four types of bankruptcy proceedings you may commence; and (3) Informs you about bankruptcy crimes and

notifies you that the Attorney General may examine all information you supply in connection with a bankruptcy case. 

You are cautioned that bankruptcy law is complicated and not easily described. Thus, you may wish to seek the

advice of an attorney to learn of your rights and responsibilities should you decide to file a petition. Court employees

cannot give you legal advice. 

Notices from the bankruptcy court are sent to the mailing address you list on your bankruptcy petition. In order to

ensure that you receive information about events concerning your case, Bankruptcy Rule 4002 requires that you notify the

court of any changes in your address. If you are filing a joint case (a single bankruptcy case for two individuals married to

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

receive a single copy of each notice mailed from the bankruptcy court in a jointly-addressed envelope, unless you file a

statement with the court requesting that each spouse receive a separate copy of all notices. 

1. Services Available from Credit Counseling Agencies

With limited exceptions, § 109(h) of the Bankruptcy Code requires that all individual debtors who file for

bankruptcy relief on or after October 17, 2005, receive a briefing that outlines the available opportunities for

credit counseling and provides assistance in performing a budget analysis. The briefing must be given within 180

days before the bankruptcy filing. The briefing may be provided individually or in a group (including briefings conducted

by telephone or on the Internet) and must be provided by a nonprofit budget and credit counseling agency approved by the

United States trustee or bankruptcy administrator. The clerk of the bankruptcy court has a list that you may consult of the

approved budget and credit counseling agencies. Each debtor in a joint case must complete the briefing. 

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

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

financial management instructional courses. Each debtor in a joint case must complete the course. 

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

Chapter 7: Liquidation ($245 filing fee, $46 administrative fee, $15 trustee surcharge: Total fee $306) 

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

Debtors whose debts are primarily consumer debts are subject to a “means test” designed to determine whether the case

should be permitted to proceed under chapter 7. If your income is greater than the median income for your state of

residence and family size, in some cases, the United States trustee (or bankruptcy administrator), the trustee, or creditors

have the right to file a motion requesting that the court dismiss your case under § 707(b) of the Code. It is up to the court

to decide whether the case should be dismissed. 

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

right to take possession of and sell the remaining property that is not exempt and use the sale proceeds to pay your

creditors. 

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

have committed certain kinds of improper conduct described in the Bankruptcy Code, the court may deny your

Case: 13-11038-JMD Doc #: 1 Filed: 04/19/13 Desc: Main Document Page 25 of 41
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B201A (Form 201A) (11/12) Page 2

discharge and, if it does, the purpose for which you filed the bankruptcy petition will be defeated. 

Even if you receive a general discharge, some particular debts are not discharged under the law. Therefore, you

may still be responsible for most taxes and student loans; debts incurred to pay nondischargeable taxes; domestic support

and property settlement obligations; most fines, penalties, forfeitures, and criminal restitution obligations; certain debts

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

motor vehicle, vessel, or aircraft while intoxicated from alcohol or drugs. Also, if a creditor can prove that a debt arose

from fraud, breach of fiduciary duty, or theft, or from a willful and malicious injury, the bankruptcy court may determine

that the debt is not discharged. 

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

$46 administrative fee: Total fee $281) 

Chapter 13 is designed for individuals with regular income who would like to pay all or part of their debts in

installments over a period of time. You are only eligible for chapter 13 if your debts do not exceed certain dollar amounts

set forth in the Bankruptcy Code. 

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

them, using your future earnings. The period allowed by the court to repay your debts may be three years or five years,

depending upon your income and other factors. The court must approve your plan before it can take effect. 

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

obligations; most student loans; certain taxes; most criminal fines and restitution obligations; certain debts which are not

properly listed in your bankruptcy papers; certain debts for acts that caused death or personal injury; and certain long term

secured obligations. 

Chapter 11: Reorganization ($1167 filing fee, $46 administrative fee: Total fee $1213) 

Chapter 11 is designed for the reorganization of a business but is also available to consumer debtors. Its

provisions are quite complicated, and any decision by an individual to file a chapter 11 petition should be reviewed with

an attorney. 

Chapter 12: Family Farmer or Fisherman ($200 filing fee, $46 administrative fee: Total fee $246) 

Chapter 12 is designed to permit family farmers and fishermen to repay their debts over a period of time from

future earnings and is similar to chapter 13. The eligibility requirements are restrictive, limiting its use to those whose

income arises primarily from a family-owned farm or commercial fishing operation. 

3. Bankruptcy Crimes and Availability of Bankruptcy Papers to Law Enforcement Officials

A person who knowingly and fraudulently conceals assets or makes a false oath or statement under penalty of

perjury, either orally or in writing, in connection with a bankruptcy case is subject to a fine, imprisonment, or both. All

information supplied by a debtor in connection with a bankruptcy case is subject to examination by the Attorney General

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

employees of the Department of Justice. 

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

your creditors, assets, liabilities, income, expenses and general financial condition. Your bankruptcy case may be

dismissed if this information is not filed with the court within the time deadlines set by the Bankruptcy Code, the

Bankruptcy Rules, and the local rules of the court. The documents and the deadlines for filing them are listed on Form

B200, which is posted at http://www.uscourts.gov/bkforms/bankruptcy_forms.html#procedure. 

Case: 13-11038-JMD Doc #: 1 Filed: 04/19/13 Desc: Main Document Page 26 of 41
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B201B (Form 201B) (12/09)

IN RE: Case No. 

Debtor(s)

Chapter 

UNDER § 342(b) OF THE BANKRUPTCY CODE

Certificate of [Non-Attorney] Bankruptcy Petition Preparer

I, the [non-attorney] bankruptcy petition preparer signing the debtor’s petition, hereby certify that I delivered to the debtor the attached

notice, as required by § 342(b) of the Bankruptcy Code.

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

Address:

X

Signature of Bankruptcy Petition Preparer of officer, principal, responsible person, or

partner whose Social Security number is provided above.

Social Security number (If the bankruptcy

petition preparer is not an individual, state

the Social Security number of the officer,

principal, responsible person, or partner of

the bankruptcy petition preparer.)

(Required by 11 U.S.C. § 110.)

Certificate of the Debtor

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

Printed Name(s) of Debtor(s)

X

Signature of Debtor Date

Case No. (if known) X

Signature of Joint Debtor (if any) Date

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

Use this form to certify that the debtor has received the notice required by 11 U.S.C. § 342(b) only if the certification has

NOT been made on the Voluntary Petition, Official Form B1. Exhibit B on page 2 of Form B1 contains a certification by the debtor’s

attorney that the attorney has given the notice to the debtor. The Declarations made by debtors and bankruptcy petition preparers on

page 3 of Form B1 also include this certification.

United States Bankruptcy Court

District of New Hampshire

CERTIFICATION OF NOTICE TO CONSUMER DEBTOR(S)

Ash, Kalen 7

Ash, Kalen /s/ Kalen Ash 4/18/2013

Case: 13-11038-JMD Doc #: 1 Filed: 04/19/13 Desc: Main Document Page 27 of 41
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IN RE: Case No. 

Debtor(s)

Chapter 

The above named Debtor hereby certifies under penalty of perjury that the attached master mailing list of creditors, consisting

of pages is complete, correct and consistent with the Debtor’s schedules pursuant to Local Bankruptcy Rules and

assumes all responsibility for errors and omissions.

Date:

Debtor Signature

United States Bankruptcy Court

District of New Hampshire

VERIFICATION OF CREDITOR MATRIX

Ash, Kalen 7

1

April 18, 2013 /s/ Kalen Ash

Ash, Kalen

40B Lyford Road

Pittsfield, NH 03263

Case: 13-11038-JMD Doc #: 1 Filed: 04/19/13 Desc: Main Document Page 28 of 41
Barclays Bank

PO Box 8803

Wilmington, DE 19899-8803

Concord Hospital

250 Pleasant St

Concord, NH 03301-7539

Dartmouth-Hitchcock Clinic

PO Box 10493

Bedford, NH 03110-0493

Debt Recovery Solutions

900 Merchants Concourse

Westbury, NY 11590

Discover Bank

PO Box 3025

New Albany, OH 43054-3025

GE Money Bank

Attn: Bankruptcy Dept.

PO Box 103104

Roswell, GA 30076-9104

Retail Services

PO Box 5893

Carol Stream, IL 60197-5893

St. Mary's Bank

48 Perimeter Road

Manchester, NH 03103

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United States Bankruptcy Court

IN RE: Case No. 

Debtor(s)

Chapter 

1. Pursuant to 11 U.S.C. § 329(a) and Bankruptcy Rule 2016(b), I certify that I am the attorney for the above-named debtor(s) and that compensation paid to me within

one year before the filing of the petition in bankruptcy, or agreed to be paid to me, for services rendered or to be rendered on behalf of the debtor(s) in contemplation

of or in connection with the bankruptcy case is as follows:

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

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

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

2. The source of the compensation paid to me was: Debtor Other (specify):

3. The source of compensation to be paid to me is: Debtor Other (specify):

4. I have not agreed to share the above-disclosed compensation with any other person unless they are members and associates of my law firm.

I have agreed to share the above-disclosed compensation with a person or persons who are not members or associates of my law firm. A copy of the agreement,

together with a list of the names of the people sharing in the compensation, is attached.

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

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

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

c. Representation of the debtor at the meeting of creditors and confirmation hearing, and any adjourned hearings thereof;

d. Representation of the debtor in adversary proceedings and other contested bankruptcy matters;

e. [Other provisions as needed]

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

CERTIFICATION

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

proceeding.

Date

District of New Hampshire

DISCLOSURE OF COMPENSATION OF ATTORNEY FOR DEBTOR

Ash, Kalen 7

1,200.00

1,200.00

0.00

9

9

April 18, 2013 /s/ Mark Cornell

Mark Cornell 04976

Mark P. Cornell,

Attorney at Law, PLLC

2 Greenwood Ave.

Concord, NH 03301-0000

(603) 225-9900 Fax: 60-224-9100

mark.p.cornell@bankruptcynh.com

Case: 13-11038-JMD Doc #: 1 Filed: 04/19/13 Desc: Main Document Page 30 of 41
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B8 (Official Form 8) (12/08)

IN RE: Case No. 

Debtor(s)

Chapter 

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

estate. Attach additional pages if necessary.)

Property No. 1

Creditor’s Name: Describe Property Securing Debt:

Property will be (check one):

 Surrendered Retained

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

 Redeem the property

 Reaffirm the debt

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

Property is (check one):

 Claimed as exempt Not claimed as exempt

Property No. 2 (if necessary)

Creditor’s Name: Describe Property Securing Debt:

Property will be (check one):

 Surrendered Retained

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

 Redeem the property

 Reaffirm the debt

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

Property is (check one):

 Claimed as exempt Not claimed as exempt

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

additional pages if necessary.)

Property No. 1

Lessor’s Name: Describe Leased Property: Lease will be assumed pursuant to

11 U.S.C. § 365(p)(2): 

 Yes No

Property No. 2 (if necessary)

Lessor’s Name: Describe Leased Property: Lease will be assumed pursuant to

11 U.S.C. § 365(p)(2): 

 Yes No

 continuation sheets attached (if any)

I declare under penalty of perjury that the above indicates my intention as to any property of my estate securing a debt and/or

personal property subject to an unexpired lease.

Date: 

Signature of Debtor

Signature of Joint Debtor

United States Bankruptcy Court

District of New Hampshire

CHAPTER 7 INDIVIDUAL DEBTOR'S STATEMENT OF INTENTION

Ash, Kalen 7

Retail Services Snowmobile

9

9

9

April 18, 2013 /s/ Kalen Ash

Case: 13-11038-JMD Doc #: 1 Filed: 04/19/13 Desc: Main Document Page 31 of 41
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B6 Summary (Form 6 - Summary) (12/07)

IN RE: Case No. 

Debtor(s)

Chapter 

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

provided. Add the amounts from Schedules A and B to determine the total amount of the debtor’s assets. Add the amounts of all claims from Schedules D, E, and F to

determine the total amount of the debtor’s liabilities. Individual debtors also must complete the “Statistical Summary of Certain Liabilities and Related Data” if they file

a case under chapter 7, 11, or 13.

NAME OF SCHEDULE ATTACHED

(YES/NO)

NUMBER OF

SHEETS ASSETS LIABILITIES OTHER

A - Real Property $

B - Personal Property $

C - Property Claimed as Exempt

D - Creditors Holding Secured Claims $

E - Creditors Holding Unsecured Priority

Claims (Total of Claims on Schedule E)

 $

F - Creditors Holding Unsecured

Nonpriority Claims $

G - Executory Contracts and Unexpired

Leases

H - Codebtors

I - Current Income of Individual

Debtor(s) $

J - Current Expenditures of Individual

Debtor(s) $

TOTAL $ $

United States Bankruptcy Court

District of New Hampshire

SUMMARY OF SCHEDULES

Ash, Kalen 7

Yes 1 0.00

Yes 3 7,718.00

Yes 1

Yes 1 6,628.39

Yes 1 0.00

Yes 2 26,572.84

Yes 1

Yes 1

Yes 1 1,213.24

Yes 2 2,445.00

14 7,718.00 33,201.23

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Form 6 - Statistical Summary (12/07)

IN RE: Case No. 

Debtor(s)

Chapter 

If you are an individual debtor whose debts are primarily consumer debts, as defined in § 101(8) of the Bankruptcy Code (11 U.S.C. §

101(8)), filing a case under chapter 7, 11 or 13, you must report all information requested below.

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

information here.

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

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

Type of Liability Amount

Domestic Support Obligations (from Schedule E) $

Taxes and Certain Other Debts Owed to Governmental Units (from Schedule E) $

Claims for Death or Personal Injury While Debtor Was Intoxicated (from Schedule E) (whether

disputed or undisputed) $

Student Loan Obligations (from Schedule F) $

Domestic Support, Separation Agreement, and Divorce Decree Obligations Not Reported on

Schedule E $

Obligations to Pension or Profit-Sharing, and Other Similar Obligations (from Schedule F) $

TOTAL $

State the following:

Average Income (from Schedule I, Line 16) $

Average Expenses (from Schedule J, Line 18) $

Current Monthly Income (from Form 22A Line 12; OR, Form 22B Line 11; OR, Form 22C

Line 20 ) $

State the following:

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

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

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

4. Total from Schedule F $

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

United States Bankruptcy Court

District of New Hampshire

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

Ash, Kalen 7

0.00

0.00

0.00

0.00

0.00

0.00

0.00

1,213.24

2,445.00

2,673.93

3,128.39

0.00

0.00

26,572.84

29,701.23

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B22A (Official Form 22A) (Chapter 7) (04/13) According to the information required to be entered on this

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

statement):

The presumption arises

The presumption does not arise

The presumption is temporarily inapplicable.

In re: 

Debtor(s)

Case Number: 

(If known)

AND MEANS-TEST CALCULATION

In addition to Schedules I and J, this statement must be completed by every individual chapter 7 debtor. If none of the exclusions in

Part I applies, joint debtors may complete one statement only. If any of the exclusions in Part I applies, joint debtors should complete

separate statements if they believe this is required by § 707(b)(2)(C).

Part I. MILITARY AND NON-CONSUMER DEBTORS

1A

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

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

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

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

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

defined in 10 U.S.C. § 101(d)(1)) or while I was performing a homeland defense activity (as defined in 32 U.S.C. §901(1)).

1B

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

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

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

1C

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

of the Armed Forces and members of the National Guard who were called to active duty (as defined in 10 U.S.C. §

101(d)(1)) after September 11, 2001, for a period of at least 90 days, or who have performed homeland defense activity (as

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

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

temporary exclusion, (1) check the appropriate boxes and complete any required information in the Declaration of

Reservists and National Guard Members below, (2) check the box for “The presumption is temporarily inapplicable” at the

top of this statement, and (3) complete the verification in Part VIII. During your exclusion period you are not required to

complete the balance of this form, but you must complete the form no later than 14 days after the date on which your

exclusion period ends, unless the time for filing a motion raising the means test presumption expires in your case

before your exclusion period ends.

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

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

component of the Armed Forces or the National Guard

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

 I remain on active duty /or/

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

bankruptcy case was filed;

OR

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

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

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

CHAPTER 7 STATEMENT OF CURRENT MONTHLY INCOME

Ash, Kalen 9

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B22A (Official Form 22A) (Chapter 7) (04/13)

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

2

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

a. Unmarried. Complete only Column A (“Debtor’s Income”) for Lines 3-11.

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

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

are living apart other than for the purpose of evading the requirements of § 707(b)(2)(A) of the Bankruptcy Code.”

Complete only Column A (“Debtor’s Income”) for Lines 3-11.

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

Column A (“Debtor’s Income”) and Column B (“Spouse’s Income”) for Lines 3-11.

d. Married, filing jointly. Complete both Column A (“Debtor’s Income”) and Column B (“Spouse’s Income”) for

Lines 3-11.

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

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

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

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

Column A

Debtor’s

Income

Column B

Spouse’s

Income

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

4

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

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

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

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

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

$ $

a. Gross receipts $

b. Ordinary and necessary business expenses $

c. Business income Subtract Line b from Line a

5

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

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

not include any part of the operating expenses entered on Line b as a deduction in

Part V.

$ $

a. Gross receipts $

b. Ordinary and necessary operating expenses $

c. Rent and other real property income Subtract Line b from Line a

6 Interest, dividends, and royalties. $ $

7 Pension and retirement income. $ $

8

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

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

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

by your spouse if Column B is completed. Each regular payment should be reported in only

one column; if a payment is listed in Column A, do not report that payment in Column B. $ $

9

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

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

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

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

$ $

Unemployment compensation

claimed to be a benefit under the

Social Security Act Debtor $ Spouse $ 

9

966.60

1,707.33

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B22A (Official Form 22A) (Chapter 7) (04/13)

10

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

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

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

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

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

a victim of international or domestic terrorism.

$ $

a. $

b. $

Total and enter on Line 10

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

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

12

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

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

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

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

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

12 and enter the result. $

14

Applicable median family income. Enter the median family income for the applicable state and

household size. (This information is available by family size at www.usdoj.gov/ust/ or from the clerk of

the bankruptcy court.)

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

15

Application of Section707(b)(7). Check the applicable box and proceed as directed.

The amount on Line 13 is less than or equal to the amount on Line 14. Check the box for “The presumption does

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

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

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

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

16 Enter the amount from Line 12. $

17

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

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

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

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

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

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

a. $

b. $

c. $

Total and enter on Line 17. $

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

Part V. CALCULATION OF DEDUCTIONS FROM INCOME

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

19A

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

National Standards for Food, Clothing and Other Items for the applicable number of persons. (This

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

number of persons is the number that would currently be allowed as exemptions on your federal income tax

return, plus the number of any additional dependents whom you support. $

2,673.93

2,673.93

32,087.16

New Hampshire 1 52,588.00

9

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B22A (Official Form 22A) (Chapter 7) (04/13)

19B

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

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

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

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

persons who are under 65 years of age, and enter in Line b2 the applicable number of persons who are 65

years of age or older. (The applicable number of persons in each age category is the number in that

category that would currently be allowed as exemptions on your federal income tax return, plus the number

of any additional dependents whom you support.) Multiply Line a1 by Line b1 to obtain a total amount for

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

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

amount, and enter the result in Line 19B.

$

Persons under 65 years of age Persons 65 years of age or older

a1. Allowance per person a2. Allowance per person

b1. Number of persons b2. Number of persons

c1. Subtotal c2. Subtotal

20A

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

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

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

family size consists of the number that would currently be allowed as exemptions on your federal income

tax return, plus the number of any additional dependents whom you support. $

20B

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

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

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

family size consists of the number that would currently be allowed as exemptions on your federal income

tax return, plus the number of any additional dependents whom you support); enter on Line b the total of

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

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

$

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

b. Average Monthly Payment for any debts secured by your home, if

any, as stated in Line 42 $

c. Net mortgage/rental expense Subtract Line b from Line a

21

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

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

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

for your contention in the space below:

$

22A

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

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

and regardless of whether you use public transportation.

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

expenses are included as a contribution to your household expenses in Line 8.

 0 1 2 or more.

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

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

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

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

of the bankruptcy court.) $

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B22A (Official Form 22A) (Chapter 7) (04/13)

22B

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

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

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

Transportation” amount from IRS Local Standards: Transportation. (This amount is available at

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

23

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

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

than two vehicles.)

 1 2 or more.

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

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

the total of the Average Monthly Payments for any debts secured by Vehicle 1, as stated in Line 42;

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

$

a. IRS Transportation Standards, Ownership Costs $

b.

Average Monthly Payment for any debts secured by Vehicle 1, as

stated in Line 42 $

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

24

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

checked the “2 or more” Box in Line 23.

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

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

the total of the Average Monthly Payments for any debts secured by Vehicle 2, as stated in Line 42;

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

$

a. IRS Transportation Standards, Ownership Costs, Second Car $

b.

Average Monthly Payment for any debts secured by Vehicle 2, as

stated in Line 42 $

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

25

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

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

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

26

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

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

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

27

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

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

whole life or for any other form of insurance. $

28

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

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

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

29

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

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

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

whom no public education providing similar services is available. $

30

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

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

payments. $

31

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

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

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

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

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32

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

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

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

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

deducted. $

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

Subpart B: Additional Living Expense Deductions

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

34

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

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

spouse, or your dependents.

$

a. Health Insurance $

b. Disability Insurance $

c. Health Savings Account $

Total and enter on Line 34

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

the space below:

$ 

35

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

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

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

unable to pay for such expenses. $

36

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

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

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

confidential by the court. $

37

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

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

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

that the additional amount claimed is reasonable and necessary. $

38

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

you actually incur, not to exceed $156.25* per child, for attendance at a private or public elementary or

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

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

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

39

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

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

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

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

additional amount claimed is reasonable and necessary. $

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

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

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

$

* Amount subject to adjustment on 4/01/16, and every three years thereafter with respect to cases commenced on or after the date of adjustment.

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B22A (Official Form 22A) (Chapter 7) (04/13)

Subpart C: Deductions for Debt Payment

42

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

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

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

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

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

page. Enter the total of the Average Monthly Payments on Line 42.

$

Name of Creditor Property Securing the Debt

Average

Monthly

Payment

Does payment

include taxes or

insurance?

a. $ yes no

b. $ yes no

c. $ yes no

Total: Add lines a, b and c.

43

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

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

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

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

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

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

separate page.

$

Name of Creditor Property Securing the Debt

1/60th of the

Cure Amount

a. $

b. $

c. $

Total: Add lines a, b and c.

44

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

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

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

45

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

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

administrative expense.

$

a. Projected average monthly chapter 13 plan payment. $

b. Current multiplier for your district as determined under

schedules issued by the Executive Office for United States

Trustees. (This information is available at

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

court.) X

c. Average monthly administrative expense of chapter 13

case

Total: Multiply Lines a

and b

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

Subpart D: Total Deductions from Income

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

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

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

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

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

51 60-month disposable income under § 707(b)(2). Multiply the amount in Line 50 by the number 60 and

enter the result. $

52

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

The amount on Line 51 is less than $7,475*. Check the box for “The presumption does not arise” at the top of page 1

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

The amount set forth on Line 51 is more than $12,475*. Check the box for “The presumption arises” at the top of

page 1 of this statement, and complete the verification in Part VIII. You may also complete Part VII. Do not complete

the remainder of Part VI.

The amount on Line 51 is at least $7,475*, but not more than $12,475*. Complete the remainder of Part VI (Lines

53 though 55).

53 Enter the amount of your total non-priority unsecured debt $

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

result. $

55

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

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

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

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

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

VII.

Part VII. ADDITIONAL EXPENSE CLAIMS

56

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

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

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

average monthly expense for each item. Total the expenses.

Expense Description Monthly Amount

a. $

b. $

c. $

Total: Add Lines a, b and c $

Part VIII. VERIFICATION

57

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

both debtors must sign.)

Date: Signature: 

(Debtor)

Date: Signature: 

(Joint Debtor, if any)

* Amount subject to adjustment on 4/01/16, and every three years thereafter with respect to cases commenced on or after the date of adjustment.

April 18, 2013 /s/ Kalen Ash

Case: 13-11038-JMD Doc #: 1 Filed: 04/19/13 Desc: Main Document Page 41 of 41