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B l ( O f f i c i a l F o r m 1) (4110)

United States Bankruptcy Court
Northern District of Alabama

Eastern Division

Name of Debtor (

t

i

~ndlvldual, cnter Lusl. Frrrt. Middle)

Ball, D o r o t h y . A.

All Other Namcs used by rhc Debtor ~n the last 8 years
Oncludz manled. ma~den, and ttade names)

I Name of Jolot Debtor (Spooicl I

All Olhcr Names used by the J o ~ n l Oebror ~n ihc last 8 yzars
(~ncludc manled. rnaldeo. 2nd trade names1

Last four dlglts afSoc. Sec or lnd~vcdual-Taxpayer I D (ITIN)iCa,npletc EIN(ifmore
than one, state all)

9699

four dagns 01 Sou Scc or Indlv>dual-Taxpayer I D 1ITIN)IComplete EIN(11nlore

l:ast
than one. stale all)

Street Address of Drbtor (No &Street. CIQ, and State)

Street Addrers af Jolnt Debtor (No t Street, Cify, and State)

1 1 2 1 H i l l s b o r o D r i v e
Cadsden, A L

ZIP CODE

35901

ZIP CODE

County o f Rrridencc or of the Prcnc~pal Place of Business

E t n w n h

. .

Counr\. o f Residence or o l Ihe Principal Place of Business

I

M a h g Addrzss o f Debtor ( ( I d~ifeferen Rom slreet nddrzss)

M a ~ l ~ n g Address o f J o ~ n t Debtor (~fd\ffercnt from rlrccl address)

Locatlon of Prlnclpal Assets of Bus~nl'ba Debtor ( i f dzllerrnt from street address above)

ZIP CODE

ZIP CODE

ZIP CODE

Type o f Dehror

(~ormoiOrgsnization)

(Check one box )

Ind~\ldual (includes Joint Debtors)
See Exhibrr D o n page 2 oJ'rl,~r/nrm.
0 Corpom~ion(~ncluder L L C and 1.I.P)
p Pannzrshlp

Other (If debtor i s not une aifhe above e n l ~ l ~ e s ,
cheek thlr box and rtalc type ofenlily belax )

F i l i n g Fee (Check onc bux)

Full Flllng Fee rttsct~cd

I

Nature of Business

I

(Check one box)
0 Healrh Care Ruimers
-
3 Single Asset Real Cslnrc ss delinzd in

I 1 U S C g l O l ( 5 l B )

0 Rallruad
0 Stazkbruker
0 Commod~ly Brake,
0 Clzarlng Rank
3 Other

T a r - E x e m p l Enhtily

(Chzck box. if appl~cable)

0 Debtor i s a tax-crcmpt urgsnza~ion

undzr Tltlc 26 oilhe Unltzd Stater
Code (the InLernal Revenue Code )

Chaoter of Bankruotcv Code Under W h i c h

. .

the P ~ t i t i o l b is Filed ( C h n k o n r box)

p Chapter 7
0 Chapter 9
0 Chaptcr 1 1
Chapter I2
0 Chapter 13

p Cilaprer 15 Pvut~on for

R ~ ~ o g n l t l o n 01'3 Fomlgn
Main Proczzd~ng

p Chaplcr 15 Pcl#l~on
i'or

Recognitton "fa Forcign

Nonmaln Proeecd~ng

N a t u r e o f D e b t s

a Dzblrare prtmnrily consumer 0 Dzbts arc pr~marlly

bus~ness deblr

debts, drfinrd in I I U S C
p IOI(8) r s 'incurred by an
tndivldual pr~maiily for a
personal, fam~ly. or huuse-
hold purpose '

I

a Ftllng bee ro be paid in ~nslallments lappl~cable lo mdtvtdusli only) Must atturh

slgned sppllestton for the coun', ~ o n s ~ d e r a l ~ o n
unable tu pay fez exczpt in ~nitalllncnts Rule 1006,b) See Oif~fic~al Form 3A

cznlh:ng that thz dzbtor I,

0 Flllng Fce walvsr requenled (appl!cable to shaprcr 7 ~nd~v>duals only) Must
attach iignzd applratiun for thz coun's considcruuon See OiTielal Form 3 8

SlatisticallAdminisrrarivr lnforrnafiu~n
0 Debtor est8males lhal lunds w ~ l l be ava~lahle for d ~ s l r ~ b u t ~ o n
- a Debtor estimates that, aner any exempt p r o p e q is zxcluded and adm~n~srral~vu

to unsecured crud~rori

expenses patd, there will hc no hnds avallvblc lor d~slrlbullan l o unsecured crzd~lars

C h ~ p t e r I I Debtors

Check one box:
0 Deblur 1s a small bur~nosdehrur as delinzd in I I Li S C S IOI15ID)
-
0 Drblur is not s small buslncrs debtor as delinrd in I I US C 3 IOl(51D)
Check il:
0 Deblur's aggreerte naneontlngznt l~quldarcd deb& (exeludlvg debts owzd to

lnsidzrs or alli11alt.b) are less than $?,343,300 (amormr rukecr ro ad/usfmenr on
/o!/!3-,d

! ~ z a ! h ~ ~ ~ u r ~ ~ ~ r h ~ ~ ~ ! f i ~ ! ) .

.. . . - - - - . . .

Check a l l applicable boxes
0 A plan is brmgfilud wlth th~s pcllllon
p Acccplancei o f the plan wurr solicned prepetltian from one or ,nore slassds

- -

ofcrcdbtors, in accordance with I I U 5 C 3 I I26(b)

I' I'HIS SPACE IS FOR

COliRTUSE 0NI.Y

Est~mated Number ofCrcd8tors

a

0 0
100-
50-
99
199

0
200-
999

1,000-
5.000

5.001
10.000

10.001-
25.000

0
25,OUI-
50.000

0
50.001-
lUU.000

0
Over
100.000

E~tlmated Asselr

0 a

0

0

0

0

0

0

0

$0 (0 %50.001 to $100.001 to %500,001 l o $1,000,001 %10,000,001 %50,000 001 16100.000001 S5U0.000,001 Mare lhan
%50,000 S100.000
lo $1 b l l l ~ a n $1 b8lllon

$500.000

$ I
m l l l ~ a n

l o $ l O
mllllon

~ ~ $ 5 0 la%lOO
million

ro$500
m ~ l l ~ o n mlillan

Esttnlated L ~ a b ~ l ~ t ~ c s
P

Et
%50,001 10 $1~0,001 %'lJ0,00I to %1.l!l!0.001 S10.000,MJI %50000,001 %l00.l)0O,lJOl 850 0,00 0,001 Marrlha,,
la161 b ~ l l ~ u n %I bllllon

$~OO.OIJO

0

0

0

0

0

0

1 0 ~ 1 0 0
m,ll>on

toSSnu
mtlllan

mllllon

to $10
t0%50
~ n ~ l l # o n rnllllon

$jo,000 %lOD.OOO

Case 10-42788-JJR13 Doc 1 Filed 10/01/10 Entered 10/01/10 13:55:46 Desc Main

Document Page 1 of 45

FORM B1, Pagc 2

Dnlr F ~ l e d
05/28/2009

B l (Officinl F o r m 1) (4110)
Voluntary Pelilion

/This page musf be complered and/i/ed in every cose)

Name of Debtor(s):
D o r o l h y A. B a l l

All P r i o r Bnnkruptey Cnses Filed W i l h i n Larl

I.aca~~on
Where Fllcd
Locallon
Where r'lcd' N o r t h e r n D i s t r i c t A l a b a m a E a s t e r n Div

N o r t h e r n D i s t r i c t A l a b a m a E a s t e r n Div

Pending Bankruptcy P r s e Filed b y any Spuusr. P a r l u r r ur

Name olDcblor
NONE
D!str>ct

E x h l b i l h

(To be co~npleled 11 debtor is rrqulrcd lo file perlodlc repons (e g , farms IDK and
IOQ) w ~ t h the Securltles and Exchange Commlsr~an pursuant lo Secllan 13 or 15(d)
u f l h e Secur~l~es Exchange Acl oi 1931 and is rcquesltng relief underchapter I I )

Ekhibll A i s auached aud madc a pan o f l h ~ s pelll~on

X \ r s r s ( I l m o r r Than two, nnach addltlonal shed)
Case Numbzr
09-41552-JJR13
Care Number
01-40853-JJR13
A f l i l i r t e u l t h i s Debtor (Ifmore than one. attach
Caw Numhei

Relaltonslup

Date Filed
0311012004
addlrlonal sheel,

Ilalc Ibllcd

Judge

Exhibit B

('I" be cumpleled f d c b l o r IS an lnd>rldual
whuse debls rrr prlmrr~l) consumer debls)

I. the ntlorrley for (he pelnioner usmed in ,he lorcgolng peuoon. declare that I
have ~nformed the prlilloner that [he or she] may proceed under chapler 7, 1 I,
12, or 13 of tltle I I , Unlled Slates Code, and have cxplalned the rel>ef
ava~lable under each such chapter I lunher cenlly !ha, I have delivered to the
debtor the nollce rcqu~ced by I I I 1 S C 5 3421b)

x / s / Ralph K. Strawn, J r .

Signature o f .Attorney for Dcbtur(s)
R a l n h K. S t r a w n . Jr.

10-1-2010
Date
STRDOZ

IB No

Dues the cleblur awn or have passerrcon olany properry thal poles or li ullcgccl to pose a threat orlrnrn~r>er>t anrl ~deut~fiablc h a m lo p ~ l b l ! ~ health or sabR.7

Ye,. and Exhlbll C is atlached and mvde a pun of thm peunon

Exhibit D

(To be completed by ?*en. lnd~vidual deblor l l a j o ~ n l perlrlon 1s lilcd, each spouse musl complele and vlrach a separale Cxhlbll D I

E x h l b ~ l Dcomplclcd and ilgned b) the debtor IS allached and mvde a pan afthis petlllon

lfthls 1s ajolnl PeUllOn

Exhlbll D also completed and 51gned by lhejolnl deblor is atlached and made a pan ollhls pellllon

l n l o r m n t i a n Regarding I h r D r b l v r - V r n u ~

(Check any appl>cablc box)

I

Dcblar has bccn domtc~led or has had a res~deuce. prlnclpal plnce ofbun>nei,. or pr~nclpal assets in lllls D l i t r ~ c l for 180days ~rnrnedlntely
preccd~ng the dare of this peurlon or for a longer punofsuch 180 da>s than in any other D n t r ~ c l

There is a bankruptcy case concerning debtor's allil~ale general pnnner, or punnersh~p pendtrlg in thts D~sIrlcL

'J lJcr.dr I, .% J L ' I I ~ ~ ~

0 2 f . , # c ~ ; n ) ~ ~ . c t ' J # n :

J ~ J

1 l2.c
0.5 n.) ~#.ll~..l
I I tr I1 *III.C

.I# l o r in.c...il$.,l

. l ' l ~ ~ < # n t . ~ ,

. r J\\<Y\

11, 1:

1 2 % C .
11,. I n I C J \I~.c>

lpdl p',.:

1h.t

,> ?.>
7 > .!.f~'nJ>nt .n dr 2 . t . ~ n IP~.I.L,L'J

( ? , > .dr >r n: p,. J,W, 1 I r e I 0 .eJ \ I ~ C L ' \ 8ntO > ll8~!. . J ,
In

( 6 ( 8 2 >J:t.>

S I . > I L ' . J > ~ I

lnc 2.n t.5 n 11 I,. .:#s:J

n rcllrJ 1.1 u c r c r.: 3 ) . l r 1

I 11 r I1 -LC .l

C e r t i f i c a t i o n by a D e b t o r W h o Resides as a T e n a n t o l R e s i d e n t i a l P r o p e r t y

(Check a l l applicable b o x c s )

Laudlord has aiudgmenl agninst the dchtar lor possesn~on ofdebtor's res~deuce (If hox ehecked, fomplelr thr lollow~r~g!

(Name ollandlord that obtn~nedludgmenll

(Address ollandlord)

[Jeblar clalmr that under appl~cable nonbnrlkruptfy law. lhsrr arc c~rcumstances under w h ~ c h thedcbrar isauld he perm~lled tocure the
entlre monetary defaull lhal gave rlse to the judgment lor poireirbon alter the judgment for purscsslon isar cnarcd. and

Uebtor has lrlcluded in thar pelluon lhe deporlt wllh the counol an? renl lhvl wuuld become dueduilng rhe 30-day pec~od alter ,he
lillngal thepellllon

0

Debtor cert~fies thm helshe has served lhc Landlord wnll l h l i cen~fical#an ( I I U 5 C P 362(1))

Case 10-42788-JJR13 Doc 1 Filed 10/01/10 Entered 10/01/10 13:55:46 Desc Main

Document Page 2 of 45

I

I
I

I

B l IOfIicial Form 1) 14/10)

V o l u n t a r y Petition

( 7 h i ~ p o g r must be completidorrdJiied irr e v e 3 cuse)

Narnc of Deblor(s):
Dorothy A. Ball

F O R M B I . Paer

I declare under pcnally o f p r r ~ u r y that the ~nbrmarlorl provided in this p c l ~ t ~ u n
and correct.
111 oelltloner i s an tndivldual whuse debts are ~ r l m a r l l v consumer debts and lhas

IS IIUC

I deciarc under penalty olpequry that the tnlbrlnallon provlded in Ihls petlliun ir true
and correct. lhnl I am the forclgn representallvc " I n debtor in a r o r l g n proceeding,
and that I am a u t l ~ o n z d to file lhls pellllun

Signature of a Foreign Representative

(Chcch only one box )

[If no attorney reprssenls me and no bankruptcy peliliorl prepsrcr signs the petition] 1
have obtained and read the notice required by I I U S C $ 342(h).

I rcqucsl relief in accordance wxh (he chapter o f l ~ l l e I I, Unlted Statcs Code, ipciifie
in this permon

U I'.r\lllll

. I JI.ICI

JJ;I

0 I request relief in accordance will) chapler 15 of'T~Ue I I. Untied Stater Codc.
CenlIied Copies ufthe documrnll required by 5 ISIS oftttle I I arc attaehed

'. I ( S . ) 5 .

.)I I I . c . 50::

ICIICI
I IC.I.C>I

' c'J n tlc'pc IC t !. ,\ .<rt#I#cJ .,,p!

I!. I... cJ1 I:U .. n l 'r'
1 . 8 ~ 18 pr. ; : c ~ # n ; . 11td.n~:

,,( tr:

;11111111;

IC;.,

r 1 . 0 ~ . a1 inr

.~rr.l;t.

X

/ s / Dorothy A . B a l l
A, ~

Signalurr of Debtor ~

~

I X No1 Applicable

~
~

1

1

~



t

h

X Not Applicable
~



(S~gnuturcof Furelgn Kepresentut~vc)

/

I
I
I
I
I

Tclephon~ Number ( I f rnol ~eprcsmtcd by auorney)

10-1-7010

Signature of Atlornty
x / s / Ralph K. Strawn, J r .

Signature olAnor!ry far Debloris)

Ralph K. Strawn, Jr. Bar No. STROO2
I'nnlcd Nalrle ofAllorney for DebIar(s1 i Bar No

-



Henslee, Robertson, Strawn & Sullivan LL
Firm Namc
P.O. Box 246 Gadsden, A L 35902-0246

Address

256-543-9790
Telcphune Number

- - -

Dale
.In a case in wh~ch P 707(b)(4)iD) applies, tlus rigrlalurc also conititules il
cen~ficat~or~
~nfurmilt~on

rhat the artorney has no knowledge alter an lnquly rhat the
in the schedules is mcorrect

Signature oTDebtor (CorporrtioniPortnorship)

.,I lcr pl.1~ I , .I

t

.

. I IIC

1 1 ~ 1 1 .n 11 -1 Ill. ~u.l.,r : # ~ l . d n p r d .Ic.l ? t o # . 1 1 ~ 1 11.111 8.
ICL'I. 2.m r ,cJ 18 I..< (n , pc!ltlm .,!I OL'IIJ
I IIIC

r

I I Jc: Jrc

I
J
debtor

The deblor requests the relccr~n accordance wich che chapler oftitle I I. Unllcd Svales
Code, spec~fied in this pctltlon

x N o t Applicable

S~gnature o f Aulhurlred Indl\#dual

Pr~iccd Name o f Authorlred lndlvldual

I declvrc under penalty o f perjury that ( I ) I am a bsnhiuprr.) petmon preparer as dulil~ed
in I I U S C 6 1 10. ( 2 ) 1 oreoared this documerlt ror compcnsalion and have orovlded
the debtor w>;h s copy a i r h l r document and lhc notlcer &d mformallon req&ed under
i I U S C $9 I lU(b). I IO(h1. and 342ib). and, (3) ifrulcs or gu~drllnes have beer1
promulgated pursuanl to I I U S C $ I IO(h) rrtllng a maximum f?? for rentcrs
chareeable bv bankru~tcv oeullon oruoarers I have mven the deblor not~cc o f lhr
maxlrnurn amounl before preparing any documcnl ibr f i l ~ n g for a debtor or accepting any
fee from thcdebtor. as required in that scctlan Oflic~al Form 19 1s allachcd

, ,

.

,

,

Not Applicable
Printed Name snd title, if m y , orBankruptcy Petillon Preparer

Social-Security number (Irthe bankruptcy peltlwn preparer is nolan indlv~dual.
slate the Soccal-Security number urlhu umser, prlnclpul. rerpons~blc person ur
pannrr urlhe bankruplcy petitcon preparer ) (Rcqulred by I I U S C 9 110 )

Address

X N o t Applicable

Dale
Signature of bankruprcy petition preparer or afliciccr, prlnclpal, respons~ble person. or
pantlei whose Social-Security number is provldcd nbave

Names and Social-Securily numbers orall other ind~vlduals who prepared or
ass~itrd in prrparlng rhls document unless the bankruptcy pellllon preparcr 1s no1 an
lndwzdual

I f more than orlc person prepared thls documcnl, anilch to the appiaprlsrr otliclal
Corn) for each person

.I bankmp~uprcype,irianpri~~rer's
!be Federal Rules ojBanh-uplcy Procedure may rs~ult infine3 or ,,npnsunmenl or
bola. I1 osc. 5 / l o . 18 USC. 5 136

/o,lure ro ao,nply wirb rbuprob~is!ans a/rrrle I i an0

111 .

I

Case 10-42788-JJR13 Doc 1 Filed 10/01/10 Entered 10/01/10 13:55:46 Desc Main

Document Page 3 of 45

B 1D (Official Form 1, Exhibit D) (12/09)

UNITED STATES BANKRUPTCY COURT

Northern District of Alabama

Eastern Division

In re

Dorothy A. Ball

Debtor

Case No.

(if known)

EXHIBIT D - INDIVIDUAL DEBTOR'S STATEMENT OF COMPLIANCE WITH

CREDIT COUNSELING REQUIREMENT

Warning: You must be able to check truthfully one of the five statements regarding credit


counseling listed below. If you cannot do so, you are not eligible to file a bankruptcy case, and the court can
dismiss any case you do file. If that happens, you will lose whatever filing fee you paid, and your creditors
will be able to resume collection activities against you. If your case is dismissed and you file another
bankruptcy case later, you may be required to pay a second filing fee and you may have to take extra steps
to stop creditors' collection activities.




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

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




(cid:0)(cid:0)

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.




(cid:0)

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.




(cid:0)

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 from the
agency that provided the counseling, together with a copy of any debt management plan developed
through the agency. Failure to fulfill these requirements may result in dismissal of your case. Any
extension of the 30-day deadline can be granted only for cause and is limited to a maximum of 15 days.
Your case may also be dismissed if the court is not satisfied with your reasons for filing your bankruptcy
case without first receiving a credit counseling briefing.

Case 10-42788-JJR13 Doc 1 Filed 10/01/10 Entered 10/01/10 13:55:46 Desc Main

Document Page 4 of 45

B 1D (Official Form 1, Exh. D) (12/09) – Cont.




statement.] [Must be accompanied by a motion for determination by the court.]

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


(cid:0)




(cid:0)

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.);




(cid:0)

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.


(cid:0)






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


(cid:0)

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





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

Signature of Debtor:

s/ Dorothy A. Ball
Dorothy A. Ball

Date:

10/01/2010

Case 10-42788-JJR13 Doc 1 Filed 10/01/10 Entered 10/01/10 13:55:46 Desc Main

Document Page 5 of 45

DOROTHY A. BALL
1121 HILLSBORO DRIVE
GADSDEN, AL 35901

RALPH K. STRAWN, JR.
HENSLEE, ROBERTSON, STRA
P.O. BOX 246
GADSDEN, AL 35902-0246

CLARANCE BALL
P.O. BOX 2503
GADSDEN, AL 35903

ACCOUNTS RECEIVABLE MANA
P.O. BOX 129
THOROFARE, NJ 08086

DIGESTIVE DISEASE SPECIA
900 GOODYEAR AVE STE A
GADSDEN, AL 35903

FIRST PREMIER BANK
3820 N LOUISE AVENUE
SIOUX FALLS, SD 57104

HOMECOMING FINANCIAL
P.O. BOX 939072
SAN DIEGO, CA 92193

IRS
P.O. BOX 21126
PHILADELPHIA, PA 19114

MIDLAND CREDIT
8875 AREO DR. STE 200
SAND DIEGO, CA 92123

NCO FINANCIAL SYSTEMS
C/O PROGRESSIVE INSURANC
P.O. BOX 17095
WILMINGTON, DE 19850

RIVERVIEW REGIONAL MEDIC
P.O. BOX 268
GADSDEN, AL 35902-0268

SECURITY CHECK, LLC
2612 JACKSON AVENUE W
OXFORD, MS 38655

SOUTHEASTERN AUTO BROKER
521 CLUB VIEW DRIVE
GADSDEN, AL 35905

ZARZAU & SCHWARTZ, PC
P.O. BOX 11366
BIRMINGHAM, AL 35202

ZENITH ACQUISITION
C/O TRIBUTE MASTERCARD
220 JOHN GLEN DR #1
AMHERST, NY 14228-2228

Case 10-42788-JJR13 Doc 1 Filed 10/01/10 Entered 10/01/10 13:55:46 Desc Main

Document Page 6 of 45

UNITED STATES BANKRUPTCY COURT
NORTHERN DISTRICT OF ALABAMA

EASTERN DIVISION

In re:

Dorothy A. Ball

Debtor

Case No.
Chapter 13

VERIFICATION OF CREDITOR MATRIX


The above named debtor(s), or debtor’s attorney if applicable, do hereby certify under penalty of perjury that
the attached Master Mailing List of creditors, consisting of 1 sheet(s) is complete, correct and consistent with the
debtor’s schedules pursuant to Local Bankruptcy Rules and I/we assume all responsibility for errors and omissions.

Dated:

10/01/2010

Signed:

s/ Dorothy A. Ball
Dorothy A. Ball

Case 10-42788-JJR13 Doc 1 Filed 10/01/10 Entered 10/01/10 13:55:46 Desc Main

Document Page 7 of 45

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

In re:

Dorothy A. Ball

Debtor

,

Case No.

(If known)

SCHEDULE A - REAL PROPERTY

DESCRIPTION AND

LOCATION OF
PROPERTY

NATURE OF DEBTOR'S
INTEREST IN PROPERTY

CURRENT VALUE

OF DEBTOR'S
INTEREST IN

PROPERTY, WITHOUT

DEDUCTING ANY
SECURED CLAIM
OR EXEMPTION

AMOUNT OF
SECURED

CLAIM

I

Y
T
N
U
M
M
O
C
R
O



I

T
N
O
J


,

E
F
W

I


,

D
N
A
B
S
U
H

home located at
1121 Hillsboro Drive
Gadsden, AL



$ 53,981.00

$ 47,000.0

Total



$ 53,981.00

(Report also on Summary of Schedules.)

Case 10-42788-JJR13 Doc 1 Filed 10/01/10 Entered 10/01/10 13:55:46 Desc Main

Document Page 8 of 45

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

In re

Dorothy A. Ball

Debtor

,

Case No.

(If known)

SCHEDULE B - PERSONAL PROPERTY

CURRENT VALUE OF
DEBTOR'S INTEREST
IN PROPERTY, WITH-
OUT DEDUCTING ANY

SECURED CLAIM
OR EXEMPTION

10.00
11.00

1,500.00

150.00

2,500.00

I

Y
T
N
U
M
M
O
C
R
O



TYPE OF PROPERTY

E
N
O
N

DESCRIPTION AND LOCATION

OF PROPERTY

I

T
N
O
J

,

E
F
W

I


,

D
N
A
B
S
U
H

Cash
Wachovia

Furniture

Clothes

401K

1.

2.

3.

4.

5.

6.

7.

8.

9.

Cash on hand

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.

Security deposits with public utilities,
telephone companies, landlords, and
others.

Household goods and furnishings,
including audio, video, and computer
equipment.

Books, pictures and other art objects,
antiques, stamp, coin, record, tape,
compact disc, and other collections or
collectibles.

Wearing apparel.

Furs and jewelry.

Firearms and sports, photographic, and
other hobby equipment.

Interests in insurance policies. Name
insurance company of each policy and
itemize surrender or refund value of
each.

10.

Annuities. Itemize and name each
issuer.

11.

Interests in 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).)

12.

Interests in IRA, ERISA, Keogh, or other
pension or profit sharing plans. Give
particulars.

13.

Stock and interests in incorporated and
unincorporated businesses. Itemize.

14.

Interests in partnerships or joint
ventures. Itemize.

15.

16.

17.

Government and corporate bonds and
other negotiable and nonnegotiable
instruments.

Accounts receivable.

Alimony, maintenance, support, and
property settlements to which the debtor
is or may be entitled. Give particulars.

18.

Other liquidated debts owed to debtor
including tax refunds. Give particulars.

19.

Equitable or future interests, life estates,
and rights or powers exercisable for the
benefit of the debtor other than those
listed in Schedule A - Real Property.

20.

Contingent and noncontingent interests
in estate of a decedent, death benefit
plan, life insurance policy, or trust.

X

X

X
X

X

X

X

X

X

X

X
X

X

X

X

Case 10-42788-JJR13 Doc 1 Filed 10/01/10 Entered 10/01/10 13:55:46 Desc Main

Document Page 9 of 45

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

In re

Dorothy A. Ball

Debtor

,

Case No.

(If known)

SCHEDULE B - PERSONAL PROPERTY

(Continuation Sheet)

TYPE OF PROPERTY

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.

22.

Patents, copyrights, and other
intellectual property. Give particulars.

23.

Licenses, franchises, and other general
intangibles. Give particulars.

24.

Customer lists or other compilations
containing personally identifiable
information (as defined in 11 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.

25.

Automobiles, trucks, trailers, and other
vehicles and accessories.

26.

27.

28.

Boats, motors, and accessories.

Aircraft and accessories.

Office equipment, furnishings, and
supplies.

29.

Machinery, fixtures, equipment and
supplies used in business.

30.

Inventory.

31.

Animals.

32.

Crops - growing or harvested. Give
particulars.

33.

34.

35.

Farming equipment and implements.

Farm supplies, chemicals, and feed.

Other personal property of any kind not
already listed. Itemize.

E
N
O
N

X

X

X

X

X
X
X

X

X
X
X

X
X
X

DESCRIPTION AND LOCATION

OF PROPERTY

I

T
N
O
J

,

E
F
W

I


,

D
N
A
B
S
U
H

I

Y
T
N
U
M
M
O
C
R
O



CURRENT VALUE OF
DEBTOR'S INTEREST
IN PROPERTY, WITH-
OUT DEDUCTING ANY

SECURED CLAIM
OR EXEMPTION

1996 Ford Explorer

2,650.00

1

continuation sheets attached

Total



$ 6,821.00

(Include amounts from any continuation she
attached. Report total also on Summary of
Schedules.)

Case 10-42788-JJR13 Doc 1 Filed 10/01/10 Entered 10/01/10 13:55:46 Desc Main

Document Page 10 of 45

B6C (Official Form 6C) (4/10)

In re

Dorothy A. Ball

Debtor

,

Case No.

(If known)

SCHEDULE C - PROPERTY CLAIMED AS EXEMPT

Debtor claims the exemptions to which debtor is entitled under:
(Check one box)
(cid:0)
(cid:0)
(cid:2)

11 U.S.C. § 522(b)(2)
11 U.S.C. § 522(b)(3)

(cid:0)

Check if debtor claims a homestead exemption that exceeds
$146,450.*

DESCRIPTION OF PROPERTY

SPECIFY LAW

PROVIDING EACH

EXEMPTION

VALUE OF
CLAIMED

EXEMPTION

CURRENT

VALUE OF PROPERTY
WITHOUT DEDUCTING

EXEMPTION

401K

Cash

Clothes

Furniture

home located at
1121 Hillsboro Drive
Gadsden, AL
Wachovia

11 USC § 522(b)(3)(C )

Ala. Code § 6-10-6

Ala. Code § 6-10-6

Ala. Code § 6-10-6

Ala. Code § 6-10-2

Ala. Code § 6-10-6

2,500.00

10.00

150.00

1,500.00

5,000.00

11.00

2,500.0

10.0

150.0

1,500.0

53,981.0

11.0

* Amount subject to adjustment on 4/1/13 and every three years thereafter with respect to cases commenced on or after the date of adjustment.

Case 10-42788-JJR13 Doc 1 Filed 10/01/10 Entered 10/01/10 13:55:46 Desc Main

Document Page 11 of 45

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

In re

Dorothy A. Ball

Debtor

,

Case No.

(If known)

SCHEDULE D - CREDITORS HOLDING SECURED CLAIMS

(cid:0)

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

I

T
N
O
J

,

E
F
W

I


,

D
N
A
B
S
U
H

I

Y
T
N
U
M
M
O
C
R
O



CREDITOR'S NAME AND

MAILING ADDRESS

INCLUDING ZIP CODE AND

AN ACCOUNT NUMBER
(See Instructions, Above.)

ACCOUNT NO. 5530
Homecoming Financial
P.O. Box 939072
San Diego, CA 92193

ACCOUNT NO. 0369
Southeastern Auto Brokers
521 Club View Drive
Gadsden, AL 35905

R
O
T
B
E
D
O
C

X

DATE CLAIM WAS
INCURRED, NATURE

OF LIEN, AND

DESCRIPTION AND

VALUE OF PROPERTY

SUBJECT TO LIEN

AMOUNT OF

CLAIM WITHOUT

DEDUCTING
VALUE OF

COLLATERAL

T
N
E
G
N
T
N
O
C

I

I

D
E
T
A
D
U
Q
L
N
U

I

D
E
T
U
P
S
D

I

UNSECURE
PORTION, IF

ANY

01/01/2001
Mortgage
home located at
1121 Hillsboro Drive
Gadsden, AL
__________________________
VALUE $53,981.00
01/01/1996
Security Agreement
1996 Ford Explorer
__________________________
VALUE $2,650.00

47,000.00

0.0

2,500.00

0.0

0

continuation sheets
attached

Subtotal
(Total of this page)



Total
(Use only on last page)



$

$

49,500.00

$

0.0

49,500.00

$

0.0

(Report also on Summary of
Schedules)

(If applicable, repo
also on Statistical
Summary of Certa
Liabilities and
Related Data.)

Case 10-42788-JJR13 Doc 1 Filed 10/01/10 Entered 10/01/10 13:55:46 Desc Main

Document Page 12 of 45

B6E (Official Form 6E) (4/10)

In re

Dorothy A. Ball

Debtor

,

Case No.

(If known)

SCHEDULE E - CREDITORS HOLDING UNSECURED PRIORITY CLAIMS

(cid:0)



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.)

(cid:0)



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
(cid:0)

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
(cid:0)

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


independent sales representatives up to $11,725* 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).

(cid:0)



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
(cid:0)



Claims of certain farmers and fishermen, up to $5,775* per farmer or fisherman, against the debtor, as provided in 11 U.S.C. § 507(a)(6).

(cid:0)



Deposits by individuals

Claims of individuals up to $2,600* 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).

(cid:0)(cid:0) 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
(cid:0)

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).

(cid:0)

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 4/01/13, and every three years thereafter with respect to cases commenced on or after the date of adjustment.

1 continuation sheets attached

Case 10-42788-JJR13 Doc 1 Filed 10/01/10 Entered 10/01/10 13:55:46 Desc Main

Document Page 13 of 45

B6E (Official Form 6E) (4/10) – Cont.

In re

Dorothy A. Ball

Debtor

,

Case No.

(If known)

SCHEDULE E - CREDITORS HOLDING UNSECURED PRIORITY CLAIMS

(Continuation Sheet)

Type of Priority: Taxes and Certain Other Debts Owed to Governmental Units

I

T
N
O
J

,

E
F
W

I


,

D
N
A
B
S
U
H

I

Y
T
N
U
M
M
O
C
R
O



CREDITOR'S NAME,
MAILING ADDRESS

INCLUDING ZIP CODE,

AND ACCOUNT NUMBER
(See instructions above.)

ACCOUNT NO.

9699

IRS
P.O. Box 21126
Philadelphia, PA 19114

R
O
T
B
E
D
O
C



DATE CLAIM WAS
INCURRED AND
CONSIDERATION

FOR CLAIM

T
N
E
G
N
T
N
O
C

I

12/31/2009
2009 Federal Income
Tax

I

D
E
T
A
D
U
Q
L
N
U

I

AMOUNT
OF CLAIM

AMOUNT

ENTITLED TO

PRIORITY

D
E
T
U
P
S
D

I

AMOUNT

NOT

ENTITLED T
PRIORITY, I

ANY

200.00

200.00

$0.00

Sheet no. 1 of 1 continuation sheets attached to Schedule of
Creditors Holding Priority Claims

Subtotals
(Totals of this page)



(Use only on last page of the completed
Schedule E. Report also on the Summary of
Schedules.)

Total



Total



(Use only on last page of the completed
Schedule E. If applicable, report also on the
Statistical Summary of Certain Liabilities
and Related Data. )

$

$

200.00

$

200.00

$

0.0

200.00

$

200.00

$

0.0

Case 10-42788-JJR13 Doc 1 Filed 10/01/10 Entered 10/01/10 13:55:46 Desc Main

Document Page 14 of 45

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

In re

Dorothy A. Ball

Debtor

,

Case No.

(If known)

SCHEDULE F - CREDITORS HOLDING UNSECURED NONPRIORITY CLAIMS

(cid:0)

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

CREDITOR'S NAME,
MAILING ADDRESS

INCLUDING ZIP CODE,

AND ACCOUNT NUMBER
(See instructions above.)

R
O
T
B
E
D
O
C

I

T
N
O
J

,

E
F
W

I

I

Y
T
N
U
M
M
O
C
R
O




,

D
N
A
B
S
U
H

DATE CLAIM WAS
INCURRED AND

CONSIDERATION FOR

CLAIM.

IF CLAIM IS SUBJECT TO

SETOFF, SO STATE

ACCOUNT NO.

9699

Accounts Receivable Management
P.O. Box 129
Thorofare, NJ 08086

07/01/2007
Collection agency for
First Premier Bank

06/01/2010
medical bill

07/01/2007
credit card

06/01/2007
collection agency for Apire Visa

07/01/2004
open account

ACCOUNT NO.

6603

Digestive Disease Specialists
900 Goodyear Ave Ste A
Gadsden, AL 35903

ACCOUNT NO.

9865
First Premier Bank
3820 N Louise Avenue
Sioux Falls, SD 57104

ACCOUNT NO.

6172

Midland Credit
8875 Areo Dr. Ste 200
Sand Diego, CA 92123

ACCOUNT NO.

7920

NCO Financial Systems
c/o Progressive Insuranc
P.O. Box 17095
Wilmington, DE 19850

1

Continuation sheets attached

T
N
E
G
N
T
N
O
C

I

I

D
E
T
A
D
U
Q
L
N
U

I

AMOUNT OF

CLAIM

D
E
T
U
P
S
D

I

0.00

513.00

422.00

1,492.00

346.00

2,773.00

Subtotal



Total 

$

$

(Use only on last page of the completed Schedule F.)
(Report also on Summary of Schedules and, if applicable on the Statistical
Summary of Certain Liabilities and Related Data.)

Case 10-42788-JJR13 Doc 1 Filed 10/01/10 Entered 10/01/10 13:55:46 Desc Main

Document Page 15 of 45

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

In re

Dorothy A. Ball

Debtor

,

Case No.

(If known)

SCHEDULE F - CREDITORS HOLDING UNSECURED NONPRIORITY CLAIMS

(Continuation Sheet)

I

T
N
O
J

,

E
F
W

I


,

D
N
A
B
S
U
H

I

Y
T
N
U
M
M
O
C
R
O



CREDITOR'S NAME,
MAILING ADDRESS

INCLUDING ZIP CODE,

AND ACCOUNT NUMBER
(See instructions above.)

R
O
T
B
E
D
O
C

ACCOUNT NO.

9699

Riverview Regional Medic
P.O. Box 268
Gadsden, AL 35902-0268

ACCOUNT NO.

3511

Security Check, LLC
2612 Jackson Avenue W
Oxford, MS 38655

ACCOUNT NO.

5485

Security Check, LLC
2612 Jackson Avenue W
Oxford, MS 38655

ACCOUNT NO.

9699

Zarzau & Schwartz, PC
P.O. Box 11366
Birmingham, AL 35202

ACCOUNT NO.

5691
Zenith Acquisition
c/o Tribute Mastercard
220 John Glen Dr #1
Amherst, NY 14228-2228

DATE CLAIM WAS
INCURRED AND

CONSIDERATION FOR

CLAIM.

IF CLAIM IS SUBJECT TO

SETOFF, SO STATE

01/01/2010
medical bill

11/01/2004
open account

12/01/2004
open account

06/01/2007
collection agency for
Midland Credit

06/01/2008
open account

T
N
E
G
N
T
N
O
C

I

I

D
E
T
A
D
U
Q
L
N
U

I

AMOUNT OF

CLAIM

D
E
T
U
P
S
D

I

150.00

68.00

69.00

0.00

618.00

Sheet no. 1 of 1 continuation sheets attached to Schedule of Creditors
Holding Unsecured
Nonpriority Claims

Subtotal



Total



$

$

905.00

3,678.00

(Use only on last page of the completed Schedule F.)
(Report also on Summary of Schedules and, if applicable on the Statistical
Summary of Certain Liabilities and Related Data.)

Case 10-42788-JJR13 Doc 1 Filed 10/01/10 Entered 10/01/10 13:55:46 Desc Main

Document Page 16 of 45

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

In re:

Dorothy A. Ball

Debtor

,

Case No.

(If known)

SCHEDULE G - EXECUTORY CONTRACTS AND UNEXPIRED LEASES

(cid:0)(cid:0)

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

NAME AND MAILING ADDRESS, INCLUDING ZIP CODE,

OF OTHER PARTIES TO LEASE OR CONTRACT.

DESCRIPTION OF CONTRACT OR LEASE AND NATURE OF

DEBTOR'S INTEREST, STATE WHETHER LEASE IS FOR
NONRESIDENTIAL REAL PROPERTY. STATE CONTRACT

NUMBER OF ANY GOVERNMENT CONTRACT.

Case 10-42788-JJR13 Doc 1 Filed 10/01/10 Entered 10/01/10 13:55:46 Desc Main

Document Page 17 of 45

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

In re:

Dorothy A. Ball

Debtor

,

Case No.

(If known)

SCHEDULE H - CODEBTORS

(cid:0)



Check this box if debtor has no codebtors.

NAME AND ADDRESS OF CODEBTOR

NAME AND ADDRESS OF CREDITOR

Clarance Ball
P.O. Box 2503
Gadsden, AL 35903

Southeastern Auto Brokers
521 Club View Drive
Gadsden, AL 35905

Case 10-42788-JJR13 Doc 1 Filed 10/01/10 Entered 10/01/10 13:55:46 Desc Main

Document Page 18 of 45

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

In re

Dorothy A. Ball

,

Case No.

Debtor

(If known)

SCHEDULE I - CURRENT INCOME OF INDIVIDUAL DEBTOR(S)

The column labeled “Spouse” must be completed in all cases filed by joint debtors and by every married debtor, whether or not a joint petition is
filed, unless the spouses are separated and a joint petition is not filed. Do not state the name of any minor child. The average monthly income
calculated on this form may differ from the current monthly income calculated on Form 22A, 22B, or 22C.

Debtor’s Marital
Status:

M / separated 6 yrs

DEPENDENTS OF DEBTOR AND SPOUSE

Employment:

Occupation
Name of Employer

How long employed

Address of Employer

RELATIONSHIP(S):

son

DEBTOR

machine operator
Mid-South Electrics, Inc.
25 years

2620 E Meighan Blvd
Gadsden, AL 35903

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


case filed)





1. Monthly gross wages, salary, and commissions

2. Estimate monthly overtime

(Prorate if not paid monthly.)

3. SUBTOTAL
4. LESS PAYROLL DEDUCTIONS

a. Payroll taxes and social security
b. Insurance
c. Union dues

d. Other (Specify)

401K loan

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

debtor’s use or that of dependents listed above.

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

11. Social security or other government assistance
(Specify)

social securit for son

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)

AGE(S):

42

SPOUSE

DEBTOR

SPOUSE

$

$

$

$
$

$

$

$

$

$

$

$

$

$
$

$

$

$

1,495.00 $
271.00 $

1,766.00

434.00
130.00
0.00

56.00

620.00

1,146.00

0.00
0.00
0.00

0.00

670.00

0.00

$

$
$

$

$

$

$

$

$

$

$

$
$

0.00 $

670.00

$

1,816.00 $

$ 1,816.00

(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.:
NONE

Case 10-42788-JJR13 Doc 1 Filed 10/01/10 Entered 10/01/10 13:55:46 Desc Main

Document Page 19 of 45

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

In re

Dorothy A. Ball

(If known)
SCHEDULE J - CURRENT EXPENDITURES OF INDIVIDUAL DEBTOR(S)

Debtor

,

Case No.

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.

(cid:0)

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)

Yes
Yes

(cid:0)

(cid:0)

No
No



2. Utilities:

a. Are real estate taxes included?
b. Is property insurance included?
a. Electricity and heating fuel
b. Water and sewer
c. Telephone
d. Other

cable
gas

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.)

$

$
$
$
$

$
$
$
$
$
$
$
$
$

$
$
$
$
$

$

$

$
$
$
$

$

$

480.00

120.00
15.00
69.00
64.00
100.00
0.00
250.00
30.00
10.00
79.00
80.00
0.00
0.00

0.00
0.00
0.00
150.00
0.00

0.00

0.00
0.00
0.00
0.00
0.00
0.00

1,447.00

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

20. STATEMENT OF MONTHLY NET INCOME

a. Average monthly income from Line 15 of Schedule I
b. Average monthly expenses from Line 18 above
c. Monthly net income (a. minus b.)

$
$
$

1,816.00
1,447.00
369.00

Case 10-42788-JJR13 Doc 1 Filed 10/01/10 Entered 10/01/10 13:55:46 Desc Main

Document Page 20 of 45

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

United States Bankruptcy Court

Northern District of Alabama

Eastern Division

In re Dorothy A. Ball

Debtor

,

Case No.

Chapter

13

SUMMARY OF SCHEDULES

Indicate as to each schedule whether that schedule is attached and state the number of pages in each. Report the totals from Schedules A, B, D, E, F, I,
and J in the boxes provided. Add the amounts from Schedules A and B to determine the total amount of the debtor’s assets. Add the amounts of all claims from
Schedules D, E, and F to determine the total amount of the debtor’s liabilities. Individual debtors also must complete the “Statistical Summary of Certain Liabilities
and Related Data” if they file a case under chapter 7, 11, or 13.

NAME OF SCHEDULE

ATTACHED
(YES/NO)

NO. OF SHEETS

ASSETS

LIABILITIES

OTHER

$

$

53,981.00

6,821.00

$

$

$

49,500.00

200.00

3,678.00

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)

YES

YES

YES

YES

YES

YES

YES

YES

YES

YES

1

2

1

1

2

2

1

1

1

1

TOTAL

13

$

60,802.00

$

53,378.00

$

$

1,816.0

1,447.0

Case 10-42788-JJR13 Doc 1 Filed 10/01/10 Entered 10/01/10 13:55:46 Desc Main

Document Page 21 of 45

Form 6 - Statistical Summary (12/07)

United States Bankruptcy Court

Northern District of Alabama

Eastern Division

In re

Dorothy A. Ball

Debtor

,

Case No.

Chapter

13

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




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

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.



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.


(cid:0)

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 )

$

$

$

$

$

$

$

$

$

$

0.00

200.00

0.00

0.00

0.00

0.00

200.00

1,816.00

1,447.00

2,436.00

State the following:

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

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

$

200.00

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)

$

0.00

$

$

$

0.00

3,678.00

3,678.00

Case 10-42788-JJR13 Doc 1 Filed 10/01/10 Entered 10/01/10 13:55:46 Desc Main

Document Page 22 of 45

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

In re

Dorothy A. Ball

Debtor

,

Case No.

(If known)

DECLARATION CONCERNING DEBTOR'S SCHEDULES

DECLARATION UNDER PENALTY OF PERJURY BY INDIVIDUAL DEBTOR

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


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

15

Date:

10/01/2010

Signature:

s/ Dorothy A. Ball
Dorothy A. Ball

[If joint case, both spouses must sign]

Debtor

DECLARATION UNDER PENALTY OF PERJURY ON BEHALF OF CORPORATION OR PARTNERSHIP

(NOT APPLICABLE)

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

Case 10-42788-JJR13 Doc 1 Filed 10/01/10 Entered 10/01/10 13:55:46 Desc Main

Document Page 23 of 45

UNITED STATES BANKRUPTCY COURT

NORTHERN DISTRICT OF ALABAMA

EASTERN DIVISION

In re

Dorothy A. Ball

Debtor.

Case No.

Chapter

13

STATEMENT OF MONTHLY GROSS INCOME

The undersigned certifies the following is the debtor's monthly income .

Income:

Six months ago

Five months ago

Four months ago

Three months ago

Two months ago

Last month

Income from other sources

Total net income for six
months preceding filing

Average Monthly Gross
Income

Debtor

$

1,545.00

$

3,944.00

$

1,336.00

$

1,922.00

$

3,062.00

$

1,930.00

$

4,020.00

$

17,759.00

$ 2,959.83




Attached are all payment advices received by the undersigned debtor prior to the petition date, I declare
under penalty of perjury that I have read the foregoing statement and that it is true and correct to the best of my
knowledge, information, and belief.

Dated:

10/01/2010

s/ Dorothy A. Ball
Dorothy A. Ball

Debtor

Case 10-42788-JJR13 Doc 1 Filed 10/01/10 Entered 10/01/10 13:55:46 Desc Main

Document Page 24 of 45

B7 (Official Form 7) (4/10)

UNITED STATES BANKRUPTCY COURT

Northern District of Alabama

Eastern Division

In re:

Dorothy A. Ball

Debtor

,

Case No.

(If known)

STATEMENT OF FINANCIAL AFFAIRS

None
(cid:0)

1. Income from employment or operation of business
State the gross amount of income the debtor has received from employment, trade, or profession, or from operation of the
debtor's business, including part-time activities either as an employee or in independent trade or business, from the
beginning of this calendar year to the date this case was commenced. State also the gross amounts received during the two
years immediately preceding this calendar year. (A debtor that maintains, or has maintained, financial records on the basis
of a fiscal rather than a calendar year may report fiscal year income. Identify the beginning and ending dates of the debtor's
fiscal year.) If a joint petition is filed, state income for each spouse separately. (Married debtors filing under chapter 12 or
chapter 13 must state income of both spouses whether or not a joint petition is filed, unless the spouses are separated and a
joint petition is not filed.)

AMOUNT

17,000.00

12,000.00

SOURCE

Mid-South Electrics

Mid-South Electrics

FISCAL YEAR PERIOD

2009

2010

None
(cid:0)(cid:0)

2. Income other than from employment or operation of business
State the amount of income received by the debtor other than from employment, trade, profession, operation of the debtor's
business during the two years immediately preceding the commencement of this case. Give particulars. If a joint petition is
filed, state income for each spouse separately. (Married debtors filing under chapter 12 or chapter 13 must state income for
each spouse whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.)

AMOUNT

SOURCE

3. Payments to creditors

FISCAL YEAR PERIOD

None
(cid:0)(cid:0)

Complete a. or b., as appropriate, and c.
a. Individual or joint debtor(s) with primarily consumer debts: List all payments on loans, installment purchases of goods or
services, and other debts to any creditor made within 90 days immediately preceding the commencement of this case unless
the aggregate value of all property that constitutes or is affected by such transfer is less than $600. Indicate with an asterisk
(*) any payments that were made to a creditor on account of a domestic support obligation or as part of an alternative
repayment schedule under a plan by an approved nonprofit budgeting and 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.)

NAME AND ADDRESS OF
CREDITOR

DATES OF
PAYMENTS

AMOUNT
PAID

AMOUNT
STILL OWING

Case 10-42788-JJR13 Doc 1 Filed 10/01/10 Entered 10/01/10 13:55:46 Desc Main

Document Page 25 of 45

2

None
(cid:0)(cid:0)

b. Debtor whose debts are not primarily consumer debts: List each payment or other transfer to any creditor made within 90
days immediately preceding the commencement of the case unless the aggregate value of all property that constitutes or is
affected by such transfer is less than $5,850*. If the debtor is an individual, indicate with an asterisk (*) any payments that
were made to a creditor on account of a domestic support obligation or as part of an alternative repayment schedule under
a plan by an approved nonprofit budgeting and credit counseling agency. (Married debtors filing under chapter 12 or chapter
13 must include payments and other transfers by either or both spouses whether or not a joint petition is filed, unless the
spouses are separated and a joint petition is not filed.)

NAME AND ADDRESS OF CREDITOR

DATES OF
PAYMENTS/
TRANSFERS

AMOUNT
PAID OR
VALUE OF
TRANSFERS

AMOUNT
STILL
OWING

*Amount subject to adjustment on 4/01/13, and every three years thereafter with respect to cases commenced on or after the


date of adjustment.

None
(cid:0)(cid:0)

c. All debtors: List all payments made within one year immediately preceding the commencement of this case to or for the
benefit of creditors who are or were insiders. (Married debtors filing under chapter 12 or chapter 13 must include payments
by either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is
not filed.)
NAME AND ADDRESS OF CREDITOR
AND RELATIONSHIP TO DEBTOR

DATE OF
PAYMENT

AMOUNT
PAID

AMOUNT
STILL OWING



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

None
(cid:0)(cid:0)

a. List all suits and administrative proceedings to which the debtor is or was a party within one year immediately preceding
the filing of this bankruptcy case. (Married debtors filing under chapter 12 or chapter 13 must include information concerning
either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is
not filed.)

CAPTION OF SUIT
AND CASE NUMBER



NATURE OF PROCEEDING

COURT OR AGENCY
AND LOCATIO

STATUS OR
DISPOSITION

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

(cid:0)(cid:0)

immediately preceding the commencement of this case. (Married debtors filing under chapter 12 or chapter 13 must include
information concerning property of either or both spouses whether or not a joint petition is filed, unless the spouses are
separated and a joint petition is not filed.)

NAME AND ADDRESS
OF PERSON FOR WHOSE
BENEFIT PROPERTY WAS SEIZED

DATE OF
SEIZURE

DESCRIPTION
AND VALUE OF
PROPERTY

None
(cid:0)(cid:0)

5. Repossessions, foreclosures and returns
List all property that has been repossessed by a creditor, sold at a foreclosure sale, transferred through a deed in lieu of
foreclosure or returned to the seller, within one year immediately preceding the commencement of this case. (Married
debtors filing under chapter 12 or chapter 13 must include information concerning property of either or both spouses
whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.)

NAME AND ADDRESS
OF CREDITOR OR SELLER

DATE OF REPOSSESSION,
FORECLOSURE SALE,
TRANSFER OR RETURN

DESCRIPTION
AND VALUE OF
PROPERTY

Case 10-42788-JJR13 Doc 1 Filed 10/01/10 Entered 10/01/10 13:55:46 Desc Main

Document Page 26 of 45

3

None
(cid:0)(cid:0)

6. Assignments and receiverships
a. Describe any assignment of property for the benefit of creditors made within 120 days immediately preceding the
commencement of this case. (Married debtors filing under chapter 12 or chapter 13 must include any assignment by either
or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not
filed.)

NAME AND ADDRESS
OF ASSIGNEE

DATE OF
ASSIGNMENT

TERMS OF
ASSIGNMENT
OR SETTLEMENT

None
(cid:0)(cid:0)

b. List all property which has been in the hands of a custodian, receiver, or court-appointed official within one year
immediately preceding the commencement of this case. (Married debtors filing under chapter 12 or chapter 13 must
include information concerning property of either or both spouses whether or not a joint petition is filed, unless the
spouses are separated and a joint petition is not filed.)

NAME AND ADDRESS
OF CUSTODIAN

7. Gifts

NAME AND ADDRESS
OF COURT
CASE TITLE & NUMBER

DATE OF
ORDER

DESCRIPTION
AND VALUE OF
PROPERTY

None
(cid:0)(cid:0)

List all gifts or charitable contributions made within one year immediately preceding the commencement of this case except
ordinary and usual gifts to family members aggregating less than $200 in value per individual family member and charitable
contributions aggregating less than $100 per recipient. (Married debtors filing under chapter 12 or chapter 13 must include
gifts or contributions by either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a
joint petition is not filed.)

NAME AND ADDRESS
OF PERSON
OR ORGANIZATION

8. Losses

RELATIONSHIP
TO DEBTOR,
IF ANY

DATE
OF GIFT

DESCRIPTION
AND VALUE OF
GIFT

None
(cid:0)(cid:0)

List all losses from fire, theft, other casualty or gambling within one year immediately preceding the commencement
of this case or since the commencement of this case. (Married debtors filing under chapter 12 or chapter 13 must
include losses by either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a
joint petition is not filed.)

DESCRIPTION
AND VALUE OF
PROPERTY

DESCRIPTION OF CIRCUMSTANCES AND, IF
LOSS WAS COVERED IN WHOLE OR IN PART
BY INSURANCE, GIVE PARTICULARS

DATE OF
LOSS

None

(cid:0)(cid:0)

9. Payments related to debt counseling or bankruptcy
List all payments made or property transferred by or on behalf of the debtor to any persons, including attorneys, for
consultation concerning debt consolidation, relief under the bankruptcy law or preparation of a petition in bankruptcy within
one year immediately preceding the commencement of this case.

NAME AND ADDRESS
OF PAYEE

DATE OF PAYMENT,
NAME OF PAYOR IF
OTHER THAN DEBTOR

AMOUNT OF MONEY OR
DESCRIPTION AND VALUE
OF PROPERTY

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Document Page 27 of 45

None
(cid:0)(cid:0)

10. Other transfers
a. List all other property, other than property transferred in the ordinary course of the business or financial affairs of the
debtor, transferred either absolutely or as security within two years immediately preceding the commencement of this case.
(Married debtors filing under chapter 12 or chapter 13 must include transfers by either or both spouses whether or not a joint
petition is filed, unless the spouses are separated and a joint petition is not filed.)

4

NAME AND ADDRESS OF TRANSFEREE,
RELATIONSHIP TO DEBTOR

DATE



DESCRIBE PROPERTY
TRANSFERRED
AND VALUE RECEIVED

None
(cid:0)(cid:0)

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

NAME OF TRUST OR OTHER
DEVICE

DATE(S) OF
TRANSFER(S)

AMOUNT OF MONEY OR DESCRIPTION
AND VALUE OF PROPERTY OR DEBTOR
INTEREST IN PROPERTY

11. Closed financial accounts

None
(cid:0)(cid:0)

List all financial accounts and instruments held in the name of the debtor or for the benefit of the debtor which were closed,
sold, or otherwise transferred within one year immediately preceding the commencement of this case. Include checking,
savings, or other financial accounts, certificates of deposit, or other instruments; shares and share accounts held in banks,
credit unions, pension funds, cooperatives, associations, brokerage houses and other financial institutions. (Married debtors
filing under chapter 12 or chapter 13 must include information concerning accounts or instruments held by or for either or
both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.)

NAME AND ADDRESS
OF INSTITUTION

12. Safe deposit boxes

TYPE OF ACCOUNT, LAST FOUR
DIGITS OF ACCOUNT NUMBER,
AND AMOUNT OF FINAL BALANCE

AMOUNT AND
DATE OF SALE
OR CLOSING

None
(cid:0)(cid:0)

List each safe deposit or other box or depository in which the debtor has or had securities, cash, or other valuables within
one year immediately preceding the commencement of this case. (Married debtors filing under chapter 12 or chapter 13
must include boxes or depositories of either or both spouses whether or not a joint petition is filed, unless the spouses are
separated and a joint petition is not filed.)

NAME AND ADDRESS
OF BANK OR
OTHER DEPOSITORY

NAMES AND ADDRESSES
OF THOSE WITH ACCESS
TO BOX OR DEPOSITOR

DESCRIPTION
OF
CONTENTS

DATE OF TRANSFER
OR SURRENDER,
IF ANY

None
(cid:0)(cid:0)

13. Setoffs
List all setoffs made by any creditor, including a bank, against a debt or deposit of the debtor within 90 days preceding
the commencement of this case. (Married debtors filing under chapter 12 or chapter 13 must include information
concerning either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint
petition is not filed.)

NAME AND ADDRESS OF CREDITOR

DATE OF
SETOFF

AMOUNT OF
SETOFF

14. Property held for another person
List all property owned by another person that the debtor holds or controls.

NAME AND ADDRESS
OF OWNER

DESCRIPTION AND VALUE
OF PROPERTY

LOCATION OF PROPERTY

None
(cid:0)(cid:0)

Case 10-42788-JJR13 Doc 1 Filed 10/01/10 Entered 10/01/10 13:55:46 Desc Main

Document Page 28 of 45

5

None
(cid:0)(cid:0)

15. Prior address of debtor
If debtor has moved within three years immediately preceding the commencement of this case, list all premises which the
debtor occupied during that period and vacated prior to the commencement of this case. If a joint petition is filed, report also
any separate address of either spouse.

ADDRESS

NAME USED

DATES OF OCCUPANCY

None
(cid:0)(cid:0)

16. Spouses and Former Spouses
If the debtor resides or resided in a community property state, commonwealth, or territory (including Alaska, Arizona,
California, Idaho, Louisiana, Nevada, New Mexico, Puerto Rico, Texas, Washington, or Wisconsin) within eight years
immediately preceding the commencement of the case, identify the name of the debtor 's spouse and of any former spouse
who resides or resided with the debtor in the community property state.

NAME

17. Environmental Information.

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

"Environmental Law" means any federal, state or local statute or regulation regulating pollution, contamination, releases of
hazardous or toxic substances, wastes or material into the air, land, soil, surface water, groundwater, or other medium,
including, but not limited to, statutes or regulations regulating the cleanup of these substances, wastes, or material.

"Site" means any location, facility, or property as defined under any Environmental Law, whether or not presently or
formerly owned or operated by the debtor, including, but not limited to, disposal sites.

"Hazardous Material" means anything defined as a hazardous waste, hazardous substance, toxic substance,
hazardous material, pollutant, or contaminant or similar term under an Environmental Law.

None
(cid:0)(cid:0)

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.

SITE NAME AND
ADDRESS

NAME AND ADDRESS
OF GOVERNMENTAL UNIT

DATE OF
NOTICE

ENVIRONMENTAL
LAW

None
(cid:0)(cid:0)

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

SITE NAME AND
ADDRESS

NAME AND ADDRESS
OF GOVERNMENTAL UNIT

DATE OF
NOTICE

ENVIRONMENTAL
LAW

None
(cid:0)(cid:0)

c. List all judicial or administrative proceedings, including settlements or orders, under any Environmental Law with
respect to which the debtor is or was a party. Indicate the name and address of the governmental unit that is or was a party
to the proceeding, and the docket number.

NAME AND ADDRESS
OF GOVERNMENTAL UNIT

DOCKET NUMBER

STATUS OR
DISPOSITION

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Document Page 29 of 45

18. Nature, location and name of business

None
(cid:0)(cid:0)

a. If the debtor is an individual, list the names, addresses, taxpayer identification numbers, nature of the businesses,
and beginning and ending dates of all businesses in which the debtor was an officer, director, partner, or managing
executive of a corporation, partner in a partnership, sole proprietor, or was self-employed in a trade, profession, or
other activity either full- or part-time within the six years immediately preceding the commencement of this case,
or in which the debtor owned 5 percent or more of the voting or equity securities within the six years immediately
preceding the commencement of this case.

If the debtor is a partnership, list the names, addresses, taxpayer identification numbers, nature of the businesses,
and beginning and ending dates of all businesses in which the debtor was a partner or owned 5 percent or more of
the voting or equity securities, within the six years immediately preceding the commencement of this case.

6

If the debtor is a corporation, list the names, addresses, taxpayer identification numbers, nature of the business, and
beginning and ending dates of all businesses in which the debtor was a partner or owned 5 percent or more of the voting or
equity securities within the six years immediately preceding the commencement of this case.

NAME

LAST FOUR DIGITS
OF SOCIAL SECURITY
OR OTHER INDIVIDUAL
TAXPAYER-I.D. NO.
(ITIN)/ COMPLETE EIN

ADDRESS

NATURE OF
BUSINESS

BEGINNING AND ENDIN
DATES

None
(cid:0)(cid:0)

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

NAME

ADDRESS

* * * * * *

[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

10/01/2010

Signature
of Debtor

s/ Dorothy A. Ball
Dorothy A. Ball

Case 10-42788-JJR13 Doc 1 Filed 10/01/10 Entered 10/01/10 13:55:46 Desc Main

Document Page 30 of 45

B22C (Official Form 22C) (Chapter 13) (04/10)

In re

Dorothy A. Ball

Case Number:

Debtor(s)

(If known)

(cid:0)(cid:0)
(cid:0)

According to the calculations required by this statement:
The applicable commitment period is 3 years.
The applicable commitment period is 5 years.
Disposable income is determined under § 1325(b)(3)
(cid:0)
Disposable income is not determined under § 1325(b)(3)
(cid:0)(cid:2)
(Check the boxes as directed in Lines 17 and 23 of this statement.)

CHAPTER 13 STATEMENT OF CURRENT MONTHLY INCOME

AND CALCULATION OF COMMITMENT PERIOD AND DISPOSABLE INCOME

In addition to Schedules I and J, this statement must be completed by every individual chapter 13 debtor, whether or not filing
jointly. Joint debtors may complete one statement only.

Part I. REPORT OF INCOME

1

2

3

4

5

6

7

8

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

Unmarried. Complete only Column A ("Debtor's Income") for Lines 2-10.
Married. Complete both Column A ("Debtor's Income") and Column B (Spouse's Income) for Lines 2-10.


(cid:0)

(cid:0)(cid:2)

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
Spouse'
Income

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

$

1,766.00

$

0.00

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 3. 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 IV.

a.
b.
c.

Gross Receipts
Ordinary and necessary business expenses
Business income

0.00
0.00

$
$
Subtract Line b from Line a

$

0.00

$

0.00

Rent and other real property income. Subtract Line b from Line a and enter the difference
in the appropriate column(s) of Line 4. 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 IV.

a.
b.
c.

Gross Receipts
Ordinary and necessary operating expenses
Rent and other real property income

Interest, dividends, and royalties.

0.00
0.00

$
$
Subtract Line b from Line a

Pension and retirement income.
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 the debtor’s spouse.

Unemployment compensation. Enter the amount in the appropriate column(s) of Line 8.
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:

$

0.00

$

0.00

$

0.00

$

0.00

$

0.00

$

0.00

$

0.00

$0.00

Unemployment compensation claimed to
be a benefit under the Social Security Act

Debtor

$

Spouse

$

$

$

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B22C (Official Form 22C) (Chapter 13) (04/10)

Income from all other sources. Specify source and amount. If necessary, list additional
sources on a separate page. Total and enter on Line 9. Do not include alimony or separate
maintenance payments paid by your spouse, 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. sons SSI

$

670.00

$

670.00

$

0.00

Subtotal. Add Lines 2 thru 9 in Column A, and, if Column B is completed, add Lines 2 thru 9
in Column B. Enter the total(s).

$

2,436.00

$

0.00

Total. If Column B has been completed, add Line 10, Column A to Line 10, Column B, and
enter the total. If Column B has not been completed, enter the amount from Line 10, Column
A.

$ 2,436.00

Part II. CALCULATION OF § 1325(b)(4) COMMITMENT PERIOD

Enter the amount from Line 11.

$

2,436.00

Marital adjustment. If you are married, but are not filing jointly with your spouse, AND if you contend that
calculation of the commitment period under § 1325(b)(4) does not require inclusion of the income of your
spouse, enter on Line 13 the amount of the income listed in Line 10, Column B that was NOT paid on a
regular basis for the household expenses of you or your dependents and specify, in the lines below, the
basis for excluding this 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 the conditions for entering this
adjustment do not apply, enter zero.

a.

Total and enter on Line 13.

Subtract Line 13 from Line 12 and enter the result.

$

Annualized current monthly income for § 1325(b)(4). Multiply the amount from Line 14 by the number 12
and enter the result.
Applicable median family income. Enter the median family income for 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: ____________

AL

2

$0.00

$

2,436.0

$

29,232.0

$

47,904.0

9

10

11

12

13

14

15

16

Application of § 1325(b)(4). Check the applicable box and proceed as directed.

(cid:0)(cid:2)

The amount on Line 15 is less than the amount on Line 16. Check the box for "The applicable commitment per
is 3 years" at the top of page 1 of this statement and continue with this statement.

17

(cid:0)

The amount on Line 15 is not less than the amount on Line 16. Check the box for "The applicable commitment
period is 5 years" at the top of page 1 of this statement and continue with this statement.

Part III. APPLICATION OF § 1325(b)(3) FOR DETERMINING DISPOSABLE INCOME

18

Enter the amount from Line 11.

$

2,436.

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B22C (Official Form 22C) (Chapter 13) (04/10)

19

20

21

22

23

24A

24B

Marital adjustment. If you are married, but are not filing jointly with your spouse, enter on Line 19 the total
of any income listed in Line 10, 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 the conditions for entering this adjustment do not apply, enter
zero.

a.

Total and enter on Line 19.

$

Current monthly income for § 1325(b)(3). Subtract Line 19 from Line 18 and enter the result.
Annualized current monthly income for § 1325(b)(3). Multiply the amount from Line 20 by the number
12 and enter the result.

Applicable median family income. Enter the amount from Line 16

Application of § 1325(b)(3). Check the applicable box and proceed as directed.

$

$

$

$

0

2,436.

29,232.

47,904.

(cid:0)

(cid:0)(cid:2)

The amount on Line 21 is more than the amount on Line 22. Check the box for “Disposable income is determined under
1325(b)(3)” at the top of page 1 of this statement and complete the remaining parts of this statement.
The amount on Line 21 is not more than the amount on Line 22. Check the box for “Disposable income is not determined
under § 1325(b)(3)” at the top of page 1 of this statement and complete Part VII of this statement. Do not complete Parts IV, V, or VI.

Part IV. CALCULATION OF DEDUCTIONS FROM INCOME

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

National Standards: food, apparel and services, housekeeping supplies, personal care, and
miscellaneous. Enter in Line 24A the “Total” amount from IRS National Standards for Allowable Living
Expenses for the applicable household size. (This information is available at www.usdoj.gov/ust/ or from the
clerk of the bankruptcy court.)

$

National Standards: health care. Enter in Line a1 below the amount from IRS National Standards for
Out-of-Pocket Health Care for persons under 65 years of age, and in Line a2 the IRS National Standards for
Out-of-Pocket Health Care for persons 65 years of age or older. (This information is available at
www.usdoj.gov/ust/ or from the clerk of the bankruptcy court.) Enter in Line b1 the number of members of
your household who are under 65 years of age, and enter in Line b2 the number of members of your
household who are 65 years of age or older. (The total number of household members must be the same as
the number stated in Line 16b.) Multiply Line a1 by Line b1 to obtain a total amount for household members
under 65, and enter the result in Line c1. Multiply Line a2 by Line b2 to obtain a total amount for household
members 65 and older, and enter the result in Line c2. Add Lines c1 and c2 to obtain a total health care
amount, and enter the result in Line 24B.

Household members under 65 years of age
a1.

Allowance per member

b1.

Number of members

c1.

Subtotal

Household members 65 years of age or older

a2.

b2.

c2.

Allowance per member

Number of members
Subtotal

25A

Local Standards: housing and utilities; non-mortgage expenses. Enter the amount of the IRS Housing
and Utilities Standards; non-mortgage expenses for the applicable county and household size. (This
information is available at www.usdoj.gov/ust/ or from the clerk of the bankruptcy court).

$

$

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B22C (Official Form 22C) (Chapter 13) (04/10)

25B

Local Standards: housing and utilities; mortgage/rent expense. Enter, in Line a below, the amount of
the IRS Housing and Utilities Standards; mortgage/rent expense for your county and household size (this
information is available at www.usdoj.gov/ust/ or from the clerk of the bankruptcy court); enter on Line b the
total of the Average Monthly Payments for any debts secured by your home, as stated in Line 47; subtract
Line b from Line a and enter the result in Line 25B. Do not enter an amount less than zero.

a.

b.

c.

IRS Housing and Utilities Standards; mortgage/rent expense

Average Monthly Payment for any debts secured by home, if
any, as stated in Line 47.
Net mortgage/rental expense

$

$

Subtract Line b from Line a

Local Standards: housing and utilities; adjustment. If you contend that the process set out in Lines 25A
and 25B 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:

26

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.

27A

27B

28

29

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 7.
If you checked 0, enter on Line 27A the “Public Transportation” amount from IRS Local Standards:
Transportation. If you checked 1 or 2 or more, enter on Line 27A 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.)

(cid:0) (cid:0) (cid:0)

2 or more.

0

1

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 27B 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.)
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.)
(cid:0) (cid:0)
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 47; subtract Line b from
Line a and enter the result in Line 28. Do not enter an amount less than zero.

2 or more.

1

a.
b.

c.

IRS Transportation Standards, Ownership Costs
Average Monthly Payment for any debts secured by Vehicle 1,
as stated in Line 47.
Net ownership/lease expense for Vehicle 1

$

$
Subtract Line b from Line a

Local Standards: transportation ownership/lease expense; Vehicle 2. Complete this Line only if you checked
the “2 or more” Box in Line 28.
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 47; subtract Line b from
Line a and enter the result in Line 29. Do not enter an amount less than zero.

a.
b.

c.

IRS Transportation Standards, Ownership Costs
Average Monthly Payment for any debts secured by Vehicle 2,
as stated in Line 47
Net ownership/lease expense for Vehicle 2

$
$

Subtract Line b from Line a

30

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.

$

$

$

$

$

$

$

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B22C (Official Form 22C) (Chapter 13) (04/10)

31

32

33

34

35

36

37

38

39

40

41

42

43

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.
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.

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 49.

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.
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.
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 24B. Do not include payments for health insurance or health savings accounts listed in Line 39.
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.
Total Expenses Allowed under IRS Standards. Enter the total of Lines 24 through 37.

Subpart B: Additional Living Expense Deductions

Note: Do not include any expenses that you have listed in Lines 24-37

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.
b.
c.

Health Insurance
Disability Insurance
Health Savings Account

$
$
$

Total and enter on Line 39
If you do not actually expend this total amount, state your actual total average monthly expenditures in
the space below:
$

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. Do not include payments listed in Line 34.
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.
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.
Education expenses for dependent children under 18. Enter the total average monthly expenses that
you actually incur, not to exceed $147.92* 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.

$

$

$

$

$

$

$

$

$

$

$

$

$

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Document Page 35 of 45

B22C (Official Form 22C) (Chapter 13) (04/10)

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.

Charitable contributions. Enter the amount reasonably necessary for you to expend each month on
charitable contributions in the form of cash or financial instruments to a charitable organization as defined in
26 U.S.C. § 170(c)(1)-(2). Do not include any amount in excess of 15% of your gross monthly income.

Total Additional Expense Deductions under § 707(b). Enter the total of Lines 39 through 45.

$

$

$

Subpart C: Deductions for Debt Payment

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 47.

Name of
Creditor

Property Securing the Debt

Average
Monthly
Payment

$

Does payment
include taxes
or insurance?

(cid:0)

yes

(cid:0)

no

a.

Total: Add Lines a, b and c

$

Other payments on secured claims. If any of debts listed in Line 47 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 47, 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

44

45

46

47

48

49

50

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 33.

Chapter 13 administrative expenses. Multiply the amount in line a by the amount in line b, and enter the
resulting administrative expense.

Total: Add Lines a, b and c

a.
b.

c.

Projected average monthly Chapter 13 plan payment.
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.)
Average monthly administrative expense of Chapter 13 case

$

x

Total: Multiply Lines a and b

51

Total Deductions for Debt Payment. Enter the total of Lines 47 through 50.

Subpart D: Total Deductions from Income

52

Total of all deductions from income. Enter the total of Lines 38, 46, and 51.

$

$

$

$

$

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Document Page 36 of 45

B22C (Official Form 22C) (Chapter 13) (04/10)

Part V. DETERMINATION OF DISPOSABLE INCOME UNDER § 1325(b)(2)

Total current monthly income. Enter the amount from Line 20.
Support income. Enter the monthly average of any child support payments, foster care payments, or
disability payments for a dependent child, reported in Part I, that you received in accordance with applicable
nonbankruptcy law, to the extent reasonably necessary to be expended for such child.
Qualified retirement deductions. Enter the monthly total of (a) all amounts withheld by your employer
from wages as contributions for qualified retirement plans, as specified in § 541(b)(7) and (b) all required
repayments of loans from retirement plans, as specified in § 362(b)(19).

Total of all deductions allowed under § 707(b)(2). Enter the amount from Line 52.
Deduction for special circumstances. If there are special circumstances that justify additional expenses
for which there is no reasonable alternative, describe the special circumstances and the resulting expenses
in lines a-c below. If necessary, list additional entries on a separate page. Total the expenses and enter the
total in Line 57. You must provide your case trustee with documentation of these expenses and you
must provide a detailed explanation of the special circumstances that make such expenses
necessary and reasonable.

Nature of special circumstances

Amount of expense

a.

$

Total: Add Lines a, b, and c

Total adjustments to determine disposable income. Add the amounts on Lines 54, 55, 56, and 57 and
enter the result.

Monthly Disposable Income Under § 1325(b)(2). Subtract Line 58 from Line 53 and enter the result.

$

$

$

$

$

$

$

Part VI. ADDITIONAL EXPENSE CLAIMS

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.

53

54

55

56

57

58

59

60

Expense Description

Monthly Amount

Total: Add Lines a, b, and c

$

Part VII: VERIFICATION

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.)

61

Date:

10/01/2010

Signature:

s/ Dorothy A. Ball
Dorothy A. Ball, (Debtor)

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Document Page 37 of 45

Part IV. Debtor’s Signature

I certify under penalty of perjury that the information provided in these certifications is true and correct


to the best of my knowledge and belief.

Executed on

10/01/2010

Date

s/ Dorothy A. Ball
Dorothy A. Ball

Debtor



Case 10-42788-JJR13 Doc 1 Filed 10/01/10 Entered 10/01/10 13:55:46 Desc Main

Document Page 38 of 45

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

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

Bankruptcy Rule 1007(c) is shortened to 14 days. For further information, see note at bottom of page 2.

UNITED STATES BANKRUPTCY COURT
NORTHERN DISTRICT OF ALABAMA

EASTERN DIVISION

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

OF THE BANKRUPTCY CODE



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


Describes briefly the services available from credit counseling services; (2) Describes briefly the purposes, benefits and
costs of the four types of bankruptcy proceedings you may commence; and (3) Informs you about bankruptcy crimes and
notifies you that the Attorney General may examine all information you supply in connection with a bankruptcy case.



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


advice of an attorney to learn of your rights and responsibilities should you decide to file a petition. Court employees cannot
give you legal advice.




Notices from the bankruptcy court are sent to the mailing address you list on your bankruptcy petition. In order to
ensure that you receive information about events concerning your case, Bankruptcy Rule 4002 requires that you notify the
court of any changes in your address. If you are filing a joint case (a single bankruptcy case for two individuals married to
each other), and each spouse lists the same mailing address on the bankruptcy petition, you and your spouse will generally
receive a single copy of each notice mailed from the bankruptcy court in a jointly-addressed envelope, unless you file a
statement with the court requesting that each spouse receive a separate copy of all notices.

1. Services Available from Credit Counseling Agencies

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


bankruptcy relief on or after October 17, 2005, receive a briefing that outlines the available opportunities for credit
counseling and provides assistance in performing a budget analysis. The briefing must be given within 180 days
before the bankruptcy filing. The briefing may be provided individually or in a group (including briefings conducted by
telephone or on the Internet) and must be provided by a nonprofit budget and credit counseling agency approved by the
United States trustee or bankruptcy administrator. The clerk of the bankruptcy court has a list that you may consult of the
approved budget and credit counseling agencies. Each debtor in a joint case must complete the briefing.



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


management instructional course before he or she can receive a discharge. The clerk also has a list of approved
financial management instructional courses. Each debtor in a joint case must complete the course.

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





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



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

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


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.

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

have committed certain kinds of improper conduct described in the Bankruptcy Code, the court may deny your discharge
and, if it does, the purpose for which you filed the bankruptcy petition will be defeated.

may still be responsible for most taxes and student loans; debts incurred to pay nondischargeable taxes; domestic support
and property settlement obligations; most fines, penalties, forfeitures, and criminal restitution obligations; certain debts
which are not properly listed in your bankruptcy papers; and debts for death or personal injury caused by operating a motor
vehicle, vessel, or aircraft while intoxicated from alcohol or drugs. Also, if a creditor can prove that a debt arose from fraud,
breach of fiduciary duty, or theft, or from a willful and malicious injury, the bankruptcy court may determine that the debt is
not discharged.


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

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

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








administrative fee: Total fee $274)

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Document Page 39 of 45

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

Page 2







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

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


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.

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.


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


Chapter 11: Reorganization ($1000 filing fee, $39 administrative fee: Total fee $1039)


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

Chapter 12: Family Farmer or Fisherman ($200 filing fee, $39 administrative fee: Total fee $239)







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


future earnings and is similar to chapter 13. The eligibility requirements are restrictive, limiting its use to those whose
income arises primarily from a family-owned farm or commercial fishing operation.

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



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


perjury, either orally or in writing, in connection with a bankruptcy case is subject to a fine, imprisonment, or both. All
information supplied by a debtor in connection with a bankruptcy case is subject to examination by the Attorney General
acting through the Office of the United States Trustee, the Office of the United States Attorney, and other components and
employees of the Department of Justice.

WARNING: Section 521(a)(1) of the Bankruptcy Code requires that you promptly file detailed information regarding your
creditors, assets, liabilities, income, expenses and general financial condition. Your bankruptcy case may be dismissed if
this information is not filed with the court within the time deadlines set by the Bankruptcy Code, the Bankruptcy Rules, and
the local rules of the court. The documents and the deadlines for filing them are listed on Form B200, which is posted at
http://www.uscourts.gov/bkforms/bankruptcy_forms.html#procedure.

Many filing deadlines change on December 1, 2009. Of special note, 12 rules that set 15 days to act are amended to
require action within 14 days, including Rule 1007(c), filing the initial case papers; Rule 3015(b), filing a chapter 13
plan; Rule 8009(a), filing appellate briefs; and Rules 1019, 1020, 2015, 2015.1, 2016, 4001, 4002, 6004, and 6007.

Case 10-42788-JJR13 Doc 1 Filed 10/01/10 Entered 10/01/10 13:55:46 Desc Main

Document Page 40 of 45

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

UNITED STATES BANKRUPTCY COURT
NORTHERN DISTRICT OF ALABAMA

EASTERN DIVISION

In re

Dorothy A. Ball

Debtor

Case No.

Chapter

13

CERTIFICATION OF NOTICE TO CONSUMER DEBTOR(S)

UNDER § 342(b) OF THE BANKRUPTCY CODE

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

Certificate of the Debtor

Dorothy A. Ball
Printed Name of Debtor

Case No. (if known)

X

s/ Dorothy A. Ball
Dorothy A. Ball
Signature of Debtor

10/01/2010













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.

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B10 (Official Form 10) (4/10)

UNITED STATES BANKRUPTCY COURT
Name of Debtor:

PROOF OF CLAIM

Case Number:

This form should not be used to make a claim for an administrative expense arising after the commencement of the case. A request for payment of an

NOTE:

Name of Creditor (the person or other entity to whom the debtor owes money or property):

administrative expense may be filed pursuant to 11 U.S.C. § 503.

Name and address where notices should be sent:

Telephone number:
Name and address where payment should be sent (if different from above):

Telephone number:

1. Amount of Claim as of Date Case Filed:

$

If all or part of your claim is secured, complete item 4 below; however, if all of your claim is unsecured, do not
complete item 4.
If all or part of your claim is entitled to priority, complete item 5.

(cid:0)

Check this box if claim includes interest or other charges in addition to the principal amount of claim.
Attach itemized statement of interest or charges.

2. Basis for Claim:
(See instruction #2 on reverse side.)

3. Last four digits of any number by which creditor identifies debtor:

3a. Debtor may have scheduled account as:

(See instruction #3a on reverse side.)

4. Secured Claim (See instruction #4 on reverse side.)
Check the appropriate box if your claim is secured by a lien on property or a right of setoff and provide the requested
information.
Nature of property or right of setoff:
Describe:
Value of Property:$__________ Annual Interest Rate __________ %
Amount of arrearage and other charges as of time case filed included in secured claim,

Motor Vehicle

Real Estate

(cid:0)

Other

(cid:0)

(cid:0)

if any: $

Basis for perfection:

Amount of Secured Claim: $

Amount of Unsecured: $

(cid:0)

Check this box to indicate that this claim
amends a previously filed claim.

Court Claim Number:
(If known)

Filed on:

(cid:0)

Check this box if you are aware that anyone else
has filed a proof of claim relating to your claim.
Attach copy of statement giving particulars.

(cid:0)

Check this box if you are the debtor
or trustee in this case.

5.

Amount of Claim Entitled to Priority under 11
U.S.C. §507(a). If any portion of your claim
falls in one of the following categories, check
the box and state the amount.

Specify the priority of the claim.

(cid:0)

(cid:0)

Domestic support obligations under
11 U.S.C. §507(a)(1)(A) or (a)(1)(B).
Wages, salaries, or commissions (up to $11,725*)
earned within 180 days before filing of the
bankruptcy petition or cessation of the debtor’s
business, whichever is earlier – 11 U.S.C. §507
(a)(4).

(cid:0)

(cid:0)

Contributions to an employee benefit
plan – 11 U.S.C. §507 (a)(5).

Up to $2,600* of deposits toward
purchase, lease, or rental of property
or services for personal, family, or household use –
11 U.S.C. §507 (a)(7).

(cid:0) Taxes or penalties owed to governmental units – 11

U.S.C. §507(a)(8).

(cid:0) Other – Specify applicable paragraph

of 11 U.S.C. §507 (a)().

6. Credits: The amount of all payments on this claim has been credited for the purpose of making this proof of
claim.
7. Documents: Attach redacted copies of any documents that support the claim, such as promissory notes,
purchase orders, invoices, itemized statements of running accounts, contracts, judgments, mortgages, and security
agreements. You may also attach a summary. Attach redacted copies of documents providing evidence of
perfection of a security interest. You may also attach a summary. (See instruction 7 and definition of “redacted” on
reverse side.)

Amount entitled to priority

$

*Amounts are subject to adjustment on 4/1/13 and every 3
years thereafter with respect to cases commenced on or
after the date of adjustment.

DO NOT SEND ORIGINAL DOCUMENTS. ATTACHED DOCUMENTS MAY BE DESTROYED AFTER
SCANNING.

If the documents are not available, please explain:

Date:

Signature: The person filing this claim must sign it. Sign and print name and title, if any, of the
creditor or other person authorized to file this claim and state address and telephone number if
different from the notice address above. Attach copy of power of attorney, if any.

FOR COURT USE ONLY

Penalty for presenting fraudulent claim: Fine of up to $500,000 or imprisonment for up to 5 years, or both. 18 U.S.C. §§ 152 and 3571.

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B10 (Official Form 10) (4/10)- Cont.

The instructions and definitions below are general explanations of the law. In certain circumstances, such as bankruptcy cases not filed voluntarily by the debtor,

INSTRUCTIONS FOR PROOF OF CLAIM FORM

there may be exceptions to these general rules.
Items to be completed in Proof of Claim form

Court, Name of Debtor, and Case Number:
Fill in the federal judicial district where the bankruptcy case was filed (for
example, Central District of California), the bankruptcy debtor’s name, and
the bankruptcy case number. If the creditor received a notice of the case
from the bankruptcy court, all of this information is located at the top of
the notice.
Creditor’s Name and Address:
Fill in the name of the person or entity asserting a claim and the name and
address of the person who should receive notices issued during the
bankruptcy case. A separate space is provided for the payment address if it
differs from the notice address. The creditor has a continuing obligation to
keep the court informed of its current address. See Federal Rule of
Bankruptcy Procedure (FRBP) 2002(g).

1. Amount of Claim as of Date Case Filed:
State the total amount owed to the creditor on the date of the Bankruptcy
filing. Follow the instructions concerning whether to complete items 4 and
5. Check the box if interest or other charges are included in the claim.

2. Basis for Claim:
State the type of debt or how it was incurred. Examples include goods sold,
money loaned, services performed, personal injury/wrongful death, car
loan, mortgage note, and credit card. If the claim is based on the delivery of
health care goods or services, limit the disclosure of the goods or services
so as to avoid embarrassment or the disclosure of confidential health care
information. You may be required to provide additional disclosure if the
trustee or another party in interest files an objection to your claim.

3. Last Four Digits of Any Number by Which Creditor Identifies
Debtor:
State only the last four digits of the debtor’s account or other number used by the
creditor to identify the debtor.

3a. Debtor May Have Scheduled Account As:
Use this space to report a change in the creditor’s name, a transferred claim, or any
other information that clarifies a difference between this proof of claim and the
claim as scheduled by the debtor.

4. Secured Claim:
Check the appropriate box and provide the requested information if
the claim is fully or partially secured. Skip this section if the claim is
entirely unsecured. (See DEFINITIONS, below.) State the type and
the value of property that secures the claim, attach copies of lien
documentation, and state annual interest rate and the amount past due
on the claim as of the date of the bankruptcy filing.

5. Amount of Claim Entitled to Priority Under 11 U.S.C. §507(a).

If any portion of your claim falls in one or more of the listed categories, check the
appropriate box(es) and state the amount entitled to priority. (See DEFINITIONS, below.)
A claim may be partly priority and partly non-priority. For example, in some of the
categories, the law limits the amount entitled to priority.

6. Credits:
An authorized signature on this proof of claim serves as an acknowledgment that when
calculating the amount of the claim, the creditor gave the debtor credit for any payments
received toward the debt.

7. Documents:
Attach to this proof of claim form redacted copies documenting the existence of the debt and
of any lien securing the debt. You may also attach a summary. You must also attach copies
of documents that evidence perfection of any security interest. You may also attach a
summary. FRBP 3001(c) and (d). If the claim is based on the delivery of health care goods
or services, see instruction 2. Do not send original documents, as attachments may be
destroyed after scanning.

Date and Signature:
The person filing this proof of claim must sign and date it. FRBP 9011. If the claim is filed
electronically, FRBP 5005(a)(2), authorizes courts to establish local rules specifying what
constitutes a signature. Print the name and title, if any, of the creditor or other person
authorized to file this claim. State the filer’s address and telephone number if it differs from
the address given on the top of the form for purposes of receiving notices. Attach a complete
copy of any power of attorney. Criminal penalties apply for making a false statement on a
proof of claim.

__________DEFINITIONS__________

______INFORMATION______

Debtor
A debtor is the person, corporation, or other entity that has filed
a bankruptcy case.
Creditor

A lien may be voluntarily granted by a debtor or may be obtained
through a court proceeding. In some states, a court judgment is a
lien. A claim also may be secured if the creditor owes the debtor
money (has a right to setoff).

A creditor is a person, corporation, or other entity owed a
debt by the debtor that arose on or before the date of the
bankruptcy filing. See 11 U.S.C. §101 (10)
Claim
A claim is the creditor’s right to receive payment on a
debt owed by the debtor that arose on the date of the
bankruptcy filing. See 11 U.S.C. §101 (5). A claim may
be secured or unsecured.

Proof of Claim

A proof of claim is a form used by the creditor to indicate the
amount of the debt owed by the debtor on the date of the
bankruptcy filing. The creditor must file the form with the
clerk of the same bankruptcy court in which the bankruptcy
case was filed.
Secured Claim Under 11 U.S.C. §506(a)

A secured claim is one backed by a lien on property of the
debtor. The claim is secured so long as the creditor has the right
to be paid from the property prior to other creditors. The
amount of the secured claim cannot exceed the value of the
property. Any amount owed to the creditor in excess of the
value of the property is an unsecured claim. Examples of liens
on property include a mortgage on real estate or a security
interest in a car.

Unsecured Claim
An unsecured claim is one that does not meet the
requirements of a secured claim. A claim may be partly unsecured
if the amount of the claim exceeds the value
of the property on which the creditor has a lien.

Claim Entitled to Priority Under 11 U.S.C. §507(a)
Priority claims are certain categories of unsecured claims that are
paid from the available money or property in a bankruptcy case
before other unsecured claims.

Redacted
A document
A document has been redacted when the person filing it has
masked, edited out, or otherwise deleted, certain information. A
creditor should redact and use only the last four digits of any
social-security, individual’s tax identification, or financial-account
number, all but the initials of a minor’s name and only the year of
any person’s date of birth.

Evidence of Perfection

Evidence of perfection may include a mortgage, lien, certificate
of title, financing statement, or other document showing that
the lien has been filed or recorded.

Acknowledgment of Filing of Claim

To receive acknowledgment of your filing, you may either
enclose a stamped self-addressed envelope and a copy of
this proof of claim or you may access the court’s PACER
system (www.pacer.psc.uscourts.gov) for a small fee to
view your filed proof of claim.

Offers to Purchase a Claim

Certain entities are in the business of purchasing claims
for an amount less than the fact value of the claims. One
or more of these entities may contact the creditor and
offer to purchase the claim. Some of the written
communications from these entities may easily be
confused with official court documentation or
communications from the debtor. These entities do not
represent the bankruptcy court or the debtor. The creditor
has no obligation to sell its claim. However, if the creditor
decides to sell its claim, any transfer of such claim is
subject to FRBP 3001(e), any applicable provisions of the
Bankruptcy Code (11 U.S.C. § 101 et seq.), and any
applicable orders of the bankruptcy court.

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UNITED STATES BANKRUPTCY COURT

NORTHERN DISTRICT OF ALABAMA

EASTERN DIVISION

STATEMENT OF INFORMATION REQUIRED BY 11 U.S.C. § 341

INTRODUCTION



including the effects on credit history;

Pursuant to the Bankruptcy Reform Act of 1994, the Office of the United States Bankruptcy


Administrator has prepared this information sheet to help you understand some of the possible consequences
of filing a bankruptcy petition under chapter 7 of the Bankruptcy Code. This information is intended to make
you aware of -







statement contains only general principles of law and is not a substitute for legal advice. If you have any
questions or need further information as to how the bankruptcy laws apply to your specific case, you should
consult with your lawyer.

(1) the potential consequences of seeking a discharge in bankruptcy,

(2) the effect of receiving a discharge of debts in bankruptcy;
(3) the effect of reaffirming a debt; and
(4) your ability to file a petition under a different chapter of the Bankruptcy

There are many other provisions of the Bankruptcy Code that may affect your situation. This

Code.









WHAT IS A DISCHARGE?



The filing of a chapter 7 petition is designed to result in a discharge of most of the debts you


listed in your bankruptcy schedules. A discharge is a court order that says that you do not have to repay your
debts, but there are a number of exceptions. Debts which usually may not be discharged in your chapter 7
case include, for example, most taxes, child support, alimony, and student loans; court-ordered fines and
restitution; debts obtained through fraud or deception; debts which were not listed in your bankruptcy
schedules; and personal injury debts caused by driving while intoxicated or taking drugs. Your discharge may
be denied entirely if you, for example, destroy or conceal property; destroy, conceal or falsify records; or make
a false oath. Creditors cannot ask you to repay debts which have been discharged. You can only receive a
chapter 7 discharge once every eight (8) years.

WHAT ARE THE POTENTIAL EFFECTS OF A DISCHARGE?



The fact that you filed bankruptcy can appear on your credit report for as long as 10 years.


Thus, filing a bankruptcy petition may affect your ability to obtain credit in the future. Also, you may not be
excused from repaying debts that were not listed on your bankruptcy schedules or that you incurred after you
filed bankruptcy. There are exceptions to this general statement. See your lawyer if you have questions.

WHAT ARE THE EFFECTS OF REAFFIRMING A DEBT?





Reaffirmation agreements are strictly voluntary. They are not required by the Bankruptcy Code


After you file your bankruptcy petition, a creditor may ask you to reaffirm a certain debt or you
may seek to do so on your own. Reaffirming a debt means that you sign and file with the court a legally
enforceable document which states that you promise to repay all or a portion of the debt that may otherwise
have been discharged in your bankruptcy case. Reaffirmation agreements must generally be filed with the court
sixty (60) days after the first meeting of creditors.

or other state or federal law. You can voluntarily repay any debt instead of signing a reaffirmation agreement,
but there may be valid reasons for wanting to reaffirm a particular debt. This is particularly true when property
you wish to retain is collateral for a debt.

must be in your best interest. If you decide to sign a reaffirmation agreement, you may cancel it at any time
before the court issues an order of discharge or within sixty (60) days after you filed the reaffirmation agreement
with the court, whichever is later.

the creditor can take action against you to recover any property that was given as security for the loan and you
may remain personally liable for any deficiency. In addition, creditors may seek other remedies, such as
garnishment of wages.

If you reaffirm a debt and fail to make the payments as required in the reaffirmation agreement,

Reaffirmation agreements must not impose an undue burden on you or your dependents and





OTHER BANKRUPTCY OPTIONS



You have a choice in deciding what chapter of the Bankruptcy Code will best suit your needs.


Even if you have already filed for relief under chapter 7, you may be eligible to convert your case to a different
chapter.

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Chapter 7 is the liquidation chapter of the Bankruptcy Code. Under chapter 7, a trustee is

Chapter 12 offers bankruptcy relief to those who qualify as family farmers. Family farmers

Chapter 11 is the reorganization chapter most commonly used by businesses, but it is also


appointed to collect and sell, if economically feasible, all property you own that is not exempt from these
actions.

available to individuals. Creditors vote on whether to accept or reject a plan, which also must be approved by
the court. While the debtor normally remains in control of the assets, the court can order the appointment of
a trustee to take possession and control of the business.

must propose a plan to repay their creditors over a three-to-five year period and it must be approved by the
court. Plan payments are made through a chapter 12 trustee, who also monitors the debtors' farming
operations during the pendency of the plan.

out of their future income. Each chapter 13 debtor writes a plan which must be approved by the bankruptcy
court. The debtors must pay the chapter 13 trustee the amount set forth in their plan. Debtors receive a
discharge after they complete their chapter 13 repayment plan. Chapter 13 is only available to individuals with
regular income whose debts do not exceed $1,000,000 ($250,000 in unsecured debts and $750,000 in secured
debts).

Finally, chapter 13 generally permits individuals to keep their property by repaying creditors




AGAIN, PLEASE SPEAK TO YOUR LAWYER IF YOU NEED FURTHER INFORMATION OR
EXPLANATION, INCLUDING HOW THE BANKRUPTCY LAWS RELATE TO YOUR SPECIFIC CASE.


I/we have had an opportunity to discuss the information in this document with an attorney of my/our choice.

By signing below, I/we acknowledge that I/we have received a copy of this document, and that




Date

10/01/2010

s/ Dorothy A. Ball
Dorothy A. Ball

/s/ Ralph K. Strawn, Jr.
Ralph K. Strawn, Jr.

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