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Case 9:13-bk-09523-FMD Doc 13 Filed 08/08/13 Page 1 of 37

B6 Summary (Official Form 6 - Summary) (12107)

United States Bankruptcy Court

Middle District of Florida

In re Angel I Rubio

Debtor

Chapter
SUMMARY OF SCHEDULES

i= ;& -

8

)



.

I

f -

i:?3 -8 2313

1 . . . . . . . . . 4
7

Indicate as to each schedule whether that schedule is attached and state the number of pages in each. Report the totals from Schedules A, 6, 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.

Case 9:13-bk-09523-FMD Doc 13 Filed 08/08/13 Page 2 of 37

Form 6 - Statistical Summary (12/07)

United States Bankruptcy Court

Middle District of Florida

In re Angel l Rubio

Debtor

Case NO.
Chapter

7

/ d 095.33

STATISTICAL SUMMARY OF CERTAIN LIABILITIES AND RELATED DATA (28 U.S.C. 5 159)

If you are an individual debtor whose debts are primarily consumer debts, as defined in § 101(8) of the Bankruptcy Code (1 1 U.S.C.

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

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

information here.

This information is for statistical purposes only under 28 U.S.C. 5 159.

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

Type of Liability

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

Amount

$

0.00

$

0.00

$

$

0.00

0.00

$

0.00

$

$

0.00

0.00

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

$

$

1,050.00

1,106.00

State the following:

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

RITY, IF ANY" column

Case 9:13-bk-09523-FMD Doc 13 Filed 08/08/13 Page 3 of 37

B6B (Official Form 6B) (12107)

In re Angel l Rubio

Debtor

Case NO. d 3 - ~ % 9 3

(If known)

SCHEDULE B - PERSONAL PROPERTY

TYPE OF PROPERTY

DESCRIPTION AND LOCATION

OF PROPERTY

1, Cash on hand

2. Checking, savings or other financial
accounts, certificates of deposit, or
shares in banks, savings and loan, thrift,
building and loan, and homestead
associations, or credit unions, brokerage
houses, or cooperatives.

1 cash
checking account

CURRENT VALUE OF
DEBTORS INTEREST
IN PROPERTY, WITH-
OUT DEDUCTING ANY

SECURED CLAIM
OR EXEMPTION

I
~

I
I 8
5
3 2
0 z o a

3
I

20.00
100.00

1

1

Wearing apparel

75.00

10. Annuities. Itemize and name each

issuer.

11. lnterests in an education IRA as defined

8. Firearms and sports, photographic, and

X

X

X

X

6. Wearing apparel.

7. Furs and jewelry.

x
x
----

4. Household goods and furnishings,

including audio, video, and computer
equipment.

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

5. Books, pictures and other art objects,

antiques, stamp, coin, record, tape.
compact disc, and other collections or

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

in 26 U.S.C. 5 530(b)(l) or under a
qualified State tuition plan as defined
in
26 U.S.C. 6 529(bl(Il. Give oarticulars.
(File sepa&ely iher&rd(sj of any such
interest(s). I 1 U.S.C. 3 521(c).)

includin tax refunds. Give articulars. . 17. Alimony, maintenance, support, and

13. Stock and interests in incorporated and

unincorporated businesses. Itemize.

property settlements to which the debtor
is or may be entitled. Give particulars.

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

pension or profit sharing plans. Give

other negotiable and nonnegotiable
instruments.

14. Interests in partnerships or joint ventures.

Itemize.

15. Government and corporate bonds and

18. Other liquidated debts owed to debtor

X

X
x

x
X

16. Accounts receivable.

Case 9:13-bk-09523-FMD Doc 13 Filed 08/08/13 Page 4 of 37

B6B (Official Form 6B) (12107) -- Cont.
In re Angel l Rubio

Debtor

Case NO.

/3- 0432 3
(If known)

SCHEDULE B - PERSONAL PROPERTY

(Continuation Sheet)

TYPE OF PROPERTY

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.

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.

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

SECURED CLAIM
OR EXEMPTION

I-

Z c
$ 5 3 z
5 2 .f IY % 0

3
I

DESCRIPTION AND LOCATION

OF PROPERTY

W z s?

X

)(

X

X
x

X

r----

24.C~stomer lists or other compilations

containing personally identifiable
information (as defined in 11 U.S.C. 5
lOl(41A)) provided to the debtor by
individuals in connection with obtaining a
product or service from the debtor primarily
for personal, family, or household
purposes.

25. Automobiles, trucks, trailers, and other

vehicles and accessories.

26. Boats, motors, and accessories.

27. Aircraft and accessories.

28. Omce equipment, furnishings, and

supplies.

29. Machinery, fixtures, equipment and

supplies used in business.

30. Inventory.

31, Animals.

32. Crops -growing or harvested. Give

particulars.

33. Farming equipment and implements.

34. Farm supplies, chemicals. and feed.

35. Other personal properly of any kind not

already listed. Itemize.

X
x
x
X

X

X
x
X
x
x
x

1 continuation sheets attached

Total

$ 195.00

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

Case 9:13-bk-09523-FMD Doc 13 Filed 08/08/13 Page 5 of 37

B6D (Official Form 6D) (1 2/07)

In re Angel l Rubio

Case No. 13- o4523
SCHEDULE D - CREDITORS HOLDING SECURED CLAIMS

(If known)

Debtor

a

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

CREDITOR'S NAME AND

MAILING ADDRESS

INCLUDING ZIP CODE AND

AN ACCOUNT NUMBER
(See Instructions, Above.)

I- z
? c
%
?i iE
0- 0 z u
cc 3 0
2 I

DATE CLAIM WAS
INCURRED, NATURE

OF LIEN, AND

DESCRIPTION AND

VALUE OF PROPERTY

SLIB.IECT TO LIEN

AMOUNT OF

CLAIM WITHOUT

DEDUCTING
VALUE OF

COLLATERAL

UNSECURED
PORTION, IF

ANY

Bank of America
P.O. Box 5170 '
Sim Valley, CA 93062

P.0.Box 5170
Simi Valley, CA 93062

Shapiro, Fishman & Gachet
2424 North Federal Highway
Suite 360

Mortgage
5435 S.W. 153 Ave Rd
Miami, FL 33185

1 VALUE $175,000.00

Second Lien on Residence
5435 S.W. 153 Ave. Rd.
Miami, FL 33185

VALUE $0.00

I

Mortgage
Real Estate Property

VALUE $150,000.00

I

l

l



208,000.00

140,000.00

224,279.56

0

continuation sheets
attached

Subtotal +
(Total of this page)

Total i
(Use only on last page)

(Report also on Summary of (If applicable, report
Schedules)

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

Case 9:13-bk-09523-FMD Doc 13 Filed 08/08/13 Page 6 of 37

B6E (Official Form 6E) (4110)

In re

Angel I Rubio

Case NO. /3--0C1533

(If known)

SCHEDULE E - CREDITORS HOLDING UNSECURED PRIORITY CLAIMS

Debtor

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.)
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. g 507(a)(l).

0 Extensions of credit in an involuntary case

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

appointment of a trustee or the order for relief. 11 U.S.C. 9 507(a)(3).

Wages, salaries, and commissions

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

independent sales representatives up to $1 1,725' 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. 9 507(a)(4).

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. 9 507(a)(5).

Certain farmers and fishermen

Claims of certain farmers and fishermen, up to $5,775" per farmer or fisherman, against the debtor, as provided in 11 U.S.C. 9 507(a)(6).

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. 9 507(a)(7).

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. 9 507(a)(8).

0 Commitments to Maintain the Capital of an Insured Depository Institution

Claims based on commitments to the FDIC, RTC, Director of the Ofice 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.
9 507 (aI(9).
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. 9 507(a)(10).

Amounts are subject to adjustment on 410111 3, and every three years thereafter with respect to cases commenced on or after the date of

adjustment.

1 continuation sheets attached

Case 9:13-bk-09523-FMD Doc 13 Filed 08/08/13 Page 7 of 37

B6C (Official Form 6C) (4110)

In re Angel l Rubio

Debtor

Case NO. 13-0953 3

(If known)

SCHEDULE C - PROPERTY CLAIMED AS EXEMPT

Debtor claims the exemptions to which debtor is entitled under:
(Check one box)
0 1 1 U.S.C. § 522(b)(2)
0 11 U.S.C. § 522(b)(3)

a Check if debtor claims a homestead exemption that exceeds

$146,450.'

DESCRIPTION OF PROPERTY

I

cash

checking account

Wearing apparel

I

I

SPECIFY LAW

PROVIDING EACH

EXEMPTION

Art. 10 Q 4(a)(2), FSA Q 222.061

Art. 10 Q 4(a)(2), FSA Q 222.061

1 Art. 10 Q 4(a)(2). FSA 3 222.061

20.00

I

100.00

20.00

100.00

I

I

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

Case 9:13-bk-09523-FMD Doc 13 Filed 08/08/13 Page 8 of 37

B6E (Official Form 6E) (4110) - Cont.

In re

Angel I Rubio

Debtor

Case NO.

/3--0L/513

(If known)

SCHEDULE E - CREDITORS HOLDING UNSECURED PRIORITY CLAIMS

(Continuation Sheet)

CREDITOR'S NAME,
MAILING ADDRESS

INCLUDING ZIP CODE,
AND ACCOUNT NUMBER
(See instructions above.)

ACCOUNT NO.

+
z_ o >

o n o

I

DATE CLAIM WAS
INCURRED AND
CONSIDERATION

FOR CLAIM

' 0

AMOUNT
OF CLAIM

AMOUNT

ENTITLEDTO

PRIORITY

AMOUNT

NOT

ENTITLED TO

I

$0.00

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

Subtotals;
(Totals of this page)

$

0.00

$

0.00 $

0.00

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

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. )

Total ;

Case 9:13-bk-09523-FMD Doc 13 Filed 08/08/13 Page 9 of 37

B6F (Official Form 6F) (1 2/07)

In re

Angel I Rubio

case NO. /3-0 Q 533

(If known)

SCHEDULE F - CREDITORS HOLDING UNSECURED NONPRlORlTY CLAIMS

Debtor

a Check this b o x if d e b t o r has no c r e d i t o r s holding u n s e c u r e d claims to r e p o r t on this Schedule F.

CREDITOR'S NAME,
MAILING ADDRESS

INCLUDING ZIP CODE,
AND ACCOUNT NUMBER
(See instructions above.)

DATE CLAIM WAS
INCURRED AND

CONSIDERATION FOR

CLAIM.

IF CLAIM IS SUBJECT TO

SETOFF, SO STATE

AMOUNT OF

CLAIM

ACCOUNT NO.

Advanta
P.O. Box 31032
Tampa, FL 33631

ACCOUNT

X X X X X X X X X X X ~ ~ ~ ~

Advanta Credit
P.O. Box 31032
Tampa, FL 33631

Aspire
PO Box 75970
W Desmoines, IA 50265

ACCOUNT

41 71 4377

Asset Acceptance
PO Box 2036
Warren, MI 48090

NO.

42145594

Asset Acceptance
HABC
P.O. Box 2036
Waren, MI 48090

Credit Card

..

Credit Card

- - - - - - . . .

Credit Card

- - -- - . . . - .- - -- - - ..

West Mar

Credit Card

5 Continuation sheets attached

Subtotal i

(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 Dab.)

Total 2 I§

I

I

Case 9:13-bk-09523-FMD Doc 13 Filed 08/08/13 Page 10 of 37

B6F (Official Form 6F) (12107) - Cont.

In re

Angel I Rubio

Case NO. /3 .05523

(If known)

SCHEDULE F - CREDITORS HOLDING UNSECURED NONPRlORlTY CLAIMS

Debtor

CREDITOR'S NAME,
MAILING ADDRESS

INCLUDING ZIP CODE,

AND ACCOUNT NUMBER
(See rnstruct~ons above )

+ z
2
E5
3:
00
Z O
4~ % 0

3
I

(L p s o

0
0

A C a U N T N O

A-12210529

Asset Acceptance
Bank of America
P.O. Box 2036
Warren, MI 48090

(Continuation Sheet)

DATE CLAIM WAS
INCURRED AND

CONSIDERATION FOR

CLAIM.

IF CLAIM IS SUBJECT TO

SETOFF, SO STATE

Credit card

ACCOUNTNO

X X X X X X X X X X X ~ ~ ~ ~

Asset Acceptance LLC
P.O. Box 2036
Warren, MI 48090

Credit Card HSBC Card

ACCOUNTNO

41714377

Asset Acceptance, LLC
P.O. Box 2036
Warren, MI 48090

ACCOUNT No

431 3085999800555

Bank of America
P.O. Box 2240
Brea, CA 92822

No

5490357999724842

Bank of America
P.0.Box 2240
Brea, CA 92822

Credit Card Citibank
XXXXXX1519

Credit Card

Credit Card

o

w z ?
+
z W n
2 = 2
s
5 9 :

g





AMOUNT OF

CLAIM

8,638.00

2,706.70

1,074.31

8,638.00

17,200.00

5 Continuation sheets attached

Sheet no. 1 of 5 continuation sheets attached to Schedule of Creditors
Holding Unsecured
Nonpriorily Claims

Subtotal

38,257.01

(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.)

I

I

Case 9:13-bk-09523-FMD Doc 13 Filed 08/08/13 Page 11 of 37

B6F (Official Form 6F) (12107) - Cont.

In re Angel I Rubio

Case NO.

/ 3 0 7 5 ~ 3

(If known)

SCHEDULE F - CREDITORS HOLDING UNSECURED NONPRlORlTY CLAIMS

Debtor

CREDITOR'S NAME,
MAILING ADDRESS

INCLUDING ZIP CODE,
AND ACCOUNT NUMBER
(See instructions above.)

Capital One
P.O. Box 85520
Richmond, VA 23285

438864807692

Capital One
P.O. Box 85015
Richmond, VA 23285

Capital One

I P.O. BOX 85015

Richmond, VA 23285

Capital One
P.O. Box 8501 5

Capital One
P.0.Box 8501 5
Richmond, VA 23285

(Continuation Sheet)

DATE CLAIM WAS
INCURRED AND

CONSIDERATION FOR

CLAIM.

IF CLAIM IS SUBJECT TO

SETOFF, SO STATE

Credit Card

Credit Card

Credit Card

Credit Card

Credit Card

S Continuation sheets attached

Sheet no. 2 of 5 continuation sheets attached to Schedule of Creditors
Holding Unsecured
Nonpriority Claims

Subtotal

(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.)

b

I

10,758.00

I

Case 9:13-bk-09523-FMD Doc 13 Filed 08/08/13 Page 12 of 37

B6F (Official Form 6F) (1 2/07) - Cont.

In re Angel I Rubio

~ a s e ~ o .

/ - ? 3 - 0 Y ~ 2 ~

SCHEDULE F - CREDITORS HOLDING UNSECURED NONPRlORlTY CLAIMS

Debtor

(If known)

CREDITOR'S NAME,
MAILING ADDRESS

INCLUDING ZIP CODE,
AND ACCOUNT NUMBER
(See instructions above.)

Central Financial
Imperial Promenade
Santa Ana,CA 92707

900 Stewart Ave.
Garden City, NY 11530

41 8587662295

AccouNT
Chase
900 Stewart Ave.
Garden City, NY 11 530

ACCoUNT

41 88582810001 8

Chase
900 Stewart Ave
Garden City NY 11530

Chase
900 Stewart Ave
Garden City, NY 11 530

(Continuation Sheet)

DATE CLAIM WAS
INCURRED AND

CONSIDERATION FOR

CLAIM.

IF CLAIM IS SUB.IECT TO

SETOFF, SO STATE

Credit Card

Credit Card

Credit Card

Credit Card

5 Continuation sheets attached

Sheet no. 3 of 5 continuation sheets attached to Schedule of Creditors
Holding Unsecured
Nonpriority Claims

Subtotal +

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

Total

I P
I

I

Case 9:13-bk-09523-FMD Doc 13 Filed 08/08/13 Page 13 of 37

B6F (Official Form 6F) (12107) - Cont.

In re

Angel I Rubio

SCHEDULE F - CREDITORS HOLDING UNSECURED NONPRlORlTY CLAIMS

Debtor

Case NO.

/3 -O 9533

(If known)

CREDITOR'S NAME,
MAILING ADDRESS

INCLUDING ZIP CODE,
AND ACCOUNT NUMBER
(See instructions above.)

4227651 0251 0

*
Chase BP
900 Stewart Ave
Garden City, NY 11 530

5256500309901 51 9

AmouNT
CitilCBNA
399 Park Ave.
New York, NY 10022

No

601 100437261

Discover Financial
P.0.Box 15316
Wilmington, DE 19850

I

476935891 1420

DSNB Macys
2201 WarrenbillsCente Rd
University High, OH 441

Expo Home Depot
3355 Steelyard Dr.
Cleveland, OH 44109

5 Continuation sheets attached

Sheet no. 4 of 5 continuation sheets attached to Schedule of Creditors
Holding Unsecured
Nonpriority Claims

(Continuation Sheet)

DATE CLAIM WAS
INCURRED AND

CONSIDERATION FOR

CLAIM.

IF CLAIM IS SUBJECT TO

SETOFF, SO STATE

AMOUNT OF

CLAIM

Credit Card

Credit Card

Credit Card

Credit Card

Credit Card

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.)

Subtotal ;

i I--

1

14,423.88

I

Case 9:13-bk-09523-FMD Doc 13 Filed 08/08/13 Page 14 of 37

B6F (Official Form 6F) (12107) - Cont.

In re Angel I Rubio

case NO. 1.3 -07 5.93

(If known)

SCHEDULE F - CREDITORS HOLDING UNSECURED NONPRlORlTY CLAIMS

Debtor

CREDITOR'S NAME,
MAILING ADDRESS

INCLUDING ZIP CODE,
AND ACCOUNT NUMBER
(See instructions above )

r e X

0
0

ACCOUNT

331 7621 2001

I C System Inc.
P.0.Box 64378
Saint Paul, MN 55164

ACcoUNT NO

321 102260491 3

Key Bank
P.O.Box 94917
Cleveland, OH 44101

60353201 341 84769

Accoum
THDICBNA
3355 Steelyard Dr.
Cleveland, OH 44109

I

12-1 11 99 CA

I Zoila Valdes
C/O Karel Remudo
782 N.W. LeJeune Rd.#M50
1 Miami, FL 33126

(Continuation Sheet)

I-

EC ~ i z
2: 0-0
e m 5'0

Z O

3
I

DATE CLAIM WAS
INCURRED AND

CoNslDERATloN FOR

CLAIM.

IF CLAIM IS SUBJECT TO

SETOFF, SO STATE

Miami Veterinary

Boat repossessed

Credit Card Home depot

Law Suit

'2
9

4
! Z C C
8

;
n

AMOUNT OF

CLAIM



1,021.00

---

54,551 .OO

3,174.00

2,000,000.00

5 Continuation sheets attached

Sheet no. 5 of 5 continuation sheets attached to Schedule of Creditors
Holding Unsecured
Nonpriority Claims

Subtotal k

(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.)

1

I

Case 9:13-bk-09523-FMD Doc 13 Filed 08/08/13 Page 15 of 37

B6G (Official Form 6G) (1 2/07)

In re: Anael l Rubio

Debtor

Case No.

/.3 -095 23

(If known)

SCHEDULE G - EXECUTORY CONTRACTS AND UNEXPIRED LEASES
a 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 9:13-bk-09523-FMD Doc 13 Filed 08/08/13 Page 16 of 37

B6H (Official Form 6H) (1 2/07)

I" re: Angel I Rubio

Debtor

CaseNo. /3-04533

(If known)

0 Check this box if debtor has no codebtors.

SCHEDULE H - CODEBTORS

NAME AND ADDRESS OF CODEBTOR

NAME AND ADDRESS OF CREDITOR

Case 9:13-bk-09523-FMD Doc 13 Filed 08/08/13 Page 17 of 37

B61 (Official Form 61) (12107)
In re Angel l Rubio

Case No.

SCHEDULE I - CURRENT INCOME OF INDIVIDUAL DEBTOR(S)

The column labeled "Spouse" must be completed in all cases filed by joint debtors and by 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

(If known)

DEPENDENTSOFDEBTORANDSPOUSE

RELATIONSHIP(S):

DEBTOR

self employed

AGE@):

1

SPOUSE

I

Debtor's Marital
Status:

Single

1 Employment:

Occupation
Name of Employer

How long employed

Address of Employer

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

case filed)

DEBTOR

SPOUSE

Monthly gross wages, salary, and commissions

(Prorate if not paid monthly.)

Estimate monthly overtime

3. SUBTOTAL
4. LESS PAYROLL DEDUCTIONS

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

d. Other (Specify)

5. SUBTOTAL OF PAYROLL DEDUCTIONS

6. TOTAL NET MONTHLY TAKE HOME PAY

$A$

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

(Attach detailed statement)

8. Income from real property
9. Interest and dividends
10. Alimony, maintenance or support payments payable to the debtor for the

debtor's use or that of dependents listed above.

$

$

$

$

0.00 $

0.00 $

0.00 $

0.00 $

1 1. Social security or other government assistance
(Specify)
12. Pension or retirement income
13. Other monthly income

14. SUBTOTAL OF LINES 7 THROUGH 13

$
$o.OO$

0.00 $

1 $A$ I

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

$

1.050.00 $

16. COMBINEDAVERAGE MONTHLY INCOME: (Combine column
totals from line 15)

$ 1,050.00

(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 9:13-bk-09523-FMD Doc 13 Filed 08/08/13 Page 18 of 37

B6J (Official Form 6J) (12107)

In re Anael I R u b i o

case NO. /3- 0 95 2 3

SCHEDULE J - CURRENT EXPENDITURES OF INDIVIDUAL DEBTOR(S)

(If known)

Debtor

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.

a 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)
No
No

a. Are real estate taxes included?
b. Is property insurance included?
2. Utilities: a. Electricity and heating fuel

Yes
Yes

4
4

$

0.00

b. Water and sewer
c. Telephone
d. Other Cable

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. OtherHomeowners a s s o c i a t i o n

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.)

$

$

$

$
$

$
$
$

0.00

0.00

0.00
0.00
0.00
n nn
0.00
86.00

- a - -

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.)

Case 9:13-bk-09523-FMD Doc 13 Filed 08/08/13 Page 19 of 37

66 Declaration (Official Form 6 - Declaration) (12107)

In re Anael I Rubio

Debtor

Case NO. 13- 9 9523

(If known)

DECLARATION CONCERNING DEBTOR'S SCHEDULES

DECLARATION UNDER PENALTY OF PERJURY BY INDIVIDUAL DEBTOR

I declare under penalty of pe jury that I have read the foregoing summary and
sheets, and that they are true and correct to the best of my knowledge, information,

19

Date:

Signature:

\
' ('J&>

An&

I e u b d

Debtor

[If joint case, both spouses must sign]

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 55 152 and
3571.

Case 9:13-bk-09523-FMD Doc 13 Filed 08/08/13 Page 20 of 37

87 (Official Form 7) (411 0)

In re: Angel l Rubio

UNITED STATES BANKRUPTCY COURT

Middle District of Florida

l , . . P'i;

-8 2313

Debtor

Ta 1.;. (If known)

.

STATEMENT OF FINANCIAL AFFAIRS

1. Income from employment or operation of business

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

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

AMOUNT

18,328.00

26,628.00

22,268.00

SOURCE

from work

from work

from work

FISCAL YEAR PERIOD

201 0

201 1

2012

2.

Income other than from employment or operation of business

None State the amount of income received by the debtor other than from employment, trade, profession, operation of the debtor's
business during the two years immediately preceding the commencement of this case. Give particulars. If a joint petition is
filed, state income for each spouse separately. (Married debtors filing under chapter 12 or chapter 13 must state income for
each spouse whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.)

AMOUNT

SOURCE

FISCAL YEAR PERIOD

3. Payments to creditors

None

Complete a. orb., as appropriate, and c.
a. Individual orjoint debtor@) 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 &se 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 9:13-bk-09523-FMD Doc 13 Filed 08/08/13 Page 21 of 37

None b. Debtor whose debts are not primarily consumer debts: List each payment or other transfer to any creditor made within 90
days immediately preceding the commencement of the case unless the aggregate value of all property that constitutes or is
affected by such transfer is less than $5,850*. 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
PAYMENTS1
TRANSFERS

AMOUNT
PAID OR
VALUE OF
TRANSFERS

AMOUNT
STILL

OWING

*Amount subject to adjustment on 4/07/73, and every three years thereafter with respect to cases commenced on or after the date

of adjustment.

None

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

DATE OF
PAYMENT

AMOUNT
PAID

AMOUNT
STILL OWING

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

None

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

CAPTION OF SUIT
AND CASE NUMBER
Zoila Valdez
VS.
Angel I. Rubio

12-11199

NATURE OF PROCEEDING
damage

COURT OR AGENCY
AND LOCATION
Miami-DadeCounty

STATUS OR
DISPOSITION

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

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

NAME AND ADDRESS
OF PERSON FOR WHOSE
BENEFIT PROPERTY WAS SEIZED

DATE OF
SEIZURE

DESCRIPTION
AND VALUE OF
PROPERTY

Case 9:13-bk-09523-FMD Doc 13 Filed 08/08/13 Page 22 of 37

None
6a

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

IlESCRlPTlON
AND VALUE OF
PROPERTY

None

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

NAME AND ADDRESS
OF ASSIGNEE

DATE OF
ASSIGNMENT

TERMS OF
ASSIGNMENT
OR SElTLEMENT

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

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

NAME AND ADDRESS
OF CUSTODIAN

7. Gifts

NAME AND ADDRESS
OF COURT
CASE TITLE 8 NUMBER

DATE OF
ORDER

DESCRIPTION
AND VALUE OF
PROPERTY

None
81

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

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
ANDVALUEOF
PROPERTY

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

DATE OF
LOSS

Case 9:13-bk-09523-FMD Doc 13 Filed 08/08/13 Page 23 of 37

4

None

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

' one year immediately preceding the commencement of this case.

NAME AND ADDRESS
OF PAYEE

DATE OF PAYMENT,
NAME OF PAYOR IF
OTHER THAN DEBTOR

AMOUNT OF MONEY OR
DESCRIPTION AND VALUE
OF PROPERTY

None

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

NAME AND ADDRESS OF TRANSFEREE,
RELATIONSHIP TO DEBTOR

DATE

DESCRIBE PROPERTY
TRANSFERRED
AND VALLIE RECEIVED

None

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

NAME OF TRUST OR OTHER
DEVICE

11. Closed financial accounts

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

None

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

NAME AND ADDRESS
OF INSTITUTION

12. Safe deposit boxes

TYPE OF ACCOUNT, US-r FOUR
DIGITS OF ACCOUNT NUMBER,
AND AMOUNT OF FINAL BALANCE

AMOUNT AND
DATE OF SALE
OR CLOSING

None
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

NAMESANDADDRESSES
OF THOSE WITH ACCESS
TO BOX OR DEPOSITORY

DESCRIPTION
OF
CONTENTS

DATE OF TRANSFER
OR SURRENDER,
IF ANY

Case 9:13-bk-09523-FMD Doc 13 Filed 08/08/13 Page 24 of 37

None

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

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.

None
a NAME AND ADDRESS

OF OWNER

DESCRIPTION AND VALUE
OF PROPERTY

LOCATION OF PROPERTY

15. Prior address of debtor
None
If debtor has moved within three years immediately preceding the commencement of this case, list all premises which the
a debtor occupied during that period and vacated prior to the commencement of this case. If a joint petition is filed, report also

any separate address of either spouse.

ADDRESS

NAME USED

DATES OF OCCUPANCY

None

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

NAME

17. Environmental Information.

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

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

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

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

None a.

' it may be liable or potentially liable under or in violation of an Environmental Law. Indicate the governmental unit, the date of

List the name and address of every site for which the debtor has received notice in writing by a governmental unit that

the notice, and, if known, the Environmental Law.

SITE NAME AND
ADDRESS

NAME AND ADDRESS
OF GOVERNMENTAL UNIT

DATE OF
NOTICE

ENVIRONMENTAL
LAW

Case 9:13-bk-09523-FMD Doc 13 Filed 08/08/13 Page 25 of 37

None

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

b.
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
81

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

c.
respect to which the debtor is or was a party. lndicate 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 UNlT

DOCKET NUMBER

STATUS OR
DISPOSITION

18. Nature, location and name of business

None

a. I f 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.

I f 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.

I f 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

Israel group
lnestments inc.

LAST FOUR DIGITS
OF SOCIAL SECURITY ADDRESS
OR OTHER INDIVIDUAL
TAXPAYER-I.D. NO.
(ITIN)/ COMPLETE EIN
06-1 633361

5435 S.W. 154 Ave Rd.
Miami, FL 33185

NATURE OF
BUSINESS

BEGINNING AND ENDING
DATES

Investment

07/02/2001

None

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

b.
U.S.C. 9 101.

[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

Date

Signature
of Debtor ~~~~l I

Case 9:13-bk-09523-FMD Doc 13 Filed 08/08/13 Page 26 of 37

B 8 (Official Form 8) (1 2/08)

UNITED STATES BANKRUPTCY COURT

Middle District of Florida

Angel I Rubio

Debtor

Case No.

Chapter 7

CHAPTER 7 INDIVIDUAL DEBTOR'S STATEMENT OF INTENTION

PART A - Debts secured by property of the estate. (Part A must be fully completed for EACH debt which is secured
by property of the estate. Attach additional pages if necessary.)

Property No. 1

Creditor's Name:
Bank of America

Property will be (check one):

Surrendered

0 Retained

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

a Redeem the property
d Reaffirm the debt

Other. Explain

Property is (check one):

[a Claimed as exempt

Property No. 2

Creditor's Name:
Bank of America

Property will be (check one):

d Surrendered

O Retained

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

a Redeem the property
a Reaffirm the debt
0 Other. Explain

Describe Property Securing Debt:
5435 S.W. 153 Ave Rd
Miami, FL 33185

(for example, avoid lien using 11 U.S.C. 5 5220)

Not claimed as exempt

Describe Property Securing Debt:
5435 S.W. 153 Ave. Rd.
Miami, FL 33185

(for example, avoid lien using 11 U.S.C. 5 522(f))

Property is (check one):

Claimed as exempt

[a Not claimed as exempt

Case 9:13-bk-09523-FMD Doc 13 Filed 08/08/13 Page 27 of 37

B 8 (ORicial Form 8) (12108)

Property No. 3

Creditor's Name:
CitiMortgage, Inc.

Page 2

Describe Property Securing Debt:
Real Estate Property

Property will be (check one):

d Surrendered

Retained

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

Redeem the property
Reaffirm the debt
a Other. Explain

Property is (check one):

Claimed as exempt

(for example, avoid lien using 11 U.S.C. 5 522(f))

[a Not claimed as exempt

PART B - Personal property subject to unexpired leases. (All three columns of Part B must be completed for
each unexpired lease. Attach additional pages i f necessary.)

Property No. 1

Lessor's Name:
None

Describe Leased Property:

Lease will be Assumed pursuant
to 11 U.S.C. 5 365(p)(2):
iJ YES

0 NO

0 continuation sheets attached (if any)

I declare under penalty of perjury that the above indicates my intention as to any property of my estate
securing a debt andlor personal property subject to an unexpired lease.

r

Date:

Signature of ~ e b t o ; \ C

Case 9:13-bk-09523-FMD Doc 13 Filed 08/08/13 Page 28 of 37

UNITED STATES BANKRUPTCY COURT

MIDDLE DISTRICT OF FLORIDA

In re: Angel I Rubio

Debtor

Case NO. /3 -093-a3
Chapter 7

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 lhve assume all responsibility for errors and omissions.

Dated: -

Signed:

Case 9:13-bk-09523-FMD Doc 13 Filed 08/08/13 Page 29 of 37

B22A (Official Form 22A) (Chapter 7) (12110)

In re Angel l Rubio

Debtor@)

Case Number:

r,

I I

/,,:.jb -0 L U I J

\ ! I

. ' J .. .
, .,

. I & . . .

-. c,
.

According to the information required to be entered on this
statement (check one box as directed in Part 1, Ill, or VI of this
statement):
iJ

The presumption arises

a The presumption does not arise

The presumption is temporarily inapplicable.

CHAPTER 7 STATEMENT OF CURRENT MONTHLY INCOME

AND MEANS-TEST CALCULATION

In addition to Schedules I and J, this statement must be completed by every individual chapter 7 debtor. If none of the exclusions in
Part I applies, joint debtors may complete one statement only. If any of the exclusions in Part I applies, joint debtors should complete
separate statements if they believe this is required by 707(b)(2)(C).

Part I. MILITARY AND NON-CONSUMER DEBTORS

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