You're viewing Docket Item 1 from the case Maureen Claire Smith. View the full docket and case details.

Download this document:




Case 13-30301 Doc 1 Filed 05/08/13 Entered 05/08/13 10:30:28 Desc Main

Document Page 1 of 47

}bk1{Form 1. Voluntary Petition}bk{B1 (Official Form 1)(04/13)United States Bankruptcy CourtVoluntary PetitionName of Debtor (if individual, enter Last, First, Middle):All Other Names used by the Debtor in the last 8 years(include married, maiden, and trade names):Last four digits of Soc. Sec. or Individual-Taxpayer I.D. (ITIN)/Complete EIN(if more than one, state all)Street Address of Debtor (No. and Street, City, and State):County of Residence or of the Principal Place of Business:Mailing Address of Debtor (if different from street address):Location of Principal Assets of Business Debtor(if different from street address above):Name of Joint Debtor (Spouse) (Last, First, Middle):All Other Names used by the Joint Debtor in the last 8 years(include married, maiden, and trade names):Last four digits of Soc. Sec. or Individual-Taxpayer I.D. (ITIN) No./Complete EIN(if more than one, state all)Street Address of Joint Debtor (No. and Street, City, and State):County of Residence or of the Principal Place of Business:Mailing Address of Joint Debtor (if different from street address):ZIP CodeZIP CodeZIP CodeZIP CodeType of Debtor(Form of Organization) (Check one box)Individual (includes Joint Debtors)See Exhibit D on page 2 of this form.Corporation (includes LLC and LLP)PartnershipOther (If debtor is not one of the above entities,check this box and state type of entity below.)Chapter 15 DebtorsCountry of debtor's center of main interests:Each country in which a foreign proceedingby, regarding, or against debtor is pending:Filing Fee (Check one box)Full Filing Fee attachedFiling Fee to be paid in installments (applicable to individuals only). Mustattach signed application for the court's consideration certifying that thedebtor is unable to pay fee except in installments. Rule 1006(b). See OfficialForm 3A.Filing Fee waiver requested (applicable to chapter 7 individuals only). Mustattach signed application for the court's consideration. See Official Form 3B.Nature of Business(Check one box)Health Care BusinessSingle Asset Real Estate as definedin 11 U.S.C. § 101 (51B)RailroadStockbrokerCommodity BrokerClearing BankOtherTax-Exempt Entity(Check box, if applicable)Debtor is a tax-exempt organizationunder Title 26 of the United StatesCode (the Internal Revenue Code).Chapter of Bankruptcy Code Under Whichthe Petition is Filed (Check one box)Chapter 7Chapter 9Chapter 11Chapter 12Chapter 13Chapter 15 Petition for Recognitionof a Foreign Main ProceedingChapter 15 Petition for Recognitionof a Foreign Nonmain ProceedingNature of Debts(Check one box)Debts are primarily consumer debts,Debts are primarilydefined in 11 U.S.C. § 101(8) asbusiness debts."incurred by an individual primarily fora personal, family, or household purpose."Chapter 11 DebtorsCheck one box:Debtor is a small business debtor as defined in 11 U.S.C. § 101(51D).Debtor is not a small business debtor as defined in 11 U.S.C. § 101(51D).Check if:Debtor’s aggregate noncontingent liquidated debts (excluding debts owed to insiders or affiliates)are less than $2,490,925 (amount subject to adjustment on 4/01/16 and every three years thereafter).Check all applicable boxes:A plan is being filed with this petition.Acceptances of the plan were solicited prepetition from one or more classes of creditors,in accordance with 11 U.S.C. § 1126(b).THIS SPACE IS FOR COURT USE ONLYStatistical/Administrative InformationDebtor estimates that funds will be available for distribution to unsecured creditors.Debtor estimates that, after any exempt property is excluded and administrative expenses paid, there will be no funds available for distribution to unsecured creditors.Estimated Number of Creditors1-50-100-200-1,000-5,001-10,001-25,001-50,001- OVER4999 199 999 5,000 10,000 25,000 50,000 100,000100,000Estimated Assets$0 to $50,001 to$100,001 to$500,001$1,000,001$10,000,001$50,000,001$100,000,001$500,000,001More than$50,000$100,000$500,000to $1to $10to $50to $100to $500to $1 billion$1 billionmillionmillionmillionmillionmillionEstimated Liabilities$0 to $50,001 to$100,001 to$500,001$1,000,001$10,000,001$50,000,001$100,000,001$500,000,001More than$50,000$100,000$500,000to $1to $10to $50to $100to $500to $1 billion$1 billionmillionmillionmillionmillionmillionDistrict of North DakotaSmith, Maureen Clairexxx-xx-7438110 2nd Ave.Mekinock, NDGrand Forks58258Case 13-30301 Doc 1 Filed 05/08/13 Entered 05/08/13 10:30:28 Desc Main

Document Page 2 of 47

B1 (Official Form 1)(04/13)Page 2Voluntary Petition(This page must be completed and filed in every case)Name of Debtor(s):All Prior Bankruptcy Cases Filed Within Last 8 Years(If more than two, attach additional sheet)LocationCase Number:Date Filed:Where Filed:LocationCase Number:Date Filed:Where Filed:Pending Bankruptcy Case Filed by any Spouse, Partner, or Affiliate of this Debtor(If more than one, attach additional sheet)Name of Debtor:Case Number:Date Filed:District:Relationship:Judge:Exhibit A(To be completed if debtor is required to file periodic reports (e.g.,forms 10K and 10Q) with the Securities and Exchange Commissionpursuant to Section 13 or 15(d) of the Securities Exchange Act of 1934and is requesting relief under chapter 11.)Exhibit A is attached and made a part of this petition.Exhibit CDoes the debtor own or have possession of any property that poses or is alleged to pose a threat of imminent and identifiable harm to public health or safety?Yes, and Exhibit C is attached and made a part of this petition.No.Exhibit D(To be completed by every individual debtor. If a joint petition is filed, each spouse must complete and attach a separate Exhibit D.)Exhibit D completed and signed by the debtor is attached and made a part of this petition.If this is a joint petition:Exhibit D also completed and signed by the joint debtor is attached and made a part of this petition.Information Regarding the Debtor - Venue(Check any applicable box)Debtor has been domiciled or has had a residence, principal place of business, or principal assets in this District for 180days immediately preceding the date of this petition or for a longer part of such 180 days than in any other District.There is a bankruptcy case concerning debtor's affiliate, general partner, or partnership pending in this District.Debtor is a debtor in a foreign proceeding and has its principal place of business or principal assets in the United States inthis District, or has no principal place of business or assets in the United States but is a defendant in an action orproceeding [in a federal or state court] in this District, or the interests of the parties will be served in regard to the reliefsought in this District.Certification by a Debtor Who Resides as a Tenant of Residential Property(Check all applicable boxes)Landlord has a judgment against the debtor for possession of debtor's residence.(If box checked, complete the following.)(Name of landlord that obtained judgment)(Address of landlord)Debtor claims that under applicable nonbankruptcy law, there are circumstances under which the debtor would be permitted to curethe entire monetary default that gave rise to the judgment for possession, after the judgment for possession was entered, and Debtor has included with this petition the deposit with the court of any rent that would become due during the 30-day periodafter the filing of the petition.Debtor certifies that he/she has served the Landlord with this certification. (11 U.S.C. § 362(l)).Exhibit B(To be completed if debtor is an individual whose debts are primarily consumer debts.)I, the attorney for the petitioner named in the foregoing petition, declare that Ihave informed the petitioner that [he or she] may proceed under chapter 7, 11,12, or 13 of title 11, United States Code, and have explained the relief availableunder each such chapter. I further certify that I delivered to the debtor the noticerequired by 11 U.S.C. §342(b).XSignature of Attorney for Debtor(s)(Date)Smith, Maureen Claire- None -- None -May 8, 2013/s/ Shawn L. AutreyShawn L. AutreyCase 13-30301 Doc 1 Filed 05/08/13 Entered 05/08/13 10:30:28 Desc Main

Document Page 3 of 47

B1 (Official Form 1)(04/13)Page 3Voluntary Petition(This page must be completed and filed in every case)Name of Debtor(s):SignaturesSignature(s) of Debtor(s) (Individual/Joint)I declare under penalty of perjury that the information provided in thispetition is true and correct.[If petitioner is an individual whose debts are primarily consumer debts andhas chosen to file under chapter 7] I am aware that I may proceed underchapter 7, 11, 12, or 13 of title 11, United States Code, understand the reliefavailable under each such chapter, and choose to proceed under chapter 7.[If no attorney represents me and no bankruptcy petition preparer signs thepetition] I have obtained and read the notice required by 11 U.S.C. §342(b).I request relief in accordance with the chapter of title 11, United States Code,specified in this petition.XSignature of DebtorXSignature of Joint DebtorTelephone Number (If not represented by attorney)DateSignature of Attorney*XSignature of Attorney for Debtor(s)Printed Name of Attorney for Debtor(s)Firm NameAddressTelephone NumberDate*In a case in which § 707(b)(4)(D) applies, this signature also constitutes acertification that the attorney has no knowledge after an inquiry that theinformation in the schedules is incorrect.Signature of Debtor (Corporation/Partnership)I declare under penalty of perjury that the information provided in thispetition is true and correct, and that I have been authorized to file this petitionon behalf of the debtor.The debtor requests relief in accordance with the chapter of title 11, UnitedStates Code, specified in this petition.XSignature of Authorized IndividualPrinted Name of Authorized IndividualTitle of Authorized IndividualDateSignature of a Foreign RepresentativeI declare under penalty of perjury that the information provided in this petitionis true and correct, that I am the foreign representative of a debtor in a foreignproceeding, and that I am authorized to file this petition.(Check only one box.)I request relief in accordance with chapter 15 of title 11. United States Code.Certified copies of the documents required by 11 U.S.C. §1515 are attached.Pursuant to 11 U.S.C. §1511, I request relief in accordance with the chapterof title 11 specified in this petition. A certified copy of the order grantingrecognition of the foreign main proceeding is attached.XSignature of Foreign RepresentativePrinted Name of Foreign RepresentativeDateSignature of Non-Attorney Bankruptcy Petition PreparerI declare under penalty of perjury that: (1) I am a bankruptcy petitionpreparer as defined in 11 U.S.C. § 110; (2) I prepared this document forcompensation and have provided the debtor with a copy of this documentand the notices and information required under 11 U.S.C. §§ 110(b),110(h), and 342(b); and, (3) if rules or guidelines have been promulgatedpursuant to 11 U.S.C. § 110(h) setting a maximum fee for serviceschargeable by bankruptcy petition preparers, I have given the debtor noticeof the maximum amount before preparing any document for filing for adebtor or accepting any fee from the debtor, as required in that section.Official Form 19 is attached.Printed Name and title, if any, of Bankruptcy Petition PreparerSocial-Security number (If the bankrutpcy petition preparer is notan individual, state the Social Security number of the officer,principal, responsible person or partner of the bankruptcy petitionpreparer.)(Required by 11 U.S.C. § 110.)AddressXDateSignature of bankruptcy petition preparer or officer, principal, responsibleperson,or partner whose Social Security number is provided above.Names and Social-Security numbers of all other individuals who prepared orassisted in preparing this document unless the bankruptcy petition preparer isnot an individual:If more than one person prepared this document, attach additional sheetsconforming to the appropriate official form for each person.A bankruptcy petition preparer’s failure to comply with the provisions oftitle 11 and the Federal Rules of Bankruptcy Procedure may result infines or imprisonment or both. 11 U.S.C. §110; 18 U.S.C. §156.Smith, Maureen Claire/s/ Maureen Claire SmithMaureen Claire SmithMay 8, 2013/s/ Shawn L. AutreyShawn L. Autrey 05782Autrey Law Firm110 North 3rd StreetGrand Forks, ND 58201May 8, 2013Case 13-30301 Doc 1 Filed 05/08/13 Entered 05/08/13 10:30:28 Desc Main

Document Page 4 of 47

B 1D (Official Form 1, Exhibit D) (12/09)United States Bankruptcy CourtDistrict of North DakotaIn reMaureen Claire SmithCase No.Debtor(s)Chapter7EXHIBIT D - INDIVIDUAL DEBTOR'S STATEMENT OF COMPLIANCE WITHCREDIT COUNSELING REQUIREMENTWarning: You must be able to check truthfully one of the five statements regarding creditcounseling listed below. If you cannot do so, you are not eligible to file a bankruptcy case, and the courtcan dismiss any case you do file. If that happens, you will lose whatever filing fee you paid, and yourcreditors will be able to resume collection activities against you. If your case is dismissed and you fileanother bankruptcy case later, you may be required to pay a second filing fee and you may have to takeextra steps to stop creditors' collection activities.Every individual debtor must file this Exhibit D. If a joint petition is filed, each spouse must completeand file a separate Exhibit D. Check one of the five statements below and attach any documents as directed.(cid:132) 1. Within the 180 days before the filing of my bankruptcy case, I received a briefing from a creditcounseling agency approved by the United States trustee or bankruptcy administrator that outlined theopportunities for available credit counseling and assisted me in performing a related budget analysis, and I havea certificate from the agency describing the services provided to me. Attach a copy of the certificate and a copyof any debt repayment plan developed through the agency.(cid:134) 2. Within the 180 days before the filing of my bankruptcy case, I received a briefing from a creditcounseling agency approved by the United States trustee or bankruptcy administrator that outlined theopportunities for available credit counseling and assisted me in performing a related budget analysis, but I donot have a certificate from the agency describing the services provided to me. You must file a copy of acertificate from the agency describing the services provided to you and a copy of any debt repayment plandeveloped through the agency no later than 14 days after your bankruptcy case is filed.(cid:134) 3. I certify that I requested credit counseling services from an approved agency but was unable toobtain the services during the seven days from the time I made my request, and the following exigentcircumstances merit a temporary waiver of the credit counseling requirement so I can file my bankruptcy casenow. [Summarize exigent circumstances here.]If your certification is satisfactory to the court, you must still obtain the credit counseling briefingwithin the first 30 days after you file your bankruptcy petition and promptly file a certificate from theagency that provided the counseling, together with a copy of any debt management plan developedthrough the agency. Failure to fulfill these requirements may result in dismissal of your case. Anyextension 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 bankruptcycase without first receiving a credit counseling briefing.(cid:134) 4. I am not required to receive a credit counseling briefing because of: [Check the applicablestatement.] [Must be accompanied by a motion for determination by the court.]Software Copyright (c) 1996-2013 CCH INCORPORATED - www.bestcase.comBest Case BankruptcyCase 13-30301 Doc 1 Filed 05/08/13 Entered 05/08/13 10:30:28 Desc Main

Document Page 5 of 47

B 1D (Official Form 1, Exhibit D) (12/09) - Cont.Page 2(cid:134) Incapacity. (Defined in 11 U.S.C. § 109(h)(4) as impaired by reason of mental illness ormental deficiency so as to be incapable of realizing and making rational decisions with respect tofinancial responsibilities.);(cid:134) Disability. (Defined in 11 U.S.C. § 109(h)(4) as physically impaired to the extent of beingunable, after reasonable effort, to participate in a credit counseling briefing in person, by telephone, orthrough the Internet.);(cid:134) Active military duty in a military combat zone.(cid:134) 5. The United States trustee or bankruptcy administrator has determined that the credit counselingrequirement of 11 U.S.C. § 109(h) does not apply in this district.I certify under penalty of perjury that the information provided above is true and correct.Signature of Debtor:/s/ Maureen Claire SmithMaureen Claire SmithDate:May 8, 2013Software Copyright (c) 1996-2013 CCH INCORPORATED - www.bestcase.comBest Case BankruptcyCase 13-30301 Doc 1 Filed 05/08/13 Entered 05/08/13 10:30:28 Desc Main

Document Page 6 of 47

}bk1{Form 6. Summary of Schedules}bk{United States Bankruptcy CourtDistrict of North DakotaIn re,DebtorCase No.Chapter7Maureen Claire SmithB6 Summary (Official Form 6 - Summary) (12/07)Indicate as to each schedule whether that schedule is attached and state the number of pages in each. Report the totals from Schedules A,B, D, E, F, I, and J in the boxes provided. Add the amounts from Schedules A and B to determine the total amount of the debtor’s assets.Add the amounts of all claims from Schedules D, E, and F to determine the total amount of the debtor’s liabilities. Individual debtors mustalso complete the "Statistical Summary of Certain Liabilities and Related Data" if they file a case under chapter 7, 11, or 13.SUMMARY OF SCHEDULESATTACHEDNO. OFNAME OF SCHEDULEASSETSLIABILITIESOTHER(YES/NO)SHEETSA - Real PropertyB - Personal PropertyC - Property Claimed as ExemptD - Creditors Holding Secured ClaimsE - Creditors Holding UnsecuredPriority ClaimsF - Creditors Holding UnsecuredNonpriority ClaimsG - Executory Contracts andUnexpired LeasesH - CodebtorsI -Current Income of IndividualDebtor(s)J -Current Expenditures of IndividualDebtor(s)Total Number of Sheets of ALL SchedulesTotal AssetsTotal Liabilities(Total of Claims on Schedule E)Software Copyright (c) 1996-2013 - CCH INCORPORATED - www.bestcase.comBest Case BankruptcyYesYesYesYesYesYesYesYesYesYes163,200.00428,436.00124,780.0010.00141,247.0021113,235.7424,146.431591,636.0066,027.00Case 13-30301 Doc 1 Filed 05/08/13 Entered 05/08/13 10:30:28 Desc Main

Document Page 7 of 47

}bk1{Form 6. Statistical Summary of Certain Liabilities and Related Data}bk{United States Bankruptcy CourtDistrict of North DakotaIn re,DebtorCase No.Chapter7Maureen Claire SmithForm 6 - Statistical Summary (12/07)STATISTICAL SUMMARY OF CERTAIN LIABILITIES AND RELATED DATA (28 U.S.C. § 159)If you are an individual debtor whose debts are primarily consumer debts, as defined in § 101(8) of the Bankruptcy Code (11 U.S.C.§ 101(8)), filinga case under chapter 7, 11 or 13, you must report all information requested below.Check this box if you are an individual debtor whose debts are NOT primarily consumer debts. You are not required to report any information here.This information is for statistical purposes only under 28 U.S.C. § 159.Summarize the following types of liabilities, as reported in the Schedules, and total them.Type of LiabilityAmountDomestic 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 DecreeObligations Not Reported on Schedule EObligations to Pension or Profit-Sharing, and Other Similar Obligations(from Schedule F)TOTALState the following:Average Income (from Schedule I, Line 16)Average Expenses (from Schedule J, Line 18)Current Monthly Income (from Form 22A Line 12; OR,Form 22B Line 11; OR, Form 22C Line 20 )State the following:1. Total from Schedule D, "UNSECURED PORTION, IF ANY"column2. Total from Schedule E, "AMOUNT ENTITLED TO PRIORITY"column3. Total from Schedule E, "AMOUNT NOT ENTITLED TOPRIORITY, IF ANY" column4. Total from Schedule F5. Total of non-priority unsecured debt (sum of 1, 3, and 4)Software Copyright (c) 1996-2013 - CCH INCORPORATED - www.bestcase.comBest Case Bankruptcy0.000.000.000.000.000.000.003,235.744,146.432,556.062,819.000.000.0041,247.0044,066.00Case 13-30301 Doc 1 Filed 05/08/13 Entered 05/08/13 10:30:28 Desc Main

Document Page 8 of 47

}bk1{Schedule A - Real Property}bk{In re,DebtorCase No.Maureen Claire SmithB6A (Official Form 6A) (12/07)Except as directed below, list all real property in which the debtor has any legal, equitable, or future interest, including all property owned as acotenant, community property, or in which the debtor has a life estate. Include any property in which the debtor holds rights and powers exercisable forthe debtor's own benefit. If the debtor is married, state whether husband, wife, both, or the marital community own the property by placing an "H," "W,""J," or "C" in the column labeled "Husband, Wife, Joint, or Community." If the debtor holds no interest in real property, write "None" under"Description and Location of Property."Do not include interests in executory contracts and unexpired leases on this schedule. List them in Schedule G - Executory Contracts andUnexpired Leases.If an entity claims to have a lien or hold a secured interest in any property, state the amount of the secured claim. See Schedule D. If no entityclaims to hold a secured interest in the property, write "None" in the column labeled "Amount of Secured Claim." If the debtor is an individual orif a joint petition is filed, state the amount of any exemption claimed in the property only in Schedule C - Property Claimed as Exempt.DescriptionandLocationofPropertyNature of Debtor'sInterest in PropertyHusband,Wife,Joint, orCommunityCurrent Value ofDebtor'sInterestinProperty,withoutDeductinganySecuredClaimorExemptionAmountofSecuredClaimcontinuation sheets attached to the Schedule of Real PropertySCHEDULE A - REAL PROPERTYSoftware Copyright (c) 1996-2013 - CCH INCORPORATED - www.bestcase.comBest Case Bankruptcy0PT SE1/4NE1/4BEG ON E LINE SEC 1131.22'N & 32.6'E of NE COR OF L1 BLK 13,MEKINOCK W396.70'S247.22',E396.70',N TO BEG, 1-152-53-63,200.000.00Sub-Total >(Total of this page)63,200.00Total >(Report also on Summary of Schedules)63,200.00Case 13-30301 Doc 1 Filed 05/08/13 Entered 05/08/13 10:30:28 Desc Main

Document Page 9 of 47

}bk1{Schedule B - Personal Property}bk{In re,DebtorCase No.Maureen Claire SmithB6B (Official Form 6B) (12/07)Except as directed below, list all personal property of the debtor of whatever kind. If the debtor has no property in one or more of the categories, placean "x" in the appropriate position in the column labeled "None." If additional space is needed in any category, attach a separate sheet properly identifiedwith the case name, case number, and the number of the category. If the debtor is married, state whether husband, wife, both, or the marital communityown the property by placing an "H," "W," "J," or "C" in the column labeled "Husband, Wife, Joint, or Community." If the debtor is an individual or a jointpetition is filed, state the amount of any exemptions claimed only in Schedule C - Property Claimed as Exempt.Do not list interests in executory contracts and unexpired leases on this schedule. List them in Schedule G - Executory Contracts andUnexpired Leases.If the property is being held for the debtor by someone else, state that person's name and address under "Description and Location of Property."If the property is being held for a minor child, simply state the child's initials and the name and address of the child's parent or guardian, such as"A.B., a minor child, by John Doe, guardian." Do not disclose the child's name. See, 11 U.S.C. §112 and Fed. R. Bankr. P. 1007(m).TypeofPropertyNONEDescriptionandLocationofPropertyHusband,Wife,Joint, orCommunityCurrent Value ofDebtor'sInterestinProperty,withoutDeductinganySecuredClaimorExemptioncontinuationsheetsattachedtotheScheduleofPersonalPropertySCHEDULE B - PERSONAL PROPERTYSoftware Copyright (c) 1996-2013 - CCH INCORPORATED - www.bestcase.comBest Case Bankruptcy31.Cash on handX2.Checking, savings or other financialaccounts, certificates of deposit, orshares in banks, savings and loan,thrift, building and loan, andhomestead associations, or creditunions, brokerage houses, orcooperatives.1st Liberty Federal Credit Union Ck Acct#7043-15$675 & Ssv7043-01 $50GRand Forks, N.D. 58201-725.00Choice Financial Health Savings Account #3760-2,300.00First Liberty Bank checking xxxxxx5220 $110 andchecking xxxxx4463 $290. These accounts are inher sons names but the debtor is a cosignerbecause the kids were minors when the accountswere opened. None of the monies in the accountsare from the debtor or for the debtors use.-400.003.Security deposits with publicutilities, telephone companies,landlords, and others.X4.Household goods and furnishings,including audio, video, andcomputer equipment.washer/dryer, frig, stove, queen bed, king bed, bunkbeds, night stands, 3 TV's, E-Center, VCR (2),Counch/love end/coffee tables, buffett, table/chairs,misc kitchen utensils, micro, lamps 93), lap top(8yrs), computer(10yrs) lawn mower, snow blower,wall & knick knack decor, childrens toys/games-1,200.005.Books, pictures and other artobjects, antiques, stamp, coin,record, tape, compact disc, andother collections or collectibles.X6.Wearing apparel.everyday apparel-200.007.Furs and jewelry.gold chain, mothers ring, misc. costume jewelry-200.008.Firearms and sports, photographic,and other hobby equipment.XSub-Total >(Total of this page)5,025.00Case 13-30301 Doc 1 Filed 05/08/13 Entered 05/08/13 10:30:28 Desc Main

Document Page 10 of 47

B6B (Official Form 6B) (12/07) - Cont.TypeofPropertyNONEDescriptionandLocationofPropertyHusband,Wife,Joint, orCommunityCurrent Value ofDebtor'sInterestinProperty,withoutDeductinganySecuredClaimorExemptionSheetofcontinuationsheetsattachedtotheScheduleofPersonalPropertySCHEDULE B - PERSONAL PROPERTY(Continuation Sheet)Software Copyright (c) 1996-2013 - CCH INCORPORATED - www.bestcase.comBest Case BankruptcyIn re,DebtorCase No.Maureen Claire Smith9.Interests in insurance policies.Name insurance company of eachpolicy and itemize surrender orrefund value of each.X10.Annuities. Itemize and name eachissuer.X11.Interests in an education IRA asdefined in 26 U.S.C. § 530(b)(1) orunder a qualified State tuition planas defined in 26 U.S.C. § 529(b)(1).Give particulars. (File separately therecord(s) of any such interest(s).11 U.S.C. § 521(c).)X12.Interests in IRA, ERISA, Keogh, orother pension or profit sharingplans. Give particulars.X13.Stock and interests in incorporatedand unincorporated businesses.Itemize.X14.Interests in partnerships or jointventures. Itemize.X15.Government and corporate bondsand other negotiable andnonnegotiable instruments.X16.Accounts receivable.X17.Alimony, maintenance, support, andproperty settlements to which thedebtor is or may be entitled. Giveparticulars.X18.Other liquidated debts owed to debtorincluding tax refunds. Give particulars.2013 estimated tax return $4,021 4/12 equals1340.33-1,400.0019.Equitable or future interests, lifeestates, and rights or powersexercisable for the benefit of thedebtor other than those listed inSchedule A - Real Property.XSub-Total >(Total of this page)1,400.0013Case 13-30301 Doc 1 Filed 05/08/13 Entered 05/08/13 10:30:28 Desc Main

Document Page 11 of 47

B6B (Official Form 6B) (12/07) - Cont.TypeofPropertyNONEDescriptionandLocationofPropertyHusband,Wife,Joint, orCommunityCurrent Value ofDebtor'sInterestinProperty,withoutDeductinganySecuredClaimorExemptionSheetofcontinuationsheetsattachedtotheScheduleofPersonalPropertySCHEDULE B - PERSONAL PROPERTY(Continuation Sheet)Software Copyright (c) 1996-2013 - CCH INCORPORATED - www.bestcase.comBest Case BankruptcyIn re,DebtorCase No.Maureen Claire Smith20.Contingent and noncontingentinterests in estate of a decedent,death benefit plan, life insurancepolicy, or trust.X21.Other contingent and unliquidatedclaims of every nature, includingtax refunds, counterclaims of thedebtor, and rights to setoff claims.Give estimated value of each.X22.Patents, copyrights, and otherintellectual property. Giveparticulars.X23.Licenses, franchises, and othergeneral intangibles. Giveparticulars.X24.Customer lists or other compilationscontaining personally identifiableinformation (as defined in 11 U.S.C.§ 101(41A)) provided to the debtorby individuals in connection withobtaining a product or service fromthe debtor primarily for personal,family, or household purposes.X25.Automobiles, trucks, trailers, andother vehicles and accessories.2010 Saturn Vue 62,095mi-15,500.0002 Chevy Silverado 1500 178,848mi-6,461.0026.Boats, motors, and accessories.X27.Aircraft and accessories.X28.Office equipment, furnishings, andsupplies.X29.Machinery, fixtures, equipment, andsupplies used in business.X30.Inventory.X31.Animals.2 dogs, 1 cat-50.0032.Crops - growing or harvested. Giveparticulars.XSub-Total >(Total of this page)22,011.0023Case 13-30301 Doc 1 Filed 05/08/13 Entered 05/08/13 10:30:28 Desc Main

Document Page 12 of 47

B6B (Official Form 6B) (12/07) - Cont.TypeofPropertyNONEDescriptionandLocationofPropertyHusband,Wife,Joint, orCommunityCurrent Value ofDebtor'sInterestinProperty,withoutDeductinganySecuredClaimorExemptionSheetofcontinuationsheetsattachedtotheScheduleofPersonalPropertySCHEDULE B - PERSONAL PROPERTY(Continuation Sheet)Software Copyright (c) 1996-2013 - CCH INCORPORATED - www.bestcase.comBest Case BankruptcyIn re,DebtorCase No.Maureen Claire Smith33.Farming equipment andimplements.X34.Farm supplies, chemicals, and feed.X35.Other personal property of any kindnot already listed. Itemize.XSub-Total >(Total of this page)0.0033Total >(Report also on Summary of Schedules)28,436.00Case 13-30301 Doc 1 Filed 05/08/13 Entered 05/08/13 10:30:28 Desc Main

Document Page 13 of 47

}bk1{Schedule C - Property Claimed as Exempt}bk{In re,DebtorCase No.Maureen Claire SmithB6C (Official Form 6C) (4/13)Debtor claims the exemptions to which debtor is entitled under:Check if debtor claims a homestead exemption that exceeds(Check one box)$155,675.(Amount subject to adjustment on 4/1/16, and every three years thereafterwith respect to cases commenced on or after the date of adjustment.)11 U.S.C. §522(b)(2)11 U.S.C. §522(b)(3)Description of PropertySpecify Law ProvidingEach ExemptionValue ofClaimedExemptionCurrent Value ofProperty WithoutDeducting Exemptioncontinuation sheets attached to Schedule of Property Claimed as ExemptSCHEDULE C - PROPERTY CLAIMED AS EXEMPTSoftware Copyright (c) 1996-2013 - CCH INCORPORATED - www.bestcase.comBest Case Bankruptcy0Real PropertyPT SE1/4NE1/4BEG ON E LINE SEC 1131.22'N & 32.6'E of NE COR OF L1 BLK 13,MEKINOCK W396.70'S247.22',E396.70',N TO BEG, 1-152-5363,200.00N.D. Cent. Code §§ 28-22-02(7),28-22-02(10), 47-18-0163,200.00Checking, Savings, or Other Financial Accounts, Certificates of Deposit1st Liberty Federal Credit Union CkAcct#7043-15 $675 & Ssv7043-01 $50GRand Forks, N.D. 58201725.00N.D. Cent. Code § 28-22-03725.00Choice Financial Health Savings Account#37602,300.00N.D. Cent. Code § 28-22-032,300.00First Liberty Bank checking xxxxxx5220 $110and checking xxxxx4463 $290. These accountsare in her sons names but the debtor is acosigner because the kids were minors whenthe accounts were opened. None of the moniesin the accounts are from the debtor or for thedebtors use.400.00N.D. Cent. Code § 28-22-03400.00Household Goods and Furnishingswasher/dryer, frig, stove, queen bed, king bed,bunk beds, night stands, 3 TV's, E-Center, VCR(2), Counch/love end/coffee tables, buffett,table/chairs, misc kitchen utensils, micro,lamps 93), lap top (8yrs), computer(10yrs) lawnmower, snow blower, wall & knick knack decor,childrens toys/games1,200.00N.D. Cent. Code § 28-22-031,200.00Wearing Appareleveryday apparel200.00N.D. Cent. Code § 28-22-02(5)200.00Furs and Jewelrygold chain, mothers ring, misc. costume jewelry200.00N.D. Cent. Code § 28-22-03200.00Other Liquidated Debts Owing Debtor Including Tax Refund2013 estimated tax return $4,021 4/12 equals1340.331,400.00N.D. Cent. Code § 28-22-031,400.00Automobiles, Trucks, Trailers, and Other Vehicles2010 Saturn Vue 62,095mi15,500.00N.D. Cent. Code § 28-22-03.1(2)1.0002 Chevy Silverado 1500 178,848mi6,461.00N.D. Cent. Code § 28-22-031.00Animals2 dogs, 1 cat50.00N.D. Cent. Code § 28-22-0350.00Total:69,677.0091,636.00Case 13-30301 Doc 1 Filed 05/08/13 Entered 05/08/13 10:30:28 Desc Main

Document Page 14 of 47

}bk1{Schedule D - Creditors Holding Secured Claims}bk{AMOUNT OFCLAIMWITHOUTDEDUCTINGVALUE OFCOLLATERALDATE CLAIM WAS INCURRED,NATURE OF LIEN, ANDDESCRIPTION AND VALUEOF PROPERTYSUBJECT TO LIENCODEBTORCONTINGENTUNLIQUIDATEDDISPUTEDHusband, Wife, Joint, or CommunityHWJCCREDITOR'S NAME AND MAILING ADDRESSINCLUDING ZIP CODE,AND ACCOUNT NUMBER(See instructions above.)Account No.Value $Account No.Value $Account No.Value $Account No.Value $Subtotal_____ continuation sheets attached(Total of this page)UNSECUREDPORTION, IFANYB6D (Official Form 6D) (12/07)State the name, mailing address, including zip code, and last four digits of any account number of all entities holding claims secured by property of the debtor as ofthe date of filing of the petition. The complete account number of any account the debtor has with the creditor is useful to the trustee and the creditor and may be providedif the debtor chooses to do so. List creditors holding all types of secured interests such as judgment liens, garnishments, statutory liens, mortgages, deeds of trust, andother security interests.List creditors in alphabetical order to the extent practicable. If a minor child is a creditor, the child's initials and the name and address of the child's parent or guardian, such as "A.B., a minor child, by John Doe, guardian." Do not disclose the child's name. See, 11 U.S.C. §112 and Fed. R. Bankr. P. 1007(m). If all secured creditors will not fit on this page, use the continuation sheet provided. If any entity other than a spouse in a joint case may be jointly liable on a claim, place an "X" in the column labeled "Codebtor" ,include the entity on the appropriateschedule of creditors, and complete Schedule H - Codebtors. If a joint petition is filed, state whether the husband, wife, both of them, or the marital community may beliable on each claim by placing an "H", "W", "J", or "C" in the column labeled "Husband, Wife, Joint, or Community".If the claim is contingent, place an "X" in the column labeled "Contingent". If the claim is unliquidated, place an "X" in the column labeled "Unliquidated". If theclaim is disputed, place an "X" in the column labeled "Disputed". (You may need to place an "X" in more than one of these three columns.)Total the columns labeled "Amount of Claim Without Deducting Value of Collateral" and "Unsecured Portion, if Any" in the boxes labeled "Total(s)" on the lastsheet of the completed schedule. Report the total from the column labeled "Amount of Claim" also on the Summary of Schedules and, if the debtor is an individual withprimarily consumer debts, report the total from the column labeled "Unsecured Portion" on the Statistical Summary of Certain Liabilities and Related Data.Check this box if debtor has no creditors holding secured claims to report on this Schedule D.SCHEDULE D - CREDITORS HOLDING SECURED CLAIMSSoftware Copyright (c) 1996-2013 - CCH INCORPORATED - www.bestcase.comBest Case BankruptcyIn re,DebtorCase No.Maureen Claire Smith03770430005Opened 9/01/11 Last Active 3/25/132010 Saturn Vue 62,095mi1st Liberty Fed CreditP.o. Box 5002Great Falls, MT 59403-16,035.00535.0015,500.00815994001Opened 2/01/12 Last Active 3/04/1302 Chevy Silverado 1500 178,848miAlerus Financial2300 S Columbia RdGrand Forks, ND 58201-8,745.002,284.006,461.0024,780.002,819.0024,780.002,819.00Total(Report on Summary of Schedules)Case 13-30301 Doc 1 Filed 05/08/13 Entered 05/08/13 10:30:28 Desc Main

Document Page 15 of 47

}bk1{Schedule E - Creditors Holding Unsecured Priority Claims}bk{B6E (Official Form 6E) (4/13)A complete list of claims entitled to priority, listed separately by type of priority, is to be set forth on the sheets provided. Only holders of unsecured claims entitledto priority should be listed in this schedule. In the boxes provided on the attached sheets, state the name, mailing address, including zip code, and last four digits of theaccount number, if any, of all entities holding priority claims against the debtor or the property of the debtor, as of the date of the filing of the petition. Use a separatecontinuation sheet for each type of priority and label each with the type of priority.The complete account number of any account the debtor has with the creditor is useful to the trustee and the creditor and may be provided if the debtor chooses to doso. If a minor child is a creditor, state the child's initials and the name and address of the child's parent or guardian, such as "A.B., a minor child, by John Doe, guardian." Do not disclose the child's name. See, 11 U.S.C. §112 and Fed. R. Bankr. P. 1007(m). If any entity other than a spouse in a joint case may be jointly liable on a claim, place an "X" in the column labeled "Codebtor," include the entity on the appropriateschedule of creditors, and complete Schedule H-Codebtors. If a joint petition is filed, state whether the husband, wife, both of them, or the marital community may beliable on each claim by placing an "H," "W," "J," or "C" in the column labeled "Husband, Wife, Joint, or Community." If the claim is contingent, place an "X" in thecolumn labeled "Contingent." If the claim is unliquidated, place an "X" in the column labeled "Unliquidated." If the claim is disputed, place an "X" in the column labeled"Disputed." (You may need to place an "X" in more than one of these three columns.)Report the total of claims listed on each sheet in the box labeled "Subtotals" on each sheet. Report the total of all claims listed on this Schedule E in the box labeled"Total" on the last sheet of the completed schedule. Report this total also on the Summary of Schedules.Report the total of amounts entitled to priority listed on each sheet in the box labeled "Subtotals" on each sheet. Report the total of all amounts entitled to prioritylisted on this Schedule E in the box labeled "Totals" on the last sheet of the completed schedule. Individual debtors with primarily consumer debts report this total also on the Statistical Summary of Certain Liabilities and Related Data.Report the total of amounts not entitled to priority listed on each sheet in the box labeled "Subtotals" on each sheet. Report the total of all amounts not entitled topriority listed on this Schedule E in the box labeled "Totals" on the last sheet of the completed schedule. Individual debtors with primarily consumer debts report this total also on the Statistical Summary of Certain Liabilities and Related Data.Check this box if debtor has no creditors holding unsecured priority claims to report on this Schedule E.TYPES OF PRIORITY CLAIMS(Check the appropriate box(es) below if claims in that category are listed on the attached sheets)Domestic support obligationsClaims 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 caseClaims 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 commissionsWages, salaries, and commissions, including vacation, severance, and sick leave pay owing to employees and commissions owing to qualifying independent salesrepresentatives up to $12,475* per person earned within 180 days immediately preceding the filing of the original petition, or the cessation of business, whicheveroccurred first, to the extent provided in 11 U.S.C. § 507(a)(4).Contributions to employee benefit plansMoney 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 fishermenClaims of certain farmers and fishermen, up to $6,150* per farmer or fisherman, against the debtor, as provided in 11 U.S.C. § 507(a)(6).Deposits by individualsClaims of individuals up to $2,775* for deposits for the purchase, lease, or rental of property or services for personal, family, or household use, that were not delivered or provided. 11 U.S.C. § 507(a)(7).Taxes and certain other debts owed to governmental unitsTaxes, 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 institutionClaims based on commitments to the FDIC, RTC, Director of the Office of Thrift Supervision, Comptroller of the Currency, or Board of Governors of the FederalReserve System, or their predecessors or successors, to maintain the capital of an insured depository institution. 11 U.S.C. § 507 (a)(9).Claims for death or personal injury while debtor was intoxicatedClaims 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).* Amount subject to adjustment on 4/01/16, and every three years thereafter with respect to cases commenced on or after the date of adjustment.continuation sheets attachedSCHEDULE E - CREDITORS HOLDING UNSECURED PRIORITY CLAIMSSoftware Copyright (c) 1996-2013 - CCH INCORPORATED - www.bestcase.comBest Case BankruptcyIn re,DebtorCase No.Maureen Claire Smith0Case 13-30301 Doc 1 Filed 05/08/13 Entered 05/08/13 10:30:28 Desc Main

Document Page 16 of 47

}bk1{Schedule F - Creditors Holding Unsecured Nonpriority Claims}bk{CODEBTORCONTINGENTUNLIQUIDATEDDISPUTEDHusband, Wife, Joint, or CommunityHWJCCREDITOR'S NAME,MAILING ADDRESSINCLUDING ZIP CODE,AND ACCOUNT NUMBER(See instructions above.)Account No.Account No.Account No.Account No.Subtotal_____ continuation sheets attached(Total of this page)DATE CLAIM WAS INCURRED ANDCONSIDERATION FOR CLAIM. IF CLAIMIS SUBJECT TO SETOFF, SO STATE.AMOUNT OF CLAIMB6F (Official Form 6F) (12/07)State the name, mailing address, including zip code, and last four digits of any account number, of all entities holding unsecured claims without priority against thedebtor or the property of the debtor, as of the date of filing of the petition. The complete account number of any account the debtor has with the creditor is useful to thetrustee and the creditor and may be provided if the debtor chooses to do so. If a minor child is a creditor, state the child's initials and the name and address of the child's parent or guardian, such as "A.B., a minor child, by John Doe, guardian." Do not disclose the child's name. See, 11 U.S.C. §112 and Fed. R. Bankr. P. 1007(m). Do not include claims listed in Schedules D and E. If all creditors will not fit on this page, use the continuation sheet provided. If any entity other than a spouse in a joint case may be jointly liable on a claim, place an "X" in the column labeled "Codebtor," include the entity on the appropriateschedule of creditors, and complete Schedule H - Codebtors. If a joint petition is filed, state whether the husband, wife, both of them, or the marital community may beliable on each claim by placing an "H," "W," "J," or "C" in the column labeled "Husband, Wife, Joint, or Community."If the claim is contingent, place an "X" in the column labeled "Contingent." If the claim is unliquidated, place an "X" in the column labeled "Unliquidated." If theclaim is disputed, place an "X" in the column labeled "Disputed." (You may need to place an "X" in more than one of these three columns.)Report the total of all claims listed on this schedule in the box labeled "Total" on the last sheet of the completed schedule. Report this total also on the Summary ofSchedules and, if the debtor is an individual with primarily consumer debts, report this total also on the Statistical Summary of Certain Liabilities and Related Data.Check this box if debtor has no creditors holding unsecured claims to report on this Schedule F.S/N:31857-130502SCHEDULE F - CREDITORS HOLDING UNSECURED NONPRIORITY CLAIMSSoftware Copyright (c) 1996-2013 - CCH INCORPORATED - www.bestcase.comBest Case BankruptcyIn re,DebtorCase No.Maureen Claire Smith13770430004Opened 9/01/11 Last Active 3/25/13Unsecured1st Liberty Fed CreditP.o. Box 5002Great Falls, MT 59403-6,273.00medAltru Health SystemP.O. Box 6002Grand Forks, ND 58206-6002-UnknownCabella's Club VisaP.O. Box 82519Lincoln, NE 68501-2519-3,995.00420611905133654Opened 11/01/11 Last Active 1/13/13Charge AccountCap1/polrsPo Box 30253Salt Lake City, UT 84130-6,667.0016,935.00Case 13-30301 Doc 1 Filed 05/08/13 Entered 05/08/13 10:30:28 Desc Main

Document Page 17 of 47

B6F (Official Form 6F) (12/07) - Cont.CODEBTORCONTINGENTUNLIQUIDATEDDISPUTEDHusband, Wife, Joint, or CommunityHWJCCREDITOR'S NAME,MAILING ADDRESSINCLUDING ZIP CODE,AND ACCOUNT NUMBER(See instructions above.)Account No.Account No.Account No.Account No.Account No.Sheet no. _____ of _____ sheets attached to Schedule ofSubtotalCreditors Holding Unsecured Nonpriority Claims(Total of this page)DATE CLAIM WAS INCURRED ANDCONSIDERATION FOR CLAIM. IF CLAIMIS SUBJECT TO SETOFF, SO STATE.AMOUNT OF CLAIMSCHEDULE F - CREDITORS HOLDING UNSECURED NONPRIORITY CLAIMS(Continuation Sheet)Software Copyright (c) 1996-2013 - CCH INCORPORATED - www.bestcase.comBest Case BankruptcyIn re,DebtorCase No.Maureen Claire Smith5424180837029518Opened 3/01/89 Last Active 4/01/04Credit CardCitibank Sd, NaAttn: Centralized BankruptcyPo Box 20363Kansas City, MO 64195-Unknown6019183250112281Opened 12/01/12 Last Active 1/18/13Charge AccountGecrb/Care CreditAttn: bankruptcyPo Box 103104Roswell, GA 30076-192.007714100192227437Opened 2/01/03 Last Active 2/03/13Charge AccountSams Club / GEMBAttention: Bankruptcy DepartmentPo Box 103104Roswell, GA 30076-5,153.005121079724076523Opened 10/01/02 Last Active 2/11/13Credit CardSears/cbnaPo Box 6282Sioux Falls, SD 57117-14,950.004300230171909320Opened 4/01/11 Last Active 2/06/13Credit CardWfb-ne (Worlds Foremost Bank)Po Box 82609Lincoln, NE 68501-4,017.0024,312.001141,247.00Total(Report on Summary of Schedules)Case 13-30301 Doc 1 Filed 05/08/13 Entered 05/08/13 10:30:28 Desc Main

Document Page 18 of 47

}bk1{Schedule G - Executory Contracts and Unexpired Leases}bk{In re,DebtorCase No.Maureen Claire SmithB6G (Official Form 6G) (12/07)Describe all executory contracts of any nature and all unexpired leases of real or personal property. Include any timeshare interests. State natureof debtor's interest in contract, i.e., "Purchaser", "Agent", etc. State whether debtor is the lessor or lessee of a lease. Provide the names andcomplete mailing addresses of all other parties to each lease or contract described. If a minor child is a party to one of the leases or contracts, state the child's initials and the name and address of the child's parent or guardian, such as "A.B., a minor child, by John Doe, guardian." Do not disclose the child's name. See, 11 U.S.C. §112 and Fed. R. Bankr. P. 1007(m). Check this box if debtor has no executory contracts or unexpired leases.Name and Mailing Address, Including Zip Code,of Other Parties to Lease or ContractDescription of Contract or Lease and Nature of Debtor's Interest.State whether lease is for nonresidential real property.State contract number of any government contract.continuation sheets attached to Schedule of Executory Contracts and Unexpired LeasesSCHEDULE G - EXECUTORY CONTRACTS AND UNEXPIRED LEASESSoftware Copyright (c) 1996-2013 - CCH INCORPORATED - www.bestcase.comBest Case Bankruptcy0Case 13-30301 Doc 1 Filed 05/08/13 Entered 05/08/13 10:30:28 Desc Main

Document Page 19 of 47

}bk1{Schedule H - Codebtors}bk{In re,DebtorCase No.Maureen Claire SmithB6H (Official Form 6H) (12/07)Provide the information requested concerning any person or entity, other than a spouse in a joint case, that is also liable on any debts listedby debtor in the schedules of creditors. Include all guarantors and co-signers. If the debtor resides or resided in a community property state,commonwealth, or territory (including Alaska, Arizona, California, Idaho, Louisiana, Nevada, New Mexico, Puerto Rico, Texas, Washington, orWisconsin) within the eight year period immediately preceding the commencement of the case, identify the name of the debtor's spouse and ofany former spouse who resides or resided with the debtor in the community property state, commonwealth, or territory. Include all names usedby the nondebtor spouse during the eight years immediately preceding the commencement of this case. If a minor child is a codebtor or a creditor, state the child's initials and the name and address of the child's parent or guardian, such as "A.B., a minor child, by John Doe, guardian." Do not disclose the child's name. See, 11 U.S.C. §112 and Fed. R. Bankr. P. 1007(m). Check this box if debtor has no codebtors.NAME AND ADDRESS OF CODEBTORNAME AND ADDRESS OF CREDITORcontinuationsheetsattachedtoScheduleofCodebtorsSCHEDULE H - CODEBTORSSoftware Copyright (c) 1996-2013 - CCH INCORPORATED - www.bestcase.comBest Case Bankruptcy0Case 13-30301 Doc 1 Filed 05/08/13 Entered 05/08/13 10:30:28 Desc Main

Document Page 20 of 47

B6I (Official Form 6I) (12/07)In reMaureen Claire SmithCase No.Debtor(s)SCHEDULE I - CURRENT INCOME OF INDIVIDUAL DEBTOR(S)The column labeled "Spouse" must be completed in all cases filed by joint debtors and by every married debtor, whether or not a joint petition isfiled, unless the spouses are separated and a joint petition is not filed. Do not state the name of any minor child. The average monthly incomecalculated on this form may differ from the current monthly income calculated on Form 22A, 22B, or 22C.Debtor's Marital Status:DEPENDENTS OF DEBTOR AND SPOUSEDivorcedRELATIONSHIP(S):sonsonAGE(S):1818Employment:DEBTORSPOUSEOccupationDirect supportName of EmployerAnne Carlson's CenterHow long employed4 yrsAddress of Employer701 3rd St NWGrand Forks, ND 58201INCOME: (Estimate of average or projected monthly income at time case filed)DEBTORSPOUSE1. Monthly gross wages, salary, and commissions (Prorate if not paid monthly)$2,273.68$N/A2. Estimate monthly overtime$0.00$N/A3. SUBTOTAL$2,273.68$N/A4. LESS PAYROLL DEDUCTIONSa. Payroll taxes and social security$339.60$N/Ab. Insurance$198.34$N/Ac. Union dues$0.00$N/Ad. Other (Specify):$0.00$N/A$0.00$N/A5. SUBTOTAL OF PAYROLL DEDUCTIONS$537.94$N/A6. TOTAL NET MONTHLY TAKE HOME PAY$1,735.74$N/A7. Regular income from operation of business or profession or farm (Attach detailed statement)$0.00$N/A8. Income from real property$0.00$N/A9. Interest and dividends$0.00$N/A10. Alimony, maintenance or support payments payable to the debtor for the debtor's use or that ofdependents listed above$1,500.00$N/A11. Social security or government assistance(Specify):$0.00$N/A$0.00$N/A12. Pension or retirement income$0.00$N/A13. Other monthly income(Specify):$0.00$N/A$0.00$N/A14. SUBTOTAL OF LINES 7 THROUGH 13$1,500.00$N/A15. AVERAGE MONTHLY INCOME (Add amounts shown on lines 6 and 14)$3,235.74$N/A16. COMBINED AVERAGE MONTHLY INCOME: (Combine column totals from line 15)$3,235.74(Report also on Summary of Schedules and, if applicable, onStatistical 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:Case 13-30301 Doc 1 Filed 05/08/13 Entered 05/08/13 10:30:28 Desc Main

Document Page 21 of 47

B6J (Official Form 6J) (12/07)In reMaureen Claire SmithCase No.Debtor(s)SCHEDULE J - CURRENT EXPENDITURES OF INDIVIDUAL DEBTOR(S)Complete this schedule by estimating the average or projected monthly expenses of the debtor and the debtor's family at timecase filed. Prorate any payments made bi-weekly, quarterly, semi-annually, or annually to show monthly rate. The average monthlyexpenses calculated on this form may differ from the deductions from income allowed on Form 22A or 22C.(cid:134)Check this box if a joint petition is filed and debtor's spouse maintains a separate household. Complete a separate schedule ofexpenditures labeled "Spouse."1. Rent or home mortgage payment (include lot rented for mobile home)$0.00 a. Are real estate taxes included?Yes No X b. Is property insurance included?Yes No X 2. Utilities:a. Electricity and heating fuel$600.00b. Water and sewer$45.00c. Telephone$350.00d. OtherSee Detailed Expense Attachment$131.143. Home maintenance (repairs and upkeep)$125.004. Food$650.005. Clothing$100.006. Laundry and dry cleaning$50.007. Medical and dental expenses$150.008. Transportation (not including car payments)$300.009. Recreation, clubs and entertainment, newspapers, magazines, etc.$100.0010. Charitable contributions$0.0011. Insurance (not deducted from wages or included in home mortgage payments)a. Homeowner's or renter's$115.72b. Life$0.00c. Health$393.00d. Auto$174.20e. Other$0.0012. Taxes (not deducted from wages or included in home mortgage payments)(Specify)Property tax avg mthly$63.0013. Installment payments: (In chapter 11, 12, and 13 cases, do not list payments to be included in theplan)a. Auto$322.79b. OtherSilverado P/U pymt$255.23c. Other$0.0014. Alimony, maintenance, and support paid to others$0.0015. Payments for support of additional dependents not living at your home$0.0016. Regular expenses from operation of business, profession, or farm (attach detailed statement)$0.0017. OtherSee Detailed Expense Attachment$221.3518. AVERAGE MONTHLY EXPENSES (Total lines 1-17. Report also on Summary of Schedules and,if applicable, on the Statistical Summary of Certain Liabilities and Related Data.)$4,146.4319. Describe any increase or decrease in expenditures reasonably anticipated to occur within the yearfollowing the filing of this document:20. STATEMENT OF MONTHLY NET INCOMEa.Average monthly income from Line 15 of Schedule I$3,235.74b.Average monthly expenses from Line 18 above$4,146.43c.Monthly net income (a. minus b.)$-910.69Case 13-30301 Doc 1 Filed 05/08/13 Entered 05/08/13 10:30:28 Desc Main

Document Page 22 of 47

B6J (Official Form 6J) (12/07)In reMaureen Claire SmithCase No.Debtor(s)SCHEDULE J - CURRENT EXPENDITURES OF INDIVIDUAL DEBTOR(S)Detailed Expense AttachmentOther Utility Expenditures:Dish TV$96.14Trash P/U$35.00Total Other Utility Expenditures$131.14Other Expenditures:Sport fee annual 100 mthly budget$8.35Lunch program$88.00misc. oil changes, registration, grooming$125.00Total Other Expenditures$221.35Case 13-30301 Doc 1 Filed 05/08/13 Entered 05/08/13 10:30:28 Desc Main

Document Page 23 of 47

B6 Declaration (Official Form 6 - Declaration). (12/07)United States Bankruptcy CourtDistrict of North DakotaIn reMaureen Claire SmithCase No.Debtor(s)Chapter7DECLARATION CONCERNING DEBTOR'S SCHEDULESDECLARATION UNDER PENALTY OF PERJURY BY INDIVIDUAL DEBTORI declare under penalty of perjury that I have read the foregoing summary and schedules, consisting of 17 sheets, and that they are true and correct to the best of my knowledge, information, and belief.DateMay 8, 2013Signature/s/ Maureen Claire SmithMaureen Claire SmithDebtorPenalty 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.Software Copyright (c) 1996-2013 CCH INCORPORATED - www.bestcase.comBest Case BankruptcyCase 13-30301 Doc 1 Filed 05/08/13 Entered 05/08/13 10:30:28 Desc Main

Document Page 24 of 47

B7 (Official Form 7) (04/13)United States Bankruptcy CourtDistrict of North DakotaIn reMaureen Claire SmithCase No.Debtor(s)Chapter7STATEMENT OF FINANCIAL AFFAIRSThis statement is to be completed by every debtor. Spouses filing a joint petition may file a single statement on which the information forboth spouses is combined. If the case is filed under chapter 12 or chapter 13, a married debtor must furnish information for both spouses whether ornot a joint petition is filed, unless the spouses are separated and a joint petition is not filed. An individual debtor engaged in business as a soleproprietor, partner, family farmer, or self-employed professional, should provide the information requested on this statement concerning all suchactivities as well as the individual's personal affairs. To indicate payments, transfers and the like to minor children, state the child's initials and thename and address of the child's parent or guardian, such as "A.B., a minor child, by John Doe, guardian." Do not disclose the child's name. See, 11U.S.C. § 112; Fed. R. Bankr. P. 1007(m).Questions 1 - 18 are to be completed by all debtors. Debtors that are or have been in business, as defined below, also must completeQuestions 19 - 25. If the answer to an applicable question is "None," mark the box labeled "None." If additional space is needed for the answerto any question, use and attach a separate sheet properly identified with the case name, case number (if known), and the number of the question.DEFINITIONS"In business." A debtor is "in business" for the purpose of this form if the debtor is a corporation or partnership. An individual debtor is "inbusiness" for the purpose of this form if the debtor is or has been, within six years immediately preceding the filing of this bankruptcy case, any ofthe following: an officer, director, managing executive, or owner of 5 percent or more of the voting or equity securities of a corporation; a partner,other than a limited partner, of a partnership; a sole proprietor or self-employed full-time or part-time. An individual debtor also may be "in business"for the purpose of this form if the debtor engages in a trade, business, or other activity, other than as an employee, to supplement income from thedebtor's primary employment."Insider." The term "insider" includes but is not limited to: relatives of the debtor; general partners of the debtor and their relatives;corporations of which the debtor is an officer, director, or person in control; officers, directors, and any persons in control of a corporate debtor andtheir relatives; affiliates of the debtor and insiders of such affiliates; and any managing agent of the debtor. 11 U.S.C. § 101(2), (31).None(cid:134)1. Income from employment or operation of businessState the gross amount of income the debtor has received from employment, trade, or profession, or from operation of the debtor'sbusiness, including part-time activities either as an employee or in independent trade or business, from the beginning of this calendaryear to the date this case was commenced. State also the gross amounts received during the two years immediately preceding thiscalendar year. (A debtor that maintains, or has maintained, financial records on the basis of a fiscal rather than a calendar year mayreport fiscal year income. Identify the beginning and ending dates of the debtor's fiscal year.) If a joint petition is filed, state income foreach spouse separately. (Married debtors filing under chapter 12 or chapter 13 must state income of both spouses whether or not a jointpetition is filed, unless the spouses are separated and a joint petition is not filed.)AMOUNTSOURCE$22,735.002011' Debtor income/wages$26,683.002012' Debtor income/wages$6,269.392013' Debtor income/wages to dateNone(cid:132)2. Income other than from employment or operation of businessState the amount of income received by the debtor other than from employment, trade, profession, or operation of the debtor's businessduring the two years immediately preceding the commencement of this case. Give particulars. If a joint petition is filed, state income foreach spouse separately. (Married debtors filing under chapter 12 or chapter 13 must state income for each spouse whether or not a jointpetition is filed, unless the spouses are separated and a joint petition is not filed.)AMOUNTSOURCESoftware Copyright (c) 1996-2013 CCH INCORPORATED - www.bestcase.comBest Case BankruptcyCase 13-30301 Doc 1 Filed 05/08/13 Entered 05/08/13 10:30:28 Desc Main

Document Page 25 of 47

B7 (Official Form 7) (04/13)2None(cid:132)3. Payments to creditorsComplete 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 orservices, and other debts to any creditor made within 90 days immediately preceding the commencement of this case unless theaggregate value of all property that constitutes or is affected by such transfer is less than $600. Indicate with an asterisk (*) anypayments that were made to a creditor on account of a domestic support obligation or as part of an alternative repayment schedule undera plan by an approved nonprofit budgeting and credit counseling agency. (Married debtors filing under chapter 12 or chapter 13 mustinclude payments by either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition isnot filed.)NAME AND ADDRESSOF CREDITORDATES OFPAYMENTSAMOUNT PAIDAMOUNT STILLOWINGNone(cid:132)b.Debtor whose debts are not primarily consumer debts: List each payment or other transfer to any creditor made within 90 daysimmediately preceding the commencement of the case unless the aggregate value of all property that constitutes or is affected by suchtransfer is less than $6,225*. If the debtor is an individual, indicate with an asterisk (*) any payments that were made to a creditor onaccount of a domestic support obligation or as part of an alternative repayment schedule under a plan by an approved nonprofitbudgeting and credit counseling agency. (Married debtors filing under chapter 12 or chapter 13 must include payments and othertransfers by either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is notfiled.)NAME AND ADDRESS OF CREDITORDATES OFPAYMENTS/TRANSFERSAMOUNTPAID ORVALUE OFTRANSFERSAMOUNT STILLOWINGNone(cid:132)c. All debtors: List all payments made within one year immediately preceding the commencement of this case to or for the benefit ofcreditors who are or were insiders. (Married debtors filing under chapter 12 or chapter 13 must include payments by either or bothspouses 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 ANDRELATIONSHIP TO DEBTORDATE OF PAYMENTAMOUNT PAIDAMOUNT STILLOWINGNone(cid:132)4. Suits and administrative proceedings, executions, garnishments and attachmentsa. List all suits and administrative proceedings to which the debtor is or was a party within one year immediately preceding the filing ofthis bankruptcy case. (Married debtors filing under chapter 12 or chapter 13 must include information concerning either or both spouseswhether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.)CAPTION OF SUITAND CASE NUMBERNATURE OFPROCEEDINGCOURT OR AGENCYAND LOCATIONSTATUS ORDISPOSITIONNone(cid:132)b. Describe all property that has been attached, garnished or seized under any legal or equitable process within one year immediatelypreceding the commencement of this case. (Married debtors filing under chapter 12 or chapter 13 must include information concerningproperty of either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is notfiled.)NAME AND ADDRESS OF PERSON FOR WHOSEBENEFIT PROPERTY WAS SEIZEDDATE OF SEIZUREDESCRIPTION AND VALUE OFPROPERTY * Amount subject to adjustment on 4/01/16, and every three years thereafter with respect to cases commenced on or after the date of adjustment.Software Copyright (c) 1996-2013 CCH INCORPORATED - www.bestcase.comBest Case BankruptcyCase 13-30301 Doc 1 Filed 05/08/13 Entered 05/08/13 10:30:28 Desc Main

Document Page 26 of 47

B7 (Official Form 7) (04/13)3None(cid:132)5. Repossessions, foreclosures and returnsList all property that has been repossessed by a creditor, sold at a foreclosure sale, transferred through a deed in lieu of foreclosure orreturned to the seller, within one year immediately preceding the commencement of this case. (Married debtors filing under chapter 12or chapter 13 must include information concerning property of either or both spouses whether or not a joint petition is filed, unless thespouses are separated and a joint petition is not filed.)NAME AND ADDRESS OFCREDITOR OR SELLERDATE OF REPOSSESSION,FORECLOSURE SALE,TRANSFER OR RETURNDESCRIPTION AND VALUE OFPROPERTYNone(cid:132)6. Assignments and receivershipsa. Describe any assignment of property for the benefit of creditors made within 120 days immediately preceding the commencement ofthis case. (Married debtors filing under chapter 12 or chapter 13 must include any assignment by either or both spouses whether or not ajoint petition is filed, unless the spouses are separated and a joint petition is not filed.)NAME AND ADDRESS OF ASSIGNEEDATE OFASSIGNMENTTERMS OF ASSIGNMENT OR SETTLEMENTNone(cid:132)b. List all property which has been in the hands of a custodian, receiver, or court-appointed official within one year immediatelypreceding the commencement of this case. (Married debtors filing under chapter 12 or chapter 13 must include information concerningproperty of either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is notfiled.)NAME AND ADDRESSOF CUSTODIANNAME AND LOCATIONOF COURTCASE TITLE & NUMBERDATE OFORDERDESCRIPTION AND VALUE OFPROPERTYNone(cid:132)7. GiftsList all gifts or charitable contributions made within one year immediately preceding the commencement of this case except ordinaryand usual gifts to family members aggregating less than $200 in value per individual family member and charitable contributionsaggregating less than $100 per recipient. (Married debtors filing under chapter 12 or chapter 13 must include gifts or contributions byeither 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 OFPERSON OR ORGANIZATIONRELATIONSHIP TODEBTOR, IF ANYDATE OF GIFTDESCRIPTION ANDVALUE OF GIFTNone(cid:132)8. LossesList all losses from fire, theft, other casualty or gambling within one year immediately preceding the commencement of this case orsince the commencement of this case. (Married debtors filing under chapter 12 or chapter 13 must include losses by either or bothspouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.)DESCRIPTION AND VALUEOF PROPERTYDESCRIPTION OF CIRCUMSTANCES AND, IFLOSS WAS COVERED IN WHOLE OR IN PARTBY INSURANCE, GIVE PARTICULARSDATE OF LOSSNone(cid:134)9. Payments related to debt counseling or bankruptcyList all payments made or property transferred by or on behalf of the debtor to any persons, including attorneys, for consultationconcerning debt consolidation, relief under the bankruptcy law or preparation of the petition in bankruptcy within one year immediatelypreceding the commencement of this case.NAME AND ADDRESSOF PAYEEDATE OF PAYMENT,NAME OF PAYER IF OTHERTHAN DEBTORAMOUNT OF MONEYOR DESCRIPTION AND VALUEOF PROPERTYAutrey Law Firm110 North 3rd StreetGrand Forks, ND 582013/28/13 $1,056Software Copyright (c) 1996-2013 CCH INCORPORATED - www.bestcase.comBest Case BankruptcyCase 13-30301 Doc 1 Filed 05/08/13 Entered 05/08/13 10:30:28 Desc Main

Document Page 27 of 47

B7 (Official Form 7) (04/13)4None(cid:132)10. Other transfersa. 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 debtorsfiling under chapter 12 or chapter 13 must include transfers by either or both spouses whether or not a joint petition is filed, unless thespouses are separated and a joint petition is not filed.)NAME AND ADDRESS OF TRANSFEREE,RELATIONSHIP TO DEBTORDATEDESCRIBE PROPERTY TRANSFERREDAND VALUE RECEIVEDNone(cid:132)b. List all property transferred by the debtor within ten years immediately preceding the commencement of this case to a self-settledtrust or similar device of which the debtor is a beneficiary.NAME OF TRUST OR OTHERDEVICEDATE(S) OFTRANSFER(S)AMOUNT OF MONEY OR DESCRIPTION ANDVALUE OF PROPERTY OR DEBTOR'S INTERESTIN PROPERTYNone(cid:132)11. Closed financial accountsList all financial accounts and instruments held in the name of the debtor or for the benefit of the debtor which were closed, sold, orotherwise transferred within one year immediately preceding the commencement of this case. Include checking, savings, or otherfinancial 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 mustinclude 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 INSTITUTIONTYPE OF ACCOUNT, LAST FOURDIGITS OF ACCOUNT NUMBER,AND AMOUNT OF FINAL BALANCEAMOUNT AND DATE OF SALEOR CLOSINGNone(cid:132)12. Safe deposit boxesList each safe deposit or other box or depository in which the debtor has or had securities, cash, or other valuables within one yearimmediately preceding the commencement of this case. (Married debtors filing under chapter 12 or chapter 13 must include boxes ordepositories of either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is notfiled.)NAME AND ADDRESS OF BANKOR OTHER DEPOSITORYNAMES AND ADDRESSESOF THOSE WITH ACCESSTO BOX OR DEPOSITORYDESCRIPTIONOF CONTENTSDATE OF TRANSFER ORSURRENDER, IF ANYNone(cid:132)13. SetoffsList all setoffs made by any creditor, including a bank, against a debt or deposit of the debtor within 90 days preceding thecommencement of this case. (Married debtors filing under chapter 12 or chapter 13 must include information concerning either or bothspouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.)NAME AND ADDRESS OF CREDITORDATE OF SETOFFAMOUNT OF SETOFFNone(cid:132)14. Property held for another personList all property owned by another person that the debtor holds or controls.NAME AND ADDRESS OF OWNERDESCRIPTION AND VALUE OF PROPERTYLOCATION OF PROPERTYSoftware Copyright (c) 1996-2013 CCH INCORPORATED - www.bestcase.comBest Case BankruptcyCase 13-30301 Doc 1 Filed 05/08/13 Entered 05/08/13 10:30:28 Desc Main

Document Page 28 of 47

B7 (Official Form 7) (04/13)5None(cid:132)15. Prior address of debtorIf the debtor has moved within three years immediately preceding the commencement of this case, list all premises which the debtoroccupied during that period and vacated prior to the commencement of this case. If a joint petition is filed, report also any separateaddress of either spouse.ADDRESSNAME USEDDATES OF OCCUPANCYNone(cid:132)16. Spouses and Former SpousesIf 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 thecommencement of the case, identify the name of the debtor’s spouse and of any former spouse who resides or resided with the debtor inthe community property state.NAME17. 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 hazardousor 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 oroperated 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 LawNone(cid:132)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 liableor 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 ADDRESSNAME AND ADDRESS OFGOVERNMENTAL UNITDATE OFNOTICEENVIRONMENTALLAWNone(cid:132)b. List the name and address of every site for which the debtor provided notice to a governmental unit of a release of HazardousMaterial. Indicate the governmental unit to which the notice was sent and the date of the notice.SITE NAME AND ADDRESSNAME AND ADDRESS OFGOVERNMENTAL UNITDATE OFNOTICEENVIRONMENTALLAWNone(cid:132)c. List all judicial or administrative proceedings, including settlements or orders, under any Environmental Law with respect to whichthe 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 thedocket number.NAME AND ADDRESS OFGOVERNMENTAL UNITDOCKET NUMBERSTATUS OR DISPOSITIONSoftware Copyright (c) 1996-2013 CCH INCORPORATED - www.bestcase.comBest Case BankruptcyCase 13-30301 Doc 1 Filed 05/08/13 Entered 05/08/13 10:30:28 Desc Main

Document Page 29 of 47

B7 (Official Form 7) (04/13)6None(cid:132)18 . Nature, location and name of businessa. If the debtor is an individual, list the names, addresses, taxpayer identification numbers, nature of the businesses, and beginning andending dates of all businesses in which the debtor was an officer, director, partner, or managing executive of a corporation, partner in apartnership, sole proprietor, or was self-employed in a trade, profession, or other activity either full- or part-time within six yearsimmediately preceding the commencement of this case, or in which the debtor owned 5 percent or more of the voting or equity securitieswithin 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 andending dates of all businesses in which the debtor was a partner or owned 5 percent or more of the voting or equity securities, within sixyears immediately preceding the commencement of this case.If the debtor is a corporation, list the names, addresses, taxpayer identification numbers, nature of the businesses, and beginning andending dates of all businesses in which the debtor was a partner or owned 5 percent or more of the voting or equity securities within sixyears immediately preceding the commencement of this case.NAMELAST FOUR DIGITS OFSOCIAL-SECURITY OROTHER INDIVIDUALTAXPAYER-I.D. NO.(ITIN)/ COMPLETE EINADDRESSNATURE OF BUSINESSBEGINNING ANDENDING DATESNone(cid:132)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.NAMEADDRESSThe following questions are to be completed by every debtor that is a corporation or partnership and by any individual debtor who is or hasbeen, within six years immediately preceding the commencement of this case, any of the following: an officer, director, managing executive, orowner of more than 5 percent of the voting or equity securities of a corporation; a partner, other than a limited partner, of a partnership, a soleproprietor, or self-employed in a trade, profession, or other activity, either full- or part-time.(An individual or joint debtor should complete this portion of the statement only if the debtor is or has been in business, as defined above,within six years immediately preceding the commencement of this case. A debtor who has not been in business within those six years should godirectly to the signature page.)None(cid:132)19. Books, records and financial statementsa. List all bookkeepers and accountants who within two years immediately preceding the filing of this bankruptcy case kept orsupervised the keeping of books of account and records of the debtor.NAME AND ADDRESSDATES SERVICES RENDEREDNone(cid:132)b. List all firms or individuals who within the two years immediately preceding the filing of this bankruptcy case have audited the booksof account and records, or prepared a financial statement of the debtor.NAMEADDRESSDATES SERVICES RENDEREDNone(cid:132)c. List all firms or individuals who at the time of the commencement of this case were in possession of the books of account and recordsof the debtor. If any of the books of account and records are not available, explain.NAMEADDRESSNone(cid:132)d. List all financial institutions, creditors and other parties, including mercantile and trade agencies, to whom a financial statement wasissued by the debtor within two years immediately preceding the commencement of this case.NAME AND ADDRESSDATE ISSUEDSoftware Copyright (c) 1996-2013 CCH INCORPORATED - www.bestcase.comBest Case BankruptcyCase 13-30301 Doc 1 Filed 05/08/13 Entered 05/08/13 10:30:28 Desc Main

Document Page 30 of 47

B7 (Official Form 7) (04/13)7None(cid:132)20. Inventoriesa. List the dates of the last two inventories taken of your property, the name of the person who supervised the taking of each inventory,and the dollar amount and basis of each inventory.DATE OF INVENTORYINVENTORY SUPERVISORDOLLAR AMOUNT OF INVENTORY(Specify cost, market or other basis)None(cid:132)b. List the name and address of the person having possession of the records of each of the inventories reported in a., above.DATE OF INVENTORYNAME AND ADDRESSES OF CUSTODIAN OF INVENTORYRECORDSNone(cid:132)21 . Current Partners, Officers, Directors and Shareholdersa. If the debtor is a partnership, list the nature and percentage of partnership interest of each member of the partnership.NAME AND ADDRESSNATURE OF INTERESTPERCENTAGE OF INTERESTNone(cid:132)b. If the debtor is a corporation, list all officers and directors of the corporation, and each stockholder who directly or indirectly owns,controls, or holds 5 percent or more of the voting or equity securities of the corporation.NAME AND ADDRESSTITLENATURE AND PERCENTAGEOF STOCK OWNERSHIPNone(cid:132)22 . Former partners, officers, directors and shareholdersa. If the debtor is a partnership, list each member who withdrew from the partnership within one year immediately preceding thecommencement of this case.NAMEADDRESSDATE OF WITHDRAWALNone(cid:132)b. If the debtor is a corporation, list all officers, or directors whose relationship with the corporation terminated within one yearimmediately preceding the commencement of this case.NAME AND ADDRESSTITLEDATE OF TERMINATIONNone(cid:132)23 . Withdrawals from a partnership or distributions by a corporationIf the debtor is a partnership or corporation, list all withdrawals or distributions credited or given to an insider, including compensationin any form, bonuses, loans, stock redemptions, options exercised and any other perquisite during one year immediately preceding thecommencement of this case.NAME & ADDRESSOF RECIPIENT,RELATIONSHIP TO DEBTORDATE AND PURPOSEOF WITHDRAWALAMOUNT OF MONEYOR DESCRIPTION ANDVALUE OF PROPERTYNone(cid:132)24. Tax Consolidation Group.If the debtor is a corporation, list the name and federal taxpayer identification number of the parent corporation of any consolidatedgroup for tax purposes of which the debtor has been a member at any time within six years immediately preceding the commencementof the case.NAME OF PARENT CORPORATIONTAXPAYER IDENTIFICATION NUMBER (EIN)Software Copyright (c) 1996-2013 CCH INCORPORATED - www.bestcase.comBest Case BankruptcyCase 13-30301 Doc 1 Filed 05/08/13 Entered 05/08/13 10:30:28 Desc Main

Document Page 31 of 47

B7 (Official Form 7) (04/13)8None(cid:132)25. Pension Funds.If the debtor is not an individual, list the name and federal taxpayer-identification number of any pension fund to which the debtor, as anemployer, has been responsible for contributing at any time within six years immediately preceding the commencement of the case.NAME OF PENSION FUNDTAXPAYER IDENTIFICATION NUMBER (EIN)* * * * * *DECLARATION UNDER PENALTY OF PERJURY BY INDIVIDUAL DEBTORI declare under penalty of perjury that I have read the answers contained in the foregoing statement of financial affairs and any attachments theretoand that they are true and correct.DateMay 8, 2013Signature/s/ Maureen Claire SmithMaureen Claire SmithDebtorPenalty for making a false statement: Fine of up to $500,000 or imprisonment for up to 5 years, or both. 18 U.S.C. §§ 152 and 3571Software Copyright (c) 1996-2013 CCH INCORPORATED - www.bestcase.comBest Case BankruptcyCase 13-30301 Doc 1 Filed 05/08/13 Entered 05/08/13 10:30:28 Desc Main

Document Page 32 of 47

B8 (Form 8) (12/08)United States Bankruptcy CourtDistrict of North DakotaIn reMaureen Claire SmithCase No.Debtor(s)Chapter7CHAPTER 7 INDIVIDUAL DEBTOR'S STATEMENT OF INTENTIONPART A - Debts secured by property of the estate. (Part A must be fully completed for EACH debt which is secured byproperty of the estate. Attach additional pages if necessary.)Property No. 1Creditor's Name:1st Liberty Fed CreditDescribe Property Securing Debt:2010 Saturn Vue 62,095miProperty will be (check one):(cid:134) Surrendered(cid:132) RetainedIf retaining the property, I intend to (check at least one):(cid:134) Redeem the property(cid:132) Reaffirm the debt(cid:134) Other. Explain (for example, avoid lien using 11 U.S.C. § 522(f)).Property is (check one):(cid:132) Claimed as Exempt(cid:134) Not claimed as exemptProperty No. 2Creditor's Name:Alerus FinancialDescribe Property Securing Debt:02 Chevy Silverado 1500 178,848miProperty will be (check one):(cid:134) Surrendered(cid:132) RetainedIf retaining the property, I intend to (check at least one):(cid:134) Redeem the property(cid:132) Reaffirm the debt(cid:134) Other. Explain (for example, avoid lien using 11 U.S.C. § 522(f)).Property is (check one):(cid:132) Claimed as Exempt(cid:134) Not claimed as exemptPART B - Personal property subject to unexpired leases. (All three columns of Part B must be completed for each unexpired lease.Attach additional pages if necessary.)Property No. 1Lessor's Name:-NONE-Describe Leased Property:Lease will be Assumed pursuant to 11U.S.C. § 365(p)(2):(cid:134) YES (cid:134) NOSoftware Copyright (c) 1996-2013 CCH INCORPORATED - www.bestcase.comBest Case BankruptcyCase 13-30301 Doc 1 Filed 05/08/13 Entered 05/08/13 10:30:28 Desc Main

Document Page 33 of 47

B8 (Form 8) (12/08)Page 2I declare under penalty of perjury that the above indicates my intention as to any property of my estate securing a debt and/orpersonal property subject to an unexpired lease.DateMay 8, 2013Signature/s/ Maureen Claire SmithMaureen Claire SmithDebtorSoftware Copyright (c) 1996-2013 CCH INCORPORATED - www.bestcase.comBest Case BankruptcyCase 13-30301 Doc 1 Filed 05/08/13 Entered 05/08/13 10:30:28 Desc Main

Document Page 34 of 47

United States Bankruptcy CourtDistrict of North DakotaIn reMaureen Claire SmithCase No.Debtor(s)Chapter7DISCLOSURE OF COMPENSATION OF ATTORNEY FOR DEBTOR(S)1.Pursuant to 11 U.S.C. § 329(a) and Bankruptcy Rule 2016(b), I certify that I am the attorney for the above-named debtor and thatcompensation paid to me within one year before the filing of the petition in bankruptcy, or agreed to be paid to me, for services rendered or tobe rendered on behalf of the debtor(s) in contemplation of or in connection with the bankruptcy case is as follows:For legal services, I have agreed to accept$1,164.00Prior to the filing of this statement I have received$720.00Balance Due$444.002.The source of the compensation paid to me was:(cid:132)Debtor(cid:134)Other (specify):3.The source of compensation to be paid to me is:(cid:132)Debtor(cid:134)Other (specify):4.(cid:132)I have not agreed to share the above-disclosed compensation with any other person unless they are members and associates of my law firm.(cid:134)I have agreed to share the above-disclosed compensation with a person or persons who are not members or associates of my law firm. Acopy of the agreement, together with a list of the names of the people sharing in the compensation is attached.5.In return for the above-disclosed fee, I have agreed to render legal service for all aspects of the bankruptcy case, including:a.Analysis of the debtor's financial situation, and rendering advice to the debtor in determining whether to file a petition in bankruptcy;b.Preparation and filing of any petition, schedules, statement of affairs and plan which may be required;c.Representation of the debtor at the meeting of creditors and confirmation hearing, and any adjourned hearings thereof;d.[Other provisions as needed]Negotiations with secured creditors to reduce to market value; exemption planning; preparation and filing ofreaffirmation agreements and applications as needed; preparation and filing of motions pursuant to 11 USC522(f)(2)(A) for avoidance of liens on household goods.6.By agreement with the debtor(s), the above-disclosed fee does not include the following service:Representation of the debtors in any dischargeability actions, judicial lien avoidances, relief from stay actions orany other adversary proceeding.CERTIFICATIONI certify that the foregoing is a complete statement of any agreement or arrangement for payment to me for representation of the debtor(s) inthis bankruptcy proceeding.Dated:May 8, 2013/s/ Shawn L. AutreyShawn L. AutreyAutrey Law Firm110 North 3rd StreetGrand Forks, ND 58201Software Copyright (c) 1996-2013 CCH INCORPORATED - www.bestcase.comBest Case BankruptcyCase 13-30301 Doc 1 Filed 05/08/13 Entered 05/08/13 10:30:28 Desc Main

Document Page 35 of 47

B 201A (Form 201A) (11/12)UNITED STATES BANKRUPTCY COURTDISTRICT OF NORTH DAKOTANOTICE TO CONSUMER DEBTOR(S) UNDER § 342(b)OF THE BANKRUPTCY CODEIn accordance with § 342(b) of the Bankruptcy Code, this notice to individuals with primarily consumer debts: (1) Describesbriefly the services available from credit counseling services; (2) Describes briefly the purposes, benefits and costs of the four types ofbankruptcy proceedings you may commence; and (3) Informs you about bankruptcy crimes and notifies you that the Attorney Generalmay 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 anattorney 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 thatyou receive information about events concerning your case, Bankruptcy Rule 4002 requires that you notify the court of any changes inyour address. If you are filing a joint case (a single bankruptcy case for two individuals married to each other), and each spouse liststhe same mailing address on the bankruptcy petition, you and your spouse will generally receive a single copy of each notice mailedfrom the bankruptcy court in a jointly-addressed envelope, unless you file a statement with the court requesting that each spousereceive a separate copy of all notices.1. Services Available from Credit Counseling AgenciesWith limited exceptions, § 109(h) of the Bankruptcy Code requires that all individual debtors who file for bankruptcyrelief on or after October 17, 2005, receive a briefing that outlines the available opportunities for credit counseling andprovides assistance in performing a budget analysis. The briefing must be given within 180 days before the bankruptcy filing. Thebriefing may be provided individually or in a group (including briefings conducted by telephone or on the Internet) and must beprovided by a nonprofit budget and credit counseling agency approved by the United States trustee or bankruptcy administrator. Theclerk of the bankruptcy court has a list that you may consult of the approved budget and credit counseling agencies. Each debtor in ajoint case must complete the briefing.In addition, after filing a bankruptcy case, an individual debtor generally must complete a financial managementinstructional course before he or she can receive a discharge. The clerk also has a list of approved financial managementinstructional courses. Each debtor in a joint case must complete the course.2. The Four Chapters of the Bankruptcy Code Available to Individual Consumer DebtorsChapter 7: Liquidation ($245 filing fee, $46 administrative fee, $15 trustee surcharge: Total Fee $306)Chapter 7 is designed for debtors in financial difficulty who do not have the ability to pay their existing debts. Debtors whosedebts are primarily consumer debts are subject to a "means test" designed to determine whether the case should be permitted toproceed 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 courtdismiss your case under § 707(b) of the Code. It is up to the court to decide whether the case should be dismissed.Under chapter 7, you may claim certain of your property as exempt under governing law. A trustee may have the right to takepossession of and sell the remaining property that is not exempt and use the sale proceeds to pay your creditors.The purpose of filing a chapter 7 case is to obtain a discharge of your existing debts. If, however, you are found to havecommitted certain kinds of improper conduct described in the Bankruptcy Code, the court may deny your discharge and, if it does, thepurpose for which you filed the bankruptcy petition will be defeated.Even if you receive a general discharge, some particular debts are not discharged under the law. Therefore, you may still beresponsible for most taxes and student loans; debts incurred to pay nondischargeable taxes; domestic support and property settlementobligations; most fines, penalties, forfeitures, and criminal restitution obligations; certain debts which are not properly listed in yourbankruptcy papers; and debts for death or personal injury caused by operating a motor vehicle, vessel, or aircraft while intoxicatedfrom 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 andmalicious injury, the bankruptcy court may determine that the debt is not discharged.Chapter 13: Repayment of All or Part of the Debts of an Individual with Regular Income ($235 filing fee,$46 administrative fee: Total fee $281)Chapter 13 is designed for individuals with regular income who would like to pay all or part of their debts in installments overSoftware Copyright (c) 1996-2013 CCH INCORPORATED - www.bestcase.comBest Case BankruptcyCase 13-30301 Doc 1 Filed 05/08/13 Entered 05/08/13 10:30:28 Desc Main

Document Page 36 of 47

Form B 201A, Notice to Consumer Debtor(s)Page 2a period of time. You are only eligible for chapter 13 if your debts do not exceed certain dollar amounts set forth in the BankruptcyCode.Under chapter 13, you must file with the court a plan to repay your creditors all or part of the money that you owe them, usingyour future earnings. The period allowed by the court to repay your debts may be three years or five years, depending upon yourincome 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 yourbankruptcy papers; certain debts for acts that caused death or personal injury; and certain long term secured obligations.Chapter 11: Reorganization ($1,167 filing fee, $46 administrative fee: Total fee $1,213)Chapter 11 is designed for the reorganization of a business but is also available to consumer debtors. Its provisions are quitecomplicated, and any decision by an individual to file a chapter 11 petition should be reviewed with an attorney.Chapter 12: Family Farmer or Fisherman ($200 filing fee, $46 administrative fee: Total fee $246)Chapter 12 is designed to permit family farmers and fishermen to repay their debts over a period of time from future earningsand is similar to chapter 13. The eligibility requirements are restrictive, limiting its use to those whose income arises primarily from afamily-owned farm or commercial fishing operation.3. Bankruptcy Crimes and Availability of Bankruptcy Papers to Law Enforcement OfficialsA person who knowingly and fraudulently conceals assets or makes a false oath or statement under penalty of perjury, eitherorally or in writing, in connection with a bankruptcy case is subject to a fine, imprisonment, or both. All information supplied by adebtor in connection with a bankruptcy case is subject to examination by the Attorney General acting through the Office of the UnitedStates 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 notfiled with the court within the time deadlines set by the Bankruptcy Code, the Bankruptcy Rules, and the local rules of the court. Thedocuments and the deadlines for filing them are listed on Form B200, which is posted athttp://www.uscourts.gov/bkforms/bankruptcy_forms.html#procedure.Software Copyright (c) 1996-2013 CCH INCORPORATED - www.bestcase.comBest Case BankruptcyCase 13-30301 Doc 1 Filed 05/08/13 Entered 05/08/13 10:30:28 Desc Main

Document Page 37 of 47

B 201B (Form 201B) (12/09)United States Bankruptcy CourtDistrict of North DakotaIn reMaureen Claire SmithCase No.Debtor(s)Chapter7CERTIFICATION OF NOTICE TO CONSUMER DEBTOR(S)UNDER § 342(b) OF THE BANKRUPTCY CODECertification of DebtorI (We), the debtor(s), affirm that I (we) have received and read the attached notice, as required by § 342(b) of the BankruptcyCode.Maureen Claire SmithX/s/ Maureen Claire SmithMay 8, 2013Printed Name(s) of Debtor(s)Signature of DebtorDateCase No. (if known)XSignature of Joint Debtor (if any)DateInstructions: Attach a copy of Form B 201 A, Notice to Consumer Debtor(s) Under § 342(b) of the Bankruptcy Code.Use this form to certify that the debtor has received the notice required by 11 U.S.C. § 342(b) only if the certification has NOT been made on theVoluntary 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 thenotice to the debtor. The Declarations made by debtors and bankruptcy petition preparers on page 3 of Form B1 also include this certification.Software Copyright (c) 1996-2013 CCH INCORPORATED - www.bestcase.comBest Case BankruptcyCase 13-30301 Doc 1 Filed 05/08/13 Entered 05/08/13 10:30:28 Desc Main

Document Page 38 of 47

United States Bankruptcy CourtDistrict of North DakotaIn reMaureen Claire SmithCase No.Debtor(s)Chapter7VERIFICATION OF CREDITOR MATRIXThe above-named Debtor hereby verifies that the attached list of creditors is true and correct to the best of his/her knowledge.Date:May 8, 2013/s/ Maureen Claire SmithMaureen Claire SmithSignature of DebtorSoftware Copyright (c) 1996-2013 CCH INCORPORATED - www.bestcase.comBest Case BankruptcyCase 13-30301 Doc 1 Filed 05/08/13 Entered 05/08/13 10:30:28 Desc Main

Document Page 39 of 47

}bk1{Creditor Address Matrix}bk{1STLIBERTYFEDCREDITP.O.BOX5002GREAT FALLS, MT 59403ALERUSFINANCIAL2300SCOLUMBIARDGRAND FORKS, ND 58201ALTRUHEALTHSYSTEMP.O.BOX6002GRAND FORKS, ND 58206-6002CABELLA'SCLUBVISAP.O.BOX82519LINCOLN, NE 68501-2519CAP1/POLRSPOBOX30253SALT LAKE CITY, UT 84130CITIBANKSD,NAATTN:CENTRALIZEDBANKRUPTCYPOBOX20363KANSAS CITY, MO 64195GECRB/CARECREDITATTN:BANKRUPTCYPOBOX103104ROSWELL, GA 30076SAMSCLUB/GEMBATTENTION:BANKRUPTCYDEPARTMENTPOBOX103104ROSWELL, GA 30076SEARS/CBNAPOBOX6282SIOUX FALLS, SD 57117WFB-NE(WORLDSFOREMOSTBANK)POBOX82609LINCOLN, NE 68501Case 13-30301 Doc 1 Filed 05/08/13 Entered 05/08/13 10:30:28 Desc Main

Document Page 40 of 47

B22A (Official Form 22A) (Chapter 7) (04/13)In reMaureen Claire SmithAccording to the information required to be entered on this statement(check one box as directed in Part I, III, or VI of this statement):(cid:134)The presumption arises.(cid:132)The presumption does not arise.(cid:134)The presumption is temporarily inapplicable.Debtor(s)Case Number:(If known)CHAPTER 7 STATEMENT OF CURRENT MONTHLY INCOMEAND MEANS-TEST CALCULATIONIn 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 theybelieve this is required by § 707(b)(2)(C).Part I. MILITARY AND NON-CONSUMER DEBTORS1ADisabled Veterans. If you are a disabled veteran described in the Declaration in this Part IA, (1) check the box at the beginning of theDeclaration, (2) check the box for "The presumption does not arise" at the top of this statement, and (3) complete the verification in PartVIII. Do not complete any of the remaining parts of this statement.(cid:134)Declaration of Disabled Veteran. By checking this box, I declare under penalty of perjury that I am a disabled veteran (as defined in38 U.S.C. § 3741(1)) whose indebtedness occurred primarily during a period in which I was on active duty (as defined in 10 U.S.C. §101(d)(1)) or while I was performing a homeland defense activity (as defined in 32 U.S.C. §901(1)).1BNon-consumer Debtors. If your debts are not primarily consumer debts, check the box below and complete the verification in Part VIII.Do not complete any of the remaining parts of this statement.(cid:134)Declaration of non-consumer debts. By checking this box, I declare that my debts are not primarily consumer debts.1CReservists and National Guard Members; active duty or homeland defense activity. Members of a reserve component of the ArmedForces and members of the National Guard who were called to active duty (as defined in 10 U.S.C. § 101(d)(1)) after September 11,2001, for a period of at least 90 days, or who have performed homeland defense activity (as defined in 32 U.S.C. § 901(1)) for a period ofat least 90 days, are excluded from all forms of means testing during the time of active duty or homeland defense activity and for 540days thereafter (the "exclusion period"). If you qualify for this temporary exclusion, (1) check the appropriate boxes and complete anyrequired information in the Declaration of Reservists and National Guard Members below, (2) check the box for "The presumption istemporarily inapplicable" at the top of this statement, and (3) complete the verification in Part VIII. During your exclusion period youare not required to complete the balance of this form, but you must complete the form no later than 14 days after the date onwhich your exclusion period ends, unless the time for filing a motion raising the means test presumption expires in your casebefore your exclusion period ends.(cid:134)Declaration of Reservists and National Guard Members. By checking this box and making the appropriate entries below, I declarethat I am eligible for a temporary exclusion from means testing because, as a member of a reserve component of the Armed Forces or theNational Guarda. (cid:134) I was called to active duty after September 11, 2001, for a period of at least 90 days and(cid:134) I remain on active duty /or/(cid:134) I was released from active duty on , which is less than 540 days before this bankruptcy case wasfiled;ORb. (cid:134) I am performing homeland defense activity for a period of at least 90 days /or/(cid:134) I performed homeland defense activity for a period of at least 90 days, terminating on , which is less than540 days before this bankruptcy case was filed.Software Copyright (c) 1996-2013 CCH INCORPORATED - www.bestcase.comBest Case BankruptcyCase 13-30301 Doc 1 Filed 05/08/13 Entered 05/08/13 10:30:28 Desc Main

Document Page 41 of 47

B22A (Official Form 22A) (Chapter 7) (04/13)2Part II. CALCULATION OF MONTHLY INCOME FOR § 707(b)(7) EXCLUSION2Marital/filing status. Check the box that applies and complete the balance of this part of this statement as directed.a. (cid:132) Unmarried. Complete only Column A ("Debtor's Income") for Lines 3-11.b.(cid:134) Married, not filing jointly, with declaration of separate households. By checking this box, debtor declares under penalty of perjury:"My spouse and I are legally separated under applicable non-bankruptcy law or my spouse and I are living apart other than for thepurpose of evading the requirements of § 707(b)(2)(A) of the Bankruptcy Code." Complete only column A ("Debtor's Income")for Lines 3-11.c. (cid:134) Married, not filing jointly, without the declaration of separate households set out in Line 2.b above. Complete both Column A("Debtor's Income") and Column B ("Spouse's Income") for Lines 3-11.d.(cid:134) Married, filing jointly. Complete both Column A ("Debtor's Income") and Column B ("Spouse's Income") for Lines 3-11.All figures must reflect average monthly income received from all sources, derived during the sixcalendar months prior to filing the bankruptcy case, ending on the last day of the month beforethe filing. If the amount of monthly income varied during the six months, you must divide thesix-month total by six, and enter the result on the appropriate line.Column ADebtor'sIncomeColumn BSpouse'sIncome3Gross wages, salary, tips, bonuses, overtime, commissions.$2,556.06$4Income from the operation of a business, profession or farm. Subtract Line b from Line a andenter the difference in the appropriate column(s) of Line 4. If you operate more than onebusiness, profession or farm, enter aggregate numbers and provide details on an attachment. Donot enter a number less than zero. Do not include any part of the business expenses entered onLine b as a deduction in Part V.$0.00$5Rent and other real property income. Subtract Line b from Line a and enter the difference inthe appropriate column(s) of Line 5. Do not enter a number less than zero. Do not include anypart of the operating expenses entered on Line b as a deduction in Part V.$0.00$6Interest, dividends, and royalties.$0.00$7Pension and retirement income.$0.00$8Any amounts paid by another person or entity, on a regular basis, for the householdexpenses of the debtor or the debtor's dependents, including child support paid for thatpurpose. Do not include alimony or separate maintenance payments or amounts paid by yourspouse if Column B is completed. Each regular payment should be reported in only one column;if a payment is listed in Column A, do not report that payment in Column B.$0.00$9Unemployment compensation. Enter the amount in the appropriate column(s) of Line 9.However, if you contend that unemployment compensation received by you or your spouse was abenefit under the Social Security Act, do not list the amount of such compensation in Column Aor B, but instead state the amount in the space below:$0.00$10Income from all other sources. Specify source and amount. If necessary, list additional sourceson a separate page. Do not include alimony or separate maintenance payments paid by yourspouse if Column B is completed, but include all other payments of alimony or separatemaintenance. Do not include any benefits received under the Social Security Act or paymentsreceived as a victim of a war crime, crime against humanity, or as a victim of international ordomestic terrorism.Total and enter on Line 10$0.00$11Subtotal of Current Monthly Income for § 707(b)(7). Add Lines 3 thru 10 in Column A, and, ifColumn B is completed, add Lines 3 through 10 in Column B. Enter the total(s).$2,556.06$Software Copyright (c) 1996-2013 CCH INCORPORATED - www.bestcase.comBest Case Bankruptcyb.Ordinary and necessary business expenses$0.00$c.Business incomeSubtract Line b from Line aDebtorSpousea.Gross receiptsDebtorSpouseUnemployment compensation claimed tobe a benefit under the Social Security ActDebtor $0.00Spouse $a.Gross receipts$0.00$DebtorSpousea.$$b.$$b.Ordinary and necessary operating expenses$0.00$c.Rent and other real property incomeSubtract Line b from Line a$0.00$Case 13-30301 Doc 1 Filed 05/08/13 Entered 05/08/13 10:30:28 Desc Main

Document Page 42 of 47

B22A (Official Form 22A) (Chapter 7) (04/13)312Total Current Monthly Income for § 707(b)(7). If Column B has been completed, add Line 11,Column A to Line 11, Column B, and enter the total. If Column B has not been completed, enterthe amount from Line 11, Column A.$2,556.06Part III. APPLICATION OF § 707(b)(7) EXCLUSION13Annualized Current Monthly Income for § 707(b)(7). Multiply the amount from Line 12 by the number 12 andenter the result.$30,672.7214Applicable median family income. Enter the median family income for the applicable state and household size.(This information is available by family size at www.usdoj.gov/ust/ or from the clerk of the bankruptcy court.)$68,688.0015Application of Section 707(b)(7). Check the applicable box and proceed as directed.(cid:132)The amount on Line 13 is less than or equal to the amount on Line 14. Check the box for "The presumption does not arise" at thetop of page 1 of this statement, and complete Part VIII; do not complete Parts IV, V, VI or VII.(cid:134)The amount on Line 13 is more than the amount on Line 14. Complete the remaining parts of this statement.Complete Parts IV, V, VI, and VII of this statement only if required. (See Line 15.)Part IV. CALCULATION OF CURRENT MONTHLY INCOME FOR § 707(b)(2)16Enter the amount from Line 12.$17Marital adjustment. If you checked the box at Line 2.c, enter on Line 17 the total of any income listed in Line 11,Column B that was NOT paid on a regular basis for the household expenses of the debtor or the debtor'sdependents. Specify in the lines below the basis for excluding the Column B income (such as payment of thespouse's tax liability or the spouse's support of persons other than the debtor or the debtor's dependents) and theamount of income devoted to each purpose. If necessary, list additional adjustments on a separate page. If you didnot check box at Line 2.c, enter zero.Total and enter on Line 17$18Current monthly income for § 707(b)(2). Subtract Line 17 from Line 16 and enter the result.$Part V. CALCULATION OF DEDUCTIONS FROM INCOMESubpart A: Deductions under Standards of the Internal Revenue Service (IRS)19ANational Standards: food, clothing and other items. Enter in Line 19A the "Total" amount from IRS NationalStandards for Food, Clothing and Other Items for the applicable number of persons. (This information is availableat www.usdoj.gov/ust/ or from the clerk of the bankruptcy court.) The applicable number of persons is the numberthat would currently be allowed as exemptions on your federal income tax return, plus the number of anyadditional dependents whom you support.$19BNational Standards: health care. Enter in Line a1 below the amount from IRS National Standards forOut-of-Pocket Health Care for persons under 65 years of age, and in Line a2 the IRS National Standards forOut-of-Pocket Health Care for persons 65 years of age or older. (This information is available atwww.usdoj.gov/ust/ or from the clerk of the bankruptcy court.) Enter in Line b1 the applicable number of personswho are under 65 years of age, and enter in Line b2 the applicable number of persons who are 65 years of age orolder. (The applicable number of persons in each age category is the number in that category that would currentlybe allowed as exemptions on your federal income tax return, plus the number of any additional dependents whomyou support.) Multiply Line a1 by Line b1 to obtain a total amount for persons under 65, and enter the result inLine c1. Multiply Line a2 by Line b2 to obtain a total amount for persons 65 and older, and enter the result in Linec2. Add Lines c1 and c2 to obtain a total health care amount, and enter the result in Line 19B.$20ALocal Standards: housing and utilities; non-mortgage expenses. Enter the amount of the IRS Housing andUtilities Standards; non-mortgage expenses for the applicable county and family size. (This information isavailable at www.usdoj.gov/ust/ or from the clerk of the bankruptcy court). The applicable family size consists ofthe number that would currently be allowed as exemptions on your federal income tax return, plus the number ofany additional dependents whom you support.$Software Copyright (c) 1996-2013 CCH INCORPORATED - www.bestcase.comBest Case Bankruptcy$b.$c.$Persons under 65 years of agePersons 65 years of age or oldera1.Allowance per persona2.Allowance per personb1.Number of personsb2.Number of personsc1.Subtotalc2.Subtotald.$NDb. Enter debtor's household size:3a. Enter debtor's state of residence:a.Case 13-30301 Doc 1 Filed 05/08/13 Entered 05/08/13 10:30:28 Desc Main

Document Page 43 of 47

B22A (Official Form 22A) (Chapter 7) (04/13)420BLocal Standards: housing and utilities; mortgage/rent expense. Enter, in Line a below, the amount of the IRSHousing and Utilities Standards; mortgage/rent expense for your county and family size (this information isavailable at www.usdoj.gov/ust/ or from the clerk of the bankruptcy court) (the applicable family size consists ofthe number that would currently be allowed as exemptions on your federal income tax return, plus the number ofany additional dependents whom you support); enter on Line b the total of the Average Monthly Payments for anydebts secured by your home, as stated in Line 42; subtract Line b from Line a and enter the result in Line 20B. Donot enter an amount less than zero.$21Local Standards: housing and utilities; adjustment. If you contend that the process set out in Lines 20A and20B does not accurately compute the allowance to which you are entitled under the IRS Housing and UtilitiesStandards, enter any additional amount to which you contend you are entitled, and state the basis for yourcontention in the space below:$22ALocal 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 avehicle and regardless of whether you use public transportation.Check the number of vehicles for which you pay the operating expenses or for which the operating expenses areincluded as a contribution to your household expenses in Line 8.(cid:134) 0 (cid:134) 1 (cid:134) 2 or more.If you checked 0, enter on Line 22A the "Public Transportation" amount from IRS Local Standards:Transportation. If you checked 1 or 2 or more, enter on Line 22A the "Operating Costs" amount from IRS LocalStandards: Transportation for the applicable number of vehicles in the applicable Metropolitan Statistical Area orCensus Region. (These amounts are available at www.usdoj.gov/ust/ or from the clerk of the bankruptcy court.)$22BLocal Standards: transportation; additional public transportation expense. If you pay the operating expensesfor a vehicle and also use public transportation, and you contend that you are entitled to an additional deduction foryou public transportation expenses, enter on Line 22B the "Public Transportation" amount from IRS LocalStandards: Transportation. (This amount is available at www.usdoj.gov/ust/ or from the clerk of the bankruptcycourt.)$23Local Standards: transportation ownership/lease expense; Vehicle 1. Check the number of vehicles for whichyou claim an ownership/lease expense. (You may not claim an ownership/lease expense for more than twovehicles.)(cid:134) 1 (cid:134) 2 or more.Enter, in Line a below, the "Ownership Costs" for "One Car" from the IRS Local Standards: Transportation(available at www.usdoj.gov/ust/ or from the clerk of the bankruptcy court); enter in Line b the total of the AverageMonthly Payments for any debts secured by Vehicle 1, as stated in Line 42; subtract Line b from Line a and enterthe result in Line 23. Do not enter an amount less than zero.$24Local Standards: transportation ownership/lease expense; Vehicle 2. Complete this Line only if you checkedthe "2 or more" Box in Line 23.Enter, in Line a below, the "Ownership Costs" for "One Car" from the IRS Local Standards: Transportation(available at www.usdoj.gov/ust/ or from the clerk of the bankruptcy court); enter in Line b the total of the AverageMonthly Payments for any debts secured by Vehicle 2, as stated in Line 42; subtract Line b from Line a and enterthe result in Line 24. Do not enter an amount less than zero.$25Other Necessary Expenses: taxes. Enter the total average monthly expense that you actually incur for all federal,state and local taxes, other than real estate and sales taxes, such as income taxes, self employment taxes, socialsecurity taxes, and Medicare taxes. Do not include real estate or sales taxes.$Software Copyright (c) 1996-2013 CCH INCORPORATED - www.bestcase.comBest Case Bankruptcya.IRS Transportation Standards, Ownership Costs$b.Average Monthly Payment for any debts secured by Vehicle1, as stated in Line 42$c.Net ownership/lease expense for Vehicle 1Subtract Line b from Line a.b.Average Monthly Payment for any debts secured by yourhome, if any, as stated in Line 42$a.IRS Transportation Standards, Ownership Costs$b.Average Monthly Payment for any debts secured by Vehicle2, as stated in Line 42$c.Net ownership/lease expense for Vehicle 2Subtract Line b from Line a.c.Net mortgage/rental expenseSubtract Line b from Line a.a.IRS Housing and Utilities Standards; mortgage/rental expense$Case 13-30301 Doc 1 Filed 05/08/13 Entered 05/08/13 10:30:28 Desc Main

Document Page 44 of 47

B22A (Official Form 22A) (Chapter 7) (04/13)526Other Necessary Expenses: involuntary deductions for employment. Enter the total average monthly payrolldeductions 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.$27Other Necessary Expenses: life insurance. Enter total average monthly premiums that you actually pay for termlife insurance for yourself. Do not include premiums for insurance on your dependents, for whole life or forany other form of insurance.$28Other Necessary Expenses: court-ordered payments. Enter the total monthly amount that you are required topay pursuant to the order of a court or administrative agency, such as spousal or child support payments. Do notinclude payments on past due obligations included in Line 44.$29Other Necessary Expenses: education for employment or for a physically or mentally challenged child. Enterthe total average monthly amount that you actually expend for education that is a condition of employment and foreducation that is required for a physically or mentally challenged dependent child for whom no public educationproviding similar services is available.$30Other Necessary Expenses: childcare. Enter the total average monthly amount that you actually expend onchildcare - such as baby-sitting, day care, nursery and preschool. Do not include other educational payments.$31Other Necessary Expenses: health care. Enter the total average monthly amount that you actually expend onhealth care that is required for the health and welfare of yourself or your dependents, that is not reimbursed byinsurance or paid by a health savings account, and that is in excess of the amount entered in Line 19B. Do notinclude payments for health insurance or health savings accounts listed in Line 34.$32Other Necessary Expenses: telecommunication services. Enter the total average monthly amount that youactually pay for telecommunication services other than your basic home telephone and cell phone service - such aspagers, call waiting, caller id, special long distance, or internet service - to the extent necessary for your health andwelfare or that of your dependents. Do not include any amount previously deducted.$33Total Expenses Allowed under IRS Standards. Enter the total of Lines 19 through 32.$Subpart B: Additional Living Expense DeductionsNote: Do not include any expenses that you have listed in Lines 19-3234Health Insurance, Disability Insurance, and Health Savings Account Expenses. List the monthly expenses inthe categories set out in lines a-c below that are reasonably necessary for yourself, your spouse, or yourdependents.$Total and enter on Line 34.If you do not actually expend this total amount, state your actual total average monthly expenditures in the spacebelow:$35Continued contributions to the care of household or family members. Enter the total average actual monthlyexpenses that you will continue to pay for the reasonable and necessary care and support of an elderly, chronicallyill, or disabled member of your household or member of your immediate family who is unable to pay for suchexpenses.$36Protection against family violence. Enter the total average reasonably necessary monthly expenses that youactually incurred to maintain the safety of your family under the Family Violence Prevention and Services Act orother applicable federal law. The nature of these expenses is required to be kept confidential by the court.$37Home energy costs. Enter the total average monthly amount, in excess of the allowance specified by IRS LocalStandards for Housing and Utilities, that you actually expend for home energy costs. You must provide your casetrustee with documentation of your actual expenses, and you must demonstrate that the additional amountclaimed is reasonable and necessary.$38Education expenses for dependent children less than 18. Enter the total average monthly expenses that youactually incur, not to exceed $156.25* per child, for attendance at a private or public elementary or secondaryschool by your dependent children less than 18 years of age. You must provide your case trustee withdocumentation of your actual expenses, and you must explain why the amount claimed is reasonable andnecessary and not already accounted for in the IRS Standards.$*Amount subject to adjustment on 4/01/16, and every three years thereafter with respect to cases commenced on or after the date of adjustment.Software Copyright (c) 1996-2013 CCH INCORPORATED - www.bestcase.comBest Case Bankruptcy$b.Disability Insurance$c.Health Savings Account$a.Health InsuranceCase 13-30301 Doc 1 Filed 05/08/13 Entered 05/08/13 10:30:28 Desc Main

Document Page 45 of 47

B22A (Official Form 22A) (Chapter 7) (04/13)639Additional food and clothing expense. Enter the total average monthly amount by which your food and clothingexpenses exceed the combined allowances for food and clothing (apparel and services) in the IRS NationalStandards, 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 isreasonable and necessary.$40Continued charitable contributions. Enter the amount that you will continue to contribute in the form of cash orfinancial instruments to a charitable organization as defined in 26 U.S.C. § 170(c)(1)-(2).$41Total Additional Expense Deductions under § 707(b). Enter the total of Lines 34 through 40$Subpart C: Deductions for Debt Payment42Future payments on secured claims. For each of your debts that is secured by an interest in property that youown, list the name of the creditor, identify the property securing the debt, state the Average Monthly Payment, andcheck whether the payment includes taxes or insurance. The Average Monthly Payment is the total of all amountsscheduled as contractually due to each Secured Creditor in the 60 months following the filing of the bankruptcycase, divided by 60. If necessary, list additional entries on a separate page. Enter the total of the Average MonthlyPayments on Line 42.Name of CreditorProperty Securing the DebtAverage MonthlyPaymentDoes paymentinclude taxesor insurance?a.$(cid:134)yes (cid:134)noTotal: Add Lines$43Other payments on secured claims. If any of debts listed in Line 42 are secured by your primary residence, amotor vehicle, or other property necessary for your support or the support of your dependents, you may include inyour deduction 1/60th of any amount (the "cure amount") that you must pay the creditor in addition to thepayments listed in Line 42, in order to maintain possession of the property. The cure amount would include anysums in default that must be paid in order to avoid repossession or foreclosure. List and total any such amounts inthe following chart. If necessary, list additional entries on a separate page.Name of CreditorProperty Securing the Debt1/60th of the Cure Amounta.$Total: Add Lines$44Payments on prepetition priority claims. Enter the total amount, divided by 60, of all priority claims, such aspriority tax, child support and alimony claims, for which you were liable at the time of your bankruptcy filing. Donot include current obligations, such as those set out in Line 28.$45Chapter 13 administrative expenses. If you are eligible to file a case under chapter 13, complete the followingchart, multiply the amount in line a by the amount in line b, and enter the resulting administrative expense.$46Total Deductions for Debt Payment. Enter the total of Lines 42 through 45.$Subpart D: Total Deductions from Income47Total of all deductions allowed under § 707(b)(2). Enter the total of Lines 33, 41, and 46.$Part VI. DETERMINATION OF § 707(b)(2) PRESUMPTION48Enter the amount from Line 18 (Current monthly income for § 707(b)(2))$49Enter the amount from Line 47 (Total of all deductions allowed under § 707(b)(2))$50Monthly disposable income under § 707(b)(2). Subtract Line 49 from Line 48 and enter the result.$5160-month disposable income under § 707(b)(2). Multiply the amount in Line 50 by the number 60 and enter theresult.$Software Copyright (c) 1996-2013 CCH INCORPORATED - www.bestcase.comBest Case Bankruptcya.Projected average monthly chapter 13 plan payment.$b.Current multiplier for your district as determined under schedulesissued by the Executive Office for United States Trustees. (Thisinformation is available at www.usdoj.gov/ust/ or from the clerk ofthe bankruptcy court.)xc.Average monthly administrative expense of chapter 13 caseTotal: Multiply Lines a and bCase 13-30301 Doc 1 Filed 05/08/13 Entered 05/08/13 10:30:28 Desc Main

Document Page 46 of 47

B22A (Official Form 22A) (Chapter 7) (04/13)752Initial presumption determination. Check the applicable box and proceed as directed.(cid:134)The amount on Line 51 is less than $7,475*. Check the box for "The presumption does not arise" at the top of page 1 of thisstatement, and complete the verification in Part VIII. Do not complete the remainder of Part VI.(cid:134)The amount set forth on Line 51 is more than $12,475* Check the box for "The presumption arises" at the top of page 1 of thisstatement, and complete the verification in Part VIII. You may also complete Part VII. Do not complete the remainder of Part VI.(cid:134)The amount on Line 51 is at least $7,475*, but not more than $12,475*. Complete the remainder of Part VI (Lines 53 through 55).53Enter the amount of your total non-priority unsecured debt$54Threshold debt payment amount. Multiply the amount in Line 53 by the number 0.25 and enter the result.$55Secondary presumption determination. Check the applicable box and proceed as directed.(cid:134)The amount on Line 51 is less than the amount on Line 54. Check the box for "The presumption does not arise" at the top of page 1of this statement, and complete the verification in Part VIII.(cid:134)The amount on Line 51 is equal to or greater than the amount on Line 54. Check the box for "The presumption arises" at the topof page 1 of this statement, and complete the verification in Part VIII. You may also complete Part VII.Part VII. ADDITIONAL EXPENSE CLAIMS56Other Expenses. List and describe any monthly expenses, not otherwise stated in this form, that are required for the health and welfare ofyou and your family and that you contend should be an additional deduction from your current monthly income under §707(b)(2)(A)(ii)(I). If necessary, list additional sources on a separate page. All figures should reflect your average monthly expense foreach item. Total the expenses.Part VIII. VERIFICATION57I declare under penalty of perjury that the information provided in this statement is true and correct. (If this is a joint case, both debtorsmust sign.)Maureen Claire Smith(Debtor)*Amounts are subject to adjustment on 4/01/16, and every three years thereafter with respect to cases commenced on or after the date of adjustment.Software Copyright (c) 1996-2013 CCH INCORPORATED - www.bestcase.comBest Case Bankruptcyc.$d.$Total: Add Lines a, b, c, and d$Expense DescriptionMonthly Amounta.$Date:May 8, 2013Signature:/s/ Maureen Claire Smithb.$Case 13-30301 Doc 1 Filed 05/08/13 Entered 05/08/13 10:30:28 Desc Main

Document Page 47 of 47

B22A (Official Form 22A) (Chapter 7) (04/13)8Current Monthly Income Details for the DebtorDebtor Income Details:Income for the Period 11/01/2012 to 04/30/2013.Line 3 - Gross wages, salary, tips, bonuses, overtime, commissionsSource of Income: Anne Carlson CenterIncome by Month:6 Months Ago:11/2012$3,007.205 Months Ago:12/2012$1,948.424 Months Ago:01/2013$1,976.613 Months Ago:02/2013$1,984.042 Months Ago:03/2013$2,002.66Last Month:04/2013$1,933.44Average per month:$2,142.06Line 3 - Gross wages, salary, tips, bonuses, overtime, commissionsSource of Income: walmartIncome by Month:6 Months Ago:11/2012$1,234.005 Months Ago:12/2012$1,250.004 Months Ago:01/2013$0.003 Months Ago:02/2013$0.002 Months Ago:03/2013$0.00Last Month:04/2013$0.00Average per month:$414.00Software Copyright (c) 1996-2013 CCH INCORPORATED - www.bestcase.comBest Case Bankruptcy