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Case 13-17039-elf Doc 19 Filed 08/25/13 Entered 08/25/13 22:04:22 Desc Main

Document Page 1 of 14

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

UNITED STATES BANKRUPTCY COURT
EASTERN DISTRICT OF PENNSYLVANIA

In re: Amin Mohammad, Debtor

Case No: 13 - 17039 MDC
Chapter 7

SCHEDULE A - REAL PROPERTY

Except as directed below, list all real property in which Debtor has any legal, equitable, or future interest, including all property
owned as a co-tenant, community property, or in which the debtor has a life estate. Include any property in which Debtor holds rights
and powers exercisable for Debtor’s own benefit. If Debtor is married, state whether husband, wife, or both own the property by placing
an “H,” “W,” “J,” or “C” in the third column labeled “Husband, Wife, Joint or Community” if Debtor holds no interest in real property,
write “None” under “Description and Location of Property.”

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

Contracts and Unexpired Leases.

If an entity claims to have a lien or hold a security interest in any property, state the amount of the secured claim. See Schedule D.

If no entity claims to hold a secured interest in the property, write “None” in the column labeled “Amount of Secured Claim.”

If the debtor is an individual or if a joint petition is filed, state the amount of any exemption claimed in the property only in

Schedule C—Property Claimed as Exempt.

DESCRIPTION AND

LOCATION OF PROPERTY

102 Bryn Mawr Avenue
Lansdowne, PA 19050

208 So. Academy Street
Hightstown, NJ 08520

NATURE OF
DEBTOR’S
INTEREST

IN PROPERTY

HUSB
WIFE
JOINT
COM.

CURRENT MARKET
VALUE OF DEBTOR’S
INTEREST IN PROPERTY
WITHOUT DEDUCTING
ANY SECURED CLAIM

OR EXEMPTION

AMOUNT OF

SECURED CLAIM

fee simple

J

192,000

413,720 **

fee simple

124,000

**

$316,000.00

TOTAL

** - these properties are subject to the following tax liens:

a)
b)

I.R.S. - 2009-418448=$107,216.02; 2011-420933=$14,334.91; 2011-421056=$14,340.02
PA - 2009-014844=$4,393.53; 2010-000023=$673.06; 2013-061029=$2,702.85

Case 13-17039-elf Doc 19 Filed 08/25/13 Entered 08/25/13 22:04:22 Desc Main

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

UNITED STATES BANKRUPTCY COURT
EASTERN DISTRICT OF PENNSYLVANIA

In re: Amin Mohammad, Debtor

Case No: 13 - 17039 MDC
Chapter 7

SCHEDULE B — PERSONAL PROPERTY

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

“X” in the appropriate position in the column labeled “None.” If additional space is needed in any category, attach a separate sheet properly identified
with the case name, case number, and the number of the category. If Debtor is married, state whether husband, wife, or both own the property by placing
an “H,” “W,” “J,” or “C” in the column labeled “Husband, Wife, Joint, or Community.” If Debtor is an individual or a joint petition is filed, state the
amount of any exemptions claimed only in Schedule C— Property Claimed as Exempt.

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

Unexpired Leases.

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

CURRENT MARKET VALUE
OF DEBTOR’S INTEREST IN

PROPERTY, WITHOUT

DEDUCTION OF ANY SECURED

CLAIM OR EXEMPTION

1

200

100

100
20

TYPE OF PROPERTY

NONE

DESCRIPTION AND

LOCATION OF

PROPERTY

H
W
J
C

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

3. Security deposits with public utilities,
telephone companies, landlords, and others.
4. Household goods and furnishings,
including audio, video, and computer
equipment.

5. Books; pictures and other art objects;

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

6. Wearing apparel.
7. Furs and jewelry.
8. Firearms and sports, photographic,

and other hobby equipment.

9. Interests in insurance policies. Name

insurance company of each policy and
itemize surrender or refund value of each.
10. Annuities. Itemize and name each issuer.
11. Interest in an education IRA as

defined in 26 U.S.C. § 530(b)(1) or under
a qualified State tuition plan as defined in
26 U.S.C. § 529(b)(1). Give particulars.
(File separately the record(s) of any such
interests. 11 U.S.C. § 523©; Rule 1007(b)

12. Interests in IRA, ERISA,

Keogh, or other pension or profit
sharing plans. Itemize.

13. Stock and interests in

incorporated and unincorporated
businesses. Itemize.

14. Interests in partnerships or joint

ventures. Itemize.

15. Government and corporate

bonds and other negotiable and non-
negotiable instruments.

at residence

at residence

at residence

at residence
at residence

Amin Gas & Mini Mart, LLC

x

x

x

x

x
x

x

x

x

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Document Page 3 of 14

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

18. Other liquidated debts owing
debtor including tax refunds. Give
particulars.

19. Equitable or future interests, life

estates, and rights or powers
exercisable for the benefit of the
debtor other than those listed in
Schedule of Real Property.

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

21. Other contingent and

unliquidated claims of every nature,
including tax refunds, counterclaims
of the debtor, and rights to setoff
claims. Give estimated value of each.

21. Patents, copyrights, and other

intellectual property. Give particulars.
23. Licenses, franchises, and other
general intangibles. Give particulars.

24. Consumer lists or other

compilations containing personally
identifiable information (as defined in
11 U.S.C. § 101(41A) provided to the
debtor by individuals in connection
with obtaining a product or service
from the debtor primarily for personal,
family or household purposes.

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

26. Boats, motors, and accessories.
27. Aircraft and accessories.
28. Office equipment, furnishings,

34. Farm supplies, chemicals, and feed.
35. Other personal property of any

kind not already listed. Itemize

and supplies.

29. Machinery, fixtures, equipment,

and supplies used in business.

30. Inventory.
31. Animals.
32. Crops— growing or harvested.

give particulars.

33. Farming equipment and

implements.

x
x

x

x

x

x

x

x

x
x
x

x

x
x
x

x

x
x

possible tax refund

06 Chrysler T & Country
92 Toyota Corolla

**4,190
4,075

continuation sheets
attached

Total:

$8,686.00

** - N.A.D.A. value of $8,975.00 (because of mechanical problems Debtor’s believes Include amounts from any continuation sheets attached.
this automobile has a lower value. Report also on Summary of Schedules.

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B6C (Official Form 6C) (4/13)

UNITED STATES BANKRUPTCY COURT
EASTERN DISTRICT OF PENNSYLVANIA

In re: Amin Mohammad, Debtor

Case No: 13 - 17039 MDC
Chapter 7

SCHEDULE C — PROPERTY CLAIMED AS EXEMPT

Debtor elects the exemption to which Debtor is entitled under:
Check one box:
[x] 11 U.S.C. § 522(b)(2)
[] 11 U.S.C. § 522(b)(3)

[ ] Check if debtor claims a homestead exemption that exceeds
$155,675. *

Description of

Property

Specify Law
Providing Each

Exemption

Value of

Claimed Exemption

automobile

522(d)(2)

hsehld goods & frnshg,
wearing apparel,
appliance and books

jewelry

other property

(3)

(4)

(5)

3,675

12,250

1,550

12,725

Current Market
Value of Property
Without Deducting

Exemptions

** 4,190

420

20

4,076

* - 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.

** - Debtor claims part of his wild card exemption in addition to his auto exemption.

Unless specifically stated otherwise, Debtor claims 100% of Debtor’s interest in each item listed in this
Schedule as exempt in the maximum amount permitted under applicable law. Debtor also asserts that the
amount exempt is the total value of Debtor’s interest in such property.

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

UNITED STATES BANKRUPTCY COURT
EASTERN DISTRICT OF PENNSYLVANIA

In re: Amin Mohammad, Debtor

Case No: 13 - 17039 MDC
Chapter 7

SCHEDULE D — CREDITORS HOLDING SECURED CLAIMS

State the name, mailing address, including zip code, and the last four digits of any account number of all entities holding claims secured
by property of Debtor as of the date of filing of the petition. The complete account number of any account Debtor has with the creditor is
useful to the trustee and the creditor and may be provided if Debtor chooses to do so. List creditors holding all types of secured interests
such as judgment liens, garnishments, statutory liens, mortgages, deeds of trust, and other security interests.

List creditors in alphabetical order to the extent practicable. If a minor child is the creditor, state the child's initials and the name and
address of the child’s parent or guardian, such as “A.B., a minor child, by John Doe, guardian.” Do not disclose the child’s name. See, 11
U.S.C. § 112 and Fed. R. Bankr. P. 1007(m). If all secured creditors will not fit on this page, use the continuation sheet provided.

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

the entity on the appropriate schedule of creditors, and complete Schedule H— Codebtors. If a joint petition is filed, state whether
husband, wife, both of them or the marital community may be liable on each claim by placing an “H,” “W,” “J,” or “C,” in the column
labeled “Husband, Wife, Joint or Community” (Abbreviated: H,W,J,C).

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

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

Total the columns labeled “Amount of Claim Without Deducting Value of Collateral” and “Unsecured Portion, If Any” in the boxes

labeled “Total(s)” on the last sheet of the completed schedule. Report the total from the column labeled “Amount of Claim Without
Deducting Value of Collateral” also on the Summary of Schedules and, if Debtor is an individual with primarily consumer debts, report
the total from the column labeled “Unsecured Portion, if Any” on the Statistical Summary of Certain Liabilities and Related Data.”

[ ]

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

C
O
D
E
B
T
O
R

H
W
J
C

Creditor’s Name and Mailing

Address Including Zip Code

Acct No: x - x - 8462
Internal Revenue Service
P.O. Box 7346
Philadelphia, PA 19101
Acct No: x - x -
Ocwen Loan Servicing, LLC
a/k/a, Deutsche Bank
1661 Worthington Road, Suite 100
West Palm Beach, FL 33409

Date Claim Was
Incurred, Nature of
Lien, and Description

to Lien

and Value of

Property Subject

income tax liens

4/12/2004
mortgage
$192,000.00
(102 Bryn Mawr)

C
O
N
T
I
N
G
E
N
T

U
N
L
I
Q
U
I
D
A
T
E
D

D
I
S
P
U
T
E
D

Unsecured
Portion
If Any

Amount of

Claim
Without
Deducting
Value of
Collateral

135,890

413,720

221,720

Case 13-17039-elf Doc 19 Filed 08/25/13 Entered 08/25/13 22:04:22 Desc Main

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Acct No: x - x - 8462
PA Dept of Revenue
P.O. Box 280946
Harrisburg, PA 17128

income tax liens

7,770

Totals >

$446,450.00 $221,720.00

(Report total also on Summary of Schedules)
(If Applicable, report also on Statistical Summary of Certain Liabilities and Related Data)

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B6E (Official Form 6E) (4/13)

UNITED STATES BANKRUPTCY COURT
EASTERN DISTRICT OF PENNSYLVANIA

In re: Amin Mohammad, Debtor

Case No: 13 - 17039 MDC
Chapter 7

SCHEDULE E — CREDITORS HOLDING UNSECURED PRIORITY CLAIMS

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

holders of unsecured claims entitled to priority should be listed in this schedule. In the boxes provided on the attached sheets, state the
name and mailing address, including zip code, and the last four digits of the account number, if any, of all entities holding priority
claims against Debtor or property of Debtor, as of the date of the filing of the petition. Use a separate continuation sheet for each type
of priority and label each with the type of priority.

The complete account number of any account Debtor has with the creditor is useful to the trustee and the creditor and may be

provided if Debtor chooses to do so. If a minor child is a creditor, state the child’s initials and the name and address of the child’s parent
or guardian, such as “A.B., a minor child, by John Doe, guardian.” Do not disclose the child’s name. See, 11 U.S.C. § 112 and Fed. R.
Bankr. P. 1007(m).

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

include the entity in the appropriate schedule of creditors, and complete Schedule H - Codebtors. If a joint petition is filed, state
whether husband, wife, both of them, or the marital community may be liable on each claim by placing an “H,” “W,” “J,” or “C” in the
column labeled “Husband, Wife, Joint, or Community.” If the claim is contingent, place an “X” in the column labeled “Contingent.”
If the claim is unliquidated, place an “X” in the column labeled “Unliquidated.” If the claim is disputed, place an “X” in the column
labeled “Disputed.” (You may need to place an X in more than one of these three columns.)

Report the total of claims listed on each sheet in the box labeled “Subtotal” 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 in the Summary of Schedules.

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

of all amounts entitled to priority listed on this Schedule E in the box labeled “Totals” on the last sheet of the completed schedule.
Individual debtors with primarily consumer debts who file a case under Chapter 7 or 13 report this total also on the Statistical
Summary of Certain Liabilities and Related Data.

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

total of all amounts not entitled to priority listed on this Schedule E in the box labeled “Totals” on the last sheet of the completed
schedule. Individual debtors with primarily consumer debts who file a case under Chapter 7 report this total also on the Statistical
Summary of Certain Liabilities and Related Data.”

[x] Check this box if Debtor has no creditors holding unsecured, priority claims to report on this Schedule E.

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

Domestic Support Obligations
Claims for domestic support that are owed to or are recoverable by a spouse, former spouse, or child of the debtor, or the
parent, legal guardian or responsible relative of such a child or a governmental unit to whom such a domestic support claim
has been assigned to the extent provided in 11 U.S.C. § 507(a)(1).

[ ]

[ ]

Extensions of credit in an involuntary case.
Claims arising in the ordinary course of Debtor’s business or financial affairs after the commencement of the case
but before the earlier of the appointment of a trustee or the order for relief. 11 U.S.C. § 507(a)(3).

Wages, salaries, and commissions
Wages, salaries and commissions, including vacation, severance, and sick leave pay owing to employees and commissions
owing to qualifying independent sales representatives up to $12,475* per person earned within 180 days immediately
preceding the filing of the original petition, or the cessation of business, whichever occurred first, to the extent provided in 11
U.S.C. § 507(a)(4).

* - amount subject to adjustment on 4/01/16, and every three years thereafter with respect to cases commenced

on or after the date of adjustment.

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[ ]

[ ]

[ ]

[x]

[ ]

[ ]

Contributions to employee benefit plans
Money owed to employee benefit plans for services rendered within 180 days immediately preceding the filing of the
original petition, or the cessation of business, whichever occurred first, to the extent provided in 11 U.S.C. § 507(a)(5).

Certain farmers and fishermen
Claims of certain farmers and fishermen, up to a maximum of $6,150* per farmer or fisherman, against Debtor, as
provided in 11 U.S.C. § 507(a)(6).

Deposits by individuals
Claims of individuals up to a maximum of $2,775* for deposits for the purchase, lease, or rental of property or services for
personal, family or household use, that were not delivered or provided. 11 U.S.C. § 507(a)(7).

Taxes and Certain Other Debts Owed to Governmental Units
Taxes, custom duties, and penalties owing to federal, state, and local governmental units as set forth in 11 U.S.C. § 507(a)(8).

Commitments to Maintain the Capital of an Insured Depository Institution
Claims based on commitments to the FDIC, RTC, Director of the Office of Thrift Supervision, Comptroller of the Currency,
or Board of Governors of the Federal Reserve System, or their predecessors or successors, to maintain the capital of an
insured depository institution. 11 U.S.C. § 507(a)(9).

Claims for Death or Personal Injury While Debtor Was Intoxicated
Claims for death or personal injury resulting from the operation of a motor vehicle or vessel while Debtor was intoxicated
from using alcohol, a drug or other substance.

* - 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.

Type of Priority for Claims Listed on this Sheet

AMOUNT
ENTITLED

TO

PRIORITY

AMOUNT

NOT

ENTITLED

TO

PRIORITY,
IF ANY

AMOUNT

OF

CLAIM

DATE CLAIM WAS
INCURRED AND
CONSIDERATION

FOR CLAIM

R
O
T
B
E
D
O
C

H
W
J
C

T
N
E
G
N
I
T
N
O
C

D
E
T
A
D
I
U
Q
I
L
N
U

D
E
T
U
P
S
I
D

CREDITOR’S NAME,
MAILING ADDRESS

INCLUDING ZIP CODE,
AND ACCOUNT NUMBER

(See instructions above.)

Acct No:

Acct No:

Acct No:

Acct No:

(Report total also on Summary of Schedules)
(If Applicable, report also on Statistical Summary of Certain Liabilities and Related Data)

TOTALS >

$ 0.00

$ 0.00

$ 0.00

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Document Page 9 of 14

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

UNITED STATES BANKRUPTCY COURT
EASTERN DISTRICT OF PENNSYLVANIA

In re: Amin Mohammad, Debtor

Case No: 13 - 17039 MDC
Chapter 7

SCHEDULE F — CREDITORS HOLDING UNSECURED NONPRIORITY CLAIMS

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 Debtor or the property of the debtor, as of the date of filing of the petition. The complete account number of any
account Debtor has with the creditor is useful to the trustee and the creditor and may be provided if 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 in the appropriate schedule of creditors, and complete Schedule H— Codebtors. If a joint petition is filed, state whether
husband, wife, both of them, or the marital community may be liable on each claim by placing an “H,” “W,” “J,” or “C” in the column
labeled “HWJC” for “Husband, Wife, Joint, or Community.”
If the claim is contingent, place an “X” in the column labeled “CONTINGENT.” If the claim is unliquidated, place an “X” in the column
labeled “UNLIQUIDATED.” If the claim is disputed, place an “X” in the column labeled “DISPUTED.” You may need to place an X in
more than one of these three columns.

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

[ ]

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

Creditor’s Name and Mailing
Address Including Zip Code

Acct No: x - x -
Halimah Davis
1322 South 54th Street
Philadelphia, PA 19143
Acct No: x - x -
J.C. Penney Co., Inc.
First Energy Corp.
P.O. Box 32000
Orlando, FL 32890
Acct No: x - x -

Date Claim Was Incurred

And Consideration for Claim

If Claim is Subject to

Setoff, so State

C
O
D
E
B
T
O
R

H
W
J
C

premises liability

10/1/12
credit card

C
O
N
T
I
N
G
E
N
T

U
N
L
I
Q
U
I
D
A
T
E
D

D
I
S
P
U
T
E
D

d

Amount

of Claim

40,000

25

TOTAL >

$40,025.00

(Report total also on Summary of Schedules)
(If Applicable, report also on Statistical Summary of Certain Liabilities and Related Data)

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Document Page 10 of 14

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

UNITED STATES BANKRUPTCY COURT
EASTERN DISTRICT OF PENNSYLVANIA

In re: Amin Mohammad, Debtor

Case No: 13 - 17039 MDC
Chapter 7

SCHEDULE G — EXECUTORY CONTRACTS AND UNEXPIRED LEASES

Describe all executory contracts of any nature and all unexpired leases of real or personal property. Include any
timeshare interests. State nature of Debtor’s interest in contract, i.e., “Purchaser,” “Agent,” etc. State whether
Debtor is the lessor or lessee of a lease. Provide the names and complete mailing addresses of all other parties to
each lease or contract described. If a minor child is a party to one of the leases or contracts, state the child’s
initials and the name and address of the child’s parent or guardian, such as “A.B., a minor child, by John Doe,
guardian.” Do not disclose the child’s name. See, 11 U.S.C. § 112 and Fed. R. Bankr. P. 1007(m).

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

Name and Mailing Address,
including Zip Code, of Other
Parties to Lease or Contract

Description of Contract or
Lease and Nature of Debtor’s

Interest. State Whether Lease is for
Nonresidential real property. State

Contract Number of any
Government Contract

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

UNITED STATES BANKRUPTCY COURT
EASTERN DISTRICT OF PENNSYLVANIA

In re: Amin Mohammad, Debtor

Case No: 13 - 17039 MDC
Chapter 7

SCHEDULE H — CODEBTORS

Provide the information requested concerning any person or entity, other than a spouse in a joint case, that is
also liable on any debts listed by Debtor in the schedules of creditors. Include all guarantors and co-signers. If
Debtor resides or resided in a community property state, commonwealth, or territory (including Alaska, Arizona,
California, Idaho, Louisiana, Nevada, New Mexico, Puerto Rico, Texas, Washington, or Wisconsin) within the
eight-year period immediately preceding the commencement of the case, identify the name of the debtor’s spouse
and of any former spouse who resides or resided with Debtor in the community property state, commonwealth, or
territory. Include all names used by the nondebtor spouse during the eight years immediately preceding the
commencement of this case. If a minor child is a codebtor or a creditor, state the child’s initials and the name and
address of the child’s parent or guardian, such as “A.B., a minor child, by John Doe, guardian.” Do not disclose
the child’s name. See, 11 U.S.C. § 112 and Fed. R. Bankr. P. 1007(m).

[ ] Check this box if debtor has no codebtors.

Name and Address of Codebtor

Name and Address of Creditor

Farzana Amin (spouse)

Ocwen Loan Servicing, LLC, a/k/a, Deutsche Bank

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

UNITED STATES BANKRUPTCY COURT
EASTERN DISTRICT OF PENNSYLVANIA

In re: Amin Mohammad, Debtor

Case No: 13 - 17039 MDC
Chapter 7

SCHEDULE I — CURRENT INCOME OF INDIVIDUAL DEBTORS

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

Debtor’s Marital
Status:
married

RELATIONSHIP

AGE

Dependents of Debtor and Spouse

Cashier - Top Gas & Mini Mart, LLC
16 months
4548 Baltimore Ave Phila., PA 19143

Debtor

EMPLOYMENT:
Occupation, Name of Employer:
How long employed:
Address of employer:
INCOME (Estimate of average or projected monthly income at time case filed)
1. Monthly gross wages, salary, and commissions
(Prorate if not paid monthly)
2. Estimated monthly overtime
3. SUBTOTAL
4. LESS PAYROLL DEDUCTIONS
a. Payroll taxes and Social Security
b. Insurance
c. Union dues
d. Other (Specify:)
5. SUBTOTAL OF PAYROLL DEDUCTIONS
6. TOTAL NET MONTHLY TAKE HOME PAY
7. Regular income from operation of business/profession/farm (attach statement)
8. Income from real property
9. Interest and dividends
10. Alimony, maintenance, or support payments payable to Debtor for the
debtor’s use or that of the dependents listed above
11. Social security or other governmental assistance Specify:
12. Pension or retirement income
13. Other monthly income (Specify):
14. SUBTOTAL OF LINES 7 THROUGH 13
15. AVERAGE MONTHLY INCOME (Add amounts shown on lines 6 and 14)

16. COMBINED AVERAGE MONTHLY INCOME

$1,526.00

Spouse

DEBTOR

1,920

SPOUSE

$1,920.00
394

$ 0.00

$394.00
$1,526.00

$ 0.00
$ 0.00

$ 0.00
$ 0.00
(Report also on Summary of Schedules and Statistical

$ 0.00
$1,526.00

Summary of Certain Liabilities, Data)

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

None______________

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

UNITED STATES BANKRUPTCY COURT
EASTERN DISTRICT OF PENNSYLVANIA

In re: Amin Mohammad, Debtor

Case No: 13 - 17039 MDC
Chapter 7

SCHEDULE J— CURRENT EXPENDITURES OF INDIVIDUAL DEBTORS

Complete this schedule by estimating the average or projected monthly expenses of Debtor and the debtor’s family at time case filed. Prorate any
payments made biweekly, quarterly, semi-annually, or annually to show monthly rate. The average monthly expenses calculated on this form may differ
from the deductions from income allowed on Form22A or 22C.

[ ] Check this box if a joint petition is filed and debtor’s spouse maintains a separate household. Complete a separate schedule of expenditures labeled “Spouse.”

700

85

400

340
100

158

$1,783.00

$1,526.00
$1,783.00
($257.00)

1 Rent, home mortgage, or mobile-home lot rent

Are real estate taxes included? Yes _____ No _____
Is property insurance included? Yes _____ No _____

2 Utilities
a Electricity and heating fuel
b Water and sewer
c Telephone
d Other:
3 Home Maintenance (repairs and upkeep)
4 Food
5 Clothing
6 Laundry, dry cleaning
7 Medical and dental expenses
8 Transportation (not including car payments)
9 Recreation, clubs, entertainment, newspapers, magazines, etc
10 Charitable contributions
11 Insurance (not deducted from wages or included in home mortgage payments
a. Homeowner’s or renter’s
b. Life
c. Health
d. Auto
e. Other insurance:
12 Taxes (not deducted from wages or included in home mortgage) Specify:
13 Installment payments (in Chapters11, 12 and 13, do not list payments to be included in the plan)
a. Auto payment:
b. Other payment(s) (List):
14 Alimony, maintenance, and support paid to others
15 Payments for support of additional dependents not living at your home
16 Regular expenses from operation of business, profession, or farm (attach detailed statement)
17 Other expenses:
18 AVERAGE MONTHLY EXPENSES (Report also on Summary of Schedules and Statistical
Summary of Certain Liabilities, Data)
19 Describe any increase or decrease in expenditures reasonably anticipated to occur within
the year following the filing of this document: None

20 STATEMENT OF MONTHLY NET INCOME
a. Average monthly income from Line 16 of Schedule I
b. Average monthly expenses from Line 18 above
c. Monthly net income (a minus b)

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