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Case 5:12-bk-04640-JJT Doc 21 Filed 09/28/12 Entered 09/28/12 16:59:45 Desc

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© 1993-2011 EZ-Filing, Inc. [1-800-998-2424] - Forms Software OnlyB6A(OfficialForm6A)(12/07)INREDebtor(s)CaseNo.(Ifknown)Exceptasdirectedbelow,listallrealpropertyinwhichthedebtorhasanylegal,equitable,orfutureinterest,includingallpropertyownedasacotenant,communityproperty,orinwhichthedebtorhasalifeestate.Includeanypropertyinwhichthedebtorholdsrightsandpowersexercisableforthedebtor’sownbenefit.Ifthedebtorismarried,statewhetherthehusband,wife,both,orthemaritalcommunityownthepropertybyplacingan“H,”“W,”“J,”or“C”inthecolumnlabeled“Husband,Wife,Joint,orCommunity.”Ifthedebtorholdsnointerestinrealproperty,write“None”under“DescriptionandLocationofProperty.”Donotincludeinterestsinexecutorycontractsandunexpiredleasesonthisschedule.ListtheminScheduleG-ExecutoryContractsandUnexpiredLeases.Ifanentityclaimstohavealienorholdasecuredinterestinanyproperty,statetheamountofthesecuredclaim.SeeScheduleD.Ifnoentityclaimstoholdasecuredinterestintheproperty,write“None”inthecolumnlabeled“AmountofSecuredClaim.”Ifthedebtorisanindividualorifajointpetitionisfiled,statetheamountofanyexemptionclaimedinthepropertyonlyinScheduleC-PropertyClaimedasExempt.DESCRIPTIONANDLOCATIONOFPROPERTYNATUREOFDEBTOR'SINTERESTINPROPERTYHUSBAND,WIFE,JOINT,ORCOMMUNITYCURRENTVALUEOFDEBTOR'SINTERESTINPROPERTYWITHOUTDEDUCTINGANYSECUREDCLAIMOREXEMPTIONAMOUNTOFSECUREDCLAIMTOTAL(ReportalsoonSummaryofSchedules)SCHEDULE A - REAL PROPERTY 185,500.00Sypniewski, Robert A.5:12-bk-4640ResidenceFee SimpleJ 185,500.00 182,000.00223 Machell AvenueDallas, Luzerne County, PAValued based on 2008 Luzerne County ReassessmentCase 5:12-bk-04640-JJT Doc 21 Filed 09/28/12 Entered 09/28/12 16:59:45 Desc

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© 1993-2011 EZ-Filing, Inc. [1-800-998-2424] - Forms Software OnlyB6B(OfficialForm6B)(12/07)INREDebtor(s)CaseNo.(Ifknown)Exceptasdirectedbelow,listallpersonalpropertyofthedebtorofwhateverkind.Ifthedebtorhasnopropertyinoneormoreofthecategories,placean“x”intheappropriatepositioninthecolumnlabeled“None.”Ifadditionalspaceisneededinanycategory,attachaseparatesheetproperlyidentifiedwiththecasename,casenumber,andthenumberofthecategory.Ifthedebtorismarried,statewhetherthehusband,wife,both,orthemaritalcommunityownthepropertybyplacingan“H,”“W,”“J,”or“C”inthecolumnlabeled“Husband,Wife,Joint,orCommunity.”Ifthedebtorisanindividualorajointpetitionisfiled,statetheamountofanyexemptionsclaimedonlyinScheduleC-PropertyClaimedasExempt.Donotlistinterestsinexecutorycontractsandunexpiredleasesonthisschedule.ListtheminScheduleG-ExecutoryContractsandUnexpiredLeases.Ifthepropertyisbeingheldforthedebtorbysomeoneelse,statethatperson’snameandaddressunder“DescriptionandLocationofProperty.”Ifthepropertyisbeingheldforaminorchild,simplystatethechild'sinitialsandthenameandaddressofthechild'sparentorguardian,suchas"A.B.,aminorchild,byJohnDoe,guardian."Donotdisclosethechild'sname.See,11U.S.C.§112andFed.R.Bankr.P.1007(m).TYPEOFPROPERTYNONEDESCRIPTIONANDLOCATIONOFPROPERTYHUSBAND,WIFE,JOINT,ORCOMMUNITYCURRENTVALUEOFDEBTOR'SINTERESTINPROPERTYWITHOUTDEDUCTINGANYSECUREDCLAIMOREXEMPTIONSCHEDULE B - PERSONAL PROPERTYSypniewski, Robert A.5:12-bk-46401.Cashonhand.Cash on HandH 300.002.Checking,savingsorotherfinancialaccounts,certificatesofdepositorsharesinbanks,savingsandloan,thrift,buildingandloan,andhomesteadassociations,orcreditunions,brokeragehouses,orcooperatives.Savings AccountJ 500.00PNC Bank(Estimated)3.Securitydepositswithpublicutilities,telephonecompanies,landlords,andothers.X4.Householdgoodsandfurnishings,includeaudio,video,andcomputerequipment.Furniture, Appliances, ElectronicsJ 1,350.005.Books,picturesandotherartobjects,antiques,stamp,coin,record,tape,compactdisc,andothercollectionsorcollectibles.Books, Pictures, CD's 1,000.006.Wearingapparel.Wearing ApparelH 1,000.007.Fursandjewelry.JewelryH 400.008.Firearmsandsports,photographic,andotherhobbyequipment.X9.Interestininsurancepolicies.Nameinsurancecompanyofeachpolicyanditemizesurrenderorrefundvalueofeach.Term Life Insurance 0.00No Cash Survival Value10.Annuities.Itemizeandnameeachissue.X11.InterestsinaneducationIRAasdefinedin26U.S.C.§530(b)(1)orunderaqualifiedStatetuitionplanasdefinedin26U.S.C.§529(b)(1).Giveparticulars.(Fileseparatelytherecord(s)ofanysuchinterest(s).11U.S.C.§521(c).)X12.InterestsinIRA,ERISA,Keogh,orotherpensionorprofitsharingplans.Giveparticulars.X13.Stockandinterestsinincorporatedandunincorporatedbusinesses.Itemize.5:19 Investments LLCH 0.0049% Equity InterestNo ValuePenn Mortgage Inc.H 0.00Ceased All Operation on 12/31/09Case 5:12-bk-04640-JJT Doc 21 Filed 09/28/12 Entered 09/28/12 16:59:45 Desc

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© 1993-2011 EZ-Filing, Inc. [1-800-998-2424] - Forms Software OnlySypniewski, Robert A.5:12-bk-464014.Interestsinpartnershipsorjointventures.Itemize.X15.Governmentandcorporatebondsandothernegotiableandnon-negotiableinstruments.X16.Accountsreceivable.X17.Alimony,maintenance,support,andpropertysettlementsinwhichthedebtorisormaybeentitled.Giveparticulars.X18.Otherliquidateddebtsowedtodebtorincludingtaxrefunds.Giveparticulars.X19.Equitableorfutureinterest,lifeestates,andrightsorpowersexercisableforthebenefitofthedebtorotherthanthoselistedinScheduleA-RealProperty.X20.Contingentandnoncontingentinterestsinestateofadecedent,deathbenefitplan,lifeinsurancepolicy,ortrust.X21.Othercontingentandunliquidatedclaimsofeverynature,includingtaxrefunds,counterclaimsofthedebtor,andrightstosetoffclaims.Giveestimatedvalueofeach.X22.Patents,copyrights,andotherintellectualproperty.Giveparticulars.X23.Licenses,franchises,andothergeneralintangibles.Giveparticulars.X24.Customerlistsorothercompilationscontainingpersonallyidentifiableinformation(asdefinedin11U.S.C.§101(41A))providedtothedebtorbyindividualsinconnectionwithobtainingaproductorservicefromthedebtorprimarilyforpersonal,family,orhouseholdpurposes.X25.Automobiles,trucks,trailers,andothervehiclesandaccessories.2004 Cadillac SRX 15,000.0026.Boats,motors,andaccessories.X27.Aircraftandaccessories.X28.Officeequipment,furnishings,andsupplies.Office Equipment and Supplies 2,000.0029.Machinery,fixtures,equipment,andsuppliesusedinbusiness.X30.Inventory.X31.Animals.X32.Crops-growingorharvested.Giveparticulars.X33.Farmingequipmentandimplements.XB6B(OfficialForm6B)(12/07)-Cont.INREDebtor(s)CaseNo.(Ifknown)(ContinuationSheet)TYPEOFPROPERTYNONEDESCRIPTIONANDLOCATIONOFPROPERTYHUSBAND,WIFE,JOINT,ORCOMMUNITYCURRENTVALUEOFDEBTOR'SINTERESTINPROPERTYWITHOUTDEDUCTINGANYSECUREDCLAIMOREXEMPTIONSCHEDULE B - PERSONAL PROPERTYCase 5:12-bk-04640-JJT Doc 21 Filed 09/28/12 Entered 09/28/12 16:59:45 Desc

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© 1993-2011 EZ-Filing, Inc. [1-800-998-2424] - Forms Software OnlySypniewski, Robert A.5:12-bk-464034.Farmsupplies,chemicals,andfeed.X35.Otherpersonalpropertyofanykindnotalreadylisted.Itemize.XB6B(OfficialForm6B)(12/07)-Cont.INREDebtor(s)CaseNo.(Ifknown)(ContinuationSheet)TYPEOFPROPERTYNONEDESCRIPTIONANDLOCATIONOFPROPERTYHUSBAND,WIFE,JOINT,ORCOMMUNITYCURRENTVALUEOFDEBTOR'SINTERESTINPROPERTYWITHOUTDEDUCTINGANYSECUREDCLAIMOREXEMPTIONTOTAL(Includeamountsfromanycontinuationsheetsattached.ReporttotalalsoonSummaryofSchedules.)continuationsheetsattachedSCHEDULE B - PERSONAL PROPERTY 21,550.00 0Case 5:12-bk-04640-JJT Doc 21 Filed 09/28/12 Entered 09/28/12 16:59:45 Desc

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© 1993-2011 EZ-Filing, Inc. [1-800-998-2424] - Forms Software OnlyB6C(OfficialForm6C)(04/10)INREDebtor(s)CaseNo.(Ifknown)Debtorelectstheexemptionstowhichdebtorisentitledunder:Checkifdebtorclaimsahomesteadexemptionthatexceeds$146,450.*(Checkonebox)11U.S.C.§522(b)(2)11U.S.C.§522(b)(3)DESCRIPTIONOFPROPERTYSPECIFYLAWPROVIDINGEACHEXEMPTIONVALUEOFCLAIMEDEXEMPTIONCURRENTVALUEOFPROPERTYWITHOUTDEDUCTINGEXEMPTIONS*Amountsubjecttoadjustmenton4/1/13andeverythreeyearsthereafterwithrespecttocasescommencedonorafterthedateofadjustment.SCHEDULE C - PROPERTY CLAIMED AS EXEMPT(cid:252)Sypniewski, Robert A.5:12-bk-4640SCHEDULE A - REAL PROPERTYResidence11 USC § 522(d)(1) 3,500.00 185,500.00223 Machell AvenueDallas, Luzerne County, PAValued based on 2008 Luzerne CountyReassessmentSCHEDULE B - PERSONAL PROPERTYCash on Hand11 USC § 522(d)(5) 300.00 300.00Savings Account11 USC § 522(d)(5) 500.00 500.00PNC Bank(Estimated)Furniture, Appliances, Electronics11 USC § 522(d)(3) 1,350.00 1,350.00Books, Pictures, CD's11 USC § 522(d)(3) 1,000.00 1,000.00Wearing Apparel11 USC § 522(d)(3) 1,000.00 1,000.00Jewelry11 USC § 522(d)(4) 400.00 400.002004 Cadillac SRX11 USC § 522(d)(2) 2,500.00 15,000.00Office Equipment and Supplies11 USC § 522(d)(5) 2,000.00 2,000.00Case 5:12-bk-04640-JJT Doc 21 Filed 09/28/12 Entered 09/28/12 16:59:45 Desc

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© 1993-2011 EZ-Filing, Inc. [1-800-998-2424] - Forms Software OnlyB6D(OfficialForm6D)(12/07)INREDebtor(s)CaseNo.(Ifknown)Statethename,mailingaddress,includingzipcode,andlastfourdigitsofanyaccountnumberofallentitiesholdingclaimssecuredbypropertyofthedebtorasofthedateoffilingofthepetition.Thecompleteaccountnumberofanyaccountthedebtorhaswiththecreditorisusefultothetrusteeandthecreditorandmaybeprovidedifthedebtorchoosestodoso.Listcreditorsholdingalltypesofsecuredinterestssuchasjudgmentliens,garnishments,statutoryliens,mortgages,deedsoftrust,andothersecurityinterests.Listcreditorsinalphabeticalordertotheextentpracticable.Ifaminorchildisthecreditor,statethechild'sinitialsandthenameandaddressofthechild'sparentorguardian,suchas"A.B.,aminorchild,byJohnDoe,guardian."Donotdisclosethechild'sname.See,11U.S.C.§112andFed.R.Bankr.P.1007(m).Ifallsecuredcreditorswillnotfitonthispage,usethecontinuationsheetprovided.Ifanyentityotherthanaspouseinajointcasemaybejointlyliableonaclaim,placean“X”inthecolumnlabeled“Codebtor,”includetheentityontheappropriatescheduleofcreditors,andcompleteScheduleH–Codebtors.Ifajointpetitionisfiled,statewhetherthehusband,wife,bothofthem,orthemaritalcommunitymaybeliableoneachclaimbyplacingan“H,”“W,”“J,”or“C”inthecolumnlabeled“Husband,Wife,Joint,orCommunity.”Iftheclaimiscontingent,placean“X”inthecolumnlabeled“Contingent.”Iftheclaimisunliquidated,placean“X”inthecolumnlabeled“Unliquidated.”Iftheclaimisdisputed,placean“X”inthecolumnlabeled“Disputed.”(Youmayneedtoplacean“X”inmorethanoneofthesethreecolumns.)Totalthecolumnslabeled“AmountofClaimWithoutDeductingValueofCollateral”and“UnsecuredPortion,ifAny”intheboxeslabeled“Total(s)”onthelastsheetofthecompletedschedule.Reportthetotalfromthecolumnlabeled“AmountofClaimWithoutDeductingValueofCollateral”alsoontheSummaryofSchedulesand,ifthedebtorisanindividualwithprimarilyconsumerdebts,reportthetotalfromthecolumnlabeled“UnsecuredPortion,ifAny”ontheStatisticalSummaryofCertainLiabilitiesandRelatedData.CheckthisboxifdebtorhasnocreditorsholdingsecuredclaimstoreportonthisScheduleD.CREDITOR'SNAMEANDMAILINGADDRESSINCLUDINGZIPCODEANDACCOUNTNUMBER.(SeeInstructionsAbove.)CODEBTORHUSBAND,WIFE,JOINT,ORCOMMUNITYDATECLAIMWASINCURRED,NATUREOFLIEN,ANDDESCRIPTIONANDVALUEOFPROPERTYSUBJECTTOLIENCONTINGENTUNLIQUIDATEDDISPUTEDAMOUNTOFCLAIMWITHOUTDEDUCTINGVALUEOFCOLLATERALUNSECUREDPORTION,IFANYACCOUNTNO.ACCOUNTNO.ACCOUNTNO.ACCOUNTNO.continuationsheetsattachedSubtotal(Totalofthispage)$$Total(Useonlyonlastpage)$$(ReportalsoonSummaryofSchedules.)(Ifapplicable,reportalsoonStatisticalSummaryofCertainLiabilitiesandRelatedData.)SCHEDULE D - CREDITORS HOLDING SECURED CLAIMSSypniewski, Robert A.5:12-bk-464012,500.0015,000.00Credit Acceptance Corp.PO Box 551888Detroit, MI 48255-1888Car LoanVALUE $0817XJ121,000.00185,500.00One West Bank6900 Beatrice DriveKalamazoo, MI 49009-9559MortgageVALUE $9970XJ61,000.00185,500.00Wells Fargo Bank, NAP. O. Box 13765-R4057-01PRoanoke, VA 24037-3765Second MortgageVALUE $VALUE $ 0194,500.00194,500.00Case 5:12-bk-04640-JJT Doc 21 Filed 09/28/12 Entered 09/28/12 16:59:45 Desc

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© 1993-2011 EZ-Filing, Inc. [1-800-998-2424] - Forms Software OnlySypniewski, Robert A.5:12-bk-4640B6E(OfficialForm6E)(04/10)INREDebtor(s)CaseNo.(Ifknown)Acompletelistofclaimsentitledtopriority,listedseparatelybytypeofpriority,istobesetforthonthesheetsprovided.Onlyholdersofunsecuredclaimsentitledtopriorityshouldbelistedinthisschedule.Intheboxesprovidedontheattachedsheets,statethename,mailingaddress,includingzipcode,andlastfourdigitsoftheaccountnumber,ifany,ofallentitiesholdingpriorityclaimsagainstthedebtororthepropertyofthedebtor,asofthedateofthefilingofthepetition.Useaseparatecontinuationsheetforeachtypeofpriorityandlabeleachwiththetypeofpriority.Thecompleteaccountnumberofanyaccountthedebtorhaswiththecreditorisusefultothetrusteeandthecreditorandmaybeprovidedifthedebtorchoosestodoso.Ifaminorchildisacreditor,statethechild'sinitialsandthenameandaddressofthechild'sparentorguardian,suchas"A.B.,aminorchild,byJohnDoe,guardian."Donotdisclosethechild'sname.See,11U.S.C.§112andFed.R.Bankr.P.1007(m).Ifanyentityotherthanaspouseinajointcasemaybejointlyliableonaclaim,placean"X"inthecolumnlabeled"Codebtor,"includetheentityontheappropriatescheduleofcreditors,andcompleteScheduleH-Codebtors.Ifajointpetitionisfiled,statewhetherthehusband,wife,bothofthem,orthemaritalcommunitymaybeliableoneachclaimbyplacingan"H,""W,""J,"or"C"inthecolumnlabeled"Husband,Wife,Joint,orCommunity."Iftheclaimiscontingent,placean"X"inthecolumnlabeled"Contingent."Iftheclaimisunliquidated,placean"X"inthecolumnlabeled"Unliquidated."Iftheclaimisdisputed,placean"X"inthecolumnlabeled"Disputed."(Youmayneedtoplacean"X"inmorethanoneofthesethreecolumns.)Reportthetotalofclaimslistedoneachsheetintheboxlabeled"Subtotals"oneachsheet.ReportthetotalofallclaimslistedonthisScheduleEintheboxlabeled“Total”onthelastsheetofthecompletedschedule.ReportthistotalalsoontheSummaryofSchedules.Reportthetotalofamountsentitledtoprioritylistedoneachsheetintheboxlabeled"Subtotals"oneachsheet.ReportthetotalofallamountsentitledtoprioritylistedonthisScheduleEintheboxlabeled“Totals”onthelastsheetofthecompletedschedule.IndividualdebtorswithprimarilyconsumerdebtsreportthistotalalsoontheStatisticalSummaryofCertainLiabilitiesandRelatedData.Reportthetotalofamountsnotentitledtoprioritylistedoneachsheetintheboxlabeled“Subtotals”oneachsheet.ReportthetotalofallamountsnotentitledtoprioritylistedonthisScheduleEintheboxlabeled“Totals”onthelastsheetofthecompletedschedule.IndividualdebtorswithprimarilyconsumerdebtsreportthistotalalsoontheStatisticalSummaryofCertainLiabilitiesandRelatedData.CheckthisboxifdebtorhasnocreditorsholdingunsecuredpriorityclaimstoreportonthisScheduleE.TYPESOFPRIORITYCLAIMS(Checktheappropriatebox(es)belowifclaimsinthatcategoryarelistedontheattachedsheets)DomesticSupportObligationsClaimsfordomesticsupportthatareowedtoorrecoverablebyaspouse,formerspouse,orchildofthedebtor,ortheparent,legalguardian,orresponsiblerelativeofsuchachild,oragovernmentalunittowhomsuchadomesticsupportclaimhasbeenassignedtotheextentprovidedin11U.S.C.§507(a)(1).ExtensionsofcreditinaninvoluntarycaseClaimsarisingintheordinarycourseofthedebtor'sbusinessorfinancialaffairsafterthecommencementofthecasebutbeforetheearlieroftheappointmentofatrusteeortheorderforrelief.11U.S.C.§507(a)(3).Wages,salaries,andcommissionsWages,salaries,andcommissions,includingvacation,severance,andsickleavepayowingtoemployeesandcommissionsowingtoqualifyingindependentsalesrepresentativesupto$11,725*perpersonearnedwithin180daysimmediatelyprecedingthefilingoftheoriginalpetition,orthecessationofbusiness,whicheveroccurredfirst,totheextentprovidedin11U.S.C.§507(a)(4).ContributionstoemployeebenefitplansMoneyowedtoemployeebenefitplansforservicesrenderedwithin180daysimmediatelyprecedingthefilingoftheoriginalpetition,orthecessationofbusiness,whicheveroccurredfirst,totheextentprovidedin11U.S.C.§507(a)(5).CertainfarmersandfishermenClaimsofcertainfarmersandfishermen,upto$5,775*perfarmerorfisherman,againstthedebtor,asprovidedin11U.S.C.§507(a)(6).DepositsbyindividualsClaimsofindividualsupto$2,600*fordepositsforthepurchase,lease,orrentalofpropertyorservicesforpersonal,family,orhouseholduse,thatwerenotdeliveredorprovided.11U.S.C.§507(a)(7).TaxesandCertainOtherDebtsOwedtoGovernmentalUnitsTaxes,customsduties,andpenaltiesowingtofederal,state,andlocalgovernmentalunitsassetforthin11U.S.C.§507(a)(8).CommitmentstoMaintaintheCapitalofanInsuredDepositoryInstitutionClaimsbasedoncommitmentstotheFDIC,RTC,DirectoroftheOfficeofThriftSupervision,ComptrolleroftheCurrency,orBoardofGovernorsoftheFederalReserveSystem,ortheirpredecessorsorsuccessors,tomaintainthecapitalofaninsureddepositoryinstitution.11U.S.C.§507(a)(9).ClaimsforDeathorPersonalInjuryWhileDebtorWasIntoxicatedClaimsfordeathorpersonalinjuryresultingfromtheoperationofamotorvehicleorvesselwhilethedebtorwasintoxicatedfromusingalcohol,adrug,oranothersubstance.11U.S.C.§507(a)(10).*Amountsaresubjecttoadjustmenton4/01/13,andeverythreeyearsthereafterwithrespecttocasescommencedonorafterthedateofadjustment.continuationsheetsattachedSCHEDULE E - CREDITORS HOLDING UNSECURED PRIORITY CLAIMS(cid:252) 1Case 5:12-bk-04640-JJT Doc 21 Filed 09/28/12 Entered 09/28/12 16:59:45 Desc

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© 1993-2011 EZ-Filing, Inc. [1-800-998-2424] - Forms Software OnlySypniewski, Robert A.5:12-bk-4640B6E(OfficialForm6E)(04/10)-Cont.INREDebtor(s)CaseNo.(Ifknown)(ContinuationSheet)(TypeofPriorityforClaimsListedonThisSheet)CREDITOR'SNAME,MAILINGADDRESSINCLUDINGZIPCODEANDACCOUNTNUMBER.(SeeInstructionsabove.)CODEBTORHUSBAND,WIFE,JOINT,ORCOMMUNITYDATECLAIMWASINCURREDANDCONSIDERATIONFORCLAIMCONTINGENTUNLIQUIDATEDDISPUTEDAMOUNTOFCLAIMAMOUNTENTITLEDTOPRIORITYAMOUNTNOTENTITLEDTOPRIORITY,IFANYACCOUNTNO.ACCOUNTNO.ACCOUNTNO.ACCOUNTNO.ACCOUNTNO.ACCOUNTNO.Sheetno.ofcontinuationsheetsattachedtoSubtotalScheduleofCreditorsHoldingUnsecuredPriorityClaims(Totalsofthispage)$$$Total(UseonlyonlastpageofthecompletedScheduleE.ReportalsoontheSummaryofSchedules.)$Total(UseonlyonlastpageofthecompletedScheduleE.Ifapplicable,reportalsoontheStatisticalSummaryofCertainLiabilitiesandRelatedData.)$$SCHEDULE E - CREDITORS HOLDING UNSECURED PRIORITY CLAIMSTaxes and Other Certain Debts Owed to Governmental Units0.00Brenda Sue BishopPennsylvania Department Of RevenueDepartment 281061Harrisburg, PA 17128-1061 1 1Case 5:12-bk-04640-JJT Doc 21 Filed 09/28/12 Entered 09/28/12 16:59:45 Desc

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© 1993-2011 EZ-Filing, Inc. [1-800-998-2424] - Forms Software OnlyB6F(OfficialForm6F)(12/07)INREDebtor(s)CaseNo.(Ifknown)Statethename,mailingaddress,includingzipcode,andlastfourdigitsofanyaccountnumber,ofallentitiesholdingunsecuredclaimswithoutpriorityagainstthedebtororthepropertyofthedebtor,asofthedateoffilingofthepetition.Thecompleteaccountnumberofanyaccountthedebtorhaswiththecreditorisusefultothetrusteeandthecreditorandmaybeprovidedifthedebtorchoosestodoso.Ifaminorchildisacreditor,statethechild'sinitialsandthenameandaddressofthechild'sparentorguardian,suchas"A.B.,aminorchild,byJohnDoe,guardian."Donotdisclosethechild'sname.See,11U.S.C.§112andFed.R.Bankr.P.1007(m).DonotincludeclaimslistedinSchedulesDandE.Ifallcreditorswillnotfitonthispage,usethecontinuationsheetprovided.Ifanyentityotherthanaspouseinajointcasemaybejointlyliableonaclaim,placean“X”inthecolumnlabeled“Codebtor,”includetheentityontheappropriatescheduleofcreditors,andcompleteScheduleH-Codebtors.Ifajointpetitionisfiled,statewhetherthehusband,wife,bothofthem,orthemaritalcommunitymaybeliableoneachclaimbyplacingan“H,”“W,”“J,”or“C”inthecolumnlabeled“Husband,Wife,Joint,orCommunity.”Iftheclaimiscontingent,placean“X”inthecolumnlabeled“Contingent.”Iftheclaimisunliquidated,placean“X”inthecolumnlabeled“Unliquidated.”Iftheclaimisdisputed,placean“X”inthecolumnlabeled“Disputed.”(Youmayneedtoplacean“X”inmorethanoneofthesethreecolumns.)Reportthetotalofallclaimslistedonthisscheduleintheboxlabeled“Total”onthelastsheetofthecompletedschedule.ReportthistotalalsoontheSummaryofSchedulesand,ifthedebtorisanindividualwithprimarilyconsumerdebts,reportthistotalalsoontheStatisticalSummaryofCertainLiabilitiesandRelatedData.CheckthisboxifdebtorhasnocreditorsholdingunsecurednonpriorityclaimstoreportonthisScheduleF.CREDITOR'SNAME,MAILINGADDRESSINCLUDINGZIPCODE,ANDACCOUNTNUMBER.(SeeInstructionsAbove.)CODEBTORHUSBAND,WIFE,JOINT,ORCOMMUNITYDATECLAIMWASINCURREDANDCONSIDERATIONFORCLAIM.IFCLAIMISSUBJECTTOSETOFF,SOSTATECONTINGENTUNLIQUIDATEDDISPUTEDAMOUNTOFCLAIMACCOUNTNO.ACCOUNTNO.ACCOUNTNO.ACCOUNTNO.continuationsheetsattachedSubtotal(Totalofthispage)$Total(UseonlyonlastpageofthecompletedScheduleF.ReportalsoontheSummaryofSchedulesand,ifapplicable,ontheStatisticalSummaryofCertainLiabilitiesandRelatedData.)$SCHEDULE F - CREDITORS HOLDING UNSECURED NONPRIORITY CLAIMSSypniewski, Robert A.5:12-bk-4640unknownAdam L. KeysUdren Law Offices, PC111 Woodcrest Corp. Ctr., Ste. 200Cherry Hill, NJ 08003HunknownAlliance One Receivables Management4850 Street Road, Suite 300Trevose, PA 19053-6643Collection Agency for Capital One BankMore than one year old1499J0.00Bank Of AmericaNC4-105-02-514161 Piedmont PkwyGreensboro, NC 27410-8110For Notice Purposes Only9276H739.29Capital One BankP. O. Box 30281Salt Lake City, UT 84130-0281Credit CardMore than one year old 4739.29Case 5:12-bk-04640-JJT Doc 21 Filed 09/28/12 Entered 09/28/12 16:59:45 Desc

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© 1993-2011 EZ-Filing, Inc. [1-800-998-2424] - Forms Software OnlySypniewski, Robert A.5:12-bk-4640B6F(OfficialForm6F)(12/07)-Cont.INREDebtor(s)CaseNo.(Ifknown)(ContinuationSheet)CREDITOR'SNAME,MAILINGADDRESSINCLUDINGZIPCODE,ANDACCOUNTNUMBER.(SeeInstructionsAbove.)CODEBTORHUSBAND,WIFE,JOINT,ORCOMMUNITYDATECLAIMWASINCURREDANDCONSIDERATIONFORCLAIM.IFCLAIMISSUBJECTTOSETOFF,SOSTATECONTINGENTUNLIQUIDATEDDISPUTEDAMOUNTOFCLAIMACCOUNTNO.ACCOUNTNO.ACCOUNTNO.ACCOUNTNO.ACCOUNTNO.ACCOUNTNO.ACCOUNTNO.Sheetno.ofcontinuationsheetsattachedtoScheduleofCreditorsHoldingUnsecuredNonpriorityClaimsSubtotal(Totalofthispage)$Total(UseonlyonlastpageofthecompletedScheduleF.ReportalsoontheSummaryofSchedules,andifapplicable,ontheStatisticalSummaryofCertainLiabilitiesandRelatedData.)$SCHEDULE F - CREDITORS HOLDING UNSECURED NONPRIORITY CLAIMSunknownCapital One Bank(USA), NABy American Info Source LP As AgentPO Box 71083Charlotte, NC 28272-10830001J4,589.05CBUSA/Sears701 E. 60th St, NorthP. O. Box 6241Sioux Falls, SD 57117-6241Credit CardMore than one year oldunknownChase800 Brooksedge BlvDWesterville, OH 43081-2822More than one year old7328unknownER Solutions500 SW 7th StreetBuilding ARenton, VA 98057-2983More than one year old8939unknownHSBC BankPO Box 5253Carol Stream, IL 60197-5253More than one year old8704unknownLTD Financial Services7322 Southwest FreewaySuite 1600Houston, TX 77074-2053More than one year oldunknownLVNV Funding, LLCResurgent Capital ServicesPO Box 10587Greenville, SC 29603-0587 1 44,589.05Case 5:12-bk-04640-JJT Doc 21 Filed 09/28/12 Entered 09/28/12 16:59:45 Desc

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© 1993-2011 EZ-Filing, Inc. [1-800-998-2424] - Forms Software OnlySypniewski, Robert A.5:12-bk-4640B6F(OfficialForm6F)(12/07)-Cont.INREDebtor(s)CaseNo.(Ifknown)(ContinuationSheet)CREDITOR'SNAME,MAILINGADDRESSINCLUDINGZIPCODE,ANDACCOUNTNUMBER.(SeeInstructionsAbove.)CODEBTORHUSBAND,WIFE,JOINT,ORCOMMUNITYDATECLAIMWASINCURREDANDCONSIDERATIONFORCLAIM.IFCLAIMISSUBJECTTOSETOFF,SOSTATECONTINGENTUNLIQUIDATEDDISPUTEDAMOUNTOFCLAIMACCOUNTNO.ACCOUNTNO.ACCOUNTNO.ACCOUNTNO.ACCOUNTNO.ACCOUNTNO.ACCOUNTNO.Sheetno.ofcontinuationsheetsattachedtoScheduleofCreditorsHoldingUnsecuredNonpriorityClaimsSubtotal(Totalofthispage)$Total(UseonlyonlastpageofthecompletedScheduleF.ReportalsoontheSummaryofSchedules,andifapplicable,ontheStatisticalSummaryofCertainLiabilitiesandRelatedData.)$SCHEDULE F - CREDITORS HOLDING UNSECURED NONPRIORITY CLAIMSunknownMarlin Medclr Inovision507 Provincial RoadHorsham, PA 19044-2308W2,293.91MBNA AmericaP. O. Box 15026Wilmington, DE 19850-5026Credit CardMore than one year old1162unknownMidland Credit Mgmt Inc8875 Aero Drive, Ste 200San Diego, CA 92123-2255More than one year oldunknownNCO FinancialPO Box 41466Philadelphia, PA 19101More than one year oldunknownNCO Financial Systems205 Prudential ROAHorsham, PA 19044More than one year oldunknownOne West Bank155 North Lake AvenuePasadena CA, CA 91101Alternative address for mortgage companyunknownOne West Bank2900 Esperanza CrossingAustin, TX 78758-3658 2 42,293.91Case 5:12-bk-04640-JJT Doc 21 Filed 09/28/12 Entered 09/28/12 16:59:45 Desc

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© 1993-2011 EZ-Filing, Inc. [1-800-998-2424] - Forms Software OnlySypniewski, Robert A.5:12-bk-4640B6F(OfficialForm6F)(12/07)-Cont.INREDebtor(s)CaseNo.(Ifknown)(ContinuationSheet)CREDITOR'SNAME,MAILINGADDRESSINCLUDINGZIPCODE,ANDACCOUNTNUMBER.(SeeInstructionsAbove.)CODEBTORHUSBAND,WIFE,JOINT,ORCOMMUNITYDATECLAIMWASINCURREDANDCONSIDERATIONFORCLAIM.IFCLAIMISSUBJECTTOSETOFF,SOSTATECONTINGENTUNLIQUIDATEDDISPUTEDAMOUNTOFCLAIMACCOUNTNO.ACCOUNTNO.ACCOUNTNO.ACCOUNTNO.ACCOUNTNO.ACCOUNTNO.ACCOUNTNO.Sheetno.ofcontinuationsheetsattachedtoScheduleofCreditorsHoldingUnsecuredNonpriorityClaimsSubtotal(Totalofthispage)$Total(UseonlyonlastpageofthecompletedScheduleF.ReportalsoontheSummaryofSchedules,andifapplicable,ontheStatisticalSummaryofCertainLiabilitiesandRelatedData.)$SCHEDULE F - CREDITORS HOLDING UNSECURED NONPRIORITY CLAIMSunknownOne West BankP. O. Box 829009Dallas, TX 75382-9009unknownOneWest Bank FSBBankruptcy Department, ATTN CashieringPO Box 4045, 6900 Beatrice Dr.Kalamazoo, MI 49009-9559unknownPA Department Of RevenueBankruptcy DivisionPO Box 208946Harrisburg, PA 17128-0496unknownRecovery Management Systems Corporation25 SE 2nd Ave., Suite 1120Miami, FL 33131-16052325unknownSST/Cigpfi4315 Pickett RoadSt. Joseph, MO 64503-1600More than one year oldunknownStuart WinnegWoodcrest Corporate Center111 Woodcrest Corporate Ctr, Ste 200Cherry Hill, NJ 08003unknownWachovia BankP. O. Box 13765Roanoake, VA 24037-3765 3 4Case 5:12-bk-04640-JJT Doc 21 Filed 09/28/12 Entered 09/28/12 16:59:45 Desc

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© 1993-2011 EZ-Filing, Inc. [1-800-998-2424] - Forms Software OnlySypniewski, Robert A.5:12-bk-4640B6F(OfficialForm6F)(12/07)-Cont.INREDebtor(s)CaseNo.(Ifknown)(ContinuationSheet)CREDITOR'SNAME,MAILINGADDRESSINCLUDINGZIPCODE,ANDACCOUNTNUMBER.(SeeInstructionsAbove.)CODEBTORHUSBAND,WIFE,JOINT,ORCOMMUNITYDATECLAIMWASINCURREDANDCONSIDERATIONFORCLAIM.IFCLAIMISSUBJECTTOSETOFF,SOSTATECONTINGENTUNLIQUIDATEDDISPUTEDAMOUNTOFCLAIMACCOUNTNO.ACCOUNTNO.ACCOUNTNO.ACCOUNTNO.ACCOUNTNO.ACCOUNTNO.ACCOUNTNO.Sheetno.ofcontinuationsheetsattachedtoScheduleofCreditorsHoldingUnsecuredNonpriorityClaimsSubtotal(Totalofthispage)$Total(UseonlyonlastpageofthecompletedScheduleF.ReportalsoontheSummaryofSchedules,andifapplicable,ontheStatisticalSummaryofCertainLiabilitiesandRelatedData.)$SCHEDULE F - CREDITORS HOLDING UNSECURED NONPRIORITY CLAIMSunknownWachovia BankP. O. Box 41466Philadelphia, PA 19101 4 47,622.25Case 5:12-bk-04640-JJT Doc 21 Filed 09/28/12 Entered 09/28/12 16:59:45 Desc

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© 1993-2011 EZ-Filing, Inc. [1-800-998-2424] - Forms Software OnlyB6G(OfficialForm6G)(12/07)INREDebtor(s)CaseNo.(Ifknown)Describeallexecutorycontractsofanynatureandallunexpiredleasesofrealorpersonalproperty.Includeanytimeshareinterests.Statenatureofdebtor’sinterestincontract,i.e.,“Purchaser,”“Agent,”etc.Statewhetherdebtoristhelessororlesseeofalease.Providethenamesandcompletemailingaddressesofallotherpartiestoeachleaseorcontractdescribed.Ifaminorchildisapartytooneoftheleasesorcontracts,statethechild'sinitialsandthenameandaddressofthechild'sparentorguardian,suchas"A.B.,aminorchild,byJohnDoe,guardian."Donotdisclosethechild'sname.See,11U.S.C.§112andFed.R.Bankr.P.1007(m).Checkthisboxifdebtorhasnoexecutorycontractsorunexpiredleases.NAMEANDMAILINGADDRESS,INCLUDINGZIPCODEOFOTHERPARTIESTOLEASEORCONTRACTDESCRIPTIONOFCONTRACTORLEASEANDNATUREOFDEBTOR’SINTEREST.STATEWHETHERLEASEISFORNONRESIDENTIALREALPROPERTY.STATECONTRACTNUMBEROFANYGOVERNMENTCONTRACT.SCHEDULE G - EXECUTORY CONTRACTS AND UNEXPIRED LEASES(cid:252)Sypniewski, Robert A.5:12-bk-4640Case 5:12-bk-04640-JJT Doc 21 Filed 09/28/12 Entered 09/28/12 16:59:45 Desc

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© 1993-2011 EZ-Filing, Inc. [1-800-998-2424] - Forms Software OnlyB6H(OfficialForm6H)(12/07)INREDebtor(s)CaseNo.(Ifknown)Providetheinformationrequestedconcerninganypersonorentity,otherthanaspouseinajointcase,thatisalsoliableonanydebtslistedbythedebtorintheschedulesofcreditors.Includeallguarantorsandco-signers.Ifthedebtorresidesorresidedinacommunitypropertystate,commonwealth,orterritory(includingAlaska,Arizona,California,Idaho,Louisiana,Nevada,NewMexico,PuertoRico,Texas,Washington,orWisconsin)withintheeight-yearperiodimmediatelyprecedingthecommencementofthecase,identifythenameofthedebtor’sspouseandofanyformerspousewhoresidesorresidedwiththedebtorinthecommunitypropertystate,commonwealth,orterritory.Includeallnamesusedbythenondebtorspouseduringtheeightyearsimmediatelyprecedingthecommencementofthiscase.Ifaminorchildisacodebtororacreditor,statethechild'sinitialsandthenameandaddressofthechild'sparentorguardian,suchas"A.B.,aminorchild,byJohnDoe,guardian."Donotdisclosethechild'sname.See,11U.S.C.§112andFed.R.Bankr.P.1007(m).Checkthisboxifdebtorhasnocodebtors.NAMEANDADDRESSOFCODEBTORNAMEANDADDRESSOFCREDITORSCHEDULE H - CODEBTORSSypniewski, Robert A.5:12-bk-4640Tara SypniewskiOne West Bank223 Machell Avenue6900 Beatrice DriveDallas, PA 18612Kalamazoo, MI 49009-9559Wells Fargo Bank, NAP. O. Box 13765-R4057-01PRoanoke, VA 24037-3765Case 5:12-bk-04640-JJT Doc 21 Filed 09/28/12 Entered 09/28/12 16:59:45 Desc

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© 1993-2011 EZ-Filing, Inc. [1-800-998-2424] - Forms Software OnlySypniewski, Robert A.5:12-bk-4640B6I(OfficialForm6I)(12/07)INREDebtor(s)CaseNo.(Ifknown)Thecolumnlabeled“Spouse”mustbecompletedinallcasesfiledbyjointdebtorsandbyeverymarrieddebtor,whetherornotajointpetitionisfiled,unlessthespousesareseparatedandajointpetitionisnotfiled.Donotstatethenameofanyminorchild.TheaveragemonthlyincomecalculatedonthisformmaydifferfromthecurrentmonthlyincomecalculatedonFrom22A,22B,or22C.Debtor'sMaritalStatusDEPENDENTSOFDEBTORANDSPOUSERELATIONSHIP(S):AGE(S):EMPLOYMENT:DEBTORSPOUSEOccupationNameofEmployerHowlongemployedAddressofEmployerINCOME:(Estimateofaverageorprojectedmonthlyincomeattimecasefiled)DEBTORSPOUSE1.Currentmonthlygrosswages,salary,andcommissions(prorateifnotpaidmonthly)$$2.Estimatedmonthlyovertime$$3.SUBTOTAL$$4.LESSPAYROLLDEDUCTIONSa.PayrolltaxesandSocialSecurity$$b.Insurance$$c.Uniondues$$d.Other(specify)$$$$5.SUBTOTALOFPAYROLLDEDUCTIONS$$6.TOTALNETMONTHLYTAKEHOMEPAY$$7.Regularincomefromoperationofbusinessorprofessionorfarm(attachdetailedstatement)$$8.Incomefromrealproperty$$9.Interestanddividends$$10.Alimony,maintenanceorsupportpaymentspayabletothedebtorforthedebtor’suseorthatofdependentslistedabove$$11.SocialSecurityorothergovernmentassistance(Specify)$$$$12.Pensionorretirementincome$$13.Othermonthlyincome(Specify)$$$$$$14.SUBTOTALOFLINES7THROUGH13$$15.AVERAGEMONTHLYINCOME(Addamountsshownonlines6and14)$$16.COMBINEDAVERAGEMONTHLYINCOME:(Combinecolumntotalsfromline15;ifthereisonlyonedebtorrepeattotalreportedonline15)$(ReportalsoonSummaryofSchedulesand,ifapplicable,onStatisticalSummaryofCertainLiabilitiesandRelatedData)17.Describeanyincreaseordecreaseinincomereasonablyanticipatedtooccurwithintheyearfollowingthefilingofthisdocument:SCHEDULE I - CURRENT INCOME OF INDIVIDUAL DEBTOR(S)MarriedBeacon Mortgage 5,000.00 5,000.00 0.00 570.16SuILST 4.00 4.34 578.50 0.00 4,421.50 0.00 4,421.50 0.00 4,421.50NoneCase 5:12-bk-04640-JJT Doc 21 Filed 09/28/12 Entered 09/28/12 16:59:45 Desc

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© 1993-2011 EZ-Filing, Inc. [1-800-998-2424] - Forms Software OnlySypniewski, Robert A.5:12-bk-4640B6J(OfficialForm6J)(12/07)INREDebtor(s)CaseNo.(Ifknown)Completethisschedulebyestimatingtheaverageorprojectedmonthlyexpensesofthedebtorandthedebtor’sfamilyattimecasefiled.Prorateanypaymentsmadebiweekly,quarterly,semi-annually,orannuallytoshowmonthlyrate.TheaveragemonthlyexpensescalculatedonthisformmaydifferfromthedeductionsfromincomeallowedonForm22Aor22C.Checkthisboxifajointpetitionisfiledanddebtor’sspousemaintainsaseparatehousehold.Completeaseparatescheduleofexpenditureslabeled“Spouse.”1.Rentorhomemortgagepayment(includelotrentedformobilehome)$a.Arerealestatetaxesincluded?YesNob.Ispropertyinsuranceincluded?YesNo2.Utilities:a.Electricityandheatingfuel$b.Waterandsewer$c.Telephone$d.Other$$3.Homemaintenance(repairsandupkeep)$4.Food$5.Clothing$6.Laundryanddrycleaning$7.Medicalanddentalexpenses$8.Transportation(notincludingcarpayments)$9.Recreation,clubsandentertainment,newspapers,magazines,etc.$10.Charitablecontributions$11.Insurance(notdeductedfromwagesorincludedinhomemortgagepayments)a.Homeowner’sorrenter’s$b.Life$c.Health$d.Auto$e.Other$$12.Taxes(notdeductedfromwagesorincludedinhomemortgagepayments)(Specify)$$13.Installmentpayments:(inchapter11,12and13cases,donotlistpaymentstobeincludedintheplan)a.Auto$b.Other$$14.Alimony,maintenance,andsupportpaidtoothers$15.Paymentsforsupportofadditionaldependentsnotlivingatyourhome$16.Regularexpensesfromoperationofbusiness,profession,orfarm(attachdetailedstatement)$17.Other$$$18.AVERAGEMONTHLYEXPENSES(Totallines1-17.ReportalsoonSummaryofSchedulesand,ifapplicable,ontheStatisticalSummaryofCertainLiabilitiesandRelatedData.$19.Describeanyincreaseordecreaseinexpendituresanticipatedtooccurwithintheyearfollowingthefilingofthisdocument:20.STATEMENTOFMONTHLYNETINCOMEa.AveragemonthlyincomefromLine15ofScheduleI$b.AveragemonthlyexpensesfromLine18above$c.Monthlynetincome(a.minusb.)$SCHEDULE J - CURRENT EXPENDITURES OF INDIVIDUAL DEBTOR(S) 872.00(cid:252)(cid:252) 300.00 77.40 180.00See Schedule Attached 155.73 35.00 1,000.00 200.00 25.00 100.00 128.00 425.00Second Mortgage 210.00Personal Care 100.00 3,808.13None 4,421.50 3,808.13 613.37Case 5:12-bk-04640-JJT Doc 21 Filed 09/28/12 Entered 09/28/12 16:59:45 Desc

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© 1993-2011 EZ-Filing, Inc. [1-800-998-2424] - Forms Software OnlySypniewski, Robert A.5:12-bk-4640INREDebtor(s)CaseNo.SCHEDULE J - CURRENT EXPENDITURES OF INDIVIDUAL DEBTOR(S)Continuation Sheet - Page 1 of 1Other Utilities (DEBTOR)Garbage 20.00Cable 85.74Internet 49.99Case 5:12-bk-04640-JJT Doc 21 Filed 09/28/12 Entered 09/28/12 16:59:45 Desc

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© 1993-2011 EZ-Filing, Inc. [1-800-998-2424] - Forms Software OnlySypniewski, Robert A.5:12-bk-4640B6Declaration(OfficialForm6-Declaration)(12/07)INREDebtor(s)CaseNo.(Ifknown)DECLARATIONUNDERPENALTYOFPERJURYBYINDIVIDUALDEBTORIdeclareunderpenaltyofperjurythatIhavereadtheforegoingsummaryandschedules,consistingofsheets,andthattheyaretrueandcorrecttothebestofmyknowledge,information,andbelief.Date:Signature:DebtorDate:Signature:(JointDebtor,ifany)[Ifjointcase,bothspousesmustsign.]DECLARATIONANDSIGNATUREOFNON-ATTORNEYBANKRUPTCYPETITIONPREPARER(See11U.S.C.§110)Ideclareunderpenaltyofperjurythat:(1)Iamabankruptcypetitionpreparerasdefinedin11U.S.C.§110;(2)Ipreparedthisdocumentforcompensationandhaveprovidedthedebtorwithacopyofthisdocumentandthenoticesandinformationrequiredunder11U.S.C.§§110(b),110(h),and342(b);and,(3)ifrulesorguidelineshavebeenpromulgatedpursuantto11U.S.C.§110(h)settingamaximumfeeforserviceschargeablebybankruptcypetitionpreparers,Ihavegiventhedebtornoticeofthemaximumamountbeforepreparinganydocumentforfilingforadebtororacceptinganyfeefromthedebtor,asrequiredbythatsection.PrintedorTypedNameandTitle,ifany,ofBankruptcyPetitionPreparerSocialSecurityNo.(Requiredby11U.S.C.§110.)Ifthebankruptcypetitionpreparerisnotanindividual,statethename,title(ifany),address,andsocialsecuritynumberoftheofficer,principal,responsibleperson,orpartnerwhosignsthedocument.AddressSignatureofBankruptcyPetitionPreparerDateNamesandSocialSecuritynumbersofallotherindividualswhopreparedorassistedinpreparingthisdocument,unlessthebankruptcypetitionpreparerisnotanindividual:Ifmorethanonepersonpreparedthisdocument,attachadditionalsignedsheetsconformingtotheappropriateOfficialFormforeachperson.Abankruptcypetitionpreparer'sfailuretocomplywiththeprovisionoftitle11andtheFederalRulesofBankruptcyProceduremayresultinfinesorimprisonmentorboth.11U.S.C.§110;18U.S.C.§156.DECLARATIONUNDERPENALTYOFPERJURYONBEHALFOFCORPORATIONORPARTNERSHIPI,the(thepresidentorotherofficeroranauthorizedagentofthecorporationoramemberoranauthorizedagentofthepartnership)ofthe(corporationorpartnership)namedasdebtorinthiscase,declareunderpenaltyofperjurythatIhavereadtheforegoingsummaryandschedules,consistingofsheets(totalshownonsummarypageplus1),andthattheyaretrueandcorrecttothebestofmyknowledge,information,andbelief.Date:Signature:(Printortypenameofindividualsigningonbehalfofdebtor)[Anindividualsigningonbehalfofapartnershiporcorporationmustindicatepositionorrelationshiptodebtor.]Penaltyformakingafalsestatementorconcealingproperty:Fineofupto$500,000orimprisonmentforupto5yearsorboth.18U.S.C.§§152and3571.DECLARATION CONCERNING DEBTOR'S SCHEDULES 20September 27, 2012/s/ Robert A. SypniewskiRobert A. SypniewskiCase 5:12-bk-04640-JJT Doc 21 Filed 09/28/12 Entered 09/28/12 16:59:45 Desc

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© 1993-2011 EZ-Filing, Inc. [1-800-998-2424] - Forms Software OnlyB22C(OfficialForm22C)(Chapter13)(12/10)Accordingtothecalculationsrequiredbythisstatement:Theapplicablecommitmentperiodis3years.Theapplicablecommitmentperiodis5years.Disposableincomeisdeterminedunder§1325(b)(3).Disposableincomeisnotdeterminedunder§1325(b)(3).(ChecktheboxesasdirectedinLines17and23ofthisstatement.)Inre:Debtor(s)CaseNumber:(Ifknown)ANDCALCULATIONOFCOMMITMENTPERIODANDDISPOSABLEINCOMEInadditiontoSchedulesIandJ,thisstatementmustbecompletedbyeveryindividualChapter13debtor,whetherornotfilingjointly.Jointdebtorsmaycompleteonestatementonly.PartI.REPORTOFINCOME1Marital/filingstatus.Checktheboxthatappliesandcompletethebalanceofthispartofthisstatementasdirected.a.Unmarried.CompleteonlyColumnA(“Debtor’sIncome”)forLines2-10.b.Married.CompletebothColumnA(“Debtor’sIncome”)andColumnB(“Spouse’sIncome”)forLines2-10.Allfiguresmustreflectaveragemonthlyincomereceivedfromallsources,derivedduringthesixcalendarmonthspriortofilingthebankruptcycase,endingonthelastdayofthemonthbeforethefiling.Iftheamountofmonthlyincomevariedduringthesixmonths,youmustdividethesix-monthtotalbysix,andentertheresultontheappropriateline.ColumnADebtor’sIncomeColumnBSpouse’sIncome2Grosswages,salary,tips,bonuses,overtime,commissions.$$3Incomefromtheoperationofabusiness,profession,orfarm.SubtractLinebfromLineaandenterthedifferenceintheappropriatecolumn(s)ofLine3.Ifyouoperatemorethanonebusiness,professionorfarm,enteraggregatenumbersandprovidedetailsonanattachment.Donotenteranumberlessthanzero.DonotincludeanypartofthebusinessexpensesenteredonLinebasadeductioninPartIV.$$a.Grossreceipts$b.Ordinaryandnecessaryoperatingexpenses$c.BusinessincomeSubtractLinebfromLinea4Rentandotherrealpropertyincome.SubtractLinebfromLineaandenterthedifferenceintheappropriatecolumn(s)ofLine4.Donotenteranumberlessthanzero.DonotincludeanypartoftheoperatingexpensesenteredonLinebasadeductioninPartIV.$$a.Grossreceipts$b.Ordinaryandnecessaryoperatingexpenses$c.RentandotherrealpropertyincomeSubtractLinebfromLinea5Interest,dividends,androyalties.$$6Pensionandretirementincome.$$7Anyamountspaidbyanotherpersonorentity,onaregularbasis,forthehouseholdexpensesofthedebtororthedebtor’sdependents,includingchildsupportpaidforthatpurpose.Donotincludealimonyorseparatemaintenancepaymentsoramountspaidbythedebtor’sspouse.Eachregularpaymentshouldbereportedinonlyonecolumn;ifapaymentislistedinColumnA,donotreportthatpaymentinColumnB.$$CHAPTER 13 STATEMENT OF CURRENT MONTHLY INCOMESypniewski, Robert A.5:12-bk-4640(cid:252)(cid:252)(cid:252) 1,666.67 2,608.33 169.52 2,438.81Case 5:12-bk-04640-JJT Doc 21 Filed 09/28/12 Entered 09/28/12 16:59:45 Desc

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© 1993-2011 EZ-Filing, Inc. [1-800-998-2424] - Forms Software OnlyB22C(OfficialForm22C)(Chapter13)(12/10)8Unemploymentcompensation.Entertheamountintheappropriatecolumn(s)ofLine8.However,ifyoucontendthatunemploymentcompensationreceivedbyyouoryourspousewasabenefitundertheSocialSecurityAct,donotlisttheamountofsuchcompensationinColumnAorB,butinsteadstatetheamountinthespacebelow:$$UnemploymentcompensationclaimedtobeabenefitundertheSocialSecurityActDebtor$Spouse$9Incomefromallothersources.Specifysourceandamount.Ifnecessary,listadditionalsourcesonaseparatepage.TotalandenteronLine9.Donotincludealimonyorseparatemaintenancepaymentspaidbyyourspouse,butincludeallotherpaymentsofalimonyorseparatemaintenance.DonotincludeanybenefitsreceivedundertheSocialSecurityActorpaymentsreceivedasavictimofawarcrime,crimeagainsthumanity,orasavictimofinternationalordomesticterrorism.$$a.$b.$10Subtotal.AddLines2thru9inColumnA,and,ifColumnBiscompleted,addLines2through9inColumnB.Enterthetotal(s).$$11Total.IfColumnBhasbeencompleted,addLine10,ColumnAtoLine10,ColumnB,andenterthetotal.IfColumnBhasnotbeencompleted,entertheamountfromLine10,ColumnA.$PartII.CALCULATIONOF§1325(b)(4)COMMITMENTPERIOD12EntertheamountfromLine11.$13MaritalAdjustment.Ifyouaremarried,butarenotfilingjointlywithyourspouse,ANDifyoucontendthatcalculationofthecommitmentperiodunder§1325(b)(4)doesnotrequireinclusionoftheincomeofyourspouse,enteronLine13theamountoftheincomelistedinLine10,ColumnBthatwasNOTpaidonaregularbasisforthehouseholdexpensesofyouoryourdependentsandspecify,inthelinesbelow,thebasisforexcludingthisincome(suchaspaymentofthespouse’staxliabilityorthespouse’ssupportofpersonsotherthanthedebtororthedebtor’sdependents)andtheamountofincomedevotedtoeachpurpose.Ifnecessary,listadditionaladjustmentsonaseparatepage.Iftheconditionsforenteringthisadjustmentdonotapply,enterzero.$a.$b.$c.$TotalandenteronLine13.14SubtractLine13fromLine12andentertheresult.$15Annualizedcurrentmonthlyincomefor§1325(b)(4).MultiplytheamountfromLine14bythenumber12andentertheresult.$16Applicablemedianfamilyincome.Enterthemedianfamilyincomefortheapplicablestateandhouseholdsize.(Thisinformationisavailablebyfamilysizeatwww.usdoj.gov/ust/orfromtheclerkofthebankruptcycourt.)a.Enterdebtor’sstateofresidence:b.Enterdebtor’shouseholdsize:$17Applicationof§1325(b)(4).Checktheapplicableboxandproceedasdirected.TheamountonLine15islessthantheamountonLine16.Checktheboxfor“Theapplicablecommitmentperiodis3years”atthetopofpage1ofthisstatementandcontinuewiththisstatement.TheamountonLine15isnotlessthantheamountonLine16.Checktheboxfor“Theapplicablecommitmentperiodis5years”atthetopofpage1ofthisstatementandcontinuewiththisstatement.PartIII.APPLICATIONOF§1325(b)(3)FORDETERMININGDISPOSABLEINCOME 4,105.48 4,105.48 4,105.48 0.00 4,105.48 49,265.76Pennsylvania 6 94,102.00(cid:252)Case 5:12-bk-04640-JJT Doc 21 Filed 09/28/12 Entered 09/28/12 16:59:45 Desc

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© 1993-2011 EZ-Filing, Inc. [1-800-998-2424] - Forms Software OnlyB22C(OfficialForm22C)(Chapter13)(12/10)18EntertheamountfromLine11.$19Maritaladjustment.Ifyouaremarried,butarenotfilingjointlywithyourspouse,enteronLine19thetotalofanyincomelistedinLine10,ColumnBthatwasNOTpaidonaregularbasisforthehouseholdexpensesofthedebtororthedebtor’sdependents.SpecifyinthelinesbelowthebasisforexcludingtheColumnBincome(suchaspaymentofthespouse’staxliabilityorthespouse’ssupportofpersonsotherthanthedebtororthedebtor’sdependents)andtheamountofincomedevotedtoeachpurpose.Ifnecessary,listadditionaladjustmentsonaseparatepage.Iftheconditionsforenteringthisadjustmentdonotapply,enterzero.$a.$b.$c.$TotalandenteronLine19.20Currentmonthlyincomefor§1325(b)(3).SubtractLine19fromLine18andentertheresult.$21Annualizedcurrentmonthlyincomefor§1325(b)(3).MultiplytheamountfromLine20bythenumber12andentertheresult.$22Applicablemedianfamilyincome.EntertheamountfromLine16.$23Applicationof§1325(b)(3).Checktheapplicableboxandproceedasdirected.TheamountonLine21ismorethantheamountonLine22.Checktheboxfor“Disposableincomeisdeterminedunder§1325(b)(3)”atthetopofpage1ofthisstatementandcompletetheremainingpartsofthisstatement.TheamountonLine21isnotmorethantheamountonLine22.Checktheboxfor“Disposableincomeisnotdeterminedunder§1325(b)(3)”atthetopofpage1ofthisstatementandcompletePartVIIofthisstatement.DonotcompletePartsIV,V,orVI.PartIV.CALCULATIONOFDEDUCTIONSALLOWEDUNDER§707(b)(2)SubpartA:DeductionsunderStandardsoftheInternalRevenueService(IRS)24ANationalStandards:food,apparelandservices,housekeepingsupplies,personalcare,andmiscellaneous.EnterinLine24Athe“Total”amountfromIRSNationalStandardsforAllowableLivingExpensesfortheapplicablenumberofpersons.(Thisinformationisavailableatwww.usdoj.gov/ust/orfromtheclerkofthebankruptcycourt.)Theapplicablenumberofpersonsisthenumberthatwouldcurrentlybeallowedasexemptionsonyourfederalincometaxreturn,plusthenumberofanyadditionaldependentswhomyousupport.$24BNationalStandards:healthcare.EnterinLinea1belowtheamountfromIRSNationalStandardsforOut-of-PocketHealthCareforpersonsunder65yearsofage,andinLinea2theIRSNationalStandardsforOut-of-PocketHealthCareforpersons65yearsofageorolder.(Thisinformationisavailableatwww.usdoj.gov/ust/orfromtheclerkofthebankruptcycourt.)EnterinLineb1theapplicablenumberofpersonswhoareunder65yearsofage,andenterinLineb2theapplicablenumberofpersonswhoare65yearsofageorolder.(Theapplicablenumberofpersonsineachagecategoryisthenumberinthatcategorythatwouldcurrentlybeallowedasexemptionsonyourfederalincometaxreturn,plusthenumberofanyadditionaldependentswhomyousupport.)MultiplyLinea1byLineb1toobtainatotalamountforpersonsunder65,andentertheresultinLinec1.MultiplyLinea2byLineb2toobtainatotalamountforpersons65andolder,andentertheresultinLinec2.AddLinesc1andc2toobtainatotalhealthcareamount,andentertheresultinLine24B.$Personsunder65yearsofagePersons65yearsofageoroldera1.Allowanceperpersona2.Allowanceperpersonb1.Numberofpersonsb2.Numberofpersonsc1.Subtotalc2.Subtotal 4,105.48 0.00 4,105.48 49,265.76 94,102.00(cid:252)Case 5:12-bk-04640-JJT Doc 21 Filed 09/28/12 Entered 09/28/12 16:59:45 Desc

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© 1993-2011 EZ-Filing, Inc. [1-800-998-2424] - Forms Software OnlyB22C(OfficialForm22C)(Chapter13)(12/10)25ALocalStandards:housingandutilities;non-mortgageexpenses.EntertheamountoftheIRSHousingandUtilitiesStandards;non-mortgageexpensesfortheapplicablecountyandfamilysize.(Thisinformationisavailableatwww.usdoj.gov/ust/orfromtheclerkofthebankruptcycourt).Theapplicablefamilysizeconsistsofthenumberthatwouldcurrentlybeallowedasexemptionsonyourfederalincometaxreturn,plusthenumberofanyadditionaldependentswhomyousupport.$25BLocalStandards:housingandutilities;mortgage/rentexpense.Enter,inLineabelow,theamountoftheIRSHousingandUtilitiesStandards;mortgage/rentexpenseforyourcountyandfamilysize(thisinformationisavailableatwww.usdoj.gov/ust/orfromtheclerkofthebankruptcycourt)(Theapplicablefamilysizeconsistsofthenumberthatwouldcurrentlybeallowedasexemptionsonyourfederalincometaxreturn,plusthenumberofanyadditionaldependentswhomyousupport.);enteronLinebthetotaloftheAverageMonthlyPaymentsforanydebtssecuredbyyourhome,asstatedinLine47;subtractLinebfromLineaandentertheresultinLine25B.Donotenteranamountlessthanzero.$a.IRSHousingandUtilitiesStandards;mortgage/rentalexpense$b.AverageMonthlyPaymentforanydebtssecuredbyyourhome,ifany,asstatedinLine47$c.Netmortgage/rentalexpenseSubtractLinebfromLinea26LocalStandards:housingandutilities;adjustment.IfyoucontendthattheprocesssetoutinLines25Aand25BdoesnotaccuratelycomputetheallowancetowhichyouareentitledundertheIRSHousingandUtilitiesStandards,enteranyadditionalamounttowhichyoucontendyouareentitled,andstatethebasisforyourcontentioninthespacebelow:$27ALocalStandards:transportation;vehicleoperation/publictransportationexpense.Youareentitledtoanexpenseallowanceinthiscategoryregardlessofwhetheryoupaytheexpensesofoperatingavehicleandregardlessofwhetheryouusepublictransportation.CheckthenumberofvehiclesforwhichyoupaytheoperatingexpensesorforwhichtheoperatingexpensesareincludedasacontributiontoyourhouseholdexpensesinLine7.012ormore.Ifyouchecked0,enteronLine27Athe“PublicTransportation”amountfromIRSLocalStandards:Transportation.Ifyouchecked1or2ormore,enteronLine27Athe“OperatingCosts”amountfromIRSLocalStandards:TransportationfortheapplicablenumberofvehiclesintheapplicableMetropolitanStatisticalAreaorCensusRegion.(Theseamountsareavailableatwww.usdoj.gov/ust/orfromtheclerkofthebankruptcycourt.)$27BLocalStandards:transportation;additionalpublictransportationexpense.Ifyoupaytheoperatingexpensesforavehicleandalsousepublictransportation,andyoucontendthatyouareentitledtoanadditionaldeductionforyourpublictransportationexpenses,enteronLine27Bthe“PublicTransportation”amountfromIRSLocalStandards:Transportation.(Thisamountisavailableatwww.usdoj.gov/ust/orfromtheclerkofthebankruptcycourt.)$Case 5:12-bk-04640-JJT Doc 21 Filed 09/28/12 Entered 09/28/12 16:59:45 Desc

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© 1993-2011 EZ-Filing, Inc. [1-800-998-2424] - Forms Software OnlyB22C(OfficialForm22C)(Chapter13)(12/10)28LocalStandards:transportationownership/leaseexpense;Vehicle1.Checkthenumberofvehiclesforwhichyouclaimanownership/leaseexpense.(Youmaynotclaimanownership/leaseexpenseformorethantwovehicles.)12ormore.Enter,inLineabelow,the“OwnershipCosts”for“OneCar”fromtheIRSLocalStandards:Transportation(availableatwww.usdoj.gov/ust/orfromtheclerkofthebankruptcycourt);enterinLinebthetotaloftheAverageMonthlyPaymentsforanydebtssecuredbyVehicle1,asstatedinLine47;subtractLinebfromLineaandentertheresultinLine28.Donotenteranamountlessthanzero.$a.IRSTransportationStandards,OwnershipCosts$b.AverageMonthlyPaymentforanydebtssecuredbyVehicle1,asstatedinLine47$c.Netownership/leaseexpenseforVehicle1SubtractLinebfromLinea29LocalStandards:transportationownership/leaseexpense;Vehicle2.CompletethisLineonlyifyoucheckedthe“2ormore”BoxinLine28.Enter,inLineabelow,the“OwnershipCosts”for“OneCar”fromtheIRSLocalStandards:Transportation(availableatwww.usdoj.gov/ust/orfromtheclerkofthebankruptcycourt);enterinLinebthetotaloftheAverageMonthlyPaymentsforanydebtssecuredbyVehicle2,asstatedinLine47;subtractLinebfromLineaandentertheresultinLine29.Donotenteranamountlessthanzero.$a.IRSTransportationStandards,OwnershipCosts$b.AverageMonthlyPaymentforanydebtssecuredbyVehicle2,asstatedinLine47$c.Netownership/leaseexpenseforVehicle2SubtractLinebfromLinea30OtherNecessaryExpenses:taxes.Enterthetotalaveragemonthlyexpensethatyouactuallyincurforallfederal,state,andlocaltaxes,otherthanrealestateandsalestaxes,suchasincometaxes,self-employmenttaxes,social-securitytaxes,andMedicaretaxes.Donotincluderealestateorsalestaxes.$31OtherNecessaryExpenses:involuntarydeductionsforemployment.Enterthetotalaveragemonthlydeductionsthatarerequiredforyouremployment,suchasmandatoryretirementcontributions,uniondues,anduniformcosts.Donotincludediscretionaryamounts,suchasvoluntary401(k)contributions.$32OtherNecessaryExpenses:lifeinsurance.Entertotalaveragemonthlypremiumsthatyouactuallypayfortermlifeinsuranceforyourself.Donotincludepremiumsforinsuranceonyourdependents,forwholelifeorforanyotherformofinsurance.$33OtherNecessaryExpenses:court-orderedpayments.Enterthetotalmonthlyamountthatyouarerequiredtopaypursuanttotheorderofacourtoradministrativeagency,suchasspousalorchildsupportpayments.DonotincludepaymentsonpastdueobligationsincludedinLine49.$34OtherNecessaryExpenses:educationforemploymentorforaphysicallyormentallychallengedchild.Enterthetotalaveragemonthlyamountthatyouactuallyexpendforeducationthatisaconditionofemploymentandforeducationthatisrequiredforaphysicallyormentallychallengeddependentchildforwhomnopubliceducationprovidingsimilarservicesisavailable.$35OtherNecessaryExpenses:childcare.Enterthetotalaveragemonthlyamountthatyouactuallyexpendonchildcare—suchasbaby-sitting,daycare,nurseryandpreschool.Donotincludeothereducationalpayments.$36OtherNecessaryExpenses:healthcare.Enterthetotalaveragemonthlyamountthatyouactuallyexpendonhealthcarethatisrequiredforthehealthandwelfareofyourselforyourdependents,thatisnotreimbursedbyinsuranceorpaidbyahealthsavingsaccount,andthatisinexcessoftheamountenteredinLine24B.DonotincludepaymentsforhealthinsuranceorhealthsavingsaccountslistedinLine39.$37OtherNecessaryExpenses:telecommunicationservices.Enterthetotalaveragemonthlyamountthatyouactuallypayfortelecommunicationservicesotherthanyourbasichometelephoneandcellphoneservice—suchaspagers,callwaiting,callerid,speciallongdistance,orinternetservice—totheextentnecessaryforyourhealthandwelfareorthatofyourdependents.Donotincludeanyamountpreviouslydeducted.$Case 5:12-bk-04640-JJT Doc 21 Filed 09/28/12 Entered 09/28/12 16:59:45 Desc

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© 1993-2011 EZ-Filing, Inc. [1-800-998-2424] - Forms Software OnlyB22C(OfficialForm22C)(Chapter13)(12/10)38TotalExpensesAllowedunderIRSStandards.EnterthetotalofLines24through37.$SubpartB:AdditionalExpenseDeductionsunder§707(b)Note:DonotincludeanyexpensesthatyouhavelistedinLines24-3739HealthInsurance,DisabilityInsurance,andHealthSavingsAccountExpenses.Listthemonthlyexpensesinthecategoriessetoutinlinesa-cbelowthatarereasonablynecessaryforyourself,yourspouse,oryourdependents.$a.HealthInsurance$b.DisabilityInsurance$c.HealthSavingsAccount$TotalandenteronLine39Ifyoudonotactuallyexpendthistotalamount,stateyouractualtotalaveragemonthlyexpendituresinthespacebelow:$40Continuedcontributionstothecareofhouseholdorfamilymembers.Enterthetotalaverageactualmonthlyexpensesthatyouwillcontinuetopayforthereasonableandnecessarycareandsupportofanelderly,chronicallyill,ordisabledmemberofyourhouseholdormemberofyourimmediatefamilywhoisunabletopayforsuchexpenses.DonotincludepaymentslistedinLine34.$41Protectionagainstfamilyviolence.EnterthetotalaveragereasonablynecessarymonthlyexpensesthatyouactuallyincurtomaintainthesafetyofyourfamilyundertheFamilyViolencePreventionandServicesActorotherapplicablefederallaw.Thenatureoftheseexpensesisrequiredtobekeptconfidentialbythecourt.$42Homeenergycosts.Enterthetotalaveragemonthlyamount,inexcessoftheallowancespecifiedbyIRSLocalStandardsforHousingandUtilities,thatyouactuallyexpendforhomeenergycosts.Youmustprovideyourcasetrusteewithdocumentationofyouractualexpenses,andyoumustdemonstratethattheadditionalamountclaimedisreasonableandnecessary.$43Educationexpensesfordependentchildrenunder18.Enterthetotalaveragemonthlyexpensesthatyouactuallyincur,nottoexceed$147.92perchild,forattendanceataprivateorpublicelementaryorsecondaryschoolbyyourdependentchildrenlessthan18yearsofage.Youmustprovideyourcasetrusteewithdocumentationofyouractualexpenses,andyoumustexplainwhytheamountclaimedisreasonableandnecessaryandnotalreadyaccountedforintheIRSStandards.$44Additionalfoodandclothingexpense.Enterthetotalaveragemonthlyamountbywhichyourfoodandclothingexpensesexceedthecombinedallowancesforfoodandclothing(apparelandservices)intheIRSNationalStandards,nottoexceed5%ofthosecombinedallowances.(Thisinformationisavailableatwww.usdoj.gov/ust/orfromtheclerkofthebankruptcycourt.)Youmustdemonstratethattheadditionalamountclaimedisreasonableandnecessary.$45Charitablecontributions.Entertheamountreasonablynecessaryforyoutoexpendeachmonthoncharitablecontributionsintheformofcashorfinancialinstrumentstoacharitableorganizationasdefinedin26U.S.C.§170(c)(1)-(2).Donotincludeanyamountinexcessof15%ofyourgrossmonthlyincome.$46TotalAdditionalExpenseDeductionsunder§707(b).EnterthetotalofLines39through45.$Case 5:12-bk-04640-JJT Doc 21 Filed 09/28/12 Entered 09/28/12 16:59:45 Desc

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© 1993-2011 EZ-Filing, Inc. [1-800-998-2424] - Forms Software OnlyB22C(OfficialForm22C)(Chapter13)(12/10)SubpartC:DeductionsforDebtPayment47Futurepaymentsonsecuredclaims.Foreachofyourdebtsthatissecuredbyaninterestinpropertythatyouown,listthenameofthecreditor,identifythepropertysecuringthedebt,statetheAverageMonthlyPayment,andcheckwhetherthepaymentincludestaxesorinsurance.TheAverageMonthlyPaymentisthetotalofallamountsscheduledascontractuallyduetoeachSecuredCreditorinthe60monthsfollowingthefilingofthebankruptcycase,dividedby60.Ifnecessary,listadditionalentriesonaseparatepage.EnterthetotaloftheAverageMonthlyPaymentsonLine47.$NameofCreditorPropertySecuringtheDebtAverageMonthlyPaymentDoespaymentincludetaxesorinsurance?a.$yesnob.$yesnoc.$yesnoTotal:Addlinesa,bandc.48Otherpaymentsonsecuredclaims.IfanyofdebtslistedinLine47aresecuredbyyourprimaryresidence,amotorvehicle,orotherpropertynecessaryforyoursupportorthesupportofyourdependents,youmayincludeinyourdeduction1/60thofanyamount(the“cureamount”)thatyoumustpaythecreditorinadditiontothepaymentslistedinLine47,inordertomaintainpossessionoftheproperty.Thecureamountwouldincludeanysumsindefaultthatmustbepaidinordertoavoidrepossessionorforeclosure.Listandtotalanysuchamountsinthefollowingchart.Ifnecessary,listadditionalentriesonaseparatepage.$NameofCreditorPropertySecuringtheDebt1/60thoftheCureAmounta.$b.$c.$Total:Addlinesa,bandc.49Paymentsonprepetitionpriorityclaims.Enterthetotalamount,dividedby60,ofallpriorityclaims,suchasprioritytax,childsupportandalimonyclaims,forwhichyouwereliableatthetimeofyourbankruptcyfiling.Donotincludecurrentobligations,suchasthosesetoutinLine33.$50Chapter13administrativeexpenses.MultiplytheamountinLineabytheamountinLineb,andentertheresultingadministrativeexpense.$a.ProjectedaveragemonthlyChapter13planpayment.$b.CurrentmultiplierforyourdistrictasdeterminedunderschedulesissuedbytheExecutiveOfficeforUnitedStatesTrustees.(Thisinformationisavailableatwww.usdoj.gov/ust/orfromtheclerkofthebankruptcycourt.)Xc.AveragemonthlyadministrativeexpenseofChapter13caseTotal:MultiplyLinesaandb51TotalDeductionsforDebtPayment.EnterthetotalofLines47through50.$SubpartD:TotalDeductionsfromIncome52Totalofalldeductionsfromincome.EnterthetotalofLines38,46,and51.$Case 5:12-bk-04640-JJT Doc 21 Filed 09/28/12 Entered 09/28/12 16:59:45 Desc

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© 1993-2011 EZ-Filing, Inc. [1-800-998-2424] - Forms Software OnlyB22C(OfficialForm22C)(Chapter13)(12/10)PartV.DETERMINATIONOFDISPOSABLEINCOMEUNDER§1325(b)(2)53Totalcurrentmonthlyincome.EntertheamountfromLine20.$54Supportincome.Enterthemonthlyaverageofanychildsupportpayments,fostercarepayments,ordisabilitypaymentsforadependentchild,reportedinPartI,thatyoureceivedinaccordancewithapplicablenonbankruptcylaw,totheextentreasonablynecessarytobeexpendedforsuchchild.$55Qualifiedretirementdeductions.Enterthemonthlytotalof(a)allamountswithheldbyyouremployerfromwagesascontributionsforqualifiedretirementplans,asspecifiedin§541(b)(7)and(b)allrequiredrepaymentsofloansfromretirementplans,asspecifiedin§362(b)(19).$56Totalofalldeductionsallowedunder§707(b)(2).EntertheamountfromLine52.$57Deductionforspecialcircumstances.Iftherearespecialcircumstancesthatjustifyadditionalexpensesforwhichthereisnoreasonablealternative,describethespecialcircumstancesandtheresultingexpensesinlinesa-cbelow.Ifnecessary,listadditionalentriesonaseparatepage.TotaltheexpensesandenterthetotalinLine57.Youmustprovideyourcasetrusteewithdocumentationoftheseexpensesandyoumustprovideadetailedexplanationofthespecialcircumstancesthatmakesuchexpensesnecessaryandreasonable.$NatureofspecialcircumstancesAmountofexpensea.$b.$c.$Total:AddLinesa,b,andc58Totaladjustmentstodeterminedisposableincome.AddtheamountsonLines54,55,56,and57andentertheresult.$59MonthlyDisposableIncomeUnder§1325(b)(2).SubtractLine58fromLine53andentertheresult.$PartVI.ADDITIONALEXPENSECLAIMS60OtherExpenses.Listanddescribeanymonthlyexpenses,nototherwisestatedinthisform,thatarerequiredforthehealthandwelfareofyouandyourfamilyandthatyoucontendshouldbeanadditionaldeductionfromyourcurrentmonthlyincomeunder§707(b)(2)(A)(ii)(I).Ifnecessary,listadditionalsourcesonaseparatepage.Allfiguresshouldreflectyouraveragemonthlyexpenseforeachitem.Totaltheexpenses.ExpenseDescriptionMonthlyAmounta.$b.$c.$Total:AddLinesa,bandc$PartVII.VERIFICATION61Ideclareunderpenaltyofperjurythattheinformationprovidedinthisstatementistrueandcorrect.(Ifthisajointcase,bothdebtorsmustsign.)Date:Signature:(Debtor)Date:Signature:(JointDebtor,ifany)September 27, 2012/s/ Robert A. SypniewskiCase 5:12-bk-04640-JJT Doc 21 Filed 09/28/12 Entered 09/28/12 16:59:45 Desc

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© 1993-2011 EZ-Filing, Inc. [1-800-998-2424] - Forms Software OnlyB7(OfficialForm7)(04/10)INRE:CaseNo.Debtor(s)ChapterThisstatementistobecompletedbyeverydebtor.Spousesfilingajointpetitionmayfileasinglestatementonwhichtheinformationforbothspousesiscombined.Ifthecaseisfiledunderchapter12orchapter13,amarrieddebtormustfurnishinformationforbothspouseswhetherornotajointpetitionisfiled,unlessthespousesareseparatedandajointpetitionisnotfiled.Anindividualdebtorengagedinbusinessasasoleproprietor,partner,familyfarmer,orself-employedprofessional,shouldprovidetheinformationrequestedonthisstatementconcerningallsuchactivitiesaswellastheindividual'spersonalaffairs.Toindicatepayments,transfersandtheliketominorchildren,statethechild'sinitialsandthenameandaddressofthechild'sparentorguardian,suchas"A.B.,aminorchild,byJohnDoe,guardian."Donotdisclosethechild'sname.See,11U.S.C.§112andFed.R.Bankr.P.1007(m).Questions1-18aretobecompletedbyalldebtors.Debtorsthatareorhavebeeninbusiness,asdefinedbelow,alsomustcompleteQuestions19-25.Iftheanswertoanapplicablequestionis"None,"marktheboxlabeled"None."Ifadditionalspaceisneededfortheanswertoanyquestion,useandattachaseparatesheetproperlyidentifiedwiththecasename,casenumber(ifknown),andthenumberofthequestion.DEFINITIONS"Inbusiness."Adebtoris"inbusiness"forthepurposeofthisformifthedebtorisacorporationorpartnership.Anindividualdebtoris"inbusiness"forthepurposeofthisformifthedebtorisorhasbeen,withinsixyearsimmediatelyprecedingthefilingofthisbankruptcycase,anyofthefollowing:anofficer,director,managingexecutive,orownerof5percentormoreofthevotingorequitysecuritiesofacorporation;apartner,otherthanalimitedpartner,ofapartnership;asoleproprietororself-employedfull-timeorpart-time.Anindividualdebtoralsomaybe“inbusiness”forthepurposeofthisformifthedebtorengagesinatrade,business,orotheractivity,otherthanasanemployee,tosupplementincomefromthedebtor’sprimaryemployment."Insider."Theterm"insider"includesbutisnotlimitedto:relativesofthedebtor;generalpartnersofthedebtorandtheirrelatives;corporationsofwhichthedebtorisanofficer,director,orpersonincontrol;officers,directors,andanyownerof5percento