Free [PFP#970398992] - Virginia


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Form 6

12/03 USBC, Eastern District of Virginia

United States Bankruptcy Court Eastern District of Virginia

In re Debtor.

Case Number: (If Known)

SUMMARY OF SCHEDULES
Indicate as to each schedule whether that schedule is attached and state the number of pages in each. Report the totals from Schedules A, B, D, E, F, I, and J in the boxes provided. Add the amounts from Schedules A and B to determine the total amount of the debtor's assets. Add the amounts from Schedules D, E, and F to determine the total amount of the debtor's liabilities. AMOUNTS SCHEDULED
NAME OF SCHEDULE AReal Property ATTACHED (YES/NO) NO. OF SHEETS $ ASSETS LIABILITIES OTHER

B-

Personal Property

$

C-

Property Claimed as Exempt

D-

Creditors Holding Secured Claims Creditors Holding Unsecured Priority Claims Creditors Holding Unsecured Nonpriority Claims Executory Contracts and Unexpired Leases Codebtors

$

E-

$

F-

$

G-

H-

I-

Current Income of Individual Debtor(s) Current Expenditures of Individual Debtor(s) Total Number of Sheets of ALL Schedules Total Assets $

$

J-

$

Total Liabilities

$

Form 6A In re Debtor.

12/03 USBC, Eastern District of Virginia Case Number: (If Known)

SCHEDULE A - REAL PROPERTY
Except as directed below, list all real property in which the 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 the debtor holds rights and powers exercisable for the debtor's own benefit. If the 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 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 and Unexpired 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 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.
CURRENT MARKET VALUE OF DEBTOR'S INTEREST IN PROPERTY WITHOUT DEDUCTING ANY SECURED CLAIM OR EXEMPTION

DESCRIPTION AND LOCATION OF PROPERTY

NATURE OF DEBTOR'S INTEREST IN PROPERTY

HUSBAND, WIFE, JOINT OR COMMUNITY

AMOUNT OF SECURED CLAIM

Total

$ (Report also on Summary of Schedules.)

Form 6B In re Debtor.

12/03 USBC, Eastern District of Virginia Case Number: (If Known)

SCHEDULE B - PERSONAL PROPERTY
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, 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 the 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 the 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 the debtor by someone else, state that person's name and address under "Description and Location of Property."

TYPE OF PROPERTY

NONE

DESCRIPTION AND LOCATION OF PROPERTY

HUSBAND, WIFE, JOINT OR COMMUNITY

CURRENT MARKET VALUE OF DEBTOR'S INTEREST IN PROPERTY, WITHOUT DEDUCTING ANY SECURED CLAIM OR EXEMPTION

1. 2.

Cash on hand. Checking, savings or other financial accounts, certificates of deposit, or shares in banks, savings and loan, thrift, building and loan, and homestead associations, or credit unions, brokerage houses, or cooperatives. Security deposits with public utilities, telephone companies, landlords, and others. Household goods and furnishings, including audio, video, and computer equipment. Books, pictures and other art objects, antiques, stamp, coin, record, tape, compact disc, and other collections or collectibles. Wearing apparel. Furs and jewelry. Firearms and sports, photographic, and other hobby equipment. Interests in insurance policies. Name insurance company of each policy and itemize surrender or refund value of each. Annuities. Itemize and name each issuer.

3.

4.

5.

6. 7. 8.

9.

10.

Form 6B - Continued In re Debtor.

12/03 USBC, Eastern District of Virginia Case Number: (If Known)

SCHEDULE B - PERSONAL PROPERTY (Continuation Sheet)
CURRENT MARKET VALUE OF DEBTOR'S INTEREST IN PROPERTY, WITHOUT DEDUCTING ANY SECURED CLAIM OR EXEMPTION

TYPE OF PROPERTY

NONE

DESCRIPTION AND LOCATION OF PROPERTY

HUSBAND, WIFE, JOINT OR COMMUNITY

11.

Interests in IRA, ERISA, Keogh, or other pension or profit sharing plans. Itemize. Stock and interests in incorporated and unincorporated businesses. Itemize. Interests in partnerships or joint ventures. Itemize. Government and corporate bonds and other negotiable and nonnegotiable instruments. Accounts receivable. Alimony, maintenance, support, and property settlements to which the debtor is or may be entitled. Give particulars. Other liquidated debts owing debtor including tax refunds. Give particulars. 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. (Form 6A.) Contingent and noncontingent interests in estate of a decedent, death benefit plan, life insurance policy, or trust. 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. Patents, copyrights, and intellectual property. particulars. other Give

12.

13.

14.

15. 16.

17.

18.

19.

20.

21.

22.

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

Form 6B - Continued In re Debtor.

12/03 USBC, Eastern District of Virginia Case Number: (If Known)

SCHEDULE B - PERSONAL PROPERTY (Continuation Sheet)
CURRENT MARKET VALUE OF DEBTOR'S INTEREST IN PROPERTY, WITHOUT DEDUCTING ANY SECURED CLAIM OR EXEMPTION

TYPE OF PROPERTY

NONE

DESCRIPTION AND LOCATION OF PROPERTY

HUSBAND, WIFE, JOINT OR COMMUNITY

23.

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

24.

Boats, motors, and accessories.

25.

Aircraft and accessories.

26.

Office equipment, furnishings, and supplies.

27.

Machinery, fixtures, equipment and supplies used in business.

28.

Inventory.

29.

Animals.

30.

Crops - growing or harvested. Give particulars.

31.

Farming equipment and implements.

32.

Farm supplies, chemicals, and feed.

33.

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

______ continuation sheets attached

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

Form 6C In re Debtor.

12/03 USBC, Eastern District of Virginia Case Number: (If Known)

SCHEDULE C - PROPERTY CLAIMED AS EXEMPT
Debtor elects the exemption to which debtor is entitled under (Check one box)

q q

11 U.S.C. § 522(b)(1) Exemptions provided in 11 U.S.C. § 522(d). Note: These exemptions are available only in certain states. 11 U.S.C. § 522(b)(2) Exemptions available under applicable nonbankruptcy federal laws, state or local law where the debtor's domicile has been located for the 180 days immediately preceding the filing of the petition, or for a longer portion of the 180-day period than in any other place, and the debtor's interest as a tenant by the entirety or joint tenant to the extent the interest is exempt from process under applicable nonbankruptcy law.
SPECIFY LAW PROVIDING EACH EXEMPTION VALUE OF CLAIMED EXEMPTION CURRENT MARKET VALUE OF PROPERTY, WITHOUT DEDUCTING EXEMPTIONS

DESCRIPTION OF PROPERTY

Form B6D

In re _______________________________________________,
Debtor

Case No. _________________________________
(If known)

SCHEDULE D - CREDITORS HOLDING SECURED CLAIMS
State the name, mailing address, including zip code, and last four digits of the account number, if any, of all entities holding claims secured by property of the debtor as of the date of filing of the petition. 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 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." 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 in the box labeled "Total" on the last sheet of the completed schedule. Report this total also on the Summary of Schedules. G Check this box if debtor has no creditors holding secured claims to report on this Schedule D.
UNLIQUIDATED CREDITOR'S NAME AND MAILING ADDRESS INCLUDING ZIP CODE DATE CLAIM WAS INCURRED, NATURE OF LIEN, AND DESCRIPTION AND MARKET VALUE OF PROPERTY SUBJECT TO LIEN AMOUNT OF CLAIM WITHOUT DEDUCTING VALUE OF COLLATERAL

CONTINGENT

CODEBTOR

HUSBAND, WIFE, JOINT, OR COMMUNITY

DISPUTED

UNSECURED PORTION, IF ANY

ACCOUNT NO.

VALUE $
ACCOUNT NO.

VALUE $
ACCOUNT NO.

VALUE $
ACCOUNT NO.

VALUE $ _______continuation sheets attached Subtotal' (Total of this page) Total' (Use only on last page) $ $

(Report total also on Summary of Schedules)

Form B6 D - C ont.

In re __________________________________________________,
Debtor

Case No. _________________________________
(If known)

SCHEDULE D - CREDITORS HOLDING SECURED CLAIMS
(Continuation Sheet)
AMOUNT OF CLAIM WITHOUT DEDUCTING VALUE OF COLLATERAL UNLIQUIDATED CONTINGENT CODEBTOR DISPUTED

HUSBAND, WIFE, JOINT, OR COMMUNITY

CREDITOR'S NAME AND MAILING ADDRESS INCLUDING ZIP CODE

DATE CLAIM WAS INCURRED, NATURE OF LIEN, AND DESCRIPTION AND MARKET VALUE OF PROPERTY SUBJECT TO LIEN

UNSECURED PORTION, IF ANY

ACCOUNT NO.

VALUE $
ACCOUNT NO.

VALUE $
ACCOUNT NO.

VALUE $
ACCOUNT NO.

VALUE $
ACCOUNT NO.

VALUE $
Sheet no. ___ of ___continuation sheets attached to Schedule of Creditors Holding Secured Claims Subtotal' (Total of this page) Total' $ (Use only on last page) $

(Report total also on Summary of Schedules)

Form B6E (04/04)

In re Debtor

,

Case No. (if known)

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, mailing address, including zip code, and last four digits of the account 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. 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 do so. 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." 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. Repeat this total also on the Summary of Schedules. 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)
Extensions of credit in an involuntary case Claims arising in the ordinary course of the debtor's business or financial affairs after the commencement of the case but before the earlier of the appointment of a trustee or the order for relief. 11 U.S.C. § 507(a)(2). 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 $4,925* per person earned within 90 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)(3). 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)(4). Certain farmers and fishermen Claims of certain farmers and fishermen, up to $4,925* per farmer or fisherman, against the debtor, as provided in 11 U.S.C. § 507(a)(5). Deposits by individuals Claims of individuals up to $2,225* 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)(6).

Form B6E (04/04)

In re Debtor (if known)

,

Case No.

Alimony, Maintenance, or Support Claims of a spouse, former spouse, or child of the debtor for alimony, maintenance, or support, to the extent provided in 11 U.S.C. § 507(a)(7). Taxes and Certain Other Debts Owed to Governmental Units Taxes, customs duties, and penalties owing to federal, state, and local governmental units as set forth in 11 U.S.C. § 507(a)(8). Commitments to Maintain the Capital of an Insured Depository Institution 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).

* Amounts are subject to adjustment on April 1, 2007, and every three years thereafter with respect to cases commenced on or after the date of adjustment.

____ continuation sheets attached

Form B6E - Cont. (04/04)

In re __________________________________________,
Debtor

Case No. _________________________________
(If known)

SCHEDULE E - CREDITORS HOLDING UNSECURED PRIORITY CLAIMS
(Continuation Sheet)
TYPE OF PRIORITY

UNLIQUIDATED

CONTINGENT

CODEBTOR

HUSBAND, WIFE, JOINT, OR COMMUNITY

DISPUTED

CREDITOR'S NAME, MAILING ADDRESS INCLUDING ZIP CODE, AND ACCOUNT NUMBER (See instructions.)

DATE CLAIM WAS INCURRED AND CONSIDERATION FOR CLAIM

AMOUNT OF CLAIM

AMOUNT ENTITLED TO PRIORITY

ACCOUNT NO.

ACCOUNT NO.

ACCOUNT NO.

ACCOUNT NO.

ACCOUNT NO.

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

Subtotal' $ (Total of this page) $ Total' (Use only on last page of the completed Schedule E.) (Report total also on Summary of Schedules)

Form B6F

In re __________________________________________,
Debtor

Case No. _________________________________
(If known)

SCHEDULE F- CREDITORS HOLDING UNSECURED NONPRIORITY CLAIMS
State the name, mailing address, including zip code, and last four digits of account number, if any, of all entities holding unsecured claims without priority against the debtor or the property of the debtor, as of the date of filing of the petition. 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 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 maybe 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 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 of Schedules.
G

Check this box if debtor has no creditors holding unsecured claims to report on this Schedule F.
UNLIQUIDATED CONTINGENT AMOUNT OF CLAIM WITHOUT DEDUCTING VALUE OF COLLATERAL

CODEBTOR

HUSBAND, WIFE, JOINT, OR COMMUNITY

CREDITOR'S NAME AND MAILING ADDRESS INCLUDING ZIP CODE

DATE CLAIM WAS INCURRED, NATURE OF LIEN, AND DESCRIPTION AND MARKET VALUE OF PROPERTY SUBJECT TO LIEN

ACCOUNT NO.

ACCOUNT NO.

ACCOUNT NO.

ACCOUNT NO.

_____continuation sheets attached

Subtotal ' $ Total ' $ (Report also on Summary of Schedules)

DISPUTED

Form B6 F - C ont.

In re __________________________________________,
Debtor

Case No. _________________________________
(If known)

SCHEDULE F - CREDITORS HOLDING UNSECURED NONPRIORITY CLAIMS
(Continuation Sheet)

CREDITOR'S NAME AND MAILING ADDRESS INCLUDING ZIP CODE

DATE CLAIM WAS INCURRED, NATURE OF LIEN, AND DESCRIPTION AND MARKET VALUE OF PROPERTY SUBJECT TO LIEN

AMOUNT OF CLAIM WITHOUT DEDUCTING VALUE OF COLLATERAL

UNLIQUIDATED

CONTINGENT

CODEBTOR

ACCOUNT NO.

ACCOUNT NO.

ACCOUNT NO.

ACCOUNT NO.

ACCOUNT NO.

HUSBAND, WIFE, JOINT, OR COMMUNITY

Sheet no. ___ of ___sheets attached to Schedule of Creditors Holding Unsecured Nonpriority Claims

Subtotal ' $ (Total of this page) Total ' $ (Use only on last page of the completed Schedule E.) (Report total also on Summary of Schedules)

DISPUTED

Form 6G

12/03 USBC, Eastern District of Virginia

In re Debtor.

Case Number: (If Known)

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. NOTE: A party listed on this schedule will not receive notice of the filing of this case unless the party is also scheduled in the appropriate schedule of creditors.

q

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

NAME AND MAILING ADDRESS, INCLUDING ZIP CODE, OF OTHER PARTIES TO LEASE OR CONTRACT

Form 6H In re Debtor.

12/03 USBC, Eastern District of Virginia Case Number: (If Known)

SCHEDULE H - CODEBTORS
Provide the information required 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. In community property states, a married debtor not filing a joint case should report the name and address of the non-debtor spouse on this schedule. Include all names used by the nondebtor spouse during the six years immediately preceding the commencement of this case.

q

Check this box if debtor has no codebtors.

NAME AND ADDRESS OF CODEBTOR

NAME AND ADDRESS OF CREDITOR

Form B6I

In re Debtor

Case No. (if known)

SCHEDULE I - CURRENT INCOME OF INDIVIDUAL DEBTOR(S)
The column labeled "Spouse" must be completed in all cases filed by joint debtors and by a married debtor in a chapter 12 or 13 case whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed. Debtor's Marital Status: RELATIONSHIP Employment: Occupation Name of Employer How long employed Address of Employer DEBTOR SPOUSE DEPENDENTS OF DEBTOR AND SPOUSE AGE

Income: (Estimate of average monthly income) Current monthly gross wages, salary, and commissions (pro rate if not paid monthly.) Estimated monthly overtime SUBTOTAL LESS PAYROLL DEDUCTIONS a. Payroll taxes and social security b. Insurance c. Union dues d. Other (Specify: ______________________________________)

DEBTOR $ ____________ $ ____________

SPOUSE $ ____________ $ ____________

$__________
$ $ $ $ ____________ ____________ ____________ ____________

$ _________
$ $ $ $ ____________ ____________ ____________ ____________

SUBTOTAL OF PAYROLL DEDUCTIONS TOTAL NET MONTHLY TAKE HOME PAY

$__________ $__________
$ ____________ $ ____________ $ ____________ $ ____________ $ ____________ $ ____________ $ ____________ $ ____________ $ ____________

$ __________ $ __________
$ ____________ $ ____________ $ ____________ $ ____________ $ ____________ $ ____________ $ ____________ $ ____________ $ ____________

Regular income from operation of business or profession or farm (attach detailed statement) Income from real property Interest and dividends Alimony, maintenance or support payments payable to the debtor for the debtor's use or that of dependents listed above. Social security or other government assistance (Specify) __________________________________________________ Pension or retirement income Other monthly income (Specify) _________________________________________________ _________________________________________________ TOTAL MONTHLY INCOME

$__________
$_________________

$ __________

TOTAL COMBINED MONTHLY INCOME

(Report also on Summary of Schedules)

Describe any increase or decrease of more than 10% in any of the above categories anticipated to occur within the year following the filing of this document:

Form B6J (6/90)

In re Debtor

,

Case No. (if known)

SCHEDULE J - CURRENT EXPENDITURES OF INDIVIDUAL DEBTOR(S)
Complete this schedule by estimating the average monthly expenses of the debtor and the debtor's family. Pro rate any payments made bi-weekly, quarterly, semi-annually, or annually to show monthly rate. 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." Rent or home mortgage payment (include lot rented for mobile home) Are real estate taxes included? Is property insurance included? Utilities Electricity and heating fuel Water and sewer Telephone Other ________________________________________________________________________ Home maintenance (repairs and upkeep) Food Clothing Laundry and dry cleaning Medical and dental expenses Transportation (not including car payments) Recreation, clubs and entertainment, newspapers, magazines, etc. Charitable contributions Insurance (not deducted from wages or included in home mortgage payments) Homeowner's or renter's Life Health Auto Other ________________________________________________________________________ Taxes (not deducted from wages or included in home mortgage payments) (Specify) ___________________________________________________________________________ Installment payments: (In chapter 12 and 13 cases, do not list payments to be included in the plan) Auto Other ________________________________________________________________________ Other ________________________________________________________________________ Alimony, maintenance, and support paid to others Payments for support of additional dependents not living at your home Regular expenses from operation of business, profession, or farm (attach detailed statement) Other ______________________________________________________________________________ TOTAL MONTHLY EXPENSES (Report also on Summary of Schedules) $ ______________ $ ______________ $ ______________ $ ______________ $ ______________ $ ______________ $ ______________ $______________ $ ______________ $ ______________ $ ______________ $ ______________ $ ______________ $ ______________ Yes ________ No ________ Yes ________ No ________ $ ______________ $ ______________ $ ______________ $ ______________ $ ______________ $ ______________ $ ______________ $ ______________ $ ______________ $ ______________ $ ______________ $ ______________ $ _____________

[FOR CHAPTER 12 AND 13 DEBTORS ONLY] Provide the information requested below, including whether plan payments are to be made bi-weekly, monthly, annually, or at some other regular interval. A. Total projected monthly income B. Total projected monthly expenses C. Excess income (A minus B) D. Total amount to be paid into plan each _________________________________________________ (interval) $ ______________ $ ______________ $ ______________

Form 6J - Continued In re Debtor.

12/03 USBC, Eastern District of Virginia Case Number: (If Known)

DECLARATION CONCERNING DEBTOR'S SCHEDULES
DECLARATION UNDER PENALTY OF PERJURY BY INDIVIDUAL DEBTOR

I declare under penalty of perjury that I have read the foregoing summary and schedules, consisting of _______________ sheets, and that they are correct to the best of my knowledge, information, and belief. (Total shown on summary
page plus 1)

Date__________________________________________

Signature ___________________________________________________________ Debtor

Date__________________________________________

Signature___________________________________________________________ (Joint Debtor, if any) [If joint case, both spouses must sign

-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------CERTIFICATION AND SIGNATURE OF NON-ATTORNEY BANKRUPTCY PETITION PREPARER (See 11 U.S.C. § 110) I certify that I am a bankruptcy petition preparer as defined in 11 U.S.C. § 110, that I prepared this document for compensation, and that I have provided the debtor with a copy of this document. _____________________________________________________ Printed or Typed Name of Bankruptcy Petition Preparer _____________________________________________________ _____________________________________________________ Address Name and Social Security numbers of all other individuals who prepared or assisted in preparing this document: If more than one person prepared this document, attach additional signed sheets conforming to the appropriate Official Form for each person. X __________________________________________________ Signature of Bankruptcy Petition Preparer _______________________________________ Date ________________________________________ Social Security Number

A bankruptcy petition preparer's failure to comply with the provisions of title 11 and the Federal Rules of Bankruptcy Procedure may result in fines or imprisonment or both. 11 U.S.C. § 110; 18 U.S.C. § 156. ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------DECLARATION UNDER PENALTY OF PERJURY ON BEHALF OF CORPORATION OR PARTNERSHIP

I, the ___________________________________ [the president or other officer or an authorized agent of the corporation or member or an authorized agent of the partnership] of the ___________________________ [corporation or partnership] named as debtor in this case, declare under penalty of perjury that I have read the foregoing summary and schedules, consisting of _______ sheets, and that they are true and correct to the best of my knowledge, information, and belief.

Date ________________________________________

Signature__________________________________________________________ ______________________________________________
[Print or type name of individual signing on behalf of debtor]

[An individual signing on behalf of a partnership or corporation must indicate position or relationship to debtor.] ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Penalty for making a false statement or concealing property. Fine of up to $500,000 or imprisonment for up to 5 years or both. 18 U.S.C. §§ 152 and 3571.