Preview
FILED: NASSAU COUNTY CLERK 06/27/2023 02:05 PM INDEX NO. 601610/2015
NYSCEF DOC. NO. 77 RECEIVED NYSCEF: 06/27/2023
"K"
EXHIBIT
FILED: NASSAU COUNTY CLERK 06/27/2023 02:05 PM INDEX NO. 601610/2015
NYSCEF DOC. NO. 77 Case 8-16-70141-ast Doc 1 Filed 01/13/16 Entered 01/13/16RECEIVED
11:03:12 NYSCEF: 06/27/2023
CLERK
. CY COURT
U S.BANKRUP T
ASTERNDISTRICT 0F
E
HEW Y ORK
United States Bankruptcy Court for the: Û" Ù
EASTERN DISTRICT OF NEW YORK
Case number (ifknown). Chapter you are flilng under:
E Chapter 7
O Chapter 11
O Chapter 12
O Ch pie i O Check if this an
arnended filing
Official Form 101
Petition for Individuals Filing for Bankruptcy wis
Voluntary
The bankruptcy forms use you and Debtor 1 to refer to a debtor filing alone. A married couple may file a bankruptcy case together-called a Jobtf
case-and in Joint cases, these forms use you to ask for information from both debtors. For example, if a form asks, "Do you own a car," the answer
would be yes if either debtor owns a car. When information is needed about the spouses separately, the form uses Debtor f and Debtor 2 to distinguish
. between them. In joint cases, one of the spouses must report information as Debtor f and the other as Debtor 2. The same person must be Debfor f in
all of the forms.
.
Be as complete and accurate as possible. If two married people are filing together, both are equally responsible for supplying correct information. If
more space is needed, attach a separate sheet to this form. On the top of any additional pages, write your name and case number (if known). Answer
every question.
Identify Yourself
About Debtor 1: About Debtor 2 (Spouse Only in a Joint Case):
1. Your futi name
Write the name that is on Nelson
your govemment-issued First name First name
picture identification (for
example, your driver's
Ilcense or passport). Middle name Middle name
Bring your picture Rojas
Last name and Suffix (Sr., Jr., 11,111) Last name and Suffix (Sr., Jr., II, III)
nettig th the stee.
2. AII other names you have
used in the last 8 years
Include your married or o
maiden names.
.. 3. .... .' .
Only the lastA digits f
your Social Security
number or federal XXX-xx-0257
Individual Taxpayer
Identification number
(ITIN)
Official Form 101 Voluntary Petition for individuals FIIIng for Bankruptcy page 1
FILED: NASSAU COUNTY CLERK 06/27/2023 02:05 PM INDEX NO. 601610/2015
NYSCEF DOC. NO. 77 Case 8-16-70141-ast DOC 1 Filed 01/13/16 Entered 01/13/16RECEIVED
11:03:12 NYSCEF: 06/27/2023
Debtor 1 Nelson Rojas Case number orknown)
About Debtor 1: About Debtor 2 (Spouse Only in a Joint Case):
4. Any business names and
Employer identification
Numbers (EIN) you have E I have not used any business name or ElNs. O I have not used any business name or EINs.
used in the last 8 years
Include trade names and Business name(s) Business name(s)
doing business as names
EINs EINs
" 5. Where you IIve If Debtor 2 lives at a different address:
30 Carroll Avenue
Valley Stream, NY 11580
Number, Street, City, State & ZIP Code Number, Street, City, State & ZIP Code
Nassau
County County
If your malling address Is different fromtthe one If Debtor 2's maillng address la different from yours, fill it
above, fill it In here. Note that the court will send any in here. Note that the court will send any notices to this
notices to you at this mailing address. mailing address.
Number, P.O. Box, Street, City, State & ZIP Code Number, P.O. Box, Street, City, State & ZIP Code
6. Why you are choosing Check one: Check one:
this district to file for
. bankruptcy g Over the last 180 days before IIIIng this petition, O Over the last 180 days before filing this petition, I
l have lived in this district longer than in any have lived in this district longer than in any other
other district. district.
O I have another reason. I have another reason.
Explain. (See 28 U.S.C. § 1408.) Explain. (See 28 U.S.C. § 1408.)
.
Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 2
FILED: NASSAU COUNTY CLERK 06/27/2023 02:05 PM INDEX NO. 601610/2015
NYSCEF DOC. NO. 77 Case 8-16-70141-ast DOC 1 Filed 01/13/16 Entered 01/13/16RECEIVED
11:03:12 NYSCEF: 06/27/2023
Debtor 1 Nelson Rojas case numbertirunown)
Tell the Court About Your Bankruptcy Case
7. The chapter of the Check one. (For a brief description of each, see Notice Required by f f U.S.C. § 342(b) for Individuals Filing for Bankruptcy
Bankruptcy Code you are (Form 2010)). Also, go to the top of page 1 and check the appropriate box.
choosing to file under
E Chapter 7
O Chapter 11
Chapter 12
O Chapter 13
8. How you will pay the fee I will pay the entire fee when I file my petition. Please check with the clerk's office in your local court for more details
about how you may pay. Typically, if you are paying the fee yourself, you may pay with cash, cashlers check, or money
order. If your attorney is submitting your payment on your behalf, your attomey may pay with a credit card or check with
a pre-printed address.
O I need to pay the fee in Installments. If you choose this option, sign and attach the Application for Individuals to Pay
The Filing Fee in Installments (Official Form 103A).
I request that my fee be waived (You may request this option only if you are filing for Chapter 7. By law, a judge may,
but is not required to, waive your fee, and may do so only if your income is less than 150% of the official poverty line that
applies to your family size and you are unable to pay the fee in installments). If you choose this option, you must fill out
the Application to Have the Chapter 7 Filing Fee Weived (Official Form 103B) and file it with your petition.
9. Have you filed for g No
bankruptcy within the
last 8 years? O Yes.
District When Case number
District When Case number
District _ When Case number
_. .
10. Are any bankruptcy g No
casee pending or being
filed by a spouse who is O Yes.
not filing this case with
you, or by a business
partner, or by an
affiliate?
Debtor Relationship to you
District When Case number, if known
Debtor Relationship to you
District When Case number, if known
11. Do you rent your g Go to line 12. , ,
residence?
O Yes, Has your landlord obtained an eviction Judgment against you and do you want to stay in your residence?
D No. Go to line 12.
.
Yes. Flll out Initial Statement About an Eviction Judgment Against You (Form 101A) and file it with this
bankruptcy petition.
Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 3
FILED: NASSAU COUNTY CLERK 06/27/2023 02:05 PM INDEX NO. 601610/2015
NYSCEF DOC. NO. 77Case 8-16-70141-ast Doc 1 Filed 01/13/16 Entered 01/13/16RECEIVED
11:03:12 NYSCEF: 06/27/2023
Debtor 1 Nelson Rojas Case number (ifknown)
Report About Anó Businesses You Own as a Sole Proprietor
12. Are you a sole proprietor
of any full- or part-time E No. Go to Part 4.
business?
O Yes. Name and location of business
A sole proprietorship is a __.. --.
business you operate as Name of business, if any
an individual, and is not a
separate legal entity such
as a corporation,
partriership or LLC.
If you have more than one Number, Street, City, State & ZIP Code
sole proprietorship, use a
separate sheet and attach
it to this petition. Check the appropriate box to describe your business:
O Health Care Business (as defined in 11 U.S.C. § 101(27A))
O Single Asset Real Estate (as defined in 11 U.S.C. § 101(51B))
O Stockbroker (as defined In 11 U.S.C. § 101(53A))
O Commodity Broker (as defined in 11 U.S.C. § 101(6))
O None of the above
13. Are you filing under If you are Gilng under Chapter 11, the court must Imow whether you are a small business debtor so that it can set appropriate
Chapter 11 of the deadlines. If you indicate that you are a small business debtor, you must attach your most recent balance sheet, statement of
Bankruptcy Code and are operations, cash-flow statement, and federal Income tax retum or if any of these documents do not exist. follow the procedure
you a small business in 11 U.S.C. 1116(1)(B).
debtor?
g No i am not filing under Chapter 11.
6 For a definition of small
O No. I am filing under Chapter 11, but I am NOT a small business debtor according to the definition in the Bankruptcy
U C § 1 1 51D)
Code.
O Yes. 1am filing under Chapter 11 and I am a small business debtor according to the definition In the Bankruptcy Code.
Report if You Own or Have Any Hazardous Property or Any Property That Needs Immediate Attention
14. Do you own or have any g No
property that poses or is
alleged to pose a threat O Yes.
of imminent and What is the hazard?
Identifiable hazard to
public health or safety?
Or do you own any
property that needs If immediate attention Is
Immediate attention? needed, why is it needed?
For example, do you own
perishable goods, or
livestock that must be fed, Where is the property?
or a building that needs
urgent repairs?
Number,Street,City, State& Zip Code
Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 4
FILED: NASSAU COUNTY CLERK 06/27/2023 02:05 PM INDEX NO. 601610/2015
NYSCEF DOC. NO. 77Case 8-16-70141-ast Doc 1 Ried 01/13/16 Entered 01/13/16RECEIVED
11:03:12 NYSCEF: 06/27/2023
Debtor 1 Nelson Rojas Case number (irknown)
Expiain Your Efforts to Receive a Briefing About Credit Counseling
About Debtor 1: About Debtor 2 (Spouse Only in a Joint Case):
15. Tell the court whether You must check one: You must check one:
you have received a g I received a briefing from an approved credit O I received a briefing from an approved credit
briefing about credit counseling agency within the 180 days before I counseling agency within the 180 days before i filed
counseling. filed this bankruptcy petition, and I received a this bankruptcy petition, and I received a certificate of
The law requires that you .
receive a briefing about Attach a copy of the certificate and the payment Attach a copy of the certificate and the payment plan, if
credit counseling before plan, if any, that you developed with the agency. any, that you developed with the agency.
you file for bankruptcy.
You must truthfully check O I received a briefing from an approved credit O i received a briefing from an approved credit . .
one of the following counseling agency within,the 8 I days before 1 . counseling agency within the '180 days before MilpA
choices. If you cannot do filed this bankruptcy petition, but Edo not have this bankruptcy petition, but I do not have a certificate
so, you are not eligible to a certificate of completion. of completion.
file.
Within 14 days after you file this bankruptcy Within 14 days after you file this bankruptcy petition, you
If you file anyway, the court petition, you MUST file a copy of the certificate and MUST file a copy of the certificate and payment plan, if
can dismiss your case, you payment plan, If any. any:
will lose whatever filing fee
you paid, and your O I certify that I asked for credit counseling O I certify that I asked for credit counseling services
creditors can begin services from an approved agency, but was fmm an approved agency, but was unable to obtain
collection activities again. unable to obtain those services during the 7 those services during the 7 days after I made my
days after I made my request, and exigent request, and exigent circumstances merit a 30-day
circumstances merit a 30-day temporary waiver temporary waiver of the requirement.
of the requirement
To ask for a 30-day temporary waiver of the requirement,
To ask for a 30-day temporary waiver of the attach a separate sheet explaining what efforts you made
requirement, attach a separate sheet explaining to obtain the briefing, why you were unable to obtain it
what efforts you made to obtain the briefing, why before you filed for bankruptcy, and what exigent
you were unable to obtain it before you filed for circumstances required you to file this case.
bankruptcy, and what exigent circumstances
required you to file this case. Your case may be dismissed if the court is dissatisfied
with your reasons for not receiving a briefing before you
Your case may be dismissed if the court is filed for bankruptcy.
dissatisfied with your reasons for not receiving a
If the court is satisfied with your reasons, you must still
briefing before you filed for bankruptcy.
If the court is satisfied with your reasons, you must receive a briefing within 30 days after you file. You must
still receive a briefing within 30 days after you file. file a certificate from the approved agency, along with a
You must file a certificate from the approved copy of the payment plan you developed, if any. If you do
agency, along with a copy of the payment plan you not do so, your case may be dismissed.
developed, if any. If you do not do so, your case
Any extension of the 30-day deadline is granted only for
may be dismissed. cause and is limited to a maximum of 15 days.
Any extension of the 30-day deadline is granted
only for cause and is limited to a maximum of 15
days.
O I am not required to receive a briefing about O I am not required to receive a briefing about credit
credit counseling because of: counseling because of:
O Incapacity. I have a mental illness or a O Incapacity. I have a mental illness or a mental
mental deficiency that makes deficiency that makes me Incapable
me incapable of realizing or of realizing or making rational
making rational decisions decisions about finances.
about finances.
O Disability. My physical disability causes O Disability. My physical disability causes me to
me to be unable to participate be unable to participate in a briefing
in a briefing in person, by in person, by phone, or through the
phone, or through the internet, even after I reasonably tried
intemet, even after I to do 502
reasonably tried to do so.
O Active duty. I am currently on active O Active duty. ILafn cunently on active military duty
military duty in a military in a military combat zone.
combat zone.
If you believe you are not required to receive a If you believe you are not required to receive a briefing
briefing about credit counseling, you must file a about credit counseling, you Inust file a motion for waiver
motion for waiver of credit counseling with the of credit counseling with the court.
court.
Official Form 101 Page 5
Voluntary Petition for Individuals Filing for Bankruptcy
FILED: NASSAU COUNTY CLERK 06/27/2023 02:05 PM INDEX NO. 601610/2015
NYSCEF DOC. NO. 77Case 8-16-70141-ast Doc 1 Filed 01/13/16 Entered 11:03:12
01/13/16 RECEIVED NYSCEF: 06/27/2023
Debtor 1 Nelson Rojas Case number (ifknown)
Answer These Questions for Reporting Purposes
16. What kind of debts do 16a. Are your debts primarily consumer debts? Consumer debts are defined in 11 U.S.C. § 101(8) as "incurred by an
you have? individual primarily for a personal, family, or household purpose."
O No. Go to line 16b.
Yes. Go to line 17.
16b. Are your debts primarily business debts? Business debts are debts that you incurred to obtain
money for a business or investment or through the operation of the business or investment.
O No. Go to line 16c.
O Yep. Go to line 17. . ...: x
16c. State p type of debts you owe that are not consumer debts or business debts ,,
17. Are you filing under O No. I am not filing under Chapter 7. Go to line 18,
Chapter 7?
Do you estimate that g Yes I am filing under Chapter 7. Do you estimate that after any exempt property is excluded and administrative expenses
after any exempt are paid that funds will be available to distribute to unsecured creditors?
property is excluded and
administrative expenses g No
are paid that funds will
be available for ¤ Yes
distribution to unsecured
creditors?
18. How many Creditors do g 1-49 O 1,000-5,000 O 25,001-50,000
you estimate that you
O 50-99 O 5001-10,000 O 50,001-100,000
O 100-199 10,001-25,000 O More than100,000
O 200-999
19. How much do you O $0 - $50,000 O $1,000,001 - $10 million O $500,000,001 - $1 billion
betima e our assets to $1,000,000,001 - $10 billion
O $50,001 - $100,000 $10,000,001 - $50 million
E $100,001 -$500,000 O $50,000,001 - $100 million O $10,000,000,001 - $50 billion
O $500,001 - $1 million O $100,000,001 -$500 million O More than $50 billion
_.
20. How much do you ¤ $0 - $50,000 O $1,000,001 - $10 million O $500,000,001 - $1 billion
est mate your liabilitieS
O $50,001 - $100,000 O $10,000,001 - $50 million O $1,000,000,001 - $10 billion
E $100,001 - $500,000 O $50,000,001 - $100 million O $10,000,000,001 - $50 billion
O $500,001 -$1 million O $100,000,001 - $500 million O More than $50 billion
Mgn Below
For you I have examined this petition, and I declare under penalty of perjury thatithe information provided is true and correct.
If I have chosen to file under Chapter 7, I am aware that I may proceed, If ellglble, under Chapter 7, 11,12, or 13 of title 11,
United States Code. i understand the relief available under each chapter, and I choose to proceed under Chapter 7.
If no attorney represents me and I did not pay or agree to pay someone who Is not an attorney to help me fill out this
document, I have obtained and read the notice required by 11 U.S.C. § 342(b).
v no I request relief in accordance with the chapter of title 11, United States-Gode, specified In this petition.
I understand maid a fa statement, ng property. or obtaining money or property by fraud in connection with a y -
bankruptcy re In fines u ,000, or imprisonmentfor up to 20 years, or both. 18 U.S.C. §§ 152, 1341; 1519,
:i · '' and 357
el ojas Signature of Debtor 2
ature of Debtor 1
Executed on Executed on
MI b / Yv MM / DD / YYYY
Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 6
FILED: NASSAU COUNTY CLERK 06/27/2023 02:05 PM INDEX NO. 601610/2015
NYSCEF DOC. NO. 77Case 8-16-70141-ast Doc 1 Filed 01/13/16 Entered 11:03:12
01/13/16 RECEIVED NYSCEF: 06/27/2023
Debtor 1 Nelson Rojas Case number tirknown)
For you if you are fliIng this The law allows you, as an individual, to represent yourself in bankruptcy court, but you should understand that many
bankruptcy without an people find it extremely difficult to represent themselves successfully. Because bankruptcy has long-term
attomey financial and legal consequences, you are strongly urged to hire a qualified attorney,
If you are represented by an To be successful, you must correctly file and handle your bankruptcy case. The rules are very technical, and a mistake or
attorney, you do not need to inaction may affect your rights. For exarnple, your case may be dismissed because you did not file a required document,
file this page, pay a fee on time, attend a meeting or hearing, or cooperate with the court, case trustee, U.S. trustee, bankruptcy
administrator, or audit firm if your case is selected for audit. If that happens, you could lose your right to file another case,
or you may lose protections, including the benefit of the automatic stay.
You must Ilst all your property and debts in the schedules that you are required to file with the court. Even if you plan to pay
,, a particular debt outside of your bankruptcy, you must list that debt in your schedules. If you do not list a debt, the debt may
not be discharged. If you do not list property or properly claim it as exempt, youimay not be able to keep the property. The
judge can also deny you a discharge of all your debts if you do something dishonest In your bankruptcy case, such as
destroying or hiding property, falsifying records, or lying. Individual bankruptcy cases are randomly audited to determine if
debtors have been accurate, truthful, and complete. Bankruptcy fraud is a serious crime; you could be fined and
Imprisoned.
If you decide to file without an attorney, the court expects you to follow the rules as if you had hired an attorney. The court
will not treat you differently because you are fHing for yourself. To be successful, you must be familiar with the United
States Bankruptcy Code, the Federal Rules of Bankruptcy Procedure, and the local rules of the court in which your case is
filed. You must also be familiar with any state exemption laws that apply.
Are you aware that filing for bankruptcy is a serious action with long-term financial and legal consequences?
O No
E Yes
Are you aware that bankruptcy fraud is a serious crime and that If your bankruptcy forms are inaccurate or incomplete, you
could be fined or imprisoned?
O No
.. E Yes
Did you pay or agree to pay someone who is not an attomey to help you fill out your bankruptcy forms?
No
O yes Name of Person
Attach Bankruptcy Petition Preparers Notice, Declaration, and Signature (Official Form 119).
By signing here, I acknowledge that I understand the risks involved in fliing without an attorney. I have read and understood
this notice, and I am that filing bankruptcy case without an attomey may cause me to lose my rights or property if I do
, not prope case.
N as Signature of Debtor 2
ure of Debtor 1
Date P Date
. .. MM / DD / Y MM / DD / YYYY
Contact phone Contact phone
Cell phone Cell phone
Email address Email address
Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 8
FILED: NASSAU COUNTY CLERK 06/27/2023 02:05 PM INDEX NO. 601610/2015
NYSCEF DOC. NO. 77Case 8-16-70141-ast Doc 1 Filed 01/13/16 Entered 11:U3:12
01/13/1b RECEIVED NYSCEF: 06/27/2023
Debtor 1 Nelson Rojas
" Fht Name MkMeName LastName
Debtor 2
(Spouse
if,filing) FirstName MddleName LastName
United States Bankruptcy Court for the: EASTERN DISTRICT OF NEW YORK
Case number
(m=0 O Check if this is an
amended filing
ficial Form..106Sum
of Your Assets and Liabilities and Certain Statistical Information 12/15
Summary
Be as complete and accurate as possible. If two married people are filing together, both are equally responsible for supplying correct
information. FIII out all of your schedules first; then complete the information on this form. If you are fillng amended schedules after you file
your original forms, you must fill out a new Summary and check the box at the top of this page.
Summarize Your Assets
V$1E oNhat you o
1. Schedule AIB: Property (Official Form 106AIB)
1a. Copy line 55, Total real estate. from Schedule A/B................................................................................................ $ 350,000.00
1b. Copy Ilne 62, Total personal property, from Schedule A/B..................................................................................... $ 16,439.33
1c. Copy line 63, Total of all property on Schedule A/B............................................................................................... S 366,439.33
,
Summarize Your Liabilities
ur iialilllties
Ginount ye owet
2. Schedule D: Creditors Who Have Claims Secured by Property (Official Form 106D)
2a. Copy the total you listed in Column A, Amount of claim, at the bottom of the last page of Part 1 of Schedule D...
3. Schedule F4F: Creditors Who Have Unsecured Claims (Official Form 106E/F)
0.00
3a. Copy the tocal claims from Part 1 (priority unsecured claims) from line 6e of Schedule E/F.................................
3b. Copy the total claims from Part 2 (nonpriority unsecured claims) from line 6j of Schedule FJF............................ $ 41,876.00
Your total Ilabilities S 275,495.00
Summarize YourIncome and Expenses ___,__
. 4. Schedule I: Your Inmme (Official Form 1061)
Copy your combined monthly Incorne from line 12 of Schedule l................................................................--..............
5. Schedule J: Your Expenses (Official Form 106J)
$ 6,853.50
Copy your monthly expenses from line 22c of Schedule J...........--.............................................................
Answer These Questions for Administrative and Statistical Records .
6. Are you filing for bankruptcy under Chapters 7, 11, or 13?
No. You liave nothing to report ori this part3f,the form. Check this box and submit this form to the courtwith your other schedules.
E Yes
7. What kind of debt do you have?
g Your debts are primarily consumer debts. Consumer debts are those "Incurred by an Individual primarily for a personal, family, or
purpose."
household 11 U.S.C. § 101(8). Fill out lines 8-99 for statistical purposes. 28 U.S.C. § 159.
Your debts are not primarily consumer debts. You have nothing to report on this part of the form. Check this box and submit this form to
the court with your other schedules.
page 1 of 2
Official Form 106Sum Summary of Your Assets and Liabilities and Certain Statistical Information
Software BestCase,LLc - www.bestcase.com
(c)1996-2015
Copyright BestCaseBankmptcy
FILED: NASSAU COUNTY CLERK 06/27/2023 02:05 PM INDEX NO. 601610/2015
NYSCEF DOC. NO. 77Case 8-16-70141-ast Doc 1 Filed 01/13/16
Preview
FILED: NASSAU COUNTY CLERK 06/27/2023 02:05 PM INDEX NO. 601610/2015 NYSCEF DOC. NO. 77 RECEIVED NYSCEF: 06/27/2023 "K" EXHIBIT FILED: NASSAU COUNTY CLERK 06/27/2023 02:05 PM INDEX NO. 601610/2015 NYSCEF DOC. NO. 77 Case 8-16-70141-ast Doc 1 Filed 01/13/16 Entered 01/13/16RECEIVED 11:03:12 NYSCEF: 06/27/2023 CLERK . CY COURT U S.BANKRUP T ASTERNDISTRICT 0F E HEW Y ORK United States Bankruptcy Court for the: Û" Ù EASTERN DISTRICT OF NEW YORK Case number (ifknown). Chapter you are flilng under: E Chapter 7 O Chapter 11 O Chapter 12 O Ch pie i O Check if this an arnended filing Official Form 101 Petition for Individuals Filing for Bankruptcy wis Voluntary The bankruptcy forms use you and Debtor 1 to refer to a debtor filing alone. A married couple may file a bankruptcy case together-called a Jobtf case-and in Joint cases, these forms use you to ask for information from both debtors. For example, if a form asks, "Do you own a car," the answer would be yes if either debtor owns a car. When information is needed about the spouses separately, the form uses Debtor f and Debtor 2 to distinguish . between them. In joint cases, one of the spouses must report information as Debtor f and the other as Debtor 2. The same person must be Debfor f in all of the forms. . Be as complete and accurate as possible. If two married people are filing together, both are equally responsible for supplying correct information. If more space is needed, attach a separate sheet to this form. On the top of any additional pages, write your name and case number (if known). Answer every question. Identify Yourself About Debtor 1: About Debtor 2 (Spouse Only in a Joint Case): 1. Your futi name Write the name that is on Nelson your govemment-issued First name First name picture identification (for example, your driver's Ilcense or passport). Middle name Middle name Bring your picture Rojas Last name and Suffix (Sr., Jr., 11,111) Last name and Suffix (Sr., Jr., II, III) nettig th the stee. 2. AII other names you have used in the last 8 years Include your married or o maiden names. .. 3. .... .' . Only the lastA digits f your Social Security number or federal XXX-xx-0257 Individual Taxpayer Identification number (ITIN) Official Form 101 Voluntary Petition for individuals FIIIng for Bankruptcy page 1 FILED: NASSAU COUNTY CLERK 06/27/2023 02:05 PM INDEX NO. 601610/2015 NYSCEF DOC. NO. 77 Case 8-16-70141-ast DOC 1 Filed 01/13/16 Entered 01/13/16RECEIVED 11:03:12 NYSCEF: 06/27/2023 Debtor 1 Nelson Rojas Case number orknown) About Debtor 1: About Debtor 2 (Spouse Only in a Joint Case): 4. Any business names and Employer identification Numbers (EIN) you have E I have not used any business name or ElNs. O I have not used any business name or EINs. used in the last 8 years Include trade names and Business name(s) Business name(s) doing business as names EINs EINs " 5. Where you IIve If Debtor 2 lives at a different address: 30 Carroll Avenue Valley Stream, NY 11580 Number, Street, City, State & ZIP Code Number, Street, City, State & ZIP Code Nassau County County If your malling address Is different fromtthe one If Debtor 2's maillng address la different from yours, fill it above, fill it In here. Note that the court will send any in here. Note that the court will send any notices to this notices to you at this mailing address. mailing address. Number, P.O. Box, Street, City, State & ZIP Code Number, P.O. Box, Street, City, State & ZIP Code 6. Why you are choosing Check one: Check one: this district to file for . bankruptcy g Over the last 180 days before IIIIng this petition, O Over the last 180 days before filing this petition, I l have lived in this district longer than in any have lived in this district longer than in any other other district. district. O I have another reason. I have another reason. Explain. (See 28 U.S.C. § 1408.) Explain. (See 28 U.S.C. § 1408.) . Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 2 FILED: NASSAU COUNTY CLERK 06/27/2023 02:05 PM INDEX NO. 601610/2015 NYSCEF DOC. NO. 77 Case 8-16-70141-ast DOC 1 Filed 01/13/16 Entered 01/13/16RECEIVED 11:03:12 NYSCEF: 06/27/2023 Debtor 1 Nelson Rojas case numbertirunown) Tell the Court About Your Bankruptcy Case 7. The chapter of the Check one. (For a brief description of each, see Notice Required by f f U.S.C. § 342(b) for Individuals Filing for Bankruptcy Bankruptcy Code you are (Form 2010)). Also, go to the top of page 1 and check the appropriate box. choosing to file under E Chapter 7 O Chapter 11 Chapter 12 O Chapter 13 8. How you will pay the fee I will pay the entire fee when I file my petition. Please check with the clerk's office in your local court for more details about how you may pay. Typically, if you are paying the fee yourself, you may pay with cash, cashlers check, or money order. If your attorney is submitting your payment on your behalf, your attomey may pay with a credit card or check with a pre-printed address. O I need to pay the fee in Installments. If you choose this option, sign and attach the Application for Individuals to Pay The Filing Fee in Installments (Official Form 103A). I request that my fee be waived (You may request this option only if you are filing for Chapter 7. By law, a judge may, but is not required to, waive your fee, and may do so only if your income is less than 150% of the official poverty line that applies to your family size and you are unable to pay the fee in installments). If you choose this option, you must fill out the Application to Have the Chapter 7 Filing Fee Weived (Official Form 103B) and file it with your petition. 9. Have you filed for g No bankruptcy within the last 8 years? O Yes. District When Case number District When Case number District _ When Case number _. . 10. Are any bankruptcy g No casee pending or being filed by a spouse who is O Yes. not filing this case with you, or by a business partner, or by an affiliate? Debtor Relationship to you District When Case number, if known Debtor Relationship to you District When Case number, if known 11. Do you rent your g Go to line 12. , , residence? O Yes, Has your landlord obtained an eviction Judgment against you and do you want to stay in your residence? D No. Go to line 12. . Yes. Flll out Initial Statement About an Eviction Judgment Against You (Form 101A) and file it with this bankruptcy petition. Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 3 FILED: NASSAU COUNTY CLERK 06/27/2023 02:05 PM INDEX NO. 601610/2015 NYSCEF DOC. NO. 77Case 8-16-70141-ast Doc 1 Filed 01/13/16 Entered 01/13/16RECEIVED 11:03:12 NYSCEF: 06/27/2023 Debtor 1 Nelson Rojas Case number (ifknown) Report About Anó Businesses You Own as a Sole Proprietor 12. Are you a sole proprietor of any full- or part-time E No. Go to Part 4. business? O Yes. Name and location of business A sole proprietorship is a __.. --. business you operate as Name of business, if any an individual, and is not a separate legal entity such as a corporation, partriership or LLC. If you have more than one Number, Street, City, State & ZIP Code sole proprietorship, use a separate sheet and attach it to this petition. Check the appropriate box to describe your business: O Health Care Business (as defined in 11 U.S.C. § 101(27A)) O Single Asset Real Estate (as defined in 11 U.S.C. § 101(51B)) O Stockbroker (as defined In 11 U.S.C. § 101(53A)) O Commodity Broker (as defined in 11 U.S.C. § 101(6)) O None of the above 13. Are you filing under If you are Gilng under Chapter 11, the court must Imow whether you are a small business debtor so that it can set appropriate Chapter 11 of the deadlines. If you indicate that you are a small business debtor, you must attach your most recent balance sheet, statement of Bankruptcy Code and are operations, cash-flow statement, and federal Income tax retum or if any of these documents do not exist. follow the procedure you a small business in 11 U.S.C. 1116(1)(B). debtor? g No i am not filing under Chapter 11. 6 For a definition of small O No. I am filing under Chapter 11, but I am NOT a small business debtor according to the definition in the Bankruptcy U C § 1 1 51D) Code. O Yes. 1am filing under Chapter 11 and I am a small business debtor according to the definition In the Bankruptcy Code. Report if You Own or Have Any Hazardous Property or Any Property That Needs Immediate Attention 14. Do you own or have any g No property that poses or is alleged to pose a threat O Yes. of imminent and What is the hazard? Identifiable hazard to public health or safety? Or do you own any property that needs If immediate attention Is Immediate attention? needed, why is it needed? For example, do you own perishable goods, or livestock that must be fed, Where is the property? or a building that needs urgent repairs? Number,Street,City, State& Zip Code Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 4 FILED: NASSAU COUNTY CLERK 06/27/2023 02:05 PM INDEX NO. 601610/2015 NYSCEF DOC. NO. 77Case 8-16-70141-ast Doc 1 Ried 01/13/16 Entered 01/13/16RECEIVED 11:03:12 NYSCEF: 06/27/2023 Debtor 1 Nelson Rojas Case number (irknown) Expiain Your Efforts to Receive a Briefing About Credit Counseling About Debtor 1: About Debtor 2 (Spouse Only in a Joint Case): 15. Tell the court whether You must check one: You must check one: you have received a g I received a briefing from an approved credit O I received a briefing from an approved credit briefing about credit counseling agency within the 180 days before I counseling agency within the 180 days before i filed counseling. filed this bankruptcy petition, and I received a this bankruptcy petition, and I received a certificate of The law requires that you . receive a briefing about Attach a copy of the certificate and the payment Attach a copy of the certificate and the payment plan, if credit counseling before plan, if any, that you developed with the agency. any, that you developed with the agency. you file for bankruptcy. You must truthfully check O I received a briefing from an approved credit O i received a briefing from an approved credit . . one of the following counseling agency within,the 8 I days before 1 . counseling agency within the '180 days before MilpA choices. If you cannot do filed this bankruptcy petition, but Edo not have this bankruptcy petition, but I do not have a certificate so, you are not eligible to a certificate of completion. of completion. file. Within 14 days after you file this bankruptcy Within 14 days after you file this bankruptcy petition, you If you file anyway, the court petition, you MUST file a copy of the certificate and MUST file a copy of the certificate and payment plan, if can dismiss your case, you payment plan, If any. any: will lose whatever filing fee you paid, and your O I certify that I asked for credit counseling O I certify that I asked for credit counseling services creditors can begin services from an approved agency, but was fmm an approved agency, but was unable to obtain collection activities again. unable to obtain those services during the 7 those services during the 7 days after I made my days after I made my request, and exigent request, and exigent circumstances merit a 30-day circumstances merit a 30-day temporary waiver temporary waiver of the requirement. of the requirement To ask for a 30-day temporary waiver of the requirement, To ask for a 30-day temporary waiver of the attach a separate sheet explaining what efforts you made requirement, attach a separate sheet explaining to obtain the briefing, why you were unable to obtain it what efforts you made to obtain the briefing, why before you filed for bankruptcy, and what exigent you were unable to obtain it before you filed for circumstances required you to file this case. bankruptcy, and what exigent circumstances required you to file this case. Your case may be dismissed if the court is dissatisfied with your reasons for not receiving a briefing before you Your case may be dismissed if the court is filed for bankruptcy. dissatisfied with your reasons for not receiving a If the court is satisfied with your reasons, you must still briefing before you filed for bankruptcy. If the court is satisfied with your reasons, you must receive a briefing within 30 days after you file. You must still receive a briefing within 30 days after you file. file a certificate from the approved agency, along with a You must file a certificate from the approved copy of the payment plan you developed, if any. If you do agency, along with a copy of the payment plan you not do so, your case may be dismissed. developed, if any. If you do not do so, your case Any extension of the 30-day deadline is granted only for may be dismissed. cause and is limited to a maximum of 15 days. Any extension of the 30-day deadline is granted only for cause and is limited to a maximum of 15 days. O I am not required to receive a briefing about O I am not required to receive a briefing about credit credit counseling because of: counseling because of: O Incapacity. I have a mental illness or a O Incapacity. I have a mental illness or a mental mental deficiency that makes deficiency that makes me Incapable me incapable of realizing or of realizing or making rational making rational decisions decisions about finances. about finances. O Disability. My physical disability causes O Disability. My physical disability causes me to me to be unable to participate be unable to participate in a briefing in a briefing in person, by in person, by phone, or through the phone, or through the internet, even after I reasonably tried intemet, even after I to do 502 reasonably tried to do so. O Active duty. I am currently on active O Active duty. ILafn cunently on active military duty military duty in a military in a military combat zone. combat zone. If you believe you are not required to receive a If you believe you are not required to receive a briefing briefing about credit counseling, you must file a about credit counseling, you Inust file a motion for waiver motion for waiver of credit counseling with the of credit counseling with the court. court. Official Form 101 Page 5 Voluntary Petition for Individuals Filing for Bankruptcy FILED: NASSAU COUNTY CLERK 06/27/2023 02:05 PM INDEX NO. 601610/2015 NYSCEF DOC. NO. 77Case 8-16-70141-ast Doc 1 Filed 01/13/16 Entered 11:03:12 01/13/16 RECEIVED NYSCEF: 06/27/2023 Debtor 1 Nelson Rojas Case number (ifknown) Answer These Questions for Reporting Purposes 16. What kind of debts do 16a. Are your debts primarily consumer debts? Consumer debts are defined in 11 U.S.C. § 101(8) as "incurred by an you have? individual primarily for a personal, family, or household purpose." O No. Go to line 16b. Yes. Go to line 17. 16b. Are your debts primarily business debts? Business debts are debts that you incurred to obtain money for a business or investment or through the operation of the business or investment. O No. Go to line 16c. O Yep. Go to line 17. . ...: x 16c. State p type of debts you owe that are not consumer debts or business debts ,, 17. Are you filing under O No. I am not filing under Chapter 7. Go to line 18, Chapter 7? Do you estimate that g Yes I am filing under Chapter 7. Do you estimate that after any exempt property is excluded and administrative expenses after any exempt are paid that funds will be available to distribute to unsecured creditors? property is excluded and administrative expenses g No are paid that funds will be available for ¤ Yes distribution to unsecured creditors? 18. How many Creditors do g 1-49 O 1,000-5,000 O 25,001-50,000 you estimate that you O 50-99 O 5001-10,000 O 50,001-100,000 O 100-199 10,001-25,000 O More than100,000 O 200-999 19. How much do you O $0 - $50,000 O $1,000,001 - $10 million O $500,000,001 - $1 billion betima e our assets to $1,000,000,001 - $10 billion O $50,001 - $100,000 $10,000,001 - $50 million E $100,001 -$500,000 O $50,000,001 - $100 million O $10,000,000,001 - $50 billion O $500,001 - $1 million O $100,000,001 -$500 million O More than $50 billion _. 20. How much do you ¤ $0 - $50,000 O $1,000,001 - $10 million O $500,000,001 - $1 billion est mate your liabilitieS O $50,001 - $100,000 O $10,000,001 - $50 million O $1,000,000,001 - $10 billion E $100,001 - $500,000 O $50,000,001 - $100 million O $10,000,000,001 - $50 billion O $500,001 -$1 million O $100,000,001 - $500 million O More than $50 billion Mgn Below For you I have examined this petition, and I declare under penalty of perjury thatithe information provided is true and correct. If I have chosen to file under Chapter 7, I am aware that I may proceed, If ellglble, under Chapter 7, 11,12, or 13 of title 11, United States Code. i understand the relief available under each chapter, and I choose to proceed under Chapter 7. If no attorney represents me and I did not pay or agree to pay someone who Is not an attorney to help me fill out this document, I have obtained and read the notice required by 11 U.S.C. § 342(b). v no I request relief in accordance with the chapter of title 11, United States-Gode, specified In this petition. I understand maid a fa statement, ng property. or obtaining money or property by fraud in connection with a y - bankruptcy re In fines u ,000, or imprisonmentfor up to 20 years, or both. 18 U.S.C. §§ 152, 1341; 1519, :i · '' and 357 el ojas Signature of Debtor 2 ature of Debtor 1 Executed on Executed on MI b / Yv MM / DD / YYYY Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 6 FILED: NASSAU COUNTY CLERK 06/27/2023 02:05 PM INDEX NO. 601610/2015 NYSCEF DOC. NO. 77Case 8-16-70141-ast Doc 1 Filed 01/13/16 Entered 11:03:12 01/13/16 RECEIVED NYSCEF: 06/27/2023 Debtor 1 Nelson Rojas Case number tirknown) For you if you are fliIng this The law allows you, as an individual, to represent yourself in bankruptcy court, but you should understand that many bankruptcy without an people find it extremely difficult to represent themselves successfully. Because bankruptcy has long-term attomey financial and legal consequences, you are strongly urged to hire a qualified attorney, If you are represented by an To be successful, you must correctly file and handle your bankruptcy case. The rules are very technical, and a mistake or attorney, you do not need to inaction may affect your rights. For exarnple, your case may be dismissed because you did not file a required document, file this page, pay a fee on time, attend a meeting or hearing, or cooperate with the court, case trustee, U.S. trustee, bankruptcy administrator, or audit firm if your case is selected for audit. If that happens, you could lose your right to file another case, or you may lose protections, including the benefit of the automatic stay. You must Ilst all your property and debts in the schedules that you are required to file with the court. Even if you plan to pay ,, a particular debt outside of your bankruptcy, you must list that debt in your schedules. If you do not list a debt, the debt may not be discharged. If you do not list property or properly claim it as exempt, youimay not be able to keep the property. The judge can also deny you a discharge of all your debts if you do something dishonest In your bankruptcy case, such as destroying or hiding property, falsifying records, or lying. Individual bankruptcy cases are randomly audited to determine if debtors have been accurate, truthful, and complete. Bankruptcy fraud is a serious crime; you could be fined and Imprisoned. If you decide to file without an attorney, the court expects you to follow the rules as if you had hired an attorney. The court will not treat you differently because you are fHing for yourself. To be successful, you must be familiar with the United States Bankruptcy Code, the Federal Rules of Bankruptcy Procedure, and the local rules of the court in which your case is filed. You must also be familiar with any state exemption laws that apply. Are you aware that filing for bankruptcy is a serious action with long-term financial and legal consequences? O No E Yes Are you aware that bankruptcy fraud is a serious crime and that If your bankruptcy forms are inaccurate or incomplete, you could be fined or imprisoned? O No .. E Yes Did you pay or agree to pay someone who is not an attomey to help you fill out your bankruptcy forms? No O yes Name of Person Attach Bankruptcy Petition Preparers Notice, Declaration, and Signature (Official Form 119). By signing here, I acknowledge that I understand the risks involved in fliing without an attorney. I have read and understood this notice, and I am that filing bankruptcy case without an attomey may cause me to lose my rights or property if I do , not prope case. N as Signature of Debtor 2 ure of Debtor 1 Date P Date . .. MM / DD / Y MM / DD / YYYY Contact phone Contact phone Cell phone Cell phone Email address Email address Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 8 FILED: NASSAU COUNTY CLERK 06/27/2023 02:05 PM INDEX NO. 601610/2015 NYSCEF DOC. NO. 77Case 8-16-70141-ast Doc 1 Filed 01/13/16 Entered 11:U3:12 01/13/1b RECEIVED NYSCEF: 06/27/2023 Debtor 1 Nelson Rojas " Fht Name MkMeName LastName Debtor 2 (Spouse if,filing) FirstName MddleName LastName United States Bankruptcy Court for the: EASTERN DISTRICT OF NEW YORK Case number (m=0 O Check if this is an amended filing ficial Form..106Sum of Your Assets and Liabilities and Certain Statistical Information 12/15 Summary Be as complete and accurate as possible. If two married people are filing together, both are equally responsible for supplying correct information. FIII out all of your schedules first; then complete the information on this form. If you are fillng amended schedules after you file your original forms, you must fill out a new Summary and check the box at the top of this page. Summarize Your Assets V$1E oNhat you o 1. Schedule AIB: Property (Official Form 106AIB) 1a. Copy line 55, Total real estate. from Schedule A/B................................................................................................ $ 350,000.00 1b. Copy Ilne 62, Total personal property, from Schedule A/B..................................................................................... $ 16,439.33 1c. Copy line 63, Total of all property on Schedule A/B............................................................................................... S 366,439.33 , Summarize Your Liabilities ur iialilllties Ginount ye owet 2. Schedule D: Creditors Who Have Claims Secured by Property (Official Form 106D) 2a. Copy the total you listed in Column A, Amount of claim, at the bottom of the last page of Part 1 of Schedule D... 3. Schedule F4F: Creditors Who Have Unsecured Claims (Official Form 106E/F) 0.00 3a. Copy the tocal claims from Part 1 (priority unsecured claims) from line 6e of Schedule E/F................................. 3b. Copy the total claims from Part 2 (nonpriority unsecured claims) from line 6j of Schedule FJF............................ $ 41,876.00 Your total Ilabilities S 275,495.00 Summarize YourIncome and Expenses ___,__ . 4. Schedule I: Your Inmme (Official Form 1061) Copy your combined monthly Incorne from line 12 of Schedule l................................................................--.............. 5. Schedule J: Your Expenses (Official Form 106J) $ 6,853.50 Copy your monthly expenses from line 22c of Schedule J...........--............................................................. Answer These Questions for Administrative and Statistical Records . 6. Are you filing for bankruptcy under Chapters 7, 11, or 13? No. You liave nothing to report ori this part3f,the form. Check this box and submit this form to the courtwith your other schedules. E Yes 7. What kind of debt do you have? g Your debts are primarily consumer debts. Consumer debts are those "Incurred by an Individual primarily for a personal, family, or purpose." household 11 U.S.C. § 101(8). Fill out lines 8-99 for statistical purposes. 28 U.S.C. § 159. Your debts are not primarily consumer debts. You have nothing to report on this part of the form. Check this box and submit this form to the court with your other schedules. page 1 of 2 Official Form 106Sum Summary of Your Assets and Liabilities and Certain Statistical Information Software BestCase,LLc - www.bestcase.com (c)1996-2015 Copyright BestCaseBankmptcy FILED: NASSAU COUNTY CLERK 06/27/2023 02:05 PM INDEX NO. 601610/2015 NYSCEF DOC. NO. 77Case 8-16-70141-ast Doc 1 Filed 01/13/16