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ole ZoIz~ CA = 203066
BI (Official Form 1) (04/13)
UNITED STATES BANKRUPTCY COURT
VOLUNTARY PETITION
Name of Debtor (if individ snter Last, First, Mic le): ‘Name of Joint Debtor (Spouse) (Last, First, Middle):
2 o
All Other Names used by the Debtor in the last 8 years ‘All Other Names used by the Joint Debtor in the last 8 years
(include married, maiden, and trade names): (include married, maiden, and trade names):
Vernelle D, Jones
Last four digits of Soc. Sec. or Individual-Taxpayer I.D. ([TINYComplete EIN Last four digits of Soc. Sec. or Individual- Taxpayer LD. (ITINY/Complete EIN
(if more than one, state all): or73 (if more than one, state all):
‘Street Address of Debtor (No. and Street, City, and State): ‘Street Address of Joint Debtor (No. and Street, City, and State):
1515 se [sth Ave ze CODE
‘County of Residence or of the Principal Place of Business:
fipcove
‘County of Residence or of the Principal Place of Business:
lachuc 3264/
Mailing Address of Debtor (if different from street address): Mailing Address of Joint Debtor (ifdifferent from street address):
-
Eipcope
Location of Principal Assets of Business Debtor (ifdifferent from street address above):
pico i ll
/ a P CODE
Type of Debtor Nature of Business Chapter of Bankruptcy Code Under Which
(Form of Organization) (Check one box.) the Petition is Filed (Check one box.)
(Check one box.) Chapter 7 1 Chapter 15 Petition for
Health Care Business
En idual (includes Joint Debtors) Single Asset Real Estate as defined in o Chapter 9 Recognition of a Foreign
See Exhibit D on page 2 of this form. 11 USC. § 101(51B) Chapter 11 Main Proceeding
Chapter 12
a oO Chapter 15 Petition for
Qo Corporation (includes LLC and LLP) Railroad
Chapter 13 Recognition of a Foreign
ag Partnership Stockbroker
Nonmain Proceeding
o Other (If debtor is not one of the above entities, check Commodity
Clearing Bank
Broker
this box and state type of entity below.)
Other
Chapter 15 Debtors Tax-Exempt Entity Nature of Debts
(Check box, if applicable.) (Check one box.)
Country of debtor's center of main interests: bts are primarily consumer O Debts are
Debtor is a tax-exempt organization debts, defined in 11 U.S.C. primarily
Each country in which a foreign proceeding by, regarding, or under title 26 of the United States § 101(8) as “incurred by an business debts.
against debtor is pending: Code (the Internal Revenue Code). individual primarily for a
personal, family, or
household purpose.”
Filing Fee (Check one box.) ‘Chapter 11 Debtors
Check one box:
rut Filing Fee attached. oO Debtor is a small business debtoras defined in 11in U.S.C. § 101(51D).
§ 101(51D).
a Debtor is not a small business as
debtor defined 11 U.S.C.
o Filing Fee to be paid in installments (applicable to individuals only). Must attach
signed application for the court’s consideration certifying that the debtor is, ‘Check if
owed to
unable to pay fee except in installments. Rule 1006(b). See Official Form 3A. oO Debtor's aggregate noncontingent liquidated debts (excluding debts
insiders or affiliates) are less than $2,490,925 (amount subject to adjustment
o Filing Fee waiver requested (applicable to chapter 7 individuals only), Must on 4/01/16 and every three years thereafter).
See Official Form 3B.
wee -
attach signed application for the court’s consideration.
Check all applicable boxes:
0 Aplan is being filed with this petition.
o Acceptances of the plan were solicited prepetition from one or more classes
of creditors, in accordance with 11 U.S.C_§ 1126(b).
‘THIS SPACE IS FOR
Statistical/Administrative Information ‘COURT USE ONLY
x Debtor estimates that funds will be available for distribution to unsecured creditors.
Debtor estimates that, after any exempt property is excluded and administrative expenses paid, there will be no funds available for >
distribution to unsecured creditors.
DH
a ‘Number of Creditors
a QO a oO a
1,000- 5,001- 10,001- 25,001- 50,001- Ove on+
1-49 50-99 100-199 200-999
5,000 10,000 25,000 50,000 100,000 100,000; x fr
Estimated Assets. St
at
$0to $50,001 to $100,001 to $500,001 $1,000,001 $10,000,001 $50,000,001 $100,000,001 $500,000,001
$1 SDR =
2 Y
$50,000 $100,000 $500,000 to$1 to $10 to $50 to $100 to $500
million
to $1 billion
million million million million
Estimated Liabilities
Q oO
$0 to $50,001 to $100,001 to $500,001 $1,000,001 $10,000,001 $50,000,001 $100,000,001 $500,000,001 More than
to $1 billion $1 billion
$50,000 $100,000 $500,000 to $1 to $10 to $50 to $100
million
to $500
million
million million million
Bl(Official Form 1) (04/13) Page 2
Voluntary Petition ‘Name of Debtor(s)
(This page must he completed and filed in every case.)
All Prior Bankruptcy C: es Filed W Last 8 Years (i more than two. attach additional sheet.)
Location C © Number, Date Filed:
Where Filed
Location ‘Case Number Date Filed
Where Filed
Pending Bankruptcy Case Filed by any Spouse, Partner, or Affiliate of this Debtor (If more than one, attach additional sheet.)
Name oF Debtor ‘Case Number: Date Filed
Relationship Judge
:
bb
Exhibit A Exhibit B
(To be completed if debtor is required to file periodic reports (ex., forms 10K and (To be completed if debtor is an individual
100) with the Securities and Exchange Comn jon pursuant to Section 13 or 15(4) whose debis are primarily consumer debts.)
Of the Securities xchange Act of 1934 and is requesting relief under chapter 11.)
1. the attomey for the petitioner named in the foregoing petition, declare that | have
informed the petitioner that [he or she] may proceed under ter 7. 1. 12,or 13
of title 11. United States Code, and have explained the relief available under each
‘ such chapter. | further certify that [ have delivered to the debtdr the notice required
by HL US.C. § 342(b)
o Exhibit A is attached and made a part of this petition
x
Signature of Attomey for Debtor(s) (Date)
Exhibit C
Does the debtor own or have possession of any property that poses or is all -d to pose a threat of imminent and identifiable harm to public health or salety?
a Yes. and Exhibit C is attached and made a part of this petition.
W ro
Exhibit D
(To be completed by ever individual debtor. It'a joint petition is filed. each spouse must complete and attach a separate Exhibit D.)
wv ibit 1D, completed und signed by the debtor, is attached and made a part of this petition.
If this is a joint petition:
‘Oo Exhibit D. also completed and signed by the joint debtor. is attached and made a part of this petition,
Information Regarding the Debtor - Venue
(Check any applicable box.)
Debtor has been domiciled or has had a residence, principal place of busines or principal assets in this District for 180 days immediately
preceding the date of this petition or for a longer part of such 180 days than in any other District
‘There is a bankruptcy case concerning debtor's affiliate, general partner, or partnership pending in this District
Debtor is a debtor in a foreign proceeding and hi its principal place of business or principal as ets in the United States in this District, or has
no principal place of business or asse in the United ates but a del endant in an action or proceeding {in a federal or state count in this
Dist oF the interests of the partic ill be served in regard to the relie! wught in this District
Certification by a Debtor Who Resides as a Tenant of R lential Property
(Check all applicable boxes.)
Landlord has a judgment against the debtor for possession of debtor's residence. (1f"box checked, complete the following.)
(Name of landlord that obtained judgment)
(Address of landlord)
Debtor claims that under applicable nonbankruptcy law. there are circumstances under which the debtor would be permitted to cure the
entire monetary default that gave rise to the judgment for pos: ion. after the judgment for possession was entered, and
Debtor has included with this petition the deposit with the court of any rent that would become due during the 30-day period afier the filing
of the petition.
Debtor certifies that he/she has served the Landlord with this centification, (11 U.S.C. § 362(1)),
BE (Ollicial Form 1) (04/13) Page 3
‘Voluntary Petition Name of Debtor(s):
Sins page must be completed and filed in every case.)
Signatures
Signature(s) of Debtor(s) (Individual/Joint) Signature of a For ign Representative
Bacelare under penalty of per) ry that the information provided in this petition is tue | declare under penalty of perjury that the information provided in this petition is true
and correct. and correct, that | am the forcign representative of a debtor in a foreign proceeding,
{If petitioner is an individual whose debis are primarily consumer debts and has and that | am authorized to file this petition.
chosen to file under chapter 7] 1 am aware that | may proceed under chapter 7. 11, 12
Of 13 of title 11, United States Code. understand the relief available under each ich (Check only one box.)
chapter, and choose to proceed under chapter 7. [request reliefin accordance with chapter 15 of title 11, United States Code.
{If no attorney represents me and no bankruptey petition preparer signs the petition] 1 Certified copies of the documents required by I! U.S.C. § 1515 are attached
Have obtained and read the notice required by 11 U.S.C. § 342(b)
(2 Pursuant to 11 U.S.C. § E511, | request relief in accordance with the
Frrequest relief in accordance with the chapter of title 11. United States Code, chapter of title 11 specified in this petition, A certified copy of the
SBecifed in this petition. order granting recognition of the foreign main proceeding is attached
Signature of Debtor (Signature of Foreign Representative)
Signature of Joint Debtor (Printed Name of Foreign Representative)
‘Telephone Number (if not represented by attorney)
- T1- Date
Date
Signature of Attorney™ ‘Signature of Non-Attorney Bankruptcy Petition Preparer
1 declare under penalty of perjury that: (1)1 am a bankruptey petition preparer as
Signature of Attorney for Debtor(s) defined in 11 U.S.C. § 110: (2)1 prepared this document for empensation and have
provided the deblor with a copy of this document and the notices and information
Printed Name of Attorney for Debtors) required under 1] USC. $$ 110(b). 110(h), and 342(b), and, (3)if rules or
guidelines have been promulgated pursuant to 11 U.S.C. § 110(h) setting a maximum
Firm Name f for services chargeable by bankruptcy petition preparers. | have given the debtor
notice of the maximum amount belore preparing any document tor filing for a debtor
or accepting any tee from the debtor, as required in that section, Official Form 19 is
attached,
Address:
Telephone Numbe Printed Name and title, if any, of Bankruptcy Petition Preparer
Date
cial-Security number
(If the bankruptey petition preparer is not an individual,
{na case in which § 707(b\4XD) applies. this signature also constitutes a te the Social-Security number of the officer. principal, responsible person or
Certification that the attorney has no knowledge after an inquiry that the intormation partner of the bankruptcy petition preparer.) (Required by 1 U.S.C, § 110.)
in the schedules is incorrect
i
Signature of Debtor (Corporation/Partnership)
Léeclare under penalty of perju that the formation provided in this petition true Address
and correct, and that | have been authorized t file this petition on behalf of the
debtor
“The debtor requests the reli in accordance with the chapter of title 11, United States Signature
Code. specified in this petition
x
. Date
Signature of Authorized Individual
¥ Signature of bankruptcy petition preparer or officer, principal. responsible person, or
Printed Name of Authorized Individual partner whose Social -curity number is provided above.
Vitle of Authorized individual Names and Social-Security numbers of all other individuals who prepared or assisted
Date in preparing this document unless the bankruptcy petition preparer is not an
individual
If more than one person prepared this document. attach additional sheets conforming
to the appropriate official form for each person
a A bankruprey petition preparer’s failure to comply with the provisions of title 1 and
the Federal Rul es of Bankruptcy Procedure may result in fines or imprisonment or
both 11 U. 110; IS USC. § 156.
Certificate Number: 15725-FLN-CC-024209700
HN 0 40
CERTIFICATE OF COUNSELING
I CERTIFY that on September 19, 2014, at 10:43 o'clock AM EDT, Vernelle
Jones received from 001 Debtorcc, Inc., an agency approved pursuant to 11
U.S.C. § 111 to provide credit counseling in the Northern District of Florida, an
individual [or group] briefing that complied with the provisions of 11 U.S.C. §§
109(h) and 111.
A debt repayment plan was not prepared. If a debt repayment plan was prepared, a
copy of the debt repayment plan is attached to this certificate.
This counseling session was conducted by internet.
Date: September 19, 2014 By: /sfLandes Thomas
Name: Landes Thomas
Title: Counselor
* Individuals who wish to file a bankruptcy case under title 11 of the United States Bankruptcy
Code are required to file with the United States Bankruptcy Court a completed certificate of
counseling from the nonprofit budget and credit counseling agency that provided the individual
the counseling services and a copy of the debt repayment plan, if any, developed through the
credit counseling agency. See 11 U.S.C. §§ 109(h) and 521(b).
Preview
> ole ZoIz~ CA = 203066 BI (Official Form 1) (04/13) UNITED STATES BANKRUPTCY COURT VOLUNTARY PETITION Name of Debtor (if individ snter Last, First, Mic le): ‘Name of Joint Debtor (Spouse) (Last, First, Middle): 2 o All Other Names used by the Debtor in the last 8 years ‘All Other Names used by the Joint Debtor in the last 8 years (include married, maiden, and trade names): (include married, maiden, and trade names): Vernelle D, Jones Last four digits of Soc. Sec. or Individual-Taxpayer I.D. ([TINYComplete EIN Last four digits of Soc. Sec. or Individual- Taxpayer LD. (ITINY/Complete EIN (if more than one, state all): or73 (if more than one, state all): ‘Street Address of Debtor (No. and Street, City, and State): ‘Street Address of Joint Debtor (No. and Street, City, and State): 1515 se [sth Ave ze CODE ‘County of Residence or of the Principal Place of Business: fipcove ‘County of Residence or of the Principal Place of Business: lachuc 3264/ Mailing Address of Debtor (if different from street address): Mailing Address of Joint Debtor (ifdifferent from street address): - Eipcope Location of Principal Assets of Business Debtor (ifdifferent from street address above): pico i ll / a P CODE Type of Debtor Nature of Business Chapter of Bankruptcy Code Under Which (Form of Organization) (Check one box.) the Petition is Filed (Check one box.) (Check one box.) Chapter 7 1 Chapter 15 Petition for Health Care Business En idual (includes Joint Debtors) Single Asset Real Estate as defined in o Chapter 9 Recognition of a Foreign See Exhibit D on page 2 of this form. 11 USC. § 101(51B) Chapter 11 Main Proceeding Chapter 12 a oO Chapter 15 Petition for Qo Corporation (includes LLC and LLP) Railroad Chapter 13 Recognition of a Foreign ag Partnership Stockbroker Nonmain Proceeding o Other (If debtor is not one of the above entities, check Commodity Clearing Bank Broker this box and state type of entity below.) Other Chapter 15 Debtors Tax-Exempt Entity Nature of Debts (Check box, if applicable.) (Check one box.) Country of debtor's center of main interests: bts are primarily consumer O Debts are Debtor is a tax-exempt organization debts, defined in 11 U.S.C. primarily Each country in which a foreign proceeding by, regarding, or under title 26 of the United States § 101(8) as “incurred by an business debts. against debtor is pending: Code (the Internal Revenue Code). individual primarily for a personal, family, or household purpose.” Filing Fee (Check one box.) ‘Chapter 11 Debtors Check one box: rut Filing Fee attached. oO Debtor is a small business debtoras defined in 11in U.S.C. § 101(51D). § 101(51D). a Debtor is not a small business as debtor defined 11 U.S.C. o Filing Fee to be paid in installments (applicable to individuals only). Must attach signed application for the court’s consideration certifying that the debtor is, ‘Check if owed to unable to pay fee except in installments. Rule 1006(b). See Official Form 3A. oO Debtor's aggregate noncontingent liquidated debts (excluding debts insiders or affiliates) are less than $2,490,925 (amount subject to adjustment o Filing Fee waiver requested (applicable to chapter 7 individuals only), Must on 4/01/16 and every three years thereafter). See Official Form 3B. wee - attach signed application for the court’s consideration. Check all applicable boxes: 0 Aplan is being filed with this petition. o Acceptances of the plan were solicited prepetition from one or more classes of creditors, in accordance with 11 U.S.C_§ 1126(b). ‘THIS SPACE IS FOR Statistical/Administrative Information ‘COURT USE ONLY x Debtor estimates that funds will be available for distribution to unsecured creditors. Debtor estimates that, after any exempt property is excluded and administrative expenses paid, there will be no funds available for > distribution to unsecured creditors. DH a ‘Number of Creditors a QO a oO a 1,000- 5,001- 10,001- 25,001- 50,001- Ove on+ 1-49 50-99 100-199 200-999 5,000 10,000 25,000 50,000 100,000 100,000; x fr Estimated Assets. St at $0to $50,001 to $100,001 to $500,001 $1,000,001 $10,000,001 $50,000,001 $100,000,001 $500,000,001 $1 SDR = 2 Y $50,000 $100,000 $500,000 to$1 to $10 to $50 to $100 to $500 million to $1 billion million million million million Estimated Liabilities Q oO $0 to $50,001 to $100,001 to $500,001 $1,000,001 $10,000,001 $50,000,001 $100,000,001 $500,000,001 More than to $1 billion $1 billion $50,000 $100,000 $500,000 to $1 to $10 to $50 to $100 million to $500 million million million million Bl(Official Form 1) (04/13) Page 2 Voluntary Petition ‘Name of Debtor(s) (This page must he completed and filed in every case.) All Prior Bankruptcy C: es Filed W Last 8 Years (i more than two. attach additional sheet.) Location C © Number, Date Filed: Where Filed Location ‘Case Number Date Filed Where Filed Pending Bankruptcy Case Filed by any Spouse, Partner, or Affiliate of this Debtor (If more than one, attach additional sheet.) Name oF Debtor ‘Case Number: Date Filed Relationship Judge : bb Exhibit A Exhibit B (To be completed if debtor is required to file periodic reports (ex., forms 10K and (To be completed if debtor is an individual 100) with the Securities and Exchange Comn jon pursuant to Section 13 or 15(4) whose debis are primarily consumer debts.) Of the Securities xchange Act of 1934 and is requesting relief under chapter 11.) 1. the attomey for the petitioner named in the foregoing petition, declare that | have informed the petitioner that [he or she] may proceed under ter 7. 1. 12,or 13 of title 11. United States Code, and have explained the relief available under each ‘ such chapter. | further certify that [ have delivered to the debtdr the notice required by HL US.C. § 342(b) o Exhibit A is attached and made a part of this petition x Signature of Attomey for Debtor(s) (Date) Exhibit C Does the debtor own or have possession of any property that poses or is all -d to pose a threat of imminent and identifiable harm to public health or salety? a Yes. and Exhibit C is attached and made a part of this petition. W ro Exhibit D (To be completed by ever individual debtor. It'a joint petition is filed. each spouse must complete and attach a separate Exhibit D.) wv ibit 1D, completed und signed by the debtor, is attached and made a part of this petition. If this is a joint petition: ‘Oo Exhibit D. also completed and signed by the joint debtor. is attached and made a part of this petition, Information Regarding the Debtor - Venue (Check any applicable box.) Debtor has been domiciled or has had a residence, principal place of busines or principal assets in this District for 180 days immediately preceding the date of this petition or for a longer part of such 180 days than in any other District ‘There is a bankruptcy case concerning debtor's affiliate, general partner, or partnership pending in this District Debtor is a debtor in a foreign proceeding and hi its principal place of business or principal as ets in the United States in this District, or has no principal place of business or asse in the United ates but a del endant in an action or proceeding {in a federal or state count in this Dist oF the interests of the partic ill be served in regard to the relie! wught in this District Certification by a Debtor Who Resides as a Tenant of R lential Property (Check all applicable boxes.) Landlord has a judgment against the debtor for possession of debtor's residence. (1f"box checked, complete the following.) (Name of landlord that obtained judgment) (Address of landlord) Debtor claims that under applicable nonbankruptcy law. there are circumstances under which the debtor would be permitted to cure the entire monetary default that gave rise to the judgment for pos: ion. after the judgment for possession was entered, and Debtor has included with this petition the deposit with the court of any rent that would become due during the 30-day period afier the filing of the petition. Debtor certifies that he/she has served the Landlord with this centification, (11 U.S.C. § 362(1)), BE (Ollicial Form 1) (04/13) Page 3 ‘Voluntary Petition Name of Debtor(s): Sins page must be completed and filed in every case.) Signatures Signature(s) of Debtor(s) (Individual/Joint) Signature of a For ign Representative Bacelare under penalty of per) ry that the information provided in this petition is tue | declare under penalty of perjury that the information provided in this petition is true and correct. and correct, that | am the forcign representative of a debtor in a foreign proceeding, {If petitioner is an individual whose debis are primarily consumer debts and has and that | am authorized to file this petition. chosen to file under chapter 7] 1 am aware that | may proceed under chapter 7. 11, 12 Of 13 of title 11, United States Code. understand the relief available under each ich (Check only one box.) chapter, and choose to proceed under chapter 7. [request reliefin accordance with chapter 15 of title 11, United States Code. {If no attorney represents me and no bankruptey petition preparer signs the petition] 1 Certified copies of the documents required by I! U.S.C. § 1515 are attached Have obtained and read the notice required by 11 U.S.C. § 342(b) (2 Pursuant to 11 U.S.C. § E511, | request relief in accordance with the Frrequest relief in accordance with the chapter of title 11. United States Code, chapter of title 11 specified in this petition, A certified copy of the SBecifed in this petition. order granting recognition of the foreign main proceeding is attached Signature of Debtor (Signature of Foreign Representative) Signature of Joint Debtor (Printed Name of Foreign Representative) ‘Telephone Number (if not represented by attorney) - T1- Date Date Signature of Attorney™ ‘Signature of Non-Attorney Bankruptcy Petition Preparer 1 declare under penalty of perjury that: (1)1 am a bankruptey petition preparer as Signature of Attorney for Debtor(s) defined in 11 U.S.C. § 110: (2)1 prepared this document for empensation and have provided the deblor with a copy of this document and the notices and information Printed Name of Attorney for Debtors) required under 1] USC. $$ 110(b). 110(h), and 342(b), and, (3)if rules or guidelines have been promulgated pursuant to 11 U.S.C. § 110(h) setting a maximum Firm Name f for services chargeable by bankruptcy petition preparers. | have given the debtor notice of the maximum amount belore preparing any document tor filing for a debtor or accepting any tee from the debtor, as required in that section, Official Form 19 is attached, Address: Telephone Numbe Printed Name and title, if any, of Bankruptcy Petition Preparer Date cial-Security number (If the bankruptey petition preparer is not an individual, {na case in which § 707(b\4XD) applies. this signature also constitutes a te the Social-Security number of the officer. principal, responsible person or Certification that the attorney has no knowledge after an inquiry that the intormation partner of the bankruptcy petition preparer.) (Required by 1 U.S.C, § 110.) in the schedules is incorrect i Signature of Debtor (Corporation/Partnership) Léeclare under penalty of perju that the formation provided in this petition true Address and correct, and that | have been authorized t file this petition on behalf of the debtor “The debtor requests the reli in accordance with the chapter of title 11, United States Signature Code. specified in this petition x . Date Signature of Authorized Individual ¥ Signature of bankruptcy petition preparer or officer, principal. responsible person, or Printed Name of Authorized Individual partner whose Social -curity number is provided above. Vitle of Authorized individual Names and Social-Security numbers of all other individuals who prepared or assisted Date in preparing this document unless the bankruptcy petition preparer is not an individual If more than one person prepared this document. attach additional sheets conforming to the appropriate official form for each person a A bankruprey petition preparer’s failure to comply with the provisions of title 1 and the Federal Rul es of Bankruptcy Procedure may result in fines or imprisonment or both 11 U. 110; IS USC. § 156. Certificate Number: 15725-FLN-CC-024209700 HN 0 40 CERTIFICATE OF COUNSELING I CERTIFY that on September 19, 2014, at 10:43 o'clock AM EDT, Vernelle Jones received from 001 Debtorcc, Inc., an agency approved pursuant to 11 U.S.C. § 111 to provide credit counseling in the Northern District of Florida, an individual [or group] briefing that complied with the provisions of 11 U.S.C. §§ 109(h) and 111. A debt repayment plan was not prepared. If a debt repayment plan was prepared, a copy of the debt repayment plan is attached to this certificate. This counseling session was conducted by internet. Date: September 19, 2014 By: /sfLandes Thomas Name: Landes Thomas Title: Counselor * Individuals who wish to file a bankruptcy case under title 11 of the United States Bankruptcy Code are required to file with the United States Bankruptcy Court a completed certificate of counseling from the nonprofit budget and credit counseling agency that provided the individual the counseling services and a copy of the debt repayment plan, if any, developed through the credit counseling agency. See 11 U.S.C. §§ 109(h) and 521(b).