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STATEMENT OF RELATED CASESINFORMATION REQUIRED BY LOCAL BANKRUPTCY RULE 1015-2
UNITED STATES BANKRUPTCY COURT, CENTRAL DISTRICT OF CALIFORNIA
1. A petition under the Bankruptcy Act of 1898 or the Bankruptcy Reform Act of 1978 has previously been filed by oagainst the debtor, his/her spouse, his or her current or former domestic partner, an affiliate of the debtor, anycopartnership or joint venture of which debtor is or formerly was a general or limited partner, or member, or any
corporation of which the debtor is a director, officer, or person in control, as follows: (Set forth the complete numberand title of each such of prior proceeding, date filed, nature thereof, the Bankruptcy Judge and court to whomassigned, whether still pending and, if not, the disposition thereof. If none, so indicate. Also, list any real propertyincluded in Schedule A that was filed with any such prior proceeding(s).)
None.
2. (If petitioner is a partnership or joint venture) A petition under the Bankruptcy Act of 1898 or the Bankruptcy ReformAct of 1978 has previously been filed by or against the debtor or an affiliate of the debtor, or a general partner in thedebtor, a relative of the general partner, general partner of, or person in control of the debtor, partnership in which thedebtor is a general partner, general partner of the debtor, or person in control of the debtor as follows: (Set forth thecomplete number and title of each such prior proceeding, date filed, nature of the proceeding, the Bankruptcy Judgeand court to whom assigned, whether still pending and, if not, the disposition thereof. If none, so indicate. Also, lisany real property included in Schedule A that was filed with any such prior proceeding(s).)
None.
3. (If petitioner is a corporation) A petition under the Bankruptcy Act of 1898 or the Bankruptcy Reform Act of 1978 haspreviously been filed by or against the debtor, or any of its affiliates or subsidiaries, a director of the debtor, an officerof the debtor, a person in control of the debtor, a partnership in which the debtor is general partner, a general partnerof the debtor, a relative of the general partner, director, officer, or person in control of the debtor, or any persons, firmsor corporations owning 20% or more of its voting stock as follows: (Set forth the complete number and title of eachsuch prior proceeding, date filed, nature of proceeding, the Bankruptcy Judge and court to whom assigned, whetherstill pending, and if not, the disposition thereof. If none, so indicate. Also, list any real property included in Schedule Athat was filed with any such prior proceeding(s).)
None.
4. (If petitioner is an individual) A petition under the Bankruptcy Reform Act of 1978, including amendments thereof, hasbeen filed by or against the debtor within the last 180 days: (Set forth the complete number and title of each such prio
proceeding, date filed, nature of proceeding, the Bankruptcy Judge and court to whom assigned, whether still pendingand if not, the disposition thereof. If none, so indicate. Also, list any real property included in Schedule A that was filedwith any such prior proceeding(s).)
None.
I declare, under penalty of perjury, that the foregoing is true and correct.
Executed at , California. /s/ William BuseyWilliam Busey
Dated February 15, 2012 Debtor
Joint Debtor
This form is mandatory by Order of the United States Bankruptcy Court for the Central District of California.
January 2009 F 1015-2.1
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B201 - Notice of Available Chapters (Rev. 11/11) USBC, Central District of California
Name: Michael Jay Berger 100291
Address: 9454 Wilshire Boulevard6th FloorBeverly Hills, CA 90212-2929
Telephone: (310) 271-6223 Fax: (310) 271-9805
Attorney for Debtor Debtor in Pro Per
UNITED STATES BANKRUPTCY COURTCENTRAL DISTRICT OF CALIFORNIA
List all names including trade names, used by Debtor(s)within last 8 years:
Case No.: 1:12-bk-11182
William Busey
NOTICE OF AVAILABLECHAPTERS
(Notice to Individual Consumer Debtor Under 342(b) of the Bankruptcy Code)
In accordance with 342(b) of the Bankruptcy Code, this notice to individuals with primarily consumer debts: (1) Describes brieflythe services available from credit counseling services; (2) Describes briefly the purposes, benefits and costs of the four types ofbankruptcy proceedings you may commence; and (3) Informs you about bankruptcy crimes and notifies you that the Attorney Generalmay examine all information you supply in connection with a bankruptcy case.
You are cautioned that bankruptcy law is complicated and not easily described. Thus, you may wish to seek the advice of an attorneyto learn of your rights and responsibilities should you decide to file a petition. Court employees cannot give you legal advice.
Notices from the bankruptcy court are sent to the mailing address you list on your bankruptcy petition. In order to ensure that youreceive information about events concerning your case, Bankruptcy Rule 4002 requires that you notify the court of any changes in youraddress. If you are filing a joint case (a single bankruptcy case for two individuals married to each other), and each spouse lists thesame mailing address on the bankruptcy petition, you and your spouse will generally receive a single copy of each notice mailed fromthe bankruptcy court in a jointly-addressed envelope, unless you file a statement with the court requesting that each spouse receive aseparate copy of all notices.
1. Services Available from Credit Counseling Agencies
With limited exceptions, 109(h) of the Bankruptcy Code requires that all individual debtors who file for bankruptcyrelief on or after October 17, 2005, receive a briefing that outlines the available opportunities for credit counselingand provides assistance in performing a budget analysis. The briefing must be given within 180 days before thebankruptcy filing. The briefing may be provided individually or in a group (including briefings conducted by telephone or onthe Internet) and must be provided by a nonprofit budget and credit counseling agency approved by the United States trusteeor bankruptcy administrator. The clerk of the bankruptcy court has a list that you may consult of the approved budget andcredit counseling agencies. Each debtor in a joint case must complete the briefing.
In addition, after filing a bankruptcy case, an individual debtor generally must complete a financial managementinstructional course before he or she can receive a discharge. The clerk also has a list of approved financial managemeninstructional courses. Each debtor in a joint case must complete the course.
2. The Four Chapters of the Bankruptcy Code Available to Individual Consumer Debtors
Chapter 7: Liquidation ($245 filing fee, $46 administrative fee, $15 trustee surcharge: Total Fee $306)
1. Chapter 7 is designed for debtors in financial difficulty who do not have the ability to pay their existing debts. Debtorswhose debts are primarily consumer debts are subject to a "means test" designed to determine whether the case should bepermitted to proceed under chapter 7. If your income is greater than the median income for your state of residence andfamily size, in some cases, creditors have the right to file a motion requesting that the court dismiss your case under 707(b) of the Code. It is up to the court to decide whether the case should be dismissed.
2. Under chapter 7, you may claim certain of your property as exempt under governing law. A trustee may have the right totake possession of and sell the remaining property that is not exempt and use the sale proceeds to pay your creditors.
3. The purpose of filing a chapter 7 case is to obtain a discharge of your existing debts. If, however, you are found to havecommitted certain kinds of improper conduct described in the Bankruptcy Code, the court may deny your discharge and,if it does, the purpose for which you filed the bankruptcy petition will be defeated.
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}bk1{Form6.SummaryofSchedules}bk{
United States Bankruptcy CourtCentral District of California
In re,
Debtor
Case No.
Chapter
1:12-bk-11182
7
William Busey
B6 Summary (Official Form 6 - Summary) (12/07)
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 debtors assets.Add the amounts of all claims from Schedules D, E, and F to determine the total amount of the debtors liabilities. Individual debtors mustalso complete the "Statistical Summary of Certain Liabilities and Related Data" if they file a case under chapter 7, 11, or 13.
SUMMARY OF SCHEDULES
ATTACHED NO. OFNAME OF SCHEDULE ASSETS LIABILITIES OTHER(YES/NO) SHEETS
A - Real Property
B - Personal Property
C - Property Claimed as Exempt
D - Creditors Holding Secured Claims
E - Creditors Holding Unsecured
Priority Claims
F - Creditors Holding UnsecuredNonpriority Claims
G - Executory Contracts and
Unexpired Leases
H - Codebtors
I - Current Income of Individual
Debtor(s)
J - Current Expenditures of Individual
Debtor(s)
Total Number of Sheets of ALL Schedules
Total Assets
Total Liabilities
(Total of Claims on Schedule E)
Software Copyright (c) 1996-2012 - CCH INCORPORATED - www.bestcase.com Best Case Bankruptc
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
1 0.00
4 26,225.00
2
0.001
451,297.334
57,303.633
1
1
2 19,730
3 22,669
22
26,225.00
508,600.96
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}bk1{Form6.StatisticalSummaryofCertainLiabilitiesandRelatedData}bk{
United States Bankruptcy CourtCentral District of California
In re,
Debtor
Case No.
Chapter
1:12-bk-11182
7
William Busey
Form 6 - Statistical Summary (12/07)
STATISTICAL SUMMARY OF CERTAIN LIABILITIES AND RELATED DATA (28 U.S.C. 159
If you are an individual debtor whose debts are primarily consumer debts, as defined in 101(8) of the Bankruptcy Code (11 U.S.C. 101(8)), fa case under chapter 7, 11 or 13, you must report all information requested below.
Check this box if you are an individual debtor whose debts are NOT primarily consumer debts. You are not required toreport any information here.
This information is for statistical purposes only under 28 U.S.C. 159.
Summarize the following types of liabilities, as reported in the Schedules, and total them.
Type of Liability Amount
Domestic Support Obligations (from Schedule E)
Taxes and Certain Other Debts Owed to Governmental Units(from Schedule E)
Claims for Death or Personal Injury While Debtor Was Intoxicated(from Schedule E) (whether disputed or undisputed)
Student Loan Obligations (from Schedule F)
Domestic Support, Separation Agreement, and Divorce DecreeObligations Not Reported on Schedule E
Obligations to Pension or Profit-Sharing, and Other Similar Obligations(from Schedule F)
TOTAL
State the following:
Average Income (from Schedule I, Line 16)
Average Expenses (from Schedule J, Line 18)
Current Monthly Income (from Form 22A Line 12; OR,Form 22B Line 11; OR, Form 22C Line 20 )
State the following:
1. Total from Schedule D, "UNSECURED PORTION, IF ANY"
column2. Total from Schedule E, "AMOUNT ENTITLED TO PRIORITY"
column
3. Total from Schedule E, "AMOUNT NOT ENTITLED TOPRIORITY, IF ANY" column
4. Total from Schedule F
5. Total of non-priority unsecured debt (sum of 1, 3, and 4)
Software Copyright (c) 1996-2012 - CCH INCORPORATED - www.bestcase.com Best Case Bankruptc
0.00
451,297.33
0.00
0.00
0.00
0.00
451,297.33
19,730.71
22,669.79
11,455.76
0.00
71,908.00
379,389.33
57,303.63
436,692.96
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}bk1{ScheduleA-RealProperty}bk{
In re,
Debtor
Case No. 1:12-bk-11182William Busey
B6A (Official Form 6A) (12/07)
Except as directed below, list all real property in which the debtor has any legal, equitable, or future interest, including all property owned as acotenant, community property, or in which the debtor has a life estate. Include any property in which the debtor holds rights and powers exercisable forthe debtor's own benefit. If the debtor is married, state whether husband, wife, both, or the marital community 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 anUnexpired 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 entityclaims to hold a secured interest in the property, write "None" in the column labeled "Amount of Secured Claim." If the debtor is an individual orif a joint petition is filed, state the amount of any exemption claimed in the property only in Schedule C - Property Claimed as Exempt.
Description and Location of Property Nature of Debtor'sInterest in Property
Husband,Wife,Joint, or
Community
Current Value ofDebtor's Interest inProperty, without
Deducting any SecuredClaim or Exemption
Amount ofSecured Claim
continuation sheets attached to the Schedule of Real Property
SCHEDULE A - REAL PROPERTY
Software Copyright (c) 1996-2012 - CCH INCORPORATED - www.bestcase.com Best Case Bankruptc
0
None
Sub-Total > (Total of this p0.00
Total >
(Report also on Summary of Schedules)
0.00
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}bk1{ScheduleB-PersonalProperty}bk{
In re,
Debtor
Case No. 1:12-bk-11182William Busey
B6B (Official Form 6B) (12/07)
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, plaan "x" in the appropriate position in the column labeled "None." If additional space is needed in any category, attach a separate sheet properly identifiedwith the case name, case number, and the number of the category. If the debtor is married, state whether husband, wife, both, or the marital communityown 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 jopetition 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 andUnexpired 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."If the property is being held for a minor child, simply state the child's initials and the name and address of the child's parent or guardian, such as"A.B., a minor child, by John Doe, guardian." Do not disclose the child's name. See, 11 U.S.C. 112 and Fed. R. Bankr. P. 1007(m).
Type of Property
NONE
Description and Location of Property
Husband,Wife,Joint, or
Community
Current Value ofDebtor's Interest in Prope
without Deducting anySecured Claim or Exemp
continuation sheets attached to the Schedule of Personal Property
SCHEDULE B - PERSONAL PROPERTY
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3
1. Cash on hand Cash - 75.00
2. Checking, savings or other financialaccounts, certificates of deposit, orshares in banks, savings and loan,thrift, building and loan, andhomestead associations, or creditunions, brokerage houses, orcooperatives.
Chase Business Checking Account No. ending in096529211 Heathercliff RoadMalibu, CA 90265
- 1,000.00
Wells Fargo Business Checking Account No.ending in 463223361 Pacific Coast HighwayMalibu, CA 90265
- 100.00
Wells Fargo Business Market Rate SavingsAccount No. ending in 724023361 Pacific Coast HighwayMalibu, CA 90265
- 100.00
3. Security deposits with publicutilities, telephone companies,landlords, and others.
Security deposit with landlordDana Eurich
- 7,000.00
4. Household goods and furnishings,including audio, video, andcomputer equipment.
Dining room table with 8 chairs, 2 T.V.'s, DVDplayer, old book case, end table, small drum table,2 mirrors, 2 cabinets, child's small table and chairs,old cloth and wooden chair, dishes, utensils,glasses, pots and pans, bedding, coffee maker,rocking chair, baby rocking chair, hutch, futon,dresser, 2 night stands, mattress and box springs,coffee table, 2 metal candle holders, old large taperecorder, small tape recorder, boombox, bookends,2 lampsLocation:
6808 Las Olas WayMalibu, CA 90265
- 1,800.00
Sub-Total >(Total of this page)
10,075.00
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B6B (Official Form 6B) (12/07) - Cont.
Type of Property
NONE
Description and Location of Property
Husband,Wife,Joint, or
Community
Current Value ofDebtor's Interest in Prope
without Deducting anySecured Claim or Exemp
Sheet of continuation sheets attached
to the Schedule of Personal Property
SCHEDULE B - PERSONAL PROPERTY(Continuation Sheet)
Software Copyright (c) 1996-2012 - CCH INCORPORATED - www.bestcase.com Best Case Bankruptc
In re,
Debtor
Case No. 1:12-bk-11182William Busey
5. Books, pictures and other artobjects, antiques, stamp, coin,record, tape, compact disc, andother collections or collectibles.
50 hardback books, 100 compact discs, 300 VHStapes, 100 DVD's, 200 cassette tapes, 11 poster artprints, acrylic on canvas painting depicting anindian, oil paintings depicting a woman dancing, oilpainting depicting angels in a forest, acrylic oncanvas depicting abstract shapes, small acrylic oncanvas painting depicting a horse, old bulls head, 5pair old moccasins, 2 small decorative teepees, 4clay vases, acrylic on canvas hand made paintingof blue circles with white outlines, 3 indian style
bowls, small figurine of bald eagle, old bows andarrows
- 1,000.00
6. Wearing apparel. Clothes and shoes - 2,000.00
7. Furs and jewelry. Fabric strap with an attached eagle talon, beadednecklace with an attached arrowhead, boleronecklace with black and white ying/yang pendant
- 150.00
8. Firearms and sports, photographic,and other hobby equipment.
Broken pellet gun, Rollerblades, 2 old surf boards,boogy board, old mountain bike, old Nikon filmcamera, electric guitar, Collins SJ acoustic guitar,12 string Guild acoustic guitar, Fender Stratocasterelectric guitar, amplifier, J200 acoustic Gibsonguitar, 2 tambourines
- 3,000.00
9. Interests in insurance policies.Name insurance company of eachpolicy and itemize surrender orrefund value of each.
AAA Term Life Policy Account No. ending in 814917900 N. Laurel Park DriveLivonia, MI 48152
- 0.00
10. Annuities. Itemize and name eachissuer.
X
11. Interests in an education IRA asdefined in 26 U.S.C. 530(b)(1) orunder a qualified State tuition planas defined in 26 U.S.C. 529(b)(1).Give particulars. (File separately therecord(s) of any such interest(s).11 U.S.C. 521(c).)
X
12. Interests in IRA, ERISA, Keogh, orother pension or profit sharingplans. Give particulars.
X
13. Stock and interests in incorporatedand unincorporated businesses.Itemize.
100% owner of Rising Star, Inc. This company doesnot have any assets and owes $1,128.00 to theFranchise Tax Board. This company isnon-operational.
- 0.00
Sub-Total >(Total of this page)
6,150.00
1 3
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B6B (Official Form 6B) (12/07) - Cont.
Type of Property
NONE
Description and Location of Property
Husband,Wife,Joint, or
Community
Current Value ofDebtor's Interest in Prope
without Deducting anySecured Claim or Exemp
Sheet of continuation sheets attached
to the Schedule of Personal Property
SCHEDULE B - PERSONAL PROPERTY(Continuation Sheet)
Software Copyright (c) 1996-2012 - CCH INCORPORATED - www.bestcase.com Best Case Bankruptc
In re,
Debtor
Case No. 1:12-bk-11182William Busey
100% owner of Lighting Strikes, Inc. This companyis in the process of being closed.This company hasno assets. This company owes the Franchise TaxBoard $263.46.
- 0.00
100% owner of Standing Rock Entertainment, Inc.This company has no assets. This company wasset up to receive services rendered and pay bills.
- 0.00
14. Interests in partnerships or jointventures. Itemize. X
15. Government and corporate bondsand other negotiable andnonnegotiable instruments.
X
16. Accounts receivable. Minor residuals from several T.V. and movie parts. - 10,000.00
17. Alimony, maintenance, support, andproperty settlements to which thedebtor is or may be entitled. Giveparticulars.
X
18. Other liquidated debts owed to debtorincluding tax refunds. Give particulars.
X
19. Equitable or future interests, lifeestates, and rights or powersexercisable for the benefit of thedebtor other than those listed inSchedule A - Real Property.
X
20. Contingent and noncontingentinterests in estate of a decedent,death benefit plan, life insurancepolicy, or trust.
X
21. Other contingent and unliquidatedclaims of every nature, includingtax refunds, counterclaims of thedebtor, and rights to setoff claims.Give estimated value of each.
Potential claim against Carla Loeffler and DavidDrexler, Esq., for malicious prosecution for claimfiled against Debtor for battery, intentional inflictionof emotional distress, general negligence and
negligent infliction of emotional distress.
- Unknown
22. Patents, copyrights, and otherintellectual property. Giveparticulars.
X
Sub-Total >(Total of this page)
10,000.00
2 3
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B6B (Official Form 6B) (12/07) - Cont.
Type of Property
NONE
Description and Location of Property
Husband,Wife,Joint, or
Community
Current Value ofDebtor's Interest in Prope
without Deducting anySecured Claim or Exemp
Sheet of continuation sheets attached
to the Schedule of Personal Property
SCHEDULE B - PERSONAL PROPERTY(Continuation Sheet)
Software Copyright (c) 1996-2012 - CCH INCORPORATED - www.bestcase.com Best Case Bankruptc
In re,
Debtor
Case No. 1:12-bk-11182William Busey
23. Licenses, franchises, and othergeneral intangibles. Giveparticulars.
X
24. Customer lists or other compilationscontaining personally identifiableinformation (as defined in 11 U.S.C. 101(41A)) provided to the debtorby individuals in connection withobtaining a product or service from
the debtor primarily for personal,family, or household purposes.
X
25. Automobiles, trucks, trailers, andother vehicles and accessories.
X
26. Boats, motors, and accessories. X
27. Aircraft and accessories. X
28. Office equipment, furnishings, andsupplies.
X
29. Machinery, fixtures, equipment, andsupplies used in business.
X
30. Inventory. X
31. Animals. X
32. Crops - growing or harvested. Giveparticulars.
X
33. Farming equipment andimplements.
X
34. Farm supplies, chemicals, and feed. X
35. Other personal property of any kindnot already listed. Itemize.
X
Sub-Total >(Total of this page)
0.00
3 3Total >
(Report also on Summary of Schedu
26,225.00
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}bk1{ScheduleC-PropertyClaimedasExempt}bk{
In re,
Debtor
Case No. 1:12-bk-11182William Busey
B6C (Official Form 6C) (4/10)
Debtor claims the exemptions to which debtor is entitled under: Check if debtor claims a homestead exemption that exceeds(Check one box) $146,450. (Amount subject to adjustment on 4/1/13, and every three years ther
with respect to cases commenced on or after the date of adjustment.11 U.S.C. 522(b)(2)11 U.S.C. 522(b)(3)
Description of Property Specify Law ProvidingEach Exemption
Value ofClaimed
Exemption
Current Value ofProperty Without
Deducting Exemption
continuation sheets attached to Schedule of Property Claimed as Exempt
SCHEDULE C - PROPERTY CLAIMED AS EXEMPT
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1
Cash on HandCash 75.00C.C.P. 703.140(b)(5) 75.00
Checking, Savings, or Other Financial Accounts, Certificates of DepositChase Business Checking Account No. endingin 096529211 Heathercliff Road
Malibu, CA 90265
1,000.00C.C.P. 703.140(b)(5) 1,000.00
Wells Fargo Business Checking Account No.ending in 463223361 Pacific Coast HighwayMalibu, CA 90265
100.00C.C.P. 703.140(b)(5) 100.00
Wells Fargo Business Market Rate SavingsAccount No. ending in 724023361 Pacific Coast HighwayMalibu, CA 90265
100.00C.C.P. 703.140(b)(5) 100.00
Security Deposits with Utilities, Landlords, and OthersSecurity deposit with landlordDana Eurich
7,000.00C.C.P. 703.140(b)(5) 7,000.00
Household Goods and FurnishingsDining room table with 8 chairs, 2 T.V.'s, DVDplayer, old book case, end table, small drumtable, 2 mirrors, 2 cabinets, child's small tableand chairs, old cloth and wooden chair, dishes,utensils, glasses, pots and pans, bedding,coffee maker, rocking chair, baby rocking chair,hutch, futon, dresser, 2 night stands, mattressand box springs, coffee table, 2 metal candleholders, old large tape recorder, small taperecorder, boombox, bookends, 2 lampsLocation:6808 Las Olas WayMalibu, CA 90265
1,800.00C.C.P. 703.140(b)(3) 1,800.00
Books, Pictures and Other Art Objects; Collectibles50 hardback books, 100 compact discs, 300VHS tapes, 100 DVD's, 200 cassette tapes, 11poster art prints, acrylic on canvas paintingdepicting an indian, oil paintings depicting awoman dancing, oil painting depicting angels ina forest, acrylic on canvas depicting abstractshapes, small acrylic on canvas paintingdepicting a horse, old bulls head, 5 pair oldmoccasins, 2 small decorative teepees, 4 clayvases, acrylic on canvas hand made painting ofblue circles with white outlines, 3 indian stylebowls, small figurine of bald eagle, old bowsand arrows
1,000.00C.C.P. 703.140(b)(5) 1,000.00
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B6C (Official Form 6C) (4/10) -- Cont.
Description of Property Specify Law ProvidingEach Exemption
Value ofClaimed
Exemption
Current Value ofProperty Without
Deducting Exemption
Sheet of continuation sheets attached to the Schedule of Property Claimed as Exempt
SCHEDULE C - PROPERTY CLAIMED AS EXEMPT(Continuation Sheet)
Software Copyright (c) 1996-2012 - CCH INCORPORATED - www.bestcase.com Best Case Bankruptc
In re,
Debtor
Case No. 1:12-bk-11182William Busey
Wearing ApparelClothes and shoes 2,000.00C.C.P. 703.140(b)(3) 2,000.00
Furs and JewelryFabric strap with an attached eagle talon,beaded necklace with an attached arrowhead,bolero necklace with black and white ying/yangpendant
150.00C.C.P. 703.140(b)(4) 150.00
Firearms and Sports, Photographic and Other Hobby Equipment
Broken pellet gun, Rollerblades, 2 old surfboards, boogy board, old mountain bike, oldNikon film camera, electric guitar, Collins SJacoustic guitar, 12 string Guild acoustic guitar,Fender Stratocaster electric guitar, amplifier,J200 acoustic Gibson guitar, 2 tambourines
3,000.00C.C.P. 703.140(b)(5) 3,000.00
Accounts ReceivableMinor residuals from several T.V. and movieparts.
10,000.00C.C.P. 703.140(b)(5) 10,000.00
1 1Total: 26,225.00 26,225.00
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}bk1{ScheduleD-CreditorsHoldingSecuredClaims}bk{
AMOUNT OFCLAIM
WITHOUTDEDUCTINGVALUE OF
COLLATERAL
DATE CLAIM WAS INCURRED,
NATURE OF LIEN, ANDDESCRIPTION AND VALUE
OF PROPERTYSUBJECT TO LIEN
COD
EBTOR
CON
TINGENT
UNL
IQUIDATED
DIS
PUTED
Husband, Wife, Joint, or Community
H
WJ
C
CREDITOR'S NAMEAND MAILING ADDRESS
INCLUDING ZIP CODE,AND ACCOUNT NUMBER
(See instructions above.)
Account No.
Value $
Account No.
Value $
Account No.
Value $
Account No.
Value $
Subtotal_____ continuation sheets attached
(Total of this page)
UNSECUREPORTION, I
ANY
B6D (Official Form 6D) (12/07)
State the name, mailing address, including zip code, and last four digits of any account number of all entities holding claims secured by property of the debtor as ofthe date of 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 providif the debtor chooses to do so. List creditors holding all types of secured interests such as judgment liens, garnishments, statutory liens, mortgages, deeds of trust, andother security interests.
List creditors in alphabetical order to the extent practicable. If a minor child is a creditor, the child's initials and the name and address of the child's parent orguardian, such as "A.B., a minor child, by John Doe, guardian." Do not disclose the child's name. See, 11 U.S.C. 112 and Fed. R. Bankr. P. 1007(m). If all securedcreditors 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 appropriatschedule of creditors, and complete Schedule H - Codebtors. If a joint petition is filed, state whether the husband, wife, both of them, or the marital community may beliable 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 theclaim is disputed, place an "X" in the column labeled "Disputed". (You may need to place an "X" in more than one of these three columns.)
Total the columns labeled "Amount of Claim Without Deducting Value of Collateral" and "Unsecured Portion, if Any" in the boxes labeled "Total(s)" on the lastsheet of the completed schedule. Report the total from the column labeled "Amount of Claim" also on the Summary of Schedules and, if the debtor is an individual withprimarily consumer debts, report the total from the column labeled "Unsecured Portion" on the Statistical Summary of Certain Liabilities and Related Data.
Check this box if debtor has no creditors holding secured claims to report on this Schedule D.
SCHEDULE D - CREDITORS HOLDING SECURED CLAIMS
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In re,
Debtor
Case No. 1:12-bk-11182William Busey
0
0.00 0.Total
(Report on Summary of Schedules)
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}bk1{ScheduleE-CreditorsHoldingUnsecuredPriorityClaims}bk{
B6E (Official Form 6E) (4/10)
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 entitto 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 taccount 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. Use a separatecontinuation sheet for each type of priority and label each with the type of priority.
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 choosesso. If a minor child is a creditor, state the child's initials and the name and address of the child's parent or guardian, such as "A.B., a minor child, by John Doe, guardiDo not disclose the child's name. See, 11 U.S.C. 112 and Fed. R. Bankr. P. 1007(m).
If any entity other than a spouse in a joint case may be jointly liable on a claim, place an "X" in the column labeled "Codebtor," include the entity on the appropschedule of creditors, and complete Schedule H-Codebtors. If a joint petition is filed, state whether the husband, wife, both of them, or the marital community may beliable 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 thecolumn 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 lab"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 "Subtotals" on each sheet. Report the total of all claims listed on this Schedule E in the box lab"Total" on the last sheet of the completed schedule. Report this total also on the Summary of Schedules.
Report the total of amounts entitled to priority listed on each sheet in the box labeled "Subtotals" on each sheet. Report the total of all amounts entitled to priorilisted on this Schedule E in the box labeled "Totals" on the last sheet of the completed schedule. Individual debtors with primarily consumer debts report this totalalso on the Statistical Summary of Certain Liabilities and Related Data.
Report the total of amounts not entitled to priority listed on each sheet in the box labeled "Subtotals" on each sheet. Report the total of all amounts not entitled tpriority listed on this Schedule E in the box labeled "Totals" on the last sheet of the completed schedule. Individual debtors with primarily consumer debts report thitotal also on the Statistical Summary of Certain Liabilities and Related Data.
Check this box if debtor has no creditors holding unsecured priority claims to report on this Schedule E.
TYPES OF PRIORITY CLAIMS (Check the appropriate box(es) below if claims in that category are listed on the attached sheets)
Domestic support obligations
Claims for domestic support that are owed to or recoverable by a spouse, former spouse, or child of the debtor, or the parent, legal guardian, or responsible relativof such a child, or a governmental unit to whom such a domestic support claim has been assigned to the extent provided in 11 U.S.C. 507(a)(1).
Extensions of credit in an involuntary case
Claims arising in the ordinary course of the debtor's business or financial affairs after the commencement of the case but before the earlier of the appointment of trustee or the order for relief. 11 U.S.C. 507(a)(3).
Wages, salaries, and commissions
Wages, salaries, and commissions, including vacation, severance, and sick leave pay owing to employees and commissions owing to qualifying independent salerepresentatives up to $11,725* per person earned within 180 days immediately preceding the filing of the original petition, or the cessation of business, whicheveroccurred first, to the extent provided in 11 U.S.C. 507(a)(4).
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 businewhichever occurred first, to the extent provided in 11 U.S.C. 507(a)(5).
Certain farmers and fishermen
Claims of certain farmers and fishermen, up to $5,775* per farmer or fisherman, against the debtor, as provided in 11 U.S.C. 507(a)(6).
Deposits by individuals
Claims of individuals up to $2,600* for deposits for the purchase, lease, or rental of property or services for personal, family, or household use, that were notdelivered or provided. 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 FederaReserve System, or their predecessors or successors, to maintain the capital of an insured depository institution. 11 U.S.C. 507 (a)(9).
Claims for death or personal injury while debtor was intoxicated
Claims for death or personal injury resulting from the operation of a motor vehicle or vessel while the debtor was intoxicated from using alcohol, a drug, oranother substance. 11 U.S.C. 507(a)(10).
*Amount subject to adjustment on 4/01/13, and every three years thereafter with respect to cases commenced on or after the date of adjustment.
continuation sheets attached
SCHEDULE E - CREDITORS HOLDING UNSECURED PRIORITY CLAIMS
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In re,
Debtor
Case No. 1:12-bk-11182William Busey
3
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B6E (Official Form 6E) (4/10) - Cont.
CODEBTOR
CONTINGENT
UNLIQUIDATED
DISPUTED
Husband, Wife, Joint, or Community
H
W
J
C
CREDITOR'S NAME,AND MAILING ADDRESS
INCLUDING ZIP CODE,AND ACCOUNT NUMBER
(See instructions.)
DATE CLAIM WAS INCURRED AMOUNTAND CONSIDERATION FOR CLAIM OF CLAIM
Account No.
Account No.
Account No.
Account No.
Account No.
SubtotalSheet _____ of _____ continuation sheets attached to
(Total of this page)Schedule of Creditors Holding Unsecured Priority Claims
TYPE OF PRIORITY
AMOUNT NOTENTITLED TOPRIORITY, IF ANY
AMOUENTITLED
PRIORI
SCHEDULE E - CREDITORS HOLDING UNSECURED PRIORITY CLAIMS(Continuation Sheet)
Software Copyright (c) 1996-2012 - CCH INCORPORATED - www.bestcase.com Best Case Bankruptc
In re,
Debtor
Case No. 1:12-bk-11182William Busey
Taxes and Certain Other DebtsOwed to Governmental Units
1689 2008
TaxesFranchise Tax BoardPO Box 1673
Sacramento, CA 95812-
6,187.66 6,187.
0.00
1689 2006
TaxesFranchise Tax BoardPO Box 1673Sacramento, CA 95812
-
10,583.03 0.
10,583.03
1689 2003
TaxesFranchise Tax BoardPO Box 1673Sacramento, CA 95812
-
22,377.37 0.
22,377.37
1689 2001
TaxesFranchise Tax Board
PO Box 1673Sacramento, CA 95812
-
3,493.81 0.
3,493.81
1689 1999
TaxesFranchise Tax BoardPO Box 1673
Sacramento, CA 95812-
70,061.11 0.
70,061.11
112,702.98 6,187.
106,515.321 3
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In re,
Debtor
Case No. 1:12-bk-11182William Busey
B6E (Official Form 6E) (4/10) - Cont.
CODEBTOR
CONTINGENT
UNLIQUIDATED
DISPUTED
Husband, Wife, Joint, or Community
H
W
J
C
CREDITOR'S NAME,AND MAILING ADDRESS
INCLUDING ZIP CODE,AND ACCOUNT NUMBER
(See instructions.)
DATE CLAIM WAS INCURRED AMOUNTAND CONSIDERATION FOR CLAIM OF CLAIM
Account No.
Account No.
Account No.
Account No.
Account No.
SubtotalSheet _____ of _____ continuation sheets attached to
(Total of this page)Schedule of Creditors Holding Unsecured Priority Claims
TYPE OF PRIORITY
AMOUNT NOTENTITLED TOPRIORITY, IF ANY
AMOUENTITLED
PRIORI
SCHEDULE E - CREDITORS HOLDING UNSECURED PRIORITY CLAIMS(Continuation Sheet)
Software Copyright (c) 1996-2012 - CCH INCORPORATED - www.bestcase.com Best Case Bankruptc
Taxes and Certain Other DebtsOwed to Governmental Units
1689 1998
TaxesFranchise Tax BoardPO Box 1673
Sacramento, CA 95812-
95,186.89 0.
95,186.89
6797 November 2002
TaxesInternal Revenue ServicePO Box 7346Philadelphia, PA 19101
-
12,433.51 0.
12,433.51
6797 October 2003
TaxesInternal Revenue ServicePO Box 7346Philadelphia, PA 19101
-
9,480.63 0.
9,480.63
6797 October 2004
TaxesInternal Revenue Service
PO Box 7346Philadelphia, PA 19101
-
99,839.51 0.
99,839.51
6797 October 2005
TaxesInternal Revenue ServicePO Box 7346
Philadelphia, PA 19101-
634.63 0.
634.63
217,575.17 0.
217,575.172 3
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In re,
Debtor
Case No. 1:12-bk-11182William Busey
B6E (Official Form 6E) (4/10) - Cont.
CODEBTOR
CONTINGENT
UNLIQUIDATED
DISPUTED
Husband, Wife, Joint, or Community
H
W
J
C
CREDITOR'S NAME,AND MAILING ADDRESS
INCLUDING ZIP CODE,AND ACCOUNT NUMBER
(See instructions.)
DATE CLAIM WAS INCURRED AMOUNTAND CONSIDERATION FOR CLAIM OF CLAIM
Account No.
Account No.
Account No.
Account No.
Account No.
SubtotalSheet _____ of _____ continuation sheets attached to
(Total of this page)Schedule of Creditors Holding Unsecured Priority Claims
TYPE OF PRIORITY
AMOUNT NOTENTITLED TOPRIORITY, IF ANY
AMOUENTITLED
PRIORI
SCHEDULE E - CREDITORS HOLDING UNSECURED PRIORITY CLAIMS(Continuation Sheet)
Software Copyright (c) 1996-2012 - CCH INCORPORATED - www.bestcase.com Best Case Bankruptc
Taxes and Certain Other DebtsOwed to Governmental Units
6797 September 2006
TaxesInternal Revenue ServicePO Box 7346
Philadelphia, PA 19101-
25,636.25 0.
25,636.25
6797 September 2007
TaxesInternal Revenue ServicePO Box 7346Philadelphia, PA 19101
-
29,662.59 0.
29,662.59
6797 September 2009
TaxesInternal Revenue ServicePO Box 7346Philadelphia, PA 19101
-
65,720.34 65,720.
0.00
121,019.18 65,720.
55,298.843 3
451,297.33 71,908.
379,389.33Total
(Report on Summary of Schedules)
Software Copyright (c) 1996-2012 - CCH INCORPORATED - www.bestcase.com Best Case Bankruptc
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}bk1{ScheduleF-CreditorsHoldingUnsecuredNonpriorityClaims}bk{
CO
DEBTOR
CO
NTINGENT
UN
LIQUIDATED
DI
SPUTED
Husband, Wife, Joint, or Community
H
W
J
C
CREDITOR'S NAME,
MAILING ADDRESSINCLUDING ZIP CODE,
AND ACCOUNT NUMBER(See instructions above.)
Account No.
Account No.
Account No.
Account No.
Subtotal_____ continuation sheets attached
(Total of this page)
DATE CLAIM WAS INCURRED ANDCONSIDERATION FOR CLAIM. IF CLAIM
IS SUBJECT TO SETOFF, SO STATE.AMOUNT OF CLA
B6F (Official Form 6F) (12/07)
State the name, mailing address, including zip code, and last four digits of any account number, of all entities holding unsecured claims without priority against thedebtor or the property of the debtor, as of the date of filing of the petition. The complete account number of any account the debtor has with the creditor is useful to thetrustee and the creditor and may be provided if the debtor chooses to do so. If a minor child is a creditor, state the child's initials and the name and address of the child'sparent or guardian, such as "A.B., a minor child, by John Doe, guardian." Do not disclose the child's name. See, 11 U.S.C. 112 and Fed. R. Bankr. P. 1007(m). Do notinclude 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 appropriatschedule of creditors, and complete Schedule H - Codebtors. If a joint petition is filed, state whether the husband, wife, both of them, or the marital community may beliable 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 theclaim 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 ofSchedules and, if the debtor is an individual with primarily consumer debts, report this total also on the Statistical Summary of Certain Liabilities and Related Data.
Check this box if debtor has no creditors holding unsecured claims to report on this Schedule F.
S/N:24271-120208
SCHEDULE F - CREDITORS HOLDING UNSECURED NONPRIORITY CLAIMS
Software Copyright (c) 1996-2012 - CCH INCORPORATED - www.bestcase.com Best Case Bankruptc
In re,
Debtor
Case No. 1:12-bk-11182William Busey
2
N/A October 2011Complaint for Damages
Carla Loffler
c/o David Drexler, Esq.13808 Ventura Blvd.Sherman Oaks, CA 91423
- X X X
Unkno
N/A 2010Professional Fees
Cary W Goldstein8383 Wilshire Blvd Ste 830Beverly Hills, CA 90211
-
3,609.
N/A 2001Loan
Glen Alpert8899 Beverly Blvd. #918
Los Angeles, CA 90048
- X X X
25,000.
N/A 2011Professional Fees
Law Offices of Barry Fischer9454 Wilshire Blvd., Ste 701
Beverly Hills, CA 90212
-
1,950.
30,559.
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B6F (Official Form 6F) (12/07) - Cont.
CODEBTOR
CONTINGENT
UNLIQUIDATED
DISPUTED
Husband, Wife, Joint, or Community
H
W
J
C
CREDITOR'S NAME,MAILING ADDRESS
INCLUDING ZIP CODE,AND ACCOUNT NUMBER
(See instructions above.)
Account No.
Account No.
Account No.
Account No.
Account No.
Sheet no. _____ of _____ sheets attached to Schedule of Subtotal
Creditors Holding Unsecured Nonpriority Claims (Total of this page)
DATE CLAIM WAS INCURRED ANDCONSIDERATION FOR CLAIM. IF CLAIM
IS SUBJECT TO SETOFF, SO STATE.AMOUNT OF CLA
SCHEDULE F - CREDITORS HOLDING UNSECURED NONPRIORITY CLAIMS(Continuation Sheet)
Software Copyright (c) 1996-2012 - CCH INCORPORATED - www.bestcase.com Best Case Bankruptc
In re,
Debtor
Case No. 1:12-bk-11182William Busey
5622 2011Utility Bill
Los Angeles County
Waterworks Districts
PO Box 512150Los Angeles, CA 90051
-
72.
xxxxxx xx A000 2009Medical Bill
Pacific Hearing
11645 Wilshire Blvd. #600Los Angeles, CA 90025
-
3,230.
1037 12/5/11Medical Bills
PMSProgressive Management SystemsPO Box 2220West Covina, CA 91793
-
2,000.
xxxxxx xx 5123 2010Credit Card
Portfolio Recovery Associates, LLCP.O. Box 12914
Norfolk, VA 23541
- X X X
4,098.
8812 2011Medical Bills
Santa Monica UCLA MedicalPatient Business Services
File 51139Los Angeles, CA 90074
-
1,441.
10,842.1 2
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B6F (Official Form 6F) (12/07) - Cont.
CODEBTOR
CONTINGENT
UNLIQUIDATED
DISPUTED
Husband, Wife, Joint, or Community
H
W
J
C
CREDITOR'S NAME,MAILING ADDRESS
INCLUDING ZIP CODE,AND ACCOUNT NUMBER
(See instructions above.)
Account No.
Account No.
Account No.
Account No.
Account No.
Sheet no. _____ of _____ sheets attached to Schedule of Subtotal
Creditors Holding Unsecured Nonpriority Claims (Total of this page)
DATE CLAIM WAS INCURRED ANDCONSIDERATION FOR CLAIM. IF CLAIM
IS SUBJECT TO SETOFF, SO STATE.AMOUNT OF CLA
SCHEDULE F - CREDITORS HOLDING UNSECURED NONPRIORITY CLAIMS(Continuation Sheet)
Software Copyright (c) 1996-2012 - CCH INCORPORATED - www.bestcase.com Best Case Bankruptc
In re,
Debtor
Case No. 1:12-bk-11182William Busey
2831 2011Utility Bill
Waste Management
PO Box 541008
Los Angeles, CA 90054
-
39.
3490 2011Credit Card
Wells Fargo
c/o Equitable RecoveryPO Box 1479Lombard, IL 60148
-
15,862.
15,902.2 2
57,303.Total
(Report on Summary of Schedules)
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}bk1{ScheduleG-ExecutoryContractsandUnexpiredLeases}bk{
In re,
Debtor
Case No. 1:12-bk-11182William Busey
B6G (Official Form 6G) (12/07)
Describe all executory contracts of any nature and all unexpired leases of real or personal property. Include any timeshare interests. State natuof debtor's interest in contract, i.e., "Purchaser", "Agent", etc. State whether debtor is the lessor or lessee of a lease. Provide the names andcomplete mailing addresses of all other parties to each lease or contract described. If a minor child is a party to one of the leases or contracts,state the child's initials and the name and address of the child's parent or guardian, such as "A.B., a minor child, by John Doe, guardian." Do nodisclose the child's name. See, 11 U.S.C. 112 and Fed. R. Bankr. P. 1007(m).
Check this box if debtor has no executory contracts or unexpired leases.
Name and Mailing Address, Including Zip Code,of Other Parties to Lease or Contract
Description of Contract or Lease and Nature of Debtor's Interest.State whether lease is for nonresidential real property.
State contract number of any government contract.
continuation sheets attached to Schedule of Executory Contracts and Unexpired Leases
SCHEDULE G - EXECUTORY CONTRACTS AND UNEXPIRED LEASES
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0
Westside Storage2270 Centinela Ave.Los Angeles, CA 90064
Month to month lease for 3 storage units.Payment is $700.00.00 per month.Contents: old electronics, personal documents,personal family documents, family photographs,
son's personal documents, Mother'sfurniture/piano, old broken drumsets.
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}bk1{ScheduleH-Codebtors}bk{
In re,
Debtor
Case No. 1:12-bk-11182William Busey
B6H (Official Form 6H) (12/07)
Provide the information requested concerning any person or entity, other than a spouse in a joint case, that is also liable on any debts listedby debtor in the schedules of creditors. Include all guarantors and co-signers. If the debtor resides or resided in a community property state,commonwealth, or territory (including Alaska, Arizona, California, Idaho, Louisiana, Nevada, New Mexico, Puerto Rico, Texas, Washington, orWisconsin) within the eight year period immediately preceding the commencement of the case, identify the name of the debtor's spouse and ofany former spouse who resides or resided with the debtor in the community property state, commonwealth, or territory. Include all names usedby the nondebtor spouse during the eight years immediately preceding the commencement of this case. If a minor child is a codebtor or a creditor,state the child's initials and the name and address of the child's parent or guardian, such as "A.B., a minor child, by John Doe, guardian." Do notdisclose the child's name. See, 11 U.S.C. 112 and Fed. R. Bankr. P. 1007(m).
Check this box if debtor has no codebtors.
NAME AND ADDRESS OF CODEBTOR NAME AND ADDRESS OF CREDITOR
continuation sheets attached to Schedule of Codebtors
SCHEDULE H - CODEBTORS
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0
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B6I (Official Form 6I) (12/07)
In re William Busey Case No. 1:12-bk-11182Debtor(s)
SCHEDULE I - CURRENT INCOME OF INDIVIDUAL DEBTOR(S)
The column labeled "Spouse" must be completed in all cases filed by joint debtors and by every married debtor, whether or not a joint petition isfiled, unless the spouses are separated and a joint petition is not filed. Do not state the name of any minor child. The average monthly incomecalculated on this form may differ from the current monthly income calculated on Form 22A, 22B, or 22C.
Debtor's Marital Status: DEPENDENTS OF DEBTOR AND SPOUSE
SingleRELATIONSHIP(S):
DaughterSon
AGE(S):
1723 months
Employment: DEBTOR SPOUSE
Occupation Actor
Name of Employer Self-employed
How long employed 30 + years
Address of Employer
INCOME: (Estimate of average or projected monthly income at time case filed) DEBTOR SPOUSE1. Monthly gross wages, salary, and commissions (Prorate if not paid monthly) $ 0.00 $ 0.002. Estimate monthly overtime $ 0.00 $ 0.00
3. SUBTOTAL $ 0.00 $ 0.00
4. LESS PAYROLL DEDUCTIONS
a. Payroll taxes and social security $ 0.00 $ 0.00b. Insurance $ 0.00 $ 0.00c. Union dues $ 0.00 $ 0.00d. Other (Specify): $ 0.00 $ 0.00
$ 0.00 $ 0.00
5. SUBTOTAL OF PAYROLL DEDUCTIONS $ 0.00 $ 0.00
6. TOTAL NET MONTHLY TAKE HOME PAY $ 0.00 $ 0.00
7. Regular income from operation of business or profession or farm (Attach detailed statement) $ 14,808.08 $ 0.008. Income from real property $ 0.00 $ 0.009. Interest and dividends $ 0.00 $ 0.0010. Alimony, maintenance or support payments payable to the debtor for the debtor's use or that of
dependents listed above $ 0.00 $ 0.00
11. Social security or government assistance
(Specify): Social Security $ 770.00 $ 0.00Pension from SAG and AFTRA $ 4,021.00 $ 0.00
12. Pension or retirement income $ 0.00 $ 0.0013. Other monthly income(Specify): Residual Income $ 131.63 $ 0.00
$ 0.00 $ 0.00
14. SUBTOTAL OF LINES 7 THROUGH 13 $ 19,730.71 $ 0.00
15. AVERAGE MONTHLY INCOME (Add amounts shown on lines 6 and 14) $ 19,730.71 $ 0.00
16. COMBINED AVERAGE MONTHLY INCOME: (Combine column totals from line 15) $ 19,730.71
(Report also on Summary of Schedules and, if applicable, onStatistical Summary of Certain Liabilities and Related Data)
17. Describe any increase or decrease in income reasonably anticipated to occur within the year following the filing of this document:
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B6J (Official Form 6J) (12/07)
In re William Busey Case No. 1:12-bk-11182Debtor(s)
SCHEDULE J - CURRENT EXPENDITURES OF INDIVIDUAL DEBTOR(S)
Complete this schedule by estimating the average or projected monthly expenses of the debtor and the debtor's family at timecase filed. Prorate any payments made bi-weekly, quarterly, semi-annually, or annually to show monthly rate. The average monthlyexpenses calculated on this form may differ from the deductions from income allowed on Form 22A or 22C.
Check this box if a joint petition is filed and debtor's spouse maintains a separate household. Complete a separate schedule ofexpenditures labeled "Spouse."
1. Rent or home mortgage payment (include lot rented for mobile home) $ 3,595.0
a. Are real estate taxes included? Yes No X
b. Is property insurance included? Yes No X2. Utilities: a. Electricity and heating fuel $ 200.0
b. Water and sewer $ 0.0
c. Telephone $ 74.8
d. Other Cable, cell and DSL $ 289.0
3. Home maintenance (repairs and upkeep) $ 30.0
4. Food $ 400.0
5. Clothing $ 75.0
6. Laundry and dry cleaning $ 100.0
7. Medical and dental expenses $ 200.0
8. Transportation (not including car payments) $ 325.0
9. Recreation, clubs and entertainment, newspapers, magazines, etc. $ 75.0
10. Charitable contributions $ 100.0
11. Insurance (not deducted from wages or included in home mortgage payments)
a. Homeowner's or renter's $ 0.0
b. Life $ 763.0
c. Health $ 25.0
d. Auto $ 175.0
e. Other $ 0.0
12. Taxes (not deducted from wages or included in home mortgage payments)
(Specify) Income Taxes $ 4,500.0
13. Installment payments: (In chapter 11, 12, and 13 cases, do not list payments to be included in theplan)
a. Auto $ 0.0
b. Other $ 0.0
c. Other $ 0.0
14. Alimony, maintenance, and support paid to others $ 0.0
15. Payments for support of additional dependents not living at your home $ 1,158.0
16. Regular expenses from operation of business, profession, or farm (attach detailed statement) $ 7,574.9
17. Other See Detailed Expense Attachment $ 3,010.0
18. AVERAGE MONTHLY EXPENSES (Total lines 1-17. Report also on Summary of Schedules and,if applicable, on the Statistical Summary of Certain Liabilities and Related Data.)
$ 22,669.7
19. Describe any increase or decrease in expenditures reasonably anticipated to occur within the year
following the filing of this document:
20. STATEMENT OF MONTHLY NET INCOME
a. Average monthly income from Line 15 of Schedule I $ 19,730.7
b. Average monthly expenses from Line 18 above $ 22,669.7
c. Monthly net income (a. minus b.) $ -2,939.0
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B6J (Official Form 6J) (12/07)
In re William Busey Case No. 1:12-bk-11182Debtor(s)
SCHEDULE J - CURRENT EXPENDITURES OF INDIVIDUAL DEBTOR(S)Detailed Expense Attachment
Other Expenditures:
Son's day care $ 1,680.0Son's special food for medical condition maintenance $ 400.0Professional cleaning for home required to alleviate asthma $ 230.0Storage $ 700.0
Total Other Expenditures $ 3,010.0
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B6 Declaration (Official Form 6 - Declaration). (12/07)
United States Bankruptcy CourtCentral District of California
In re William Busey Case No. 1:12-bk-11182Debtor(s) Chapter 7
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 24sheets, and that they are true and correct to the best of my knowledge, information, and belief.
Date February 15, 2012 Signature /s/ William BuseyWilliam Busey
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.
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B7 (Official Form 7) (04/10)
United States Bankruptcy CourtCentral District of California
In re William Busey Case No. 1:12-bk-11182Debtor(s) Chapter 7
STATEMENT OF FINANCIAL AFFAIRS
This statement is to be completed by every debtor. Spouses filing a joint petition may file a single statement on which the information forboth spouses is combined. If the case is filed under chapter 12 or chapter 13, a married debtor must furnish information for both spouses whether ornot a joint petition is filed, unless the spouses are separated and a joint petition is not filed. An individual debtor engaged in business as a soleproprietor, partner, family farmer, or self-employed professional, should provide the information requested on this statement concerning all suchactivities as well as the individual's personal affairs. To indicate payments, transfers and the like to minor children, state the child's initials and thename and address of the child's parent or guardian, such as "A.B., a minor child, by John Doe, guardian." Do not disclose the child's name. See, 11U.S.C. 112; Fed. R. Bankr. P. 1007(m).
Questions 1 - 18 are to be completed by all debtors. Debtors that are or have been in business, as defined below, also must completeQuestions 19 - 25. If the answer to an applicable question is "None," mark the box labeled "None." If additional space is needed for the answerto any question, use and attach a separate sheet properly identified with the case name, case number (if known), and the number of the question.
DEFINITIONS
"In business." A debtor is "in business" for the purpose of this form if the debtor is a corporation or partnership. An individual debtor is "inbusiness" for the purpose of this form if the debtor is or has been, within six years immediately preceding the filing of this bankruptcy case, any ofthe following: an officer, director, managing executive, or owner of 5 percent or more of the voting or equity securities of a corporation; a partner,other than a limited partner, of a partnership; a sole proprietor or self-employed full-time or part-time. An individual debtor also may be "in business"for the purpose of this form if the debtor engages in a trade, business, or other activity, other than as an employee, to supplement income from thedebtor's primary employment.
"Insider." The term "insider" includes but is not limited to: relatives of the debtor; general partners of the debtor and their relatives;corporations of which the debtor is an officer, director, or person in control; officers, directors, and any owner of 5 percent or more of the voting orequity securities of a corporate debtor and their relatives; affiliates of the debtor and insiders of such affiliates; any managing agent of the debtor. 11U.S.C. 101.
None
1. Income from employment or operation of business
State the gross amount of income the debtor has received from employment, trade, or profession, or from operation of the debtor'sbusiness, including part-time activities either as an employee or in independent trade or business, from the beginning of this calendaryear to the date this case was commenced. State also the gross amounts received during the two years immediately preceding thiscalendar year. (A debtor that maintains, or has maintained, financial records on the basis of a fiscal rather than a calendar year mayreport fiscal year income. Identify the beginning and ending dates of the debtor's fiscal year.) If a joint petition is filed, state income foreach spouse separately. (Married debtors filing under chapter 12 or chapter 13 must state income of both spouses whether or not a jointpetition is filed, unless the spouses are separated and a joint petition is not filed.)
AMOUNT SOURCE$9,429.25 2012 YTD: Debtor Gross Income from Self-Employment
$177,696.00 2011: Debtor Gross income from self employment$148,800.00 2010: Debtor Gross income from self employment
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4
None
7. Gifts
List all gifts or charitable contributions made within one year immediately preceding the commencement of this case except ordinaryand usual gifts to family members aggregating less than $200 in value per individual family member and charitable contributionsaggregating less than $100 per recipient. (Married debtors filing under chapter 12 or chapter 13 must include gifts or contributions byeither or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.)
NAME AND ADDRESS OFPERSON OR ORGANIZATION RELATIONSHIP TODEBTOR, IF ANY DATE OF GIFT DESCRIPTION ANDVALUE OF GIFT
None
8. Losses
List all losses from fire, theft, other casualty or gambling within one year immediately preceding the commencement of this case orsince the commencement of this case. (Married debtors filing under chapter 12 or chapter 13 must include losses by either or bothspouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.)
DESCRIPTION AND VALUEOF PROPERTY
DESCRIPTION OF CIRCUMSTANCES AND, IFLOSS WAS COVERED IN WHOLE OR IN PART
BY INSURANCE, GIVE PARTICULARS DATE OF LOSS
None
9. Payments related to debt counseling or bankruptcy
List all payments made or property transferred by or on behalf of the debtor to any persons, including attorneys, for consultationconcerning debt consolidation, relief under the bankruptcy law or preparation of the petition in bankruptcy within one year immediatelypreceding the commencement of this case.
NAME AND ADDRESSOF PAYEE
DATE OF PAYMENT,NAME OF PAYOR IF OTHER
THAN DEBTOR
AMOUNT OF MONEYOR DESCRIPTION AND VALUE
OF PROPERTYLaw Offices of Michael Jay Berger9454 Wilshire Boulevard6th FloorBeverly Hills, CA 90212-2929
12/16/111/31/12
$4,500.00$3,500.00
None
10. Other transfers
a. List all other property, other than property transferred in the ordinary course of the business or financial affairs of the debtor,transferred either absolutely or as security within two years immediately preceding the commencement of this case. (Married debtorsfiling under chapter 12 or chapter 13 must include transfers by either or both spouses whether or not a joint petition is filed, unless thespouses are separated and a joint petition is not filed.)
NAME AND ADDRESS OF TRANSFEREE,RELATIONSHIP TO DEBTOR DATE
DESCRIBE PROPERTY TRANSFERREDAND VALUE RECEIVED
None
b. List all property transferred by the debtor within ten years immediately preceding the commencement of this case to a self-settledtrust or similar device of which the debtor is a beneficiary.
NAME OF TRUST OR OTHERDEVICE DATE(S) OF
TRANSFER(S)
AMOUNT OF MONEY OR DESCRIPTION ANDVALUE OF PROPERTY OR DEBTOR'S INTERESTIN PROPERTY
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None
11. Closed financial accounts
List all financial accounts and instruments held in the name of the debtor or for the benefit of the debtor which were closed, sold, orotherwise transferred within one year immediately preceding the commencement of this case. Include checking, savings, or otherfinancial accounts, certificates of deposit, or other instruments; shares and share accounts held in banks, credit unions, pension funds,cooperatives, associations, brokerage houses and other financial institutions. (Married debtors filing under chapter 12 or chapter 13 mustinclude information concerning accounts or instruments held by or for either or both spouses whether or not a joint petition is filed,
unless the spouses are separated and a joint petition is not filed.)
NAME AND ADDRESS OF INSTITUTION
TYPE OF ACCOUNT, LAST FOURDIGITS OF ACCOUNT NUMBER,
AND AMOUNT OF FINAL BALANCE
AMOUNT AND DATE OF SALEOR CLOSING
Wells Fargo8571 Santa Monica Blvd.West Hollywood, CA 90069
Personal Checking Account No. endingin 9328
$0.00May 2011
Wells Fargo8571 Santa Monica Blvd.West Hollywood, CA 90069
Money Market Account No. ending in2707
$0.00May 2011
Wells Fargo Bank23361 Pacific Coast HighwayMalibu, CA 90265
Business Savings Account No. ending in8762
$0.009/11/11
None
12. Safe deposit boxes
List each safe deposit or other box or depository in which the debtor has or had securities, cash, or other valuables within one yearimmediately preceding the commencement of this case. (Married debtors filing under chapter 12 or chapter 13 must include boxes ordepositories of either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is notfiled.)
NAME AND ADDRESS OF BANKOR OTHER DEPOSITORY
NAMES AND ADDRESSESOF THOSE WITH ACCESSTO BOX OR DEPOSITORY
DESCRIPTIONOF CONTENTS
DATE OF TRANSFER ORSURRENDER, IF ANY
None
13. Setoffs
List all setoffs made by any creditor, including a bank, against a debt or deposit of the debtor within 90 days preceding thecommencement of this case. (Married debtors filing under chapter 12 or chapter 13 must include information concerning either or bothspouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.)
NAME AND ADDRESS OF CREDITOR DATE OF SETOFF AMOUNT OF SETOFF
None
14. Property held for another person
List all property owned by another person that the debtor holds or controls.
NAME AND ADDRESS OF OWNER DESCRIPTION AND VALUE OF PROPERTY LOCATION OF PROPERTY
None
15. Prior address of debtor
If the debtor has moved within three years immediately preceding the commencement of this case, list all premises which the debtoroccupied during that period and vacated prior to the commencement of this case. If a joint petition is filed, report also any separateaddress of either spouse.
ADDRESS NAME USED DATES OF OCCUPANCY5855 Bonsall DriveMalibu, CA 90265
William Busey 2010 - 2011
1725 Oceanfront Walk # 307Santa Monica, CA 90401
William Busey 6/2008 - 2010
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None
16. Spouses and Former Spouses
If the debtor resides or resided in a community property state, commonwealth, or territory (including Alaska, Arizona, California, Idaho,Louisiana, Nevada, New Mexico, Puerto Rico, Texas, Washington, or Wisconsin) within eight years immediately preceding thecommencement of the case, identify the name of the debtors spouse and of any former spouse who resides or resided with the debtor inthe community property state.
NAME
17. Environmental Information.
For the purpose of this question, the following definitions apply:
"Environmental Law" means any federal, state, or local statute or regulation regulating pollution, contamination, releases of hazardousor toxic substances, wastes or material into the air, land, soil, surface water, groundwater, or other medium, including, but not limited to,statutes or regulations regulating the cleanup of these substances, wastes, or material.
"Site" means any location, facility, or property as defined under any Environmental Law, whether or not presently or formerlyowned or operated by the debtor, including, but not limited to, disposal sites.
"Hazardous Material" means anything defined as a hazardous waste, hazardous substance, toxic substance, hazardous material,pollutant, or contaminant or similar term under an Environmental Law
None
a. List the name and address of every site for which the debtor has received notice in writing by a governmental unit that it may be liableor potentially liable under or in violation of an Environmental Law. Indicate the governmental unit, the date of the notice, and, if known,the Environmental Law:
SITE NAME AND ADDRESSNAME AND ADDRESS OFGOVERNMENTAL UNIT
DATE OFNOTICE
ENVIRONMENTALLAW
None
b. List the name and address of every site for which the debtor provided notice to a governmental unit of a release of HazardousMaterial. Indicate the governmental unit to which the notice was sent and the date of the notice.
SITE NAME AND ADDRESSNAME AND ADDRESS OFGOVERNMENTAL UNIT
DATE OFNOTICE
ENVIRONMENTALLAW
None
c. List all judicial or administrative proceedings, including settlements or orders, under any Environmental Law with respect to which
the debtor is or was a party. Indicate the name and address of the governmental unit that is or was a party to the proceeding, and thedocket number.
NAME AND ADDRESS OFGOVERNMENTAL UNIT DOCKET NUMBER STATUS OR DISPOSITION
None
18 . Nature, location and name of business
a.If the debtor is an individual, list the names, addresses, taxpayer identification numbers, nature of the businesses, and beginning andending dates of all businesses in which the debtor was an officer, director, partner, or managing executive of a corporation, partner in apartnership, sole proprietor, or was self-employed in a trade, profession, or other activity either full- or part-time within six yearsimmediately preceding the commencement of this case, or in which the debtor owned 5 percent or more of the voting or equity securitieswithin six years immediately preceding the commencement of this case.
If the debtor is a partnership, list the names, addresses, taxpayer identification numbers, nature of the businesses, and beginning andending dates of all businesses in which the debtor was a partner or owned 5 percent or more of the voting or equity securities, within sixyears immediately preceding the commencement of this case.
If the debtor is a corporation, list the names, addresses, taxpayer identification numbers, nature of the businesses, and beginning andending dates of all businesses in which the debtor was a partner or owned 5 percent or more of the voting or equity securities within sixyears immediately preceding the commencement of this case.
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7
NAME
LAST FOUR DIGITS OFSOCIAL-SECURITY OROTHER INDIVIDUALTAXPAYER-I.D. NO.(ITIN)/ COMPLETE EIN ADDRESS NATURE OF BUSINESS
BEGINNING ANDENDING DATES
Rising Star, Inc. 95-2896544 6808 Las Olas Way
Malibu, CA 90265
Loan out company for
William Busey
7/1974 - 2005
Lighting Strikes, Inc 95-4232824 6808 Las Olas WayMalibu, CA 90265
Loan out company forWilliam Busey
1/1990 - June 2011
Standing RockEntertainment, Inc
6797 16027 Brookhurst Street#G274Fountain Valley, CA 92708
Loan out company forWilliam Busey
2011 - present
None
b. Identify any business listed in response to subdivision a., above, that is "single asset real estate" as defined in 11 U.S.C. 101.
NAME ADDRESS
The following questions are to be completed by every debtor that is a corporation or partnership and by any individual debtor who is or hasbeen, within six years immediately preceding the commencement of this case, any of the following: an officer, director, managing executive, orowner of more than 5 percent of the voting or equity securities of a corporation; a partner, other than a limited partner, of a partnership, a soleproprietor, or self-employed in a trade, profession, or other activity, either full- or part-time.
(An individual or joint debtor should complete this portion of the statementonly if the debtor is or has been in business, as defined above,within six years immediately preceding the commencement of this case. A debtor who has not been in business within those six years should godirectly to the signature page.)
None
19. Books, records and financial statements
a. List all bookkeepers and accountants who within two years immediately preceding the filing of this bankruptcy case kept orsupervised the keeping of books of account and records of the debtor.
NAME AND ADDRESS DATES SERVICES RENDERED
Michael Medkiff, CPAWilshire Blvd. 2009 - present
None
b. List all firms or individuals who within the two years immediately preceding the filing of this bankruptcy case have audited the booksof account and records, or prepared a financial statement of the debtor.
NAME ADDRESS DATES SERVICES RENDERED
None
c. List all firms or individuals who at the time of the commencement of this case were in possession of the books of account and recordsof the debtor. If any of the books of account and records are not available, explain.
NAME ADDRESSWilliam Busey 6808 Las Olas Way
Malibu, CA 90265
None
d. List all financial institutions, creditors and other parties, including mercantile and trade agencies, to whom a financial statement wasissued by the debtor within two years immediately preceding the commencement of this case.
NAME AND ADDRESS DATE ISSUED
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None
20. Inventories
a. List the dates of the last two inventories taken of your property, the name of the person who supervised the taking of each inventory,and the dollar amount and basis of each inventory.
DATE OF INVENTORY INVENTORY SUPERVISORDOLLAR AMOUNT OF INVENTORY(Specify cost, market or other basis)
None
b. List the name and address of the person having possession of the records of each of the two inventories reported in a., above.
DATE OF INVENTORYNAME AND ADDRESSES OF CUSTODIAN OF INVENTORYRECORDS
None
21 . Current Partners, Officers, Directors and Shareholders
a. If the debtor is a partnership, list the nature and percentage of partnership interest of each member of the partnership.
NAME AND ADDRESS NATURE OF INTEREST PERCENTAGE OF INTEREST
None
b. If the debtor is a corporation, list all officers and directors of the corporation, and each stockholder who directly or indirectly owns,
controls, or holds 5 percent or more of the voting or equity securities of the corporation.
NAME AND ADDRESS TITLENATURE AND PERCENTAGEOF STOCK OWNERSHIP
None
22 . Former partners, officers, directors and shareholders
a. If the debtor is a partnership, list each member who withdrew from the partnership within one year immediately preceding thecommencement of this case.
NAME ADDRESS DATE OF WITHDRAWAL
None
b. If the debtor is a corporation, list all officers, or directors whose relationship with the corporation terminated within one yearimmediately preceding the commencement of this case.
NAME AND ADDRESS TITLE DATE OF TERMINATION
None
23 . Withdrawals from a partnership or distributions by a corporation
If the debtor is a partnership or corporation, list all withdrawals or distributions credited or given to an insider, including compensationin any form, bonuses, loans, stock redemptions, options exercised and any other perquisite during one year immediately preceding thecommencement of this case.
NAME & ADDRESSOF RECIPIENT,RELATIONSHIP TO DEBTOR
DATE AND PURPOSEOF WITHDRAWAL
AMOUNT OF MONEYOR DESCRIPTION ANDVALUE OF PROPERTY
None
24. Tax Consolidation Group.
If the debtor is a corporation, list the name and federal taxpayer identification number of the parent corporation of any consolidatedgroup for tax purposes of which the debtor has been a member at any time within six years immediately preceding the commencementof the case.
NAME OF PARENT CORPORATION TAXPAYER IDENTIFICATION NUMBER (EIN)
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None
25. Pension Funds.
If the debtor is not an individual, list the name and federal taxpayer-identification number of any pension fund to which the debtor, as anemployer, has been responsible for contributing at any time within six years immediately preceding the commencement of the case.
NAME OF PENSION FUND TAXPAYER IDENTIFICATION NUMBER (EIN)
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10
DECLARATION UNDER PENALTY OF PERJURY BY INDIVIDUAL DEBTOR
I declare under penalty of perjury that I have read the answers contained in the foregoing statement of financial affairs and any attachments theretoand that they are true and correct.
Date February 15, 2012 Signature /s/ William BuseyWilliam Busey
Debtor
Penalty for making a false statement: Fine of up to $500,000 or imprisonment for up to 5 years, or both. 18 U.S.C. 152 and 3571
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B8 (Form 8) (12/08)
United States Bankruptcy CourtCentral District of California
In re William Busey Case No. 1:12-bk-11182Debtor(s) Chapter 7
CHAPTER 7 INDIVIDUAL DEBTOR'S STATEMENT OF INTENTION
PART A - Debts secured by property of the estate. (Part A must be fully completed for EACH debt which is secured byproperty of the estate. Attach additional pages if necessary.)
Property No. 1
Creditor's Name:-NONE-
Describe Property Securing Debt:
Property will be (check one): Surrendered Retained
If retaining the property, I intend to (check at least one):
Redeem the property Reaffirm the debt Other. Explain (for example, avoid lien using 11 U.S.C. 522(f)).
Property is (check one): Claimed as Exempt Not claimed as exempt
PART B - Personal property subject to unexpired leases. (All three columns of Part B must be completed for each unexpired lease.Attach additional pages if necessary.)
Property No. 1
Lessor's Name:
-NONE-
Describe Leased Property: Lease will be Assumed pursuant to 11
U.S.C. 365(p)(2): YES NO
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B8 (Form 8) (12/08) Page 2
I declare under penalty of perjury that the above indicates my intention as to any property of my estate securing a debt and/orpersonal property subject to an unexpired lease.
Date February 15, 2012 Signature /s/ William BuseyWilliam Busey
Debtor
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Form B203 - Disclosure of Compensation of Attorney for Debtor - (1/88) 1998 USBC, Central District of California
UNITED STATES BANKRUPTCY COURTCENTRAL DISTRICT OF CALIFORNIA
In re
William Busey
Debtor.
Case No.: 1:12-bk-11182
DISCLOSURE OF COMPENSATIONOF ATTORNEY FOR DEBTOR
1. Pursuant to 11 U.S.C. 329(a) and Bankruptcy Rule 2016(b), I certify that I am the attorney for the above-named debtor(s) andthat compensation paid to me within one year before the filing of the petition in bankruptcy, or agreed to be paid to me, forservices rendered or to be rendered on behalf of the debtor(s) in contemplation of or in connection with the bankruptcy case is asfollows:
For legal services, I have agreed to accept $ 8,000.00
Prior to the filing of this statement I have received $ 8,000.00
Balance Due $ 0.0