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Click here or scroll down to respond to this candidate 7/19/22 4:30PM
Fill in this information to identify your case:
United States Bankruptcy Court for the:
DISTRICT OF KANSAS
Case number (if known) Chapter you are filing under:
Chapter 7
Chapter 11
Chapter 12
Chapter 13 Check if this is an
amended filing
Official Form 101
Voluntary Petition for Individuals Filing for Bankruptcy 06/22
The bankruptcy forms use you and Debtor 1 to refer to a debtor filing alone. A married couple may file a bankruptcy case together called a joint
case and in joint cases, these forms use you to ask for information from both debtors. For example, if a form asks, Do you own a car, the answer
would be yes if either debtor owns a car. When information is needed about the spouses separately, the form uses Debtor 1 and Debtor 2 to distinguish
between them. In joint cases, one of the spouses must report information as Debtor 1 and the other as Debtor 2. The same person must be Debtor 1 in
all of the forms.
Be as complete and accurate as possible. If two married people are filing together, both are equally responsible for supplying correct information. If
more space is needed, attach a separate sheet to this form. On the top of any additional pages, write your name and case number (if known). Answer
every question.
Part 1: Identify Yourself
About Debtor 1: About Debtor 2 (Spouse Only in a Joint Case):
1. Your full name
Write the name that is on Richard
your government-issued First name First name
picture identification (for
example, your driver's Dwane
license or passport). Middle name Middle name
Bring your picture
identification to your
Englebrecht
meeting with the trustee. Last name and Suffix (Sr., Jr., II, III) Last name and Suffix (Sr., Jr., II, III)
2. All other names you have
used in the last 8 years
Include your married or
maiden names.
3. Only the last 4 digits of
your Social Security
number or federal xxx-xx-8620
Individual Taxpayer
Identification number
(ITIN)
ENVPHONE NUMBER AVAILABLE-EBFD-0134-BFEA
07/19/2022 17:44
Official Form 101 PM CDT Voluntary Petition for Individuals Filing for Bankruptcy page 1
7/19/22 4:30PM
Debtor 1 Richard Dwane Englebrecht Case number (if known)
About Debtor 1: About Debtor 2 (Spouse Only in a Joint Case):
4. Any business names and
Employer Identification
Numbers (EIN) you have I have not used any business name or EINs. I have not used any business name or EINs.
used in the last 8 years
Include trade names and Business name(s) Business name(s)
doing business as names
EIN EIN
5. Where you live If Debtor 2 lives at a different address:
328 Beaumont Street
Eudora, KS 66025
Number, Street, City, State & ZIP Code Number, Street, City, State & ZIP Code
Douglas
County County
If your mailing address is different from the one If Debtor 2's mailing address is different from yours, fill it
above, fill it in here. Note that the court will send any in here. Note that the court will send any notices to this
notices to you at this mailing address. mailing address.
Number, P.O. Box, Street, City, State & ZIP Code Number, P.O. Box, Street, City, State & ZIP Code
6. Why you are choosing Check one: Check one:
this district to file for
bankruptcy Over the last 180 days before filing this petition, Over the last 180 days before filing this petition, I
I have lived in this district longer than in any have lived in this district longer than in any other
other district. district.
I have another reason. I have another reason.
Explain. (See 28 U.S.C. 1408.) Explain. (See 28 U.S.C. 1408.)
ENVPHONE NUMBER AVAILABLE-EBFD-0134-BFEA
07/19/2022 17:44
Official Form 101PM CDT Voluntary Petition for Individuals Filing for Bankruptcy page 2
7/19/22 4:30PM
Debtor 1 Richard Dwane Englebrecht Case number (if known)
Part 2: Tell the Court About Your Bankruptcy Case
7. The chapter of the Check one. (For a brief description of each, see Notice Required by 11 U.S.C. 342(b) for Individuals Filing for Bankruptcy
Bankruptcy Code you are (Form 2010)). Also, go to the top of page 1 and check the appropriate box.
choosing to file under
Chapter 7
Chapter 11
Chapter 12
Chapter 13
8. How you will pay the fee I will pay the entire fee when I file my petition. Please check with the clerk s office in your local court for more details
about how you may pay. Typically, if you are paying the fee yourself, you may pay with cash, cashier s check, or money
order. If your attorney is submitting your payment on your behalf, your attorney may pay with a credit card or check with
a pre-printed address.
I need to pay the fee in installments. If you choose this option, sign and attach the Application for Individuals to Pay
The Filing Fee in Installments (Official Form 103A).
I request that my fee be waived (You may request this option only if you are filing for Chapter 7. By law, a judge may,
but is not required to, waive your fee, and may do so only if your income is less than 150% of the official poverty line that
applies to your family size and you are unable to pay the fee in installments). If you choose this option, you must fill out
the Application to Have the Chapter 7 Filing Fee Waived (Official Form 103B) and file it with your petition.
9. Have you filed for
bankruptcy within the
No.
last 8 years? Yes.
District When Case number
District When Case number
District When Case number
10. Are any bankruptcy No
cases pending or being
filed by a spouse who is Yes.
not filing this case with
you, or by a business
partner, or by an
affiliate?
Debtor Relationship to you
District When Case number, if known
Debtor Relationship to you
District When Case number, if known
11. Do you rent your No. Go to line 12.
residence?
Yes. Has your landlord obtained an eviction judgment against you?
No. Go to line 12.
Yes. Fill out Initial Statement About an Eviction Judgment Against You (Form 101A) and file it as part of
this bankruptcy petition.
ENVPHONE NUMBER AVAILABLE-EBFD-0134-BFEA
07/19/2022 17:44
Official Form 101PM CDT Voluntary Petition for Individuals Filing for Bankruptcy page 3
7/19/22 4:30PM
Debtor 1 Richard Dwane Englebrecht Case number (if known)
Part 3: Report About Any Businesses You Own as a Sole Proprietor
12. Are you a sole proprietor
of any full- or part-time No. Go to Part 4.
business?
Yes. Name and location of business
A sole proprietorship is a
business you operate as Name of business, if any
an individual, and is not a
separate legal entity such
as a corporation,
partnership, or LLC.
Number, Street, City, State & ZIP Code
If you have more than one
sole proprietorship, use a
separate sheet and attach
it to this petition. Check the appropriate box to describe your business:
Health Care Business (as defined in 11 U.S.C. 101(27A))
Single Asset Real Estate (as defined in 11 U.S.C. 101(51B))
Stockbroker (as defined in 11 U.S.C. 101(53A))
Commodity Broker (as defined in 11 U.S.C. 101(6))
None of the above
13. Are you filing under If you are filing under Chapter 11, the court must know whether you are a small business debtor or a debtor choosing to
Chapter 11 of the proceed under Subchapter V so that it can set appropriate deadlines. If you indicate that you are a small business debtor or
Bankruptcy Code, and you are choosing to proceed under Subchapter V, you must attach your most recent balance sheet, statement of operations,
are you a small business cash-flow statement, and federal income tax return or if any of these documents do not exist, follow the procedure in 11 U.S.C.
debtor or a debtor as 1116(1)(B).
defined by 11 U.S. C. No. I am not filing under Chapter 11.
1182(1)?
For a definition of small
business debtor, see 11 No. I am filing under Chapter 11, but I am NOT a small business debtor according to the definition in the Bankruptcy
Code.
U.S.C. 101(51D).
Yes. I am filing under Chapter 11, I am a small business debtor according to the definition in the Bankruptcy Code, and
I do not choose to proceed under Subchapter V of Chapter 11.
Yes. I am filing under Chapter 11, I am a debtor according to the definition in 1182(1) of the Bankruptcy Code, and I
choose to proceed under Subchapter V of Chapter 11.
Part 4: Report if You Own or Have Any Hazardous Property or Any Property That Needs Immediate Attention
14. Do you own or have any
property that poses or is
No.
alleged to pose a threat Yes.
of imminent and What is the hazard?
identifiable hazard to
public health or safety?
Or do you own any
property that needs If immediate attention is
immediate attention? needed, why is it needed?
For example, do you own
perishable goods, or
livestock that must be fed, Where is the property?
or a building that needs
urgent repairs?
Number, Street, City, State & Zip Code
ENVPHONE NUMBER AVAILABLE-EBFD-0134-BFEA
07/19/2022 17:44
Official Form 101PM CDT Voluntary Petition for Individuals Filing for Bankruptcy page 4
7/19/22 4:30PM
Debtor 1 Richard Dwane Englebrecht Case number (if known)
Part 5: Explain Your Efforts to Receive a Briefing About Credit Counseling
About Debtor 1: About Debtor 2 (Spouse Only in a Joint Case):
15. Tell the court whether You must check one: You must check one:
you have received a I received a briefing from an approved credit I received a briefing from an approved credit
briefing about credit counseling agency within the 180 days before I counseling agency within the 180 days before I filed
counseling. filed this bankruptcy petition, and I received a this bankruptcy petition, and I received a certificate of
certificate of completion. completion.
The law requires that you
receive a briefing about Attach a copy of the certificate and the payment Attach a copy of the certificate and the payment plan, if
credit counseling before plan, if any, that you developed with the agency. any, that you developed with the agency.
you file for bankruptcy.
You must truthfully check I received a briefing from an approved credit I received a briefing from an approved credit
one of the following counseling agency within the 180 days before I counseling agency within the 180 days before I filed
choices. If you cannot do filed this bankruptcy petition, but I do not have this bankruptcy petition, but I do not have a certificate
so, you are not eligible to a certificate of completion. of completion.
file.
Within 14 days after you file this bankruptcy Within 14 days after you file this bankruptcy petition, you
If you file anyway, the court petition, you MUST file a copy of the certificate and MUST file a copy of the certificate and payment plan, if
can dismiss your case, you payment plan, if any. any.
will lose whatever filing fee
you paid, and your I certify that I asked for credit counseling I certify that I asked for credit counseling services
creditors can begin services from an approved agency, but was from an approved agency, but was unable to obtain
collection activities again. unable to obtain those services during the 7 those services during the 7 days after I made my
days after I made my request, and exigent request, and exigent circumstances merit a 30-day
circumstances merit a 30-day temporary waiver temporary waiver of the requirement.
of the requirement.
To ask for a 30-day temporary waiver of the requirement,
To ask for a 30-day temporary waiver of the attach a separate sheet explaining what efforts you made
requirement, attach a separate sheet explaining to obtain the briefing, why you were unable to obtain it
what efforts you made to obtain the briefing, why before you filed for bankruptcy, and what exigent
you were unable to obtain it before you filed for circumstances required you to file this case.
bankruptcy, and what exigent circumstances
required you to file this case. Your case may be dismissed if the court is dissatisfied
with your reasons for not receiving a briefing before you
Your case may be dismissed if the court is filed for bankruptcy.
dissatisfied with your reasons for not receiving a
briefing before you filed for bankruptcy. If the court is satisfied with your reasons, you must still
If the court is satisfied with your reasons, you must receive a briefing within 30 days after you file. You must
still receive a briefing within 30 days after you file. file a certificate from the approved agency, along with a
You must file a certificate from the approved copy of the payment plan you developed, if any. If you do
agency, along with a copy of the payment plan you not do so, your case may be dismissed.
developed, if any. If you do not do so, your case
Any extension of the 30-day deadline is granted only for
may be dismissed.
cause and is limited to a maximum of 15 days.
Any extension of the 30-day deadline is granted
only for cause and is limited to a maximum of 15
days.
I am not required to receive a briefing about I am not required to receive a briefing about credit
credit counseling because of: counseling because of:
Incapacity. Incapacity.
I have a mental illness or a mental deficiency I have a mental illness or a mental deficiency that
that makes me incapable of realizing or makes me incapable of realizing or making rational
making rational decisions about finances. decisions about finances.
Disability. Disability.
My physical disability causes me to be My physical disability causes me to be unable to
unable to participate in a briefing in person, participate in a briefing in person, by phone, or
by phone, or through the internet, even after I through the internet, even after I reasonably tried to
reasonably tried to do so. do so.
Active duty. Active duty.
I am currently on active military duty in a I am currently on active military duty in a military
military combat zone. combat zone.
If you believe you are not required to receive a If you believe you are not required to receive a briefing
briefing about credit counseling, you must file a about credit counseling, you must file a motion for waiver
motion for waiver credit counseling with the court. of credit counseling with the court.
ENVPHONE NUMBER AVAILABLE-EBFD-0134-BFEA
07/19/2022 17:44
Official Form 101PM CDT Voluntary Petition for Individuals Filing for Bankruptcy page 5
7/19/22 4:30PM
Debtor 1 Richard Dwane Englebrecht Case number (if known)
Part 6: Answer These Questions for Reporting Purposes
16. What kind of debts do 16a. Are your debts primarily consumer debts? Consumer debts are defined in 11 U.S.C. 101(8) as incurred by an
you have? individual primarily for a personal, family, or household purpose.
No. Go to line 16b.
Yes. Go to line 17.
16b. Are your debts primarily business debts? Business debts are debts that you incurred to obtain
money for a business or investment or through the operation of the business or investment.
No. Go to line 16c.
Yes. Go to line 17.
16c. State the type of debts you owe that are not consumer debts or business debts
17. Are you filing under No. I am not filing under Chapter 7. Go to line 18.
Chapter 7?
Do you estimate that Yes. I am filing under Chapter 7. Do you estimate that after any exempt property is excluded and administrative expenses
after any exempt are paid that funds will be available to distribute to unsecured creditors?
property is excluded and
administrative expenses No
are paid that funds will
be available for Yes
distribution to unsecured
creditors?
18. How many Creditors do 1-49 1,000-5,000 25,001-50,000
you estimate that you 5001-10,000 50,001-100,000
owe? 50-99
100-199 10,001-25,000 More than100,000
200-999
19. How much do you $0 - $50,000 $1,000,001 - $10 million $500,000,001 - $1 billion
estimate your assets to
be worth? $50,001 - $100,000 $10,000,001 - $50 million $1,000,000,001 - $10 billion
$100,001 - $500,000 $50,000,001 - $100 million $10,000,000,001 - $50 billion
$500,001 - $1 million $100,000,001 - $500 million More than $50 billion
20. How much do you $0 - $50,000 $1,000,001 - $10 million $500,000,001 - $1 billion
estimate your liabilities $50,001 - $100,000 $10,000,001 - $50 million $1,000,000,001 - $10 billion
to be?
$100,001 - $500,000 $50,000,001 - $100 million $10,000,000,001 - $50 billion
$500,001 - $1 million $100,000,001 - $500 million More than $50 billion
Part 7: Sign Below
For you I have examined this petition, and I declare under penalty of perjury that the information provided is true and correct.
If I have chosen to file under Chapter 7, I am aware that I may proceed, if eligible, under Chapter 7, 11,12, or 13 of title 11,
United States Code. I understand the relief available under each chapter, and I choose to proceed under Chapter 7.
If no attorney represents me and I did not pay or agree to pay someone who is not an attorney to help me fill out this
document, I have obtained and read the notice required by 11 U.S.C. 342(b).
I request relief in accordance with the chapter of title 11, United States Code, specified in this petition.
I understand making a false statement, concealing property, or obtaining money or property by fraud in connection with a
bankruptcy case can result in fines up to $250,000, or imprisonment for up to 20 years, or both. 18 U.S.C. 152, 1341, 1519,
and 3571.
/s/ Richard Dwane Englebrecht
Richard Dwane Englebrecht Signature of Debtor 2
Signature of Debtor 1
07/19/2022
Executed on July 19, 2022 Executed on
MM / DD / YYYY MM / DD / YYYY
ENVPHONE NUMBER AVAILABLE-EBFD-0134-BFEA
07/19/2022 17:44
Official Form 101PM CDT Voluntary Petition for Individuals Filing for Bankruptcy page 6
7/19/22 4:30PM
Debtor 1 Richard Dwane Englebrecht Case number (if known)
For your attorney, if you are I, the attorney for the debtor(s) named in this petition, declare that I have informed the debtor(s) about eligibility to proceed
represented by one under Chapter 7, 11, 12, or 13 of title 11, United States Code, and have explained the relief available under each chapter
for which the person is eligible. I also certify that I have delivered to the debtor(s) the notice required by 11 U.S.C. 342(b)
If you are not represented by and, in a case in which 707(b)(4)(D) applies, certify that I have no knowledge after an inquiry that the information in the
an attorney, you do not need schedules filed with the petition is incorrect.
to file this page.
07/19/2022
/s/ Michael J. Watton, Esq. Date July 19, 2022
Signature of Attorney for Debtor MM / DD / YYYY
Michael J. Watton, Esq.
Printed name
Watton Law Group
Firm name
Watton Law Group
301 West Wisconsin Avenue, 5th Floor
Milwaukee, WI 53203
Number, Street, City, State & ZIP Code
Contact phone PHONE NUMBER AVAILABLE Email address EMAIL AVAILABLE
78431 KS
Bar number & State
ENVPHONE NUMBER AVAILABLE-EBFD-0134-BFEA
07/19/2022 17:44
Official Form 101PM CDT Voluntary Petition for Individuals Filing for Bankruptcy page 7
7/19/22 4:30PM
Fill in this information to identify your case and this filing:
Debtor 1 Richard Dwane Englebrecht
First Name Middle Name Last Name
Debtor 2
(Spouse, if filing) First Name Middle Name Last Name
United States Bankruptcy Court for the: DISTRICT OF KANSAS
Case number Check if this is an
amended filing
Official Form 106A/B
Schedule A/B: Property 12/15
In each category, separately list and describe items. List an asset only once. If an asset fits in more than one category, list the asset in the category where you
think it fits best. Be as complete and accurate as possible. If two married people are filing together, both are equally responsible for supplying correct
information. If more space is needed, attach a separate sheet to this form. On the top of any additional pages, write your name and case number (if known).
Answer every question.
Part 1: Describe Each Residence, Building, Land, or Other Real Estate You Own or Have an Interest In
1. Do you own or have any legal or equitable interest in any residence, building, land, or similar property?
No. Go to Part 2.
Yes. Where is the property?
Part 2: Describe Your Vehicles
Do you own, lease, or have legal or equitable interest in any vehicles, whether they are registered or not? Include any vehicles you own that
someone else drives. If you lease a vehicle, also report it on Schedule G: Executory Contracts and Unexpired Leases.
3. Cars, vans, trucks, tractors, sport utility vehicles, motorcycles
No
Yes
3.1 Make: Chevrolet Who has an interest in the property? Check one Do not deduct secured claims or exemptions. Put
the amount of any secured claims on Schedule D:
Model: 3500 Debtor 1 only Creditors Who Have Claims Secured by Property.
Year: 2016 Debtor 2 only Current value of the Current value of the
Approximate mileage: 80,001 Debtor 1 and Debtor 2 only entire property? portion you own?
Other information: At least one of the debtors and another
Check if this is community property $35,000.00 $35,000.00
(see instructions)
3.2 Make: Chevrolet Who has an interest in the property? Check one Do not deduct secured claims or exemptions. Put
the amount of any secured claims on Schedule D:
Model: Blazer Debtor 1 only Creditors Who Have Claims Secured by Property.
Year: 2019 Debtor 2 only Current value of the Current value of the
Approximate mileage: 30,001 Debtor 1 and Debtor 2 only entire property? portion you own?
Other information: At least one of the debtors and another
Check if this is community property $30,000.00 $30,000.00
(see instructions)
Official Form 106A/B Schedule A/B: Property page 1
ENVPHONE NUMBER AVAILABLE-EBFD-0134-BFEA
07/19/2022 17:44 PM CDT
7/19/22 4:30PM
Debtor 1 Richard Dwane Englebrecht Case number (if known)
4. Watercraft, aircraft, motor homes, ATVs and other recreational vehicles, other vehicles, and accessories
Examples: Boats, trailers, motors, personal watercraft, fishing vessels, snowmobiles, motorcycle accessories
No
Yes
4.1 Make: Shed Who has an interest in the property? Check one
Do not deduct secured claims or exemptions. Put
the amount of any secured claims on Schedule D:
Model: Debtor 1 only Creditors Who Have Claims Secured by Property.
Year: Debtor 2 only Current value of the Current value of the
Debtor 1 and Debtor 2 only entire property? portion you own?
Other information: At least one of the debtors and another
Check if this is community property $4,000.00 $4,000.00
(see instructions)
5 Add the dollar value of the portion you own for all of your entries from Part 2, including any entries for
.pages you have attached for Part 2. Write that number here.............................................................................=> $69,000.00
Part 3: Describe Your Personal and Household Items
Do you own or have any legal or equitable interest in any of the following items? Current value of the
portion you own?
Do not deduct secured
claims or exemptions.
6. Household goods and furnishings
Examples: Major appliances, furniture, linens, china, kitchenware
No
Yes. Describe.....
Living Room Set, Dining Room Set, Kitchen Set, Miscellaneous
Appliances, Bedroom Set, Deep Freezer, Lawnmower, Miscellaneous
Tools, Washer and Dryer. $6,450.00
7. Electronics
Examples: Televisions and radios; audio, video, stereo, and digital equipment; computers, printers, scanners; music collections; electronic devices
including cell phones, cameras, media players, games
No
Yes. Describe.....
Three Televisions, Cell Phone and Computer. $1,700.00
8. Collectibles of value
Examples: Antiques and figurines; paintings, prints, or other artwork; books, pictures, or other art objects; stamp, coin, or baseball card collections;
other collections, memorabilia, collectibles
No
Yes. Describe.....
9. Equipment for sports and hobbies
Examples: Sports, photographic, exercise, and other hobby equipment; bicycles, pool tables, golf clubs, skis; canoes and kayaks; carpentry tools;
musical instruments
No
Yes. Describe.....
10. Firearms
Examples: Pistols, rifles, shotguns, ammunition, and related equipment
No
Yes. Describe.....
40 Calibur Handgun $350.00
Official Form 106A/B Schedule A/B: Property page 2
ENVPHONE NUMBER AVAILABLE-EBFD-0134-BFEA
07/19/2022 17:44 PM CDT
7/19/22 4:30PM
Debtor 1 Richard Dwane Englebrecht Case number (if known)
11. Clothes
Examples: Everyday clothes, furs, leather coats, designer wear, shoes, accessories
No
Yes. Describe.....
Clothing $50.00
12. Jewelry
Examples: Everyday jewelry, costume jewelry, engagement rings, wedding rings, heirloom jewelry, watches, gems, gold, silver
No
Yes. Describe.....
Wedding Jewelry $250.00
13. Non-farm animals
Examples: Dogs, cats, birds, horses
No
Yes. Describe.....
Dog $5.00
14. Any other personal and household items you did not already list, including any health aids you did not list
No
Yes. Give specific information.....
15. Add the dollar value of all of your entries from Part 3, including any entries for pages you have attached
for Part 3. Write that number here .............................................................................. $8,805.00
Part 4: Describe Your Financial Assets
Do you own or have any legal or equitable interest in any of the following? Current value of the
portion you own?
Do not deduct secured
claims or exemptions.
16. Cash
Examples: Money you have in your wallet, in your home, in a safe deposit box, and on hand when you file your petition
No
Yes................................................................................................................
17. Deposits of money
Examples: Checking, savings, or other financial accounts; certificates of deposit; shares in credit unions, brokerage houses, and other similar
institutions. If you have multiple accounts with the same institution, list each.
No
Yes........................ Institution name:
17.1. Checking Commerce Bank $500.00
18. Bonds, mutual funds, or publicly traded stocks
Examples: Bond funds, investment accounts with brokerage firms, money market accounts
No
Yes.................. Institution or issuer name:
19. Non-publicly traded stock and interests in incorporated and unincorporated businesses, including an interest in an LLC, partnership, and
joint venture
No
Yes. Give specific information about them...................
Name of entity: % of ownership:
Official Form 106A/B Schedule A/B: Property page 3
ENVPHONE NUMBER AVAILABLE-EBFD-0134-BFEA
07/19/2022 17:44 PM CDT
7/19/22 4:30PM
Debtor 1 Richard Dwane Englebrecht Case number (if known)
20. Government and corporate bonds and other negotiable and non-negotiable instruments
Negotiable instruments include personal checks, cashiers checks, promissory notes, and money orders.
Non-negotiable instruments are those you cannot transfer to someone by signing or delivering them.
No
Yes. Give specific information about them
Issuer name:
21. Retirement or pension accounts
Examples: Interests in IRA, ERISA, Keogh, 401(k), 403(b), thrift savings accounts, or other pension or profit-sharing plans
No
Yes. List each account separately.
Type of account: Institution name:
22. Security deposits and prepayments
Your share of all unused deposits you have made so that you may continue service or use from a company
Examples: Agreements with landlords, prepaid rent, public utilities (electric, gas, water), telecommunications companies, or others
No
Yes. ..................... Institution name or individual:
23. Annuities (A contract for a periodic payment of money to you, either for life or for a number of years)
No
Yes............. Issuer name and description.
24. Interests in an education IRA, in an account in a qualified ABLE program, or under a qualified state tuition program.
26 U.S.C. 530(b)(1), 529A(b), and 529(b)(1).
No
Yes............. Institution name and description. Separately file the records of any interests.11 U.S.C. 521(c):
25. Trusts, equitable or future interests in property (other than anything listed in line 1), and rights or powers exercisable for your benefit
No
Yes. Give specific information about them...
26. Patents, copyrights, trademarks, trade secrets, and other intellectual property
Examples: Internet domain names, websites, proceeds from royalties and licensing agreements
No
Yes. Give specific information about them...
27. Licenses, franchises, and other general intangibles
Examples: Building permits, exclusive licenses, cooperative association holdings, liquor licenses, professional licenses
No
Yes. Give specific information about them...
Money or property owed to you? Current value of the
portion you own?
Do not deduct secured
claims or exemptions.
28. Tax refunds owed to you
No
Yes. Give specific information about them, including whether you already filed the returns and the tax years.......
29. Family support
Examples: Past due or lump sum alimony, spousal support, child support, maintenance, divorce settlement, property settlement
No
Yes. Give specific information......
30. Other amounts someone owes you
Examples: Unpaid wages, disability insurance payments, disability benefits, sick pay, vacation pay, workers compensation, Social Security
benefits; unpaid loans you made to someone else
No
Yes. Give specific information..
Official Form 106A/B Schedule A/B: Property page 4
ENVPHONE NUMBER AVAILABLE-EBFD-0134-BFEA
07/19/2022 17:44 PM CDT
7/19/22 4:30PM
Debtor 1 Richard Dwane Englebrecht Case number (if known)
31. Interests in insurance policies
Examples: Health, disability, or life insurance; health savings account (HSA); credit, homeowner s, or renter s insurance
No
Yes. Name the insurance company of each policy and list its value.
Company name: Beneficiary: Surrender or refund
value:
32. Any interest in property that is due you from someone who has died
If you are the beneficiary of a living trust, expect proceeds from a life insurance policy, or are currently entitled to receive property because
someone has died.
No
Yes. Give specific information..
33. Claims against third parties, whether or not you have filed a lawsuit or made a demand for payment
Examples: Accidents, employment disputes, insurance claims, or rights to sue
No
Yes. Describe each claim.........
34. Other contingent and unliquidated claims of every nature, including counterclaims of the debtor and rights to set off claims
No
Yes. Describe each claim.........
35. Any financial assets you did not already list
No
Yes. Give specific information..
36. Add the dollar value of all of your entries from Part 4, including any entries for pages you have attached
for Part 4. Write that number here..................................................................................................................... $500.00
Part 5: Describe Any Business-Related Property You Own or Have an Interest In. List any real estate in Part 1.
37. Do you own or have any legal or equitable interest in any business-related property?
No. Go to Part 6.
Yes. Go to line 38.
Part 6: Describe Any Farm- and Commercial Fishing-Related Property You Own or Have an Interest In.
If you own or have an interest in farmland, list it in Part 1.
46. Do you own or have any legal or equitable interest in any farm- or commercial fishing-related property?
No. Go to Part 7.
Yes. Go to line 47.
Part 7: Describe All Property You Own or Have an Interest in That You Did Not List Above
53. Do you have other property of any kind you did not already list?
Examples: Season tickets, country club membership
No
Yes. Give specific information.........
54. Add the dollar value of all of your entries from Part 7. Write that number here .................................... $0.00
Official Form 106A/B Schedule A/B: Property page 5
ENVPHONE NUMBER AVAILABLE-EBFD-0134-BFEA
07/19/2022 17:44 PM CDT
7/19/22 4:30PM
Debtor 1 Richard Dwane Englebrecht Case number (if known)
Part 8: List the Totals of Each Part of this Form
55. Part 1: Total real estate, line 2 ...................................................................................................................... $0.00
56. Part 2: Total vehicles, line 5 $69,000.00
57. Part 3: Total personal and household items, line 15 $8,805.00
58. Part 4: Total financial assets, line 36 $500.00
59. Part 5: Total business-related property, line 45 $0.00
60. Part 6: Total farm- and fishing-related property, line 52 $0.00
61. Part 7: Total other property not listed, line 54 + $0.00
62. Total personal property. Add lines 56 through 61... $78,305.00 Copy personal property total $78,305.00
63. Total of all property on Schedule A/B. Add line 55 + line 62 $78,305.00
Official Form 106A/B Schedule A/B: Property page 6
ENVPHONE NUMBER AVAILABLE-EBFD-0134-BFEA
07/19/2022 17:44 PM CDT
7/19/22 4:30PM
Fill in this information to identify your case:
Debtor 1 Richard Dwane Englebrecht
First Name Middle Name Last Name
Debtor 2
(Spouse if, filing) First Name Middle Name Last Name
United States Bankruptcy Court for the: DISTRICT OF KANSAS
Case number
(if known)
Check if this is an
amended filing
Official Form 106C
Schedule C: The Property You Claim as Exempt 4/22
Be as complete and accurate as possible. If two married people are filing together, both are equally responsible for supplying correct information. Using
the property you listed on Schedule A/B: Property (Official Form 106A/B) as your source, list the property that you claim as exempt. If more space is
needed, fill out and attach to this page as many copies of Part 2: Additional Page as necessary. On the top of any additional pages, write your name and
case number (if known).
For each item of property you claim as exempt, you must specify the amount of the exemption you claim. One way of doing so is to state a
specific dollar amount as exempt. Alternatively, you may claim the full fair market value of the property being exempted up to the amount of
any applicable statutory limit. Some exemptions such as those for health aids, rights to receive certain benefits, and tax-exempt retirement
funds may be unlimited in dollar amount. However, if you claim an exemption of 100% of fair market value under a law that limits the
exemption to a particular dollar amount and the value of the property is determined to exceed that amount, your exemption would be limited
to the applicable statutory amount.
Part 1: Identify the Property You Claim as Exempt
1. Which set of exemptions are you claiming? Check one only, even if your spouse is filing with you.
You are claiming state and federal nonbankruptcy exemptions. 11 U.S.C. 522(b)(3)
You are claiming federal exemptions. 11 U.S.C. 522(b)(2)
2. For any property you list on Schedule A/B that you claim as exempt, fill in the information below.
Brief description of the property and line on Current value of the Amount of the exemption you claim Specific laws that allow exemption
Schedule A/B that lists this property portion you own
Copy the value from Check only one box for each exemption.
Schedule A/B
2016 Chevrolet 3500 80,001 miles Kan. Stat. Ann. 60-2304(c)
Line from Schedule A/B: 3.1
$35,000.00 $3,464.00
100% of fair market value, up to
any applicable statutory limit
Living Room Set, Dining Room Set, Kan. Stat. Ann. 60-2304(a)
Kitchen Set, Miscellaneous Appliances,
$6,450.00 $6,450.00
Bedroom Set, Deep Freezer, 100% of fair market value, up to
Lawnmower, Miscellaneous Tools, any applicable statutory limit
Washer and Dryer.
Line from Schedule A/B: 6.1
Three Televisions, Cell Phone and Kan. Stat. Ann. 60-2304(a)
Computer.
$1,700.00 $1,700.00
Line from Schedule A/B: 7.1 100% of fair market value, up to
any applicable statutory limit
Clothing Kan. Stat. Ann. 60-2304(a)
Line from Schedule A/B: 11.1
$50.00 $50.00
100% of fair market value, up to
any applicable statutory limit
Official Form 106C Schedule C: The Property You Claim as Exempt page 1 of 2
ENVPHONE NUMBER AVAILABLE-EBFD-0134-BFEA
07/19/2022 17:44 PM CDT
7/19/22 4:30PM
Debtor 1 Richard Dwane Englebrecht Case number (if known)
Brief description of the property and line on Current value of the Amount of the exemption you claim Specific laws that allow exemption
Schedule A/B that lists this property portion you own
Copy the value from Check only one box for each exemption.
Schedule A/B
Wedding Jewelry Kan. Stat. Ann. 60-2304(b)
Line from Schedule A/B: 12.1
$250.00 $250.00
100% of fair market value, up to
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