throbber
Case 15-21233 Doc 1 Filed 07/13/15 Entered 07/13/15 09:39:38 Desc Main
` Document Page 1 of 5
`
`B1 (Official Form 1)(04/13)
`
`}bk1{Form 1. Voluntary Petition}bk{
`
`United States Bankruptcy Court
`District of Connecticut
`Name of Debtor (if individual, enter Last, First, Middle):
`Jackson, Curtis James III
`
`Name of Joint Debtor (Spouse) (Last, First, Middle):
`
`Voluntary Petition
`
`All Other Names used by the Debtor in the last 8 years
`(include married, maiden, and trade names):
`
`All Other Names used by the Joint Debtor in the last 8 years
`(include married, maiden, and trade names):
`
`Last four digits of Soc. Sec. or Individual-Taxpayer I.D. (ITIN)/Complete EIN
`(if more than one, state all)
`xxx-xx-0616
`Street Address of Debtor (No. and Street, City, and State):
`50 Poplar Hill Drive
`Farmington, CT
`
`County of Residence or of the Principal Place of Business:
`Hartford
`Mailing Address of Debtor (if different from street address):
`
`Last four digits of Soc. Sec. or Individual-Taxpayer I.D. (ITIN) No./Complete EIN
`(if more than one, state all)
`
`Street Address of Joint Debtor (No. and Street, City, and State):
`
`County of Residence or of the Principal Place of Business:
`
`Mailing Address of Joint Debtor (if different from street address):
`
`ZIP Code
`
`ZIP Code
`
`ZIP Code
`06032
`
`ZIP Code
`
`Location of Principal Assets of Business Debtor
`(if different from street address above):
`
`Type of Debtor
`(Form of Organization) (Check one box)
`Individual (includes Joint Debtors)
`See Exhibit D on page 2 of this form.
`Corporation (includes LLC and LLP)
`Partnership
`Other (If debtor is not one of the above entities,
`check this box and state type of entity below.)
`
`Chapter 15 Debtors
`Country of debtor's center of main interests:
`
`Each country in which a foreign proceeding
`by, regarding, or against debtor is pending:
`
`Nature of Business
`(Check one box)
`Health Care Business
`Single Asset Real Estate as defined
`in 11 U.S.C. § 101 (51B)
`Railroad
`Stockbroker
`Commodity Broker
`Clearing Bank
`Other
`
`Tax-Exempt Entity
`(Check box, if applicable)
`Debtor is a tax-exempt organization
`under Title 26 of the United States
`Code (the Internal Revenue Code).
`
`Filing Fee (Check one box)
`Full Filing Fee attached
`
`Filing Fee to be paid in installments (applicable to individuals only). Must
`attach signed application for the court's consideration certifying that the
`debtor is unable to pay fee except in installments. Rule 1006(b). See Official
`Form 3A.
`
`Filing Fee waiver requested (applicable to chapter 7 individuals only). Must
`attach signed application for the court's consideration. See Official Form 3B.
`
`Chapter of Bankruptcy Code Under Which
`the Petition is Filed (Check one box)
`
`Chapter 7
`Chapter 9
`Chapter 11
`Chapter 12
`Chapter 13
`
`Chapter 15 Petition for Recognition
`of a Foreign Main Proceeding
`Chapter 15 Petition for Recognition
`of a Foreign Nonmain Proceeding
`
`Debts are primarily
`business debts.
`
`Nature of Debts
`(Check one box)
`Debts are primarily consumer debts,
`defined in 11 U.S.C. § 101(8) as
`"incurred by an individual primarily for
`a personal, family, or household purpose."
`Chapter 11 Debtors
`Check one box:
`Debtor is a small business debtor as defined in 11 U.S.C. § 101(51D).
`Debtor is not a small business debtor as defined in 11 U.S.C. § 101(51D).
`Check if:
`Debtor’s aggregate noncontingent liquidated debts (excluding debts owed to insiders or affiliates)
`are less than $2,490,925 (amount subject to adjustment on 4/01/16 and every three years thereafter).
`Check all applicable boxes:
`A plan is being filed with this petition.
`Acceptances of the plan were solicited prepetition from one or more classes of creditors,
`in accordance with 11 U.S.C. § 1126(b).
`
`THIS SPACE IS FOR COURT USE ONLY
`
`Statistical/Administrative Information
`Debtor estimates that funds will be available for distribution to unsecured creditors.
`Debtor estimates that, after any exempt property is excluded and administrative expenses paid,
`there will be no funds available for distribution to unsecured creditors.
`Estimated Number of Creditors
`
`50-
`1-
`99
`49
`Estimated Assets
`
`100-
`199
`
`200-
`999
`
`1,000-
`5,000
`
`5,001-
`10,000
`
`10,001-
`25,000
`
`25,001-
`50,000
`
`50,001-
`100,000
`
`OVER
`100,000
`
`$0 to
`$50,000
`
`$50,001 to
`$100,000
`
`$100,001 to
`$500,000
`
`$500,001
`to $1
`million
`
`$1,000,001
`to $10
`million
`
`$10,000,001
`to $50
`million
`
`$50,000,001
`to $100
`million
`
`$100,000,001 $500,000,001 More than
`to $500
`to $1 billion
`$1 billion
`million
`
`Estimated Liabilities
`
`$0 to
`$50,000
`
`$50,001 to
`$100,000
`
`$100,001 to
`$500,000
`
`$500,001
`to $1
`million
`
`$1,000,001
`to $10
`million
`
`$10,000,001
`to $50
`million
`
`$50,000,001
`to $100
`million
`
`$100,000,001 $500,000,001 More than
`to $500
`to $1 billion
`$1 billion
`million
`
`

`
`Case 15-21233 Doc 1 Filed 07/13/15 Entered 07/13/15 09:39:38 Desc Main
` Document Page 2 of 5
`
`B1 (Official Form 1)(04/13)
`Voluntary Petition
`(This page must be completed and filed in every case)
`All Prior Bankruptcy Cases Filed Within Last 8 Years (If more than two, attach additional sheet)
`Case Number:
`Date Filed:
`
`Name of Debtor(s):
`Jackson, Curtis James III
`
`Page 2
`
`- None -
`
`Location
`Where Filed:
`Location
`Where Filed:
`Pending Bankruptcy Case Filed by any Spouse, Partner, or Affiliate of this Debtor (If more than one, attach additional sheet)
`Name of Debtor:
`Case Number:
`Date Filed:
`- None -
`District:
`
`Case Number:
`
`Date Filed:
`
`Relationship:
`
`Judge:
`
`Exhibit A
`
`(To be completed if debtor is required to file periodic reports (e.g.,
`forms 10K and 10Q) with the Securities and Exchange Commission
`pursuant to Section 13 or 15(d) of the Securities Exchange Act of 1934
`and is requesting relief under chapter 11.)
`
`Exhibit A is attached and made a part of this petition.
`
`Exhibit B
`(To be completed if debtor is an individual whose debts are primarily consumer debts.)
`I, the attorney for the petitioner named in the foregoing petition, declare that I
`have informed the petitioner that [he or she] may proceed under chapter 7, 11,
`12, or 13 of title 11, United States Code, and have explained the relief available
`under each such chapter. I further certify that I delivered to the debtor the notice
`required by 11 U.S.C. §342(b).
`X
`/s/ James Berman
`Signature of Attorney for Debtor(s)
`James Berman ct06027
`
`July 13, 2015
`(Date)
`
`Exhibit C
`Does the debtor own or have possession of any property that poses or is alleged to pose a threat of imminent and identifiable harm to public health or safety?
`Yes, and Exhibit C is attached and made a part of this petition.
`No.
`
`Exhibit D
`(To be completed by every individual debtor. If a joint petition is filed, each spouse must complete and attach a separate Exhibit D.)
`Exhibit D completed and signed by the debtor is attached and made a part of this petition.
`If this is a joint petition:
`Exhibit D also completed and signed by the joint debtor is attached and made a part of this petition.
`
`Information Regarding the Debtor - Venue
`(Check any applicable box)
`Debtor has been domiciled or has had a residence, principal place of business, or principal assets in this District for 180
`days immediately preceding the date of this petition or for a longer part of such 180 days than in any other District.
`There is a bankruptcy case concerning debtor's affiliate, general partner, or partnership pending in this District.
`Debtor is a debtor in a foreign proceeding and has its principal place of business or principal assets in the United States in
`this District, or has no principal place of business or assets in the United States but is a defendant in an action or
`proceeding [in a federal or state court] in this District, or the interests of the parties will be served in regard to the relief
`sought in this District.
`Certification by a Debtor Who Resides as a Tenant of Residential Property
`(Check all applicable boxes)
`Landlord has a judgment against the debtor for possession of debtor's residence. (If box checked, complete the following.)
`
`(Name of landlord that obtained judgment)
`
`(Address of landlord)
`
`Debtor claims that under applicable nonbankruptcy law, there are circumstances under which the debtor would be permitted to cure
`the entire monetary default that gave rise to the judgment for possession, after the judgment for possession was entered, and
`Debtor has included with this petition the deposit with the court of any rent that would become due during the 30-day period
`after the filing of the petition.
`Debtor certifies that he/she has served the Landlord with this certification. (11 U.S.C. § 362(l)).
`
`

`
`Case 15-21233 Doc 1 Filed 07/13/15 Entered 07/13/15 09:39:38 Desc Main
` Document Page 3 of 5
`
`B1 (Official Form 1)(04/13)
`Voluntary Petition
`(This page must be completed and filed in every case)
`
`Name of Debtor(s):
`Jackson, Curtis James III
`
`Signatures
`
`Page 3
`
`Signature(s) of Debtor(s) (Individual/Joint)
`I declare under penalty of perjury that the information provided in this
`petition is true and correct.
`[If petitioner is an individual whose debts are primarily consumer debts and
`has chosen to file under chapter 7] I am aware that I may proceed under
`chapter 7, 11, 12, or 13 of title 11, United States Code, understand the relief
`available under each such chapter, and choose to proceed under chapter 7.
`[If no attorney represents me and no bankruptcy petition preparer signs the
`petition] 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.
`
`Signature of a Foreign Representative
`I declare under penalty of perjury that the information provided in this petition
`is true and correct, that I am the foreign representative of a debtor in a foreign
`proceeding, and that I am authorized to file this petition.
`(Check only one box.)
`I request relief in accordance with chapter 15 of title 11. United States Code.
`Certified copies of the documents required by 11 U.S.C. §1515 are attached.
`Pursuant to 11 U.S.C. §1511, I request relief in accordance with the chapter
`of title 11 specified in this petition. A certified copy of the order granting
`recognition of the foreign main proceeding is attached.
`
`X
`
`X
`
`X
`
`/s/ Curtis James Jackson, III
`Curtis James Jackson, III
`Signature of Debtor
`
`Signature of Joint Debtor
`
`Telephone Number (If not represented by attorney)
`July 13, 2015
`Date
`
`Signature of Attorney*
`
`/s/ James Berman
`Signature of Attorney for Debtor(s)
`James Berman ct06027
`Printed Name of Attorney for Debtor(s)
`Zeisler & Zeisler, P.C.
`Firm Name
`10 Middle Street, 15th Floor
`P.O. Box 1220
`Bridgeport, CT 06604
`
`Address
`
`(203) 368-4234 Fax: (203) 367-9678
`Telephone Number
`July 13, 2015
`Date
`*In a case in which § 707(b)(4)(D) applies, this signature also constitutes a
`certification that the attorney has no knowledge after an inquiry that the
`information in the schedules is incorrect.
`
`Signature of Debtor (Corporation/Partnership)
`
`I declare under penalty of perjury that the information provided in this
`petition is true and correct, and that I have been authorized to file this petition
`on behalf of the debtor.
`The debtor requests relief in accordance with the chapter of title 11, United
`States Code, specified in this petition.
`
`X
`
`Signature of Authorized Individual
`
`Printed Name of Authorized Individual
`
`Title of Authorized Individual
`
`Date
`
`X
`
`Signature of Foreign Representative
`
`Printed Name of Foreign Representative
`
`Date
`Signature of Non-Attorney Bankruptcy Petition Preparer
`
`I declare under penalty of perjury that: (1) I am a bankruptcy petition
`preparer as defined in 11 U.S.C. § 110; (2) I prepared this document for
`compensation and have provided the debtor with a copy of this document
`and the notices and information required under 11 U.S.C. §§ 110(b),
`110(h), and 342(b); and, (3) if rules or guidelines have been promulgated
`pursuant to 11 U.S.C. § 110(h) setting a maximum fee for services
`chargeable by bankruptcy petition preparers, I have given the debtor notice
`of the maximum amount before preparing any document for filing for a
`debtor or accepting any fee from the debtor, as required in that section.
`Official Form 19 is attached.
`
`Printed Name and title, if any, of Bankruptcy Petition Preparer
`
`Social-Security number (If the bankrutpcy petition preparer is not
`an individual, state the Social Security number of the officer,
`principal, responsible person or partner of the bankruptcy petition
`preparer.)(Required by 11 U.S.C. § 110.)
`
`Address
`
`X
`
`Date
`
`Signature of bankruptcy petition preparer or officer, principal, responsible
`person,or partner whose Social Security number is provided above.
`
`Names and Social-Security numbers of all other individuals who prepared or
`assisted in preparing this document unless the bankruptcy petition preparer is
`not an individual:
`
`If more than one person prepared this document, attach additional sheets
`conforming to the appropriate official form for each person.
`
`A bankruptcy petition preparer’s failure to comply with the provisions of
`title 11 and the Federal Rules of Bankruptcy Procedure may result in
`fines or imprisonment or both. 11 U.S.C. §110; 18 U.S.C. §156.
`
`

`
`Case 15-21233 Doc 1 Filed 07/13/15 Entered 07/13/15 09:39:38 Desc Main
` Document Page 4 of 5
`
`B 1D (Official Form 1, Exhibit D) (12/09)
`
`United States Bankruptcy Court
`District of Connecticut
`
`In re
`
`Curtis James Jackson, III
`
`Debtor(s)
`
`Case No.
`Chapter
`
`11
`
`EXHIBIT D - INDIVIDUAL DEBTOR'S STATEMENT OF COMPLIANCE WITH
`CREDIT COUNSELING REQUIREMENT
`Warning: You must be able to check truthfully one of the five statements regarding credit
`counseling listed below. If you cannot do so, you are not eligible to file a bankruptcy case, and the court
`can dismiss any case you do file. If that happens, you will lose whatever filing fee you paid, and your
`creditors will be able to resume collection activities against you. If your case is dismissed and you file
`another bankruptcy case later, you may be required to pay a second filing fee and you may have to take
`extra steps to stop creditors' collection activities.
`Every individual debtor must file this Exhibit D. If a joint petition is filed, each spouse must complete
`and file a separate Exhibit D. Check one of the five statements below and attach any documents as directed.
`(cid:134) 1. Within the 180 days before the filing of my bankruptcy case, I received a briefing from a credit
`counseling agency approved by the United States trustee or bankruptcy administrator that outlined the
`opportunities for available credit counseling and assisted me in performing a related budget analysis, and I have
`a certificate from the agency describing the services provided to me. Attach a copy of the certificate and a copy
`of any debt repayment plan developed through the agency.
`(cid:132) 2. Within the 180 days before the filing of my bankruptcy case, I received a briefing from a credit
`counseling agency approved by the United States trustee or bankruptcy administrator that outlined the
`opportunities for available credit counseling and assisted me in performing a related budget analysis, but I do
`not have a certificate from the agency describing the services provided to me. You must file a copy of a
`certificate from the agency describing the services provided to you and a copy of any debt repayment plan
`developed through the agency no later than 14 days after your bankruptcy case is filed.
`
`(cid:134) 3. I certify that I requested credit counseling services from an approved agency but was unable to
`obtain the services during the seven days from the time I made my request, and the following exigent
`circumstances merit a temporary waiver of the credit counseling requirement so I can file my bankruptcy case
`now. [Summarize exigent circumstances here.]
`If your certification is satisfactory to the court, you must still obtain the credit counseling briefing
`within the first 30 days after you file your bankruptcy petition and promptly file a certificate from the
`agency that provided the counseling, together with a copy of any debt management plan developed
`through the agency. Failure to fulfill these requirements may result in dismissal of your case. Any
`extension of the 30-day deadline can be granted only for cause and is limited to a maximum of 15 days.
`Your case may also be dismissed if the court is not satisfied with your reasons for filing your bankruptcy
`case without first receiving a credit counseling briefing.
`
`(cid:134) 4. I am not required to receive a credit counseling briefing because of: [Check the applicable
`statement.] [Must be accompanied by a motion for determination by the court.]
`
`Software Copyright (c) 1996-2014 Best Case, LLC - www.bestcase.com
`
`Best Case Bankruptcy
`
`

`
`Case 15-21233 Doc 1 Filed 07/13/15 Entered 07/13/15 09:39:38 Desc Main
` Document Page 5 of 5
`
`B 1D (Official Form 1, Exhibit D) (12/09) - Cont.
`
`Page 2
`
`(cid:134) Incapacity. (Defined in 11 U.S.C. § 109(h)(4) as impaired by reason of mental illness or mental
`deficiency so as to be incapable of realizing and making rational decisions with respect to financial
`responsibilities.);
`(cid:134) Disability. (Defined in 11 U.S.C. § 109(h)(4) as physically impaired to the extent of being
`unable, after reasonable effort, to participate in a credit counseling briefing in person, by telephone, or
`through the Internet.);
`(cid:134) Active military duty in a military combat zone.
`(cid:134) 5. The United States trustee or bankruptcy administrator has determined that the credit counseling
`requirement of 11 U.S.C. § 109(h) does not apply in this district.
`I certify under penalty of perjury that the information provided above is true and correct.
`
`Signature of Debtor:
`
`Date:
`
`July 13, 2015
`
`/s/ Curtis James Jackson, III
`Curtis James Jackson, III
`
`Software Copyright (c) 1996-2014 Best Case, LLC - www.bestcase.com
`
`Best Case Bankruptcy

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