Fill and Sign the Scholarship Application Avera Health Avera Form

Case:11-31115-MER Doc#:1 Filed:09/02/11 B1 (Official Form 1) (4/10) Entered:09/02/11 15:11:51 Page1 of 61 United States Bankruptcy Court District of Colorado Name of Debtor (if individual, enter Last, First, Middle): Voluntary Petition Name of Joint Debtor (Spouse) (Last, First, Middle): Martino, Thomas Gerard 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): See Schedule Attached Last four digits of Soc. Sec. or Individual-Taxpayer I.D. (ITIN) No./Complete EIN (if more than one, state all): 9406 Last four digits of Soc. Sec. or Individual-Taxpayer I.D. (ITIN) No./Complete EIN (if more than one, state all): Street Address of Debtor (No. & Street, City, State & Zip Code): Street Address of Joint Debtor (No. & Street, City, State & Zip Code): 1013 East Belleview Avenue Cherry Hills Village, CO ZIPCODE 80121 ZIPCODE County of Residence or of the Principal Place of Business: County of Residence or of the Principal Place of Business: Arapahoe Mailing Address of Debtor (if different from street address) Mailing Address of Joint Debtor (if different from street address): ZIPCODE ZIPCODE Location of Principal Assets of Business Debtor (if different from street address above): © 1993-2011 EZ-Filing, Inc. [1-800-998-2424] - Forms Software Only 1013 East Belleview Avenue, Cherry Hills Village, CO Type of Debtor (Form of Organization) (Check one box.) ZIPCODE 80121 Nature of Business (Check one box.) Individual Debtors) üSee Exhibit(includes Jointof this form. D on page 2 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 of Bankruptcy Code Under Which the Petition is Filed (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 ü 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) ü 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 7 ü Chapter 9 Chapter 15 Petition for Recognition of a Foreign Main Proceeding Chapter 15 Petition for Recognition of a Foreign Nonmain Proceeding Chapter 11 Chapter 12 Chapter 13 Nature of Debts (Check one box.) Debts are primarily consumer Debts are primarily debts, defined in 11 U.S.C. business debts. § 101(8) as “incurred by an individual primarily for a personal, family, or household purpose.” ü 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 owed to non-insiders or affiliates are less than $2,343,300 (amount subject to adjustment on 4/01/13 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). 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. ü Estimated Number of Creditors ü 1-49 50-99 Estimated Assets 100-199 200-999 1,0005,000 5,00110,000 10,00125,000 25,00150,000 50,001100,000 Over 100,000 ü $0 to $50,001 to $100,001 to $500,001 to $1,000,001 to $10,000,001 $50,000,001 to $100,000,001 $500,000,001 More than $50,000 $100,000 $500,000 $1 million $10 million to $50 million $100 million to $500 million to $1 billion $1 billion Estimated Liabilities ü $0 to $50,001 to $100,001 to $500,001 to $1,000,001 to $10,000,001 $50,000,001 to $100,000,001 $500,000,001 More than $50,000 $100,000 $500,000 $1 million $10 million to $50 million $100 million to $500 million to $1 billion $1 billion THIS SPACE IS FOR COURT USE ONLY Case:11-31115-MER Doc#:1 Filed:09/02/11 Entered:09/02/11 15:11:51 Page2 of 61 B1 (Official Form 1) (4/10) Page 2 Name of Debtor(s): Martino, Thomas Gerard Voluntary Petition (This page must be completed and filed in every case) Prior Bankruptcy Case Filed Within Last 8 Years (If more than two, attach additional sheet) Location Where Filed:None Case Number: Date Filed: Location Where Filed: Case Number: Date Filed: Pending Bankruptcy Case Filed by any Spouse, Partner or Affiliate of this Debtor (If more than one, attach additional sheet) Name of Debtor: Appel Farms, LLC Case Number: 10-28331 Date Filed: 7/22/2010 District: Colorado Relationship: Interest In LLC As A Mem Judge: Michael E. Romero Exhibit A Exhibit B (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.) (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 § 342(b) of the Bankruptcy Code. © 1993-2011 EZ-Filing, Inc. [1-800-998-2424] - Forms Software Only Exhibit A is attached and made a part of this petition. X Signature of Attorney for Debtor(s) 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. ü 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.) ü 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 a made a part of this petition. Information Regarding the Debtor - Venue (Check any applicable box.) ü 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 or lessor that obtained judgment) (Address of landlord or lessor) 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 in 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:11-31115-MER Doc#:1 Filed:09/02/11 Entered:09/02/11 15:11:51 Page3 of 61 B1 (Official Form 1) (4/10) Page 3 Name of Debtor(s): Martino, Thomas Gerard Voluntary Petition (This page must be completed and filed in every case) Signatures Signature(s) of Debtor(s) (Individual/Joint) Signature of a Foreign Representative 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 State 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. 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. X (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 /s/ Thomas Gerard Martino Signature of Foreign Representative Thomas Gerard Martino Signature of Debtor X Printed Name of Foreign Representative Signature of Joint Debtor Date © 1993-2011 EZ-Filing, Inc. [1-800-998-2424] - Forms Software Only Telephone Number (If not represented by attorney) September 2, 2011 Date Signature of Attorney* X /s/ Stephen E. Berken Signature of Attorney for Debtor(s) Stephen E. Berken 14926 Law Offices of Stephen Berken 1159 Delaware Street Denver, CO 80204 stephenberkenlaw@gmail.com Signature of Non-Attorney 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); 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 September 2, 2011 Social Security Number (If the bankruptcy 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.) 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. Address X Signature of Bankruptcy Petition Preparer or officer, principal, responsible person, or partner whose social security number is provided above. Date The debtor requests relief in accordance with the chapter of title 11, United States Code, specified in this petition. X 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: Signature of Authorized Individual Printed Name of Authorized Individual Title of Authorized Individual Date 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:11-31115-MER Doc#:1 Filed:09/02/11 Entered:09/02/11 15:11:51 Page4 of 61 IN RE Martino, Thomas Gerard Case No. Debtor(s) VOLUNTARY PETITION Continuation Sheet - Page 1 of 1 All Other Names used by the Debtor in the last 8 years: © 1993-2011 EZ-Filing, Inc. [1-800-998-2424] - Forms Software Only Tom Gerard Martino Tom Martino Tom Martino, The Troubleshooter Troubleshooter Tom Martino ods Troubleshooter Network, Inc Tom Martino's Referral List mem Tom Martino Consulting, LLC mem Tom Martino Real Estate Man., LLC mem Appel Farms Group mem Colorado Airplane Hangar Company mem Liberty Bell Telecom, LLC ods Moomba2, Inc mem Parker Place, LLC mem Parker Tech, LLC mem Sherman Street Properties, LLC mem Welton Street Properties, LLC mem WSOP Investments, LLC Case:11-31115-MER Doc#:1 Filed:09/02/11 Entered:09/02/11 15:11:51 Page5 of 61 B1D (Official Form 1, Exhibit D) (12/09) United States Bankruptcy Court District of Colorado IN RE: Case No. Chapter 7 Martino, Thomas Gerard Debtor(s) EXHIBIT D - INDIVIDUAL DEBTOR'S STATEMENT OF COMPLIANCE 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. ü © 1993-2011 EZ-Filing, Inc. [1-800-998-2424] - Forms Software Only 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. 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. 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. 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.] 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.); 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.); Active military duty in a military combat zone. 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: /s/ Thomas Gerard Martino Date: September 2, 2011 Case:11-31115-MER Doc#:1 Filed:09/02/11 Entered:09/02/11 15:11:51 Page6 of 61 Case:11-31115-MER B7 (Official Form 7) (04/10) Doc#:1 Filed:09/02/11 Entered:09/02/11 15:11:51 Page7 of 61 United States Bankruptcy Court District of Colorado IN RE: Case No. Chapter 7 Martino, Thomas Gerard Debtor(s) 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 for both spouses is combined. If the case is filed under chapter 12 or chapter 13, a married debtor must furnish information for both spouses whether or not 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 sole proprietor, partner, family farmer, or self-employed professional, should provide the information requested on this statement concerning all such activities as well as the individual's personal affairs. To indicate payments, transfers and the like to minor children, 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). Questions 1 - 18 are to be completed by all debtors. Debtors that are or have been in business, as defined below, also must complete Questions 19 25. If the answer to an applicable question is "None," mark the box labeled "None." If additional space is needed for the answer to any question, use and attach a separate sheet properly identified with the case name, case number (if known), and the number of the question. © 1993-2011 EZ-Filing, Inc. [1-800-998-2424] - Forms Software Only 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 "in business" 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 of the 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 the debtor’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 or equity securities of a corporate debtor and their relatives; affiliates of the debtor and insiders of such affiliates; any managing agent of the debtor. 11 U.S.C. § 101. 1. Income from employment or operation of business None State the gross amount of income the debtor has received from employment, trade, or profession, or from operation of the debtor's business, including part-time activities either as an employee or in independent trade or business, from the beginning of this calendar year to the date this case was commenced. State also the gross amounts received during the two years immediately preceding this calendar year. (A debtor that maintains, or has maintained, financial records on the basis of a fiscal rather than a calendar year may report fiscal year income. Identify the beginning and ending dates of the debtor's fiscal year.) If a joint petition is filed, state income for each spouse separately. (Married debtors filing under chapter 12 or chapter 13 must state income of both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.) AMOUNT SOURCE 1,585,799.00 2009-Troubleshooter Network, Inc., Tom Martino Consulting, LLC, Community Television, LLC (Fox 31) 2,154,175.00 2010-Troubleshooter Network, Inc., Tom Martino Consulting, LLC, Community Television, LLC (Fox 31) 260,626.90 2011 YTD- (Jan.-July) Troubleshooter Network, Inc., - $173,076.90 Tom Martino Consulting, LLC, Community Television, LLC (Fox 31)- $87,550.00 2. Income other than from employment or operation of business None State the amount of income received by the debtor other than from employment, trade, profession, operation of the debtor’s business during the two years immediately preceding the commencement of this case. Give particulars. If a joint petition is filed, state income for each spouse separately. (Married debtors filing under chapter 12 or chapter 13 must state income for each spouse whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.) AMOUNT SOURCE 36,802.00 2009-Interest Received 36,897.00 2009-Real Estate 6,723.00 2010-Interest Received 8,000.00 2011-Interest Received (estimated) Interest received Case:11-31115-MER Doc#:1 Filed:09/02/11 Entered:09/02/11 15:11:51 Page8 of 61 3. Payments to creditors Complete a. or b., as appropriate, and c. None a. Individual or joint debtor(s) with primarily consumer debts: List all payments on loans, installment purchases of goods or services, and other debts to any creditor made within 90 days immediately preceding the commencement of this case unless the aggregate value of all property that constitutes or is affected by such transfer is less than $600. Indicate with an asterisk (*) any payments that were made to a creditor on account of a domestic support obligation or as part of an alternative repayment schedule under a plan by an approved nonprofit budgeting and credit counseling agency. (Married debtors filing under chapter 12 or chapter 13 must include payments by either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.) DATES OF PAYMENTS 6/2011, 7/2011, 8/2011 AMOUNT PAID 26,662.88 AMOUNT STILL OWING 3,000,000.00 Macquarie Mortgage 125 West 55th Street New York, NY 10019 6/2011, 7/2011, 8/2011 12,294.00 2,000,000.00 Chase/United Airlines Master Card PO Box 94014 Palatine, IL 60094-4014 6/2011, 7/2011, 8/2011 9,150.84 0.00 Bank of America Visa PO Box 8999 San Francisco, CA 94128 © 1993-2011 EZ-Filing, Inc. [1-800-998-2424] - Forms Software Only NAME AND ADDRESS OF CREDITOR First Western Trust Bank 1200 17th Street Suite 1050 Denver, CO 80202 6/2011, 7/2011, 8/2011 39,506.98 0.00 None ü b. Debtor whose debts are not primarily consumer debts: List each payment or other transfer to any creditor made within 90 days immediately preceding the commencement of the case unless the aggregate value of all property that constitutes or is affected by such transfer is less than $5,850.* If the debtor is an individual, indicate with an asterisk (*) any payments that were made to a creditor on account of a domestic support obligation or as part of an alternative repayment schedule under a plan by an approved nonprofit budgeting and credit counseling agency. (Married debtors filing under chapter 12 or chapter 13 must include payments and other transfers by either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.) * 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. None ü c. All debtors: List all payments made within one year immediately preceding the commencement of this case to or for the benefit of creditors who are or were insiders. (Married debtors filing under chapter 12 or chapter 13 must include payments by either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.) 4. Suits and administrative proceedings, executions, garnishments and attachments None a. List all suits and administrative proceedings to which the debtor is or was a party within one year immediately preceding the filing of this bankruptcy case. (Married debtors filing under chapter 12 or chapter 13 must include information concerning either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.) CAPTION OF SUIT AND CASE NUMBER Colorado Capital Bank vs. Thomas Gerard Martino, et al., case # 2010CV6527 International Bank v. Tom and Holly Martino, case # 2011CV1425 None ü NATURE OF PROCEEDING Failure to pay a debt As to Mr. Martino, breach of contract COURT OR AGENCY STATUS OR AND LOCATION DISPOSITION El Paso County, District Court, Judgement entered, 270 South Tejon Street, Colorado pending Motion for Springs, CO 80903 Reconsideration Douglas County District, Colorado pending b. Describe all property that has been attached, garnished or seized under any legal or equitable process within one year immediately preceding the commencement of this case. (Married debtors filing under chapter 12 or chapter 13 must include information concerning property of either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.) 5. Repossessions, foreclosures and returns None List all property that has been repossessed by a creditor, sold at a foreclosure sale, transferred through a deed in lieu of foreclosure or returned to the seller, within one year immediately preceding the commencement of this case. (Married debtors filing under chapter 12 or chapter 13 must include information concerning property of 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 CREDITOR OR SELLER DATE OF REPOSSESSION, FORECLOSURE SALE, TRANSFER OR RETURN DESCRIPTION AND VALUE OF PROPERTY Case:11-31115-MER Doc#:1 Filed:09/02/11 Colorado Capital Bank (Closed By FDIC) 5251 DTC Parkway, Suites 100 &112 Greenwood Village, CO 80111 12/1/2010 Entered:09/02/11 15:11:51 Page9 of 61 Moomba 2, Inc. 7 Condos put in court-ordered receivorship. Successor-in-interest to CCB may be First Citizens Bank. 6. Assignments and receiverships None ü None ü a. Describe any assignment of property for the benefit of creditors made within 120 days immediately preceding the commencement of this case. (Married debtors filing under chapter 12 or chapter 13 must include any assignment by either or both spouses whether or not a joint petition is filed, unless the spouses are separated and joint petition is not filed.) b. List all property which has been in the hands of a custodian, receiver, or court-appointed official within one year immediately preceding the commencement of this case. (Married debtors filing under chapter 12 or chapter 13 must include information concerning property of either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.) 7. Gifts None ü List all gifts or charitable contributions made within one year immediately preceding the commencement of this case except ordinary and usual gifts to family members aggregating less than $200 in value per individual family member and charitable contributions aggregating less than $100 per recipient. (Married debtors filing under chapter 12 or chapter 13 must include gifts or contributions by either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.) 8. Losses © 1993-2011 EZ-Filing, Inc. [1-800-998-2424] - Forms Software Only None ü List all losses from fire, theft, other casualty or gambling within one year immediately preceding the commencement of this case or since the commencement of this case. (Married debtors filing under chapter 12 or chapter 13 must include losses by either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.) 9. Payments related to debt counseling or bankruptcy None List all payments made or property transferred by or on behalf of the debtor to any persons, including attorneys, for consultation concerning debt consolidation, relief under bankruptcy law or preparation of a petition in bankruptcy within one year immediately preceding the commencement of this case. NAME AND ADDRESS OF PAYEE Stephen E. Berken 1159 Delaware St. Denver, CO 80204 DATE OF PAYMENT, NAME OF PAYOR IF OTHER THAN DEBTOR 12/20/10 AMOUNT OF MONEY OR DESCRIPTION AND VALUE OF PROPERTY 5,000.00 10. Other transfers None 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 debtors filing under chapter 12 or chapter 13 must include transfers by 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 TRANSFEREE, RELATIONSHIP TO DEBTOR Pueblo Bank & Trust 2351 South Colorado Blvd Denver, CO 80222 none DATE 2010 DESCRIBE PROPERTY TRANSFERRED AND VALUE RECEIVED WSOP Investments, LLC Dolce Vita Development 130,000 Sq. Ft. Commercial Space Holly F. Martino, jointly 1013 E. Bellview Ave Cherry Hills Village, CO 80121 spouse 3/8/11 $3405.16 from Tom's Checking to Joint Checking (entire amount from wages) Holly F. Martino, jointly 1013 E. Bellview Ave Cherry Hills Village, CO 80121 spouse 3/18/11 $3782.88 from Tom's Checking to Joint Checking (entire amount from wages) Holly F. Martino, jointly 1013 E. Bellview Ave Cherry Hills Village, CO 80121 spouse 3/18/11 $6483.81 from Tom's Checking to Joint Checking (entire amount from wages) Holly F. Martino, jointly 1013 E. Bellview Ave 4/12/11 $10,000 from Tom's Checking to Joint Checking (entire amount from Case:11-31115-MER Doc#:1 Filed:09/02/11 Entered:09/02/11 15:11:51 Page10 of 61 Cherry Hills Village, CO 80121 spouse wages) Holly F. Martino, jointly 1013 E. Bellview Ave Cherry Hills Village, CO 80121 spouse 6/7/11 $2500.00 from Tom's Checking to Joint Checking (entire amount from wages) Holly F. Martino, individually 1013 E. Bellview Ave Cherry Hills Village, CO 80121 spouse 6/7/11 $6017.26 from Tom's Checking to Holly's Checking (entire amount from wages) Holly F. Martino, jointly 1013 E. Bellview Ave Cherry Hills Village, CO 80121 spouse 7/21/11 $5788.00 from Tom's Checking to Joint Checking (entire amount from wages) Holly F. Martino, individually 1013 E. Bellview Ave Cherry Hills Village, CO 80121 spouse 10/12/2010 $26,000 from Tom's Checking to Holly's Checking (entire amount from wages) None ü b. List all property transferred by the debtor within ten years immediately preceding the commencement of this case to a self-settled trust or similar device of which the debtor is a beneficiary. © 1993-2011 EZ-Filing, Inc. [1-800-998-2424] - Forms Software Only 11. Closed financial accounts None ü List all financial accounts and instruments held in the name of the debtor or for the benefit of the debtor which were closed, sold, or otherwise transferred within one year immediately preceding the commencement of this case. Include checking, savings, or other financial 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 must include 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.) 12. Safe deposit boxes None ü List each safe deposit or other box or depository in which the debtor has or had securities, cash, or other valuables within one year immediately preceding the commencement of this case. (Married debtors filing under chapter 12 or chapter 13 must include boxes or depositories of either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.) 13. Setoffs None ü List all setoffs made by any creditor, including a bank, against a debt or deposit of the debtor within 90 days preceding the commencement of this case. (Married debtors filing under chapter 12 or chapter 13 must include information concerning either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.) 14. Property held for another person None List all property owned by another person that the debtor holds or controls. NAME AND ADDRESS OF OWNER Holly F. Martino 1013 E. Bellview Ave Cherry Hills Village, CO 80121 DESCRIPTION AND VALUE OF PROPERTY Household Items, approx FMV $19k LOCATION OF PROPERTY 1013 E. Bellview Ave 15. Prior address of debtor None If debtor has moved within three years immediately preceding the commencement of this case, list all premises which the debtor occupied during that period and vacated prior to the commencement of this case. If a joint petition is filed, report also any separate address of either spouse. ADDRESS 7900 Fox Creek Trail Franktown, CO 80116 NAME USED Thomas G. Martino DATES OF OCCUPANCY 1993 - 02/2010 16. Spouses and Former Spouses None ü 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 the commencement of the case, identify the name of the debtor’s spouse and of any former spouse who resides or resided with the debtor in the community property state. Case:11-31115-MER Doc#:1 Filed:09/02/11 Entered:09/02/11 15:11:51 Page11 of 61 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 hazardous or 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 formerly owned 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 liable or 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 ADDRESS Appel Farms Group LLC. Fined By State$200,000.00 NAME AND ADDRESS OF GOVERNMENTAL UNIT Appel Farms Subdivision 321 Denver Avenue Fort Lupton, CO 80621 DATE OF NOTICE 2010 ENVIRONMENTAL LAW State Waters Fined by State - $200,000.00 None © 1993-2011 EZ-Filing, Inc. [1-800-998-2424] - Forms Software Only ü None ü b. List the name and address of every site for which the debtor provided notice to a governmental unit of a release of Hazardous Material. Indicate the governmental unit to which the notice was sent and the date of the notice. 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 the docket number. 18. Nature, location and name of business None a. If the debtor is an individual, list the names, addresses, taxpayer identification numbers, nature of the businesses, and beginning and ending dates of all businesses in which the debtor was an officer, director, partner, or managing executive of a corporation, partner in a partnership, sole proprietor, or was self-employed in a trade, profession, or other activity either full- or part-time within six years immediately preceding the commencement of this case, or in which the debtor owned 5 percent or more of the voting or equity securities within 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 and ending dates of all businesses in which the debtor was a partner or owned 5 percent or more of the voting or equity securities, within six years 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 and ending dates of all businesses in which the debtor was a partner or owned 5 percent or more of the voting or equity securities within six years immediately preceding the commencement of this case. NAME Troublershooter Network, Inc. LAST FOUR DIGITS OF SOCIALSECURITY OR OTHER INDIVIDUAL TAXPAYER-I.D. NO. (ITIN)/COMPLETE EIN ADDRESS 841251437 4695 South Monaco Suite 111 Denver, CO 80237 NATURE OF BUSINESS Network BEGINNING AND ENDING DATES Present Donna S. Martino (former wife) is removed from Troubleshooter Network Inc. RTC Money Purchase Plan. Account No. - 040000244421 Tom Martino Consulting, LLC 870719386 (Owned by Troubleshooter Network) Po Box 2498 Littleton, CO 80161 Broadcasting Present Liberty Bell, LLC 141845442 (Owned By Troubleshooter Telecom Network, Inc) 2460 West 26th Avenue #380-C Denver, CO 80211 Present Appel Farms Group LLC 841500380 PO Box 2498 Littleton, CO 80161 Real Estate Dissolved Moomba II Inc. 202965336 PO Box 2498 Real Estate Present Case:11-31115-MER Doc#:1 Filed:09/02/11 Entered:09/02/11 15:11:51 Page12 of 61 Littleton, CO 80161 Parker Place LLC 208704411 PO Box 2498 Littleton, CO 80161 Real Estate Present Parker Tech Center 900192443 PO Box 2498 Littleton, CO 80161 Real Estate Present Sherman Properties LLC 061761617 PO Box 2498 Littleton, CO 80161 Real Estate Present WSOP Investments LLC. 571212531 PO Box 2498 Littleton, CO 80161 Real Estate Dissolved Welton Street Properties LLC 161778895 PO Box 2498 Littleton, CO 80161 Real Estate Present Colorado Airplane Hangar Company, LLC 20021168802 PO Box 2498 Littleton, CO 80161 Real Estate Dissolved None ü 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. © 1993-2011 EZ-Filing, Inc. [1-800-998-2424] - Forms Software Only The following questions are to be completed by every debtor that is a corporation or partnership and by any individual debtor who is or has been, within six years immediately preceding the commencement of this case, any of the following: an officer, director, managing executive, or owner 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 sole proprietor, 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 statement only if the debtor is or has been in business, as defined above, within the six years immediately preceding the commencement of this case. A debtor who has not been in business within those six years should go directly to the signature page.) 19. Books, records and financial statements None a. List all bookkeepers and accountants who within the two years immediately preceding the filing of this bankruptcy case kept or supervised the keeping of books of account and records of the debtor. NAME AND ADDRESS Susan Rossi Deceased DATES SERVICES RENDERED 2009 Ken Glass, Bookkeeper PO Box 2498 Littleton, CO 80161 2010 Steve Levey, CPA GHP Financial Group 1670 Broadway Suite 3000 Denver, CO 80202 2010 None b. List all firms or individuals who within the two years immediately preceding the filing of this bankruptcy case have audited the books of account and records, or prepared a financial statement of the debtor. NAME AND ADDRESS Steve Levey, CPA GHP Financial Group 1670 Broadway Suite 3000 Denver, CO 80202 DATES SERVICES RENDERED 2010 and 2011 Preparer for Troubleshooter Network and IRS Audit. 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 records of the debtor. If any of the books of account and records are not available, explain. NAME AND ADDRESS Steve Levey, CPA GHP Financial Group 1670 Broadway Suite 3000 Denver, CO 80202 Ken Glass, Bookkeeper PO Box 2498 Littleton, CO 80161 Debtor's former bookkeeper, Susan Rossi, died in 2009. Some records in Ms. Rossi's possession were unable to locate subsequent to her death. Case:11-31115-MER Doc#:1 Filed:09/02/11 None Entered:09/02/11 15:11:51 Page13 of 61 d. List all financial institutions, creditors, and other parties, including mercantile and trade agencies, to whom a financial statement was issued within the two years immediately preceding the commencement of the case by the debtor. NAME AND ADDRESS Colorado Capital Bank 7505 Village Square Drive Suite 101 Castle Rock, CO 80108 DATE ISSUED 2010 Bank Of The West 4818 Chambers Rd. Denver, CO 80239 2010 International Bank 24450 E Smoky Hill Rd Aurora, CO 80016 2010 20. Inventories None ü None ü 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. b. List the name and address of the person having possession of the records of each of the two inventories reported in a., above. 21. Current Partners, Officers, Directors and Shareholders © 1993-2011 EZ-Filing, Inc. [1-800-998-2424] - Forms Software Only None ü None ü a. If the debtor is a partnership, list the nature and percentage of partnership interest of each member of the partnership. 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. 22. Former partners, officers, directors and shareholders None ü None ü a. If the debtor is a partnership, list each member who withdrew from the partnership within one year immediately preceding the commencement of this case. b. If the debtor is a corporation, list all officers, or directors whose relationship with the corporation terminated within one year immediately preceding the commencement of this case. 23. Withdrawals from a partnership or distributions by a corporation None ü If the debtor is a partnership or corporation, list all withdrawals or distributions credited or given to an insider, including compensation in any form, bonuses, loans, stock redemptions, options exercised and any other perquisite during one year immediately preceding the commencement of this case. 24. Tax Consolidation Group None ü If the debtor is a corporation, list the name and federal taxpayer identification number of the parent corporation of any consolidated group for tax purposes of which the debtor has been a member at any time within six years immediately preceding the commencement of the case. 25. Pension Funds. None ü If the debtor is not an individual, list the name and federal taxpayer identification number of any pension fund to which the debtor, as an employer, has been responsible for contributing at any time within six years immediately preceding the commencement of the case. Case:11-31115-MER Doc#:1 Filed:09/02/11 Entered:09/02/11 15:11:51 Page14 of 61 [If completed by an individual or individual and spouse] I declare under penalty of perjury that I have read the answers contained in the foregoing statement of financial affairs and any attachments thereto and that they are true and correct. Date: September 2, 2011 Date: Signature /s/ Thomas Gerard Martino of Debtor Thomas Gerard Martino Signature of Joint Debtor (if any) 0 continuation pages attached © 1993-2011 EZ-Filing, Inc. [1-800-998-2424] - Forms Software Only 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. Case:11-31115-MER Doc#:1 Filed:09/02/11 Entered:09/02/11 15:11:51 Page15 of 61 B201A (Form 201A) (12/09) WARNING: Effective December 1, 2009, the 15-day deadline to file schedules and certain other documents under Bankruptcy Rule 1007(c) is shortened to 14 days. For further information, see note at bottom of page 2 UNITED STATES BANKRUPTCY COURT NOTICE TO CONSUMER DEBTOR(S) 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 briefly the services available from credit counseling services; (2) Describes briefly the purposes, benefits and costs of the four types of bankruptcy proceedings you may commence; and (3) Informs you about bankruptcy crimes and notifies you that the Attorney General may examine all information you supply in connection with a bankruptcy case. © 1993-2011 EZ-Filing, Inc. [1-800-998-2424] - Forms Software Only You are cautioned that bankruptcy law is complicated and not easily described. Thus, you may wish to seek the advice of an attorney to 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 you receive information about events concerning your case, Bankruptcy Rule 4002 requires that you notify the court of any changes in your address. If you are filing a joint case (a single bankruptcy case for two individuals married to each other), and each spouse lists the same mailing address on the bankruptcy petition, you and your spouse will generally receive a single copy of each notice mailed from the bankruptcy court in a jointly-addressed envelope, unless you file a statement with the court requesting that each spouse receive a separate 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 bankruptcy relief on or after October 17, 2005, receive a briefing that outlines the available opportunities for credit counseling and provides assistance in performing a budget analysis. The briefing must be given within 180 days before the bankruptcy filing. The briefing may be provided individually or in a group (including briefings conducted by telephone or on the Internet) and must be provided by a nonprofit budget and credit counseling agency approved by the United States trustee or bankruptcy administrator. The clerk of the bankruptcy court has a list that you may consult of the approved budget and credit 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 management instructional course before he or she can receive a discharge. The clerk also has a list of approved financial management instructional 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, $39 administrative fee, $15 trustee surcharge: Total fee $299) Chapter 7 is designed for debtors in financial difficulty who do not have the ability to pay their existing debts. Debtors whose debts are primarily consumer debts are subject to a “means test” designed to determine whether the case should be permitted to proceed under chapter 7. If your income is greater than the median income for your state of residence and family size, in some cases, the United States trustee (or bankruptcy administrator), the trustee, or 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. Under chapter 7, you may claim certain of your property as exempt under governing law. A trustee may have the right to take possession of and sell the remaining property that is not exempt and use the sale proceeds to pay your creditors. The purpose of filing a chapter 7 case is to obtain a discharge of your existing debts. If, however, you are found to have committed certain kinds of improper conduct described in the Bankruptcy Code, the court may deny your Case:11-31115-MER Doc#:1 Filed:09/02/11 Entered:09/02/11 15:11:51 Page16 of 61 B201A (Form 201A) (12/09) Page 2 © 1993-2011 EZ-Filing, Inc. [1-800-998-2424] - Forms Software Only discharge and, if it does, the purpose for which you filed the bankruptcy petition will be defeated. Even if you receive a general discharge, some particular debts are not discharged under the law. Therefore, you may still be responsible for most taxes and student loans; debts incurred to pay nondischargeable taxes; domestic support and property settlement obligations; most fines, penalties, forfeitures, and criminal restitution obligations; certain debts which are not properly listed in your bankruptcy papers; and debts for death or personal injury caused by operating a motor vehicle, vessel, or aircraft while intoxicated from alcohol or drugs. Also, if a creditor can prove that a debt arose from fraud, breach of fiduciary duty, or theft, or from a willful and malicious injury, the bankruptcy court may determine that the debt is not discharged. Chapter 13: Repayment of All or Part of the Debts of an Individual with Regular Income ($235 filing fee, $39 administrative fee: Total fee $274) Chapter 13 is designed for individuals with regular income who would like to pay all or part of their debts in installments over a period of time. You are only eligible for chapter 13 if your debts do not exceed certain dollar amounts set forth in the Bankruptcy Code. Under chapter 13, you must file with the court a plan to repay your creditors all or part of the money that you owe them, using your future earnings. The period allowed by the court to repay your debts may be three years or five years, depending upon your income and other factors. The court must approve your plan before it can take effect. After completing the payments under your plan, your debts are generally discharged except for domestic support obligations; most student loans; certain taxes; most criminal fines and restitution obligations; certain debts which are not properly listed in your bankruptcy papers; certain debts for acts that caused death or personal injury; and certain long term secured obligations. Chapter 11: Reorganization ($1000 filing fee, $39 administrative fee: Total fee $1039) Chapter 11 is designed for the reorganization of a business but is also available to consumer debtors. Its provisions are quite complicated, and any decision by an individual to file a chapter 11 petition should be reviewed with an attorney. Chapter 12: Family Farmer or Fisherman ($200 filing fee, $39 administrative fee: Total fee $239) Chapter 12 is designed to permit family farmers and fishermen to repay their debts over a period of time from future earnings and is similar to chapter 13. The eligibility requirements are restrictive, limiting its use to those whose income arises primarily from a family-owned farm or commercial fishing operation. 3. Bankruptcy Crimes and Availability of Bankruptcy Papers to Law Enforcement Officials A person who knowingly and fraudulently conceals assets or makes a false oath or statement under penalty of perjury, either orally or in writing, in connection with a bankruptcy case is subject to a fine, imprisonment, or both. All information supplied by a debtor in connection with a bankruptcy case is subject to examination by the Attorney General acting through the Office of the United States Trustee, the Office of the United States Attorney, and other components and employees of the Department of Justice. WARNING: Section 521(a)(1) of the Bankruptcy Code requires that you promptly file detailed information regarding your creditors, assets, liabilities, income, expenses and general financial condition. Your bankruptcy case may be dismissed if this information is not filed with the court within the time deadlines set by the Bankruptcy Code, the Bankruptcy Rules, and the local rules of the court. The documents and the deadlines for filing them are listed on Form B200, which is posted at http://www.uscourts.gov/bkforms/bankruptcy_forms.html#procedure. Many filing deadlines change on December 1, 2009. Of special note, 12 rules that set 15 days to act are amended to require action within 14 days, including Rule 1007(c), filing the initial case papers; Rule 3015(b), filing a chapter 13 plan; Rule 8009(a), filing appellate briefs; and Rules 1019, 1020, 2015, 2015.1, 2016, 4001, 4002, 6004, and 6007. Case:11-31115-MER B201B (Form 201B) (12/09) Doc#:1 Filed:09/02/11 Entered:09/02/11 15:11:51 Page17 of 61 United States Bankruptcy Court District of Colorado IN RE: Case No. Chapter 7 Martino, Thomas Gerard Debtor(s) CERTIFICATION OF NOTICE TO CONSUMER DEBTOR(S) UNDER § 342(b) OF THE BANKRUPTCY CODE Certificate of [Non-Attorney] Bankruptcy Petition Preparer I, the [non-attorney] bankruptcy petition preparer signing the debtor’s petition, hereby certify that I delivered to the debtor the attached notice, as required by § 342(b) of the Bankruptcy Code. © 1993-2011 EZ-Filing, Inc. [1-800-998-2424] - Forms Software Only Printed Name and title, if any, of Bankruptcy Petition Preparer Address: Social Security number (If the bankruptcy 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.) X Signature of Bankruptcy Petition Preparer of officer, principal, responsible person, or partner whose Social Security number is provided above. Certificate of the Debtor I (We), the debtor(s), affirm that I (we) have received and read the attached notice, as required by § 342(b) of the Bankruptcy Code. Martino, Thomas Gerard X /s/ Thomas Gerard Martino Printed Name(s) of Debtor(s) 9/02/2011 Date Signature of Joint Debtor (if any) Case No. (if known) Signature of Debtor Date X Instructions: Attach a copy of Form B 201A, Notice to Consumer Debtor(s) Under § 342(b) of the Bankruptcy Code. Use this form to certify that the debtor has received the notice required by 11 U.S.C. § 342(b) only if the certification has NOT been made on the Voluntary Petition, Official Form B1. Exhibit B on page 2 of Form B1 contains a certification by the debtor’s attorney that the attorney has given the notice to the debtor. The Declarations made by debtors and bankruptcy petition preparers on page 3 of Form B1 also include this certification. Case:11-31115-MER B6 Summary (Form 6 - Summary) (12/07) Doc#:1 Filed:09/02/11 Entered:09/02/11 15:11:51 Page18 of 61 United States Bankruptcy Court District of Colorado IN RE: Case No. Chapter 7 Martino, Thomas Gerard Debtor(s) SUMMARY OF SCHEDULES 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 debtor’s assets. Add the amounts of all claims from Schedules D, E, and F to determine the total amount of the debtor’s liabilities. Individual debtors also must complete the “Statistical Summary of Certain Liabilities and Related Data” if they file a case under chapter 7, 11, or 13. NAME OF SCHEDULE ATTACHED (YES/NO) NUMBER OF SHEETS ASSETS LIABILITIES OTHER Yes 1 $ 550,000.00 B - Personal Property © 1993-2011 EZ-Filing, Inc. [1-800-998-2424] - Forms Software Only A - Real Property Yes 3 $ 821,085.36 C - Property Claimed as Exempt Yes 1 D - Creditors Holding Secured Claims Yes 2 $ 3,006,392.00 E - Creditors Holding Unsecured Priority Claims (Total of Claims on Schedule E) Yes 1 $ 0.00 F - Creditors Holding Unsecured Nonpriority Claims Yes 4 $ 75,595,970.80 G - Executory Contracts and Unexpired Leases Yes 1 H - Codebtors Yes 1 I - Current Income of Individual Debtor(s) Yes 2 $ 113,633.16 J - Current Expenditures of Individual Debtor(s) Yes 1 $ 23,773.00 TOTAL 17 $ 1,371,085.36 $ 78,602,362.80 Form 6 -Case:11-31115-MER Statistical Summary (12/07) Doc#:1 Filed:09/02/11 Entered:09/02/11 15:11:51 Page19 of 61 United States Bankruptcy Court District of Colorado IN RE: Case No. Chapter 7 Martino, Thomas Gerard Debtor(s) 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)), filing a case under chapter 7, 11 or 13, you must report all information requested below. ü Check this box if you are an individual debtor whose debts are NOT primarily consumer debts. You are not required to report 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 © 1993-2011 EZ-Filing, Inc. [1-800-998-2424] - Forms Software Only 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 Decree Obligations 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” column 2. Total from Schedule E, “AMOUNT ENTITLED TO PRIORITY” column. $ $ 3. Total from Schedule E, “AMOUNT NOT ENTITLED TO PRIORITY, IF ANY” column $ 4. Total from Schedule F $ 5. Total of non-priority unsecured debt (sum of 1, 3, and 4) $ Case:11-31115-MER B6A (Official Form 6A) (12/07) Doc#:1 Filed:09/02/11 Entered:09/02/11 15:11:51 Page20 of 61 IN RE Martino, Thomas Gerard Case No. Debtor(s) (If known) SCHEDULE A - REAL PROPERTY Except as directed below, list all real property in which the debtor has any legal, equitable, or future interest, including all property owned as a cotenant, community property, or in which the debtor has a life estate. Include any property in which the debtor holds rights and powers exercisable for the debtor’s own benefit. If the debtor is married, state whether the 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 and Unexpired 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 entity claims to hold a secured interest in the property, write “None” in the column labeled “Amount of Secured Claim.” DESCRIPTION AND LOCATION OF PROPERTY NATURE OF DEBTOR'S INTEREST IN PROPERTY HUSBAND, WIFE, JOINT, OR COMMUNITY If the debtor is an individual or if a joint petition is filed, state the amount of any exemption claimed in the property only in Schedule C - Property Claimed as Exempt. 550,000.00 AMOUNT OF SECURED CLAIM 3,006,392.00 © 1993-2011 EZ-Filing, Inc. [1-800-998-2424] - Forms Software Only 22 residential homesites in Fort Lupton, Colorado Recently conveyed from Apple farms, LLC to the debtor. These properties have no equity. CURRENT VALUE OF DEBTOR'S INTEREST IN PROPERTY WITHOUT DEDUCTING ANY SECURED CLAIM OR EXEMPTION TOTAL 550,000.00 (Report also on Summary of Schedules) Case:11-31115-MER B6B (Official Form 6B) (12/07) Doc#:1 Filed:09/02/11 Entered:09/02/11 15:11:51 Page21 of 61 IN RE Martino, Thomas Gerard Case No. Debtor(s) (If known) SCHEDULE B - PERSONAL PROPERTY 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, place an “x” in the appropriate position in the column labeled “None.” If additional space is needed in any category, attach a separate sheet properly identified with the case name, case number, and the number of the category. If the debtor is married, state whether the 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 is an individual or a joint petition 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 and Unexpired Leases. TYPE OF PROPERTY N O N E DESCRIPTION AND LOCATION OF PROPERTY HUSBAND, WIFE, JOINT, OR COMMUNITY 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). CURRENT VALUE OF DEBTOR'S INTEREST IN PROPERTY WITHOUT DEDUCTING ANY SECURED CLAIM OR EXEMPTION © 1993-2011 EZ-Filing, Inc. [1-800-998-2424] - Forms Software Only 1. C