Professional Documents
Culture Documents
All Other Names used by the Debtor in the last 6 years All Other Names used by the Joint Debtor in the last 6 years
(include married, maiden, and trade names): (include married, maiden, and trade names):
Last four digits of Soc. Sec. No. / Complete EIN or other Tax I.D. No. Last four digits of Soc. Sec. No. / Complete EIN or other Tax I.D. No.
(if more than one, state all): (if more than one, state all):
xxx-xx-0630 xxx-xx-5271
Street Address of Debtor (No. & Street, City, State & Zip Code): Street Address of Joint Debtor (No. & Street, City, State & Zip Code):
4344 Smith Acres Lane 4344 Smith Acres Lane
Fordoche, LA 70732 Fordoche, LA 70732
Mailing Address of Debtor (if different from street address): Mailing Address of Joint Debtor (if different from street address):
P. O. Box 463
Fordoche, LA 70732
Estimated Assets
$0 to $50,001 to $100,001 to $500,001 to $1,000,001 to $10,000,001 to $50,000,001 to More than
$50,000 $100,000 $500,000 $1 million $10 million $50 million $100 million $100 million
Estimated Debts
$0 to $50,001 to $100,001 to $500,001 to $1,000,001 to $10,000,001 to $50,000,001 to More than
$50,000 $100,000 $500,000 $1 million $10 million $50 million $100 million $100 million
(Official Form Case 05-10098
1) (12/03) Doc 1 Filed 01/12/05 Entered 01/12/05 10:23:53 Page 2 of 5
Name of Debtor(s): FORM B1, Page 2
Voluntary Petition
(This page must be completed and filed in every case) Disotell, Cory Shane
Disotell, Misti Hyatt
Prior Bankruptcy Case Filed Within Last 6 Years (If more than one, attach additional sheet)
Location Case Number: Date Filed:
Where Filed: - None -
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: Relationship: Judge:
Signatures
Signature(s) of Debtor(s) (Individual/Joint) Exhibit A
I declare under penalty of perjury that the information provided in this (To be completed if debtor is required to file periodic reports (e.g., forms
petition is true and correct. 10K and 10Q) with the Securities and Exchange Commission pursuant to
[If petitioner is an individual whose debts are primarily consumer debts Section 13 or 15(d) of the Securities Exchange Act of 1934 and is
and has chosen to file under chapter 7] I am aware that I may proceed requesting relief under chapter 11)
under chapter 7, 11, 12, or 13 of title 11, United States Code, understand Exhibit A is attached and made a part of this petition.
the relief available under each such chapter, and choose to proceed under
chapter 7. Exhibit B
I request relief in accordance with the chapter of title 11, United States (To be completed if debtor is an individual
Code, specified in this petition. 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
X /s/ Cory Shane Disotell
chapter 7, 11, 12, or 13 of title 11, United States Code, and have
Signature of Debtor Cory Shane Disotell explained the relief available under each such chapter.
X /s/ Misti Hyatt Disotell X /s/ V. Katharine Crumby-Nance 28544 January 12, 2005
Signature of Joint Debtor Misti Hyatt Disotell Signature of Attorney for Debtor(s) Date
V. Katharine Crumby-Nance 28544
Exhibit C
Telephone Number (If not represented by attorney) Does the debtor own or have possession of any property that poses
January 12, 2005 a threat of imminent and identifiable harm to public health or
safety?
Date
Yes, and Exhibit C is attached and made a part of this petition.
Signature of Attorney No
X /s/ V. Katharine Crumby-Nance 28544
Signature of Non-Attorney Petition Preparer
Signature of Attorney for Debtor(s)
I certify that I am a bankruptcy petition preparer as defined in 11 U.S.C.
V. Katharine Crumby-Nance 28544 § 110, that I prepared this document for compensation, and that I have
Printed Name of Attorney for Debtor(s) provided the debtor with a copy of this document.
Blanche and Nance
Firm Name Printed Name of Bankruptcy Petition Preparer
423 Spain Street
Baton Rouge, LA 70802
Social Security Number (Required by 11 U.S.C.§ 110(c).)
Address
(225) 387-2241 Fax: (225) 838-6300
Telephone Number Address
January 12, 2005
Date Names and Social Security numbers of all other individuals who
prepared or assisted in preparing this document:
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, If more than one person prepared this document, attach additional
United States Code, specified in this petition. sheets conforming to the appropriate official form for each person.
X X
Signature of Authorized Individual Signature of Bankruptcy Petition Preparer
MAILING MATRIX
Verification/Declaration
(The penalties for making a false statement or for concealing property is a fine up to $500.00 or imprisonment for
up to five (5) years or both). (18 U.S.C. §§ 152 and 4571).
DECLARATION
I/We, Cory Shane Disotell and Misti Hyatt Disotell , named as the debtor(s) in this case,
and V. Katharine Crumby-Nance , counsel of record for the debtor(s) in this case, declare under penalty of
perjury that we have read the foregoing mailing matrix, consisting of 2 pages, and that it is true and correct to the best
of our information and belief.
Software Copyright (c) 1996-2001 Best Case Solutions, Inc. - Evanston, IL - (800) 492-8037 Best Case Bankruptcy
Case 05-10098 Doc 1 Filed 01/12/05 Entered 01/12/05 10:23:53 Page 4 of 5
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Discover Card
P.O. Box 15251
Wilmington, DE 19886-5251
Gateway
Processing Center
Des Moines, IA 50364-0001
General Collections & Recoveries
P. O. Box 1637
Opelousas, LA 70571-1637
GMAC
P.O. Bxo 660208
Dallas, TX 75263-0070
Case 05-10098 Doc 1 Filed 01/12/05 Entered 01/12/05 10:23:53 Page 5 of 5
Home Furniture
P. O. Box 94498
Las Vegas, NV 89193-4498
La Capitol Federal Credit Union
P.O. Box 3398
Baton Rouge, LA 70821-3398
Peter S. Thriffiley
P.O. Box 24757
New Orleans, LA 70184-4757
Sallie Mae
P. O. Box 470
Marlton, NJ 08053