Case 17-43815-mxm7 Doc 28 Filed 11/20/17 Entered 11/20/17 09:27:15 Page 1 of 4 Fill in this information to identify your case: Debtor 4 rd Lee McCusker Debtor 2 (Spouse, i fling) FiatWare Tae a Tana United States Bankruptcy Cour for the: NORTHERN DISTRICT OF TEXAS ED check this isan Case number 17-43815-7 amended fing (noun) Official Form 106C ‘Schedule C: The Property You Claim as Exempt oat Be as complete and accurate as possible, Iftwo married people ae fling together, bot are equally responsible for supplying correct information Using the property you listed on Schedule A/2: Property (Official Form 106A/2) as your source, lit the property that you claim as exemp. i mare space is needed, fil out and attach to this page as mary copies of Part 2: Adcltonal Page as necessary. On he top of any addtional pages, wile your name and ease number (if known). For each item of property you claim as exempt, you must specify the amount ofthe exemption you claim. One way of doing so is to state specific dolar amount as exempt. Alternatively, you may claim the full fair market value ofthe property being exempted up tothe amount of any applicable statutory limit. Some exemptions—such as those for health aids, rights to receive certain benefits, and tax-exempt ratrement funds-may be unlimited in dollar amount. However, ifyou claim an exemption of 100% of fair market value under a law that limits the exemption to a particular dollar amount and the value ofthe property is determined to exceed that amount, your exemption would be limited to the applicable statutory amount. TERE contity the Property You Claim as Exempt 1. Which set of exemptions are you claiming? Check one ony, even if your spause is fling with you Ly Youare claiming state and federal nonbankruptcy exemptions, 11 U.S.C. § 5221013) IZ Youare claiming federal exemptions. 11 U.S.C. § 522(0)2) 2. For any property you list on Schedule A/B that you claim as exempt, lin the information below. Brief description ofthe property andiine on Currentvalue of Amount ofthe ‘Specific laws that allow exemption ‘Schedule A/B that lists this property the portion you exemption you claim Copy the value trom Check ony one box for ‘Schedule A/B wach exemption Bret description: HZ $6,500.00 11U..c. § 522(4)(3) (Claimed: household goods and furnishings F008 of aiemarkor $6,500.00 Line from Schedule Af: value, up to any 100% FMV without any restrictions) + applicable statutory Tit Bret deserption $1,500.00 $1,500.00 11 USC. § 522(4)(3) (Claimed: television, computer, verledidvd stereo 1D 10% otfarmanet $1,500.00 component value, upto ary 100% FMV without any restrictions) Line fom Schedule Afa:_7- ‘applicable statutory Tit 3. Are you claiming a homestead exemption of more than $160,375? (Subject to acjustment an 401/19 and every 3 years ater that for casas fled on or after the date of adjustment.) wy No Ey Yes. Did you acquire the property covered by the exomplion within 1,215 days before you fd his case? Ne B ves Official Form 106 ‘Schedule C: The Property You Claim as Exempt page 1Case 17-43815-mxm7 Doc 28 Filed 11/20/17 Entered 11/20/17 09:27:15 Page 2 of 4 Dobior1 Willard Lee MeCusker Ccase number (f own) _17-43815-7 Additional Pagi Brief description ofthe property andiline on Current value of Amount ofthe ‘Specific laws that allow exemption ‘Schedule A/B that lists this property the pertion you exemption you claim Copy he value from Check only one box for ‘Schedule Beach exemption Bret deseripton: $415.00 $415.00 41 U.S.C. § 522(4)(3) (Claimed: artwork, dvds, books, pictures & art LD 10% offarmaret $415.00 objects, records, tapes, cds. value,up to ary 100% FMV without any restrictions) Line fom Schedule AfB:__ 8 applicable statutory Tmt Bret description: $225.00 $225.00 11 U.S.C. § 522(4)(3) (Claimed: camera, exercise equipment 1 Wo%ettaimarat $225.00 Line fom Schedule A/B:__9 value, upto ary 100% FMV without any restrictions) applicable statutory Tit Biel description $000 a $0.00 11 U.S.C. § 522(d)(3) (Claimed: Sporting equipment; Non Filing Spouse's LD Wo%ertarmanct $0.00 sole management community property; value, up to ery 100% FMV without any restrictions) therefore, not property of the estate; applicable statutory estimated value $1,200.00 Tit Line fom Schedule AB: Bret description: ss 11 USC. § 522(4)(3) (Claimed: clothing and personal effects, 1 00% otfaiemarkat $350.00 Lin from Schedule AB: _ 14 value, up to any 100% FMV without any restrictions) st applicable statutory Tit Bret description $0.00 $0.00 11 USC. § 522(4)(3) (Claimed: clothing and personal effects: Non: TOO% oftair market $0.00 Spouse's separate property or sole value, upto ary 100% FMV without any restrictions) management community property; applicable statutory therefore, not property of the estate; limit estimated value $2000.00 Lin from Schedule AB:_14 Brot deserpton: $325.00] __ $325.00 11 U.S.C. § 522(4)(4) (Claimed: high schoo! ring, watches, wedding band LD 100% offarmarat $325.00 Line from Schedule am: 12 value, upto ary 100% FMV without any restrictions) 2 applicable statutony Tit iret description: $0.00 $0.00 14 USC. § 522(4)(4) (Claimed: joworly: Non-Filing Spouse's sole O Wo%ertarmanet $0.00 management community property; value, upto ary 100% FMV without any restrictions) therefore, not property of the est applicable statutory estimated value $1588.00 lit Lin from Schedule A> 12 Bret desenpton $150.00 __$150.00 11 USC. § 622(4\(5) (Claimed: cash on hand Ly W0mottairmarkat $150.00 Line fom Schedule VB _16. value, upto ary 100% FMV without any restrictions) ss applicable statutory Tit Official Form 106 ‘Schedule C: The Property You Claim as Exempt page 2Case 17-43815-mxm7 Doc 28 Filed 11/20/17 Entered 11/20/17 09:27:15 Page 3 of 4 Dobior1 Willard Lee MeCusker Ccase number (f known) _17-43815-7 Additional Pagi Brief description ofthe property andiline on Current value of Amount ofthe ‘Specific laws that allow exemption ‘Schedule A/B that lists this property the pertion you exemption you claim Copy he value from Check only one box for ‘Schedule Beach exemption Bret description: $143.00] __ $143.00 41 U.S.C. § 522(4)(5) (Claimed: First Internet Bank of Indiana; checking LD 10% offarmaret $143.00 account ending 200 value,upto ary 100% FMV without any restrictions) Line feo Schedule VB: _17.4 applicable statutory Tim Bret description: $22.00 ‘$22.00 11 U.S.C. § 622(4\(5) (Claimed: First Internet Bank of Indiana; 2 savings O Wo%ortarmanat $22.00 accounts ending 001 & 002 value, up o any 100% FMV without any restrictions) Line from Schedule B:_17.3 applicable statutory Tit Bret description: $000 a $0.00 11 U.S.C. § 522(4)(5) (Claimed: Capital One Bank; checking account LD Wo%ertarmarct $0.00 ending 213; Non-Filing Spouse's sole value, up to ery 100% FMV without any restrictions) management community property; applicable statutory therefore, not property of the estate; Tmt estimated value $231.00 Line fem Schedule B:_17.2 Bret doserpton: $000 a $0.00 11 U.S.C. § 522(€)(5) (Claimed: Capital One Bank; savings account ending LD Womortarmanct $0.00 063; Non-Filing Spouse's sole value, up o ary 100% FMV without any restrictions) management community property: applicable statutony therefore, not property of the estat Tint estimated value $33.00 Line from Schedule AB:_17.4 Bret doserpton: $000 a $0.00 11 U.S.C. § 522(4)(12) (Claimed: Empire Today profit sharing plan: Non- 1D W0%ortarmanct $0.00 Filing Spouse's sole management value, upto ary 100% FMV without any restrictions) community property; therefore, not applicable statutony property of the estate; estimated value limit $28,260.54 Line from Schedule AB: _24 Bret doserpton EZ __$3,400.00 11 U.S.C. § 522(a\(5) (Claimed: residental lease: Jan Debeuckdaer 1 0% orfairmarcet $3,400.00 Line fiom Schedule AB: 22 value, upto ary 100% FMV without any restrictions) a applicable statutony Timi Bret description: $500.00 $500.00, 41 US.C. § 522(4)(5) (Claimed: Tricounty Coop LD W0% orfairmarat $800.00 Line from Schedule A: 22 value, up to any 100% FMV without any restrictions) 2 applicable statutory Tit Bret dascrpton: $000 $0.00 11 USC. § 522(d)(8) (Claimed: ‘American Life; torm lif life policy insuring 1D Wo%ettarmanet $0.00 the life of Non-iling Spouse; $200,000.00 value, up to ary 100% FMV without any restrictions) face value; no cash value applicable statutory Line from Schedule AB _34 lit Official Form 106 ‘Schedule C: The Property You Claim as Exempt pagesCase 17-43815-mxm7 Doc 28 Filed 11/20/17 Entered 11/20/17 09:27:15 Page 4 of 4 Debtor? Wil Ccase number (f known) _17-43815-7 Adc Brief description ofthe property andiline on Current value of Amount ofthe ‘Specific laws that allow exemption ‘Schedule A/B that lists this property the pertion you exemption you claim Copy he value from Check only one box for ‘Schedule Beach exemption Bret description: $1,150.00] _$1,150.00 11 U.S.C. § 522(4)(6) (Claimed: chairs, desk, computers, printer scanner LD 100% offarmaret $1,150.00 Line from Schedule A/B:_39 value,upto ary 100% FMV without any restrictions) a applicable statutory Tim Official Form 106 ‘Schedule C: The Property You Claim as Exempt page 4