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Voluntary Petition For Individuals Filing For Bankruptcy: Official Form 101

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Case 22-50073 Doc 19 Filed 02/23/22 Entered 02/23/22 18:57:26 Page 1 of 9

Fill in this information to identify your case:

United States Bankruptcy Court for the:

District of ConnecticutDistrict of ________


________________

22-50073
Case number (If known): _________________________ Chapter you are filing under:
‰ Chapter 7

‰ Chapter 11
‰ Chapter 12
‰ Chapter 13
✔ Check if this is an
‰
amended filing

Official Form 101


Voluntary Petition for Individuals Filing for Bankruptcy /

The bankruptcy forms use you and Debtor 1 to refer to a debtor filing alone. A married couple may file a bankruptcy case together—called a
joint case—and in joint cases, these forms use you to ask for information from both debtors. For example, if a form asks, “Do you own a car,”
the answer would be yes if either debtor owns a car. When information is needed about the spouses separately, the form uses Debtor 1 and
Debtor 2 to distinguish between them. In joint cases, one of the spouses must report information as Debtor 1 and the other as Debtor 2. The
same person must be Debtor 1 in all of the forms.
Be as complete and accurate as possible. If two married people are filing together, both are equally responsible for supplying correct
information. If more space is needed, attach a separate sheet to this form. On the top of any additional pages, write your name and case number
(if known). Answer every question.

Part 1: Identify Yourself

About Debtor 1: About Debtor 2 (Spouse Only in a Joint Case):


1. Your full name
Write the name that is on your
government-issued picture
Ho Wan
__________________________________________________ __________________________________________________
identification (for example, First name First name
your driver’s license or __________________________________________________ __________________________________________________
passport). Middle name Middle name

Bring your picture Kwok


__________________________________________________ __________________________________________________
identification to your meeting Last name Last name
with the trustee. ___________________________ ___________________________
Suffix (Sr., Jr., II, III) Suffix (Sr., Jr., II, III)

2. All other names you Miles


__________________________________________________ __________________________________________________
have used in the last 8 First name First name
years
__________________________________________________ __________________________________________________
Include your married or Middle name Middle name
maiden names. Kwok; Guo
__________________________________________________ __________________________________________________
Last name Last name

Wengui
__________________________________________________ __________________________________________________
First name First name
__________________________________________________ __________________________________________________
Middle name Middle name
Guo
__________________________________________________ __________________________________________________
Last name Last name

3. Only the last 4 digits of


your Social Security xxx 9 ____
– xx – ____ 5 ____
9 ____
5 xxx – xx – ____ ____ ____ ____
number or federal OR OR
Individual Taxpayer
Identification number 9 xx – xx – ____ ____ ____ ____ 9 xx – xx – ____ ____ ____ ____
(ITIN)

Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 1
Case 22-50073 Doc 19 Filed 02/23/22 Entered 02/23/22 18:57:26 Page 2 of 9

Debtor 1 Ho Wan Kwok


_______________________________________________________ 22-50073
Case number (if known)_____________________________________
First Name Middle Name Last Name

About Debtor 1: About Debtor 2 (Spouse Only in a Joint Case):

4. Any business names


and Employer ✔ I have not used any business names or EINs.
‰ ‰ I have not used any business names or EINs.
Identification Numbers
(EIN) you have used in _________________________________________________ _________________________________________________
the last 8 years Business name Business name

Include trade names and


_________________________________________________ _________________________________________________
doing business as names Business name Business name

___ ___ – ___ ___ ___ ___ ___ ___ ___ ___ ___ – ___ ___ ___ ___ ___ ___ ___
EIN EIN

___ ___ – ___ ___ ___ ___ ___ ___ ___ ___ ___ – ___ ___ ___ ___ ___ ___ ___
EIN EIN

5. Where you live If Debtor 2 lives at a different address:

c/o Golden Spring (New York) Ltd.


_________________________________________________ _________________________________________________
Number Street Number Street

162 East 64th Street


_________________________________________________ _________________________________________________

New York NY 10065


_________________________________________________ _________________________________________________
City State ZIP Code City State ZIP Code

New York
_________________________________________________ _________________________________________________
County County

If your mailing address is different from the one If Debtor 2’s mailing address is different from
above, fill it in here. Note that the court will send yours, fill it in here. Note that the court will send
any notices to you at this mailing address. any notices to this mailing address.

_________________________________________________ _________________________________________________
Number Street Number Street

_________________________________________________ _________________________________________________
P.O. Box P.O. Box

_________________________________________________ _________________________________________________
City State ZIP Code City State ZIP Code

6. Why you are choosing Check one: Check one:


this district to file for ✔ Over the last 180 days before filing this petition,
bankruptcy ‰ ‰ Over the last 180 days before filing this petition,
I have lived in this district longer than in any I have lived in this district longer than in any
other district. other district.

‰ I have another reason. Explain. ‰ I have another reason. Explain.


(See 28 U.S.C. § 1408.) (See 28 U.S.C. § 1408.)
________________________________________ ________________________________________
________________________________________ ________________________________________
________________________________________ ________________________________________
________________________________________ ________________________________________

Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 2
Case 22-50073 Doc 19 Filed 02/23/22 Entered 02/23/22 18:57:26 Page 3 of 9

Debtor 1 Ho Wan Kwok


_______________________________________________________ 22-50073
Case number (if known)_____________________________________
First Name Middle Name Last Name

Part 2: Tell the Court About Your Bankruptcy Case

7. The chapter of the Check one. (For a brief description of each, see Notice Required by 11 U.S.C. § 342(b) for Individuals Filing
Bankruptcy Code you for Bankruptcy (Form 2010)). Also, go to the top of page 1 and check the appropriate box.
are choosing to file
under
‰ Chapter 7
‰
✔ Chapter 11
‰ Chapter 12
‰ Chapter 13

8. How you will pay the fee ✔ I will pay the entire fee when I file my petition. Please check with the clerk’s office in your
‰
local court for more details about how you may pay. Typically, if you are paying the fee
yourself, you may pay with cash, cashier’s check, or money order. If your attorney is
submitting your payment on your behalf, your attorney may pay with a credit card or check
with a pre-printed address.

‰ I need to pay the fee in installments. If you choose this option, sign and attach the
Application for Individuals to Pay The Filing Fee in Installments (Official Form 103A).

‰ I request that my fee be waived (You may request this option only if you are filing for Chapter 7.
By law, a judge may, but is not required to, waive your fee, and may do so only if your income is
less than 150% of the official poverty line that applies to your family size and you are unable to
pay the fee in installments). If you choose this option, you must fill out the Application to Have the
Chapter 7 Filing Fee Waived (Official Form 103B) and file it with your petition.

9. Have you filed for ✔ No


‰
bankruptcy within the
last 8 years? ‰ Yes. District __________________________ When _______________ Case number ___________________________
MM / DD / YYYY

District __________________________ When _______________ Case number ___________________________


MM / DD / YYYY

District __________________________ When _______________ Case number ___________________________


MM / DD / YYYY

10. Are any bankruptcy ✔ No


‰
cases pending or being
filed by a spouse who is ‰ Yes. Debtor _________________________________________________ Relationship to you _____________________
not filing this case with District __________________________ When _______________ Case number, if known____________________
you, or by a business MM / DD / YYYY
partner, or by an
affiliate?
Debtor _________________________________________________ Relationship to you _____________________

District __________________________ When _______________ Case number, if known____________________


MM / DD / YYYY

11. Do you rent your ✔ No.


‰ Go to line 12.
residence? ‰ Yes. Has your landlord obtained an eviction judgment against you?

‰ No. Go to line 12.


‰ Yes. Fill out Initial Statement About an Eviction Judgment Against You (Form 101A) and file it as
part of this bankruptcy petition.

Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 3
Case 22-50073 Doc 19 Filed 02/23/22 Entered 02/23/22 18:57:26 Page 4 of 9

Debtor 1 Ho Wan Kwok


_______________________________________________________ 22-50073
Case number (if known)_____________________________________
First Name Middle Name Last Name

Part 3: Report About Any Businesses You Own as a Sole Proprietor

12. Are you a sole proprietor ✔ No. Go to Part 4.


‰
of any full- or part-time
business? ‰ Yes. Name and location of business
A sole proprietorship is a
business you operate as an _______________________________________________________________________________________
Name of business, if any
individual, and is not a
separate legal entity such as
a corporation, partnership, or _______________________________________________________________________________________
Number Street
LLC.
If you have more than one
_______________________________________________________________________________________
sole proprietorship, use a
separate sheet and attach it
to this petition. _______________________________________________ _______ __________________________
City State ZIP Code

Check the appropriate box to describe your business:


‰ Health Care Business (as defined in 11 U.S.C. § 101(27A))
‰ Single Asset Real Estate (as defined in 11 U.S.C. § 101(51B))
‰ Stockbroker (as defined in 11 U.S.C. § 101(53A))
‰ Commodity Broker (as defined in 11 U.S.C. § 101(6))
‰ None of the above

13. Are you filing under If you are filing under Chapter 11, the court must know whether you are a small business debtorRUDGHEWRU
Chapter 11 of the FKRRVLQJWRSURFHHGXQGHU6XEFKDSWHU9 so that it can set appropriate deadlines. If you indicate that you
Bankruptcy Code and are a small business debtorRU\RXDUHFKRRVLQJWRSURFHHGXQGHU6XEFKDSWHU9, you must attach your
most recent balance sheet, statement of operations, cash-flow statement, and federal income tax return or
are you a small business
if any of these documents do not exist, follow the procedure in 11 U.S.C. § 1116(1)(B).
debtorRUDGHEWRUDV
GHILQHGE\86&† ‰ No. I am not filing under Chapter 11.
  ? ✔ No.
‰ I am filing under Chapter 11, but I am NOT a small business debtor according to the definition in
For a definition of small the Bankruptcy Code.
business debtor, see
11 U.S.C. § 101(51D).
‰ <HV,DPILOLQJXQGHU&KDSWHU,DPDVPDOOEXVLQHVVGHEWRUDFFRUGLQJWRWKHGHILQLWLRQLQWKH%DQNUXSWF\
&RGHDQG,GRQRWFKRRVHWRSURFHHGXQGHU6XEFKDSWHU9RI&KDSWHU
‰ <HV,DPILOLQJXQGHU&KDSWHU,DPDGHEWRUDFFRUGLQJWRWKHGHILQLWLRQLQ†  RIWKH
%DQNUXSWF\&RGHDQG,FKRRVHWRSURFHHGXQGHU6XEFKDSWHU9RI&KDSWHU

Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 4
Case 22-50073 Doc 19 Filed 02/23/22 Entered 02/23/22 18:57:26 Page 5 of 9

Debtor 1 Ho Wan Kwok


_______________________________________________________ 22-50073
Case number (if known)_____________________________________
First Name Middle Name Last Name

Part 4: Report if You Own or Have Any Hazardous Property or Any Property That Needs Immediate Attention

14. Do you own or have any ✔ No


‰
property that poses or is
alleged to pose a threat ‰ Yes. What is the hazard? ________________________________________________________________________
of imminent and
identifiable hazard to ________________________________________________________________________
public health or safety?
Or do you own any
property that needs
If immediate attention is needed, why is it needed? _______________________________________________
immediate attention?
For example, do you own ________________________________________________________________________
perishable goods, or livestock
that must be fed, or a building
that needs urgent repairs?
Where is the property? ________________________________________________________________________
Number Street

________________________________________________________________________

________________________________________ _______ ____________________


City State ZIP Code

Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 5
Case 22-50073 Doc 19 Filed 02/23/22 Entered 02/23/22 18:57:26 Page 6 of 9

Debtor 1 Ho Wan Kwok


_______________________________________________________
First Name Middle Name Last Name
22-50073
Case number (if known)_____________________________________

Part 5: Explain Your Efforts to Receive a Briefing About Credit Counseling

About Debtor 1: About Debtor 2 (Spouse Only in a Joint Case):


15. Tell the court whether
you have received a
briefing about credit You must check one: You must check one:
counseling. ✔ I received a briefing from an approved credit
‰ ‰ I received a briefing from an approved credit
counseling agency within the 180 days before I counseling agency within the 180 days before I
The law requires that you filed this bankruptcy petition, and I received a filed this bankruptcy petition, and I received a
receive a briefing about credit certificate of completion. certificate of completion.
counseling before you file for
Attach a copy of the certificate and the payment Attach a copy of the certificate and the payment
bankruptcy. You must
plan, if any, that you developed with the agency. plan, if any, that you developed with the agency.
truthfully check one of the
following choices. If you ‰ I received a briefing from an approved credit ‰ I received a briefing from an approved credit
cannot do so, you are not counseling agency within the 180 days before I counseling agency within the 180 days before I
eligible to file. filed this bankruptcy petition, but I do not have a filed this bankruptcy petition, but I do not have a
certificate of completion. certificate of completion.
If you file anyway, the court
Within 14 days after you file this bankruptcy petition, Within 14 days after you file this bankruptcy petition,
can dismiss your case, you
you MUST file a copy of the certificate and payment you MUST file a copy of the certificate and payment
will lose whatever filing fee
plan, if any. plan, if any.
you paid, and your creditors
can begin collection activities ‰ I certify that I asked for credit counseling ‰ I certify that I asked for credit counseling
again. services from an approved agency, but was services from an approved agency, but was
unable to obtain those services during the 7 unable to obtain those services during the 7
days after I made my request, and exigent days after I made my request, and exigent
circumstances merit a 30-day temporary waiver circumstances merit a 30-day temporary waiver
of the requirement. of the requirement.
To ask for a 30-day temporary waiver of the To ask for a 30-day temporary waiver of the
requirement, attach a separate sheet explaining requirement, attach a separate sheet explaining
what efforts you made to obtain the briefing, why what efforts you made to obtain the briefing, why
you were unable to obtain it before you filed for you were unable to obtain it before you filed for
bankruptcy, and what exigent circumstances bankruptcy, and what exigent circumstances
required you to file this case. required you to file this case.
Your case may be dismissed if the court is Your case may be dismissed if the court is
dissatisfied with your reasons for not receiving a dissatisfied with your reasons for not receiving a
briefing before you filed for bankruptcy. briefing before you filed for bankruptcy.
If the court is satisfied with your reasons, you must If the court is satisfied with your reasons, you must
still receive a briefing within 30 days after you file. still receive a briefing within 30 days after you file.
You must file a certificate from the approved You must file a certificate from the approved
agency, along with a copy of the payment plan you agency, along with a copy of the payment plan you
developed, if any. If you do not do so, your case developed, if any. If you do not do so, your case
may be dismissed. may be dismissed.
Any extension of the 30-day deadline is granted Any extension of the 30-day deadline is granted
only for cause and is limited to a maximum of 15 only for cause and is limited to a maximum of 15
days. days.

‰ I am not required to receive a briefing about ‰ I am not required to receive a briefing about
credit counseling because of: credit counseling because of:

‰ Incapacity. I have a mental illness or a mental ‰ Incapacity. I have a mental illness or a mental
deficiency that makes me deficiency that makes me
incapable of realizing or making incapable of realizing or making
rational decisions about finances. rational decisions about finances.
‰ Disability. My physical disability causes me ‰ Disability. My physical disability causes me
to be unable to participate in a to be unable to participate in a
briefing in person, by phone, or briefing in person, by phone, or
through the internet, even after I through the internet, even after I
reasonably tried to do so. reasonably tried to do so.
‰ Active duty. I am currently on active military ‰ Active duty. I am currently on active military
duty in a military combat zone. duty in a military combat zone.
If you believe you are not required to receive a If you believe you are not required to receive a
briefing about credit counseling, you must file a briefing about credit counseling, you must file a
motion for waiver of credit counseling with the court. motion for waiver of credit counseling with the court.

Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 
Case 22-50073 Doc 19 Filed 02/23/22 Entered 02/23/22 18:57:26 Page 7 of 9

Debtor 1 Ho Wan Kwok


_______________________________________________________ 22-50073
Case number (if known)_____________________________________
First Name Middle Name Last Name

Part 6: Answer These Questions for Reporting Purposes

16a. Are your debts primarily consumer debts? Consumer debts are defined in 11 U.S.C. § 101(8)
16. What kind of debts do as “incurred by an individual primarily for a personal, family, or household purpose.”
you have?

‰ No. Go to line 16b.
‰ Yes. Go to line 17.

16b. Are your debts primarily business debts? Business debts are debts that you incurred to obtain
money for a business or investment or through the operation of the business or investment.

‰ No. Go to line 16c.
‰ Yes. Go to line 17.

16c. State the type of debts you owe that are not consumer debts or business debts.
Litigation expenses, claims, and judgments
_______________________________________________________________

17. Are you filing under


Chapter 7? ‰
✔ No. I am not filing under Chapter 7. Go to line 18.

Do you estimate that after ‰ Yes. I am filing under Chapter 7. Do you estimate that after any exempt property is excluded and
any exempt property is administrative expenses are paid that funds will be available to distribute to unsecured creditors?
excluded and ‰ No
administrative expenses
are paid that funds will be ‰ Yes
available for distribution
to unsecured creditors?

18. How many creditors do ‰ 1-49 ‰ 1,000-5,000 ‰ 25,001-50,000


you estimate that you ✔ 50-99
‰ ‰ 5,001-10,000 ‰ 50,001-100,000
owe? ‰ 100-199 ‰ 10,001-25,000 ‰ More than 100,000
‰ 200-999
19. How much do you ‰ $0-$50,000 ‰ $1,000,001-$10 million ‰ $500,000,001-$1 billion
estimate your assets to ✔ $50,001-$100,000
‰ ‰ $10,000,001-$50 million ‰ $1,000,000,001-$10 billion
be worth? ‰ $100,001-$500,000 ‰ $50,000,001-$100 million ‰ $10,000,000,001-$50 billion
‰ $500,001-$1 million ‰ $100,000,001-$500 million ‰ More than $50 billion
20. How much do you ‰ $0-$50,000 ‰ $1,000,001-$10 million ‰ $500,000,001-$1 billion
estimate your liabilities ‰ $50,001-$100,000 ‰ $10,000,001-$50 million ‰ $1,000,000,001-$10 billion
to be? ‰ $100,001-$500,000 ‰ $50,000,001-$100 million ‰ $10,000,000,001-$50 billion
‰ $500,001-$1 million ✔ $100,000,001-$500 million
‰ ‰ More than $50 billion
Part 7: Sign Below

I have examined this petition, and I declare under penalty of perjury that the information provided is true and
For you correct.
If I have chosen to file under Chapter 7, I am aware that I may proceed, if eligible, under Chapter 7, 11,12, or 13
of title 11, United States Code. I understand the relief available under each chapter, and I choose to proceed
under Chapter 7.
If no attorney represents me and I did not pay or agree to pay someone who is not an attorney to help me fill out
this document, I have obtained and read the notice required by 11 U.S.C. § 342(b).
I request relief in accordance with the chapter of title 11, United States Code, specified in this petition.
I understand making a false statement, concealing property, or obtaining money or property by fraud in connection
with a bankruptcy case can result in fines up to $250,000, or imprisonment for up to 20 years, or both.
18 U.S.C. §§ 152, 1341, 1519, and 3571.

8 /s/ Ho Wan Kwok


______________________________________________ 8_____________________________
Signature of Debtor 1 Signature of Debtor 2

02/23/2022
Executed on _________________ Executed on __________________
MM / DD / YYYY MM / DD / YYYY

Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 
Case 22-50073 Doc 19 Filed 02/23/22 Entered 02/23/22 18:57:26 Page 8 of 9

Debtor 1 Ho Wan Kwok


_______________________________________________________ 22-50073
Case number (if known)_____________________________________
First Name Middle Name Last Name

I, the attorney for the debtor(s) named in this petition, declare that I have informed the debtor(s) about eligibility
For your attorney, if you are to proceed under Chapter 7, 11, 12, or 13 of title 11, United States Code, and have explained the relief
represented by one available under each chapter for which the person is eligible. I also certify that I have delivered to the debtor(s)
the notice required by 11 U.S.C. § 342(b) and, in a case in which § 707(b)(4)(D) applies, certify that I have no
If you are not represented knowledge after an inquiry that the information in the schedules filed with the petition is incorrect.
by an attorney, you do not
need to file this page.
8_________________________________
/s/ Dylan Kletter Date _________________
02/23/2022
Signature of Attorney for Debtor MM / DD / YYYY

Dylan Kletter
_________________________________________________________________________________________________
Printed name

Brown Rudnick LLP


_________________________________________________________________________________________________
Firm name

185 Asylum Street


_________________________________________________________________________________________________
Number Street

_________________________________________________________________________________________________

Hartford
______________________________________________________ CT
____________ 06103
______________________________
City State ZIP Code

(860) 509-6557
Contact phone _____________________________________ Email address dkletter@brownrudnick.com
______________________________

429244
______________________________________________________ CT
____________
Bar number State

Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 
Case 22-50073 Doc 19 Filed 02/23/22 Entered 02/23/22 18:57:26 Page 9 of 9

Debtor 1 Ho Wan Kwok


_______________________________________________________ 22-50073
Case number (if known)_____________________________________
First Name Middle Name Last Name

For you if you are filing this The law allows you, as an individual, to represent yourself in bankruptcy court, but you
bankruptcy without an should understand that many people find it extremely difficult to represent
attorney themselves successfully. Because bankruptcy has long-term financial and legal
consequences, you are strongly urged to hire a qualified attorney.
If you are represented by
an attorney, you do not To be successful, you must correctly file and handle your bankruptcy case. The rules are very
need to file this page. technical, and a mistake or inaction may affect your rights. For example, your case may be
dismissed because you did not file a required document, pay a fee on time, attend a meeting or
hearing, or cooperate with the court, case trustee, U.S. trustee, bankruptcy administrator, or audit
firm if your case is selected for audit. If that happens, you could lose your right to file another
case, or you may lose protections, including the benefit of the automatic stay.
You must list all your property and debts in the schedules that you are required to file with the
court. Even if you plan to pay a particular debt outside of your bankruptcy, you must list that debt
in your schedules. If you do not list a debt, the debt may not be discharged. If you do not list
property or properly claim it as exempt, you may not be able to keep the property. The judge can
also deny you a discharge of all your debts if you do something dishonest in your bankruptcy
case, such as destroying or hiding property, falsifying records, or lying. Individual bankruptcy
cases are randomly audited to determine if debtors have been accurate, truthful, and complete.
Bankruptcy fraud is a serious crime; you could be fined and imprisoned.

If you decide to file without an attorney, the court expects you to follow the rules as if you had
hired an attorney. The court will not treat you differently because you are filing for yourself. To be
successful, you must be familiar with the United States Bankruptcy Code, the Federal Rules of
Bankruptcy Procedure, and the local rules of the court in which your case is filed. You must also
be familiar with any state exemption laws that apply.

Are you aware that filing for bankruptcy is a serious action with long-term financial and legal
consequences?
‰ No
‰ Yes

Are you aware that bankruptcy fraud is a serious crime and that if your bankruptcy forms are
inaccurate or incomplete, you could be fined or imprisoned?
‰ No
‰ Yes

Did you pay or agree to pay someone who is not an attorney to help you fill out your bankruptcy forms?
‰ No
‰ Yes. Name of Person_____________________________________________________________________.
Attach Bankruptcy Petition Preparer’s Notice, Declaration, and Signature (Official Form 119).

By signing here, I acknowledge that I understand the risks involved in filing without an attorney. I
have read and understood this notice, and I am aware that filing a bankruptcy case without an
attorney may cause me to lose my rights or property if I do not properly handle the case.

8_______________________________________________ 8______________________________
Signature of Debtor 1 Signature of Debtor 2

Date _________________ Date _________________


MM / DD / YYYY MM / DD / YYYY

Contact phone ______________________________________ Contact phone ________________________________

Cell phone ______________________________________ Cell phone ________________________________

Email address ______________________________________ Email address ________________________________

Official Form 101 Voluntary Petition for Individuals Filing for Bankruptcy page 

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