Form B1 2

Case 2:12-bk-17635-RJH Doc 1-1 Filed 08/07/12 Entered 08/07/12 11:26:33 Desc
Petition Part II Page 1 of 32

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B6F (Official Form SF) (12/07)- Cont.
In re lntermedia Publishing Group
Case
Debtor
(If known)
SCHEDULE F -CREDITORS HOLDING UNSECURED NC NPRIORITY CLAIMS
(Continuation Sheet) I
ACCOUNT NO.
Jay Harvey
CREDITOR'S NAME,
MAILING ADDRESS
INCLUDING ZIP CODE,
AND ACCOUNT NUMBER
(See instructions above.)
114 E Michelle Lane
Pendleton, IN 46064
ACCOUNT NO.
JeffKidlow
5540 S Marshall St
Littleton, CO 80123
ACCOUNT NO.
Jill Glassco
1031 Blue Heron Pt.
Birmingham, AL 35242
ACCOUNT NO.
Jim Conway
7169 Stanley Ct.
Petoskey, Ml 49770
ACCOUNT NO.
Jim Walters
10001 W Jewell Ave
Lakewood, CO 80232
1-
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DATE CLAIM WAS
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1-
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CONSIDERATION FOR
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CLAIM.
i=
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0
(/)
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IF CLAIM IS SUBJECT TO
0
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SETOFF, SO STATE
::J
royalty
royalty
royalty
royalty
Sheet no. 1 0 of 22 continuation sheets attached to Schedule of Creditors
Holding Unsecured
Subtotal li>
Nonpriority Claims
Total li>
(Use only on last page of the corr leted Schedule F.)
(Report also on Summary of Schedules and, if on the Statistical
Summary of Certain Llabilltie
1
and Related Data.)
.,
''
AMOUNT OF
CLAIM
41.97
9.50
100.74
205.84
12.20
370.25
B6F (Official Form 6F) (12/07). Cont.
In re
lntermedia Publishing Group

Debtor'i _ _ ' ' :
(If known)
... ,/';
SCHEDULE F - CREDITORS'HpLDING UNSECURED NPRIORITY CLAIMS
- I (C&it\thuation Sheet) [
ACCOUNT NO.
CREDITOR'S NAME,
MAILING ADDRESS
INCLUDING ZIP CODE,
AND ACCOUNT NUMBER
Jo Mangum
1712 Briarforest PI
Raleigh, NC 27615
ACCOUNT NO.
Jo Russell
PO Box 941
Taylor, AZ 85939
ACCOUNT NO.
Judy Billings
1601 S Ashton Ave
Stillwater, OK 74074
ACCOUNT NO.
Karisa Ewinger
PO Box383
Destin, FL 32540
ACCOUNT NO.
Kay Wise
PO Box4006
Upper Marlboro, MD 20775
royalty
royalty
DATE CLAIM WAS
INCURRED AND
CONSIDERATION FOR
CLAIM.
SETOFF, SO STATE
q' ;._ .
e<p-.... o.'e< -_,, .. ' ._, ':' ..
royalty
royalty
-t-. ---- ......... ..
"}!- ,_,; "'. ,;,- -.;. "
fil

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5
0
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a.
en
0
no. 11 of 22 continuation sheets attached to Schedule of . Nd-{
Holding Unsecured _ ._ . ';Mil' . ..
Subtotal
Non priority Claims . .' 0,;.
!' .
Total
(Use only on last page of the corr leted Schedule F.)
(Report also on Summary of Schedules and, if applical e on the Statistical
Summary of Certain Liabilitie and Related Data.)
AMOUNT OF
CLAIM
15.83
6.12
100.02
4.97
4.97
131.91
B6F (Official Form 6F) (12107)- Cont.
CaseNo. ~ - - - - - - - - - - - - - - - - - - -
Debtor I
In re
(If known)
SCHEDULE F - CREDITORS HOLDING UNSECURED NC NPRIORITY CLAIMS
I
ACCOUNT NO.
CREDITOR'S NAME,
MAILING ADDRESS
INCLUDING ZIP CODE,
AND ACCOUNT NUMBER
Ken Roberts
16777 78th Ave, N
Maple Grove, MN 55311
ACCOUNT NO.
Kenn Renner
4311 Rum Runner
Austin, TX 78734
ACCOUNT NO.
Kevin Ford
3541 Chain Bridge Rd, #6
Fairfax, VA 22030
Lake Biltmore Offices
11024 N 28th Dr
Phoenix, AZ 85029
ACCOUNT NO.
Lee Ann Maxwell
16186 Dogwood Ave
Gardendale, TX 79758
I
Sheet no. 12 of 22 continuation sheets attached to Schedule of Creditors
Holding Unsecured
Nonpriority Claims
(Continuation Sheet)
royalty
royalty
royalty
royalty
0
w
~
0
5
0
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z
:::>
fil
~
a.
(f)
i5
Subtotal l> ~
AMOUNT OF
CLAIM
11.47
4.96
119.23
unknown
5.94
141.60
B6F (Official Form 6F) (12/07)- Cont.
In re
CaseNo.
, J (If known)
Debtor
SCHEDULE F - CREDITORS N1NPRIORITY CLAIMS
ACCOUNT NO.
CREDITOR'S NAME,
MAILING ADDRESS
INCLUDING ZIP CODE,
AND ACCOUNT NUMBER
Lela Buchanan
9 Manor Dr.
East Stroudsberg, PA 18301
ACCOUNT NO.
Lola Knudson
4700 N Sauther Dr E
Prescott Valley, AZ 86314
ACCOUNT NO.
Lora Allison
PO Box 2051
LaPorte, TX 77572
ACCOUNT NO.
Lorita Boyle
1606 Saxony Dr
Mt. Laurel, NJ 08054
ACCOUNT NO.
Marita Noon
PO Box 52103
Albuquerque, NM 87181
1-
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0 zu
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DATE CLAIM WAS
1- 0
INCURRED AND
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CONSIDERATION FOR
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CLAIM.
f=
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SETOFF, SO STATE
::::J
royalty
royalty
royalty
Holding Unsecured
Subtotal > 1$
Nonpriority Claims
Total >
(Use only on last page of the cor pleted Schedule F.)
(Report also on Summary of Schedules and, if appllcal e on the Statistical
Summary of Certain Llablliti1
1
and Related Data.)
AMOUNT OF
CLAIM
5.36
3.75
5.74
5.94
0.00
20.79
In re lntermedia Publishing Group , . . . .: Case No. -ill----------
SCHEDULE F - NCI CLAIMS
ACCOUNT NO.
CREDITOR'S NAME,
MAILING ADDRESS
INCLUDING ZIP CODE,
AND ACCOUNT NUMBER
Mark Peters
10026 Pine Springs Dr
Conroe, TX 77304
ACCOUNT NO.
Martin Powell
2914 Huckleberry Hill Dr
Ft. Mill, SC 29715
ACCOUNT NO.
Mary Bortel
709 E Brentup Dr
Tempe, AZ 85283
ACCOUNT NO.
Melva Beacham
33 Rose Court
Toms River, NJ 08753
ACCOUNT NO.
Michael Youssef
2660 Peachtree Rd #37G
Atlanta, GA 30305
I
\. (Continuation Sheet)
royalty
royalty
royalty
royalty
DATE CLAIM WAS
INCURRED AND
CONSIDERATION FOR
CLAIM.
SETOFF, SO STATE
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...:r ::.
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Sheet no. 14 of 22 continuation sheets attached to Schedule ofCreditori(): : rJfNt' :,
Holding Unsecured j .
., :
I Subtotal }>
I
Non priority Claims . ;C, '! t'!
Total }>
(Use only on last page of the con leted Schedule F.)
(Report also on Summary of Schedules and, if e on the Statistical
Summary of Certain Llabllitle and Related Data.)
I
II
AMOUNT OF
CLAIM
11.89
19.13
3.40
28.64
84.55
147.61
II
B6F (Official Fonn 6F) (12107) - Conl I
In re lntermedia Publishing Group Case No. 'lli
1
---------
Debtor ' /I (If known)
SCHEDULE F - CREDITORS HOLDING UNSECURED NC NPRIORITY CLAIMS
(Continuation Sheet) I
ACCOUNT NO.
CREDITOR'S NAME,
MAILING ADDRESS
INCLUDING ZIP CODE,
AND ACCOUNT NUMBER
Michelle Burton
PO Box 1452
Sunnybank Hills, Queensland
Australia 4109
ACCOUNT NO.
Myrna Hoekstra
13494 Loon Ln
Lake Park, MN 56554
ACCOUNT NO.
Nanci Ricks
8168 N Pinewood Dr
Castle Rock, CO 80108
ACCOUNT NO.
lz
Q1= DATE CLAIM WAS
INCURRED AND
ffi CONSIDERATION FOR
c g:gl . . . . .. . ." . CLAIM.
8 IF CLAIM' IS SUBJECT TO
ltL) SETOF.F,SOSTATE
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royalty
royalty
royalty
:' t :'
1--------------------'----'--'."";.,.-j. .. t:-;:,;.:
Nancy Marshall ..:. '"royaltY"''
4009 E Coolidge St
Phoenix, AZ 85018
ACCOUNT NO.
Nara Wenrich
4063 Seabury Dr
Dallas, TX 75287
f.'
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royalty
c
w
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c
5
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:::;
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Holding Unsecured
Subtotal :r
Nonpriority Claims
, . ,, . , 1 Total >
;;t; .... (li'1'a 'only on last page ofthe coni leted Schedule F.)
eport also. of Schedules and, if appllcab eon the Statistical
, .. . . .. :t,::T.: oS.Ilrimary of Certain Llabilitle and Related Data.)
,:.;;{_. ; : . s ';
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AMOUNT OF
CLAIM
6.10
10.11
11.46
21.54
12.98
62.19
I
CaseNo. In re
Debtor
SCHEDULE F - CREDITORS HOLDING
I (If known)
UNSECURED NPRIORITY CLAIMS
I
ACCOUNT NO.
CREDITOR'S NAME,
MAILING ADDRESS
INCLUDING ZIP CODE,
AND ACCOUNT NUMBER
Pat McManus
996 South Hamton Ct
Aurora, IL 60506
royalty
DATE CLAIM WAS
INCURRED AND
CONSIDERATION FOR
CLAIM.
SETOFF, SO STATE
1-A_c_co_u_N_r_No_. -----------------..L.....J...-'-'--j" .
Ras Robinson
7804 Regatta Court
Ft. Worth, TX 76179
ACCOUNT NO.
Richard Harshaw
4625 E Brilliant Sky Dr
Cave Creek, AZ 85331
ACCOUNT NO.
Richard Roukema
402 Arbor View
Pompton Plains, NJ 07444
royaltY
royalty
royalty (deceased)
ACCOUNT NO. .>.-ti'
1
._ .-.,. '
1
i;
. .3: .
Rick Kendall .. , royalty
PO Box 7847 >
Port St Lucie, FL 34985
0
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(/)
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Holding Unsecured
Subtotal
Nonpriority Claims
Total
(Report also on Summary of Schedules and, If e on the Statistical
Summary of Certain Llabllitle
1
and Related Data.)
AMOUNT OF
CLAIM
5.36
5.74
35.03
17.47
8.40
72.00
B6F (Official Form 6F) (12/07)- Cont. 11
In re lntermedia Publishing Group . . . . . . . . . , Case No. llll ----------
. . I (lfknown)
SCHEDULE F -CREDITORS UNSECURED NQ NPRIORITY CLAIMS
..I' , ..
ACCOUNT NO.
CREDITOR'S NAME,
MAILING ADDRESS
INCLUDING ZIP CODE,
AND ACCOUNT NUMBER
Robert Mowry
780W4thAve
Truth or Consequence, NM 87901
ACCOUNT NO.
Robert Scott
7917 81st St NW
Edmonton, Alberta, Canada
T6C 4K6
ACCOUNT NO.
Rod Maclivaine
2517 Georgetown Dr
Bartesville, OK 74006
ACCOUNT NO.
Ron Irvine
648 NW Ohio Ave
Chehalis, WA 98532
ACCOUNT NO.
Rosalie Dow
6 Leonard St., Box 326
Inman, SC 29349
'" ' Sheet)
royalty
royalty
royalty
royalty
. . ... -- - ..
DATE CLAIM WAS
INCURRED AND
CONSIDERATION FOR
CLAIM.
SETOFF, 50 STATE
,., - :: , ..
.. ,c,,.l
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Cl
w

Cl
5
0
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Sheet no. 17 of 22 continuation sheets attached to Schedule of l.
Holding Unsecured .. ,; .:.,
Subtotal )>
Nonpriority Claims ; .. , . q'J!I,
) '
Total )>
(Report also on Summary of Schedules and, if applicatj e on the Statistical
,......,. ....... ., ""''"]'"' ,._, .... ,
II
II
AMOUNT OF
CLAIM
5.94
17.47
12.56
5.94
7.64
49.55
II
B6F (Official Form SF) (12/07)- Cont.
I
CaseNo.
[
In re
Debtor
(If known)
SCHEDULE F -CREDITORS HOLDING UNSECURED NPRIORITY CLAIMS
I
(Continuation Sheet) [,
ACCOUNT NO.
CREDITOR'S NAME,
MAILING ADDRESS
INCLUDING ZIP CODE,
AND ACCOUNT NUMBER
Russell Doebler
319 Mindy Lane
Montrose, MN 55363
ACCOUNT NO.
Sally Sweeney
16931 Gibson Rd SW
Tenino, WA 98589
ACCOUNT NO.
Sandra Cloer
ACCOUNT NO.
lZ
DATECLAIMWAS
. INCURRED AND
ffi , .. . , . CONSIDERATION FOR
c co . CLAIM.
8 ',: . !'tiH q lF CLAIM IS SUBJECT TO
3:'' I .. ,,, SETOFF, so STATE
::t:
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royalty
royalty
royalty
. J'
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Sandy Mason royalty
6021 E Long Shadow Tr
Scottsdale, AZ 85266
ACCOUNT NO.
Scott Galloway
1309 Spalding Dr
Atlanta GA 30350
royalty
I
if
II
fil

Cl
5
0
:::;
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:::>
Holding Unsecured
Subtotal $
Nonpriority Claims
: . ' ...
L .. -- .. ,., ,, .... . . Total
: . /, JetedScheduleF.)
, :;.; on Sum_ .. ll),&!Y of Schedules and, if applica le on the Statistical
: i't (t1- Sulrlmary of Certain Llabllltle and Related Data.)
: . . . ... ' ' ... . .. ' ' .
. . .1(1:,;,
'
r
$
AMOUNT OF
CLAIM
5.70
5.74
0.00
5.74
53.52
70.70
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B6F {Official Form 6F) {12107)- Cont.
In re
Case No. iJ
____ __
Debtor
SCHEDULE F - CREDITORS HOLDING UNSECURED N
1
NPRIORITY CLAIMS
II
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CREDITOR'S NAME,

DATE CLAIM WAS
0
MAILING ADDRESS
a::
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II
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ACCOUNT NO.
lj
Sharon Ascano royalty
I,
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PO Box 325
II
Breckenridge, MN 56520 ;
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ACCOUNT NO.
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Sharon Parkes ; royaJty
/i
242 Hamon Ave
,I
Santa Rosa Beach, FL 32459
II
II
ACCOUNT NO.
II
Sheila Bailey royalty
PO Box 3150
II
Desoto, TX 75123
I
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ACCOUNT NO.
I
Shirley Roberts royalty
5792 Highview Dr
II Milford, OH 45150
II
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II
ACCOUNT NO.
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Simona Pipko
, ... . ;I
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2764 Hidden Lake Blvd
--
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Sarasota, FL 34237
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II
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Holding Unsecured
I
I I Subtotal
Nonpriority Claims
II
rl Total
(Use only on last page of the co li leted Schedule F.)
(Report also on Summary of Schedules and, If applica e on the Statistical
,.._ ........ "'"'""'i'"""""'""-'
II
li
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AMOUNT OF
0
w
CLAIM
1-
::J
a.
en
0
12.31
4.97
9.07
4.59
14.34
45.28
II
B6F (Official Form 6F) (12/07)- Cont. lj
[I
In re lntermedia Publishing Group _ Case No. 41-!1 ________ _
__ . __ .. ,. :";:-' II (If known)
SCHEDULE F - CREDITORS :HflLDING,.UNSECURED NC
1
NPRIORITY CLAIMS
ACCOUNT NO.
CREDITOR'S NAME,
MAILING ADDRESS
INCLUDING ZIP CODE,
AND ACCOUNT NUMBER
Stephen Steeves
12804 Willow Centre Dr, Ste A
Houston, TX 77066
ACCOUNT NO.
Steve Diehl
205 Sprice St
Middletown, PA 17057
ACCOUNT NO.
Susan Gontarek
1241 Elkhorn Dr
Laurel, MT 59044
ACCOUNT NO.
Synectic
1111 W University Dr #1 04
Tempe, AZ 85281
ACCOUNT NO.
Tedd Galloway
111 E Main St.
Morenci, Ml 49256
royalty
royalty
debt
royalty
DATE CLAIM WAS
INCURRED AND
CONSIDERATION FOR
CLAIM.
SETOFF, SO STATE
;,, i --- -- - . : .
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[,
II
II
I
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II
II
II
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II
II
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0
!z w
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Sheet no. 20 of22 continuation sheets attached to Schedule of \ ';1 ;\:
Holding Unsecured -, :::
I
Subtotal >
Non priority Claims l . .
,_
i
!
I
Total >
Summary of Certain Llabilltie
1
and Related Data.)
(Use only on last page ofthe collated Schedule F.)
(Report also on Summary of Schedules and, if applica on the Statistical
II
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II
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,,
AMOUNT OF
CLAIM
18.30
63.07
26.19
6,000.00
20.44
6,128.00
In re
II
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II

Debtor
li
(If known)
SCHEDULE F - CREDITORS HOLDING UNSECURED N 1 NPRIORITY CLAIMS
ACCOUNT NO.
CREDITOR'S NAME,
MAILING ADDRESS
INCLUDING ZIP CODE,
AND ACCOUNT NUMBER
Terry Lakin
Re Marco Ciavolino Trust
1603 Belvue Dr
Naples, FL 34109
ACCOUNT NO.
Terry Whalin
ACCOUNT NO.
Tim Sotos
4950 Cental St, Rm 1201
Kansas City, MO 64112
{Continuation Sheet)
!Z
DATECLAIMWAS
a: INCURRED AND
;: ::;: CONSIDERATION FOR
w _::;:
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u iiin:J . IF CLAIM IS SUBJECT TO
Cll9! . SETOFF, SO STATE
\ -.. ;:
royalty
royalty
royalty
I.,
ACCOUNT NO. i '
1-T-o_m_M_o_r-ri_s_o_n ______________ .:.:
595 E Lake Dr
Livingston, TX 77351
ACCOUNT NO.
Trisha Craft
3270 Nancy Creek Rd
Atlanta, GA 30327
Holding Unsecured
Nonpriority Claims
I, It
" '
royalty
II
II
II
II
I
I.
!Z
w
(9
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8
c
w
!;(
c
5
0
:::;
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:;)
Subtotal

a.
(/)
0
AMOUNT OF
CLAIM
0.00
15.26
3.81
11.89
6.87
37.83
..
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II
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1
II
l
7,.:
Case No. II
In re
> I
Debtor
I (If known)
SCHEDULE F -CREDITORS HOLDING UNSECURED N(l I NPRIORITY CLAIMS
f-
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CREDITOR'S NAME,

DATE CLAIM WAS
MAILING ADDRESS
a:

INCURRED AND
0
INCLUDING ZIP CODE, li:i

CONSIDERATION FOR
AND ACCOUNT NUMBER
w
CLAIM. c
gg
0
(.)
<a: IF CLAIM IS SUBJECT TO
gJo
SETOFF, SO STATE
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ACCOUNT NO.
Vanita Warren royalty
393 N De Gaulle Court
Aurora, CO 80018
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ACCOUNT NO.
Wesleyan Publishing House

PO Box50434
Indianapolis, IN 46250
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II
II
II
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II
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Holding Unsecured
II
IJ
II
Subtotal >
Nonpriority Claims
I,
II
Total II
II
(Use only on last page of the co leted Schedule F.)
(Report also on Summary of Schedules and, if applica ' e on the Statistical
Summary of Certain Llabiliti1 and Related Data.)
II
tl
II
!I
!I
'
AMOUNT OF
CLAIM
5.94
9,000.00
9,005.94
56,982.63
ll
lj
B6G (Official Form 6G) (12/07)
l1
In re: lntermedia Publishing Group , Case No. -...!111!--------
, - ,J- '"',: : '.': _\.; 2,, . , ll
(If known)
SCHEDULE G - EXECUTQRjj CONTRACTS AND U EXPIRED LEASES
.,}w,; , - 11
0 Check this box if debtor has no executory contracts &r unexpired leases. II
I.
NAME AND MAILING ADDRESS, INCLUDING ZIP CODE,
OF OTHER PARTIES TO LEASE OR CONTRACT.
Lease
Davis Ellis
1716 E Aire Libre
Phoenix, AZ 85022
b . ,.
II
DESCRIPTION OF CONTfjfAcT OR LEASE AND NATURE OF
DEBTOR'S INTEREST, TATE WHETHER LEASE IS FOR
NONRESIDENTIAL REA! PROPERTY. STATE CONTRACT
NUMBER OF CONTRACT.
I
office lease through 2016 II
II
II
II
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BSH (Official Form SH) (12107)
In re: lntermedia Publishing Group Case No.
Debtor
!I
II
II
1/
I.
I
II
(I known)
I
I
SCHEDULE H - CODEBTORS II
(iJ Check this box if debtor has no codebtors. 1'
NAME AND ADDRESS OF CODEBTOR
. '
-;
;,:,. {
:- >
II
II
NAME AND OF CREDITOR
,1/
II
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II
UNITED STATES BANKRUPTCY COURT /I
District of Arizona ,1
II Case No. ---------
11
In re: lntermedia Publishing Group
"hapter 7
/,/
operation.)
BUSINESS INCOME AND EXPENSEf
FINANCIAL REVIEW OF THE DEBTOR'S BUSINESS(NOTE: ONLY INCLUDE information related to the business
II
PART A- GROSS BUSINESS INCOME FOR PREVIOUS 12 MONTHS: II
lj
1. Gross Income For 12 Months Prior to Filing:
PART B- ESTIMATED AVERAGE FUTURE GROSS MONTHLY INCOME:
2. Gross Monthly Income:
PART C- ESTIMATED FUTURE MONTHLY EXPENSES:
3. Net Employee Payroll (Other Than Debtor)
4. Payroll Taxes
5. Unemployment Taxes
6. Worker's Compensation
7. Other Taxes
8. Inventory Purchases (Including raw materials)
9. Purchase of Feed/Fertilizer/Seed/Spray
10. Rent (Other than debtor's principal residence)
11. Utilities
12. Office Expenses and Supplies
13. Repairs and Maintenance
14. Vehicle Expenses
15. Travel and Entertainment
16. Equipment Rental and Leases
17. Legal/Accounting/Other Professional Fees
18. Insurance
19. Employee Benefits (e.g., pension, medical, etc.)
20. Payments to Be Made Directly By Debtor to Secured Creditors For
Pre-Petition Business Debts (Specify):
None
21. Other (Specify):
None
22. Total Monthly Expenses (Add items 3- 21)
PART D- ESTIMATED AVERAGE NET MONTHLY INCOME:
. ,,. ' ' I
23. AVERAGE NET MONTHLY INCOME (Subtract 22 Item 2)
$
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II
II
$
II
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,.
96,000.00
$ __ __,8..,,0..,0""0'-".0""'0
12,000.00
0.00
0.00
0.00
0.00
0.00
Q.OO
1.900.00
250.00
0.00
$ __ . .!!;00,._
$ ======(7=,5=2=5.=00=)
86 Summary (Official Form 6- Summary) (12/07)
United States Court
District of Arizona
\.' <
,,- . .. ':.::.. ..;..,z c . , .
!
CaseNo.
Debtor
Chapter
SUMMARY OF SCHEDULES I
I
Indicate as to each schedule whether that schedule is attached and state the number of pages in each. Report 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 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 the "Statistical Summary of
Certain Liabilities and Related Data" if they file a case under chapter 7, 11, or 13.
NAME OF SCHEDULE
A - Real Property
B -Personal Property
C - Property Claimed
as Exempt
D -Creditors Holding
E -Creditors Holding Unsecured
Priority Claims
(Total of Claims on Schedule E)
F - Creditors Holding Unsecured
Nonpriority Claims
G -Executory Contracts and
Unexpired Leases
H - Codebtors
I - Current Income of
Individual Debtor(s)
J - Current Expenditures of
Individual Debtor(s)
ATTACHED NO. OF SHEETS
(YES/NO)
NO 1
YES 2
NO
NO
YES
. :.; .. 2 --
"f
YES 23
YES 1
NO 1
NO 0
NO 0
TOTAL
31
$
$
ASSETS
17,000.00
56,982.63
Form 6- Statistical Summary (12/07)
United States Bankruptcy Court
District of Arizona
Debtor
Case No.f-----------
Chapter ' _7 ___________ _
STATISTICAL SUMMARY OF CERTAIN LIABILITIES AND RELA
"1' , .. ,.
If you are an individual debtor whose debts are in 101 (8)
101(8)), filing a case under chapter 7, 11 or 13, you must.report;all;infqrrnation requested below.
Q Check this box if you are an individual __ are NOT primarily consumer
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
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 ;
Amount
$0.00
$ 17,000.00
$0.00
$ 0.00
; ......
Obligations Not Reported on Schedule E. Ec
:tr<'Mnr".di-mkn'f\ei'h'" r,,,,,, ..
Obligations to Pension or Profit-Sharing, and Other Similar__ ... _' _ .... L ....... .
Obligations (from Schedule F) . ;ih ....

,$ 0.00 .
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
228 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) .
$17,000.00
$0.00
$ 0.00
$ 0.00
Bankruptcy Code (11 U.S.C.
You are not required to report any
I
In re lntermedia Publishing Group 1 Case No.
Debtor 11
DECLARATION CONCERNING DEBTOR'S S
DECLARATION UNDER PENAL TV OF PERJURY BY INDIVID i/ AL DEBTOR
I
(NOT APPLICABLE)
II
,l
(If known)
DECLARATION UNDER PENALTY OF PERJURY ON BEHALF OF CORPO '
1
TION OR PARTNERSHIP
I
I Larry Davis, the Manager/Owner of the Corporation named as debtor in this case, declare er penalty of
perjury that I have read the foregoing summary and schedules, consisting of 33 sheets (Total shown on summary page plus 1),
and that they are true and correct to the best of my knowledge, information, and belief. f/'
II
I!
,!
Date
il
)I
II
87 (Official Form 7) (12/07)
I
I
UNITED STATES BANKRUPTCY COURT II
District of Arizona I
!I
Casell o. ________ _
None
D
None

None

il (If known)
II
Debtor
iJ
li
STATEMENT OF FINANCIAL AFF
1
IRS
!I
1. Income from employment or operation of business /1
State the gross amount of income the debtor has received from employment, trade, or
1
rofession, or from operation of the
debtor's business, including part-time activities either:as an employee or in independen' trade or business, from the beginning
of this calendar year to the date this case was. also the gross amou I s received during the two years
immediately preceding this calendar year. or. has
1
records on the basis of a
fiscal rather than a calendar year may rep on fiscal Identify the beg1nmng nd endmg dates of the debtor's fiscal
year.) If a joint petition is filed, state income separately. (Married debtd s filing under chapter 12 or chapter 13
must state income of both spouses whether or' not a'Joint petition is filed, unless the sp !, uses are separated and a joint petition
is not filed.) .. /,
I
AMOUNT SOURCE FISCAJ EAR PERIOD
I
-800.00 net income 2010 /I
'I
12,000.00 net income 2011 f1
!i
I
2. Income other than from employment or operation of business I
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 cas : Give particulars. If a joint petition is
filed, state income for each spouse separately. (Married debtors filing under chapter 1' or chapter 13 must state income for
each spouse whether or not a joint petition is filed, unless the spouses are separated

a joint petition is not filed.)
AMOUNT SOURCE !II FISCAL YEAR PERIOD
3. Payments to creditors
..
Complete a. or b., as appropriate, and c .. ;,;;l ,
a. Individual or joint debtor(s) with payments on loa , installment purchases of goods or
services, and other debts to any creditor immediately preceding [ he commencement of this case unless
the aggregate value of all property that by such transfer is le s than $600. Indicate with an asterisk
(*)any payments that were made to a creditdr:on acC'oi:tntofa domestic support oblig '' tion or as part of an alternative
repayment schedule under a plan by an approved nonprofit budgeting and credit cou : eling agency. (Married debtors filing
under chapter 12 or chapter 13 must include payments by either or both spouses whe her or not a joint petition is filed, unless
the spouses are separated and a joint petition is not filed.) 1
1
NAME AND ADDRESS OF
CREDITOR
DATES OF
PAYMENTS
I
i AMOUNT
i
1 PAID
II
II
'I
II
I
I
II
1/
I
'
AMOUNT
STILL OWING
None

None
D
None
li'l
None
D
None
G2l
2
b. Debtor whose debts are not primarily consumer List each payment or other tr jl nsfer to any creditor made within 90
days immediately preceding the commencement of GijSe the aggregate val,u
11
of all property that constitutes or is
affected by such transfer is less than $5,47& . j_s an Jndividual, indicate w: h an asterisk (*) any payments that
were made to a creditor on account of a or as part of an alt, rnative repayment schedule under a
plan by an approved nonprofit budgeting age,r)cy. (Married debtor 12 or chapter 13
must include payments and other
spouses whether or a JOint petition IS filed, unless the

spouses are separated and a joint petition is. nqt, I.
NAME AND ADDRESS OF CREDITOR . DATES OF t
11
MOUNT AMOUNT
. PAYMENTS/ , AID OR STILL
TRANSFERS 1
1
ALUE OF OWING
II RANSFERS
I'
II
l!
'I
c. All debtors: List all payments made within one year immediately preceding the com
11
1
encement of this case to or for the
benefit of creditors who are or were insiders. (Married debtors filing under chapter 12 d chapter 13 must include payments by
either or both spouses whether or not a joint petition is filed, unless the spouses are arated and a joint petition is
not filed.) II
II
NAME AND ADDRESS OF CREDITOR DATE OF I' MOUNT AMOUNT
AND RELATIONSHIP TO DEBTOR PAYMENT II PAID STILL OWING
Larry Davis weekly over 6 months I 5,000.00 0.00
Owner
II
4. Suits and administrative

11
and attachments
a. List all suits and administrative or was a party wi in one year immediately preceding the
of this bankruptcy case. (Married .. or chapter st include
e1ther or both spouses whether or not a the spouses are s . parated and a JOint petJt1on 1s
not filed.) ::; 'c,f!J :;, . . I
.. . , . r .

CAPTION OF SUIT , ; :, COURT OR STATUS OR
AND CASE NUMBER NATURE OF PROCEEDING AND LOCATIO I DISPOSITION
!i
II
b. Describe all property that has been attached, garnished or seized under any legal d equitable process within one year
immediately preceding the commencement of this case. (Married debtors filing under ' hapter 12 or chapter 13 must include
information concerning property of either or both spouses whether or not a joint petitidl is filed, unless the spouses are
separated and a joint petition is not filed.) I
I
NAME AND ADDRESS DESfRIPTION
OF PERSON FOR WHOSE DATE OF ANdjjVALUE OF
BENEFIT PROPERTY WAS SEIZED SEIZURE PRO ERTY
Internal Revenue Service
PO Box 7346
Philadelphia, PA 19101-7346
I
07/30/2012
$3,0:0
I
I
. ,,... ....... .. I
>!iJ; ,l, h .' . . . J
5. ReposseSSIOns, foreclosures
5
''
1
'; I .
ust all property that has been . : sale. nsferred through a deed in lieu of .
foreclosure or returned to the seller, within 'q'1\.e . preceding the com en cement of this case. (Married
debtors filing under chapter 12 or chapter 1 :rm.u'st lf:lCU .. e' information concerning prdferty of either or both spouses whether
or not a joint petition is filed, unless the spouses and a joint petition ot filed.)
DATE OF REPOSSESSION, D, SCRIPTION
NAME AND ADDRESS FORECLOSURE SALE, VALUE OF
OF CREDITOR OR SELLER TRANSFER OR RETURN PI// OPERTY
!,
II
I
'I
lj
None
6ZI
None

None
D
None

None
D
3
6. Assignments and receiverships II/
a. Describe any assignment of property for the benefit of creditors made within 120 immediately preceding the
commencement of this case. (Married debtors filing under chapter 12 or chapter 13 mumt include any assignment by either or
both spouses whether or not a joint petition is filed, unless the spouses are separated 1[d a joint petition is not
II
. I
. . . . OF
NAME AND ADDRESS
OF ASSIGNEE
-lt :. 5,! i ASSlfNMENT
oR seTTLEMENT
' !II
b. List all property which has been in the 6"fil. or court-appoii)/ted official within one year
immediately preceding the commencement oHHis debtors filing under apter 12 or chapter 13 must
include information concerning property of either or'both spouses whether or not a join petition is filed, unless the
spouses are separated and a joint petition is not filed.) :. i
II
NAME AND ADDRESS
OF CUSTODIAN
7. Gifts
NAME AND ADDRESS
OF COURT
CASE TITLE & NUMBER
II
IJ
II
II
DESCRIPTION
AND VALUE OF
PROPERTY
.I
List all gifts or charitable contributions made within one year immediately preceding th:
1
commencement of this case except
ordinary and usual gifts to family members aggregating less than $200 in value per in !vidual family member and charitable
contributions aggregating less than $100 per recipient. (Married debtors filing under c, pter 12 or chapter 13 must include
gifts or contributions by either or both spouses whether or not a joint petition is filed, u 'I less the spouses are separated and a
joint petition is not filed.) II
NAME AND ADDRESS
OF PERSON
OR ORGANIZATION
various non-profits
RELATIONSHIP
TO DEBTOR, DATE
II
II
I
I
.,.,,;,,, :. . i
DESCRIPTION
AND VALUE OF
GIFT
$1 ,000.00 total
8. Losses .. ,.. . .;. .11
... . .<:>-":: . :: . . I
List all losses from fire, theft, other casualty or within one year immediately . ' receding the commencement
of this case or since the commencement of this case. (Married debtors filing under I hapter 12 or chapter 13 must
include losses by either or both spouses whether or not a joint petition is filed, unless : he spouses are separated and a
joint petition is not filed.) i
DESCRIPTION DESCRIPTION OF CIRCUMSTANCES : NO, IF
AND VALUE OF LOSS WAS COVERED IN WHOLE OR I PART
PROPERTY BY INSURANCE, GIVE PARTICULARS
1
I
DATE OF
LOSS
9. Payments related to debt counseling or bankruptcy I
List all payments made or property transferred by or on behalf of the debtor to any pe
11
sons, including attorneys, for
consultation concerning debt consolidation, relief under the bankruptcy law or prepar
1
ion of a petition in bankruptcy within
one year immediately preceding the commencement of this case. l
NAME AND ADDRESS
OF PAYEE
Reynolds & Reynolds, PLLC
125 E Coronado Rd
Phoenix, AZ 85004
DATE OF PAYMENT,
NAME OF PAYOR IF
OTHER THAN DEBTOR
il
A
1
OUNT OF MONEY OR
D CRIPTION AND VALUE
I

II
I,

il
ij
'I
None

None
Ill
None
G2l
None
!:a
None

4
10. Other transfers , . <. . , .: ill. . .
a. List all other property, other than property transferred 1n the ordmary course of the by mess or financ1al affa1rs of the
debtor, transferred either absolutely or as security within two years immediately preced ng the commencement of this case.
(Married debtors filing under chapter 12 or chapter 13 must include transfers by either q both spouses whether or not a joint
petition is filed, unless the spouses are separated and a joint petition is not filed.) fj
!i
NAME AND ADDRESS OF TRANSFEREE,
RELATIONSHIP TO DEBTOR DATE
'I
IJ
II
fi
II
II
DESCRIBE PROPERTY
TRANSFERRED
AND VALUE RECEIVED
i
b. List all property transferred by the debtor within ten years immediately preceding commencement of this case to a
self-settled trust or similar device of which the debtor is a beneficiary. i
NAME OF TRUST OR OTHER
DEVICE
11. Closed financial accounts

!'I
AM tl UNT OF MONEY OR DESCRIPTION
ANq VALUE OF PROPERTY OR DEBTOR'
INTSREST IN PROPERTY
Ill
ll
il
List all financial accounts and instruments held in the name of the debtor or for the beri fit of the debtor which were closed,
sold, or otherwise transferred within one year immediately preceding the commencem
1
nt of this case. Include checking,
savings, or other financial accounts, certificates of deposit, or other instruments; share
1
' and share accounts held in banks,
credit unions, pension funds, cooperatives, associations, brokerage houses and other; mancial institutions. (Married debtors
filing under chapter 12 or chapter 13 must include information concerning accounts or . struments held by or for either or both
spouses whether or not a joint petition is filed, unless the spouses are separated and petition is not filed.)
II
NAME AND ADDRESS
OF INSTITUTION
TYPE OF ACCOUNT, LAST AMOUNT AND
DIGITS OF ACCOUNT NUMBER, I DATE OF SALE
AND AMOUNT OF FINAL BALANC OR CLOSING
I
12. Safe deposit boxes
List each safe deposit or other box or depository in which the debtor has or had securi 1es, cash, or other valuables within
one year immediately preceding the commencement of this case. (Married debtors fili
1
g under chapter 12 or chapter 13
must include boxes or depositories of either or both spouses whether or not a joint pet' ion is filed, unless the spouses are
separated and a joint petition is not filed.) . . i
NAME AND ADDRESS DE ON
OF BANK OR . OF:i.'HoS:E''W.itPfACCESS OF i
OTHER DEPOSITORY TO 89'x CONTENT:
13. Setoffs i
DATE OF TRANSFER
OR SURRENDER,
IF ANY
' . II
List all setoffs made by any creditor, including a bank, against a debt or deposit of the I ebtor within 90 days preceding
the commencement of this case. (Married debtors filing under chapter 12 or chapter 1 must include information
concerning either or both spouses whether or not a joint petition is filed, unless the uses are separated and a joint
petition is not filed.)
NAME AND ADDRESS OF CREDITOR
DATE OF
SETOFF
AMOUNT OF
SETOFF
5
None
lt1
14. Property held for another person . .. . . . .
List all property owned by another person that_!l:le

NAME AND ADDRESS AND VALUE
OF OWNER
... . . . ' , ..
LOCATION OF PROPERTY
... . , I
15. Prior address of debtor I
None If debtor has moved within three years immediately preceding the commencement is case, list all premises which the
debtor occupied during that period and vacated prior to the commencement of this cas
1
If a joint petition is filed, report also
any separate address of either spouse.
ADDRESS NAME USED DATES OF OCCUPANCY
16. Spouses and Former Spouses i
None If the debtor resides or resided in a community property state, commonwealth, or territ( ry (including Alaska, Arizona,
1t1 California, Idaho, Louisiana, Nevada, New Mexico, Puerto Rico, Texas, Washington, o' Wisconsin) within eight years
immediately preceding the commencement of the case, identify the name of the debto 's spouse and of any former spouse
who resides or resided with the debtor in the community property state.
None
liZI
NAME
17. Environmental Information.
For the purpose of this question, the following definitions apply:
111\ ';, l (' . . ' '
"Environmental Law" means any federal, regulation regulating ollution, contamination, releases of
or wastes or soil, surface wate! groundwater, or other
1ncludmg, but not llm1ted to, statutes or cleanup of these wastes, or matenal.
"Site" means any location, facility, or under any Environmental Lalll, whether or not presently or
formerly owned or operated by the debtor, including, but not limited to, disposal sites. t
I
i
"Hazardous Material" means anything defined as a hazardous waste, hazardous subs. nee, toxic substance,
hazardous material, pollutant, or contaminant or similar term under an Environmental 1aw.
I
l
a. List the name and address of every site for which the debtor has received noti : in writing by a governmental unit that
it may be liable or potentially liable under or in violation of an Environmental Law. lndi
1
te the governmental unit, the date of
the notice, and, if known, the Environmental Law. !
SITE NAME AND
ADDRESS
NAME AND ADDRESS
OF GOVERNMENTAL UNIT
DATE OFI
NOTICE i
i
I
ENVIRONMENTAL
LAW
None b. List the name and address of every site for which the debtor provided notice to ! governmental unit of a release of
Hazardous Material. Indicate the governmental unit to which the notice was sent and e date of the notice.
SITE NAME AND
ADDRESS
' 'j,,;,:
DATE OF
NOTICE
ENVIRONMENTAL
LAW
6
'
None c. List all judicial or administrative proceedings, including settlements or orders, er any Environmental Law with
i:) respect to which the debtor is or was a party. Indicate the name and address of the gol' ern mental unit that is or was a party
None

None
liZI
None

to the proceeding, and the docket number. !
NAME AND ADDRESS DOCKET NUMBER
OF GOVERNMENTAL UNIT
)
STATUS OR
DISPOSITION
18. Nature location and name .:< 11
, v- .\'.. 1
a. If the debtor is an individual, list the identification numb, rs, nature of the businesses,
and beginning and ending dates of all iJ;i the debtor was an officer, d1 ector, partner, or managing
executive of a corporation, partner in a proprietor, or was self-employ: d in a trade, profession, or
other activity either full- or part-time within the six years immediately preceding the co
1
mencement of this case,
or in which the debtor owned 5 percent or more of the voting or equity securities within he six years immediately
preceding the commencement of this case.
1
I
If the debtor is a partnership, list the names, addresses, taxpayer identification numbe
1
, nature of the businesses,
and beginning and ending dates of all businesses in which the debtor was a partner ori wned 5 percent or more of
the voting or equity securities, within the six years immediately preceding the commen
1
ement of this case.
I
I
I
If the debtor is a corporation, list the names, addresses, taxpayer identification
1
s, nature of the business, and
beginning and ending dates of all businesses in which the debtor was a partner or d 5 percent or more of the voting or
equity securities within the six years immediately preceding the commencement of th! case.
NAME
LAST FOUR DIGITS
OF SOCIAL SECURITY
OR OTHER INDIVIDUAL ADDRESS
TAXPAYER-J.D. NO.
(ITIN)/ COMPLETE EIN
BEGINNING AND ENDING
DATES
b. Identify any business listed in response to subdivision a., above, that is "singl
1
asset real estate" as defined in 11
u.s.c. 101.
'''lt'-''c': .'\ '
19. Books, records and , :.
ADDRESS
a. List all bookkeepers and accountants who immediately preceding
supervised the keeping of books of account and of the debtor.
NAME AND ADDRESS
e filing of this bankruptcy case kept or
I
None b. List all firms or individuals who within two years immediately preceding the filing of is bankruptcy case have audited the
i:) books of account and records, or prepared a financial statement of the debtor. I
I
NAME ADDRESS DATES SER\11 CES RENDERED
None c. List all firms or individuals who at the time of the commencement of this case were i I possession of the books of account
and records of the debtor. If any of the books of account and records are not available! explain.
I
i
NAME ADDRESS I
None d. List all financial institutions, creditors and other parties, including mercantile and tra
1
! e agencies, to whom a
financial statement was issued by the debtor within two years immediately preceding
1
e commencement of this case.
NAME AND ADDRESS DATE ISSUED
None

None

None

None

None

'
:'
. {_.j' .
20. Inventories . . . I .
a. List the dates of the last two mventones taken of your property, the name of the pers n who superv1sed the
taking of each inventory, and the dollar amount and basis of each inventory. i
i
7
AMOUNT OF INVENTORY
(Specify
1
f' ost, market or other
basis) , .
I
DATE OF INVENTORY INVENTORY SUPERVISOR
I
b. List the name and address of the person having possession of the records of each the inventories reported
in a., above. 1
I
NAME AND ADDRESSJS OF CUSTODIAN
DATE OF INVENTORY OF INVENTORY
21. Current Partners, Officers, Directors and Shareholders I
a. If the debtor is a partnership, list the nature and percentage of partnership interest o each member of the
partnership. . I
-. .::-.;vo-
NAME AND ADDRESS .. ,;, .. OF INTEREST / PERCENTAGE OF INTEREST
. .. . ;. :
b. If the debtor is a corporation, list all and h s!ockholder who directly or indirectly
owns, controls, or holds 5 percent or more equ1ty secunt1es of the corp
1
rat1on.
'' ,; : ; .. I NATURE AND PERCENTAGE
NAME AND ADDRESS TITLE i OF STOCK OWNERSHIP
I
22. Former partners, officers, directors and shareholders i
a. If the debtor is a partnership, list each member who withdrew from the partnership,) ithin one year immediately
preceding the commencement of this case.
NAME ADDRESS DATE OF WITHDRAWAL
None b. If the debtor is a corporation, list all officers or directors whose relationship with the
1
. orporation terminated
within one year immediately preceding the commencement of this case.
None
liZI
None

NAME AND ADDRESS
TITLE
DATE OF TERMINATION
I
23. Withdrawals from a partnership or distributions by a corporat on
. , ...... , . . I
If the debtor is a partnership or corporation, .. 'JI{j " credited or given to an insider, including
compensation in any form, bonuses, ... Jc>qs;:options exercised and
1
ny other perquisite during one year
immediately preceding the fll,-. _,.
;qif.ic .. ,,. .
NAME & ADDRESS
OF RECIPIENT,
RELATIONSHIP TO DEBTOR
. ... . '!.
DATE AND PURPOSE
OF WITHDRAWAL
24. Tax Consolidation Group. r
I
AMOUNT OF MONEY
OR DESCRIPTION
AND VALUE OF PROPERTY
If the debtor is a corporation, list the name and federal taxpayer identification number ', f the parent corporation of any
consolidated group for tax purposes of which the debtor has been a member at any tir
1
e within six years immediately
preceding the commencement of the case. I
I
NAME OF PARENT CORPORATION TAXPAYER UMBER (EIN)
8
None
ba
25. Pension Funds. ... ; . .. . . . . i
If the debtor is not an individual, list the f.' '
1
r any fund t? which the
debtor, as an employer, has been :.!Ji!'Q;.a;ttn:Y t1me w1thm SIX ye rs 1mmed1ately precedmg the
commencement of the case. :
; , . !
NAME OF PENSION FUND ,,. ' . '"''':< TAXPAYER IDENTIFI,IATION NUMBER (EIN)
* * * * * *
[If completed on behalf of a partnership or corporation]
I, declare under penalty of perjury that I have read the answers contained in the foregoing statement! pf financial affairs and any
attachments thereto and that they are true and correct to the best of my knowledg formation and i elief.
i
I
Date 8-6 !J

[An individual signing on behalf of a partnership or corporation must indicate position or relationship to debtor.]
I
ij
!
continuation sheets attached
Penalty for making a false statement: Fine of up to $500,000 or imprisonment for up to 5 years, both. 18 U.S. C. 152 and 3571.
I
. . . ' "- . :
.. a. Court
Disfrict of Arizona
I
List of Equity Security Holder'
I
I
REGISTERED NAME OF HOLDER OF SECURITY
LAST KNOWN ADDRESS OR PLACE OF BUSINESS
CLASS OF
SECURITY
Larry Davis
100% Share
1,_ Larry Davis, Man_ager/Owner of the named
L1st of Equity Secunty Holders and that 1t 1s true and correc
-:.
Date:
'-' ,
NUMBER
REGISTERED I
!
1,ooo,oq
Penalty for making a false statement or concealing property. Fine of up to $500,000 or
U.S.C 152 and 3571.
List of Equity Security Holders - Page 1
KIND OF INTEREST
REGISTERED
onment for up to 5 years or both. 18
United Court
Distrlcf of Arizona
: ;'ii-lr ,,
Case No.
1 . . ' ' ;
Debtor.
Chapter 7
STATEMENT OF CORPORATE OWNERS IP
i
Comes now lntermedia Publishing Group (the "Debtor'') and pursuant to Fed. R. r. P. 1007(a) and
I
7007.1 state as follows: i
I
I
X All corporations that directly or indirectly own 10% or more of any class ofthel[rporation's equity interests
are listed below:
i
Owner % of Shares 1 ned
Larry Davis 100
1
!
OR,
___ There are no entities to report.
I,.
Bar no.:
Address.:
I
Reynolds & nolds
125 E. Corona
1
o Rd.
Phoenix, AZ a' 004
Telephone No.: 602-253-6141 I
Fax No.: 602-253-6154 I
E-mail address: michael@reyn ldsazlaw.com
In re
UNITED STATES BANKRUPTCY COURT
DISTRICT OF ARIZONA
Chapter
7
D
D
Case No.
Debtor(s)

Declaration of otE.mployers' Payments 60 Days
' _ . . : . . i
!
!
Attached hereto are copies of all payment advices, pay stubs or other eviden : e of payment received by the
debtor from any employer within 60 days prior to the filing of the petition; i
I
i
Debtor has received no payment advices, pay stubs or other evidence of payr: ent from any employer within
60 days prior to the filing of the petition; or i
!
I
Debtor has received the following payments from employers within 60 days or to the filing of the petition:
$ . i
I
Debtor declares the foregoing to be true and correct under penalty of perjury.!
i
_ . Sig]ature ofDebtor
If attaching pay stubs or other payment advice$;. it to redact (blac out) any social security
numberS, nameS Of minor Children, dateS Of bfFI:tf'ot aCCOUnt numberS before I ttaching them tO thiS
document. or;
'f(
p:;\ .f
.. i' bfrtlFtn"ndancial a,:f.'.JUI
B 203
(12/94)
UNITED STATES BANKRUPTCY COURT
.. District of Arizona
Debtor
i
FORDEBTOR i
I
Case No.
Chapter 7
!I
DISCLOSURE OF COMPENSATION OF ATf'. ORNEY
1. Pursuant to 11 U.S.C. 329(a) and Bankruptcy Rule 2016(b), I certify that I am the attorney for the atve-named debtor(s)
and that compensation paid to me within one year before the filing of the petition in bankruptcy, or agr
1
ed to be
paid to me, for services rendered or to be rendered on behalf of the debtor(s) in contemplation of or in i
connection with the bankruptcy case is as follows: I
!
For legal services, I have agreed to accept
Prior to the filing of this statement I have received
Balance Due
2. The source of compensation paid to me was:
Debtor
3. The source of compensation to be paid to me is: o t' ,j
1
0 Debtor ltn j. (. t'nc'f. . . . I

$
$
$
4,000.00
4,000.00
0.00
. t .. : ... . . . I
4. li11 I have not agreed to share the above-disclosed compensation with any other person unless the. are members and associates
of my law firm. I
0 I have agreed to share the above-disclosed compensation with a person or persons who are members or associates of
I
my law firm. A copy of the agreement, together with a list of the names of the people sharing in! he compensation, is
attached. '
5. In return for the above-disclosed fee, I have agreed to render legal service for all aspects of the bankr
1
ptcy case,
including: !
a) Analysis of the debtor's financial situation, and rendering advice to the debtor in determining whl ther to file
I
b)
c)
d)
e)
a petition in bankruptcy; i
'
Preparation and filing of any petition, schedules, statement of affairs, and plan which may be re : uired;
I
Representation of the debtor at the meeting of creditors and confirmation hearing, and any adjo
1
rned hearings thereof;
I
Representation of the debtor in adversary proceedings and other contested bankruptcy matters!
[Other provisions as needed]
None
I
6. By agreement with the debtor(s) the above disclosed fee does not include the following services:
None ni"ii'H \speciM '
"') <?'f i), :1 cg r ' .
:
I certify that the foregoing is a complete statement of an{agreeiilerit or' arrangement for payment to
representation of the debtor(s) in this bankruptcy proceeding.
Reynolds & Reynolds
Attorney for Debtor(s)
In re:
United States Bankruptcy Court
District' of
- .
: . . .
.. -':- -><" _ .... .,
'"'"-. ' '
. .., .....,...,.... ' .
Case No.
Chapter 7
STATEMENT REGARDING AUTHORITY TO SIGN AN 11 FILE PETITION
I
!
I, Larry Davis, declare under penalty of perjury that I am the Owner of lntermedia Publishind Group, a Arizona Corporation and that
on 07/23/2012 the following resolution was duly adopted by the same of this Corporation:
1
"Whereas, it is in the best interest of this Corporation to file a voluntary petition in the Unite,, States
Bankruptcy Court pursuant to Chapter 7 of Title 11 of the United States Code; I
i
Be It Therefore Resolved, that Larry Davis, Manager/Owner of this Corporation, is authorize:. and directed to execute and deliver all
documents necessary to perfect the filing of a Chapter 7 voluntary case on behalf o, the Corporation; and
Be It Further Resolved, that Larry Davis, Manager/Owner of this Corporation, is authorized d directed to appear in all bankruptcy
deeds d lo execule and deiNer all necessary (
.; ... , .... .. .
Be It Further Resolved, that Larry Davis, Manager/Ownerof is authorized : nd directed to employ Michael T.
Reynolds, attorney and lhe law firm of Reynolds & Reynolds torepresent lhe Corporation in sue I bankruptcy case."
Executed on:
; .
'
Signed:
. I, ,.
:Jy . 1.-::
)JlWith y:
i: ,..
... ;. ..
I
\
" .. , '

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Case 2:12-bk-17635-RJH Doc 1-1 Filed 08/07/12 Entered 08/07/12 11:26:33 Desc

Petition Part II Page 1 of 32

spouses whether or a JOint petition IS filed, unless the

0 Debtor ltn j. (. t'nc'f. . . . I

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