Guo Wengui / Miles Guo — bankruptcy case · ECF #249-4

| | Fill in this information to identify your case: | | |---------------------------------|-----------------------------------------------------------------|------------------------------------| | Debtor 1 | Ho Wan Kwok | | | Debtor 2<br>(Spouse, if filing) | | | | | United States Bankruptcy Court for the: District of Connecticut | | | Case number<br>(if known) | 22-50073 | Check if this is an amended filing |

## Official Form 122B Chapter 11 Statement of Your Current Monthly Income

12/21

You must file this form if you are an individual and are filing for bankruptcy under Chapter V). If more space is needed, attach a separate sheet to this form. Include the line additional information applies. On the top of any additional pages, write your name and case number (if known).

| | | Part 1: Calculate Your Current Monthly Income | | | | | | | | | |----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|----------|----------|----------|----------------------|----------------------|------|----------------------|--| | | | 1. What is your marital and filing status ? Check one only. | | | | | | | | | | | | Not married. Fill out Column A, lines 2-11. | | | | | | | | | | | | [] Married and your spouse is filing with you. Fill out both Columns A and B, lines 2-11. | | | | | | | | | | | | Married and your spouse is NOT filing with you. Fill out Column A, lines 2-11. | | | | | | | | | | | | Fill in the average monthly income that you received from all sources, derived during the 6 full months before you file this bankruptcy<br>case. 11 U.S.C. § 101(10A). For example, if you are filing on September 15, the 6-month period would be March 1 through August 31. If the amount<br>of your monthly income varied during the 6 months and divide the total by 6. Fill in the result. Do not include any<br>income anount more than once. For example, if both spouses own the income from that property in one obumn only. If<br>you have nothing to report for any line, write \$0 in the space. | | | | | | | | | | | | | | | | | Column A<br>Debtor 1 | | Column B<br>Debtor 2 | | | | 2. Your gross wages, salary, tips, bonuses, overtime, and commissions (before all<br>payroll deductions). | | | | | | S | 0.00 | S | | | 3. Alimony and maintenance payments. Do not include payments from a spouse it<br>Column B is filled in. | | | | S | | | 0.00 | S | | | | 4. All amounts from any source which are regularly paid for household expenses<br>of you or your dependents, including child support. Include regular contributions<br>from an unmarried partner, members of your household, your dependents, parents,<br>and roommates. Include regular contributions from a spouse only if Column B is not<br>filled in. Do not include payments you listed on line 3. | | | | | | | કે | 0.00 | S | | | | | 5. Net income from operating a<br>business, profession, or farm | Debtor 1 | | Debtor 2 | | | | | | | | | Gross receipts (before all deductions) | | ea | 0.00 | | | | | | | | | Ordinary and necessary operating expenses | | -5 | 0.00 | | | | | | | | | Net monthly income from a business, profession, or farm | | ಕಿ | | 0.00 Copy here -> \$ | | 0.00 | S | | | | | 6. Net income from rental and<br>other real property | Debtor 1 | Debtor 2 | | | | | | | | Gross receipts (before all deductions) | | | સ્ત્ર | 0.00 | | | | | | | | | | Ordinary and necessary operating expenses | | -8 | 0.00 | | | | | | | | | Net monthly income from rental or other real property | | ಆ | | 0.00 Copy here -> \$ | | 0.00 | S | | | | | | | | | | | | | |

DEBTOR 04

## Case 22-50073 Doc 80 Filed 03/09/22 Entered 03/09/22 23:37:34 Page 2 of 3 Case 22-50073 Doc 249-4 Filed 04/22/22 Entered 04/22/22 16:44:32 Page 2 of 3

| Debtor 1 | Ho Wan Kwok | | | | Case number (if known) | 22-50073 | | | |----------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-----|------|----------------------|------------------------|----------------------|----------|------| | | | | | Column A<br>Debtor 1 | | Column B<br>Debtor 2 | | | | | 7. Interest, dividends, and royalties | | | S | 0.00 | ea | | | | | 8. Unemployment compensation | | | ક્ક | 0.00 | ea | | | | | Do not enter the amount if you contend that the amount received was a benefit under<br>the Social Security Act. Instead, list it here: | | | | | | | | | | For you | લ્ક | 0.00 | | | | | | | | For your spouse | S | | | | | | | | | 9. Pension or retirement income. Do not include any amount received that was a<br>benefit under the Social Security Act. Also, except as stated in the next sentence, do<br>not include any compensation, pension, pay, annuity, or allowance paid by the<br>United States Government in connection with a disability, combat-related injury or<br>disability, or death of a member of the uniformed services. If you received any retired<br>pay paid under chapter 61 of title 10, then include that pay only to the extent that it<br>does not exceed the amount of retired pay to which you would otherwise be entitled<br>if retired under any provision of title 10 other than chapter 61 of that title.<br>10. Income from all other sources not listed above. Specify the source and amount.<br>Do not include any benefits received under the Social Security Act; payments made<br>under the Federal law relating to the national emergency declared by the President<br>under the National Emergencies Act (50 U.S.C. 1601 et seq.) with respect to the<br>coronavirus disease 2019 (COVID-19); payments received as a victim of a war<br>crime, a crime against humanity, or international or domestic terrorism; or<br>compensation, pension, pay, annuity, or allowance paid by the United States<br>Government in connection with a disability, combat-related injury or disability, or<br>death of a member of the uniformed services. If necessary, list other sources on a<br>separate page and put the total below. | | | ಕ್ಕಾ | 0.00 | S | | | | | | | | S | | ಕ್ಕಿ | | | | | | | | ಕ್ಕಾ | 0.00 | ಕಿ | | | | | Total amounts from separate pages, if any. | | + | ക | 0.00 | S | | | | | 11. Calculate your total current monthly income. | | | | | | | | | | Add lines 2 through 10 for each column. | | ಕ್ಕಾ | 0.00 | S | | ಕಾ<br>II | 0.00 | | | Then add the total for Column A to the total for Column B. | | | | | | | |


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Debtor 1 Ho Wan Kwok Case number (if known) 22-50073

| Part 2: | Sign Below | |---------|---------------------------------------------------------------------------------------------------------------------------------------| | | By ground here, under penally of perjury I declare that the information on this statement and in any attachments is true and correct. | | X | Ho Wan Kwok<br>Signature of Debtor 1 | | Date | 491<br>1022<br>DD / YYYY | | | | | | |

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