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Home Court filings USA v. Harun Form 106D — USA v. Harun (Dkt. 19.3)

Court filing

Form 106D — USA v. Harun (Dkt. 19.3)

Filed August 31, 2023 in USA v. Harun; one of 89 filings from this case.

Record facts

CourtU.S. District Court for the Southern District of Georgia
Filed2023-08-31

U.S. District Court for the Southern District of Georgia · No. 3:23-cr-00003-DHB-BKE · Doc. 19-3 · 2023-08-31 · Docket on CourtListener

Full text

2fficial Form 106D
Schedule D: Creditors Who Have Claims Secured by Property
page 1 of ___ 
2IILFLDO)RUP 106D 
Schedule D: Creditors Who Have Claims Secured by Property
12/15
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, copy the Additional Page, fill it out, number the entries, and attach it to this form. On the top of any 
additional pages, write your name and case number (if known).  
1. Do any creditors have claims secured by your property?
‰ No. Check this box and submit this form to the court with your other schedules. You have nothing else to report on this form.
‰ Yes. Fill in all of the information below.
Part 1:  List All Secured Claims 
2. List all secured claims. If a creditor has more than one secured claim, list the creditor separately
for each claim.  If more than one creditor has a particular claim, list the other creditors in Part 2.
As much as possible, list the claims in alphabetical order according to the creditor’s name.
Column A 
Amount of claim
Do not deduct the 
value of collateral.
Column B 
Value of collateral 
that supports this 
claim
Column C 
Unsecured 
portion 
If any
2.1
______________________________________ 
Creditor’s Name 
______________________________________ 
Number 
Street 
______________________________________ 
______________________________________ 
City 
State 
ZIP Code
Describe the property that secures the claim: 
$_________________ $________________ $____________
As of the date you file, the claim is: Check all that apply. 
‰ Contingent
‰ Unliquidated
‰ Disputed
Nature of lien. Check all that apply.
‰ An agreement you made (such as mortgage or secured 
car loan) 
‰ Statutory lien (such as tax lien, mechanic’s lien) 
‰ Judgment lien from a lawsuit 
‰ Other (including a right to offset) ____________________
Who owes the debt? Check one. 
‰ Debtor 1 only 
‰ Debtor 2 only 
‰ Debtor 1 and Debtor 2 only 
‰ At least one of the debtors and another
‰ Check if this claim relates to a
community debt
Date debt was incurred  ____________ 
Last 4 digits of account number ___  ___  ___  ___
2.2
______________________________________ 
Creditor’s Name 
______________________________________ 
Number 
Street 
______________________________________ 
______________________________________ 
City 
State 
ZIP Code
Describe the property that secures the claim: 
$_________________ $________________ $____________
As of the date you file, the claim is: Check all that apply. 
‰ Contingent
‰ Unliquidated
‰ Disputed
Nature of lien. Check all that apply.
‰ An agreement you made (such as mortgage or secured 
car loan) 
‰ Statutory lien (such as tax lien, mechanic’s lien) 
‰ Judgment lien from a lawsuit 
‰ Other (including a right to offset) ____________________
Who owes the debt? Check one. 
‰ Debtor 1 only 
‰ Debtor 2 only 
‰ Debtor 1 and Debtor 2 only 
‰ At least one of the debtors and another
‰ Check if this claim relates to a
community debt
Date debt was incurred  ____________ 
Last 4 digits of account number ___  ___  ___  ___
Add the dollar value of your entries in Column A on this page. Write that number here:
$________________
Debtor 1 
__________________________________________________________________  
First Name 
Middle Name 
Last Name
Debtor 2 
________________________________________________________________ 
(Spouse, if filing)
First Name 
Middle Name 
Last Name
United States Bankruptcy Court for the: __________ District of __________
Case number ___________________________________________ 
(If known)
Fill in this information to identify your case: 
‰ Check if this is an
amended filing
__________ District of __________
Case 3:23-cr-00003-DHB-BKE     Document 19-3     Filed 08/31/23     Page 1 of 3

Debtor 1 
_______________________________________________________ 
Case number (if known)_____________________________________  
First Name 
Middle Name 
Last Name
2IILFLDO)RUP'
Additional Page of Schedule D: Creditors Who Have Claims Secured by Property
page ___ of ___ 
Part 1: 
Additional Page 
After listing any entries on this page, number them beginning with 2.3, followed 
by 2.4, and so forth.
Column A 
Amount of claim
Do not deduct the 
value of collateral.
Column B 
Value of collateral 
that supports this 
claim
Column C 
Unsecured 
portion 
If any
______________________________________ 
Creditor’s Name 
______________________________________ 
Number 
Street 
______________________________________ 
______________________________________ 
City 
State 
ZIP Code
Describe the property that secures the claim: 
$_________________ $________________ $____________
As of the date you file, the claim is: Check all that apply. 
‰ Contingent
‰ Unliquidated
‰ Disputed
Nature of lien. Check all that apply.
‰ An agreement you made (such as mortgage or secured 
car loan) 
‰ Statutory lien (such as tax lien, mechanic’s lien) 
‰ Judgment lien from a lawsuit 
‰ Other (including a right to offset) ____________________
Who owes the debt? Check one. 
‰ Debtor 1 only 
‰ Debtor 2 only 
‰ Debtor 1 and Debtor 2 only 
‰ At least one of the debtors and another
‰ Check if this claim relates to a
community debt
Date debt was incurred  ____________ 
Last 4 digits of account number ___  ___  ___  ___
______________________________________ 
Creditor’s Name 
______________________________________ 
Number 
Street 
______________________________________ 
______________________________________ 
City 
State 
ZIP Code
Describe the property that secures the claim: 
$_________________ $________________ $____________
As of the date you file, the claim is: Check all that apply. 
‰ Contingent
‰ Unliquidated
‰ Disputed
Nature of lien. Check all that apply.
‰ An agreement you made (such as mortgage or secured 
car loan) 
‰ Statutory lien (such as tax lien, mechanic’s lien) 
‰ Judgment lien from a lawsuit 
‰ Other (including a right to offset) ____________________
Who owes the debt? Check one. 
‰ Debtor 1 only 
‰ Debtor 2 only 
‰ Debtor 1 and Debtor 2 only 
‰ At least one of the debtors and another
‰ Check if this claim relates to a
community debt
Date debt was incurred  ____________ 
Last 4 digits of account number ___  ___  ___  ___
______________________________________ 
Creditor’s Name 
______________________________________ 
Number 
Street 
______________________________________ 
______________________________________ 
City 
State 
ZIP Code
Describe the property that secures the claim: 
$_________________ $________________ $____________
As of the date you file, the claim is: Check all that apply. 
‰ Contingent
‰ Unliquidated
‰ Disputed
Nature of lien. Check all that apply.
‰ An agreement you made (such as mortgage or secured 
car loan) 
‰ Statutory lien (such as tax lien, mechanic’s lien) 
‰ Judgment lien from a lawsuit 
‰ Other (including a right to offset) ____________________
Who owes the debt? Check one. 
‰ Debtor 1 only 
‰ Debtor 2 only 
‰ Debtor 1 and Debtor 2 only 
‰ At least one of the debtors and another
‰ Check if this claim relates to a
community debt
Date debt was incurred  ____________ 
Last 4 digits of account number ___  ___  ___  ___
Add the dollar value of your entries in Column A on this page. Write that number here:  $_________________  
If this is the last page of your form, add the dollar value totals  from all pages.  
Write that number here: 
$_________________  
Case 3:23-cr-00003-DHB-BKE     Document 19-3     Filed 08/31/23     Page 2 of 3

Debtor 1 
_______________________________________________________ 
Case number (if known)_____________________________________  
First Name 
Middle Name 
Last Name
2IILFLDO)RUP'
Part 2 of Schedule D: Creditors Who Have Claims Secured by Property
page ___ of ___ 
Part 2:  
List Others to Be Notified for a Debt That You Already Listed 
Use this page only if you have others to be notified about your bankruptcy for a debt that you already listed in Part 1. For example, if a collection 
agency is trying to collect from you for a debt you owe to someone else, list the creditor in Part 1, and then list the collection agency here. Similarly, if 
you have more than one creditor for any of the debts that you listed in Part 1, list the additional creditors here. If you do not have additional persons to 
be notified for any debts in Part 1, do not fill out or submit this page.  
_____________________________________________________________________ 
Name
_____________________________________________________________________ 
Number 
Street 
_____________________________________________________________________ 
_____________________________________________________________________ 
City 
State 
ZIP Code
On which line in Part 1 did you enter the creditor? _____
Last 4 digits of account number ___  ___  ___  ___ 
_____________________________________________________________________ 
Name
_____________________________________________________________________ 
Number 
Street 
_____________________________________________________________________ 
_____________________________________________________________________ 
City 
State 
ZIP Code
On which line in Part 1 did you enter the creditor? _____
Last 4 digits of account number ___  ___  ___  ___
_____________________________________________________________________ 
Name
_____________________________________________________________________ 
Number 
Street 
_____________________________________________________________________ 
_____________________________________________________________________ 
City 
State 
ZIP Code
On which line in Part 1 did you enter the creditor? _____
Last 4 digits of account number ___  ___  ___  ___
_____________________________________________________________________ 
Name
_____________________________________________________________________ 
Number 
Street 
_____________________________________________________________________ 
_____________________________________________________________________ 
City 
State 
ZIP Code
On which line in Part 1 did you enter the creditor? _____
Last 4 digits of account number ___  ___  ___  ___
_____________________________________________________________________ 
Name
_____________________________________________________________________ 
Number 
Street 
_____________________________________________________________________ 
_____________________________________________________________________ 
City 
State 
ZIP Code
On which line in Part 1 did you enter the creditor? _____
Last 4 digits of account number ___  ___  ___  ___
_____________________________________________________________________ 
Name
_____________________________________________________________________ 
Number 
Street 
_____________________________________________________________________ 
_____________________________________________________________________ 
City 
State 
ZIP Code
On which line in Part 1 did you enter the creditor? _____ 
Last 4 digits of account number ___  ___  ___  ___ 
Case 3:23-cr-00003-DHB-BKE     Document 19-3     Filed 08/31/23     Page 3 of 3

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