Attorney or Party Name, Address, Telephone & FAX Nos., State Bar No. & Email Address FOR COURT USE ONLY Individual appearing without attorney Attorney for: UNITED STATES BANKRUPTCY COURT CENTRAL DISTRICT OF CALIFORNIA - **SELECT DIVISION** In re: CASE NO.: CHAPTER 12 DIVISION DEBTOR'S NOTICE OF CONVERSION OF BANKRUPTCY CASE FROM CHAPTER 12 TO CHAPTER 7 [11 U.S.C. § 1208(a), LBR 1017-1] [No hearing required. No order required.] Debtor(s). PLEASE TAKE NOTICE THAT DEBTOR CONVERTS THIS CHAPTER 12 CASE TO A CASE UNDER CHAPTER 7 ON THE FOLLOWING GROUNDS: 1. A voluntary petition under chapter 12 was filed on (date): 2. Name of chapter 12 trustee appointed: 3. This case has not previously been converted. 4. The additional filing fee is being paid concurrently with the filing of this notice. 5. This notice of conversion is filed in good faith, and Debtor is eligible for relief under chapter 7. Date: Respectfully submitted, . Signature of Debtor, or attorney for Debtor Printed name of Debtor, or attorney for Debtor This form is mandatory. It has been approved for use in the United States Bankruptcy Court for the Central District of California. December 2012 Page 1 F 1017-1.4.NOTICE.CONVERT.CH12 PROOF OF SERVICE OF DOCUMENT I am over the age of 18 and not a party to this bankruptcy case or adversary proceeding. My business address is: A true and correct copy of the foregoing document entitled: DEBTOR'S NOTICE OF CONVERSION OF BANKRUPTCY CASE FROM CHAPTER 12 TO CHAPTER 7 [11 U.S.C. § 1208(a), LBR 1017-1] will be served or was served (a) on the judge in chambers in the form and manner required by LBR 5005-2(d); and (b) in the manner stated below: 1. TO BE SERVED BY THE COURT VIA NOTICE OF ELECTRONIC FILING (NEF): Pursuant to controlling General Orders and LBR, the foregoing document will be served by the court via NEF and hyperlink to the document. On (date) , I checked the CM/ECF docket for this bankruptcy case or adversary proceeding and determined that the following persons are on the Electronic Mail Notice List to receive NEF transmission at the email addresses stated below: Service information continued on attached page 2. SERVED BY UNITED STATES MAIL: , I served the following persons and/or entities at the last known addresses in this bankruptcy On (date) case or adversary proceeding by placing a true and correct copy thereof in a sealed envelope in the United States mail, first class, postage prepaid, and addressed as follows. Listing the judge here constitutes a declaration that mailing to the judge will be completed no later than 24 hours after the document is filed. Service information continued on attached page 3. SERVED BY PERSONAL DELIVERY, OVERNIGHT MAIL, FACSIMILE TRANSMISSION OR EMAIL (state method for each person or entity served): Pursuant to F.R.Civ.P. 5 and/or controlling LBR, on (date) , I served the following persons and/or entities by personal delivery, overnight mail service, or (for those who consented in writing to such service method), by facsimile transmission and/or email as follows. Listing the judge here constitutes a declaration that personal delivery on, or overnight mail to, the judge will be completed no later than 24 hours after the document is filed. Service information continued on attached page I declare under penalty of perjury under the laws of the United States that the foregoing is true and correct. Date Printed Name Signature This form is mandatory. It has been approved for use in the United States Bankruptcy Court for the Central District of California. December 2012 Page 2 F 1017-1.4.NOTICE.CONVERT.CH12