Attorney or Party Name, Address, Telephone & FAX Numbers, and California State Bar Number FOR COURT USE ONLY G Individual appearing without counsel G Attorney for: UNITED STATES BANKRUPTCY COURT CENTRAL DISTRICT OF CALIFORNIA CHAPTER: In re: CASE NO.: Debtor(s). DATE: TIME: CTRM: FLOOR: DECLARATION OF RE: DEFAULT UNDER ADEQUATE PROTECTION ORDER; REQUEST FOR ENTRY OF ORDER GRANTING RELIEF FROM STAY I, , declare as follows: (print name of declarant) 1. I have personal knowledge of the matters set forth in this declaration and, if called upon to testify, I could and would testify competently hereto. I am over 18 years of age. , the Court entered an order conditioning continuation of the automatic stay in the 2. On above-entitled bankruptcy case on the performance by the debtor of certain obligations for the benefit of (name of Movant) (the “Adequate Protection Order”). A true and correct copy of the Adequate Protection Order is attached hereto as Exhibit “A.” 3. I have knowledge regarding the debtor’s performance (or lack of performance) under the terms of the Adequate Protection Order because (specify): G I am the party for whose benefit the Adequate Protection Order was entered (the “Movant”), and the Adequate Protection Order required the debtor to make payments directly to me. G I am counsel for the Movant and the Adequate Protection Order required the debtor to make payments directly to me. G I am employed as for the Movant and, as such, am one of the custodians of the books, records and files of Movant that relate to payments received from the debtor. I have personally worked on those books, records and files, and as to the following facts, I know them to be true of my own knowledge or I have gained knowledge of them from the business records of Movant on behalf of Movant, which were made at or about the time of the events recorded, and which are maintained in the ordinary course of Movant’s business at or near the time of the acts, conditions or events to which they relate. Any such document was prepared in the ordinary course of business of Movant by a person who had personal knowledge of the event being recorded and had or has a business duty to record accurately such event. The business records are available for inspection and copies can be submitted to the Court if required. This form is mandatory by Order of the United States Bankruptcy Court for the Central District of California. January 2009 F 4001-1.DEC American LegalNet, Inc. www.FormsWorkflow.com F 4001-1.DEC Declaration of RE: Default Under Adequate Protection Order; Request for Entry of Order Granting Relief From Stay - Page 2 In re (SHORT TITLE) CHAPTER: Debtor(s). G CASE NO.: Other (specify): 4. The debtor defaulted upon his/her/its obligations under the Adequate Protection Order by (specify): G G Failing to provide evidence of the existence of insurance coverage required under the terms of the Adequate Protection Order in a timely manner. G Other (specify): G a. Movant caused a notice of default (the “Notice”) identifying the default(s) referenced in paragraph 4 above to be served on the debtor on (date). A true and correct copy of the Notice is attached hereto as Exhibit “B.” G 5. Failing to make the payment(s) due Protection Order. b. Movant was not required to serve a notice of the default specified in paragraph 4, because the Adequate Protection Order only required Movant to serve a maximum of (number) notices of default and Movant had already served the required number of notices of default (collectively the “Notices”) at the time the default specified in paragraph 4 occurred. Copies of all of the Notices are attached hereto as Exhibit “B.” (date(s)) under the terms of the Adequate 6. Debtor failed to cure the defaults identified in the Notice within the cure period established by the Adequate Protection Order. 7. In light of the foregoing, under the terms of the Adequate Protection Order, Movant is entitled to relief from the automatic stay. Concurrently herewith, Movant is lodging a proposed form of order granting Movant relief from the automatic stay. I declare under penalty of perjury under the laws of the United States of America that the foregoing is true and correct and that this Declaration was executed on , , at (city, state). Print Declarant’s Name Signature of Declarant This form is mandatory by Order of the United States Bankruptcy Court for the Central District of California. January 2009 F 4001-1.DEC American LegalNet, Inc. www.FormsWorkflow.com F 4001-1.DEC Declaration of RE: Default Under Adequate Protection Order; Request for Entry of Order Granting Relief From Stay - Page 3 In re (SHORT TITLE) CHAPTER: Debtor(s). CASE NO.: NOTE: When using this form to indicate service of a proposed order, DO NOT list any person or entity in Category I. Proposed orders do not generate an NEF because only orders that have been entered are placed on a CM/ECF docket. 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 described as 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 indicated below: I. TO BE SERVED BY THE COURT VIA NOTICE OF ELECTRONIC FILING (“NEF”) - Pursuant to controlling General Order(s) and Local Bankruptcy Rule(s) (“LBR”), the foregoing document will be served by the court via NEF and hyperlink to the document. On ________________________ I checked the CM/ECF docket for this bankruptcy case or adversary proceeding and determined that the following person(s) are on the Electronic Mail Notice List to receive NEF transmission at the email addressed indicated below: 9 Service information continued on attached page II. SERVED BY U.S. MAIL OR OVERNIGHT MAIL (indicate method for each person or entity served): On _________________________ I served the following person(s) and/or entity(ies) at the last known address(es) in this bankruptcy 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/or with an overnight mail service addressed as follow. 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. 9 Service information continued on attached page III. SERVED BY PERSONAL DELIVERY, FACSIMILE TRANSMISSION OR EMAIL (indicate method for each person or entity served): Pursuant to F.R.Civ.P. 5 and/or controlling LBR, on _______________________ I served the following person(s) and/or entity(ies) by personal delivery, 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 mailing to the judge will be completed no later than 24 hours after the document is filed. 9 Service information continued on attached page I declare under penalty of perjury under the laws of the United States of America that the foregoing is true and correct. _________________________________________________________ Date Type Name _____________________________________ Signature This form is mandatory by Order of the United States Bankruptcy Court for the Central District of California. January 2009 F 4001-1.DEC American LegalNet, Inc. www.FormsWorkflow.com F 4001-1.DEC Declaration of RE: Default Under Adequate Protection Order; Request for Entry of Order Granting Relief From Stay - Page 4 In re (SHORT TITLE) CHAPTER: Debtor(s). CASE NO.: ADDITIONAL SERVICE INFORMATION (if needed): This form is mandatory by Order of the United States Bankruptcy Court for the Central District of California. January 2009 F 4001-1.DEC American LegalNet, Inc. www.FormsWorkflow.com