CHAPTER 13 REAL PROPERTY QUESTIONNAIRE Name, Address and Telephone Number of Attorney for Debtor(s) or Debtor(s) In Pro Per INSTRUCTIONS TO DEBTOR(S): FILE WITH CHAPTER 13 TRUSTEE ONLY - DO NOT FILE IN BANKRUPTCY COURT COMPLETE THIS FORM FOR EACH PROPERTY IN WHICH THE DEBTOR HAS AN INTEREST. (DO NOT COMPLETE FOR ANY PROPERTY WHICH YOU INTEND TO SURRENDER/ABANDON.) THIS COMPLETED FORM IS DUE IN THE CHAPTER 13 TRUSTEE'S OFFICE AT LEAST FIVE (5) DAYS PRIOR TO THE FIRST SCHEDULED 341(a) MEETING OF CREDITORS. Bar No. THIS FORM MAY BE COPIED IF THE DEBTOR HAS MULTIPLE PROPERTIES. PROVIDE ONE COMPLETE FORM FOR EACH PROPERTY. Attorney for Debtor / In Pro Per IN RE: OFFICE OF EDWINA E. DOWELL, CHAPTER 13 TRUSTEE CENTRAL DISTRICT OF CALIFORNIA 333 SOUTH GRAND AVENUE, SUITE 2910, LOS ANGELES, CA 90071 (213) 628-2552 DEBTOR(S). CHAPTER 13 Case Number REAL PROPERTY QUESTIONNAIRE CHECK ONE BOX: OWNED BEING PURCHASED LEASED SECTION ONE: PROPERTY OWNED OR BEING PURCHASED BY DEBTOR A. Address of property including county and state in which it is located: B. Legal description of property (i.e., Lot and Tract Number, including Tax Assessor's I.D. Number. NOTE: without this information; the County Tax Collector will be unable to properly credit any funds sent by the Trustee): C. Percentage interest in the property owned by the Debtor: D. Date of Debtor's acquisition of the property: 09/23/96 Purchase Price: $ Page 1 of 4 Real Property Questionnaire CCD-100 2002 © American LegalNet, Inc. SECTION ONE: (Cont'd) PROPERTY OWNED OR BEING PURCHASED BY DEBTOR E. Type of real property: Condominium/Co-op Commercial Industrial Unimproved Other Single Family Residence Duplex Apartment Building F. Description of property (i.e., number of units, number of offices, amenities, condition): G. Present Fair Market Value: $ H. State source and basis of the above fair market value: I. Does the property meet all federal, state and local requirements including, but not limited to health, building, safety, OSHA, earthquake and fire regulations? Yes No (If answer is "No," briefly explain and attach copies of any complaints, citations and/or recorded documents which specify the substance of the alleged violations) J. State the name(s) of the title holder(s) of record as of the date of the filing of the Petition: K. State the name of the Grantor of the property to the titleholder set forth in "J" above: L. State the date of the last transfer of any interest in the property and name of the transferor and transferee: M. Was title to the property transferred to the Debtor within ninety (90) days prior to the filing of the Chapter 13 Petition? Yes No (If your answer is "Yes," state the reason for the transfer) 9/23/96 Page 2 of 4 Real Property Questionnaire 2002 © American LegalNet, Inc. SECTION TWO: FINANCIAL STATUS OF OWNED PROPERTY A. List voluntary encumbrances of record against the property (e.g., mortgages, stipulated judgments): Lender Name Current Principal Balance Installment Amount 1st $ $ 2nd $ $ 3rd $ $ 4th $ Date Due/Date Late $ Maturity Date (If all due prior to or during term of bankruptcy) 1st 2nd 3rd 4th B. List involuntary encumbrances of record against the property (taxes, mechanics' and other liens, judgments, lis pendens): (State type of lien, amount claimed and date of recordation) C. Property Taxes: (1) Are property taxes impounded (included in your mortgage payment)? Yes No (2) If "No," what is the amount of the annual taxes and installment due date? (3) Indicate the due dates and amounts of any tax bills which have not been paid: D. Identify any person/entity other than (or in addition to) the debtor who uses, leases, or occupies the property and state that person's/entity's relationship to the debtor. SECTION THREE: INCOME FROM RENTAL OF PROPERTY A. What is the actual gross monthly income being received from rental of the property? $ per month. B. Itemize the total monthly expenses: Mortgage payment: Utilities: Homeowner's insurance: Maintenance: Property Taxes: Other: C. Is any person and/or entity occupying any portion of the property at a reduced rental rate or at no rental charge? Yes No (if your answer is "Yes," explain fully) 9/23/96 Page 3 of 4 Real Property Questionnaire 2002 © American LegalNet, Inc. SECTION FOUR: INSURANCE A. State the following as to each Policy of Insurance (even if payments are included with mortgage payments): Type of Insurance Insurance Company Name Policy Number # Amt. of Coverage Exp. Date $ B. If any policy payments are delinquent, so state and provide the amount and number of installments that are past due: I declare under penalty of perjury that the answers contained in the foregoing Real Property Questionnaire are true and correct to the best of my knowledge, information and belief. Date: Name (Please type or print): Signature of Debtor: Name (Please type or print): Signature of Co-Debtor: 9/23/96 Page 4 of 4 Real Property Questionnaire 2002 © American LegalNet, Inc.