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Exhibit A To Voluntary Petition Form. This is a California form and can be use in USBC Central Federal.
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Tags: Exhibit A To Voluntary Petition, B1, California Federal, USBC Central
Form B1, Exh. A - (Rev. 3/98)
1998 USBC, Central District of California
Exhibit “A”
[If debtor is required to file periodic reports (e.g., forms 10K and 10Q) with the Securities and Exchange Commission pursuant
to Section 13 or 15(d) of the Securities Exchange Act of 1934 and is requesting relief under chapter 11 of the Bankruptcy
Code, this Exhibit “A” shall be completed and attached to the petition.]
[Caption as in Form 16B]
Exhibit “A” to Voluntary Petition
1.
If any of the debtor’s securities are registered under Section 12 of the Securities Exchange Act of 1934, the SEC file
number is _________________________________.
2.
The following financial data is the latest available information and refers to the debtor’s condition on ______________.
a. Total assets
$ _____________________________________
b. Total debts (including debts listed in 2.c., below) $ _____________________________________
Approximate
Number
of holders
c.
Debt securities held by more than 500 holders.
q secured
q unsecured
q subordinated
$ ____________________
____________
q secured
q unsecured
q subordinated
$ ____________________
____________
q secured
q unsecured
q subordinated
$ ____________________
____________
q secured
q unsecured
q subordinated
$ ____________________
____________
q secured
q unsecured
q subordinated
$ ____________________
____________
d. Number of shares of preferred stock
____________________
____________
e. Number of shares common stock
____________________
____________
Comments, if any: __________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
3.
Brief description of debtor’s business: _____________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
4.
List the names of any person who directly or indirectly owns, controls, or holds, with power to vote, 5% or more of
the voting securities of debtor:
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________