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Voluntary Petition (USBC Central District Of California) Form. This is a California form and can be use in USBC Central Federal.
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Tags: Voluntary Petition (USBC Central District Of California), B1, California Federal, USBC Central
Form B1 (Official Form 1) - (Rev. 04/10)
2010 USBC, Central District of California
UNITED STATES BANKRUPTCY COURT
CENTRAL DISTRICT OF CALIFORNIA
Voluntary Petition
Name of Debtor (if individual, enter Last, First, Middle):
Name of Joint Debtor (Spouse) (Last, First, Middle):
All Other Names used by the Debtor in the last 8 years
(include married, maiden, ano trade names):
All Other Names used by the Joint Debtor in the last 8 years
(include married, maiden, and trade names):
Last four digits of Soc. Sec. or Individual-Taxpayer I.D. (ITIN) No./Complete EIN
(if more than one, state all):
Last four digits of Soc. Sec. or Individual-Taxpayer I.D. (ITIN) No./Complete EIN
(if more than one, state all):
Street Address of Debtor (No. & Street, City, and State):
Street Address of Joint Debtor (No. & Street, City, and State):
ZIP CODE
ZIP CODE
County of Residence or of the Principal Place of Business:
County of Residence or of the Principal Place of Business:
Mailing Address of Debtor (if different from street address):
Mailing Address of Joint Debtor (if different from street address):
ZIP CODE
ZIP CODE
Location of Principal Assets of Business Debtor (if different from street address above):
ZIP CODE
Type of Debtor (Form of Organization)
(Check one box.)
Individual (includes Joint Debtors)
See Exhibit D on page 2 of this form
Corporation (includes LLC and LLP)
Partnership
Other (if debtor is not one of the above
entities, check this box and state type
of entity below)
Nature of Business
(Check one box.)
Health Care Business
Single Asset Real Estate as defined in 11
U.S.C. § 101 (51B)
Railroad
Stockbroker
Commodity Broker
Clearing Bank
Other
Tax-Exempt Entity
(Check one box, if applicable)
Debtor is a tax-exempt organization under
Title 26 of the United States Code (the
Internal Revenue Code.)
Filing Fee (Check one box)
Full Filing Fee attached
Filing Fee to be paid in installments (Applicable to individuals only). Must attach signed
application for the court’s consideration certifying that the debtor is unable to pay fee except
in installments. Rule 1006(b). See Official Form 3A.
Filing Fee waiver requested (Applicable to chapter 7 individuals only). Must attach
signed application for the court’s consideration. See Official Form 3B.
Chapter of Bankruptcy Code Under Which
the Petition is Filed
(Check one box)
Chapter 7
Chapter 9
Chapter 11
Chapter 12
Chapter 13
Chapter 15 Petition for Recognition
of a Foreign Main Proceeding
Chapter 15 Petition for Recognition
of a Foreign Nonmain Proceeding
Nature of Debts
(Check one box.)
Debts are primarily consumer debts, defined in
11 U.S.C. § 101(8) as “incurred by an individual
primarily for a personal, family, or house-hold
purpose.”
Chapter 11 Debtors:
Check one box:
Debtor is a small business debtor as defined in 11 U.S.C. § 101(51D).
Debtor is not a small business debtor as defined in 11 U.S.C. § 101 (51D).
Check if:
Debtor’s aggregate noncontingent liquidated debts (excluding debts owed to insiders or
affiliates) are less than $2,343,300. (amount subject to adjustment on 04/01/13 and every three
years thereafter).
Check all applicable boxes:
A plan is being filed with this petition
Acceptances of the plan were solicited prepetition from one or more classes of creditors, in
Statistical/Administrative Information
Debtor estimates that funds will be available for distribution to unsecured creditors.
Debtor estimates that, after any exempt property is excluded and administrative expenses paid, there will be no funds available for distribution
to unsecured creditors.
Estimated Number of Creditors
149
5099
100199
200999
1,0005,000
5,00110,000
10,001
25,000
25,00150,000
50,001100,000
OVER
100,000
Estimated Assets
$0 to
$50,000
$50,001 to
$100,000
$100,001 to
$500,000
$500,001 to
$1 million
$1,000,001 to
$10 million
$10,000,001 to
$50 million
$50,000,001 to
$100 million
$500,001 to
$1 million
$1,000,001 to
$10 million
$10,000,001
to $50 million
$50,000,001 to
$100 million
$100,000,001
to $500 million
$500,000,001
to $1 billion
More
$1 billion
Estimated Liabilities
$0 to
$50,000
$50,001 to $100,001 to
$100,000
$500,000
Debts are primarily business debts.
$100,000,001
to $500 million
$500,000,001
to $1 billion
More than
$1 billion
THIS SPACE FOR
COURT USE ONLY
Form B1 (Official Form 1) (Rev.04/10)
2010 USBC, Central District of California
Name of Debtor(s):
Voluntary Petition
FORM B1, Page 2
(This page must be completed and filed in every case.)
Prior Bankruptcy Case Filed Within Last 8 Years (If more than two, attach additional sheet)
Location
Where Filed:
Case Number:
Date Filed:
Location
Where Filed:
Case Number:
Date Filed:
Pending Bankruptcy Case Filed by any Spouse, Partner or Affiliate of this Debtor (If more than one, attach additional sheet)
Name of Debtor:
Case Number:
Date Filed:
District:
Relationship:
Judge:
Exhibit B
(To be completed if debtor is an individual whose debts
are primarily consumer debts.)
Exhibit A
(To be completed 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.)
I, the attorney for the petitioner named in the foregoing petition, declare that I have
informed the petitioner that [he or she] may proceed under chapter 7, 11, 12, or 13 of title
11, United States Code, and have explained the relief available under each such chapter.
I further certify that I have delivered to the debtor the notice required by 11 U.S.C. § 342(b).
Exhibit A is attached and made a part of this petition.
X
Signature of Attorney for Debtor(s)
Exhibit C
Does the debtor own or have possession of any property that poses or is
alleged to pose a threat of imminent and identifiable harm to public health or
safety?
Date
Exhibit D
(To be completed by every individual debtor. If a joint petition is filed, each spouse must
complete and attach a separate Exhibit D.)
Exhibit D completed and signed by the debtor is attached and made a part of this
petition.
Yes, and Exhibit C is attached and made a part of this petition.
If this is a joint petition:
No
Exhibit D also completed and signed by the joint debtor is attached and made a part of
this petition.
Information Regarding the Debtor - Venue
(Check any applicable box)
Debtor has been domiciled or has had a residence, principal place of business, or principal assets in this District for 180 days immediately preceding the date
of this petition or for a longer part of such 180 days than in any other District.
There is a bankruptcy case concerning debtor’s affiliate, general partner, or partnership pending in this District.
Debtor is a debtor in a foreign proceeding and has its principal place of business or principal assets in the United States in this District, or has no principal
place of business or assets in the United States but is a defendant in an action or proceeding [in a federal or state court] in this District, or the interests of the
parties will be served in regard to the relief sought in this District.
Certification by a Debtor Who Resides as a Tenant of Residential Property
Check all applicable boxes.
Landlord has a judgment against the debtor for possession of debtor’s residence. (If box checked, complete the following.)
(Name of landlord that obtained judgment)
(Address of landlord)
Debtor claims that under applicable nonbankruptcy law, there are circumstances under which the debtor would be permitted to cure the entire monetary
default that gave rise to the judgment for possession, after the judgment for possession was entered, and
Debtor has included in this petition the deposit with the court of any rent that would become due during the 30-day period after the filing
of the petition.
Debtor certifies that he/she has served the Landlord with this certification (11 U.S.C. § 362(1)).
Form B1 (Official Form 1) (Rev. 1/08)
2008 USBC, Central District of California
Name of Debtor(s):
Voluntary Petition
FORM B1, Page 3
(This page must be completed and filed in every case)
Signatures
Signature(s) of Debtor(s) (Individual/Joint)
Signature of a Foreign Representative
I declare under penalty of perjury that the information provided in this petition is true and correct.
[If petitioner is an individual whose debts are primarily consumer debts and has chosen to file
under chapter 7] I am aware that I may proceed under chapter 7, 11, 12 or 13 of title 11, United
States Code, understand the relief available under each such chapter, and choose to proceed
under chapter 7. [If no attorney represents me and no bankruptcy petition preparer signs the
petition] I have obtained and read the notice required by 11 U.S.C. § 342(b).
I declare under penalty of perjury that the information provided in this petition is true and correct,
that I am the foreign representative of a debtor in a foreign main proceeding, and that I am
authorized to file this petition.
(Check only one box.)
I request relief in accordance with chapter 15 of title 11, United States Code. Certified copies
of the documents required by 11 U.S.C. § 1515 are attached.
I request relief in accordance with the chapter of title 11, United States Code, specified in this
petition.
X
X
________________________________________________________
Signature of Joint Debtor
Pursuant to 11 U.S.C. § 1511, I request relief in accordance with the chapter of title 11
specified in this petition. A certified copy of the order granting recognition of the foreign main
proceeding is attached.
________________________________________________________
Signature of Debtor
X
(Signature of Foreign Representative)
________________________________________________________
Telephone Number (If not represented by attorney)
(Printed Name of Foreign Representative)
Date
Date
Signature of Attorney
X
______________________________________________________
Signature of Attorney for Debtor(s)
______________________________________________________
Printed Name of Attorney for Debtor(s)
______________________________________________________
Firm Name
______________________________________________________
Address
______________________________________________________
______________________________________________________
Telephone Number
Date
Signature of Debtor (Corporation/Partnership)
I declare under penalty of perjury that the information provided in this petition is true and correct,
and that I have been authorized to file this petition on behalf of the debtor.
The debtor requests relief in accordance with the chapter of title 11, United States Code,
specified in this petition.
________________________________________________________
Signature of Authorized Individual
________________________________________________________
Printed Name of Authorized Individual
________________________________________________________
Title of Authorized Individual
Date
I declare under penalty of perjury that: (1) I am a bankruptcy petition preparer as defined in 11
U.S.C. § 110; (2) I prepared this document for compensation and have provided the debtor with
a copy of this document and the notices and information required under 11 U.S.C. §§ 110(b),
110(h), and 342(b); and, (3) if rules or guidelines have been promulgated pursuant to 11 U.S.C.
§ 110(h) setting a maximum fee for services chargeable by bankruptcy petition preparers, I have
given the debtor notice of the maximum amount before preparing any document for filing for a
debtor or accepting any fee from the debtor, as required in that section. Official Form 19 is
attached.
____________________________________________________________
Printed Name and title, if any, of Bankruptcy Petition Preparer
____________________________________________________________
Social Security number (If the bankruptcy petition preparer is not an individual, state the Social
Security number of the officer, principal, responsible person or partner of the bankruptcy petition
preparer.) (Required by 11 U.S.C. § 110.)
Bar Number
*In a case in which § 707(b)(4)(D) applies, this signature also constitutes a certification that the
attorney has no knowledge after an inquiry that the information in the schedules is incorrect
X
Signature of Non-Attorney Bankruptcy Petition Preparer
Address
X
Date
Signature of bankruptcy petition preparer or officer, principal, responsible person, or partner whose
Social Security number is provided above.
Names and Social Security numbers of all other individuals who prepared or assisted in preparing
this document unless the bankruptcy petition preparer is not an individual.
If more than one person prepared this document, attach additional sheets conforming to the
appropriate official form for each person.
A bankruptcy petition preparer’s failure to comply with the provisions of title 11 and the Federal
Rules of Bankruptcy Procedure may result in fines or imprisonment or both. 11 U.S.C. § 110; 18
U.S.C. § 156.