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Real Property Questionnaire (Los Angeles Division) Form. This is a California form and can be use in USBC Central Federal.
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Tags: Real Property Questionnaire (Los Angeles Division), USTLA-5, California Federal, USBC Central
Attorney or Party Name, Address, Telephone and FAX
Pro Se Debtor
OFFICE OF THE UNITED STATES TRUSTEE
LOS ANGELES DIVISION
In Re:
SUBMIT TO UNITED STATES TRUSTEE
– DO NOT FILE WITH COURT
Case Number:
REAL PROPERTY QUESTIONNAIRE
CHECK ONE BOX:
Debtor-In-Possession.
G Owned G Being Purchased G
Within seven (7) days after the filing of the petition, every chapter 11 Debtor in Possession which holds any interest in any parcel of
real property shall provide the United States Trustee with a completed Real Property Questionnaire (form UST-5). Included within
the meaning of the phrase Aany interest in any parcel of real property@ are real property leases, land sales contracts, open escrows and
other transactions under with the Debtor presently may not be a titleholder of record.
The United States Trustee deems the requested information necessary to carry out his statutory responsibilities to monitor and evaluate
all pending Chapter 11 cases in this District. Therefore, failure to timely and fully submit this form for each parcel of real property
may result in the filing of a motion to dismiss this case, convert this case to one under Chapter 7 or for appointment of a Trustee.
Consequently, the Debtor is required to fully answer each question contained in each section of this Questionnaire that applies to the
particular parcel of real property involved. A separate Questionnaire is to be filed for each parcel of real property. If additional space
is required for any answer, and continuation sheet specifying the Section and Question involved should be attached.
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)
C.
Percentage interest in the property owned by the Debtor:
D.
Date of Debtor=s Acquisition of the Property:
Purchase Price: $
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In Re:
Case No.:
Debtor.
E.
Type of real property (i.e. single family residence, condominium, apartment bldg., office bldg., commercial, industrial,
unimproved.)
F.
Description of property (i.e. square footage, number of units, number of offices, amenities, condition):
G.
Development status of property:
(1) Permits (type, date issued, expiration date):
(2) In construction (date of commencement, estimated date and cost of completion, name of construction lender):
(3) Rehabilitation (specify nature, cost and status of rehabilitation effort):
H.
Present Fair Market Value: $
I.
State source and basis of the above fair market value: (attach a copy of latest appraisal)
J.
Does the property meet all federal, state, and local requirements including, but not limited to; health, building, safety,
OSHA, earthquake and fire regulations? G YES G NO (If the answer is ANO,@ briefly explain and attach copies of any
complaints, citations and/or recorded documents which specify the substance of the alleged violations)
K.
State the name of the titleholder of records as of the date of the filing of the Petition:
L.
State the name of the Grantor of the property to the titleholder set forth in AK@ above:
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In Re:
Case No.:
Debtor.
M.
Is the titleholder, specified in AK@ above, the Debtor in this Chapter 11 proceeding? G YES G NO
(If ANO,@ explain why the titleholder and the Debtor are different persons/entities)
N.
State the date of the last transfer of any interest in the property and the name of the transferor and transferee:
O.
Was title to the property transferred to the Debtor within ninety (90) days prior to the filing of the Chapter 11 Petition?
G YES G NO (If AYES,@ state the reason for the transfer)
P.
If the Debtor is a partnership, did all of the general partners consent to the filing of the Chapter 11 Petition?
G YES G NO (If AYES,@ attach documentation to indicate such consent was given by all partners, if ANO,@ explain why
all did not consent and identify each non-consenting partner).
Q.
Is the property currently occupied? G YES G NO
R.
Does the Debtor, its principals or any other person or entity related to the Debtor or its principals occupy or use any
portion of the property? G YES G NO (If AYES,@ state the name of the tenant, nature of the relationship to the Debtor
and terms of the agreement, if any)
S.
Does any other person/entity other than the Debtor use, lease or occupy any portion of the property? G YES G NO
(If >YES@, state name of each person/entity, whether it is relation, affiliated or doing business with the Debtor or any
principal of the Debtor, and state the terms of such use, lease or occupancy)
T.
Has the Bankruptcy Petition been recorded in the Office of the Recorder of the county in which this property is located?
G YES G NO (If AYES,@ state the Date of Recordation and Instrument Number or Book and Page Number)
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In Re:
Case No.:
Debtor.
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
Maturity Date
Installment Amount
Date of Last Payment
Frequency (Mo/Qtr/Yr)
1st:
2nd:
3rd:
4th:
Number of Delinquent Installments
1st:
2nd:
3rd:
4th:
B.
List involuntary encumbrances of record against the property (tax, mechanics=s and other liens, judgments, lis pendens):
Type of lien
Amount Claimed
Date of recordation
C.
Was a Notice of Default and/or a Notice of Sale recorded prior to the filing of the bankruptcy petition? G YES G NO
(If AYES,@ state which document was recorded, the name of the lender, and the date of recordation)
D.
Property Taxes:
(1) Assessed value of property per latest real property Tax Bill $
(2) Annual taxes and installment due dates:
(3) Indicate the due dates and amounts of any Tax Bills which have not been paid:
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Case No.:
Debtor.
SECTION THREE: SALE OF PROPERTY
A.
Has a real estate broker been employed? G YES G NO (If AYES,@ state the name of the broker, name of the
salesperson, date employed, company name, address and telephone number and the listing agreement expiration date)
B.
Has an application to employ the broker been filed with the court? G YES G NO
C.
How long as the property been listed or advertised for sale with the current broker?
D.
Has any written offer been received?
E.
What is the date the property was first listed for sale with any broker?
F.
What is the current listing price? (attach a copy of the listing agreement) $
G YES G NO (If AYES,@ state the terms of each such written offer)
G.
Have other attempts been made to sell the property?
asking price and result)
G YES G NO (If AYES,@ for each such attempt, state the date,
H.
Explain other alternatives considered as to the disposition of the property (i.e. refinancing, capital infusion, stipulation
with lender):
SECTION FOUR: PURCHASE OF PROPERTY
A.
Is the Debtor currently purchasing this parcel of real property?
telephone number of the seller)
G YES G NO (If AYES,@ state the name, address and
B.
Is the Debtor a party to a land Sales Contract or other arrangement by which actual title is to be taken at some point in the
future?
G YES G NO (If AYES,@ attach a copy of any written documents which state the terms of such transaction).
C.
If an escrow has been opened, state the escrow company name, name of escrow officer, address, and telephone number:
(attach a copy of the purchase agreement and Escrow Instruction
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In Re:
Case No.:
Debtor.
D.
What is the purchase price? $
SECTION FIVE: PROPERTY LEASED BY DEBTOR AS LESSEE
A.
Address of property including county and state in which it is located:
B.
Type of real property (i.e., single family residence, condominium, apartment bldg., office bldg., commercial, industrial,
unimproved):
C.
Description of property (i.e. square footage, number of units, number of offices, amenities, condition)?
D.
Is the Debtor or any principal of the Debtor affiliated with or related to the lessor?
the relationship)
G YES G NO (If AYES,@ explain
G YES G NO (If AYES,@ attach a copy of the lease).
E.
Does a written lease exist?
F.
Lease payment amount: $
G.
Number of pre-petition delinquent payments:
H:
Total dollar amount of pre-petition delinquent lease and related payments: $
I.
Specify the type, amount and date of any deposits paid to the lessor (i.e., security deposits, first and last months’= rent)
J.
Describe provisions in the lease for increases in the lease payments:
K.
Describe type of lease (i.e. triple net, minimum plus percentage of sales, gross lease) and state basic lease terms:
L.
When did the lease commence?
When is the lease termination date?
per
G Month G Quarter G Year
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Case No.:
Debtor.
M.
Does the lease provide any options to extend the term of the lease?
G YES G NO (If AYES,@ describe each option)
N.
List the improvements made and fixtures installed by the Debtor (i.e., items so attached or integrated with the property so
as to render them legally non-removable) and state the cost:
SECTION SIX: INSURANCE
A.
State the following as to each policy of insurance (attach a copy of each current policy of insurance):
Type of Insurance
B.
Name of Ins Agent
Ins Company
Policy Number
Amt. of Coverage
Exp. Date
If any policy payments are delinquent, so state and provide the amount and number of installments that are past due:
SECTION SEVEN: INCOME FROM RENTAL OF PROPERTY
A.
What is the actual gross monthly income being received from rental of the property? $
B.
What is the current occupancy rate and the square footage presently being leased?
C.
If the property were fully leased, state the anticipated gross monthly income: $
D.
Itemize the total monthly expenses excluding debt service:
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Case No.:
Debtor.
E.
Is there any person or entity managing the property? G YES G NO (If AYES,@ state the name, address, and telephone
number of the managing person/company and attach a copy of the management company=s fidelity bond)
F.
What are the terms of the management agreement? (If written, attach a copy of the agreement)
G.
Is the manager of the property related to or affiliated with the Debtor in any way? G YES G NO (If AYES,@ explain the
relationship or affiliation)
H.
Is any person and/or entity occupying any portion of the property at a reduced rental rate or at no rental charge?
G YES G NO (If AYES,@ explain fully)
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. I have full authority to make the above answers on behalf of the debtor in possession.
Dated:
Print Name and Title of Authorized Agent for Debtor in
Possession
Signature of Authorized Agent for Debtor in Possession
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