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Real Property Questionnaire Form. This is a California form and can be use in USBC Eastern Federal.
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Tags: Real Property Questionnaire, California Federal, USBC Eastern
REAL PROPERTY QUESTIONNAIRE
EASTERN DISTRICT OF CALIFORNIA
FRESNO DIVISION
DO NOT FILE THIS QUESTIONNAIRE WITH THE BANKRUPTCY COURT
In Re:
CHAPTER 11 CASE NUMBER:
Debtor
Every Chapter 11 debtor is required to provide the United States Trustee with a completed Real Property Questionnaire for each parcel of
real property in which it holds a legal or equitable interest. This includes, but is not limited to, property held under ownership, leasehold,
land sale or open escrow. A separate Questionnaire must be filed for each parcel of real property. Continuation sheets should be attached
for each question where additional space is needed.
SECTION ONE: GENERAL PROPERTY INFORMATION
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. Type of real property (i.e.,single family residence, condominium, apartment bldg; office bldg., commercial, industrial, unimproved):
D. Description of property (i.e., square footage, number of units, number of offices, amenities, condition and/or acreage, if applicable):
E. Type of legal or equitable interest held in the property:
Ownership
Leasehold
Other - (i.e. Land Sale, Open Escrow) Explain:
F. Current use of the property:
G. Does any other person/entity other than the Debtor use, lease or occupy any portion of the property? ( ) Yes ( ) No
(If Yes, state name of such person/entity, their relationship with the Debtor and/or principal of the Debtor, and state the terms of such
use, lease or occupancy).
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H. Does the Debtor or another party carry insurance on the property? ( ) Yes
If Yes, please provide the following information:
Type of Insurance
Name of Insured Party
( ) No
Name of Insurance Company
I. Itemize the monthly expenses related to this property, excluding debt service/lease payments:
Type of Expense
Monthly Amt.
Total
SECTION TWO: PROPERTY OWNED BY DEBTOR [ Not Applicable ( ) ]
A. Is the Debtor also the titleholder to the property?
( ) Yes
(If No, provide the name of the titleholder of record)
B. Percentage interest in the property held by the Debtor:
( ) No
Type of ownership held in the property by the Debtor (i.e. fee simple,
tenants in common, joint tenancy, etc.):
%
C. Date of Debtor’s acquisition of the property:
D. Present Fair Market Value: $
Purchase Price: $
Source and basis of the fair market value:
E. Name of the Grantor of the property to the titleholder set forth in “A” above:
F. Was title to the property transferred to the Debtor within ninety (90) days prior to the filing of the Chapter 11 Petition?
( ) Yes
( ) No (If Yes, state the reason for the transfer)
G. Has the Bankruptcy Petition been recorded in the Office of the Recorder of the county in which this property is located?
( ) Yes ( ) No (If Yes, state the Date of Recordation and Instrument Number or Book and Page Number)
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H. Voluntary encumbrances of record against the property (e.g., mortgages, stipulated judgments):
Current Principal
Balance
Lender Name
Installment
Amount
P & I or
Int. Only?
No. Of
Delinquent
Payments
Frequency
(Mo/Qtr/Yr)
1st
2nd
3rd
4th
I. List involuntary encumbrances of record against the property (tax, mechanics’ and other liens, judgments, lis pendens):
(State type of lien, amount claimed and date of recordation)
J. Annual property taxes: $
Amount(s) and due date(s) of any delinquent property tax installment(s):
K. Has the Debtor made any attempts to sell the property? ( ) Yes ( ) No
(If Yes, provide the date, asking price and result of each attempt)
L. Have any other alternatives been considered as to the disposition of the property (i.e., refinancing, capital infusion, stipulation with
lender)? ( ) Yes ( ) No
( If Yes, explain)
SECTION THREE: PROPERTY LEASED BY DEBTOR AS A LESSEE [ Not Applicable ( ) ]
A. Name, address and telephone number of the lessor:
B. Does a written lease exist?
C. Lease payment amount: $
( ) Yes
Is the Debtor or any principal of the Debtor affiliated with or related to the lessor?
( ) Yes ( ) No (If Yes, explain the relationship)
( ) No (If Yes, attach a copy of the Lease)
Per:
( ) Month
( ) Quarter
D. Number and total dollar amount of delinquent pre-petition lease payments:
( ) Year
#. Of Pmts:
( ) Other:
Total $:
E. Describe the type of lease (i.e., triple net, minimum plus percentage of sales, gross lease) and state basic lease terms:
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SECTION FOUR: INCOME AND MANAGEMENT OF PROPERTY [ Not Applicable ( ) ]
A. What is the actual gross monthly income being generated from rental or use of the property by 3rd parties? $
B. What is the current occupancy rate?
Square footage presently being leased?
C. If the property were fully leased, state the anticipated gross monthly income $
D. Is any person and/or entity occupying any portion of the property at a reduced or $0 rental rate? ( ) Yes
(If Yes, explain fully)
( ) No
E. Is there any person or entity managing the property?:
( ) Yes ( ) No
(If Yes, state the name, address and telephone number of the managing person/company)
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?
(If Yes, explain the relationship or affiliation)
( ) Yes
( ) No
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.
Signature of Debtor in Possession/Authorized Agent for
Debtor in Possession
Date
Name and Title (Please Type or Print)
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RealPropertyQuestionaire Fresno revised 6.15.10
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