Local Bankruptcy Form 1007-4.1 United States Bankruptcy Court District Of Colorado In re , [Set forth here all names including married, maiden, and trade names used by debtor within last 8 years.] Debtor ) ) ) ) ) Case No. ) ) ) ) Chapter ) ) ) ) ) ) Address Last four digits of Social-Security or Individual TaxPayer-Identification (ITIN) No(s).,(if any): Employer Tax-Identification (EIN) No(s).(if any): American LegalNet, Inc. www.FormsWorkFlow.com CORPORATE OWNERSHIP STATEMENT In a case in which the debtor is a corporation (other than a governmental unit), or where any corporation is a party to an adversary proceeding (other than the debtor or a governmental unit), the following information is required pursuant to FED. R. BANKR. P. 1007(a)(1) and 7007.1 and L.B.R. 1007-4 and L.B.R. 7007.1-1: Check applicable box: [] There are no corporations that directly or indirectly own 10% or more of any class of the debtor's equity interest. [] The following corporations directly or indirectly own 10% or more of a class of the debtor's equity interest: 1. 2. 3. Dated: ______________________ By: _________________________________ Signature of debtor Dated: _____________________ By: _________________________________ Counsel to ___________________________ Attorney registration number (if applicable) Business address (or home address for pro se) Telephone number Facsimile number E-mail address American LegalNet, Inc. www.FormsWorkFlow.com