Local Bankruptcy Form 1002-1.1 COVER SHEET FOR PETITION CHECK APPLICABLE BOXES TO SHOW ALL DOCUMENTS ATTACHED Name of debtor(s): [ ] Attorney (firm name, address, telephone, and registration number): [ ] No attorney ("pro se")(home address, telephone): Filing fee (revised per directive of the Judicial Conference of the United States): [ [ [ [ [ ] ] ] ] ] $335 for chapter 7 $1,717 for chapter 11 $275 for chapter 12 $310 for chapter 13 Other fee paid: $_________. Enter amount AND attach applicable application under FED. R. BANKR. P. 1006 to pay in installments or pursuant to 28 U.S.C. § 1930(f) (if applicable). Individual and business debtor(s) (except as otherwise noted): [] Exhibit D Statement of Compliance with Credit Counseling Requirement for each individual debtor (a list of all authorized Credit Counselors for Colorado is found at http://www.usdoj.gov/ust or the court has a list that may be viewed in the Records/Public Information Room 114 of the court.) Voluntary Petition ­ Official Form 1 Statement of Financial Affairs ­ Official Form 7 Summary of Schedules A­J ­ Official Form 6­Summary Schedules A, B, C, D, E, F, G, H, I, and J ­ Official Forms 6A, 6B, 6C, 6D, 6E, 6F, 6Iand 6J Declaration Concerning Debtor's Schedules ­ Official Form 6­Declaration Notice to Debtor by Non-Attorney Bankruptcy Petition Preparer ­ Official Form 19 (submitted only if debtor used the services of a bankruptcy petition preparer) For each individual debtor, copies of all payment advices, paycheck stubs, or other evidence of all salary, commissions or income received within 60 days before the bankruptcy case was filed, copied on 8 ˝ by 11 paper with the debtor's first and last name printed on top of each page (and bankruptcy case number, if a number has been assigned); OR, as applicable, complete L.B. Form 1007-6.1 ("Statement Under Penalty of Perjury Concerning Payment Advices") for each debtor. A record of any interest in an education individual retirement account ("IRA") (26 U.S.C. § 530(b)(1)) or qualified state tuition program (26 U.S.C. § 529(b)(1) plans). [ [ [ [ ] ] ] ] [] [] [] [] American LegalNet, Inc. www.FormsWorkFlow.com [] [] [] Attorney Fee Disclosure Statement ­ Director's Procedural Form B 203 Verification of Creditors' Matrix ­ L.B. Form 1007-2.1 Creditors' Matrix (see L.B.R. 1007-2 and L.B.R. 1007-2App. for instructions). Additional items due from ALL individual debtors: [ ] Statement of Social Security Number(s) ­ Official Form 21 Chapter 7 individual debtors also must file: [] Statement of Current Monthly Income and Means Test Calculation ­ Official Form 22A* [] Statement of Intention ­ Official Form 8 (due thirty days post-petition) (the failure to comply with this statement and file reaffirmation agreements or motions to redeem personal property that the debtor does not intend to surrender has ramifications 45 days after the first scheduled meeting of creditors under 11 U.S.C. § 362(h) of the Bankruptcy Code) Chapter 11 individual debtors also must file: [] Statement of Current Monthly Income ­ Official Form 22B Chapter 13 individual debtors also must file: [] Statement of Current Monthly Income and Disposable Income Calculation ­ Official Form 22C* [] Plan ­L.B. Form 3015.1 *The links for the updated Internal Revenue Service and Census Bureau Information that may be needed to complete Statement of Current Monthly Income, Official Forms 22A and 22B, can be reached from the web site: http://www.usdoj.gov/ust/. (Not applicable in chapter 7 cases if debts are primarily business debts.) Additional items due from chapter 11 debtors: [] List of Twenty Largest Creditors ­ Official Form 4 [] Corporate Ownership Statement ­ Required by FED. R BANKR. P. 1007(a)(1) for corporations. L.B. Form 1007-4.1. [] List of Equity Interest Holders ­ Required by FED. R. BANKR. P. 1007(a)(3) for corporations. L.B. Form 1007-4.2. [] Small business debtors must file the most recent 1) balance sheet, 2) statements of operations, 3) cash-flow statement and 4) federal income tax return; OR a verified statement that those documents do not exist and have not been prepared or filed. [] Disclosure Regarding Receivers Bankruptcy Form 1007-7.1. Date: Printed name of party signing: Signature of attorney (or debtor without counsel): 97 American LegalNet, Inc. www.FormsWorkFlow.com