EXHIBIT 3 UNITED STATES BANKRUPTCY COURT WESTERN DISTRICT OF MICHIGAN In re: Case No.Chapter7 Debtor(s)./ ASSET PROTECTION REPORT Pursuant to Local Bankruptcy Rule 1007-2(d), debtors filing a Chapter 7 petition and debtors in a case converting to Chapter 7 must file an Asset Protection Report. List below any property referenced on Schedule D (Creditors Holding Secured Claims); or Schedule G (Executory Contracts and Unexpired Leases); and any insurable asset in which there is nonexempt equity. For each asset listed, provide the following information regarding property damage or casualty insurance: INSURABLE ASSET (from schedules) IS ASSET INSURED? (Yes/No) NAME & ADDRESS OF AGENT OR INSURANCE CO. POLICY EXPIRATION DATE (MM/YYYY) WILL DEBTOR RENEW INSURANCE ON EXPIRATION? (Yes/No) If the debtor is self-employed, does the debtor have general liability insurance for business activities? Yes No I declare, under penalty of perjury, that the above information is true and accurate to the best of my knowledge. I intend to provide insurance protection for any exemptible interests in real or personal property of the estate, and I request that the trustee not expend estate funds to procure insurance coverage for my exemptible assets. Dated:Debtor Dated: Joint Debtor (if any) Pursuant to LBR 1007-2(f), debtor is required to provide the trustee with a copy of the Declarations Page for any insurance policy covering an insurable asset at least 7 days before the date first set for the meeting of creditors.002 American LegalNet, Inc. www.FormsWorkFlow.com