UNITED STATES BANKRUPTCY COURT EASTERN DISTRICT OF NEW YORK www.nyeb.uscourts.gov STATEMENT PURSUANT TO LOCAL BANKRUPTCY RULE 1073-2(b) DEBTOR(S):________________________________________________ CASE NO.:____________________ Pursuant to Local Bankruptcy Rule 1073-2(b), the debtor (or any other petitioner) hereby makes the following disclosure concerning Related Cases, to the petitioner’s best knowledge, information and belief: [NOTE: Cases shall be deemed “Related Cases” for purposes of E.D.N.Y. LBR 1073-1 and E.D.N.Y. LBR 1073-2 if the earlier case was pending at any time within eight years before the filing of the new petition, and the debtors in such cases: (i) are the same; (ii) are spouses or ex-spouses; (iii) are affiliates, as defined in 11 U.S.C. § 101(2); (iv) are general partners in the same partnership; (v) are a partnership and one or more of its general partners; (vi) are partnerships which share one or more common general partners; or (vii) have, or within 180 days of the commencement of either of the Related Cases had, an interest in property that was or is included in the property of another estate under 11 U.S.C. § 541(a).] G NO RELATED CASE IS PENDING OR HAS BEEN PENDING AT ANY TIME. G THE FOLLOWING RELATED CASE(S) IS PENDING OR HAS BEEN PENDING: 1. CASE NO.:__________________ JUDGE:_____________________ DISTRICT/DIVISION:__________________________ CASE STILL PENDING (Y/N):_____ [If closed] Date of closing:________________ CURRENT STATUS OF RELATED CASE:_____________________________________________________________________ (Discharged/awaiting discharge, confirmed, dismissed, etc.) MANNER IN WHICH CASES ARE RELATED (Refer to NOTE above):_____________________________________________ REAL PROPERTY LISTED IN DEBTOR’S SCHEDULE “A” (“REAL PROPERTY”) WHICH WAS ALSO LISTED IN SCHEDULE “A” OF RELATED CASE:________________________________________________________________________ ___________________________________________________________________________________________________________ 2. CASE NO.:___________________ JUDGE:_____________________ DISTRICT/DIVISION:_________________________ CASE STILL PENDING (Y/N):_____ [If closed] Date of closing:________________ CURRENT STATUS OF RELATED CASE:_____________________________________________________________________ (Discharged/awaiting discharge, confirmed, dismissed, etc.) MANNER IN WHICH CASES ARE RELATED (Refer to NOTE above):_____________________________________________ REAL PROPERTY LISTED IN DEBTOR’S SCHEDULE “A” (“REAL PROPERTY”) WHICH WAS ALSO LISTED IN SCHEDULE “A” OF RELATED CASE:_____________________________________________________________________ ___________________________________________________________________________________________________________ (OVER) American LegalNet, Inc. www.FormsWorkFlow.com DISCLOSURE OF RELATED CASES (cont’d) 3. CASE NO.:____________________ JUDGE:_____________________ DISTRICT/DIVISION:_________________________ CASE STILL PENDING (Y/N):_____ [If closed] Date of closing:________________ CURRENT STATUS OF RELATED CASE:_____________________________________________________________________ (Discharged/awaiting discharge, confirmed, dismissed, etc.) MANNER IN WHICH CASES ARE RELATED (Refer to NOTE above):_____________________________________________ REAL PROPERTY LISTED IN DEBTOR’S SCHEDULE “A” (“REAL PROPERTY”) WHICH WAS ALSO LISTED IN SCHEDULE “A” OF RELATED CASE:_____________________________________________________________________ ___________________________________________________________________________________________________________ NOTE: Pursuant to 11 U.S.C. § 109(g), certain individuals who have had prior cases dismissed within the preceding 180 days may not be eligible to be debtors. Such an individual will be required to file a statement in support of his/her eligibility to file. TO BE COMPLETED BY DEBTOR/PETITIONER'S ATTORNEY, AS APPLICABLE: I am admitted to practice in the Eastern District of New York (Y/N):_____ CERTIFICATION (to be signed by pro se debtor/petitioner or debtor/petitioner's attorney, as applicable): I certify under penalty of perjury that the within bankruptcy case is not related to any case now pending or pending at any time, except as indicated elsewhere on this form. _____________________________________________ Signature of Debtor's Attorney _____________________________________________ Signature of Pro Se Debtor/Petitioner ____________________________________________ Mailing Address of Debtor/Petitioner ____________________________________________ City, State, Zip Code ____________________________________________ Email Address ____________________________________________ Area Code and Telephone Number Failure to fully and truthfully provide all information required by the E.D.N.Y. LBR 1073-2 Statement may subject the debtor or any other petitioner and their attorney to appropriate sanctions, including without limitation conversion, the appointment of a trustee or the dismissal of the case with prejudice. NOTE: Any change in address must be reported to the Court immediately IN WRITING. Dismissal of your petition may otherwise result. USBC - 17 Rev 09/15/11 American LegalNet, Inc. www.FormsWorkFlow.com