United States Bankruptcy Court SOUTHERN In re Bankruptcy Case No. District of NEW YORK Debtor. Social Security No.: Employer Tax I.D. No.: SUMMONS TO DEBTOR IN INVOLUNTARY CASE To the above named Debtor: A petition under title 11, United States Code was filed against you on ______________________ in this Bankruptcy Court, requesting an order for relief under Chapter _______________ of the Bankruptcy Code (title 11 of the United States Code.) YOU ARE SUMMONED and required to submit to the Clerk of the Bankruptcy Court, a motion or answer (attorneys should file online) to the petition within 21 days after the service of this summons. A copy of the petition is attached. Address of the Clerk: United States Bankruptcy Court 300 Quarropas Street, 2nd Floor White Plains, New York 10601 www.nysb.uscourts.gov At the same time, you must also serve a copy of the motion or answer upon the petitioner's attorney. Name and Address of Petitioner's Attorney If you make a motion, your time to answer is governed by Federal Rule of Bankruptcy Procedure 1011 (c) . If you fail to respond to this Summons, an order for relief will be entered. Clerk of the Bankruptcy Court By: Date Deputy Clerk ____________________________________________________________________________________________ *Set forth all names, including trade names, used by the debtor within the last 8 years. (Federal Rule of Bankruptcy Procedure 1005). For joint debtors, set forth both social security numbers. American LegalNet, Inc. www.FormsWorkFlow.com