B5 (Official Form 5) (12/07) United States Bankruptcy Court INVOLUNTARY PETITION ______________________District of______________________ IN RE (Name of Debtor – If Individual: Last, First, Middle) ALL OTHER NAMES used by debtor in the last 8 years (Include married, maiden, and trade names.) Last four digits of Social-Security or other Individual’s Tax-I.D. No./Complete EIN (If more than one, state all.): STREET ADDRESS OF DEBTOR (No. and street, city, state, and zip code) MAILING ADDRESS OF DEBTOR (If different from street address) COUNTY OF RESIDENCE OR PRINCIPAL PLACE OF BUSINESS ZIP CODE ZIP CODE LOCATION OF PRINCIPAL ASSETS OF BUSINESS DEBTOR (If different from previously listed addresses) CHAPTER OF BANKRUPTCY CODE UNDER WHICH PETITION IS FILED  Chapter 7  Chapter 11 INFORMATION REGARDING DEBTOR (Check applicable boxes) Nature of Debts (Check one box.) Petitioners believe: □ □ Debts are primarily consumer debts Debts are primarily business debts □ □ □ □ Type of Debtor (Form of Organization) Individual (Includes Joint Debtor) Corporation (Includes LLC and LLP) Partnership Other (If debtor is not one of the above entities, check this box and state type of entity below.) □ □ □ □ □ □ □ _________________________________________ FILING FEE (Check one box) VENUE □ □ Debtor has been domiciled or has had a residence, principal place of business, or principal assets in the District for 180 days immediately preceding the date of this petition or for a longer part of such 180 days than in any other District. A bankruptcy case concerning debtor’s affiliate, general partner or partnership is pending in this District. Name of Debtor Relationship Nature of Business (Check one box.) Health Care Business Single Asset Real Estate as defined in 11 U.S.C. § 101(51)(B) Railroad Stockbroker Commodity Broker Clearing Bank Other □ Full Filing Fee attached □ Petitioner is a child support creditor or its representative, and the form specified in § 304(g) of the Bankruptcy Reform Act of 1994 is attached. [If a child support creditor or its representative is a petitioner, and if the petitioner files the form specified in § 304(g) of the Bankruptcy Reform Act of 1994, no fee is required.] PENDING BANKRUPTCY CASE FILED BY OR AGAINST ANY PARTNER OR AFFILIATE OF THIS DEBTOR (Report information for any additional cases on attached sheets.) Case Number Date District ALLEGATIONS (Check applicable boxes) Judge COURT USE ONLY 1. 2. □ Petitioner (s) are eligible to file this petition pursuant to 11 U.S.C. § 303 (b). □ The debtor is a person against whom an order for relief may be entered under title 11 of the United States Code. 3.a. □ The debtor is generally not paying such debtor’s debts as they become due, unless such debts are the subject of a bona fide dispute as to liability or amount; or b. □ Within 120 days preceding the filing of this petition, a custodian, other than a trustee receiver, or agent appointed or authorized to take charge of less than substantially all of the property of the debtor for the purpose of enforcing a lien against such property, was appointed or took possession. American LegalNet, Inc. www.FormsWorkflow.com B5 (Official Form 5) (12/07) – Page 2 Name of Debtor______________________ Case No.____________________________ TRANSFER OF CLAIM  Check this box if there has been a transfer of any claim against the debtor by or to any petitioner. Attach all documents that evidence the transfer and any statements that are required under Bankruptcy Rule 1003(a). REQUEST FOR RELIEF Petitioner(s) request that an order for relief be entered against the debtor under the chapter of title 11, United States Code, specified in this petition. If any petitioner is a foreign representative appointed in a foreign proceeding, a certified copy of the order of the court granting recognition is attached. Petitioner(s) declare under penalty of perjury that the foregoing is true and correct according to the best of their knowledge, information, and belief. x__________________________________________________________ Signature of Petitioner or Representative (State title) x______________________________________________________ Signature of Attorney Date Name of Petitioner Name of Attorney Firm (If any) _______________________________________________________ Address Name & Mailing Address of Individual Signing in Representative Capacity Date Signed ______________________ ______________________ Telephone No. x__________________________________________________________ Signature of Petitioner or Representative (State title) x______________________________________________________ Signature of Attorney Date Name of Petitioner Name of Attorney Firm (If any) _______________________________________________________ Address Name & Mailing Address of Individual Signing in Representative Capacity Date Signed ______________________ ______________________ Telephone No. x__________________________________________________________ Signature of Petitioner or Representative (State title) x______________________________________________________ Signature of Attorney Date Name of Petitioner Name of Attorney Firm (If any) _______________________________________________________ Address Name & Mailing Address of Individual Signing in Representative Capacity Date Signed ______________________ ______________________ Telephone No. Name and Address of Petitioner PETITIONING CREDITORS Nature of Claim Amount of Claim Name and Address of Petitioner Nature of Claim Amount of Claim Name and Address of Petitioner Nature of Claim Amount of Claim Note: If there are more than three petitioners, attach additional sheets with the statement under penalty of perjury, each petitioner’s signature under the statement and the name of attorney and petitioning creditor information in the format above. ______continuation sheets attached Total Amount of Petitioners’ Claims American LegalNet, Inc. www.FormsWorkflow.com