Fill in this information to identify the case: Debtor name __________________________________________________________________ United States Bankruptcy Court for the: ______________________ District of _________ (State) Case number (If known): _________________________ Check if this is an amended filing Official Form 206D Schedule D: Creditors Who Have Claims Secured by Property Be as complete and accurate as possible. 1. Do any creditors have claims secured by debtor's property? 12/15 No. Check this box and submit page 1 of this form to the court with debtor's other schedules. Debtor has nothing else to report on this form. Yes. Fill in all of the information below. List Creditors Who Have Secured Claims Column A Amount of claim Do not deduct the value of collateral. Part 1: 2. List in alphabetical order all creditors who have secured claims. If a creditor has more than one secured claim, list the creditor separately for each claim. Column B Value of collateral that supports this claim $_________________ 2.1 Creditor's name __________________________________________ Describe debtor's property that is subject to a lien ___________________________________________________ $__________________ ___________________________________________________ ___________________________________________________ Creditor's mailing address ________________________________________________________ ________________________________________________________ Describe the lien __________________________________________________ No Yes No Yes. Fill out Schedule H: Codebtors (Official Form 206H). Creditor's email address, if known _________________________________________ Is the creditor an insider or related party? Date debt was incurred __________________ Is anyone else liable on this claim? Last 4 digits of account number ___ ___ ___ ___ Do multiple creditors have an interest in the same property? and its relative priority. As of the petition filing date, the claim is: Check all that apply. Contingent Unliquidated Disputed No Yes. Specify each creditor, including this creditor, ___________________________________ ___________________________________ 2.2 Creditor's name __________________________________________ Describe debtor's property that is subject to a lien ___________________________________________________ $__________________ ___________________________________________________ ___________________________________________________ $_________________ Creditor's mailing address ________________________________________________________ ________________________________________________________ Describe the lien __________________________________________________ No Yes No Yes. Fill out Schedule H: Codebtors (Official Form 206H). Creditor's email address, if known _________________________________________ Is the creditor an insider or related party? Date debt was incurred __________________ Is anyone else liable on this claim? Last 4 digits of account number ___ ___ ___ ___ Do multiple creditors have an interest in the same property? As of the petition filing date, the claim is: Check all that apply. Contingent Unliquidated Disputed No Yes. Have you already specified the relative priority? No. Specify each creditor, including this creditor, and its relative priority. _________________________________ _________________________________ Yes. The relative priority of creditors is specified on lines _____ 3. Total of the dollar amounts from Part 1, Column A, including the amounts from the Additional Page, if any. $________________ Official Form 206D Schedule D: Creditors Who Have Claims Secured by Property American LegalNet, Inc. www.FormsWorkFlow.com page 1 of ___ Debtor Name _______________________________________________________ Case number (if known)_____________________________________ Part 1: Additional Page Column A Amount of claim Copy this page only if more space is needed. Continue numbering the lines sequentially from the previous page. 2._ Creditor's name __________________________________________ Column B Value of collateral Do not deduct the value that supports this claim of collateral. Describe debtor's property that is subject to a lien ___________________________________________________ ___________________________________________________ ___________________________________________________ $__________________ $_________________ Creditor's mailing address ________________________________________________________ ________________________________________________________ Describe the lien __________________________________________________ No Yes Creditor's email address, if known _________________________________________ Is the creditor an insider or related party? Date debt was incurred __________________ Is anyone else liable on this claim? No Yes. Fill out Schedule H: Codebtors (Official Form 206H). Last 4 digits of account number ___ ___ ___ ___ Do multiple creditors have an interest in the same property? As of the petition filing date, the claim is: Check all that apply. Contingent Unliquidated Disputed No Yes. Have you already specified the relative priority? No. Specify each creditor, including this creditor, and its relative priority. _______________________________ _______________________________ _______________________________ Yes. The relative priority of creditors is specified on lines _____ 2._ Creditor's name __________________________________________ Describe debtor's property that is subject to a lien ___________________________________________________ ___________________________________________________ ___________________________________________________ $__________________ $_________________ Creditor's mailing address ________________________________________________________ ________________________________________________________ Describe the lien __________________________________________________ Creditor's email address, if known _________________________________________ Is the creditor an insider or related party? No Yes No Yes. Fill out Schedule H: Codebtors (Official Form 206H). Date debt was incurred __________________ Is anyone else liable on this claim? Last 4 digits of account number ___ ___ ___ ___ Do multiple creditors have an interest in the same property? As of the petition filing date, the claim is: Check all that apply. Contingent Unliquidated Disputed No Yes. Have you already specified the relative priority? No. Specify each creditor, including this creditor, and its relat