Official Form 20 7 Statemen t of Financial Affairs for Non - Individuals Filing for Bankruptcy page 1 Official Form 2 0 7 Statement of Financial Affairs for Non - Individuals Filing for Bankruptcy 04/1 9 The d ebtor must a nswer every question. If more space is needed, attach a separate sheet to this form. On the top of any additional pages, write name and case number (if known) . Part 1: Income 1. Gross revenue from business None , which may be a calendar year Sources of revenue Check all that apply Gross revenue (before deductions and exclusions) From the beginning of the fiscal year to filing date: From to Filing date MM / DD / YYYY Operating a business Other $ For prior year: From to MM / DD / YYYY MM / DD / YYYY Operating a business Other $ For the year before that: From to MM / DD / YYYY MM / DD / YYYY Operating a business Other $ 2. N on - business revenue Include revenue regardless of whether that revenue is taxable. Non - business income may include interest, dividends, money collected from lawsuits, and royalties. List each source and the gross revenue for each separately. Do not include revenue listed in line 1 . None Description of sources of revenue Gross revenue from each source (before deductions and exclusions) From the beginning of the fiscal year to filing date: From to Filing date MM / DD / YYYY $ For prior year: From to MM / DD / YYYY MM / DD / YYYY $ For the year before that: From to MM / DD / YYYY MM / DD / YYYY $ Check if this is an amended filing Debtor name United States Bankruptcy Court for the: District of ( State ) Case number (If known): Fill in this information to identify the case: American LegalNet, Inc. www.FormsWorkFlow.com Debtor Case number ( if known ) Name Official Form 20 7 Statement of Financial Affairs for Non - Individuals Filing for Bankruptcy page 2 Part 2: List Certain Transfers Made Before Filing for Bankruptcy 3. Certain payments or transfers to creditors within 90 days before filing this case List payments or transfers including expense reimbursements to any creditor, other than regular employee compensation, within 90 days before filing this case unless the aggregate value of all property transferred to that creditor is less than $ 6 , 8 25 . (This amount may be adjusted on 4/01/ 22 and every 3 years after that with respect to cases filed on or after the date of adjustment.) None and address Dates Total amount or value Reasons for payment or transfer Check all that apply 3.1. Street City State ZIP Code $ Secured debt Unsecured loan repayments Suppliers or vendors Services Other 3. 2 . Street City State ZIP Code $ Secured debt Unsecured loan repayments Suppliers or vendors Services Other 4. Payments or other transfers of property made within 1 year before filing this case that benefited any insider List payments or transfers , including expense reimbursements, made within 1 year before filing this case on debts owed to an insider or guaranteed or cosigned by an insider unless the aggregate value of all property transferred to or for the benefit of the insi der is less than $ 6 , 8 25 . (This amount may be adjusted on 4/01/ 22 and every 3 years after that w ith respect to cases filed on or after the date of adjustment.) Do not include any payments listed in line 3. Insiders include officers, directors, and anyone in control of a corporate debtor and their relatives; general partners of a partnership debtor and their relatives; affiliates of the debtor and insiders of such affiliates; and any managing agent of the debtor. 11 U . S . C . 247 101 (31) . None and address Dates Total amount or value Reasons for payment or transfer 4 . 1 . name Street City State ZIP Code $ Relationship to debtor 4 . 2 . name Street City State ZIP Code $ Relationship to debtor American LegalNet, Inc. www.FormsWorkFlow.com Debtor Case number ( if known ) Name Official Form 20 7 Statement of Financial Affairs for Non - Individuals Filing for Bankruptcy page 3 5. Repossessions, foreclosures, and returns List all property of the debtor that was obtained by a creditor within 1 year before filing this case, including property rep ossessed by a creditor, sold at a foreclosure sale, transferred by a deed in lieu of fore closure, or returned to the seller. Do not include property listed in line 6. None and address Description of the property Date Value of property 5 .1. Street City State ZIP Code $ 5 .2 . Street City State ZIP Code $ 6. Setoffs List any creditor, including a bank or financial institution , that within 90 days before filing this case set off or otherwise took anything from an account of the debtor without permission or refused to make a payment he debtor because the debtor owed a debt. None and address Description of the action creditor took Date action was taken Amount Street City State ZIP Code $ Last 4 digits of account number: XXXX Part 3: Legal Actions or Assignments 7. Legal actions, administrative proceedings, court actions , executions, attachments , or governmental audits List the legal actions, proceedings, investigations, arbitrations, mediations, and audits by federal or state agencies in which the debtor was involved in any capacity within 1 year before filing this case. None 7 .1. Case title Nature of case and address Status of case N ame Street City State ZIP Code Pending On appeal Concluded Case number 7 . 2 . Case title and address Pending On appeal Concluded N ame Street City State ZIP Code Case number American LegalNet, Inc. www.FormsWorkFlow.com Debtor Case number ( if known ) Name Official Form 20 7 Statement of Financial Affairs for Non - Individuals Filing for Bankruptcy page 4 8. Assignments and receivership List any property in the hands of an assignee for the benefit of creditors during the 120 days before filing this case and any property in the hands of a receiver, custodian, or other court - appointed office r within 1 year before filing this case. None and address Description of the property Value C name Street City State ZIP Code $ Case title Court name and address N ame Street City State ZIP Code Case number Date of order or assignment Part 4: Certain Gifts and Charitable Contributions 9. List all gifts or charitable contributions the debtor gave to a recipient within 2 years before filing this case unless the aggregate value of the gifts to that recipient is less than $1,000 None 9 .1. and address Description of the gifts or contributions Dates given Value name Street City State ZIP Code $ 9 . 2 . name Street City State ZIP Code $ Part 5: Certain Losses 10. All losses from fire, theft, or other casualty within 1 year before filing this case. None Description of the property lost and how the loss occurred Amount of payments received for the loss If you have received payments to cover the loss, for example, from insurance, government compensation, or tort liability, list the total received. List unpaid claims on Official Form 106A/B ( Schedu le A /B : Assets Real and Personal Property ) . Date of loss Value of property lost $ American LegalNet, Inc. www.FormsWorkFlow.com Debtor Case number ( if known ) Name Official Form 20 7 Statement of Financial Affairs for Non - Individuals Filing for Bankruptcy page 5 Part 6: Certain Payments or Transfers 11. Payments related to bankruptcy List any payments of money or other transfers of property made by the debtor or person acting on behalf of the debtor w ithin 1 year before the filing of this case to another person or entity , including attorneys, that the debtor consulted about debt consolidation or restructuring, seeking bankruptcy relief, or filing a bankruptcy case . None Who was paid or who received the transfer ? If not money, d escri be any property transferred Dates Total amount or value 11 .1. $ Address Street City State ZIP Code Email or website address Who made the payment, if not debtor? Who was paid or who received the transfer ? If not money, d escri be any property transferred Dates Total amount or value 11 . 2 . $ Address Street City State ZIP Code Email or website address Who made the payment, if not debtor? 12. Self - settled trusts of which the debtor is a beneficiary List any payments or transfers of property made b