Official Form 201 Voluntary Petition for Non-Individuals Filing for Bankruptcy page 1 Official Form 201 Voluntary Petition for Non-Individuals Filing for Bankruptcy 04/1 If more space is needed, attach a separate sheet to this form. On the top of any additional pages, write the name and the case number (if known). For more information, a separate document, Instructions for Bankruptcy Forms for Non-Individuals, is available. 1. 2. All other names debtor used in the last 8 years Include any assumed name s , trade names , and doing business as names 3. ederal Employer Identification Number (EIN) 4. Principal place of business Number Street City State ZIP Code County Mailing address, i f different from principal place of business Number Street P.O. Box City State ZIP Code Location of principal assets, i f different from principal place of business Number Street City State ZIP Code 5. (URL) 6. Type of debtor Corporation (including Limited Liability Company (LLC) and Limited Liability Partnership (LLP) ) Partnership ( excluding LLP) Other. Specify: United States Bankruptcy Court for the: District of ( State ) Case number ( If known ) : Chapter Fill in this information to identify the case: Check if this is an amended filing American LegalNet, Inc. www.FormsWorkFlow.com Debtor Case number (if known) Name Official Form 201 Voluntary Petition for Non-Individuals Filing for Bankruptcy page 2 7. D escribe business A. Check one: Health Care Business (as defined in 11 U.S.C. 247 101(27A)) Single Asset Real Estate (as defined in 11 U.S.C. 247 101(51B)) Railroad (as defined in 11 U.S.C. 247 101(44)) Stockbroker (as defined in 11 U.S.C. 247 101(53A)) Commodity Broker (as defined in 11 U.S.C. 247 101(6)) Clearing Bank (a s defined in 11 U.S.C. 247 781(3)) None of the above B . Check all that appl y : Tax - exempt entity ( as described in 26 U.S.C. 247 501) Investment company, including hedge fund or pooled investment v ehicle (as defined in 15 U.S.C. 247 80a - 3) Investment advisor (as defined in 15 U.S.C. 247 80b - 2(a)(11)) C. NAICS (North American I ndustry Classification System) 4 - digit code that best describes debtor . See http://www.uscourts.gov/four - digit - national - association - naics - codes . 8. Under w hich c hapter of the Bankruptcy Code is the debtor filing ? Check one: Chapter 7Chapter 9Chapter 11. Check all that apply:insiders or affiliates) are less than $2,, (amount subject to adjustment on4/01/ and every 3 years after that).The debtor is a small business debtor as defined in 11 U.S.C. 247 101(51D). If thedebtor is a small business debtor, attach the most recent balance sheet, statementof operations, cash-flow statement, and federal income tax return or if all of thesedocuments do not exist, follow the procedure in 11 U.S.C. 247 1116(1)(B).A plan is being filed with this petition.Acceptances of the plan were solicited prepetition from one or more classes ofcreditors, in accordance with 11 U.S.C. 247 1126(b).The debtor is required to file periodic reports (for example, 10K and 10Q) with theSecurities and Exchange Commission according to 247 13 or 15(d) of the SecuritiesExchange Act of 1934. File the Attachment to Voluntary Petition for Non-Individuals Filingfor Bankruptcy under Chapter 11 (Official Form 201A) with this form.The debtor is a shell company as defined in the Securities Exchange Act of 1934 Rule12b-2.Chapter 12 9. Were prior bankruptcy cases filed by or against the debtor within the last 8 years? If more than 2 cases , attach a separate list . No Yes. District When Case number MM / DD / YYYY District When Case number MM / DD / YYYY 10. Are any bankruptcy cases pending or being filed by a business partner or an affiliate of the debtor ? List all cases . If more than 1, attach a separate list. No Yes. Debtor Relationship District When MM / DD / YYYY Case number, if known American LegalNet, Inc. www.FormsWorkFlow.com Debtor Case number (if known) Name Official Form 201 Voluntary Petition for Non-Individuals Filing for Bankruptcy page 3 11. Why is the case filed in this district ? C heck all that apply : Debtor has had its domicile, principal place of business, or principal assets in this 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. filiate, general partner, or partnership is pending in this district. 12. D o es the debtor own or have possession of any real property or personal property that needs immediate a ttention? No Yes. Answer below for each property that needs immediate attention. Attach additional sheets if needed. Why does the property need immediate attention ? ( Check all that app ly.) It poses or is alleged to pose a threat of imminent and identifiable ha zard to public health or safety. What is the hazard ? It needs to be physically secured or protected from the weather . It includes perishable goods or assets that could quickly deteriorate or lose value without attention ( for example , livestock , seasonal goods , meat, dairy, produce, or securities - related assets or other options ) . Other Where is the property? Number Street City State ZIP Code Is the property insured? No Yes. Insurance agency Contact n ame Phone Statistical and administrative information 13. Debtor estimation of available funds Check one: Funds will be available for distribution to unsecured creditors. After any administrative expenses are paid, no funds will be available for distribution to unsecured creditors. 14. Estimated n umber of creditors 1 - 49 50 - 99 100 - 199 200 - 999 1,000 - 5,000 5 ,001 - 10,000 10,001 - 25,000 25,001 - 50,000 50,001 - 100,000 More than 100,000 15. E stimate d assets $0 - $50,000 $ 50 ,001 - $100,000 $ 100 ,001 - $500,000 $500,001 - $1 million $1,000,001 - $10 million $10,000,001 - $50 million $50,000,001 - $100 million $100,000,001 - $500 million $500,000,001 - $1 billion $1,000,000,001 - $1 0 billion $10,000,000,001 - $50 billion More than $50 billion American LegalNet, Inc. www.FormsWorkFlow.com Debtor Case number (if known) Name Official Form 201 Voluntary Petition for Non-Individuals Filing for Bankruptcy page 4 16. E stimate d liabilities $0 - $50,000 $ 50 ,001 - $100,000 $ 100 ,001 - $500,000 $500,001 - $1 million $1,000,001 - $10 million $10,000,001 - $50 million $50,000,001 - $100 million $100,000,001 - $500 million $500,000,001 - $1 billion $1,000,000,001 - $1 0 billion $10,000,000,001 - $50 billion More than $50 billion Request for Relief , Declaration, and Signatures WARNING -- Bankruptcy fraud is a serious crime. Making a false statement in connection with a bankruptcy case can result in fines up to $500,000 or imprisonment for up to 20 years, or both. 18 U.S.C. 247247 152, 1341, 1519, and 3571. 17. Declaration and si gnature of authorized representative of debtor The debtor requests relief in accordance with the chapter of title 11, United States Code, specified in this petition. I have been authorized to file this petition on behalf of the debtor. I have examined the informatio n in this petition and have a reasonable belief that the information is true and correct. I declare under penalty of perjury that the foregoing is true and correct . Executed on MM / DD / YYYY Signature of authorized representative of debtor Printed name Title 18. Signature of attorney Date S ignature of attorney for debtor MM / DD / YYYY Printed name Firm name Number Street City State ZIP Code Contact phone Email address Bar number State American LegalNet, Inc. www.FormsWorkFlow.com