In re COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : UNITED STATES BANKRUPTCY COURT No. Index DISTRICT OF OREGON : Calendar No. ) Case No. ) : JUDICIAL SUBPOENA Plaintiff(s) "C" ) EXHIBIT -against-) [If not an Ex. on Petition Pg. 2, then to : ) be FULLY completed by ALL debtors Debtor(s) ) and attached to ALL copies of the Petition.] : (NOTE: You must answer ALL questions. Attach additional sheets if necessary. Use of “UNKNOWN” is NOT acceptable!) 1. Identify and briefly describe all real or personal property owned by or in possession of the debtor that, to the best of the debtor’s : knowledge, poses or is alleged to pose a threat of imminent and identifiable harm to the public health or safety: Defendant(s) : ...................................................... 2. With respect to each parcel of real property or item of personal property identified in question 1, describe the nature and location of the dangerous condition, whether environmental or otherwise, that poses or is alleged to pose a threat of imminent and THE PEOPLE OF THE STATE OF NEW YORK identifiable harm to the public health or safety: TO 3. DESCRIBE ASSETS REQUIRING TRUSTEE'S IMMEDIATE ATTENTION: GREETINGS: 4. Street address of principal assets (note property): WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court located at County of individual] Is debtor(s), OR has debtor(s) ever been within the 6 years prior to filing, either: self-employed or 5. [If debtor(s) an in room , on the , a partnership; or an officer, director, managing executive, or person , at o'clock in the noon, and at any recessed a sole proprietor; a partner, other than day of partner, of 20 a limited or adjourned date, to testify and ~ NO in control of a corporation? ~ YES give evidence as a witness in this action on the part of the If YES, complete ALL questions in the Statement of Affairs. 6. [Unless EXACT question already answered on Petition] If debtor is CORPORATION, list name and address of chief executive officer; if debtor is PARTNERSHIP, list names and addresses of general partners: Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to individual 7. Total GROSS income of the comply. debtor(s) for the last tax year: $ (i.e., before any deductions). 8. Total amount of unsecured debt: $ . 9. Total Noncontingent, Liquidated Farming Operation Debt: $ . Witness, Honorable , one of the Justices of the 10. Total GROSS income fromCounty, operationof the individual debtor(s) for last tax year: $ farming for . Court in day , 20 11. The BANKRUPTCY DOCUMENT PREPARER DECLARATION below has been completed for any person who helped, for compensation, prepare any of the bankruptcy papers if the debtor does not have an attorney. I declare under penalty of perjury that the above information provided in this Exhibit "C" is aboveand type name below) (Attorney must sign true and correct. DATED: Debtor's Signature Phone # Joint Debtor's Signature Attorney(s) for BANKRUPTCY DOCUMENT PREPARER DECLARATION I, the undersigned, declare under penalty of perjury that (1) neither I, nor anyone else listed herein, collected or received any payment from or on behalf of the debtor for court fees in connection with filing the petition; (2) I have received $ from or on behalf of the debtor within the previous 12 month period; (3) $ is the unpaid fee charged to the debtor; and (4) the following is true and accurate about myself and any other assistants: Office and P.O. Address Individual Name and Firm (Type or Print): Address (Type or Print): Social Security Number of all OTHER individuals who prepared or assisted in the preparation of these bankruptcy documents: Telephone No.: Facsimile No.: Signature: Social Security #: Phone #: E-Mail Address: [NOTE: Penalties up to $500 per item may be assessed for omission of any required information (11 USC §110; 18 USC §156) and Fed. Mobile Tel. No.: Bankruptcy Rule 1006 prohibits any payment to any person for services until the court filing fees are paid in full.] EXHIBIT C (12/1/01) American LegalNet, Inc. www.USCourtForms.com