FORM B5. (6/90) FORM 5. INVOLUNTARY PETITION United States Bankruptcy Court ___________________________District of__________________________ INVOLUNTARY PETITION ALL OTHER NAMES used by debtor in the last 6 years (Include married, maiden, and trade names.) IN RE (Name of Debtor - If Individual: Last, First, Middle) SOC. SEC./TAX I.D. NO. (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 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) Petitioners believe: Debts are primarily consumer debts Debts are primarily business debts (complete sections A and B) TYPE OF DEBTOR Individual Corporation Publicly Held Partnership Corporation Not Publicly Held Other: ___________________________________________ A. TYPE OF BUSINESS (Check one) Professional Transportation Commodity Broker Retail/Wholesale Manufacturing/ Construction Railroad Mining Real Estate Stockbroker Other B. BRIEFLY DESCRIBE NATURE OF BUSINESS 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. PENDING BANKRUPTCY CASE FILED BY OR AGAINST ANY PARTNER OR AFFILIATE OF THIS DEBTOR (Report information for any additional cases on attached sheets.) Name of Debtor Relationship Case Number District ALLEGATIONS (Check applicable boxes) 1. 2. 3.a. b. Date Judge COURT USE ONLY 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. 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; or 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.USCourtForms.com Name of Debtor _____________________________________________ FORM 5 Involuntary Petition (6/92) Case No. ___________________________________________________ (court use only) 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 evidencing 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. 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) __________________________________________________ Name of Petitioner Date Signed Name & Mailing Address of Individual Signing in Representative Capacity _________________________ _________________________ X________________________________________________ Signature of Petitioner or Representative (State title) __________________________________________________ Name of Petitioner Date Signed Name & Mailing Address of Individual Signing in Representative Capacity __________________________ X __________________________________________________ Signature of Attorney Date ____________________________________________________ Name of Attorney Firm (If any) ____________________________________________________ Address ____________________________________________________ Telephone No. __________________________ X_________________________________________________ Signature of Petitioner or Representative (State title) ___________________________________________________ Name of Petitioner Date Signed Name & Mailing Address of Individual Signing in Representative Capacity X__________________________________________________ Signature of Attorney Date ____________________________________________________ Name of Attorney Firm (If any) ____________________________________________________ Address ____________________________________________________ Telephone No. __________________________ X __________________________________________________ Signature of Attorney Date ____________________________________________________ Name of Attorney Firm (If any) ____________________________________________________ Address ____________________________________________________ Telephone No. __________________________ PETITIONING CREDITORS Name and Address of Petitioner 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. Total Amount of Petitioners’ Claims ______continuation sheets attached American LegalNet, Inc. www.USCourtForms.com