B1 (Official Form 1) (04/13)
UNITED STATES ANKRUPTCY B OURTC
VOLUNTARY PETITION
__________ District of __________
Name of Debtor (if individual, enter Last, First, Middle): Name of Joint Debtor (Spouse) (Last, First, Middle):
All Other Names used by the Debtor in the last 8 years All Other Names used by the Joint Debtor in the last 8 years
(include married, maiden, and trade names): (include married, maiden, and trade names):
Last four digits of Soc. Sec. or Individual-Taxpayer I.D. (ITIN)/Complete EIN Last four digits of Soc. Sec. or Individual-Taxpayer I.D. (ITIN)/Complete EIN
(if more than one, state all): (if more than one, state all):
Street Address of Debtor (No. and Street, City, and State): Street Address of Joint Debtor (No. and Street, City, and State):
ZIP CODE ZIP CODE
County of Residence or of the Principal Place of Business: County of Residence or of the Principal Place of Business:
Mailing Address of Debtor (if different from street address): Mailing Address of Joint Debtor (if different from street address):
ZIP CODE ZIP CODE
Location of Principal Assets of Business Debtor (if different from street address above):
ZIP CODE
Type of Debtor Nature of Business Chapter of Bankruptcy Code Under Which
(Form of Organization) (Check one box.) the Petition is Filed (Check one box.)
(Check one box.)
Health Care Business Chapter 7 Chapter 15 Petition for
Individual (includes Joint Debtors) Single Asset Real Estate as defined in Chapter 9 Recognition of a Foreign
See Exhibit D on page 2 of this form. 11 U.S.C. § 101(51B) Chapter 11 Main Proceeding
Corporation (includes LLC and LLP) Railroad Chapter 12 Chapter 15 Petition for
Partnership Stockbroker Chapter 13 Recognition of a Foreign
Other (If debtor is not one of the above entities, check Commodity Broker Nonmain Proceeding
this box and state type of entity below.) Clearing Bank
Other
Chapter 15 Debtors Tax-Exempt Entity Nature of Debts
Country of debtor’s center of main interests: (Check box, if applicable.) (Check one box.)
Debts are primarily consumer Debts are
Debtor is a tax-exempt organization debts, defined in 11 U.S.C. primarily
Each country in which a foreign proceeding by, regarding, or under title 26 of the United States § 101(8) as “incurred by an business debts.
against debtor is pending: Code (the Internal Revenue Code). individual primarily for a
personal, family, or
household purpose.”
Filing Fee (Check one box.) Chapter 11 Debtors
Check one box:
Full Filing Fee attached. Debtor is a small business debtor as defined in 11 U.S.C. § 101(51D).
Debtor is not a small business debtor as defined in 11 U.S.C. § 101(51D).
Filing Fee to be paid in installments (applicable to individuals only). Must attach
signed application for the court’s consideration certifying that the debtor is Check if:
unable to pay fee except in installments. Rule 1006(b). See Official Form 3A. Debtor’s aggregate noncontingent liquidated debts (excluding debts owed to
insiders or affiliates) are less than $2,490,925 (amount subject to adjustment
Filing Fee waiver requested (applicable to chapter 7 individuals only). Must on 4/01/16 and every three years thereafter .)
attach signed application for the court’s consideration. See Official Form 3B. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Check all applicable boxes:
A plan is being filed with this petition.
Acceptances of the plan were solicited prepetition from one or more classes
of creditors, in accordance with 11 U.S.C. § 1126(b).
Statistical/Administrative Information THIS SPACE IS FOR
COURT USE ONLY
Debtor estimates that funds will be available for distribution to unsecured creditors.
Debtor estimates that, after any exempt property is excluded and administrative expenses paid, there will be no funds available for
distribution to unsecured creditors.
Estimated Number of Creditors
1-49 50-99 100-199 200-999 1,000- 5,001- 10,001- 25,001- 50,001- Over
5,000 10,000 25,000 50,000 100,000 100,000
Estimated Assets
$0 to $50,001 to $100,001 to $500,001 $1,000,001 $10,000,001 $50,000,001 $100,000,001 $500,000,001 More than
$50,000 $100,000 $500,000 to $1 to $10 to $50 to $100 to $500 to $1 billion $1 billion
million million million million million
Estimated Liabilities
$0 to $50,001 to $100,001 to $500,001 $1,000,001 $10,000,001 $50,000,001 $100,000,001 $500,000,001 More than
$50,000 $100,000 $500,000 to $1 to $10 to $50 to $100 to $500 to $1 billion $1 billion
million million million million million