CAEB — Chapter 7 Non-Individual

Source: https://www.caeb.uscourts.gov/documents/forms/misc/Ch7FormsPackageForNonIndividuals%28Final%29.pdf

FILING A NON-INDIVIDUAL CHAPTER 7 CASE UNITED STATES BANKRUPTCY COURT, EASTERN DISTRICT OF CALIFORNIA These documents are intended to help debtors filing without an attorney.

Forms and Legal Advice Attached to this document are forms and a list of form requirements for a chapter 7 individual case. You must complete and sign each required document before submitting them to the court. You may need to enter “zero” or “none” in a blank space to fully complete the form. Federal law prohibits the bankruptcy court from giving any type of legal advice or instruction. If you have a question about how to fill out a form, it is recommended that you contact an attorney.

Legal Representation Local Rule 183 of the U.S. District Court requires that corporations or other entities must be represented by an attorney in cases filed in the Eastern District of California. Debtors who are not individuals (e.g., debtors who are corporations, partnerships, or other entities, must, therefore, have legal representation. If a bankruptcy case is filed by a debtor who is not represented by an attorney, the Court or a party to the case may initiate actions to dismiss the case, unless the debtor obtains legal representation.

Filing Fee For the current filing fee, see the attached Required Forms for an Individual Chapter 7 Case. Filing fees from parties filing without an attorney must be paid in person or by mail with money orders or cashier’s checks. All money orders and cashier’s checks must be made payable to: Clerk, U.S. Bankruptcy Court. Debit cards are also accepted in person at our Sacramento and Fresno offices. No cash accepted.

Revised 6/2025

Where and How to File Your Documents If you reside in this county: Mail or deliver your Electronic Filing Option: documents and filing fee to:

Alpine, Amador, Butte, U.S. Bankruptcy Court To save time and the expense of Calaveras, Colusa, El Dorado, 501 I Street, #3-200 traveling to one of our Glenn, Lassen, Modoc, Mono, Sacramento, CA 95814 courthouses, you may submit Nevada, Placer Plumas, 916-930-4400 your documents online using the Sacramento, San Joaquin, Online Debtor Dropbox. If your Shasta, Sierra, Siskiyou, documents are accepted, you Solano, Stanislaus, Sutter, will receive a confirmation email, Tehama, Trinity, Tuolumne, including copies of your Yolo, Yuba documents and instructions on how to pay your filing fee.

Fresno, Inyo, Kings, Kern, U.S. Bankruptcy Court Madera, Mariposa, Merced, 2500 Tulare Street, #2501 Training Videos: Tulare Fresno, CA 93721 559-499-5800 • How to Submit a New Case • How to Submit documents in an existing Please submit original signed case. documents to the court. If you would like a copy of the documents that you file, please provide a photocopy of each one along with the original. If you are filing by mail, please also submit a self-addressed, stamped envelope with sufficient postage to return your copies to you.

After You File Read everything very closely that is sent to you regarding your bankruptcy case. A Notice of Chapter 7 Bankruptcy Case will be mailed to you and the creditors on the mailing list you prepared. This document will list important information such as the trustee assigned to your case, deadlines and the date, time, and location of a hearing called a “Meeting of Creditors.” You are required to attend this hearing. At the hearing, the trustee appointed in your case will question you about your assets and documents you filed. If you do not file all documents in your case, you will also receive a Notice of Incomplete Filing and Notice of Intent to Dismiss Case, which will include a list of documents that you still need to file and the due dates.

UNITED STATES BANKRUPTCY COURT – EASTERN DISTRICT OF CALIFORNIA REQUIRED FORMS AND FEES FOR A CHAPTER NON-INDIVIDUAL 7 CASE The current filing fee for a chapter 7 bankruptcy is $338.

Forms Form Number Required for When is this form Please submit the original plus one copy of form. Non-Individual Debtors due? each The copy will be returned to you for your records. Voluntary Petition 201 Master Address List with EDC 2-100 Verification For more information regarding creating and submitting your master address list, see attached Guidelines for Preparation of Master Address List. Time of Filing Schedule A/B 206A/B Schedule D 206D Schedule E/F 206E/F Schedule G 206G Schedule H 206H Declaration Under 202 Penalty of Perjury for Non-Individual Debtors Summary of Assets and 206Sum Liabilities Statement of Financial 207 Affairs Corporate Resolution No Form Provided Statement Regarding EDC 3-500 Ownership of Corporate Debtor Within 14 Days Attorney’s Disclosure of 2030 (Non-individuals must be represented by an attorney.) Within 7 Days Compensation

OFFICE OF THE CLERK UNITED STATES BANKRUPTCY COURT EASTERN DISTRICT OF CALIFORNIA

GUIDELINES FOR PREPARATION OF MASTER ADDRESS LISTS FOR DEBTORS NOT REPRESENTED BY ATTORNEYS1

The following guidelines have been approved by the Court and are issued pursuant to Local Bankruptcy Rule 1007-1(b).

A Master Address List includes the names, addresses and zip codes of all creditors in a bankruptcy case. This list is used for noticing and must be filed at the time the petition is filed.

The Court’s computer system requires the Master Address List to be prepared for electronic recognition. All Master Address Lists must comply with the following guidelines.

Debtors not represented by an attorney, or whose petitions are prepared by a Bankruptcy Petition Preparer, must prepare the Master Address List using one of the following methods:

• In electronic format when submitting their petition online through the court’s Debtor Drop Box program available at www.debtordropbox.caeb.uscourts.gov. This system will format your address list and electronically produce your required verification. • In hard copy format, using the court’s online application available at www.caeb.uscourts.gov/mal/. This guided process will help you complete the address list in the correct format and generate the required verification. • In hard copy format, following the example and requirements below.

Sample Master Address List

Sears Credit 123 Main Street Sacramento, CA 95222

Wells Fargo Bank

8000 W Major Blvd Chicago, IL 12345

Bank of Denver 123 Any Street PO Box 1234 Denver, CO 80202

(EDC Form 2-191, New 4/2024)

1 Attorneys should refer to EDC Form 2-190, Guidelines for Preparation of Master Address Lists and Master Equity Security Holder Lists

General Format Requirements

• Use only plain, 8.5 x 11 white paper.

• Do not print on both sides of the paper.

• Do not use letterhead or include page numbers, line numbers, headers, or footers.

• No handwriting, stray marks, correction fluid or tape.

• Lists should be typed in a single column on the page and prepared in Courier 10 cpi (same as 12 point on a word processor).

• Limit the name and address to 5 lines per creditor.

• Limit each line to 40 characters or less.

• Names of individuals must be in first/middle/last name order. Do not include titles, i.e., Mr., Mrs.

• Creditors must be listed alphabetically, according to the first letter of the company or first name.

• Do not include punctuation in names and addresses, including periods (.) after abbreviations or initials. One comma between the city and state is permitted.

• Do not use any special characters such as %. Hyphens in nine-digit zip codes are permitted.

• “Care of”, and “attention” designations may be included only on the second line.

• The city, state and zip code must be on the last line. The name of the state must be abbreviated using two upper case letters. Zip codes are mandatory.

• Foreign addresses must include the complete name of the country.

• Leave at least two blank lines between one creditor’s name and address and another’s. Do not leave blank lines within an address, or between a creditor’s name and address.

• Do not duplicate creditors with the same address, even if there is more than one account with that creditor. Do not include account numbers in the list of creditors.

• Do not include the debtor, joint debtor, attorney for the debtor(s), or United States Trustee on the list.

• When the Unites States is a creditor on a debt for other than taxes, it must be listed on Master Address Lists in accordance with Local Bankruptcy Rule 2002-1(a). Other federal and state agencies that have specified particular addresses to which notice of bankruptcy proceeding must be listed on Master Address Lists using the addressed shown on form EDC 2-785, Roster of Governmental Agencies.

• Every Master Address List must be accompanied by a Verification of Master Address List, form EDC 2- 100.

Fill in this information to identify the case:

United States Bankruptcy Court for the:

____________________ District of _________________ (State) Case number (If known): _________________________ Chapter _____ Check if this is an amended filing

Official Form 201 Voluntary Petition for Non-Individuals Filing for Bankruptcy 04/25 If more space is needed, attach a separate sheet to this form. On the top of any additional pages, write the debtor’s name and the case number (if known). For more information, a separate document, Instructions for Bankruptcy Forms for Non-Individuals, is available.

1. Debtor’s name ______________________________________________________________________________________________________

2. All other names debtor used ______________________________________________________________________________________________________ in the last 8 years ______________________________________________________________________________________________________ ______________________________________________________________________________________________________

Include any assumed names,
trade names, and doing business ______________________________________________________________________________________________________
as names ______________________________________________________________________________________________________

3. Debtor’s federal Employer ___ ___ – ___ ___ ___ ___ ___ ___ ___ Identification Number (EIN)

4. Debtor’s address Principal place of business Mailing address, if different from principal place of business ______________________________________________ _______________________________________________ Number Street Number Street ______________________________________________ _______________________________________________ P.O. Box ______________________________________________ _______________________________________________ City State ZIP Code City State ZIP Code

Location of principal assets, if different from principal place of business ______________________________________________ County _______________________________________________ Number Street

_______________________________________________

_______________________________________________
City State ZIP Code

5. Debtor’s website (URL) ____________________________________________________________________________________________________

Official Form 201 Voluntary Petition for Non-Individuals Filing for Bankruptcy page 1

Debtor _______________________________________________________ Case number (if known)_____________________________________ Name

Corporation (including Limited Liability Company (LLC) and Limited Liability Partnership (LLP)) 6. Type of debtor Partnership (excluding LLP) Other. Specify: __________________________________________________________________

A. Check one:

7. Describe debtor’s business Health Care Business (as defined in 11 U.S.C. § 101(27A)) Single Asset Real Estate (as defined in 11 U.S.C. § 101(51B)) Railroad (as defined in 11 U.S.C. § 101(44)) Stockbroker (as defined in 11 U.S.C. § 101(53A)) Commodity Broker (as defined in 11 U.S.C. § 101(6)) Clearing Bank (as defined in 11 U.S.C. § 781(3)) None of the above B. Check all that apply: Tax-exempt entity (as described in 26 U.S.C. § 501) Investment company, including hedge fund or pooled investment vehicle (as defined in 15 U.S.C. § 80a-3) Investment advisor (as defined in 15 U.S.C. § 80b-2(a)(11)) C. NAICS (North American Industry Classification System) 4-digit code that best describes debtor. See http://www.uscourts.gov/four-digit-national-association-naics-codes . ___ ___ ___ ___

8. Under which chapter of the Check one: Bankruptcy Code is the Chapter 7 debtor filing? Chapter 9 Chapter 11. Check all that apply: Debtor’s aggregate noncontingent liquidated debts (excluding debts owed to insiders or affiliates) are less than $3,424,000 (amount subject to adjustment on 4/01/28 and every 3 years after that). The debtor is a small business debtor as defined in 11 U.S.C. § 101(51D). If the debtor is a small business debtor, attach the most recent balance sheet, statement of operations, cash-flow statement, and federal income tax return or if all of these documents do not exist, follow the procedure in 11 U.S.C. § 1116(1)(B). The debtor is a small business debtor as defined in 11 U.S.C. § 101(51D), and it chooses to proceed under Subchapter V of Chapter 11. 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). The debtor is required to file periodic reports (for example, 10K and 10Q) with the Securities and Exchange Commission according to § 13 or 15(d) of the Securities Exchange Act of 1934. File the Attachment to Voluntary Petition for Non-Individuals Filing for 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 Rule 12b-2. Chapter 12

9. Were prior bankruptcy cases No filed by or against the debtor Yes. District _______________________ When _______________ Case number _________________________ within the last 8 years? MM / DD / YYYY If more than 2 cases, attach a separate list. District _______________________ When _______________ Case number _________________________ MM / DD / YYYY

Official Form 201 Voluntary Petition for Non-Individuals Filing for Bankruptcy page 2

Debtor _______________________________________________________ Case number (if known)_____________________________________ Name

10. Are any bankruptcy cases No pending or being filed by a Yes. Debtor _____________________________________________ Relationship _________________________ business partner or an

affiliate of the debtor? District _____________________________________________ When __________________
List all cases. If more than 1, MM / DD / YYYY
attach a separate list. Case number, if known ________________________________

11. Why is the case filed in this Check all that apply: district? 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. A bankruptcy case concerning debtor’s affiliate, general partner, or partnership is pending in this district.

12. Does the debtor own or have No possession of any real Yes. Answer below for each property that needs immediate attention. Attach additional sheets if needed. property or personal property that needs immediate Why does the property need immediate attention? (Check all that apply.) attention? It poses or is alleged to pose a threat of imminent and identifiable hazard 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 name ____________________________________________________________________ Phone ________________________________ Statistical and administrative information

13. Debtor’s estimation of Check one: available funds 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. 1-49 1,000-5,000 25,001-50,000

14. Estimated number of 50-99 5,001-10,000 50,001-100,000 creditors 100-199 10,001-25,000 More than 100,000 200-999

Official Form 201 Voluntary Petition for Non-Individuals Filing for Bankruptcy page 3

Debtor _______________________________________________________ Case number (if known)_____________________________________ Name

$0-$50,000 $1,000,001-$10 million $500,000,001-$1 billion

15. Estimated assets $50,001-$100,000 $10,000,001-$50 million $1,000,000,001-$10 billion $100,001-$500,000 $50,000,001-$100 million $10,000,000,001-$50 billion $500,001-$1 million $100,000,001-$500 million More than $50 billion $0-$50,000 $1,000,001-$10 million $500,000,001-$1 billion

16. Estimated liabilities $50,001-$100,000 $10,000,001-$50 million $1,000,000,001-$10 billion $100,001-$500,000 $50,000,001-$100 million $10,000,000,001-$50 billion $500,001-$1 million $100,000,001-$500 million 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. §§ 152, 1341, 1519, and 3571.

17. Declaration and signature of The debtor requests relief in accordance with the chapter of title 11, United States Code, specified in this authorized representative of petition. debtor I have been authorized to file this petition on behalf of the debtor. I have examined the information 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 _________________ Signature of attorney for debtor MM / DD / YYYY

---

Printed name
_________________________________________________________________________________________________
Firm name
_________________________________________________________________________________________________
Number Street
____________________________________________________ ____________ ______________________________
City State ZIP Code

____________________________________ __________________________________________
Contact phone Email address

______________________________________________________ ____________
Bar number State

Official Form 201 Voluntary Petition for Non-Individuals Filing for Bankruptcy page 4

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Fill in this information to identify the case:

Debtor name __________________________________________________________________

United States Bankruptcy Court for the: ______________________ District of _________ (State) Case number (If known): _________________________

Check if this is an amended filing

Official Form 207 Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy 04/25

The debtor must answer every question. If more space is needed, attach a separate sheet to this form. On the top of any additional pages, write the debtor’s name and case number (if known).

Part 1: Income

1. Gross revenue from business

None

Identify the beginning and ending dates of the debtor’s fiscal year, which Sources of revenue Gross revenue
may be a calendar year Check all that apply (before deductions and
exclusions)
From the beginning of the Operating a business
fiscal year to filing date: From ___________ to Filing date Other _______________________ $________________
MM / DD / YYYY

For prior year: From ___________ to ___________ Operating a business
MM / DD / YYYY MM / DD / YYYY $________________ Other _______________________

For the year before that: From ___________ to ___________ Operating a business
MM / DD / YYYY MM / DD / YYYY Other _______________________ $________________

2. Non-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 ___________________________ $________________

Official Form 207 Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy page 1

Debtor _______________________________________________________ Case number (if known)_____________________________________ Name

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 transfersincluding expense reimbursementsto 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 $8,575. (This amount may be adjusted on 4/01/28 and every 3 years after that with respect to cases filed on or after the date of adjustment.)

None

Creditor’s name and address Dates Total amount or value Reasons for payment or transfer
Check all that apply
3.1.
Secured debt __________________________________________ ________ $_________________
Creditor’s name Unsecured loan repayments
__________________________________________
Street ________ Suppliers or vendors
__________________________________________ Services
__________________________________________ ________ Other _______________________________ City State ZIP Code

3.2.
Secured debt __________________________________________ ________ $_________________
Creditor’s name Unsecured loan repayments
__________________________________________
Street ________ Suppliers or vendors
__________________________________________ Services
__________________________________________ ________ Other _______________________________ City State ZIP Code

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 insider is less than
$8,575. (This amount may be adjusted on 4/01/28 and every 3 years after that with 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. § 101(31).

None

Insider’s name and address Dates Total amount or value Reasons for payment or transfer

4.1.

__________________________________________ _________ $__________________ ___________________________________________
Insider’s name
__________________________________________ _________ ___________________________________________
Street
__________________________________________ _________ ___________________________________________
__________________________________________
City State ZIP Code

Relationship to debtor

__________________________________________

4.2.

__________________________________________ _________ $__________________ ___________________________________________
Insider’s name
__________________________________________ _________ ___________________________________________
Street
__________________________________________ _________ ___________________________________________
__________________________________________
City State ZIP Code

Relationship to debtor

__________________________________________

Official Form 207 Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy page 2

Debtor _______________________________________________________ Case number (if known)_____________________________________ Name

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 repossessed by a creditor, sold at a foreclosure sale, transferred by a deed in lieu of foreclosure, or returned to the seller. Do not include property listed in line 6.

None

Creditor’s name and address Description of the property Date Value of property

5.1.

__________________________________________ ___________________________________________ ______________ $___________
Creditor’s name
__________________________________________ ___________________________________________
Street
__________________________________________ ___________________________________________
__________________________________________
City State ZIP Code

5.2.

__________________________________________ ___________________________________________ _______________ $___________
Creditor’s name
__________________________________________ ___________________________________________
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 at the debtor’s direction from an account of the debtor because the debtor owed a debt.

None

Creditor’s name and address Description of the action creditor took Date action was Amount
taken

__________________________________________ ___________________________________________ _______________ $___________
Creditor’s name
__________________________________________ ___________________________________________
Street

__________________________________________
Last 4 digits of account number: XXXX– __ __ __ __ __________________________________________
City State ZIP Code

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 Case title Nature of case Court or agency’s name and address Status of case 7.1. Pending _________________________________ ______________________________ __________________________________________ Name On appeal __________________________________________ Case number Street Concluded __________________________________________ _________________________________ __________________________________________ City State ZIP Code
   Case title Court or agency’s name and address Pending 7.2. _________________________________ ______________________________ __________________________________________ On appeal Name Concluded Case number __________________________________________ Street __________________________________________ _________________________________ __________________________________________ City State ZIP Code

Official Form 207 Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy page 3

Debtor _______________________________________________________ Case number (if known)_____________________________________ Name

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 officer within 1 year before filing this case.

None

Custodian’s name and address Description of the property Value

__________________________________________ ______________________________________ $_____________
Custodian’s name
Case title Court name and address
__________________________________________
Street
______________________________________ __________________________________________
__________________________________________ Name
__________________________________________ Case number __________________________________________
City State ZIP Code Street

______________________________________ __________________________________________
Date of order or assignment __________________________________________
City State ZIP Code

______________________________________

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

Recipient’s name and address Description of the gifts or contributions Dates given Value

9.1. __________________________________________ ___________________________________________ _________________ $__________
Recipient’s name
__________________________________________ ___________________________________________
Street

__________________________________________

__________________________________________
City State ZIP Code

Recipient’s relationship to debtor

__________________________________________

__________________________________________ ___________________________________________ _________________ $__________ 9.2. Recipient’s name __________________________________________ ___________________________________________ Street

__________________________________________

__________________________________________
City State ZIP Code

Recipient’s relationship to debtor

__________________________________________

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 Amount of payments received for the loss Date of loss Value of property
occurred If you have received payments to cover the loss, for lost
example, from insurance, government compensation, or
tort liability, list the total received.
List unpaid claims on Official Form 106A/B (Schedule A/B:
Assets – Real and Personal Property).

___________________________________________ ___________________________________________ _________________ $__________

___________________________________________

Official Form 207 Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy page 4

Debtor _______________________________________________________ Case number (if known)_____________________________________ Name

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 within 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, describe 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, describe 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 by the debtor or a person acting on behalf of the debtor within 10 years before the filing of this case to a self-settled trust or similar device. Do not include transfers already listed on this statement. None

Name of trust or device Describe any property transferred Dates transfers Total amount or
were made value

__________________________________________ ___________________________________________ ______________ $_________

Trustee ___________________________________________

__________________________________________

Official Form 207 Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy page 5

Debtor _______________________________________________________ Case number (if known)_____________________________________ Name

13. Transfers not already listed on this statement List any transfers of money or other propertyby sale, trade, or any other meansmade by the debtor or a person acting on behalf of the debtor within 2 years before the filing of this case to another person, other than property transferred in the ordinary course of business or financial affairs. Include both outright transfers and transfers made as security. Do not include gifts or transfers previously listed on this statement.

None

Who received transfer? Description of property transferred or payments received Date transfer Total amount or
or debts paid in exchange was made value

13.1. __________________________________________ ___________________________________________ ________________ $_________

___________________________________________
Address

__________________________________________
Street

__________________________________________

__________________________________________
City State ZIP Code

Relationship to debtor

__________________________________________

Who received transfer?
___________________________________________ ________________ $_________

13.2. __________________________________________ ___________________________________________

Address

__________________________________________
Street

__________________________________________

__________________________________________
City State ZIP Code

Relationship to debtor

__________________________________________

Part 7: Previous Locations

14. Previous addresses List all previous addresses used by the debtor within 3 years before filing this case and the dates the addresses were used.

Does not apply

Address Dates of occupancy

14.1. _______________________________________________________________________ From ____________ To ____________
Street

_______________________________________________________________________

_______________________________________________________________________
City State ZIP Code

14.2. _______________________________________________________________________ From ____________ To ____________
Street

---

_______________________________________________________________________
City State ZIP Code

Official Form 207 Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy page 6

Debtor _______________________________________________________ Case number (if known)_____________________________________ Name

Part 8: Health Care Bankruptcies

15. Health Care bankruptcies Is the debtor primarily engaged in offering services and facilities for: diagnosing or treating injury, deformity, or disease, or providing any surgical, psychiatric, drug treatment, or obstetric care?

No. Go to Part 9. Yes. Fill in the information below.

Facility name and address Nature of the business operation, including type of services the If debtor provides meals
debtor provides and housing, number of
patients in debtor’s care

15.1. ________________________________________ ___________________________________________________________ ____________________
Facility name
____________________________________________________________

________________________________________
Street Location where patient records are maintained (if different from facility How are records kept?
address). If electronic, identify any service provider.
________________________________________
Check all that apply:
____________________________________________________________
________________________________________ Electronically City State ZIP Code ____________________________________________________________
Paper

Facility name and address Nature of the business operation, including type of services the If debtor provides meals
debtor provides and housing, number of
patients in debtor’s care

15.2. ________________________________________ ___________________________________________________________ ____________________
Facility name
___________________________________________________________

---

Street Location where patient records are maintained (if different from facility How are records kept?
address). If electronic, identify any service provider.
________________________________________
Check all that apply:
____________________________________________________________
________________________________________ Electronically City State ZIP Code ____________________________________________________________
Paper

Part 9: Personally Identifiable Information

16. Does the debtor collect and retain personally identifiable information of customers?

No. Yes. State the nature of the information collected and retained. ___________________________________________________________________ Does the debtor have a privacy policy about that information? No Yes

17. Within 6 years before filing this case, have any employees of the debtor been participants in any ERISA, 401(k), 403(b), or other pension or profit-sharing plan made available by the debtor as an employee benefit?

No. Go to Part 10. q Yes. Does the debtor serve as plan administrator? No. Go to Part 10. Yes. Fill in below: Name of plan Employer identification number of the plan

_______________________________________________________________________ EIN: ___ ___ – ___ ___ ___ ___ ___ ___ ___

Has the plan been terminated?
No
Yes

Official Form 207 Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy page 7

Debtor _______________________________________________________ Case number (if known)_____________________________________ Name

Part 10: Certain Financial Accounts, Safe Deposit Boxes, and Storage Units

18. Closed financial accounts Within 1 year before filing this case, were any financial accounts or instruments held in the debtor’s name, or for the debtor’s benefit, closed, sold, moved, or transferred? Include checking, savings, money market, or other financial accounts; certificates of deposit; and shares in banks, credit unions, brokerage houses, cooperatives, associations, and other financial institutions.

None

Financial institution name and address Last 4 digits of account Type of account Date account was Last balance
number closed, sold, moved, before closing or
or transferred transfer
18.1. ______________________________________ XXXX–___ ___ ___ ___ Checking ___________________ $__________
Name Savings
______________________________________
Street Money market
______________________________________ Brokerage
______________________________________
City State ZIP Code Other______________

18.2. ______________________________________ XXXX–___ ___ ___ ___ Checking ___________________ $__________
Name Savings
______________________________________
Street Money market
______________________________________ Brokerage
______________________________________
City State ZIP Code Other______________

19. Safe deposit boxes
List any safe deposit box or other depository for securities, cash, or other valuables the debtor now has or did have within 1 year before filing this case.

None

Depository institution name and address Names of anyone with access to it Description of the contents Does debtor still have it? ______________________________________ __________________________________ __________________________________ No Name Yes __________________________________ __________________________________ ______________________________________ Street __________________________________ __________________________________
______________________________________ ______________________________________ Address
City State ZIP Code ____________________________________

---

20. Off-premises storage List any property kept in storage units or warehouses within 1 year before filing this case. Do not include facilities that are in a part of a building in which the debtor does business.

None

Facility name and address Names of anyone with access to it Description of the contents Does debtor
still have it?
No
______________________________________ __________________________________ __________________________________ Yes Name
__________________________________ __________________________________ ______________________________________
Street __________________________________ __________________________________
______________________________________
______________________________________ Address
City State ZIP Code
________________________________

_________________________________

Official Form 207 Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy page 8

Debtor _______________________________________________________ Case number (if known)_____________________________________ Name

Part 11: Property the Debtor Holds or Controls That the Debtor Does Not Own

21. Property held for another List any property that the debtor holds or controls that another entity owns. Include any property borrowed from, being stored for, or held in trust. Do not list leased or rented property.

None

Owner’s name and address Location of the property Description of the property Value

$_______
______________________________________ __________________________________ __________________________________
Name
__________________________________ __________________________________
______________________________________
Street __________________________________ __________________________________
______________________________________

______________________________________
City State ZIP Code

Part 12: Details About Environmental Information

For the purpose of Part 12, the following definitions apply:

Environmental law means any statute or governmental regulation that concerns pollution, contamination, or hazardous material, regardless of the medium affected (air, land, water, or any other medium).

Site means any location, facility, or property, including disposal sites, that the debtor now owns, operates, or utilizes or that the debtor formerly owned, operated, or utilized.

Hazardous material means anything that an environmental law defines as hazardous or toxic, or describes as a pollutant, contaminant, or a similarly harmful substance.

Report all notices, releases, and proceedings known, regardless of when they occurred.

22. Has the debtor been a party in any judicial or administrative proceeding under any environmental law? Include settlements and orders.

No Yes. Provide details below.

Case title Court or agency name and address Nature of the case Status of case

_________________________________ _____________________________________ __________________________________ Pending Case number Name On appeal __________________________________ _____________________________________ Concluded _________________________________ Street __________________________________ _____________________________________
_____________________________________ City State ZIP Code

23. Has any governmental unit otherwise notified the debtor that the debtor may be liable or potentially liable under or in violation of an environmental law?

No Yes. Provide details below.

Site name and address Governmental unit name and address Environmental law, if known Date of notice

__________________________________ _____________________________________ __________________________________ __________
Name Name
__________________________________
__________________________________ _____________________________________
Street Street __________________________________
__________________________________ _____________________________________

__________________________________ _____________________________________
City State ZIP Code City State ZIP Code

Official Form 207 Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy page 9

Debtor _______________________________________________________ Case number (if known)_____________________________________ Name

24. Has the debtor notified any governmental unit of any release of hazardous material?

No Yes. Provide details below.

Site name and address Governmental unit name and address Environmental law, if known Date of notice

__________________________________ ______________________________________ __________________________________ __________
Name Name
__________________________________
__________________________________ ______________________________________
Street Street __________________________________
__________________________________ ______________________________________

__________________________________ ______________________________________
City State ZIP Code City State ZIP Code

Part 13: Details About the Debtor’s Business or Connections to Any Business

25. Other businesses in which the debtor has or has had an interest List any business for which the debtor was an owner, partner, member, or otherwise a person in control within 6 years before filing this case. Include this information even if already listed in the Schedules.

None

Business name and address Describe the nature of the business Employer Identification number
Do not include Social Security number or ITIN.

EIN: ___ ___ – ___ ___ ___ ___ ___ ___ ___
25.1. __________________________________ _____________________________________________
Name Dates business existed
_____________________________________________
__________________________________
Street _____________________________________________
__________________________________ From _______ To _______
__________________________________
City State ZIP Code

Business name and address Describe the nature of the business Employer Identification number
25.2. Do not include Social Security number or ITIN.

__________________________________ _____________________________________________ EIN: ___ ___ – ___ ___ ___ ___ ___ ___ ___ Name Dates business existed _____________________________________________ __________________________________ Street _____________________________________________ __________________________________ From _______ To _______ __________________________________ City State ZIP Code

Business name and address Describe the nature of the business Employer Identification number
Do not include Social Security number or ITIN.

25.3. __________________________________ _____________________________________________ EIN: ___ ___ – ___ ___ ___ ___ ___ ___ ___
Name
_____________________________________________ Dates business existed
__________________________________
Street _____________________________________________
__________________________________
From _______ To _______ __________________________________
City State ZIP Code

Official Form 207 Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy page 10

Debtor _______________________________________________________ Case number (if known)_____________________________________ Name

26. Books, records, and financial statements
26a. List all accountants and bookkeepers who maintained the debtor’s books and records within 2 years before filing this case.
None

Name and address Dates of service

From _______ To _______
26a.1. __________________________________________________________________________________
Name

__________________________________________________________________________________
Street

__________________________________________________________________________________

__________________________________________________________________________________
City State ZIP Code

Name and address Dates of service

From _______ To _______
26a.2. __________________________________________________________________________________
Name

__________________________________________________________________________________
Street

__________________________________________________________________________________

__________________________________________________________________________________
City State ZIP Code

26b. List all firms or individuals who have audited, compiled, or reviewed debtor’s books of account and records or prepared a financial
statement within 2 years before filing this case.
None

Name and address Dates of service

From _______ To _______
26b.1. ______________________________________________________________________________
Name

______________________________________________________________________________
Street

______________________________________________________________________________

______________________________________________________________________________
City State ZIP Code

Name and address Dates of service

From _______ To _______ 26b.2. ______________________________________________________________________________ Name

______________________________________________________________________________
Street

______________________________________________________________________________

______________________________________________________________________________
City State ZIP Code

26c. List all firms or individuals who were in possession of the debtor’s books of account and records when this case is filed.
None
If any books of account and records are Name and address
unavailable, explain why

26c.1. ______________________________________________________________________________ _________________________________________
Name
_________________________________________
______________________________________________________________________________
Street _________________________________________
______________________________________________________________________________

______________________________________________________________________________
City State ZIP Code

Official Form 207 Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy page 11

Debtor _______________________________________________________ Case number (if known)_____________________________________ Name

If any books of account and records are Name and address
unavailable, explain why

26c.2. ______________________________________________________________________________ _________________________________________
Name
_________________________________________
______________________________________________________________________________
Street _________________________________________
______________________________________________________________________________

______________________________________________________________________________
City State ZIP Code

26d. List all financial institutions, creditors, and other parties, including mercantile and trade agencies, to whom the debtor issued a financial statement
within 2 years before filing this case.

None

Name and address

26d.1. ______________________________________________________________________________
Name

______________________________________________________________________________
Street

______________________________________________________________________________

______________________________________________________________________________
City State ZIP Code

Name and address

26d.2. ______________________________________________________________________________
Name

______________________________________________________________________________
Street

______________________________________________________________________________

______________________________________________________________________________
City State ZIP Code

27. Inventories

Have any inventories of the debtor’s property been taken within 2 years before filing this case?

No Yes. Give the details about the two most recent inventories.

Name of the person who supervised the taking of the inventory Date of The dollar amount and basis (cost, market, or inventory other basis) of each inventory

______________________________________________________________________ _______ $___________________

Name and address of the person who has possession of inventory records

27.1. ______________________________________________________________________
Name

______________________________________________________________________
Street

______________________________________________________________________

______________________________________________________________________
City State ZIP Code

Official Form 207 Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy page 12

Debtor _______________________________________________________ Case number (if known)_____________________________________ Name

Name of the person who supervised the taking of the inventory Date of The dollar amount and basis (cost, market, or
inventory other basis) of each inventory

______________________________________________________________________ _______ $___________________

Name and address of the person who has possession of inventory records

27.2. ______________________________________________________________________
Name

______________________________________________________________________
Street

______________________________________________________________________

______________________________________________________________________
City State ZIP Code

28. List the debtor’s officers, directors, managing members, general partners, members in control, controlling shareholders, or other
people in control of the debtor at the time of the filing of this case.

Name Address Position and nature of any % of interest, if any
interest

____________________________ _____________________________________________ ____________________________ _______________

____________________________ _____________________________________________ ____________________________ _______________

____________________________ _____________________________________________ ____________________________ _______________

____________________________ _____________________________________________ ____________________________ _______________

____________________________ _____________________________________________ ____________________________ _______________

29. Within 1 year before the filing of this case, did the debtor have officers, directors, managing members, general partners, members in control
of the debtor, or shareholders in control of the debtor who no longer hold these positions?

No Yes. Identify below.

Name Address Position and nature of Period during which
any interest position or interest was
held
____________________________ _____________________________________________ ______________________ From _____ To _____

____________________________ _____________________________________________ ______________________ From _____ To _____

____________________________ _____________________________________________ ______________________ From _____ To _____

____________________________ _____________________________________________ ______________________ From _____ To _____

30. Payments, distributions, or withdrawals credited or given to insiders

Within 1 year before filing this case, did the debtor provide an insider with value in any form, including salary, other compensation, draws,
bonuses, loans, credits on loans, stock redemptions, and options exercised?

No Yes. Identify below.

Name and address of recipient Amount of money or Dates Reason for
description and value of providing the value
property

30.1. ______________________________________________________________ _________________________ _____________ ____________
Name

______________________________________________________________
Street _____________

______________________________________________________________
______________________________________________________________ _____________
City State ZIP Code

Relationship to debtor _____________

______________________________________________________________ _____________

Official Form 207 Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy page 13

Debtor _______________________________________________________ Case number (if known)_____________________________________ Name

Name and address of recipient
__________________________ _____________ ______________

30.2 ______________________________________________________________
Name _____________

______________________________________________________________
Street _____________

______________________________________________________________
______________________________________________________________ _____________
City State ZIP Code

Relationship to debtor _____________

______________________________________________________________

31. Within 6 years before filing this case, has the debtor been a member of any consolidated group for tax purposes?

No Yes. Identify below.

Name of the parent corporation Employer Identification number of the parent
corporation

______________________________________________________________ EIN: ___ ___ – ___ ___ ___ ___ ___ ___ ___

32. Within 6 years before filing this case, has the debtor as an employer been responsible for contributing to a pension fund?

No Yes. Identify below.

Name of the pension fund Employer Identification number of the pension fund

______________________________________________________________ EIN: ___ ___ – ___ ___ ___ ___ ___ ___ ___

Part 14: Signature and Declaration

WARNING -- Bankruptcy fraud is a serious crime. Making a false statement, concealing property, or obtaining money or property by fraud 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. §§ 152, 1341, 1519, and 3571.

I have examined the information in this Statement of Financial Affairs and any attachments 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

Printed name _________________________________________________ ___________________________________________________________ Signature of individual signing on behalf of the debtor

Position or relationship to debtor ____________________________________

Are additional pages to Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy (Official Form 207) attached? No Yes

Official Form 207 Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy page 14

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UNITED STATES BANKRUPTCY COURT EASTERN DISTRICT OF CALIFORNIA

In re ) ) ) Case No. ) ) ____________________________________)

VERIFICATION OF MASTER ADDRESS LIST

I (we) declare under penalty of perjury that the attached Master Address List is a true, correct, and

complete list of creditors and their addresses in this case.

I (we) acknowledge the following:

x Filing a Master Address List with incomplete or incorrect addresses may mean that creditor(s) with
incomplete or incorrect address(es) may not receive notification of this Bankruptcy case.

x The debtor(s) and the debtor’s(s’) attorney or bankruptcy petition preparer, if any, share responsibility
for the accuracy and completeness of the attached Master Address List.

x The Court will use the addresses on the attached Master Address List for all items that the Court mails,
and will not rely on other documents filed in this case (such as schedules and statements required by
the Bankruptcy Code and the Federal Rules of Bankruptcy Procedure) to obtain or verify the
addresses of creditors.

DATED:_____________________________ ___________________________________ Debtor’s Signature

DATED:_____________________________ ___________________________________ Joint Debtor’s (if any) signature

Submit this form and your Master Address List to one of the following addresses:

Sacramento Division Fresno Division
501 I Street, Suite 3-200 2500 Tulare Street, Suite 2501
Sacramento, CA 95814 Fresno, CA 93721

EDC 2-100 (Rev. 6/25)