CACB — Involuntary Petition Against a Non-Individual (205)

CACB — 205.pdf¶

Source: https://www.cacb.uscourts.gov/sites/cacb/files/documents/forms/205.pdf

Page 1¶

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 205 Involuntary Petition Against a Non-Individual 12/15 Use this form to begin a bankruptcy case against a non-individual you allege to be a debtor subject to an involuntary case. If you want to begin a case against an individual, use the Involuntary Petition Against an Individual (Official Form 105). Be as complete and accurate as possible. If more space is needed, attach any additional sheets to this form. On the top of any additional pages, write debtor’s name and case number (if known).

Part 1: Identify the Chapter of the Bankruptcy Code Under Which Petition Is Filed

Chapter of the Check one: Bankruptcy Code Chapter 7 Chapter 11

Part 2: Identify the Debtor

Debtor’s name ______________________________________________________________________________________________________
Other names you know __________________________________________________ the debtor has used in the last 8 years __________________________________________________ Include any assumed __________________________________________________ names, trade names, or doing business as names.
Debtor’s federal Unknown Employer Identification

Number (EIN) ___ ___ – ___ ___ ___ ___ ___ ___ ___ EIN

Principal place of business Mailing address, if different

Debtor’s address

________________________________________________ _________________________________________________
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

Official Form 205 Involuntary Petition Against a Non-Individual page 1

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Debtor _______________________________________________________ Case number (if known)_____________________________________ Name

Debtor’s website (URL) _____________________________________________________________________________________________________

Corporation (including Limited Liability Company (LLC) and Limited Liability Partnership (LLP))7. Type of debtor Partnership (excluding LLP) Other type of debtor. Specify: __________________________________________________________________________
Type of debtor’s Check one: 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 types of business listed. Unknown type of business.
To the best of your No knowledge, are any Yes. Debtor _________________________________________________ Relationship __________________________ bankruptcy cases pending by or against District __________________________ Date filed _______________ Case number, if known____________________ any partner or affiliate MM / DD / YYYY of this debtor?

Debtor _________________________________________________ Relationship __________________________

District __________________________ Date filed _______________ Case number, if known____________________
MM / DD / YYYY

Part 3: Report About the Case

Venue Check one: Over the last 180 days before the filing of this bankruptcy, the debtor had a domicile, principal place of business, or principal assets in this district longer than in any other district. A bankruptcy case concerning debtor’s affiliates, general partner, or partnership is pending in this district.
Allegations Each petitioner is eligible to file this petition under 11 U.S.C. § 303(b). The debtor may be the subject of an involuntary case under 11 U.S.C. § 303(a).

At least one box must be checked: The debtor is generally not paying its debts as they become due, unless they are the subject of a bona fide dispute as to liability or amount. Within 120 days before the filing of this petition, a custodian, other than a trustee, receiver, or an 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.

Has there been a No transfer of any claim Yes. Attach all documents that evidence the transfer and any statements required under Bankruptcy against the debtor by or

to any petitioner? Rule 1003(a).

Official Form 205 Involuntary Petition Against a Non-Individual page 2

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Debtor _______________________________________________________ Case number (if known)_____________________________________ Name

Each petitioner’s claim Name of petitioner Nature of petitioner’s claim Amount of the claim above the value of any lien ______________________________________ _________________________________ $ ________________ ______________________________________ _________________________________ $ ________________ ______________________________________ _________________________________ $ ________________ Total of petitioners’ claims $ ________________

If more space is needed to list petitioners, attach additional sheets. Write the alleged debtor’s name and the case number, if known, at the top of each sheet. Following the format of this form, set out the information required in Parts 3 and 4 of the form for each additional petitioning creditor, the petitioner’s claim, the petitioner’s representative, and the petitioner’s attorney. Include the statement under penalty of perjury set out in Part 4 of the form, followed by each additional petitioner’s (or representative’s) signature, along with the signature of the petitioner’s attorney.

Part 4: Request for Relief

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.

Petitioners request that an order for relief be entered against the debtor under the chapter of 11 U.S.C. specified in this petition. If a
petitioning creditor is a corporation, attach the corporate ownership statement required by Bankruptcy Rule 1010(b). If any petitioner is a
foreign representative appointed in a foreign proceeding, attach a certified copy of the order of the court granting recognition.

I have examined the information in this document and have a reasonable belief that the information is true and correct.

Petitioners or Petitioners’ Representative Attorneys

Name and mailing address of petitioner

________________________________________________________________ ______________________________________________________________
Printed name Name

______________________________________________________________ Firm name, if any

Number Street

________________________________________________________________ _________________________________ ______________ _____________
Number Street City State ZIP Code

_________________________________ ______________ _____________
City State ZIP Code

Name and mailing address of petitioner’s representative, if any

______________________________________________________________ Contact phone _________________ Email ___________________________

Name

______________________________________________________________ Bar number ___________________________________________________

Number Street

_________________________________ ______________ _____________ State _________________
City State ZIP Code

I declare under penalty of perjury that the foregoing is true and correct.

Executed on _________________ MM / DD / YYYY ________________________________________________________________
Signature of attorney

Signature of petitioner or representative, including representative’s title Date signed _________________
MM / DD / YYYY

Official Form 205 Involuntary Petition Against a Non-Individual page 3

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Debtor _______________________________________________________ Case number (if known)_____________________________________ Name

Name and mailing address of petitioner

________________________________________________________________ ______________________________________________________________
Printed name Name

________________________________________________________________
______________________________________________________________ Firm name, if any

Number Street

________________________________________________________________ _________________________________ ______________ _____________
Number Street City State ZIP Code

_________________________________ ______________ _____________
City State ZIP Code

Name and mailing address of petitioner’s representative, if any Contact phone _________________ Email ___________________________ ______________________________________________________________ Name Bar number ___________________________________________________ ______________________________________________________________ Number Street State _________________ _________________________________ ______________ _____________ City State ZIP Code

I declare under penalty of perjury that the foregoing is true and correct.

Executed on _________________ ________________________________________________________________ MM / DD / YYYY
Signature of attorney

______________________________________________________________ Date signed _________________ Signature of petitioner or representative, including representative’s title MM / DD / YYYY

Name and mailing address of petitioner

Printed name Name

________________________________________________________________
______________________________________________________________ Firm name, if any

Number Street

________________________________________________________________ _________________________________ ______________ _____________
Number Street City State ZIP Code

_________________________________ ______________ _____________
City State ZIP Code

I declare under penalty of perjury that the foregoing is true and correct.

Executed on _________________ ________________________________________________________________ MM / DD / YYYY Signature of attorney

______________________________________________________________ Date signed _________________ Signature of petitioner or representative, including representative’s title MM / DD / YYYY

Official Form 205 Involuntary Petition Against a Non-Individual page 4

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