CACB — Voluntary Petition for Non-Individuals Filing for Bankruptcy (201)

Source: https://www.cacb.uscourts.gov/sites/cacb/files/documents/forms/201.pdf

Fill in this information to identify the case:

United States Bankruptcy Court for the:

Central District of California ____________________ 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 06/24

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 $3,024,725 (amount subject to adjustment on 4/01/25 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

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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