CACB — Schedule A/B: Assets — Real and Personal Property (206AB)

Source: https://www.cacb.uscourts.gov/sites/cacb/files/documents/forms/206AB.pdf

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 206A/B Schedule A/B: Assets — Real and Personal Property 12/15

Disclose all property, real and personal, which the debtor owns or in which the debtor has any other legal, equitable, or future interest. Include all property in which the debtor holds rights and powers exercisable for the debtor's own benefit. Also include assets and properties which have no book value, such as fully depreciated assets or assets that were not capitalized. In Schedule A/B, list any executory contracts or unexpired leases. Also list them on Schedule G: Executory Contracts and Unexpired Leases (Official Form 206G). Be as complete and accurate as possible. If more space is needed, attach a separate sheet to this form. At the top of any pages added, write the debtor’s name and case number (if known). Also identify the form and line number to which the additional information applies. If an additional sheet is attached, include the amounts from the attachment in the total for the pertinent part.

For Part 1 through Part 11, list each asset under the appropriate category or attach separate supporting schedules, such as a fixed asset schedule or depreciation schedule, that gives the details for each asset in a particular category. List each asset only once. In valuing the debtor’s interest, do not deduct the value of secured claims. See the instructions to understand the terms used in this form.

Part 1: Cash and cash equivalents

1. Does the debtor have any cash or cash equivalents? No. Go to Part 2. Yes. Fill in the information below.

   All cash or cash equivalents owned or controlled by the debtor Current value of debtor’s interest

2. Cash on hand $______________________

3. Checking, savings, money market, or financial brokerage accounts (Identify all)

   Name of institution (bank or brokerage firm) Type of account Last 4 digits of account number 3.1. _________________________________________________ ______________________ ____ ____ ____ ____ $______________________ 3.2. _________________________________________________ ______________________ ____ ____ ____ ____ $______________________

4. Other cash equivalents (Identify all) 4.1. _____________________________________________________________________________________________________ $______________________ 4.2. _____________________________________________________________________________________________________ $______________________

5. Total of Part 1 $______________________ Add lines 2 through 4 (including amounts on any additional sheets). Copy the total to line 80.

Part 2: Deposits and prepayments

6. Does the debtor have any deposits or prepayments? No. Go to Part 3. Yes. Fill in the information below. Current value of debtor’s interest

7. Deposits, including security deposits and utility deposits

   Description, including name of holder of deposit 7.1. ________________________________________________________________________________________________________ $______________________ 7.2._________________________________________________________________________________________________________ $_______________________

   Official Form 206A/B Schedule A/B: Assets Real and Personal Property page 1

Debtor _______________________________________________________ Case number (if known)_____________________________________ Name

8. Prepayments, including prepayments on executory contracts, leases, insurance, taxes, and rent

   Description, including name of holder of prepayment 8.1.___________________________________________________________________________________________________________ $______________________ 8.2.___________________________________________________________________________________________________________ $_______________________

9. Total of Part 2. $______________________ Add lines 7 through 8. Copy the total to line 81.

Part 3: Accounts receivable

10. Does the debtor have any accounts receivable? No. Go to Part 4. Yes. Fill in the information below. Current value of debtor’s interest

11. Accounts receivable

    11a. 90 days old or less: ____________________________ – ___________________________ = ........ $______________________ face amount doubtful or uncollectible accounts 11b. Over 90 days old: ___________________________ – ___________________________ = ........ $______________________ face amount doubtful or uncollectible accounts

12. Total of Part 3 $______________________ Current value on lines 11a + 11b = line 12. Copy the total to line 82.

Part 4: Investments

13. Does the debtor own any investments? No. Go to Part 5. Yes. Fill in the information below. Valuation method Current value of debtor’s used for current value interest

14. Mutual funds or publicly traded stocks not included in Part 1 Name of fund or stock: 14.1. ________________________________________________________________________________ _____________________ $________________________ 14.2. ________________________________________________________________________________ _____________________ $________________________

15. Non-publicly traded stock and interests in incorporated and unincorporated businesses, including any interest in an LLC, partnership, or joint venture

Name of entity: % of ownership: 15.1._______________________________________________________________ % _____________________ $________________ 15.2._______________________________________________________________ % _____________________ $________________

16. Government bonds, corporate bonds, and other negotiable and non-negotiable instruments not included in Part 1

    Describe: 16.1.________________________________________________________________________________ ______________________ $_______________________ 16.2.________________________________________________________________________________ ______________________ $_______________________

17. Total of Part 4 $______________________ Add lines 14 through 16. Copy the total to line 83.

Official Form 206A/B Schedule A/B: Assets Real and Personal Property page 2

Debtor _______________________________________________________ Case number (if known)_____________________________________ Name

Part 5: Inventory, excluding agriculture assets

18. Does the debtor own any inventory (excluding agriculture assets)? No. Go to Part 6. Yes. Fill in the information below.

    General description Date of the last Net book value of Valuation method used Current value of physical inventory debtor's interest for current value debtor’s interest (Where available)

19. Raw materials ________________________________________ ______________ MM / DD / YYYY $__________________ ______________________ $______________________

20. Work in progress ________________________________________ ______________ MM / DD / YYYY $__________________ ______________________ $______________________

21. Finished goods, including goods held for resale ________________________________________ ______________ MM / DD / YYYY $__________________ ______________________ $______________________

22. Other inventory or supplies ________________________________________ ______________ MM / DD / YYYY $__________________ ______________________ $______________________

23. Total of Part 5 $______________________ Add lines 19 through 22. Copy the total to line 84.

24. Is any of the property listed in Part 5 perishable? No Yes

25. Has any of the property listed in Part 5 been purchased within 20 days before the bankruptcy was filed? No Yes. Book value _______________ Valuation method____________________ Current value______________

26. Has any of the property listed in Part 5 been appraised by a professional within the last year? No Yes

Part 6: Farming and fishing-related assets (other than titled motor vehicles and land)

27. Does the debtor own or lease any farming and fishing-related assets (other than titled motor vehicles and land)? No. Go to Part 7. Yes. Fill in the information below.

    General description Net book value of Valuation method used Current value of debtor’s debtor's interest for current value interest (Where available)

28. Crops—either planted or harvested ______________________________________________________________ $________________ ____________________ $______________________

29. Farm animals Examples: Livestock, poultry, farm-raised fish ______________________________________________________________ $________________ ____________________ $______________________

30. Farm machinery and equipment (Other than titled motor vehicles) ______________________________________________________________ $________________ ____________________ $______________________

31. Farm and fishing supplies, chemicals, and feed ______________________________________________________________ $________________ ____________________ $______________________

32. Other farming and fishing-related property not already listed in Part 6 ______________________________________________________________ $________________ ____________________ $______________________

Official Form 206A/B Schedule A/B: Assets Real and Personal Property page 3

Debtor _______________________________________________________ Case number (if known)_____________________________________ Name

33. Total of Part 6. $______________________ Add lines 28 through 32. Copy the total to line 85.

34. Is the debtor a member of an agricultural cooperative? No Yes. Is any of the debtor’s property stored at the cooperative? No Yes

35. Has any of the property listed in Part 6 been purchased within 20 days before the bankruptcy was filed? No Yes. Book value $_______________ Valuation method ____________________ Current value $________________

36. Is a depreciation schedule available for any of the property listed in Part 6? No Yes

37. Has any of the property listed in Part 6 been appraised by a professional within the last year? No Yes

Part 7: Office furniture, fixtures, and equipment; and collectibles

38. Does the debtor own or lease any office furniture, fixtures, equipment, or collectibles?

No. Go to Part 8. Yes. Fill in the information below.

General description Net book value of Valuation method Current value of debtor’s debtor's interest used for current value interest (Where available)

39. Office furniture ______________________________________________________________ $________________ ____________________ $______________________

40. Office fixtures

______________________________________________________________ $________________ ____________________ $______________________

41. Office equipment, including all computer equipment and communication systems equipment and software ______________________________________________________________ $________________ ____________________ $______________________

42. Collectibles Examples: Antiques and figurines; paintings, prints, or other artwork; books, pictures, or other art objects; china and crystal; stamp, coin, or baseball card collections; other collections, memorabilia, or collectibles 42.1___________________________________________________________ $________________ ____________________ $______________________ 42.2___________________________________________________________ $________________ ____________________ $______________________ 42.3___________________________________________________________ $________________ ____________________ $______________________

43. Total of Part 7. $______________________ Add lines 39 through 42. Copy the total to line 86.

44. Is a depreciation schedule available for any of the property listed in Part 7? No Yes

45. Has any of the property listed in Part 7 been appraised by a professional within the last year? No Yes

Official Form 206A/B Schedule A/B: Assets Real and Personal Property page 4

Debtor _______________________________________________________ Case number (if known)_____________________________________ Name

Part 8: Machinery, equipment, and vehicles

46. Does the debtor own or lease any machinery, equipment, or vehicles? No. Go to Part 9. Yes. Fill in the information below.

General description Net book value of Valuation method used Current value of debtor's interest for current value debtor’s interest Include year, make, model, and identification numbers (i.e., VIN, (Where available) HIN, or N-number)

47. Automobiles, vans, trucks, motorcycles, trailers, and titled farm vehicles

    47.1___________________________________________________________ $________________ ____________________ $______________________

    47.2___________________________________________________________ $________________ ____________________ $______________________

    47.3___________________________________________________________ $________________ ____________________ $______________________

    47.4___________________________________________________________ $________________ ____________________ $______________________

48. Watercraft, trailers, motors, and related accessories Examples: Boats, trailers, motors, floating homes, personal watercraft, and fishing vessels

    48.1__________________________________________________________ $________________ ____________________ $______________________

    48.2__________________________________________________________ $________________ ____________________ $______________________

49. Aircraft and accessories

49.1__________________________________________________________ $________________ ____________________ $______________________

49.2__________________________________________________________ $________________ ____________________ $______________________

50. Other machinery, fixtures, and equipment (excluding farm machinery and equipment)

    ______________________________________________________________ $________________ ____________________ $______________________

51. Total of Part 8. $______________________ Add lines 47 through 50. Copy the total to line 87.

52. Is a depreciation schedule available for any of the property listed in Part 8? No Yes

53. Has any of the property listed in Part 8 been appraised by a professional within the last year? No Yes

Official Form 206A/B Schedule A/B: Assets Real and Personal Property page 5

Debtor _______________________________________________________ Case number (if known)_____________________________________ Name

Part 9: Real property

54. Does the debtor own or lease any real property? No. Go to Part 10. Yes. Fill in the information below.

55. Any building, other improved real estate, or land which the debtor owns or in which the debtor has an interest Description and location of property Nature and extent Net book value of Valuation method used Current value of Include street address or other description such as of debtor’s interest debtor's interest for current value debtor’s interest Assessor Parcel Number (APN), and type of property in property (Where available) (for example, acreage, factory, warehouse, apartment or office building), if available. 55.1________________________________________ _________________ $_______________ ____________________ $_____________________

    55.2________________________________________ _________________ $_______________ ____________________ $_____________________

    55.3________________________________________ _________________ $_______________ ____________________ $_____________________

    55.4________________________________________ _________________ $_______________ ____________________ $_____________________

    55.5________________________________________ _________________ $_______________ ____________________ $_____________________

    55.6________________________________________ _________________ $_______________ ____________________ $_____________________

56. Total of Part 9. $_____________________ Add the current value on lines 55.1 through 55.6 and entries from any additional sheets. Copy the total to line 88.

57. Is a depreciation schedule available for any of the property listed in Part 9? No Yes

58. Has any of the property listed in Part 9 been appraised by a professional within the last year? No Yes

Part 10: Intangibles and intellectual property

59. Does the debtor have any interests in intangibles or intellectual property? No. Go to Part 11. Yes. Fill in the information below.

General description Net book value of Valuation method Current value of debtor's interest used for current value debtor’s interest (Where available) 60. Patents, copyrights, trademarks, and trade secrets ______________________________________________________________ $_________________ ______________________ $____________________ 61. Internet domain names and websites ______________________________________________________________ $_________________ ______________________ $____________________ 62. Licenses, franchises, and royalties ______________________________________________________________ $_________________ ______________________ $____________________

63. Customer lists, mailing lists, or other compilations ______________________________________________________________ $_________________ ______________________ $____________________

64. Other intangibles, or intellectual property ______________________________________________________________ $________________ _____________________ $____________________

65. Goodwill ______________________________________________________________ $________________ _____________________ $____________________

66. Total of Part 10. $____________________ Add lines 60 through 65. Copy the total to line 89.

Official Form 206A/B Schedule A/B: Assets Real and Personal Property page 6

Debtor _______________________________________________________ Case number (if known)_____________________________________ Name

67. Do your lists or records include personally identifiable information of customers (as defined in 11 U.S.C. §§ 101(41A) and 107)? No Yes
68. Is there an amortization or other similar schedule available for any of the property listed in Part 10? No Yes
69. Has any of the property listed in Part 10 been appraised by a professional within the last year? No Yes

Part 11: All other assets

70. Does the debtor own any other assets that have not yet been reported on this form? Include all interests in executory contracts and unexpired leases not previously reported on this form. No. Go to Part 12. Yes. Fill in the information below. Current value of debtor’s interest

71. Notes receivable Description (include name of obligor) _______________ – __________________________ = $_____________________ ______________________________________________________ Total face amount doubtful or uncollectible amount

72. Tax refunds and unused net operating losses (NOLs)

    Description (for example, federal, state, local)

    _________________________________________________________________________________ Tax year ___________ $_____________________

    ---

    Tax year ___________ $_____________________ _________________________________________________________________________________
    Tax year ___________ $_____________________

73. Interests in insurance policies or annuities ______________________________________________________________ $_______________________

74. Causes of action against third parties (whether or not a lawsuit has been filed)

    ______________________________________________________________ $_______________________ Nature of claim ___________________________________ Amount requested $________________

75. Other contingent and unliquidated claims or causes of action of every nature, including counterclaims of the debtor and rights to set off claims

______________________________________________________________ $_______________________ Nature of claim ___________________________________ Amount requested $________________

76. Trusts, equitable or future interests in property

    ______________________________________________________________ $_____________________

77. Other property of any kind not already listed Examples: Season tickets, country club membership

____________________________________________________________ $_____________________ ____________________________________________________________ $_____________________ 78. Total of Part 11. $_____________________ Add lines 71 through 77. Copy the total to line 90.

79. Has any of the property listed in Part 11 been appraised by a professional within the last year? No Yes

Official Form 206A/B Schedule A/B: Assets Real and Personal Property page 7

Debtor _______________________________________________________ Case number (if known)_____________________________________ Name

Part 12: Summary

In Part 12 copy all of the totals from the earlier parts of the form.

Type of property Current value of Current value
personal property of real property

80. Cash, cash equivalents, and financial assets. Copy line 5, Part 1. $_______________

81. Deposits and prepayments. Copy line 9, Part 2. $_______________

82. Accounts receivable. Copy line 12, Part 3. $_______________

83. Investments. Copy line 17, Part 4. $_______________

84. Inventory. Copy line 23, Part 5. $_______________

85. Farming and fishing-related assets. Copy line 33, Part 6. $_______________

86. Office furniture, fixtures, and equipment; and collectibles. $_______________ Copy line 43, Part 7.

87. Machinery, equipment, and vehicles. Copy line 51, Part 8. $_______________

88. Real property. Copy line 56, Part 9. . .................................................................................. $________________

89. Intangibles and intellectual property. Copy line 66, Part 10. $_______________

90. All other assets. Copy line 78, Part 11. + $_______________

91. Total. Add lines 80 through 90 for each column. ........................... 91a. $_______________ 91b. $________________ +

92. Total of all property on Schedule A/B. Lines 91a + 91b = 92. ........................................................................................... $__________________

Official Form 206A/B Schedule A/B: Assets Real and Personal Property page 8