Official Form 201 - Voluntary Petition For Non-Individuals Filing For Bankruptcy Page 2
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1
2
3
4Debtor
_______________________________________________________
Case number
_____________________________________
(if known)
Name
A. Check one:
Describe debtor’s business
7.
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
.
___ ___ ___ ___
Under which chapter of the
Check one:
8.
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 $2,566,050 (amount subject to adjustment on
4/01/19 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).
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
Were prior bankruptcy cases
9.
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
District _______________________ When _______________ Case number _________________________
separate list.
MM / DD / YYYY
Are any bankruptcy cases
10.
No
pending or being filed by a
Yes.
Debtor _____________________________________________ Relationship _________________________
business partner or an
affiliate of the debtor?
District _____________________________________________ When
__________________
MM / DD
/ YYYY
List all cases. If more than 1,
Case number, if known ________________________________
attach a separate list.
Official Form 201
Voluntary Petition for Non-Individuals Filing for Bankruptcy
page 2
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