Official Form 101 Voluntary Petition For Individuals Filing For Bankruptcy Page 4
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8Debtor 1
_______________________________________________________
Case number
_____________________________________
(if known)
First Name
Middle Name
Last Name
Part 3:
Report About Any Businesses You Own as a Sole Proprietor
Are you a sole proprietor
12.
No. Go to Part 4.
of any full- or part-time
Yes. Name and location of business
business?
A sole proprietorship is a
_______________________________________________________________________________________
business you operate as an
Name of business, if any
individual, and is not a
separate legal entity such as
_______________________________________________________________________________________
a corporation, partnership, or
Number
Street
LLC.
If you have more than one
_______________________________________________________________________________________
sole proprietorship, use a
separate sheet and attach it
_______________________________________________
_______
__________________________
to this petition.
City
State
ZIP Code
Check the appropriate box to describe your 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))
Stockbroker (as defined in 11 U.S.C. § 101(53A))
Commodity Broker (as defined in 11 U.S.C. § 101(6))
None of the above
Are you filing under
If you are filing under Chapter 11, the court must know whether you are a small business debtor so that it
13.
can set appropriate deadlines. If you indicate that you are a small business debtor, you must attach your
Chapter 11 of the
most recent balance sheet, statement of operations, cash-flow statement, and federal income tax return or if
Bankruptcy Code and
any of these documents do not exist, follow the procedure in 11 U.S.C. § 1116(1)(B).
are you a small business
debtor?
No. I am not filing under Chapter 11.
For a definition of small
business debtor, see
No. I am filing under Chapter 11, but I am NOT a small business debtor according to the definition in
11 U.S.C. § 101(51D).
the Bankruptcy Code.
Yes. I am filing under Chapter 11 and I am a small business debtor according to the definition in the
Bankruptcy Code.
Part 4:
Report if You Own or Have Any Hazardous Property or Any Property That Needs Immediate Attention
Do you own or have any
14.
No
property that poses or is
Yes. What is the hazard?
________________________________________________________________________
alleged to pose a threat
of imminent and
identifiable hazard to
________________________________________________________________________
public health or safety?
Or do you own any
property that needs
If immediate attention is needed, why is it needed?
_______________________________________________
immediate attention?
For example, do you own
________________________________________________________________________
perishable goods, or livestock
that must be fed, or a building
that needs urgent repairs?
Where is the property?
________________________________________________________________________
Number
Street
________________________________________________________________________
________________________________________ _______
____________________
City
State
ZIP Code
Official Form 101
Voluntary Petition for Individuals Filing for Bankruptcy
page 4
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