Form B1 - Voluntary Petition - United States Bankruptcy Court
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3B1 (Official Form 1) (04/13)
U
S
B
C
NITED
TATES
ANKRUPTCY
OURT
VOLUNTARY PETITION
District of
__________
__________
Name of Debtor (if individual, enter Last, First, Middle):
Name of Joint Debtor (Spouse) (Last, First, Middle):
All Other Names used by the Debtor in the last 8 years
All Other Names used by the Joint Debtor in the last 8 years
(include married, maiden, and trade names):
(include married, maiden, and trade names):
Last four digits of Soc. Sec. or Individual-Taxpayer I.D. (ITIN)/Complete EIN
Last four digits of Soc. Sec. or Individual-Taxpayer I.D. (ITIN)/Complete EIN
(if more than one, state all):
(if more than one, state all):
Street Address of Debtor (No. and Street, City, and State):
Street Address of Joint Debtor (No. and Street, City, and State):
ZIP CODE
ZIP CODE
County of Residence or of the Principal Place of Business:
County of Residence or of the Principal Place of Business:
Mailing Address of Debtor (if different from street address):
Mailing Address of Joint Debtor (if different from street address):
ZIP CODE
ZIP CODE
Location of Principal Assets of Business Debtor (if different from street address above):
ZIP CODE
Type of Debtor
Nature of Business
Chapter of Bankruptcy Code Under Which
(Form of Organization)
(Check one box.)
the Petition is Filed (Check one box.)
(Check one box.)
Health Care Business
Chapter 7
Chapter 15 Petition for
Individual (includes Joint Debtors)
Single Asset Real Estate as defined in
Chapter 9
Recognition of a Foreign
See Exhibit D on page 2 of this form.
11 U.S.C. § 101(51B)
Chapter 11
Main Proceeding
Corporation (includes LLC and LLP)
Railroad
Chapter 12
Chapter 15 Petition for
Partnership
Stockbroker
Chapter 13
Recognition of a Foreign
Other (If debtor is not one of the above entities, check
Commodity Broker
Nonmain Proceeding
this box and state type of entity below.)
Clearing Bank
Other
Chapter 15 Debtors
Tax-Exempt Entity
Nature of Debts
(Check box, if applicable.)
(Check one box.)
Country of debtor’s center of main interests:
Debts are primarily consumer
Debts are
Debtor is a tax-exempt organization
debts, defined in 11 U.S.C.
primarily
Each country in which a foreign proceeding by, regarding, or
under title 26 of the United States
§ 101(8) as “incurred by an
business debts.
against debtor is pending:
Code (the Internal Revenue Code).
individual primarily for a
personal, family, or
household purpose.”
Filing Fee (Check one box.)
Chapter 11 Debtors
Check one box:
Full Filing Fee attached.
Debtor is a small business debtor as defined in 11 U.S.C. § 101(51D).
Debtor is not a small business debtor as defined in 11 U.S.C. § 101(51D).
Filing Fee to be paid in installments (applicable to individuals only). Must attach
signed application for the court’s consideration certifying that the debtor is
Check if:
unable to pay fee except in installments. Rule 1006(b). See Official Form 3A.
Debtor’s aggregate noncontingent liquidated debts (excluding debts owed to
insiders or affiliates) are less than $2,490,925 (amount subject to adjustment
Filing Fee waiver requested (applicable to chapter 7 individuals only). Must
on 4/01/16 and every three years thereafter).
attach signed application for the court’s consideration. See Official Form 3B.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Check all applicable boxes:
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).
Statistical/Administrative Information
THIS SPACE IS FOR
COURT USE ONLY
Debtor estimates that funds will be available for distribution to unsecured creditors.
Debtor estimates that, after any exempt property is excluded and administrative expenses paid, there will be no funds available for
distribution to unsecured creditors.
Estimated Number of Creditors
1-49
50-99
100-199
200-999
1,000-
5,001-
10,001-
25,001-
50,001-
Over
5,000
10,000
25,000
50,000
100,000
100,000
Estimated Assets
$0 to
$50,001 to
$100,001 to
$500,001
$1,000,001
$10,000,001
$50,000,001
$100,000,001
$500,000,001
More than
$50,000
$100,000
$500,000
to $1
to $10
to $50
to $100
to $500
to $1 billion
$1 billion
million
million
million
million
million
Estimated Liabilities
$0 to
$50,001 to
$100,001 to
$500,001
$1,000,001
$10,000,001
$50,000,001
$100,000,001
$500,000,001
More than
$50,000
$100,000
$500,000
to $1
to $10
to $50
to $100
to $500
to $1 billion
$1 billion
million
million
million
million
million
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