Statement Of Financial Affairs Template Page 8
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which the debtor owned 5 percent or more of the voting or equity securities within six years immediately preceding
the commencement of this case.
If the debtor is a partnership, list the names, addresses, taxpayer-identification numbers, nature of the businesses,
and beginning and ending dates of all businesses in which the debtor was a partner or owned 5 percent or more of
the voting or equity securities, within six years immediately preceding the commencement of this case.
If the debtor is a corporation, list the names, addresses, taxpayer-identification numbers, nature of the businesses,
and beginning and ending dates of all businesses in which the debtor was a partner or owned 5 percent or more of
the voting or equity securities within six years immediately preceding the commencement of this case.
LAST FOUR DIGITS
OF SOCIAL-SECURITY
BEGINNING AND
NAME
OR OTHER INDIVIDUAL
ADDRESS
NATURE OF BUSINESS
ENDING DATES
TAXPAYER-I.D. NO.
(ITIN)/ COMPLETE EIN
______________________________________________________________________________________________________
b. Identify any business listed in response to subdivision a., above, that is "single asset real estate" as
None
defined in 11 U.S.C. § 101.
NAME
ADDRESS
______________________________________________________________________________________________________
The following questions are to be completed by every debtor that is a corporation or partnership and by any individual
debtor who is or has been, within six years immediately preceding the commencement of this case, any of the following: an
officer, director, managing executive, or owner of more than 5 percent of the voting or equity securities of a corporation; a
partner, other than a limited partner, of a partnership, a sole proprietor, or self-employed in a trade, profession, or other activity,
either full- or part-time.
(An individual or joint debtor should complete this portion of the statement only if the debtor is or has been in
business, as defined above, within six years immediately preceding the commencement of this case. A debtor who has not been
in business within those six years should go directly to the signature page.)
_____________________________________________________________________________________________________
19. Books, records and financial statements
a. List all bookkeepers and accountants who within two years immediately preceding the filing of this
None
bankruptcy case kept or supervised the keeping of books of account and records of the debtor.
NAME AND ADDRESS
DATES SERVICES RENDERED
________________________________________________________________________________________________
b. List all firms or individuals who within two years immediately preceding the filing of this bankruptcy
None
case have audited the books of account and records, or prepared a financial statement of the debtor.
NAME
ADDRESS
DATES SERVICES RENDERED
_____________________________________________________________________________________________________
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