Statement Of Financial Affairs Template Page 9
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c. List all firms or individuals who at the time of the commencement of this case were in possession of the
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books of account and records of the debtor. If any of the books of account and records are not available, explain.
NAME
ADDRESS
________________________________________________________________________________________________
d. List all financial institutions, creditors and other parties, including mercantile and trade agencies, to whom a
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financial statement was issued by the debtor within two years immediately preceding the commencement of this case.
NAME AND ADDRESS
DATE ISSUED
________________________________________________________________________________________________
20. Inventories
a. List the dates of the last two inventories taken of your property, the name of the person who supervised the
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taking of each inventory, and the dollar amount and basis of each inventory.
DOLLAR AMOUNT
OF INVENTORY
DATE OF INVENTORY
INVENTORY SUPERVISOR
(Specify cost, market or other
basis)
$
$
____________________________________________________________________________________________________
b. List the name and address of the person having possession of the records of each of the inventories reported
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in a., above.
NAME AND ADDRESSES
OF CUSTODIAN
DATE OF INVENTORY
OF INVENTORY RECORDS
____________________________________________________________________________________________________
21 . Current Partners, Officers, Directors and Shareholders
a. If the debtor is a partnership, list the nature and percentage of partnership interest of each member of the
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partnership.
NAME AND ADDRESS
NATURE OF INTEREST
PERCENTAGE OF INTEREST
______________________________________________________________________________________________________
b.
If the debtor is a corporation, list all officers and directors of the corporation, and each stockholder who
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directly or indirectly owns, controls, or holds 5 percent or more of the voting or equity securities of the
corporation.
NATURE AND PERCENTAGE
NAME AND ADDRESS
TITLE
OF STOCK OWNERSHIP
__________________________________________________________________________________________________
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