Exhibit "A" (United States)
This is Exhibit A to Voluntary Petition and is a form required for Chapter 11 of the Bankruptcy Code. The form provided here is simply a sample of what the actual Form B1 looks like.
Form B1, Exhibit.A (9/97)
Exhibit "A"
[If debtor is required to file periodic reports (e.g., forms 10K and 10Q) with the Securities and Exchange Commission pursuant to Section 13 or 15(d) of the Securities Exchange Act of 1934 and is requesting relief under chapter 11 of the Bankruptcy Code, this Exhibit "A" shall be completed and attached to the petition.]
[Caption as in Form 16B]
Exhibit "A" to Voluntary Petition
1. If any of the debtor's securities are registered under Section 12 of the Securities Exchange Act of 1934, the SEC file number
is _____________________.
2. The following financial data is the latest available information and refers to the debtor's condition
on ___________________.
a. Total assets $ ______________
b. Total debts (including debts listed in 2.c., below) $ _______________
c. Debt securities held by more than 500 holders.
secured ___ unsecured ___ subordinated ___ $_________________
Approximate number of holders _______________
Debt securities held by more than 500 holders.
secured ___ unsecured ___ subordinated ___ $________________
Approximate number of holders _______________
Debt securities held by more than 500 holders.
secured ___ unsecured ___ subordinated ___ $________________
Approximate number of holders _______________
d. Number of shares of preferred stock _______________________
Approximate number of holders _______________
e. Number of shares common stock _______________________
Approximate number of holders _______________
Comments, if any: _________________________________________
3. Brief description of debtor's business:
____________________________________________________
4. List the names of any person who directly or indirectly owns, controls, or holds, with power to vote, 5% or more of the voting securities of debtor:
_________________________________________