Involuntary Petition (United States)
This is a petition for an involuntary bankruptcy. The form provided here is simply a sample of what the actual Form B5 looks like.
FORM 5. INVOLUNTARY PETITION
United States Bankruptcy Court
___________________________District of__________________________
INVOLUNTARY PETITION
IN RE (Name of Debtor - If Individual: Last, First, Middle)
ALL OTHER NAMES used by debtor in the last 6 years
(Include married, maiden, and trade names.)
SOC. SEC./TAX I.D. NO. (If more than one, state all.)
___________________________
STREET ADDRESS OF DEBTOR (No. and street, city, state, and zip code)
___________________________
___________________________
___________________________
MAILING ADDRESS OF DEBTOR (If different from street address)
___________________________
___________________________
___________________________
COUNTY OF RESIDENCE OR PRINCIPAL PLACE OF BUSINESS
___________________________
LOCATION OF PRINCIPAL ASSETS OF BUSINESS DEBTOR (If different from previously listed addresses)
___________________________
CHAPTER OF BANKRUPTCY CODE UNDER WHICH PETITION IS FILED
____ Chapter 7 ____ Chapter 11
INFORMATION REGARDING DEBTOR (Check applicable boxes)
Petitioners believe:
____ Debts are primarily consumer debts
____ Debts are primarily business debts (complete sections A and B)
TYPE OF DEBTOR
____ Individual
____ Corporation Publicly Held
____ Partnership Corporation Not Publicly Held
____ Other: _____________________________________
A. TYPE OF BUSINESS (Check one)
____ Professional
____ Transportation
____ Commodity Broker
____ Retail/Wholesale
____ Manufacturing/Mining
____ Railroad
____ Construction
____ Real Estate
____ Stockbroker
____ Other _____________________________________
B. BRIEFLY DESCRIBE NATURE OF BUSINESS
_____________________________________
VENUE
____ Debtor has been domiciled or has had a residence, principal place of business, or principal assets in the District for 180 days immediately preceding the date of this petition or for a longer part of such 180 days than in any other District.
____ A bankruptcy case concerning debtor's affiliate, general partner or partnership is pending in this District.
PENDING BANKRUPTCY CASE FILED BY OR AGAINST ANY PARTNER OR AFFILIATE OF THIS DEBTOR (Report information for any additional cases on attached sheets.)
Name of Debtor _____________________________________
Case Number _____________________________________
Date _____________________________________
Relationship _____________________________________
District _____________________________________
Judge _____________________________________
ALLEGATIONS
(Check applicable boxes)
1. ____ Petitioner(s) are eligible to file this petition pursuant to 11 U.S.C. ยง 303(b).
2. ____ The debtor is a person against whom an order for relief may be entered under title 11 of the United States Code.
3.a. ____ The debtor is generally not paying such debtor's debts as they become due, unless such debts are the subject of a bona fide dispute;
or
b. ____ Within 120 days preceding the filing of this petition, a custodian, other than a trustee, receiver, or agent appointed or authorized to take charge of less than substantially all of the property of the debtor for the purpose of enforcing a lien against such property, was appointed or took possession.
COURT USE ONLY
TRANSFER OF CLAIM
____ Check this box if there has been a transfer of any claim against the debtor by or to any petitioner. Attach all documents evidencing the transfer and any statements that are required under Bankruptcy Rule 1003(a).
REQUEST FOR RELIEF
Petitioner(s) request that an order for relief be entered against the debtor under the chapter of title 11, United States Code, specified in this petition.
Petitioner(s) declare under penalty of perjury that the foregoing is true and correct according to the best of their knowledge, information, and belief.
X________________________________________________
Signature of Petitioner or Representative (State title)
__________________________________________________
Name of Petitioner
__________________________________________________
Date Signed
Name & Mailing Address of Individual _________________________
Signing in Representative Capacity _________________________
X____________________________________
Signature of Attorney
_____________________________________
Date
_____________________________________
Name of Attorney Firm (If any)
_____________________________________
Address
_____________________________________
Telephone No.
X________________________________________________
Signature of Petitioner or Representative (State title)
__________________________________________________
Name of Petitioner
__________________________________________________
Date Signed
Name & Mailing Address of Individual _________________________
Signing in Representative Capacity _________________________
X____________________________________
Signature of Attorney
_____________________________________
Date
_____________________________________
Name of Attorney Firm (If any)
_____________________________________
Address
_____________________________________
Telephone No.
X________________________________________________
Signature of Petitioner or Representative (State title)
__________________________________________________
Name of Petitioner
__________________________________________________
Date Signed
Name & Mailing Address of Individual _________________________
Signing in Representative Capacity _________________________
X____________________________________
Signature of Attorney
_____________________________________
Date
_____________________________________
Name of Attorney Firm (If any)
_____________________________________
Address
_____________________________________
Telephone No.
PETITIONING CREDITORS
Name and Address of Petitioner _____________________________________
Nature of Claim _____________________________________
Amount of Claim _____________________________________
Name and Address of Petitioner _____________________________________
Nature of Claim _____________________________________
Amount of Claim _____________________________________
Name and Address of Petitioner _____________________________________
Nature of Claim _____________________________________
Amount of Claim _____________________________________
Total Amount of Petitioners' Claims ________________________________
Note: If there are more than three petitioners, attach additional sheets with the statement under penalty of perjury, each petitioner's signature under the statement and the name of attorney and petitioning creditor information in the format above.
______ continuation sheets attached