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Exhibit C (Supplemental Petition Information) - Oregon
| Exhibit C (Supplemental Petition Information) Form. This is a Oregon form and can be used in Bankruptcy Court Federal . |
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UNITED STATES BANKRUPTCY COURT DISTRICT OF OREGON In re ) Case No. ) ) EXHIBIT "C" ) [If not an Ex. on Petition Pg. 2, then to ) be FULLY completed by ALL debtors Debtor(s) ) and attached to ALL copies of the Petition.] (NOTE: You must answer AL L questions. Attach additional sheets if necessary. Use of UNKNOWN is NOT acceptable!) 1. Identify and briefly describe all real or personal property owned by or in possession of the debtor that, to the best of the debtors knowledge, poses or is alleged to pose a threat of imminent and identifiable harm to the public health or safety: 2. With respect to each parcel of real property or item of personal property identified in question 1, describe the nature and location of the dangerous condition, whether environmental or otherwise, that poses or is alleged to pose a threat of imminent and identifiable harm to the public health or safety: 3. DESCRIBE ASSETS REQUIRING TRUSTEES IMMEDIATE ATTENTION: 4. Street address of principal assets (note property): 5. [If debtor(s) an individual] Is debtor(s), OR has debtor(s) ever been within the 6 years prior to filing, either: self-employed or a sole proprietor; a partner, other than a limited partner, of a partnership; or an officer, director, managing executive, or person in control of a corporation? ~ YES ~ NO If YES, complete ALL questions in the Statement of Affairs. 6. [Unless EXACT question already answered on Petition] If debtor is CORPORATION, list name and address of chief executive officer; if debtor is PARTNERSHIP, list names and addresses of general partners: 7. Total GROSS income of the individual debtor(s) for the last tax year: $ (i.e., before any deductions). 8. Total amount of unsecured debt: $ . 9. Total Noncontingent, Liquidated Farming Operation Debt: $ . 10. Total GROSS income from farming operation for the individual debtor(s) for last tax year: $ .11. The BANKRUPTCY DOCUMENT PREPARER DECLARAT ION below has been completed for any person who helped, for compensation, prepare any of the bankruptcy papers if the debtor does not have an attorney. I declare under penalty of perjury that the above information provided in this Exhibit "C" is true and correct.DATED: Debtors Signature Phone #Joint Debtors Signature BANKRU PTCY DOCUMENT PREP ARER DECL ARA TION I, the undersigned, declare under penalty of perjury that (1) neither I, nor anyone else listed herein, collected or received any paymentfrom or on behalf of the debtor for court fees in connection with filing the petition; (2) I have received $ from or onbehalf of the debtor within the previous 12 month period; (3) $ is the unpaid fee charged to the debtor; and (4) thefollowing is true and accurate about myself and any other assistants: Individual Name and Firm (Type or Print): Address (Type or Print): Social Security Number of all OTHER individuals who prepared or assisted in the preparation of these bankruptcy documents:Signature: Social Security #: Phone #:[NOTE: Penalties up to $500 per item may be assessed for omission of any required information (11 USC 110; 18 USC 156) and Fed.Bankruptcy Rule 1006 prohibits any payment to any person for services until the court filing fees are paid in full.]EXHIBIT C (12/1/01)
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