Statement Pursuant To LBR 4001-2 Regarding Cash Collateral Stipulations {F 4001-2.STMT.CASH.COLLAT.STIP}

Attorney or Party Name, Address, Telephone & FAX Nos., State Bar No. & Email Address FOR COURT USE ONLY Individual appearing without attorney Attorney for: UNITED STATES BANKRUPTCY COURT CENTRAL DISTRICT OF CALIFORNIA - **SELECT DIVISION** In re: CASE NO.: DIVISION CHAPTER: SELECT CHAPTER STATEMENT PURSUANT TO LBR 4001-2 REGARDING CASH COLLATERAL STIPULATIONS DATE: TIME: COURTROOM: PLACE: Debtor(s). Secured creditor: __________________________________________________________________________________ The Debtor, through a separately filed motion, has requested the approval of a stipulation providing for the use of cash collateral, or post-petition financing, or both. Attached to the motion as Exhibit ______ is a true and correct copy of the agreement for use of cash collateral or post-petition financing (Agreement), which Agreement contains the following provisions: Description of Provision Cross-collateralization clauses Provisions or findings of fact that bind the estate or all parties in interest with respect to the validity, perfection or amount of the secured party's lien or debt Provisions or findings of fact that bind the estate or all parties in interest with respect to the relative priorities of the secured party's lien and liens held by persons who are not party to the stipulation, or which create a lien senior or equal to any existing lien Page No.: Line No. (if applicable) This form is optional. It has been approved for use in the United States Bankruptcy Court for the Central District of California. December 2012 Page 1 F 4001-2.STMT.CASH.COLLAT.STIP Description of Provision Waivers of 11 U.S.C. § 506(c), unless the waiver is effective only during the period in which the debtor is authorized to use cash collateral or borrow funds Releases of liability for the creditor's alleged prepetition torts or breaches of contract Waivers of avoidance actions arising under the Bankruptcy Code Automatic relief from automatic stay upon default, conversion to chapter 7, or appointment of a trustee Waivers of procedural requirements, including those for foreclosure mandated under applicable non-bankruptcy law, and for perfection of replacement liens Adequate protection provisions which create liens on claims for relief arising under 11 U.S.C. §§ 506(c), 544, 545, 547, 548 and 549 Waivers, effective on default or expiration, of the debtor's right to move for a court order pursuant to 11 U.S.C. § 363(c)(2)(B) authorizing the use of cash collateral in the absence of the secured party's consent Provisions that grant a lien in an amount in excess of the dollar amount of cash collateral authorized under the applicable cash collateral order Provisions providing for the paying down of prepetition principal owed to a creditor Findings of fact on matters extraneous to the approval process Page No.: Line No. (if applicable) Date Printed Name Signature This form is optional. It has been approved for use in the United States Bankruptcy Court for the Central District of California. December 2012 Page 2 F 4001-2.STMT.CASH.COLLAT.STIP PROOF OF SERVICE OF DOCUMENT I am over the age of 18 and not a party to this bankruptcy case or adversary proceeding. My business address is: A true and correct copy of the foregoing document entitled: STATEMENT PURSUANT TO LBR 4001-2 REGARDING CASH COLLATERAL STIPULATIONS will be served or was served (a) on the judge in chambers in the form and manner required by LBR 5005-2(d); and (b) in the manner stated below: 1. TO BE SERVED BY THE COURT VIA NOTICE OF ELECTRONIC FILING (NEF): Pursuant to controlling General Orders and LBR, the foregoing document will be served by the court via NEF and hyperlink to the document. On (date) , I checked the CM/ECF docket for this bankruptcy case or adversary proceeding and determined that the following persons are on the Electronic Mail Notice List to receive NEF transmission at the email addresses stated below: Service information continued on attached page 2. SERVED BY UNITED STATES MAIL: , I served the following persons and/or entities at the last known addresses in this bankruptcy On (date) case or adversary proceeding by placing a true and correct copy thereof in a sealed envelope in the United States mail, first class, postage prepaid, and addressed as follows. Listing the judge here constitutes a declaration that mailing to the judge will be completed no later than 24 hours after the document is filed. Service information continued on attached page 3. SERVED BY PERSONAL DELIVERY, OVERNIGHT MAIL, FACSIMILE TRANSMISSION OR EMAIL (state method for each person or entity served): Pursuant to F.R.Civ.P. 5 and/or controlling LBR, on (date) , I served the following persons and/or entities by personal delivery, overnight mail service, or (for those who consented in writing to such service method), by facsimile transmission and/or email as follows. Listing the judge here constitutes a declaration that personal delivery on, or overnight mail to, the judge will be completed no later than 24 hours after the document is filed. Service information continued on attached page I declare under penalty of perjury under the laws of the United States that the foregoing is true and correct. Date Printed Name Signature This form is optional. It has been approved for use in the United States Bankruptcy Court for the Central District of California. December 2012 Page 3 F 4001-2.STMT.CASH.COLLAT.STIP