Corporate Ownership Statement {16}

Local Form 16 UNITED STATES BANKRUPTCY COURT WESTERN DISTRICT OF NORTH CAROLINA [insert correct division name] DIVISION IN RE: ) ) ) ) ) ) Case No: Chapter March 2013 Debtor(s). CORPORATE OWNERSHIP STATEMENT [Insert name of corporate debtor/party] Check one: DEBTOR PLAINTIFF DEFENDANT OTHER (specify): Instructions: Fed. R. Bankr. P. 7007.1 requires corporate parties to an adversary proceeding, other than the debtor or a governmental unit, to file a statement of corporate ownership with the first pleading filed. Fed. R. Bankr. P. 1007(a)(1) requires corporate debtors to file with the petition a Corporate Ownership Statement containing the information described in Fed. R. Bankr. P. 7007.1. Check one of the statements set forth below and provide any information as directed. 1. The following corporations directly or indirectly own 10% or more of any class of the above named corporate debtor's/party's equity interests: Name:________________________________________________________________________ Address:______________________________________________________________________ Name:________________________________________________________________________ Address:______________________________________________________________________ Name:________________________________________________________________________ Address:______________________________________________________________________ (For additional names, attach an addendum to this form.) 2. There are no entities that directly or indirectly own 10% or more of any class of the above named corporate debtor's/party's equity interests. Date: Signature of Authorized Individual for Corporate Debtor/Party Printed Name of Authorized Individual for Corporate Debtor/Party Title of Authorized Individual for Corporate Debtor/Party American LegalNet, Inc. www.FormsWorkFlow.com