Form 7

(9/00)

This statement is to be completed by every debtor. Spouses filing a joint petition may file a single statement on which the information for both spouses is combined. If the case is filed under chapter 12 or chapter 13, a married debtor must furnish information for both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed. An individual debtor engaged in business as a sole proprietor, partner, family farmer, or self-employed professional, should provide the information requested on this statement concerning all such activities as well as the individual's personal affairs.

Questions I - 18 are to be completed by all debtors. Debtors that are or have been in business, as defined below, also must complete Questions 19 - 25. If the answer to an applicable question is "None," mark the box labeled "None." If additional space is needed for the answer to any question, use and attach a separate sheet properly identified with the case name, case number (if known), and the number of the question.

"Insider. " The term "insider" includes but is not limited to: relatives of the debtor; general partners of the debtor and their relatives; corporations of which the debtor is an officer, director, or person in control; offcers, directors, and any owner of 5 percent or more of the voting or equity securities of a corporate debtor and their relatives; affiliates of the debtor and insiders of such affliates; any managing agent of the debtor. I I U.S.C. § 101.

________________________________________

None State the gross amount of income the debtor has received from employment, trade, or profession, or from operation of

gross amounts received during the two years immediately preceding this calendar year. (A debtor that maintains, or

has maintained, financial records on the basis of a fiscal rather than a calendar year may report fiscal year income.

Identify the beginning and ending dates of the debtor's fiscal year.) If a joint petition is filed, state income for each

spouse separately. (Married debtors filing under chapter 12 or chapter 13 must state income of both spouses whether

or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.)

AMOUNT SOURCE (if more than one)

None State the amount of income received by the debtor other than from employment, trade, profession, or operation of the debtor's business

3. Payments to Creditors

None a. List all payments on loans, installment purchases of goods or services, and other debts, aggregating more than

debtors filing under chapter 12 or chapter 13 must include payments by either or both spouses whether or not a

joint petition is filed, unless the spouses are separated and a joint petition is not filed.)

NAME AND ADDRESS OF CREDITOR DATES OF AMOUNT AMOUNT

___________________________________________________________________________________________

b. List all payments made within one year immediately preceding the commencement of this case to or for the

None benefit of creditors who are or were insiders. (Married debtors filing under chapter 12 or chapter 13 must include

joint petition is not filed.)

NAME AND ADDRESS OF CREDITOR DATES OF AMOUNT AMOUNT

AND RELATIONSHIP TO DEBTOR PAYMENTS PAID STILL OWING

__________________________________________________________________________________________

None a. List all suits and administrative proceedings to which the debtor is or was a party within one year immediately

information concerning either or both spouses whether or not a joint petition is filed, unless the spouses are

separated and a joint petition is not filed.)

CAPTION OF SUIT COURT OR AGENCY STATUS OR

____________________________________________________________________________________________

None b. Describe all property that has been attached, garnished or seized under any legal or equitable process within one

13 must include information concerning property of either or both spouses whether or not a joint petition is filed,

unless the spouses are separated and a joint petition is not filed.)

None List all property that has been repossessed by a creditor, sold at a foreclosure sale, transferred through a deed in lieu

(Married debtors filing under chapter 12 or chapter 13 must include information concerning property of either or both

spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.)

DATE OF REPOSSESSION, DESCRIPTION

NAME AND ADDRESS FORECLOSURE SALE, AND VALUE OF

OF CREDITOR OR SELLER TRANSFER OR RETURN PROPERTY

________________________________________________________________________________________

6. Assignments and receiverships

None a. Describe any assignment of property for the benefit of creditors made within 120 days immediately preceding the

by either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint

petition is not filed.)

TERMS OF

None preceding the commencement of this case. (Married debtors filing under chapter 12 or chapter 13 must include information

___________________________________________________________________________________________

7. Gifts

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None List all payments made or property transferred by or on behalf of the debtor to any persons, including attorneys, for

one year immediately preceding the commencement of this case.

None If the debtor has moved within the two years immediately preceding the commencement of this case, list all premises

filed, report also any separate address of either spouse.

ADDRESS NAME USED DATES OF OCCUPANCY

___________________________________________________________________________________________

16. Spouses and Former Spouses

None If the debtor resides or resided in a community property state, commonwealth, or territory (including Alaska, Arizona,

year period immediately preceding the commencement of the case, identify the name of the debtor's spouse and of

any former spouse who resides or resided with the debtor in the community property state.

NAME

__________________________________________________________________________________

17. Environmental Information.

For the purpose of this question, the following definitions apply:

"Environmental Law" means any federal, state, or local statute or regulation regulating pollution, contamination,

releases of hazardous or toxic substances, wastes or material into the air, land, soil, surface water, groundwater, or

other medium, including, but not limited to, statutes or regulations regulating the cleanup of these substances, wastes,

or material.

"Site" means any location, facility, or property as defined under any Environmental Law, whether or not presently

or formerly owned or operated by the debtor, including, but not limited to, disposal sites.

"Hazardous Material" means anything defined as a hazardous waste, hazardous substance, toxic substance,

hazardous material, pollutant, or contaminant or similar term under an Environmental Law

None a. List the name and address of every site for which the debtor has received notice in writing by a governmental

governmental unit, the date of the notice, and, if known, the Environmental Law:

SITE NAME NAME AND ADDRESS DATE OF ENVIRONMENTAL

____________________________________________________________________________________

None b. . List the name and address of every site for which the debtor provided notice to a governmental unit of a release

_____________________________________________________________________________________

None c. List all judicial or administrative proceedings, including settlements or orders, under any Environmental Law with

was a party to the proceeding, and the docket number.

NAME AND ADDRESS DOCKET NUMBER STATUS OR DISPOSITION

OF GOVERNMENTAL UNIT

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18. Nature, location and name of business

None a. If the debtor is an individual, list the names, addresses, taxpayer identification numbers, nature of the businesses,

executive of a corporation, partnership, sole proprietorship, or was a self-employed professional within the six

years immediately preceding the commencement of this case, or in which the debtor owned 5 percent or more of

the voting or equity securities within the six years immediately preceding the commencement of this case.

If the debtor is a partnership, list the names, addresses, taxpayer identification numbers, nature of the

businesses, and beginning and ending dates of all businesses in which the debtor was a partner or owned 5

percent or more of the voting or equity securities, within the six years immediately preceding the

commencement of this case.

If the debtor is a corporation, list the names, addresses, taxpayer identification numbers, nature of the

businesses, and beginning and ending dates of all businesses in which the debtor was a partner or owned 5

percent or more of the voting or equity securities within the six years immediately preceding the

commencement of this case.

TAXPAYER BEGINNING AND ENDING

_______________________________________________________________________________________

None b. Identify any business listed in response to subdivision a., above, that is "single asset real estate" as

NAME ADDRESS

_______________________________________________________________________________________

The following questions are to be completed by every debtor that is a corporation or partnership and by any individual

debtor who is or has been, within the six years immediately preceding the commencement of this case, any of the following: an

officer, director, managing executive, or owner of more than 5 percent of the voting or equity securities of a corporation; a

partner, other than a limited partner, of a partnership; a sole proprietor or otherwise self-employed.

(An individual or joint debtor should complete this portion of the statement only if the debtor is or has been in business, as defined above, within the six years immediately preceding the commencement of this case. A debtor who has not been in business within those six years should go directly to the signature page.)

None a. List all bookkeepers and accountants who within the two years immediately preceding the filing of this

NAME AND ADDRESS DATES SERVICES RENDERED

None b. List all firms or individuals who within the two years immediately preceding the filing of this bankruptcy

None c. List all firms or individuals who at the time of the commencement of this case were in possession of the

None d. List all financial institutions, creditors and other parties, including mercantile and trade agencies, to whom a

debtor.

NAME AND ADDRESS DATE ISSUED

____________________________________________________________________________________

20. Inventories

None a. List the dates of the last two inventories taken of your property, the name of the person who supervised the

None b. List the name and address of the person having possession of the records of each of the two inventories reported

ٱ in a., above.

NAME AND ADDRESSES OF CUSTODIAN

None a. If the debtor is a partnership, list the nature and percentage of partnership interest of each member of the

None b. If the debtor is a corporation, list all officers and directors of the corporation, and each stockholder who

corporation.

NATURE AND PERCENTAGE

NAME AND ADDRESS TITLE OF STOCK OWNERSHIP

_______________________________________________________________________________

22. Former partners, officers, directors and shareholders

None a. If the debtor is a partnership, list each member who withdrew from the partnership within one year immediately

None b. If the debtor is a corporation, list all officers, or directors whose relationship with the corporation terminated

None If the debtor is a partnership or corporation, list all withdrawals or distributions credited or given to an insider,

during one year immediately preceding the commencement of this case.

NAME & ADDRESS AMOUNT OF MONEY

OF RECIPIENT, DATE AND PURPOSE OR DESCRIPTION

None If the debtor is a corporation, list the name and federal taxpayer identification number of the parent corporation of any

ٱ consolidated group for tax purposes of which the debtor has been a member at any time within the six-year period

immediately preceding the commencement of the case.

NAME OF PARENT CORPORATION TAXPAYER IDENTIFICATION NUMBER

___________________________________________________________________________________

25. Pension Funds.

None If the debtor is not an individual, list the name and federal taxpayer identification number of any pension fund to

immediately preceding the commencement of the case.

NAME OF PENSION FUND TAXPAYER IDENTIFICATION NUMBER

______________________________________

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I certify that I am a bankruptcy petition preparer as defined in I I U.S.C. § 110, that I prepared this document for compensation, and that I have provided the debtor with a copy of this document.

_____________________________________________ ________________________________

Printed or Typed Name of Bankruptcy Petition Preparer Social Security No.

_________________________________

_________________________________

Address

Names and Social Security numbers of all other individuals who prepared or assisted in preparing this document:

If more than one person prepared this document, attach additional signed sheets conforming to the appropriate Official Form for each person.

X ___________________________________________________ _________________________________

Signature of Bankruptcy Petition Preparer Date