exhibita.pdf

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secured unsecured subordinated secured secured Exchange Act number Exhibit Form

Form B1, Exh.A (9/97)
Exhibit "A"
[If debtor is required to file periodic reports (e.g., forms 10K and 10Q) with the Securities and Exchange
Commission pursuant to Section 13 or 15(d) of the Securities Exchange Act of 1934 and is requesting relief under
chapter 11 of the Bankruptcy Code, this Exhibit “A” shall be completed and attached to the petition.]
[Caption as in Form 16B]
Exhibit "A" to Voluntary Petition
1.
If any of the debtor’s securities are registered under Section 12 of the Securities Exchange Act of 1934, the
SEC file number is _______________.
2.
The following financial data is the latest available information and refers to the debtor’s condition on
______________.
a.
Total assets
$  _____________________________
 
b.
Total debts (including debts listed in 2.c., below)
$ ______________________________
 
Approximate
number of
holders
c.
Debt securities held by more than 500 holders. 
secured /  /
unsecured /  /
subordinated /  /
$ _________________________
_______________
secured /  /
unsecured /  /
subordinated /  /
$__________________________
_______________
secured /  /
unsecured /  /
subordinated /  /
$ _________________________
_______________
secured /  /
unsecured /  /
subordinated /  /
$__________________________
_______________
secured /  /
unsecured /  /
subordinated /  /
$__________________________
_______________
d.
Number of shares of preferred stock
  _______________________
_____________
e.
Number of shares common stock
  _______________________
_____________
Comments, if any: _____________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
3.
Brief description of debtor’s business:  ____________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
4.
List the names of any person who directly or indirectly owns, controls, or holds, with power to vote, 5% or
more of the voting securities of debtor:
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________