Fill and Sign the Form B5 Fillable Fill Online Printable Fillable Blankpdffiller

B5 (Official Form 5) ( 12/07 ) United States Bankruptcy Court ______________________District of______________________ INVOLUNTARY PETITION IN RE (Name of Debtor – If I ndividual: Last, First, Middle) L ast four digits of Soc ial-Security or Individual's Tax -I.D. No. /Complete EIN (If more than one, state all .): ALL OTHER NAMES used by debtor in the last 8 years (Include married, maiden, and trade names.) STRE ET A DDR ESS OF DEB TOR (No. and stree t, ci ty , state, and zip code) ZIP CODE MAILING ADDRESS OF DEBTOR (If different from street address) ZIP CODE LOCATION OF PRINCIPAL ASSETS OF BUSINESS DEBTOR (If different from previously listed addresses) CHAPTER OF BANKRUPTCY CODE UNDER WHICH PETITION IS FILED G Chapter 7 G Chapter 11 INFORMATION REGARDING DEBTOR (Check applicable boxes) Nature of Debts (Check one box.) Petitioners believe: G Debts are primarily consumer debts G Debts are primarily business debts Type of Debtor (Form of Organization) G Individual (Includes Joint Debtor) G Corporation (Includes LLC and LLP) G Partnership G Other (If debtor is not one of the above entities, check this box and state type of entity below.) ________________________________________ Nature of Business (Check one box.) G Health Care Business G Single Asset Real Estate as defined in 11 U .S .C . § 101 (51 )(B) G Railroad G Stockb roker G Commodity Broker G Clearing Bank G Ot her VENUE G Debtor has been domiciled or has had a residence, principal place of business, or princi pal assets in the District for 180 days immediately preceding the date of this petition or for a longer part of such 180 days than in any other District. G A bankruptcy case concerni ng debtor’s affiliate, general partner or partnershi p is pending in this District. FILING FEE (Check one box) G Full Filing Fee attached G Petitioner is a child support creditor or its representative, and the form specified in § 304(g) of the Bankruptcy Reform Act of 1994 is attached. [If a child support creditor or its representative is a petitioner, and if the petitioner files the form specified in § 304( g) of the Bankruptcy Reform Act of 1994, no fee is required.] PENDING BANKRUPTCY CASE FILED BY OR AGAINST ANY PARTNER OR AFFILIATE OF THIS DEBTOR (Report information for any additional cases on attached sheets.) Name of Debtor Case Number Date Relationship District Judge ALLEGATIONS (Check applicable boxes) 1. G Petitioner (s) are eligible to file this petition pursuant to 11 U.S. C. § 303 (b). 2. G The debtor is a person against whom an order for relief may be entered under title 11 of the United States Code. 3.a. G The debtor is generally not paying such debtor’s de bts as they become due, unless such debts are the subject of a bona fide dispute as to liability or amount; or b. G Within 120 days preceding the filing of this petiti on, a custodian, other than a trustee receiver, or agent appointed or authorized to take char ge of less than substantially all of the property of the debtor for the purpose of enforcing a lie n against such property, was appointed or took possession. COURT USE ONLY B5 (Official Form 5) ( 12 /07) – Page 2 N ame of D eb to r_______________ __________ Case No.__ ___ __ ___ ___ ___ ___ ___ ___ ______ TRANSFER OF CLAIM G Check this box if there has been a transfer of any claim against the debtor or to any petitioner. Attach all documents that evidence the transfer and any statements that are required under Bankruptcy Rule 1003(a). REQUEST FOR RELIEF Petitioner(s) request that an order for relief be entered against the debtor under the chapter of title 11, United States Code, specified in this petition. If any petitioner is a foreign re presentative appointed in a foreign proceed ing, a certified copy of the order of the court granting recognition is attached. Petitioner(s) declare under penalty of perjury that the foregoing is true and correct according to the best of their knowledge, information, and belief. x__________________________________________________________ Signature of Petitioner or Representative (State title) Name of Petitioner Date Signed Name & Mailing Address of Indi vidual Signing in Representative Capacity x______________________________________________________ Signature of Attorney Date Name of Attorney Firm (If any) _______________________________________________________ Address Telephone No. x__________________________________________________________ Signature of Petitioner or Representative (State title) Name of Petitioner Date Signed Name & Mailing Address of Indi vidual Signing in Representative Capacity x______________________________________________________ Signature of Attorney Date Name of Attorney Firm (If any) _______________________________________________________ Address Telephone No. x__________________________________________________________ Signature of Petitioner or Representative (State title) Name of Petitioner Date Signed Name & Mailing Address of Indi vidual Signing in Representative Capacity x______________________________________________________ Signature of Attorney Date Name of Attorney Firm (If any) _______________________________________________________ Address Telephone No. PETITIONING CREDITORS Name and Address of Petitioner Nature of Claim Amount of Claim Name and Address of Petitioner Nature of Claim Amount of Claim Name and Address of Petitioner Nature of Claim Amount of Claim Note: If there are more than three petitio ners, attach additional sheets with the statement under penalty of perjury, each petit ioner’s signature under the statement and the name of attorney and petitioning creditor information in the format above. Total Amount of Petitioners’ Claims ______continuation sheets attached