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. b. Total assets Total debts (including debts listed in 2.c., below) $ _____________________________ $ ______________________________ Approximate number of holders c. Debt securities held by more than 500 holders. secured / /
secured / / unsecured / / unsecured / / unsecured / / unsecured / / unsecured / / subordinated / / subordinated / / subordinated / / subordinated / / subordinated / / $ _________________________ $__________________________ $ _________________________ $__________________________ $__________________________ _______________ _______________ _______________ _______________ _______________
secured / /
secured / / secured / /
d. e.
Number of shares of preferred stock 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: ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________