Statement Regarding Corporate Ownership (Adversary Proceedings)

Revised 02/04UNITED STATES BANKRUPTCY COURTEASTERN DISTRICT OF MICHIGANIn re:Case No. Chapter Debtor.Hon. /Plaintiff,v.Adv. No. Defendant./STATEMENT REGARDING CORPORATE OWNERSHIPGThe following entities directly or indirectly own 10% or more of any class of the corporation222s equity interest:Name: Address: Name: Address: Name: Address: (For additional names, attache an addendum to this form)GThere are no entities that directly or indirectly own 10% or more of any class of the corporation222s equityinterest.The undersigned is the:G PlaintiffG DefendantI declare under penalty of perjury that the foregoing is true and correct.Dated: Signature of Authorized IndividualFor Corporate PartyPrint NameTitle American LegalNet, Inc. www.FormsWorkFlow.com