Current Business Income And Expenses

Rev. 4/2011 Debtor(s) Case No. CURRENT BUSINESS INCOME AND EXPENSES Please provide figures for the full calendar month preceding the date of petition to the date of petition. Bank book balance and cash on hand at beginning of full calendar month preceding filing $ RECEIPTS & OTHER FUNDING: 1. Sales/Receipts 2. Accounts Receivable Collections 3. Loans/Financing 4. Capital Contributions 5. Other Receipts (describe below) $ $ $ I. TOTAL RECEIPTS & FUNDING (sum of lines 1-5) EXPENDITURES: 6. 7. 8. Inventory Purchases Taxes PAYROLL a. Compensation of Insiders b. Salaries & Wages c. Outside Labor 9. Payments to Professionals $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ 10. Insurance 11. Real Property Rent Payments 12. Equipment Lease Payments 13. Mortgage Payments 14. Utilities/Telephone 15. Supplies 16. Repairs & Maintenance 17. Travel & Entertainment American LegalNet, Inc. www.FormsWorkFlow.com 18. Other Expenses (describe below) $ $ $ II. TOTAL EXPENDITURES (sum of lines 6-18) NET CASH FLOW (Total Receipts less Total Expenditures) Bank book balance and cash on hand at date of filing $ $ $ $ (Note: Declaration required if form is filed separately from other schedules.) I/We declare under the penalty of perjury that the information provided in this form is true and correct. Date: (Signature of Debtor) (Printed Name of Debtor) (Signature of Joint Debtor, if any) (Printed Name of Joint Debtor, if any) American LegalNet, Inc. www.FormsWorkFlow.com