Real Property Questionnaire Debtors Principal Residence Only {USTLA-5.1}

Attorney or Professional Name, Address, Telephone and Email File with U.S. Trustee. Do not file with the Bankruptcy court. UNITED STATES BANKRUPTCY COURT CENTRAL DISTRICT OF CALIFORNIA In re: Chapter 11 Case Number Debtor REAL PROPERTY QUESTIONNAIRE DEBTOR'S PRINCIPAL RESIDENCE ONLY THIS QUESTIONAIRE IS TO BE FILLED OUT BY DEBTOR(S) FOR THEIR PRINCIPAL RESIDENCE ONLY. USTLA-5 MUST BE USED FOR ALL OTHER OWNED OR LEASED REAL PROPERTY. THE QUESTIONAIRE IS DUE WITHIN 7 DAYS FROM THE FILING OF A BANKRUPTY PETIION. IF ADDITIONAL TIME IS NEEDED, DEBTORS AND THEIR ATTORNEYS SHOULD CONTACT THE U.S. TRUSTEE TRIAL ATTORNEY ASSIGNED TO THEIR CASE TO REQUEST A REASONABLE EXTENSION OF TIME FOR GOOD CAUSE SHOWN. SECTION ONE: PROPERTY OWNED OR BEING PURCHASED BY DEBTOR A. Address of property including county and state in which it is located: B. C. D. E. Percentage interest in the property owned by the Debtor: Date of Debtor=s Acquisition of the Property: Purchase Price: $ Present Fair Market Value: $ State source and basis of the above fair market value: F. State the name of the titleholder of record as of the date of filing the Petition: Revised July 2011 REAL PROPERTY QUESTIONNAIRE (Page 1 of 2) USTLA-5-Residence In re: Debtor(s) CHAPTER CASE NUMBER 11 SECTION TWO: FINANCIAL STATUS OF OWNED PROPERTY A. List encumbrances of record against the property (e.g. mortgages, judgments): Creditor Name 1st: 2nd: 3rd: 4th: Maturity Date 1st: 2nd: 3rd: 4th: Date of Last Payment Number of Delinquent Installments Current Principal Balance Installment Amount Frequency (Mo/Qtr/Yr) I declare under penalty of perjury that the answers contained in the foregoing Real Property Questionnaire are true and correct to the best of my knowledge, information and belief. Dated: Print Name of Debtor Signature of Debtor Revised July 2011 REAL PROPERTY QUESTIONNAIRE (Page 2 of 2) USTLA-5-Residence