Initial Financial Report (Chapter 11 Cover Sheet) {1}

DEBTOR: CASE NUMBER: INITIAL FINANCIAL REPORT CHAPTER 11 COVER SHEET Date of Report THIS REPORT IS DUE 21 DAYS AFTER THE PETITION FILING DATE Debtor must attach each of the following documents or a satisfactory explanation for failure to attach a document. Submit original report to U.S. Trustee. Do not file report with Clerk of Court. Mark One Box for Each Required Document: Document Attached Previously Explanation Submitted Attached REQUIRED DOCUMENTS 1. Latest Fiscal Year Financial Statements or Tax Returns 2. Balance Sheet as of Month End Immediately Preceding Filing 3. Profit and Loss Statement for Month and Year Immediately Preceding Filing 4. Insurance & Environmental Risk Questionnaire - Proof of: a. General Liability Insurance b. Property (Fire, Theft, etc.) Insurance c. Workers' Compensation Insurance d. Vehicle Insurance e. Other: 5. Projected Revenue, Expenses and Cash Flow for First 180 Days of Post Petition Operations (Form IR-1) 6. Name and Address of Financial Institution, Account Number and Sample Voided Check for Each Debtor in Possession Bank Account a. General Account c. Tax Account (if required) I declare under penalty of perjury that the following Initial Financial Report, and any attachments thereto, are true and correct to the best of my knowledge and belief. Executed on: Debtor(s): By: Position: Email & Phone: Form 1 Rev. 12/10/2009 American LegalNet, Inc. www.FormsWorkFlow.com