Part C„ Prior/Pending Bankruptcy Cases

Has a bankruptcy case been filed by you or against you in the last 8 years? □ No □ Yes

If yes, in which district of which state was the case filed?_____________________________

Case Number:________________________ Date filed:_____________________________

Are there currently any bankruptcy cases pending against you, your business, your spouse, or your spouse’s business? □ No □ Yes

If yes, name of debtor:_________________ Relationship to you:______________________

Case Number:________________ Date filed:____________ Judge: ____________________

In which district of which state was the case filed?___________________________________

Exhibit “C” to the Voluntary Petition

Do you own or have possession of any property that poses or is alleged to pose a threat of imminent and

identifiable harm to public health or safety? □ No □ Yes (if yes, please attach a list and description of the property.)

Debtors Who Reside as Tenants of Residential Property

If you rent your home, does a landlord hold a judgment against you? □ No □ Yes

if yes, please provide the name and address of the landlord:

Name:____________________________________________________________________

Address:__________________________________________________________________

_________________________________________________________________________

City:___________________________ State:________________________ Zip: __________