Official Form 201 "Voluntary Petition for Non-individuals Filing for Bankruptcy"

What Is Official Form 201?

This is a legal form that was released by the United States Bankruptcy Court on April 1, 2019 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on April 1, 2019;
  • The latest available edition released by the United States Bankruptcy Court;
  • Easy to use and ready to print;
  • Yours to fill out and keep for your records;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Official Form 201 by clicking the link below or browse more documents and templates provided by the United States Bankruptcy Court.

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Download Official Form 201 "Voluntary Petition for Non-individuals Filing for Bankruptcy"

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Fill in this information to identify the case:
United States Bankruptcy Court for the:
____________________ District of _________________
(State)
Case number
_________________________ Chapter _____
(If known):
Check if this is an
amended filing
Official Form 201
Voluntary Petition for Non-Individuals Filing for Bankruptcy
04/20
If more space is needed, attach a separate sheet to this form. On the top of any additional pages, write the debtor’s name and the case
number (if known). For more information, a separate document, Instructions for Bankruptcy Forms for Non-Individuals, is available.
Debtor’s name
1.
______________________________________________________________________________________________________
All other names debtor used
______________________________________________________________________________________________________
2.
in the last 8 years
______________________________________________________________________________________________________
______________________________________________________________________________________________________
Include any assumed names,
______________________________________________________________________________________________________
trade names, and doing business
______________________________________________________________________________________________________
as names
Debtor’s federal Employer
3.
___ ___ – ___ ___ ___ ___ ___ ___ ___
Identification Number (EIN)
Debtor’s address
Principal place of business
Mailing address, if different from principal place
4.
of business
_______________________________________________
______________________________________________
Number
Street
Number
Street
_______________________________________________
______________________________________________
P.O. Box
______________________________________________
_______________________________________________
City
State
ZIP Code
City
State
ZIP Code
Location of principal assets, if different from
principal place of business
______________________________________________
_______________________________________________
County
Number
Street
_______________________________________________
_______________________________________________
City
State
ZIP Code
Debtor’s website (URL)
5.
____________________________________________________________________________________________________
Official Form 201
Voluntary Petition for Non-Individuals Filing for Bankruptcy
page 1
Fill in this information to identify the case:
United States Bankruptcy Court for the:
____________________ District of _________________
(State)
Case number
_________________________ Chapter _____
(If known):
Check if this is an
amended filing
Official Form 201
Voluntary Petition for Non-Individuals Filing for Bankruptcy
04/20
If more space is needed, attach a separate sheet to this form. On the top of any additional pages, write the debtor’s name and the case
number (if known). For more information, a separate document, Instructions for Bankruptcy Forms for Non-Individuals, is available.
Debtor’s name
1.
______________________________________________________________________________________________________
All other names debtor used
______________________________________________________________________________________________________
2.
in the last 8 years
______________________________________________________________________________________________________
______________________________________________________________________________________________________
Include any assumed names,
______________________________________________________________________________________________________
trade names, and doing business
______________________________________________________________________________________________________
as names
Debtor’s federal Employer
3.
___ ___ – ___ ___ ___ ___ ___ ___ ___
Identification Number (EIN)
Debtor’s address
Principal place of business
Mailing address, if different from principal place
4.
of business
_______________________________________________
______________________________________________
Number
Street
Number
Street
_______________________________________________
______________________________________________
P.O. Box
______________________________________________
_______________________________________________
City
State
ZIP Code
City
State
ZIP Code
Location of principal assets, if different from
principal place of business
______________________________________________
_______________________________________________
County
Number
Street
_______________________________________________
_______________________________________________
City
State
ZIP Code
Debtor’s website (URL)
5.
____________________________________________________________________________________________________
Official Form 201
Voluntary Petition for Non-Individuals Filing for Bankruptcy
page 1
Debtor
_______________________________________________________
Case number
_____________________________________
(if known)
Name
Corporation (including Limited Liability Company (LLC) and Limited Liability Partnership (LLP))
Type of debtor
6.
Partnership (excluding LLP)
Other. Specify: __________________________________________________________________
A. Check one:
Describe debtor’s business
7.
Health Care Business (as defined in 11 U.S.C. § 101(27A))
Single Asset Real Estate (as defined in 11 U.S.C. § 101(51B))
Railroad (as defined in 11 U.S.C. § 101(44))
Stockbroker (as defined in 11 U.S.C. § 101(53A))
Commodity Broker (as defined in 11 U.S.C. § 101(6))
Clearing Bank (as defined in 11 U.S.C. § 781(3))
None of the above
B. Check all that apply:
Tax-exempt entity (as described in 26 U.S.C. § 501)
Investment company, including hedge fund or pooled investment vehicle (as defined in 15 U.S.C.
§ 80a-3)
Investment advisor (as defined in 15 U.S.C. § 80b-2(a)(11))
C. NAICS (North American Industry Classification System) 4-digit code that best describes debtor. See
http://www.uscourts.gov/four-digit-national-association-naics-codes
.
___ ___ ___ ___
Under which chapter of the
Check one:
8.
Bankruptcy Code is the
Chapter 7
debtor filing?
Chapter 9
Chapter 11. Check all that apply:
A debtor who is a “small business
The debtor is a small business debtor as defined in 11 U.S.C. § 101(51D), and its
debtor” must check the first sub-
aggregate noncontingent liquidated debts (excluding debts owed to insiders or
box. A debtor as defined in
affiliates) are less than $2,725,625. If this sub-box is selected, attach the most
§ 1182(1) who elects to proceed
recent balance sheet, statement of operations, cash-flow statement, and federal
under subchapter V of chapter 11
income tax return or if any of these documents do not exist, follow the procedure in
(whether or not the debtor is a
11 U.S.C. § 1116(1)(B).
“small business debtor”) must
check the second sub-box.
The debtor is a debtor as defined in 11 U.S.C. § 1182(1), its aggregate
noncontingent liquidated debts (excluding debts owed to insiders or affiliates) are
less than $7,500,000, and it chooses to proceed under Subchapter V of
Chapter 11. If this sub-box is selected, attach the most recent balance sheet,
statement of operations, cash-flow statement, and federal income tax return, or if
any of these documents do not exist, follow the procedure in 11 U.S.C.
§ 1116(1)(B).
A plan is being filed with this petition.
Acceptances of the plan were solicited prepetition from one or more classes of
creditors, in accordance with 11 U.S.C. § 1126(b).
The debtor is required to file periodic reports (for example, 10K and 10Q) with the
Securities and Exchange Commission according to § 13 or 15(d) of the Securities
Exchange Act of 1934. File the Attachment to Voluntary Petition for Non-Individuals Filing
for Bankruptcy under Chapter 11 (Official Form 201A) with this form.
The debtor is a shell company as defined in the Securities Exchange Act of 1934 Rule
12b-2.
Chapter 12
Official Form 201
Voluntary Petition for Non-Individuals Filing for Bankruptcy
page 2
Debtor
_______________________________________________________
Case number
_____________________________________
(if known)
Name
Were prior bankruptcy cases
9.
No
filed by or against the debtor
Yes.
District _______________________ When _______________ Case number _________________________
within the last 8 years?
MM / DD / YYYY
If more than 2 cases, attach a
District _______________________ When _______________ Case number _________________________
separate list.
MM / DD / YYYY
Are any bankruptcy cases
10.
No
pending or being filed by a
Yes.
business partner or an
Debtor _____________________________________________ Relationship _________________________
affiliate of the debtor?
District _____________________________________________ When
__________________
MM / DD
/ YYYY
List all cases. If more than 1,
attach a separate list.
Case number, if known ________________________________
Why is the case filed in this
Check all that apply:
11.
district?
Debtor has had its domicile, principal place of business, or principal assets in this district for 180 days
immediately preceding the date of this petition or for a longer part of such 180 days than in any other
district.
A bankruptcy case concerning debtor’s affiliate, general partner, or partnership is pending in this district.
Does the debtor own or have
12.
No
possession of any real
Yes. Answer below for each property that needs immediate attention. Attach additional sheets if needed.
property or personal property
that needs immediate
Why does the property need immediate attention?
(Check all that apply.)
attention?
It poses or is alleged to pose a threat of imminent and identifiable hazard to public health or safety.
What is the hazard?
_____________________________________________________________________
It needs to be physically secured or protected from the weather.
It includes perishable goods or assets that could quickly deteriorate or lose value without
attention (for example, livestock, seasonal goods, meat, dairy, produce, or securities-related
assets or other options).
Other
_______________________________________________________________________________
Where is the property?
_____________________________________________________________________
Number
Street
____________________________________________________________________
_______________________________________
_______ ________________
City
State ZIP Code
Is the property insured?
No
Yes.
Insurance agency ____________________________________________________________________
Contact name
____________________________________________________________________
Phone
________________________________
Statistical and administrative information
Official Form 201
Voluntary Petition for Non-Individuals Filing for Bankruptcy
page 3
Debtor
_______________________________________________________
Case number
_____________________________________
(if known)
Name
Debtor’s estimation of
Check one:
13.
available funds
Funds will be available for distribution to unsecured creditors.
After any administrative expenses are paid, no funds will be available for distribution to unsecured creditors.
1-49
1,000-5,000
25,001-50,000
Estimated number of
14.
50-99
5,001-10,000
50,001-100,000
creditors
100-199
10,001-25,000
More than 100,000
200-999
$0-$50,000
$1,000,001-$10 million
$500,000,001-$1 billion
Estimated assets
15.
$50,001-$100,000
$10,000,001-$50 million
$1,000,000,001-$10 billion
$100,001-$500,000
$50,000,001-$100 million
$10,000,000,001-$50 billion
$500,001-$1 million
$100,000,001-$500 million
More than $50 billion
$0-$50,000
$1,000,001-$10 million
$500,000,001-$1 billion
Estimated liabilities
16.
$50,001-$100,000
$10,000,001-$50 million
$1,000,000,001-$10 billion
$100,001-$500,000
$50,000,001-$100 million
$10,000,000,001-$50 billion
$500,001-$1 million
$100,000,001-$500 million
More than $50 billion
Request for Relief, Declaration, and Signatures
WARNING -- Bankruptcy fraud is a serious crime. Making a false statement in connection with a bankruptcy case can result in fines up to
$500,000 or imprisonment for up to 20 years, or both. 18 U.S.C. §§ 152, 1341, 1519, and 3571.
Declaration and signature of
17.
The debtor requests relief in accordance with the chapter of title 11, United States Code, specified in this
authorized representative of
petition.
debtor
I have been authorized to file this petition on behalf of the debtor.
I have examined the information in this petition and have a reasonable belief that the information is true and
correct.
I declare under penalty of perjury that the foregoing is true and correct.
Executed on _________________
MM / DD / YYYY
_____________________________________________
_______________________________________________
Signature of authorized representative of debtor
Printed name
Title
_________________________________________
Official Form 201
Voluntary Petition for Non-Individuals Filing for Bankruptcy
page 4
Debtor
_______________________________________________________
Case number
_____________________________________
(if known)
Name
Signature of attorney
18.
Date
_____________________________________________
_________________
Signature of attorney for debtor
MM
/ DD / YYYY
_________________________________________________________________________________________________
Printed name
_________________________________________________________________________________________________
Firm name
_________________________________________________________________________________________________
Number
Street
____________________________________________________
____________ ______________________________
City
State
ZIP Code
____________________________________
__________________________________________
Contact phone
Email address
______________________________________________________ ____________
Bar number
State
Official Form 201
Voluntary Petition for Non-Individuals Filing for Bankruptcy
page 5
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