SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 8-K
Current Report
Pursuant to Section 13 or 15(d) of
the Securities Exchange Act of 1934
Date of Report: May 21, 1998
Dakota Mining Corporation
(Exact Name of Registrant as Specified in its Charter)
Canada 0-17583 84-1094683
(State or Other Jurisdiction (Commission File Number) (I.R.S. Employer
of Incorporation) Identification No.)
1560 Broadway, Suite 880
Denver, Colorado 80202
(Address of Principal Executive Offices) (Zip Code)
Registrant's telephone number, including area code: (303) 573-0221
Not Applicable
(Former Name or Former Address, if Changed Since Last Report)
<PAGE>
Item 3. Bankruptcy or Receivership
Although Dakota itself has not initiated or become the subject
of proceedings under the Bankruptcy Code or any other state or
federal law, two of its subsidiaries, USMX of Alaska Inc. ("USMXAK")
and USMX Inc. ("USMX"), filed for protection under Chapter XI of the
Bankruptcy Code in the United States Bankruptcy Court for the District
of Colorado on May 21, 1998. USMXAK is the sole gold producing
subsidiary of Dakota. USMXAK and USMX continue to operate their
respective businesses as debtors in possession pursuant to Chapter XI
of the Bankruptcy Code, subject to jurisdiction of the United
States Bankruptcy Court. No trustee or examiner has been appointed.
See also Item 5 of this report.
Item 5. Other Events
The severe liquidity and other financial issues as disclosed and
discussed in Dakota Mining Corporation's ("Dakota" or the "Company")
February 26, 1998 Form 8-K and April 14,1998 News Release continue and
the liquidity and financial condition has continued to deteriorate.The
Company was unsuccessful in selling Company assets,attracting a merger
partner or securing alternative financing. Dakota and its subsidiaries
are in default under terms of agreements with their respective
lenders.However, creditors, including lenders, have not taken any
actions against Dakota or its subsidiaries. Among other things, Dakota
has an interest payment due to the holders of their 7.5%
Convertible Subordinated Debentures on June 30, 1998 in the amount of
$640,721 (Cdn.$929,795). The Company does not currently nor expects to
have the funds adequate to service this payment.
On May 21, 1998, two of Dakota's subsidiaries, USMX of Alaska Inc.
("USMXAK") and USMX Inc.("USMX"), filed in Denver, Colorado, voluntary
reorganization under Chapter XI of the Bankruptcy Code as fully
disclosed above in Item 3. Neither Dakota nor any of its other
subsidiaries have filed bankruptcy at this time, although they may
determine to do so in the future as a result of their poor financial
condition. USMXAK is the sole gold producing subsidiary of Dakota.
Daily operations at the Illinois Creek mine are expected to continue
pending the submission of the required documents to the bankruptcy
court, including a reorganization plan which is due within 120 days of
filing. This action was taken to protect the ability of the Company to
maximize the value of the assets. USMXAK debtor in possession received
court approval to pay from the proceeds account pre-petition wages,
current operating costs from May 21, 1998 until June 12, 1998, and a
management fee of $75,000. The Company was unable to fulfill its
reporting requirements to file, among other things, audited financial
statements for the period ending December 31, 1997. As a result, the
Ontario Securities Commission filed a temporary order and hearing to
cease trading of the Company securities on the Toronto Stock Exchange.
Dakota does not intend to contest the Commission's order. The result
would be a voluntary suspension of trading in the sharesof the Company
until such time as the listing requirements can be satisfied.
<PAGE>
On May 29, 1998, the State of South Dakota obtained a Temporary
Restraining Order ("TRO") against a subsidiary of Dakota, Brohm Mining
Corp. ("Brohm"). The TRO requires Brohm to continue to operate water
treatment systems at the Gilt Edge mine in accordance with state mine
permits. Pending a court hearing scheduled for June 5, 1998, the
Company intends to comply with this order. The Gilt Edge mine is not
in operation at this time.
Dakota's subsidiary, USMX, has received notice from the property owner
of the Thunder Mountain Joint Venture. The property owner believes the
Company is in default of the agreement of which the Company strongly
disagrees.
Christopher M.T. Thompson resigned as Chairman of the Board, effective
April 21, 1998 on his acceptance of a position with N M Rothschild &
Sons,the secured lender to USMXAK, due to concerns regarding potential
conflicts of interest. A replacement has not been named.
C. Brian Cramm resigned as the Vice President of Finance, Chief
Financial Officer, and Secretary effective May 8, 1998. A replacement
has not been named.
This document contains forward-looking information, which involves a
degree of risk and uncertainty due to various factors affecting
Dakota's business, including, but not limited to, gold price
volatility, ore grade and recovery rates, exploration results, mining
and processing conditions and costs, and compliance with regulatory
and permitting requirements.
Item 7.
Exhibits
USMX, Inc. Chapter 11 Voluntary Petition
USMX of Alaska, Inc. Chapter 11 Voluntary Petition
USMX of Alaska, Inc. Notice of Stipulation Concerning Consent for
the Emergency Interim Use of Cash Collateral
USMX of Alaska, Inc Stipulation and Consent Regarding Payment of Pre-
Petition Wages
SIGNATURES
Pursuant to the requirements of the Securities Exchange Act of 1934, the
registrant has duly caused this report to be signed on its behalf by the
undersigned hereunto duly authorized.
DAKOTA MINING CORPORATION
June 5, 1998
By: c/s Alan R. Bell
Alan R. Bell, President
and Chief Executive officer
UNITED STATES BANKRUPTCY COURT
FOR THE DISTRICT OF COLORADO
In re: CHAPTER 11
USMX OF ALASKA, INC. Case No. 98-17143-DEC
Tax I.D. No. 84-1294496
NOTICE OF STIPULATION REGARDING CONSENT
FOR THE EMERGENCY INTERIM USE OF CASH COLLATERAL
USMX of Alaska, Inc. provides notice of the attached Stipulation
Regarding Consent for the Emergency Interim Use of Cash Collateral among USMX
of Alaska, Inc., NM Rothschild & Sons, Ltd., and D.H. Blattner & Sons,
Inc. The Stipulation is entered into pursuant to 11 U.S.C. ss. 363(c)(2)(A).
LeBOEUF, LAMB, GREENE & MacRAE, L.L.P.
By: _______________________________________
Carl A. Eklund, #2299
Bart B. Burnett, #21258
633 17th Street, Suite 2000
Denver, Colorado 80202
Telephone: (303) 291-2600
Facsimile: (303) 297-0422
ATTORNEYS FOR DEBTORS
UNITED STATES BANKRUPTCY COURT
FOR THE DISTRICT OF COLORADO
In re: CHAPTER 11
USMX OF ALASKA, INC. Case No. 98-17143-DEC
Tax I.D. No. 84-1294496
STIPULATION AND CONSENT REGARDING
PAYMENT OF PRE-PETITION WAGES
USMX of Alaska, Inc. ("USMXAK") (the "Debtor"), NM Rothschild & Sons,
Ltd. ("Rothschild"), and D. H.Blattner & Sons, Inc. ("Blattner"), stipulate
and consent as follows:
1. On May 27,1998, the Debtor filed an Emergency Motion for Authority
to Pay Pre-petition Wages (the "Wage Motion"). A copy of the Wage Motion is
attached hereto as Exhibit A.
2. Pursuant to the Wage Motion, the Debtor has requested that it be
allowed to pay certain pre-petition wages, along with all related taxes,
deductions and withholdings pertaining to such wages and salaries. In seeking
authority to pay its pre-petition wages, the Debtor hopes to maintain the
continuity of it business and to preserve the morale of its current employees.
As set forth more fully in the Wage Motion, the Debtor fears that any delay in
paying its employees' pre-petition wages may adversely affect the Debtor's
efforts to reorganize.
3. The Debtor, Rothschild and Blattner have since entered into a
Stipulation Regarding the Emergency Interim Use of Cash Collateral (the
"Stipulation"). Pursuant to the Stipulation, the parties have consented to the
Debtor's payment of its employees' pre-petition wages.
4. Accordingly, Rothschild and Blattner do not oppose the immediate
entry of an order authorizing payment of certain pre-petition wages of the
Debtor as requested in the Wage Motion.
WHEREFORE, the Debtor requests that this Court authorize and allow the
Debtor to pay its employees the amounts due for their pre-petition wages, along
with all related taxes, deductions and withholdings pertaining to such wages
and salaries as set forth in the Wage Motion.
<PAGE>
DATED this _____ day of May, 1998.
LeBOEUF, LAMB, GREENE & MacRAE, L.L.P.
By: ___________________________
Carl A. Eklund, #2299
Bart B. Burnett, #21258
633 17th Street, Suite 2000
Denver, Colorado 80202
Telephone: (303) 291-2600
Facsimile: (303) 297-0422
ATTORNEYS FOR DEBTORS
DAVIS, GRAHAM & STUBBS, LLP
By: ___________________________
Glen E. Keller, Jr., #3113
370 17th St., #4700
Denver, CO 80202-5647
Telephone: (303) 892-9400
Facsimile: (303) 893-1379
ATTORNEYS FOR NM ROTHSCHILD
& SONS, LTD.
FABYANSKE, WESTRA & HART, P.A.
By: __________________________
Paul L. Ratelle, #127632
Jeremiah J. Kearney
920 Second Avenue South
Suite 1100
Minneapolis, MN 55401
Telephone: (612) 338-0115
Facsimile: (612) 338-3857
ATTORNEYS FOR D.H. BLATTNER
& SONS, INC.
UNITED STATES BANKRUPTCY COURT
V O L U N T A R Y P E T I T I O N
----------------------------------------=====================================
|
| For the DISTRICT OF COLORADO
- -----------------------------------------=====================================
|IN RE (Name of debtor, if individual, Last, First, Middle)
| USMX OF ALASKA, INC.
|NAME OF JOINT DEBTOR
(Spouse)(Last, First, Middle) |
- ------------------------------------------------------------------------------
| ALL OTHER NAMES used by the debtor in the last 6 years
|Include married, maiden, and trade names)
|
| ALL OTHER NAMES used by the Joint debtor in the last 6 years
|(Include married, maiden, and trade names)|
|
- ------------------------------------------------------------------------------
| SOC.SEC./TAX I.D. NO. (If more than one, state all)
84-1294496
| SOC.SEC./TAX I.D. NO. (If more than one, state all)
|
- ------------------------------------------------------------------------------
| STREET ADDRESS OF DEBTOR (No & street, city, st. & zip code)
| 1560 Broadway, Suite 880
| Denver, CO 80202
|
| STREET ADDRESS OF JOINT DEBTOR (No. & street, city, st. & zip code)
|
| COUNTY OF RESIDENCE OR PRINCIPAL PLACE OF BUSINESS Denver
- ------------------------------------------------------------------------------
| MAILING ADDRESS OF DEBTOR (If different from street address)
| MAILING ADDRESSOF JOINT DEBTOR (If different from street address)
Same as Above
- -----------------------------------------------------------------------------
| LOCATION OF PRINCIPAL ASSETS OF BUSINESS DEBTOR
| (If different from address listed above)
|
| Interior Alaska:
| 320 NW of Anchorage
VENUE (Check one box)
----------------------------------------------------------------------------
| X Debtor has been domiciled or has had a residence 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.
| There is a bankruptcy case concerning debtor's affiliate,
| general partner, or partnership pending in this District.
- -----------------------------------------------------------------------------
| INFORMATION REGARDING DEBTOR (Check applicable boxes) |
- -----------------------------------------------------------------------------
| TYPE OF DEBTOR
| Individual Corporation Publicly Held
| __ Joint (Husband & Wife) X Corporation Not Publicly Held
| __ Partnership __ Municipality
| __ Other
| NATURE OF DEBT
| Non-Business/Consumer X Business - Complete A&B Below
| A. TYPE OF BUSINESS (Check one)
| __ Farming __ Transportation __ Commodity Broker
| __ Professional X Manufacturing/ __ Construction
| __ Retail/Wholesale Mining __ Real Estate
| __ Railroad __ Stockbroker __ Other Business
| B. BRIEFLY DESCRIBE NATURE OF BUSINESS
| Mining of gold in Alaska.
|
| CHAPTER OR SECTION OF BANKRUPTCY CODE UNDER WHICH THE PETITION
| IS FILED (Check one box)
| Chapter 7 X Chapter 11 __ Chapter 13
| __ Chapter 9 __ Chapter 12 __ Sec. 304 - Case Ancillary to
| Foreign Processing
| FILING FEE (Check one box)
| X Filing fee attached
| __ Filing fee to be paid in installments. (Applic. to individuals |
| only.) Must attach signed application for the court's consider-|
| ation certifying that the debtor is unable to pay fee except |
| in installments. Rule 1006(b). See Official Form No. 3. |
|-----------------------------------------------------------------------------
| NAME AND ADDRESS OF LAW FIRM OR ATTORNEY |
| LeBOEUF, LAMB, GREENE & MacRAE, L.L.P., 633 17th St., #2000 |
| Telephone No. (303) 291-2600 Denver, CO 80202 |
| ----------------------------------------------------------------------------
| | NAME(S) OF ATTORNEY(S) DESIGNATED TO REPRESENT DEBTOR |
| | (Print or Type Names) |
| | Carl A. Eklund |
| ----------------------------------------------------------------------------
| | __ Debtor is not represented by an attorney
==============================================================================
| STATISTICAL/ADMINISTRATIVE INFO. (USC ss.604) (Estimates only)
| (Check applicable boxes)|
- ------------------------------------------------------------------------------
| X Debtor estimates that funds will be available for distribution to unsecured
creditors|| Debtor estimates that, after any exempt property is excluded and
administrative | | expenses paid, there will be no funds available for
distribution to unsecured creditors |
- ------------------------------------------------------------------------------
| ESTIMATED NUMBER OF CREDITORS
| 1-15 16-49 50-99 100-199 200-299 1000-over
X
- ------------------------------------------------------------------------------
| ESTIMATED ASSETS (In thousands of dollars)
| Under 50 50-99 100-499 500-999 1000-9999 10,000-99,000 100,000-over
| X
- -----------------------------------------------------------------------------
| ESTIMATED LIABILITIES (In thousands of dollars)
| Under 50 50-99 100-499 500-999 1000-9999 10,000-99,000 100,000-over
| X
- ------------------------------------------------------------------------------
| EST. NO. OF EMPLOYEES - CH 11 & 12 ONLY
| 0 1-19 20-99 100-499 1000-over
X
- ------------------------------------------------------------------------------
| EST. NO. OF EQUITY SECURITY HOLDERS - CH. 11 & 12 ONLY
| 0 1-19 20-99 100-499 1000-over
X
==============================================================================
DN2 109434.1 89000 07174
5/21/98 11:23 am
|Name of Debtor USMX of Alaska, Inc.
Case No. __________________________________________
- ------------------------------------------------------------------------------
FILING OF PLAN
For Chapter 9, 11, 12 and 13 cases only. Check appropriate box.
___ A copy of debtors proposed plan dated X Debtor intends to file a plan
within the time allowed by statute, is attached rule or order of the court
- ------------------------------------------------------------------------------
PRIOR BANKRUPTCY CASE FILED WITHIN LAST 6 YEARS
(If more than one, attach additional sheet)
Location Where Filed Case Number Date Filed
- ------------------------------------------------------------------------------
PENDING BANKRUPTCY CASE FILED BY ANY SPOUSE, PARTNER, OR AFFILIATE OF THE
DEBTOR (If more than one, attach additional sheet)
Name of Debtor Case Number Date
Relationship District Judge
- ------------------------------------------------------------------------------
REQUEST FOR RELIEF
Debtor requests relief in accordance with the chapter of title 11, United
States Code specified in this petition
- ------------------------------------------------------------------------------
SIGNATURES
ATTORNEY
X _______________________________________________ __________________________
Signature Date
- ------------------------------------------------------------------------------
INDIVIDUAL JOINT DEBTOR(S)
I declare under penalty of perjury that the information provided in this
petition is true and correct
X _______________________________________________ ____________________________
Date
X _______________________________________________ ____________________________
Date
- ------------------------------------------------------------------------------
CORPORATE OR PARTNERSHIP DEBTOR
I declare under penalty of perjury that the information provided in this
petition is true and correct and that the filing of this petition on behalf of
the debtor has been authorized
X ___________________________________________________
Signature of Authorized Individual
X ___________________________________________________
Print or Type Name of Authorized Individual
X ___________________________________________________
Title of Individual Authorized by Debtor to File this Petition
_______________________________________
Date
- ------------------------------------------------------------------------------
EXHIBIT "A" (To be completed if debtor is a corporation, requesting
relief under Chapter 11.)
______ Exhibit "A" is attached and made part of this petition
- ------------------------------------------------------------------------------
TO BE COMPLETED BY INDIVIDUAL CHAPTER 7 DEBTOR WITH PRIMARILY CONSUMER DEBTS
(See P.L. 98-353 ss. 322)
I am aware that I may proceed under chapter 7, 11, or 12, or 13 of title 11,
United States Code, understand the relief available under such chapter, and
choose to proceed under chapter 7 of such title
If I am represented by an attorney Exhibit B has been completed
X ________________________________________________ ________________________
Signature of Debtor Date
X ________________________________________________ ________________________
Signature of Joint Debtor Date
- ------------------------------------------------------------------------------
EXHIBIT "B" (To be completed by attorney for individual chapter 7 debtor(s)
with primarily consumer debts.)
I, the attorney for the debtor(s)named in the foregoing petition, declare that
I have informed the debtor(s) that(he, she, or they) may proceed under chapter
7, 11, 12, or 13 of title 11, United States Code, and have explained the relief
available under such chapter
X __________________________________________________ ________________________
Signature of Attorney Date
- ------------------------------------------------------------------------------
UNITED STATES BANKRUPTCY COURT
V O L U N T A R Y P E T I T I O N
- ---------------------------------============================================
For the DISTRICT OF COLORADO
- ---------------------------------============================================
| IN RE (Name of debtor, if individual, Last, First, Middle)
| USMX, INC.
| NAME OF JOINT DEBTOR (Spouse)(Last, First, Middle)
- ----------------------------------------------------------------------------
| ALL OTHER NAMES used by the debtor in the last 6 years
| (Include married, maiden, and trade names)
|
| ALL OTHER NAMES used by the debtor in the last 6 years
| (Include married, maiden, and trade names)
- -----------------------------------------------------------------------------
| SOC.SEC./TAX I.D. NO. (If more than one, state all)
84-1076625
| SOC.SEC./TAX I.D. NO. (If more than one, state all)
- ----------------------------------------------------------------------------
| STREET ADDRESS OF DEBTOR (No & street, city, st. & zip code
| 1560 Broadway, Suite 880
| Denver, CO 80202
| STREET ADDRESS OF JOINT DEBTOR (No. & street, city, st. & zip code)|
| COUNTY OF RESIDENCE OR PRINCIPAL PLACE OF BUSINESS Denver
| COUNTY OF RESIDENCE OR PRINCIPAL PLACE OF BUSINESS
- -----------------------------------------------------------------------------
| MAILING ADDRESS OF DEBTOR (If different from street address|
MAILING ADDRESS OF JOINT DEBTOR (If different from street address)
Same as Above
- -----------------------------------------------------------------------------
| LOCATION OF PRINCIPAL ASSETS OF BUSINESS DEBTOR
(If different from address listed above)
- -----------------------------------------------------------------------------
VENUE (Check one box)
| X Debtor has been domiciled or has had a residence 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.
|
| __ There is a bankruptcy case concerning debtor's affiliate,
| general partner, or partnership pending in this District.
- -----------------------------------------------------------------------------
| INFORMATION REGARDING DEBTOR (Check applicable boxes) |
- -----------------------------------------------------------------------------
| TYPE OF DEBTOR
| Individual Corporation Publicly Held
| __ Joint (Husband & Wife) X Corporation Not Publicly Held
| __ Partnership __ Municipality
| __ Other
| NATURE OF DEBT
| Non-Business/Consumer X Business - Complete A&B Below
| A. TYPE OF BUSINESS (Check one)
| __ Farming __ Transportation __ Commodity Broker
| __ Professional X Manufacturing/ __ Construction
| __ Retail/Wholesale Mining __ Real Estate
| __ Railroad __ Stockbroker __ Other Business
| B. BRIEFLY DESCRIBE NATURE OF BUSINESS
| Parent corporation of various mining entities
|
| CHAPTER OR SECTION OF BANKRUPTCY CODE UNDER WHICH THE PETITION
| IS FILED (Check one box)
| Chapter 7 X Chapter 11 __ Chapter 13
| __ Chapter 9 __ Chapter 12 __ Sec. 304 - Case Ancillary to
| Foreign Processing
| FILING FEE (Check one box)
| X Filing fee attached
| __ Filing fee to be paid in installments. (Applic. to individuals
| only.) Must attach signed application for the court's consider-
| ation certifying that the debtor is unable to pay fee except
| in installments. Rule 1006(b). See Official Form No. 3.
- ------------------------------------------------------------------------------
| NAME AND ADDRESS OF LAW FIRM OR ATTORNEY
| LeBOEUF, LAMB, GREENE & MacRAE, L.L.P., 633 17th St., #2000
| Telephone No. (303) 291-2600 Denver, CO 80202
| ----------------------------------------------------------------------------
| | NAME(S) OF ATTORNEY(S) DESIGNATED TO REPRESENT DEBTOR |
| | (Print or Type Names) |
| | Carl A. Eklund |
| ---------------------------------------------------------------------------
| | __ Debtor is not represented by an attorney |
=================================================----------------------------
| STATISTICAL/ADMINISTRATIVE INFO. (USC ss.604) (Estimates only)
(Check applicable boxes)|
- -----------------------------------------------------------------------------
|__ Debtor estimates that funds will be available for distribution to
unsecured creditors|
| X Debtor estimates that, after any exempt property is excluded and
administrative expenses paid, there will be no funds available for
distribution to unsecured creditors |
- -----------------------------------------------------------------------------
| ESTIMATED NUMBER OF CREDITORS
| 1-15 16-49 X 50-99 100-199 200-299 1000-over
- -----------------------------------------------------------------------------
| ESTIMATED ASSETS (In thousands of dollars)
| Under 50 50-99 100-499 500-999 1000-9999 X 10,000-99,000 100,000-over
|
- -----------------------------------------------------------------------------
| ESTIMATED LIABILITIES (In thousands of dollars)
| Under 50 50-99 100-499 500-999 1000-9999 X 10,000-99,000 100,000-over
|
- -----------------------------------------------------------------------------
| EST. NO. OF EMPLOYEES - CH 11 & 12 ONLY
| 0 X 1-19 20-99 100-499 1000-over
--- --- --- --- ---
- -----------------------------------------------------------------------------
| EST. NO. OF EQUITY SECURITY HOLDERS - CH. 11 & 12 ONLY
| 0 X 1-19 20-99 100-499 1000-over
============================================================================
DN2 109457.1 89000 07174
1/22/98 12:10 pm
Name of Debtor USMX, Inc.
Case No. __________________________________________
- -----------------------------------------------------------------------------
FILING OF PLAN
For Chapter 9, 11, 12 and 13 cases only. Check appropriate box.
___ A copy of debtors proposed plan dated X Debtor intends to file a plan
within the time allowed by statute, is attached rule or order of the court
- -----------------------------------------------------------------------------
PRIOR BANKRUPTCY CASE FILED WITHIN LAST 6 YEARS (If more than one, attach
additional sheet)
- -----------------------------------------------------------------------------
Location Where Filed Case Number Date Filed
- -----------------------------------------------------------------------------
PENDING BANKRUPTCY CASE FILED BY ANY SPOUSE, PARTNER, OR AFFILIATE OF
THE DEBTOR (If more than one, attach additional sheet)
Name of Debtor Case Number Date
Relationship District Judge
- -----------------------------------------------------------------------------
REQUEST FOR RELIEF
Debtor requests relief in accordance with the chapter of title 11, United
States Code specified in this petition
- -----------------------------------------------------------------------------
SIGNATURES
- -----------------------------------------------------------------------------
ATTORNEY
X _________________________________________ _______________________________
Signature Date
- -----------------------------------------------------------------------------
INDIVIDUAL JOINT DEBTOR(S)
I declare under penalty of perjury that the information provided in
this petition is true and correct
X _____________________________________________________________
_________________________________
Date
X _____________________________________________________________
_________________________________
Date
- -----------------------------------------------------------------------------
CORPORATE OR PARTNERSHIP DEBTOR
I declare under penalty of perjury that the information provided in this
petition is true and correctand that the filing of this petition on behalf of
the debtor has been authorized
X ____________________________________________________________
Signature of Authorized Individual
_____________________________________________________________
Print or Type Name of Authorized Individual
______________________________________________________________
Title of Individual Authorized by Debtor to File this Petition
_________________________________
Date
- -----------------------------------------------------------------------------
EXHIBIT "A" (To be completed if debtor is a corporation, requesting relief
under Chapter 11.)
______ Exhibit "A" is attached and made part of this petition
- -----------------------------------------------------------------------------
TO BE COMPLETED BY INDIVIDUAL CHAPTER 7 DEBTOR WITH PRIMARILY CONSUMER DEBTS
(See P.L. 98-353 ss. 322)
I am aware that I may proceed under chapter 7, 11, or 12, or 13 of title
11, United States Code, understand the relief available under such chapter,
and choose to proceed under chapter 7 of such title
If I am represented by an attorney Exhibit B has been completed
X ________________________________________ _______________________________
Signature of Debtor Date
X ________________________________________ _______________________________
Signature of Joint Debtor Date
- -----------------------------------------------------------------------------
EXHIBIT "B" (To be completed by attorney for individual chapter 7 debtor(s)
with primarily consumer debts.)
I, the attorney for the debtor(s) named in the foregoing petition, declare
that I have informed the debtor(s) that (he, she, or they) may proceed under
chapter 7, 11, 12, or 13 of title 11, United States Code, and have explained
the relief available under such chapter
X _______________________________________________ _________________________
Signature of Attorney Date
- -----------------------------------------------------------------------------
