IN THE UNITED STATES BANKRUPTCY COURT

FOR THE _____________ DISTRICT OF __________________

CASE NAME:______________________	CASE NO.:____________________

STATUS REPORT FOR DEBTORS IN POSSESSION

NOT OPERATING ANY BUSINESS

For the Month Ending ___________________, ____

STATEMENT OF CASH

BEGINNING BALANCE (ending balance from last month)	$______________

ADD INCOME:

Salary	$_______________

Other Income (Specify):

_______________________	$_______________

_______________________	$_______________

________________________	$_______________

TOTAL INCOME	(A)	$_______________

LESS EXPENSES:

Mortgage	$_______________

Other Expenses (itemize

amounts in excess of $500)	$_______________

__________________________	$_______________

__________________________	$_______________

__________________________	$_______________

TOTAL EXPENSES	(B)	$_______________

NET RECEIPTS (Line (A) less Line (B))	$_______________

ENDING BALANCE (BEGINNING BALANCE PLUS NET RECEIPTS	$_______________

NOTE:	Attach a copy of the most recent bank statement and a reconciliation for each account.

STATUS REPORT FOR DEBTORS IN POSSESSION

NOT OPERATING ANY BUSINESS

QUESTIONNAIRE

1.	Have you incurred any debts since the

filing of the petition that remain unpaid?	YES ( ) NO ( )

If so, provide the necessary information in the space provided.

DATE DUE

PAYEE

DESCRIPTION

AMOUNT

2.	What tax forms are you required to file? ____________________

_____________________________________________________________

3.	Are you required to make estimated

payments (1040 ES)?	YES ( ) NO ( )

4.	Are your post-petition real estate taxes

paid through all current billings?	YES ( ) NO ( )

5.	Is your insurance in effect?	YES ( ) NO ( )

If no, when did coverage expire? ______________

Policy number:_________________

Company:___________________

6.	Summarize both court and non-court activities during this month that have affected the progress of your case.

___________________________________________________________

___________________________________________________________

___________________________________________________________

7.	Discuss when you anticipate filing a plan of reorganization and disclosure statement.

_____________________________________________________________

______________________________________________________________

______________________________________________________________

8.	List issues to be resolved during the administration of this case.

_____________________________________________________________

______________________________________________________________

______________________________________________________________

IN THE UNITED STATES BANKRUPTCY COURT

FOR THE ___________________DISTRICT OF ________________

FOR THE MONTH ENDING______________________, 19_____

DECLARATION UNDER PENALTY OF PERJURY

I, _______________________________________________________ declare under penalty of perjury under the laws of the United States that I have read the foregoing Monthly Report of the Debtor, and that the figures, statements, disbursements itemizations, and account balances as listed, are true and correct as of the date of this report to the best of my knowledge, information and belief.

Copies of this report have been forwarded to the U.S. Bankruptcy Court and the Internal Revenue Service.

____________________________________

Signature

Print name, capacity and phone number

of person signing this Declaration:

____________________________________

Name

____________________________________

Title

____________________________________

Phone #

Dated:___________________