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Unitbfi .S:ites.Bankr,uptcyCourt for the

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POSITION:
POSITION:

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OIrP.: d./C.Z 7, 2do7

SIGNATURE
oF PREP

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PREPARER'S
POSITION
1.

Basisfor NotificationandPossibleEstateloss:
a.

Suspecgdviolationof l8 U.S.C.Section:

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1 3 4 1 ( );

2.

1s3();

1 3 4 2 () ;

rs4();
1343() ;

b.

Othersuspected
criminalviolation

c.

PossibleEstateLoss $ Jd)

$5Q,{
1344( )

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Subjectof Notification:

^ . 4$peAtor
# (principal/responsibleperson)
L)lrustee
b. (Vf)rustee
c. ( rzf
rrlPyofessi
)otessional(SpecifyTitle)
d. ( Ufplaimholder/EquitySecurity
Securit Holder
(t/, PgblicOfficial e.(lTfPyblicofficial
e.
n / z

f. l lfother_U<4

3.

BackgroundInformation:
Nameof debtor'scase:
Casenumber/district:

Debtor'saddress:
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Telephonenumbers:

b.

CaseChapter:
Nature of Case:

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Tf* c,11n,4 l t l e
b.

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, the namesof witnesses"and the

offense or offensesbelieved to have beencommitted (provide as complete
a

descriptionaspossible)by:
(l)

(2)

P)lli"tafull

andcompleteaccountof the suspectehiolation.

17

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Providing the names,addresses,and telephonenumbers of personswith

knowledge of and information relatingp suspectedoffense.

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(3)

Indicating,(basedon availableinformation)whetherthe suspected

offenie
relatesonly to a singleincidentin a debtor'scaseor whetherthe s
offense relatesto multiple transactions/baqkruptci

(4)

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d%o!-ry6)fgiTo/t'z'W

IndicatKgwhetherthe sirbjectof tfe notificationhasbeenthe subjeJofi

prior notificationand,if so,relatingthe relevantcircumstances
surroundingthe earliernotification.
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(5)

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Disclosing
otherpertinent
information.\

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PAGE 2

3ft81*re
ilu#,$ilE$"y,
sad4ress:
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Telephone:

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3o2-57t-zzzv

d.

Name of trustee:
Appointment date:
Trustee'saddress:
Telephone:

e.

Petitionandschedules
attachedfor lists of claimholders,debts,assets,exemptproperty,
andotherinformation:z
Yes( )
No(D/

f.

If chapter7 case,Sec.705 creditors'committeeappointed:

Yes( )
No( )
yes,
If
date of appointment:
Name, addressand telephonenos. of contactpersons:

If chaptgr11
If yes, date of appointment:
Name,addrpssggdtelephonenop.of contact/personsl,.

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h.

"Y-l';::"'#;:
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o secftr/r:
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4.

CircumstancesRelating to SuspectedViolation of Chapter 9 of Title 18, United States

Name of subject of notification:
Subject'saddress:
Telephonenumbers:

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