Case Doc 1 Filed 01/29/18 Page 1 of 7 Fill in this information to identity the case: United States Bankruptcy Court for the: District of I77 6?5 (State) Case number (ifknown): Chapter 2 El Check if this is an amended ?ling Official Form 201 Voluntary Petition for Non-Individuals Filing for Bankruptcy 04:15 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-individuais, is available. 1. Debtor?s name ??ue/9f IE1 ALC- A/md?' 2. All other names debtor used in the last 8 years Include any assumed names. trade names, and doing business as names 3. Debtor?s federal Employer 7 fig 5? 7/ Identi?cation Number (EIN) 4_ Debtor's address Principal place of business{ Mailing address, if different from principal place of business 27izo ocemJ 39%? MW Number Street Number Street PO. Box Mb 247-36 wrmd&?zed FL .1374 9- 51318 ZIP Code City State ZIP Code Location of principal assets, if different from principal place of business ?lice/twee County Number Street City State ZIP Code 5. Debtor?swebsite(URL) - morporation (including Limited Liability Company (LLC) and Limited Liability Partnership Cl Partnership (excluding LLP) :1 Other. Specify: 6. Type of debtor Of?cial Form 201 Voluntary Petition for Non-Individuals Filing for Bankruptcy page 1 Case Doc 1 Filed 01/29/18 Page (?3?33 'r 3 'x 3? ?1 6?;ka V363 i? \Al 3:115x?;?as; ?sbwzu'xbt, ans-ha? ?i 5 Lr-wu?x . \x QR Case Doc 1 Filed 01/29/18 Page 3 of 7 Debtor (5 ?(9w f} A (Ufa: A Case number (riknown) Name . A. Check one: 7. Describe debtor's busmess CI Health Care Business (as de?ned in 11 U.S.C. 101 CI Single Asset Real Estate (as de?ned in 11 U.S.C. CI Railroad (as de?ned in 11 Stockbroker (as de?ned in 11 U.S.C. El Commodity Broker (as de?ned in 11 USS 101(6)) CI Clearing Bank (as de?ned in 11 USC. 781(3)) one of the above B. Check ati that appiy.? Tax-exempt entity (as described in 26 U.S.C. 501) Investment company. including hedge fund or pooled investment vehicle (as de?ned in 15 U.S.C. 80a-3) Investment adviser (as de?ned in 15 U.S.C. C. NAICS (North American Industry Classi?cation System) 4-digit code that best describes debtor. See . 3. Under which chapter of the Check one; Bankruptcy Code is the debtor filing? Chapter 7 Chapter 9 El Chapter 11. Check ait that apply: El Debtor?s aggregate noncontingent liquidated debts (excluding debts owed to insiders or af?liates) are less than $2,566,050 (amount subject to adjustment on 4201/19 and every 3 years after that). CI The debtor is a small business debtor as de?ned in 11 U.S.C. If the debtor is a small business debtor, attach the most recent balance sheet, statement of operations. cash??ow statement. and federal income tax return or if all of these documents do not exist. follow the procedure in 11 U.S.C. CI A plan is being ?led with this petition. El 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 ?le periodic reports (for example, 10K and 100) with the Securities and Exchange Commission according to 13 or 15(d) of the Securities Exchange Act of 1934. File the Attachment to Voiuntary Petition for Non-tno?ividuats Ftiing for Bankruptcy under Chapter 11 (Of?cial Form 201A) with this form. CI The debtor is a shell company as de?ned in the Securities Exchange Act of 1934 Rule 12b-2. Chapter 12 9. Were prior bankruptcy cases filed by or against the debtor within the last 8 years? Yes- When Case number If more than 2 cases, attach a ?d Wh list. '5 en ase num er sepa ate Mllili 10. Are any bankruptcy cases No endin or bein filed a af?liate of the debtor? District 5? 353+ 55 Ea 4: When 2 zen; List all cases. If more than 1, MM i DD attach a separate list. Case number. it known I I 3 0 1 Ice?H Of?cial Form 201 Voluntary Petition for Non-Individuals Filing for Bankruptcy page 2 Case Doc 1 Filed 01/29/18 Page .Ir?fw Viw??sl. is! in: ."Hza?i .02 H?okh .5 42;: Case Doc 1 Filed 01/29/18 Page 5 of 7 Debtor . (EL Case number or known] Name 11. Why is the case ?led in this Check alt that apply.- district? . Debtor has had its place of busrness. or assets In this district for 180 days mediately 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 af?liate. general partner. or partnership is pending in this district. 12. Does the debtor own or have %0 possessron 0f any real Cl 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 identi?able hazard to public health or safety. What is the hazard? CI It needs to be physically secured or protected from the weather. CI 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 13. Debtor?s estimation of Check one: available funds Funds will be available for distribution to unsecured creditors. ?er any administrative expenses are paid, no funds will be available for distribution to unsecured creditors. . mate 1000-5000 25,001-50000 14' ESti'T'ated "umber ?f 5099 El 500140.000 Cl 50001?100000 cred'tors 100-199 Cl 10001-25000 More than 100,000 Cl 200-999 Kso-ssopoo Cl 31.000.001-510 million El $500,000,001-51 billion 15' ES?mated assets Cl Slocum-5100.000 Cl $10.000.001-350 million El 31.000.000.001-310 billion It Cl million El billion CI 3500,001-51 million $100,000,001-3500 million More than $50 billion Of?cial Form 201 Voluntary Petition for Non-Individuals Filing for Bankruptcy page 3 Case Doc 1 Filed 01/29/18 Page 6 of 7 Name Debtor CAM Cf AN hf?, LLC Case number . CI 30-350000 mtuooborsm million Cl $500,000,001-51 billion 15' ESt'ma?ed "ab??t'es Cl 510000.001-350 million El 51000000001610 billion El 31000015500000 El 550.000.001-5100 million El 310.000.000001?550 billion El 3500.001-31 million El 5100.000001-8500 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 ?nes up to $500,000 or imprisonment for up to 20 years. or both 18 1341. 1519, and 3571. 17. Declaration and signature of authorized representative of The debtor requests relief in accordance with the chapter of title 11. United States Code. speci?ed in this t?t' . debtor pe I Ion 3: have been authorized to ?le this petition on behalf of the debtor. s: 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 10,8, MM 1 DD am At, ?15744 ALI) Signature of authorized represent titre of debtor Printed name Tile ?74/1/an ?realism 13. Signature of attorney L7 20 Date Signature of attorney fo?btor MM dif??try M. KIN zygf'ymgaeaam gal/tr Number Street City State ZIP Code 3 eon?m? 9 staff? 1" 0 Cam Bar number State Of?cial Form 201 Voluntary Petition for Non?Individuals Filing for Bankruptcy page 4 a 1 a 4min. Case Doc 1 Filed 01/29/18 Page 3'3.7. .: Jib-?3" ?3 . g, CV1 a 39:? -. . um-? . . a um "r35,3. C'P??llhl? "Kg; .?Vsz . . . . . .is?m?.Lv; away. A 9. km- 7) 7}er 32? .