SCHEDULE A-CREDITOR LIST | |||||
1. List all creditors having security interests or liens, showing: | |||||
Name | Address | Amount | Collateral | Whether or not disputed | |
2. List all wages, salaries, commissions, or contributions to an employee benefit plan owed, showing: | |||||
Name | Address | Amount | Whether or not disputed | ||
3. List all consumer deposits owed, showing: | |||||
Name | Address | Amount | Whether or not disputed | ||
4. List all taxes owed, showing: | |||||
Name | Address | Amount | Whether or not disputed | ||
5. List all unsecured claims, showing: | |||||
Name | Address | Amount | Whether or not disputed | ||
6. List all owners or shareholders, showing: | |||||
Name | Address | Percentage of Ownership | |||
7. List all applicable regulatory agencies, showing: | |||||
Name | Address | ||||
SCHEDULE B-LIST OF PROPERTY | |||||
List each category of property and for each give approximate value obtainable for the asset on the date of assignment/appointment of the receiver, and address where asset is located. | |||||
I. Nonexempt Property | |||||
Description and Location | Liquidation Value on Date of Assignment/Appointment of Receiver | ||||
1. | Legal Description and street address of real property, including leasehold interests: | ||||
2. | Fixtures: | ||||
3. | Cash and bank accounts: | ||||
4. | Inventory: | ||||
5. | Accounts receivable: | ||||
6. | Equipment: | ||||
7. | Prepaid expenses, including deposits, insurance, rents, and utilities: | ||||
8. | Other, including loans to third parties, claims, and choses in action: | ||||
II. Exempt Property | |||||
Description and Location | Liquidation Value on Date of Assignment/Appointment of Receiver | ||||
I DECLARE under penalty of perjury under the laws of the state of Washington that the foregoing is true, correct, and complete to the best of my knowledge. DATED this . . . day of . . . . . . . ., . . . ., at . . . . . . . ., state of . . . . . . . .. | |||||
. . . . . . . . . . . . . . .. | |||||
[SIGNATURE] |
RCW 7.60.090
Purpose-Captions not law-2004 c 165: See notes following RCW 7.60.005.