Guo Wengui / Miles Guo — bankruptcy case · ECF #1158

METADATA

Defendant: Guo Wengui / Miles Guo / Ho Wan Kwok
Court: CTB
Case No.: 22-50073
ECF #: 1158
Type: UNKNOWN
Filed: 2022-11-23

FULL TEXT

amended filing ❑

## Official Form 207

## Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy **04/22**

**The debtor must answer every question. 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 case number (if known).**

| | Part 1: Income | | | | | |----|----------------------------------------------------------|----------------------------------------------------------------------------|-----------------------------------------|---------------------------------------|--| | 1. | Gross revenue from business ❑✔ None | | | | | | | | Identify the beginning and ending dates of the debtor's fiscal year, which | Sources of revenue | Gross revenue | | | | may be a calendar year | | Check all that apply | (before deductions and exclusions) | | | | From the beginning of the fiscal year to filing date: | From 01/01/2022 to Filing date MM/ DD/ YYYY | ❑ Operating a business ❑ Other | | | | | For prior year: | From 01/01/2021 to 12/31/2021 MM/ DD/ YYYY MM/ DD/ YYYY | ❑ Operating a business ❑ Other | | | | | For the year before that: | From 01/01/2020 to 12/31/2020 MM/ DD/ YYYY MM/ DD/ YYYY | ❑ Operating a business ❑ Other | | |

## **2. Non-business revenue**

Include revenue regardless of whether that revenue is taxable. Non-business income may include interest, dividends, money collected from lawsuits, and royalties. List each source and the gross revenue for each separately. Do not include revenue listed in line 1.

None ❑✔

| | | | Description of sources of revenue | Gross revenue from each source | |----------------------------------------------------------|---------------------------------------|----------------------------|-----------------------------------|---------------------------------------| | | | | | (before deductions and exclusions) | | From the beginning of the fiscal year to filing date: | From 01/01/2022 to MM/ DD/ YYYY | Filing date | | | | For prior year: | From 01/01/2021 to MM/ DD/ YYYY | 12/31/2021 MM/ DD/ YYYY | | | | For the year before that: | From 01/01/2020 to MM/ DD/ YYYY | 12/31/2020 MM/ DD/ YYYY | | |

| Filed 11/23/22 | | Entered 11/23/22 15:33:50 Case number (if known) | Page 2 of 12 22-50542 | | |------------------------------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------|--------| | | | | | | | Part 2: List Certain Transfers Made Before Filing for Bankruptcy | | | | | | Certain payments or transfers to creditors within 90 days before filing this case years after that with respect to cases filed on or after the date of adjustment.) | | List payments or transfers—including expense reimbursements—to any creditor, other than regular employee compensation, within 90 days before filing this case unless the aggregate value of all property transferred to that creditor is less than \$7,575. (This amount may be adjusted on 4/01/25 and every 3 | | | | | | | | | | Dates | Total amount or value | Reasons for payment or transfer Check all that apply | | | | | | ❑ Secured debt ❑ Unsecured loan repayments | | | | | | ❑ Suppliers or vendors ❑ Services ❑ Other | | | | | | | | | | | Payments or other transfers of property made within 1 year before filing this case that benefited any insider | | | | | | relatives; affiliates of the debtor and insiders of such affiliates; and any managing agent of the debtor. 11 U.S.C. § 101(31). | List payments or transfers, including expense reimbursements, made within 1 year before filing this case on debts owed to an insider or guaranteed or co-signed by an insider unless the aggregate value of all property transferred to or for the benefit of the insider is less than \$7,575. (This amount may be adjusted on 4/01/25 and every 3 years after that with respect to cases filed on or after the date of adjustment.) Do not include any payments listed in line 3. Insiders include officers, directors, and anyone in control of a corporate debtor and their relatives; general partners of a partnership debtor and their | | | | Dates | Total amount or value | Reasons for payment or transfer | | | | | | | | | | | | | | | | | | | | | | | | | | | | | foreclosure sale, transferred by a deed in lieu of foreclosure, or returned to the seller. Do not include property listed in line 6. | List all property of the debtor that was obtained by a creditor within 1 year before filing this case, including property repossessed by a creditor, sold at a | | | | Description of the property | | Date | Value of property | | | | | | | | | | | | | page 2 | | | | | Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy | |

| Debtor | Case 22-50073 Genever Holdings Corporation | Doc 1158 Filed 11/23/22 | Entered 11/23/22 15:33:50 Case number (if known) | Page 3 of 12 22-50542 | |--------|--------------------------------------------------------------|-----------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------| | | Name | | | | | 5.1. | Creditor's name | | | | | | Street | | | | | | | | | | | | City State | ZIP Code | | | | 6. | Setoffs | | | | | | | | List any creditor, including a bank or financial institution, that within 90 days before filing this case set off or otherwise took anything from an account of the debtor without permission or refused to make a payment at the debtor's direction from an account of the debtor because the debtor owed a debt. | | | | ❑✔ None | | | | | | Creditor's name and address | Description of the action creditor took | Date action was taken | Amount | | 6.1. | | | | | | | Creditor's name | XXXX– | | | | | Street | | | | | | | | | | | | City State | ZIP Code | | | | | | | | | | | | | | | | 7. | Part 3: Legal Actions or Assignments | | Legal actions, administrative proceedings, court actions, executions, attachments, or governmental audits | | | | | | List the legal actions, proceedings, investigations, arbitrations, mediations, and audits by federal or state agencies in which the debtor was involved in any | | | | capacity—within 1 year before filing this case. ❑ None | | | | | 7.1. | Case title | Nature of case | Court or agency's name and address | Status of case | | | Pacific Alliance Asia | Breach of contract/alter ego | Supreme Court of the State of New York | ❑✔ Pending | | | Opportunity Fund L.P. v. Kwok | | Name | ❑ On appeal | | | Ho Wan (various akas), Genever Holdings LLC and | | 60 Centre Street Street | ❑ Concluded | | | Genever Holdings Corporation | | | | | | Case number | | New York, NY 10007-1402 City State ZIP Code | | | | 652077/2017 | | | | | 7.2. | Case title | Nature of case | Court or agency's name and address | Status of case | | | Pacific Alliance Asia | Enforcement of New York State | The Eastern Caribbean Supreme Court Virgin | ❑✔ Pending | | | Opportunity Fund, L.P. v. | Judgment | Islands in the High Court of Justice | ❑ On appeal | | | Genever Holdings Corporation, Bravo Luck, Ho Wan Kwok, | | Name PO Box 418 | ❑ Concluded | | | and Qiang Guo | | Street | | | | Case number | | Road Town, Tortola, BVI, | | | | BVIHCM 2020/0137 | | City State ZIP Code | | | | | | | |

## **8. Assignments and receivership**

List any property in the hands of an assignee for the benefit of creditors during the 120 days before filing this case and any property in the hands of a receiver, custodian, or other court-appointed officer within 1 year before filing this case. None ❑✔

| Name | | | | | 22-50542 | | |----------------------------|----------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-------|------------------------|-------------------|--| | | Custodian's name and address | Description of the property | Value | | | | | Custodian's name Street | | Case title | | Court name and address | | | | | | | Name | | | | | City State ZIP Code | | Case number | | Street | | | | | | | | | | | | | | Date of order or assignment | City | | State ZIP Code | | | | | | | | | | | | Part 4: Certain Gifts and Charitable Contributions | | | | | | | ❑✔ None | to that recipient is less than \$1,000 | List all gifts or charitable contributions the debtor gave to a recipient within 2 years before filing this case unless the aggregate value of the gifts | | | | | | | Recipient's name and address | Description of the gifts or contributions | | Dates given | Value | | | Recipient's name | | | | | | | | Street | | | | | | | | | | | | | | | | City | State ZIP Code | | | | | | | | Recipient's relationship to debtor | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | Part 5: Certain Losses | | 10. All losses from fire, theft, or other casualty within 1 year before filing this case. | | | | | | ❑✔ None | Description of the property lost and how the | Amount of payments received for the loss | | Date of loss | Value of property | | | loss occurred | | If you have received payments to cover the loss, for example, from insurance, government compensation, or tort liability, list the total received. | | | lost | | | | | List unpaid claims on Official Form 106A/B (Schedule A/B: Assets – Real and Personal Property). | | | | | | | | | | | | | | 10.1. | | | | | | | | | | | | | | | | | Part 6: Certain Payments or Transfers | | | | | | | bankruptcy case. | Payments related to bankruptcy | List any payments of money or other transfers of property made by the debtor or person acting on behalf of the debtor within 1 year before the filing of this case to another person or entity, including attorneys, that the debtor consulted about debt consolidation or restructuring, seeking bankruptcy relief, or filing a | | | | | | ❑✔ None | | | | | | |

| Debtor | Case 22-50073 Doc 1158 Genever Holdings Corporation | Filed 11/23/22 | Entered 11/23/22 15:33:50 | Case number (if known) | Page 5 of 12 22-50542 | |--------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------|-------------------------------------------------|------------------------------|--------------------------| | 11.1. | Name Who was paid or who received the transfer? | | If not money, describe any property transferred | Dates | Total amount or value | | | Address | | | | | | | Street | | | | | | | City State ZIP Code | | | | | | | Email or website address | | | | | | | Who made the payment, if not debtor? | | | | | | | | | | | | | | 12. Self-settled trusts of which the debtor is a beneficiary | | | | | | | List any payments or transfers of property made by the debtor or a person acting on behalf of the debtor within 10 years before the filing of this case to a self-settled trust or similar device. | | | | | | | Do not include transfers already listed on this statement. ❑✔ None | | | | | | 12.1. | Name of trust or device | Describe any property transferred | | Dates transfers were made | Total amount or value | | | | | | | | | | Trustee | | | | | | | | | | | | | | 13. Transfers not already listed on this statement List any transfers of money or other property—by sale, trade, or any other means—made by the debtor or a person acting on behalf of the debtor within 2 years before the filing of this case to another person, other than property transferred in the ordinary course of business or financial affairs. Include both outright transfers and transfers made as security. Do not include gifts or transfers previously listed on this statement. ❑✔ None | | | | | | 13.1. | Who received the transfer? | Description of property transferred or payments received or debts paid in exchange | | Date transfer was made | Total amount or value | | | | | | | | | | Address | | | | | | | Street | | | | | | | City State ZIP Code | | | | | | | Relationship to debtor | | | | | | | | | | | |

| Debtor | Case 22-50073 Doc 1158 Genever Holdings Corporation | Filed 11/23/22 | Entered 11/23/22 15:33:50 Case number (if known) | Page 6 of 12 22-50542 | |--------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------------------------------------------------------------------|------------------------------------------------------------------|---------------------------------------------------------------------------------| | | Name Part 7: Previous Locations | | | | | | 14. Previous addresses | | | | | | List all previous addresses used by the debtor within 3 years before filing this case and the dates the addresses were used. ❑✔ Does not apply | | | | | | Address | | Dates of occupancy | | | 14.1. | | | From | To | | | Street | | | | | | City State ZIP Code | | | | | | Part 8: Health Care Bankruptcies 15. Health Care bankruptcies | | | | | | Is the debtor primarily engaged in offering services and facilities for: —diagnosing or treating injury, deformity, or disease, or —providing any surgical, psychiatric, drug treatment, or obstetric care? ❑✔ No. Go to Part 9. ❑ Yes. Fill in the information below. | | | | | | Facility name and address | debtor provides | Nature of the business operation, including type of services the | If debtor provides meals and housing, number of patients in debtor's care | | 15.1. | | | | | | | Facility name | | | | | | Street | facility address). If electronic, identify any service provider. | Location where patient records are maintained(if different from | How are records kept? | | | City State ZIP Code | | | Check all that apply: ❑ Electronically ❑ Paper | | | | | | | | | Part 9: Personally Identifiable Information | | | | | | 16. Does the debtor collect and retain personally identifiable information of customers? ❑✔ No. | | | | | | ❑ Yes. State the nature of the information collected and retained. | | | | | | Does the debtor have a privacy policy about that information? | | | | | | ❑ No ❑ Yes | | | | | | 17. Within 6 years before filing this case, have any employees of the debtor been participants in any ERISA, 401(k), 403(b) or other pension or profit | | | | | | sharing plan made available by the debtor as an employee benefit? ❑✔ No. Go to Part 10. | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |

| Name of plan | | | | Employer identification number of the plan | | |--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------------------------------------|-------------------|------|------------------------------------------------------------|-----------------------------------------------| | | | | EIN: | – | | | Has the plan been terminated? ❑ No ❑ Yes | | | | | | | Part 10: Certain Financial Accounts, Safe Deposit Boxes, and Storage Units | | | | | | | 18. Closed financial accounts Within 1 year before filing this case, were any financial accounts or instruments held in the debtor's name, or for the debtor's benefit, closed, sold, moved, | | | | | | | or transferred? Include checking, savings, money market, or other financial accounts; certificates of deposit; and shares in banks, credit unions, brokerage houses, cooperatives, associations, and other financial institutions. ❑✔ None | | | | | | | Financial institution name and address | Last 4 digits of account number | Type of account | | Date account was closed, sold, moved, or transferred | Last balance before closing or transfer | | | XXXX– | ❑ Checking | | | | | Name | | ❑ Savings | | | | | | | | | | | | Street | | ❑ Money market | | | | | | | ❑ Brokerage | | | | | | | ❑ Other | | | | | City State ZIP Code | | | | | | | 19. Safe deposit boxes List any safe deposit box or other depository for securities, cash, or other valuables the debtor now has or did have within 1 year before filing this case. ❑✔ None | | | | | | | Depository institution name and address | Names of anyone with access to it | | | Description of the contents | Does debtor still have it? | | | | | | | ❑ No | | Name | | | | | ❑ Yes | | Street | | | | | | | | Address | | | | | | | | | | | | | City State ZIP Code | | | | | | | | | | | | | | | | | | | | | 20. Off-premises storage List any property kept in storage units or warehouses within 1 year before filing this case. Do not include facilities that are in a part of a building in which the debtor does business. ❑✔ None | | | | | |

| ❑ No Name ❑ Yes Street Address City State ZIP Code Part 11: Property the Debtor Holds or Controls That the Debtor Does Not Own List any property that the debtor holds or controls that another entity owns. Include any property borrowed from, being stored for, or held in trust. Do not list leased or rented property. ❑✔ None Owner's name and address Location of the property Description of the property Value Name Street City State ZIP Code ❑✔ No ❑ Yes. Provide details below. Case title Court or agency name and address Nature of the case ❑ Pending Name ❑ Case number<br |-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------| | | | | | | | | | | | | | | | 21. Property held for another | | | | | | | | | | | | | | | | | | | | | | | | Part 12: Details About Environmental Information For the purpose of Part 12, the following definitions apply: Environmental law means any statute or governmental regulation that concerns pollution, contamination, or hazardous material, regardless of the medium affected (air, land, water, or any other medium). Site means any location, facility, or property, including disposal sites, that the debtor now owns, operates, or utilizes or that the debtor formerly owned, operated, or utilized. Hazardous material means anything that an environmental law defines as hazardous or toxic, or describes as a pollutant, contaminant, or a similarly harmful substance. Report all notices, releases, and proceedings known, regardless of when they occurred. 22. Has the debtor been a party in any judicial or administrative proceeding | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | >❑ Street City State ZIP Code | Facility name and address | Names of anyone with access to it | Description of the contents | Does debtor still have it? | ---------------------------|-----------------------------------|-----------------------------|-------------------------------| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | under any environmental law? Include settlements and orders. | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | Status of case | | | | | | | | | | | | On appeal | | | | Concluded | | | | | | | | |

| Debtor | Case 22-50073 Genever Holdings Corporation | Doc 1158 Filed 11/23/22 | Entered 11/23/22 15:33:50 Page 9 of 12 Case number (if known) | 22-50542 | |--------|-------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------|----------------------------------------------------------------------------------|----------------| | | Name | 23. Has any governmental unit otherwise notified the debtor that the debtor may be liable or potentially liable under or in violation of an | | | | | environmental law? ❑✔ No | | | | | | ❑ Yes. Provide details below. | | | | | | Site name and address | Governmental unit name and address | Environmental law, if known | Date of notice | | | Name | Name | | | | | Street | Street | | | | | City State ZIP Code | City State ZIP Code | | | | | | 24. Has the debtor notified any governmental unit of any release of hazardous material? | | | | | ❑✔ No | | | | | | ❑ Yes. Provide details below. | | | | | | Site name and address | Governmental unit name and address | Environmental law, if known | Date of notice | | | Name | Name | | | | | Street | Street | | | | | | | | | | | City State ZIP Code | City State ZIP Code | | | | | | | | | | | | Part 13: Details About the Debtor's Business or Connections to Any Business | | | | | 25. Other businesses in which the debtor has or has had an interest information even if already listed in the Schedules. ❑✔ None | List any business for which the debtor was an owner, partner, member, or otherwise a person in control within 6 years before filing this case. Include this | | | | | Business name and address | Describe the nature of the business | Employer Identification number Do not include Social Security number or ITIN. | | | 25.1. | | | EIN: – | | | | Name | | Dates business existed | | | | Street | | From To | | | | City State ZIP Code | | | | | | 26. Books, records, and financial statements | | | | | | | 26a. List all accountants and bookkeepers who maintained the debtor's books and records within 2 years before filing this case. | | | | | ❑✔ None | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |

| Case 22-50073 Doc 1158 | | Entered 11/23/22 15:33:50 Page 10 of 12 Case number (if known) 22-50542 | |--------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------| | Name | | | | Name and address | | Dates of service | | | | From To | | | | | | | | | | | | | | State | ZIP Code | | | | | | | None | | | | Name and address | | Dates of service | | | | From To | | | | | | | | | | | | | | State | ZIP Code | | | | | | | None | | | | Name and address | | If any books of account and records are | | | | unavailable, explain why | | | | | | | | | | | | | | | | | | State | ZIP Code | | | | | | | None | | | | Name and address | | | | | | | | | | | | | | | | | | | | State | ZIP Code | | | | | | | | | | | Yes. Give the details about the two most recent inventories. | | | | | | | | | | | | | Genever Holdings Corporation Name Street City statement within 2 years before filing this case. ❑✔ Name Street City ❑✔ Name Street City statement within 2 years before filing this case. ❑✔ Name Street City 27. Inventories ❑✔ No | Filed 11/23/22 List all firms or individuals who have audited, compiled, or reviewed debtor's books of account and records or prepared a financial List all firms or individuals who were in possession of the debtor's books of account and records when this case is filed. List all financial institutions, creditors, and other parties, including mercantile and trade agencies, to whom the debtor issued a financial Have any inventories of the debtor's property been taken within 2 years before filing this case? ❑ |

| Debtor | Case 22-50073 Genever Holdings Corporation | Doc 1158 | Filed 11/23/22 | | Entered 11/23/22 15:33:50 | Case number (if known) | Page 11 of 12 22-50542 | |------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------|----------------------------------------------|-----------------------|----------------------------------------|--------------------------------|---------------------------------------------------------| | | Name | | | | | | | | | Name of the person who supervised the taking of the inventory | | | | Date of inventory | other basis) of each inventory | The dollar amount and basis (cost, market, or | | | | | | | | | | | | Name and address of the person who has possession of inventory records | | | | | | | | 27.1. | Name | | | | | | | | | | | | | | | | | | Street | | | | | | | | | | | | | | | | | | City | State | ZIP Code | | | | | | 28. List the debtor's officers, directors, managing members, general partners, members in control, controlling shareholders, or other people in control of the debtor at the time of the filing of this case. | | | | | | | | | | Name | Address | | | Position and nature of any interest | | % of interest, if any | | | Luc A Despins, as Ch 11 Trustee for Ho Wan Kwok | 10166-0019 | c/o Paul Hastings, 200 Park Ave New York, NY | | Shareholder, | | 100.00% | | | Claire Louise Abrehart | Craigmuir Chambers PO Box 71 Road Town, Tortola British Virgin Islands | | | Director, | | 0.00% | | | 29. Within 1 year before the filing of this case, did the debtor have officers, directors, managing members, general partners, members in control of the debtor, or shareholders in control of the debtor who no longer hold these positions? ❑ No ❑✔ | | | | | | | | | Yes. Identify below. Name | Address | | | Position and nature of any interest | | Period during which position or interest was held | | | Ho Wan Kwok | | 373 Taconic Road Greenwich, CT 06831-2828 | | Director, | | From 02/01/2015 To 07/08/2022 | | 30. Payments, distributions, or withdrawals credited or given to insiders | | | | | | | | | | Within 1 year before filing this case, did the debtor provide an insider with value in any form, including salary, other compensation, draws, bonuses, loans, credits on loans, stock redemptions, and options exercised? ❑✔ No | | | | | | | | | ❑ Yes. Identify below. | | | | | | | | | Name and address of recipient | | | and value of property | Amount of money or description | Dates | Reason for providing the value | | 30.1. | | | | | | | | | | Name | | | | | | | | | Street | | | | | | | | | | | | | | | | | | City | State | ZIP Code | | | | | | | Relationship to debtor | | | | | | | | | | | | | | | | | | 31. Within 6 years before filing this case, has the debtor been a member of any consolidated group for tax purposes? ❑✔ No | | | | | | | | | | | | | | | |

| Debtor | Case 22-50073 Doc 1158 Filed 11/23/22 Genever Holdings Corporation | Entered 11/23/22 15:33:50 Page 12 of 12 Case number (if known) 22-50542 | | | | | |---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------|----------------------------------------------------------------------------------|--|--|--|--| | ❑ | Name Yes. Identify below. | | | | | | | | Name of the parent corporation | Employer Identification number of the parent corporation | | | | | | | | EIN: – | | | | | | ❑✔ | 32. Within 6 years before filing this case, has the debtor as an employer been responsible for contributing to a pension fund? No | | | | | | | ❑ | Yes. Identify below. | | | | | | | | Name of the pension fund | Employer Identification number of the pension fund | | | | | | | | EIN: – | | | | | | | | | | | | | | | Part 14: Signature and Declaration | | | | | | | WARNING -- Bankruptcy fraud is a serious crime. Making a false statement, concealing property, or obtaining money or property by fraud in connection with a bankruptcy case can result in fines up to \$500,000 or imprisonment for up to 20 years, or both. 18 U.S.C. §§ 152, 1341, 1519, and 3571. | | | | | | | | I have examined the information in this Statement of Financial Affairs and any attachments 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. | | | | | | | | 11/23/2022 Executed on MM/ DD/ YYYY | | | | | | | ✘ | Printed name | Claire Abrehart | | | | | | | Signature of individual signing on behalf of the debtor | | | | | | | | Director Position or relationship to debtor | | | | | | | ❑✔ No | Are additional pages to Statement of Financial Affairs for Non-Individuals Filing for Bankruptcy (Official Form 207) attached? | | | | | | | ❑ Yes | | | | | | |