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UNITED STATES BANKRUPTCY COURT DISTRICT OF OREGON In re ) ) ) ) ) ) Case No.________________ EXHIBIT "C-1" [NOTE: Must be FULLY completed by ALL debtors, and attached to ALL copies of the Petition.]

Debtor(s)

(NOTE: You must answer ALL questions. Attach additional sheets if necessary. Use of "UNKNOWN" is NOT acceptable!) 1. DESCRIBE ASSETS REQUIRING TRUSTEE'S IMMEDIATE ATTENTION:

2. Street address and description of principal assets:

3. The BANKRUPTCY DOCUMENT PREPARER DECLARATION below has been completed for any person who helped, for compensation, prepare any of the bankruptcy papers if the debtor does not have an attorney. I declare under penalty of perjury that the above information provided in this Exhibit "C-1" is true and correct.

DATE:__________

___________________________________________ Debtor's Signature Phone #

_____________________________ Joint Debtor's Signature

BANKRUPTCY DOCUMENT PREPARER DECLARATION I, the undersigned, declare under penalty of perjury that (1) neither I, nor anyone else listed herein, collected or received any payment from or on behalf of the debtor for court fees in connection with filing the petition; (2) I have received $________________ from or on behalf of the debtor within the previous 12 month period; (3) $________________ is the unpaid fee charged to the debtor; and (4) the following is true and accurate about myself and any other assistants: Individual Name and Firm (Type or Print):____________________________________________________________________ Address (Type or Print):__________________________________________________________________________________ Last 4 digits of Social Security Number of all OTHER individuals who prepared or assisted in the preparation of these bankruptcy documents:___________________________________________________________________________________________

Signature:________________________ Last 4 digits of Social Security #:___________ Phone #:_______________________ [NOTE: Penalties up to $500 per item may be assessed for omission of any required information (11 USC §110; 18 USC §156) and Fed. Bankruptcy Rule 1006 prohibits further payment to any person for services until the court filing fees are paid in full.]

EXHIBIT C-1 (8/8/08)