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(Official Form 1) (2000) FORM B1 United States Bankruptcy Court Middle Voluntary Petition District of Name of Debtor (if individual, enter Last, First, Middle): Mitchell, Larry C. All Other Names
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G.-1181-xxxx-xxxx):-1181-xxxx-xxxx Employer Name (full name, if applicable) Is Employer Does not Identify Debtor No. (If not in the last 6 years, state the last 6 years' name, address & Social Security number and your date of birth): If Debtor Does Identify Debtor Occupation, Trade/Qualification & Years Experience: If Employer Does Not Identify: If Debtor Does Identify: I agree that I am subject to disclosure under Title 18, U.S. Code § 7201(k)-(q), which prohibits the disclosure of any personal financial information, including information related to income tax returns.

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