UNITED STATES BANKRUPTCY COURT

DISTRICT OF NEW MEXICO

In re

Debtor.	No.

CORPORATE OWNERSHIP STATEMENT – BANKRUPTCY CASE

Initial Disclosure (file with petition)

Supplemental Disclosure (file upon change in circumstances)

Pursuant to Fed. R. Bankr. P. 1007 (a)(1), the debtor:

identifies any corporation, other than a governmental unit, that directly or indirectly owns 10% or more of any class of the corporation's equity interests:

[list names of corporations here]

OR

states that there are no entities to report.

I, [the president or other officer or an authorized agent] of the debtor corporation, declare under penalty of perjury that I have read the foregoing statement and that it is true and correct to the best of my information and belief.

DEBTOR CORPORATION NAME

By: ______________________________

Signature of Authorized Individual

Name of Authorized Individual

Title of Authorized Individual

F:\FORMS\drafts\corporate ownership statement bankruptcy.wpd