BUSINESS OPERATING STATEMENT

Name(s) of Debtor(s) )
Chapter 13 Proceedings )
Case No. __________                      )
Financial Report for ______, 200__  )
_____________________ )

 1. INCOME.

Gross Business Receipts $_____________
Sales Taxes Collected                 $_____________

TOTAL INCOME                      $_____________

2. COSTS AND EXPENSES.

Advertising $__________
Auto Fuel & Operation $__________
Bad Debts & Collection Casts (non-cash basis) $__________

              Commissions & Bonuses $__________
Debt Installments (do not include the plan payment):
(a) ___________________________ $__________
(b) ___________________________ $__________
(c)  ___________________________ $__________
              Employee Benefits:
(a) Hospitalization & Medical $__________
(b) Retirement $__________
(c) Other $__________
Insurance Premiums (fire, theft, liability, etc.) $__________
Legal & Accounting $__________
Maintenance & Repairs $__________
Materials & Supplies $__________
Office Supplies $__________
Other Business Expenses (itemize):
__________________ $__________
__________________ $__________
Postage & Shipping $__________
Rent or Lease Expense $__________
Returns & Allowances $__________
Salaries/Wages (gross, do not incl. Owner's salary) $__________

Taxes:
Employers FICA (social security) contributions   $__________
Sales Taxes $__________
Unemployment Taxes  $__________
Telephone & Utilities $__________
Workers Compensation Insurance $__________

TOTAL COSTS AND EXPENSES $___________

3. NET INCOME (LOSS). (Subtract Total Costs & Expenses [#2] from Total Income #1]

$______________

I/We declare under penalty of perjury that the information provided is true and correct to the best of my/our knowledge, information and belief.

Dated: ______________, 200__.

____________________________      __________________________
Debtor: Joint Debtor:

=====================================================================