LIST OF CREDITORS

_____________, conducts a business engaged in Retail Sales, at 
________________, ____________, __________. _____________ has 
contracted to sell to _____________, in bulk, the following:

_____________________________________________________________

Pursuant to Art. 6-104 of the Uniform Commercial Code, 
_____________ herewith lists all creditors of _____________.

Undisputed creditors:

See attached sheet

Disputed creditors (the following entities claim that they are 
owed sums, however, _____________ disputes the same):

See attached sheet


_____________________________________________ 
For _______________
As its: Owner

STATE OF ___________)))))

COUNTY OF __________)))))


______________________________________________________, appeared 
before me, and swore or affirmed that the foregoing list of 
creditors is true and correct to the best of their knowledge and 
belief.


Dated: ____________________________


___________________________________________________ 
Notary Public