FORM B1
United States Bankruptcy Court Voluntary Petition
_______________________District of _______________________
Name of Debtor (if individual, enter Name of Joint Debtor (Spouse) (Last,
Last, First, Middle): First Middle):
Impulse Media Technologies, Inc.
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All Other Names used by the Debtor in All Other Names used by the Joint
the last 6 years (include married, Debtor in the last 6 years (include
maiden, and trade names): married, maiden, and trade names):
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Soc. Sec./Tax I.D. No. (if more than Soc. Sec./Tax I.D. No. (if more than
one, state all): one, state all):
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Street Address of Debtor (No. & Street, Street Address of Joint Debtor (No. &
City, State & Zip Code): Street, City, State & Zip Code):
Suite 566 - 1027 Davie St.
Vancouver, B.C., Canada
V6E 4L2
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County of Residence or of the County of Residence or of the
Principal Place of Business: Principal Place of Business:
Nevada
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Mailing Address of Debtor (if different Mailing Address of Joint Debtor (if
from street address): different from street address):
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Location of Principal Assets of Business
Debtor (if different from street address
above:
No Assets.
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Information Regarding the Debtor (Check the Applicable Boxes)
Venue (Check any applicable box)
[X] Debtor has been domiciled or has had a residence, principal place of
business, or principal assets in this District of 180 days immediately
preceding the date of this petition or for a longer part of such 180 days
than in any other District.
[ ] There is a bankruptcy case concerning debtor's affiliate, general
partner, or partnership pending in this District.
Type of Debtor (Check all boxes Chapter or Section of Bankruptcy Code
that apply Under Which the Petition is Filed
[ ] Individual(s) [ ] Railroad (Check one box)
[X] Corporation [ ] Stockbroker [X] Chapter 7 [ ] Chapter 11
[ ] Partnership [ ] Commodity Broker [ ] Chapter 9 [ ] Chapter 12
[ ] Other____________ [ ] Chapter 13
[ ] Sec. 304 - Case ancillary to
foreign proceeding
Nature of Debts (Check one box) Filing Fee (Check one box)
[ ] Consumer/Non-Business [X] Full Filing Fee attached
[X] Business [ ] Filing Fee to be paid in
Chapter 11 Small Business installments (Applicable to
(Check all boxes that apply) individuals only) Must attach
[ ] Debtor is a small business as defined signed application of the court's
in 11 U.S.C. Sect. 101 consideration certifying that the
[ ] Debtor is and elects to be considered debtor is unable to pay fee
a small business under 11 U.S.C. except in installments. Rule
Sect. 1121(e) (Optional) 1006(b). See Official Form No. 3.
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Statistical/Administrative Information (Estimates only) THIS SPACE FOR COURT
USE ONLY
[ ] Debtor estimates that funds will be available for
distribution to unsecured creditors.
[X] Debtor estimates that, after any exempt property
is excluded and administrative expenses paid,
there will be no funds available for distribution
to unsecured creditors.
Estimated Number of Creditors 1-15 16-49 50-99 100-199 200-299 1000-over
[X] [ ] [ ] [ ] [ ] [ ]
Estimated Assets
$0 to $50,001 to $100,001 to $500,001 to $1,000,001 to $10,000,001 to
$50,000 $100,000 $500,000 $1 million $10 million $50 million
[X] [ ] [ ] [ ] [ ] [ ]
$50,000,001 to More than
$100 million $100 million
[ ] [ ]
Estimated Debts
$0 to $50,001 to $100,001 to $500,001 to $1,000,001 to $10,000,001 to
$50,000 $100,000 $500,000 $1 million $10 million $50 million
[ ] [ ] [X] [ ] [ ] [ ]
$50,000,001 to More than
$100 million $100 million
[ ] [ ]
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Voluntary Petition Name of Debtor(s):
(This page must be completed and filed
in every case) Impulse Media Technologies, Inc.
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Prior Bankruptcy Case filed Within Last 6 Years
(If more than one, attach additional sheet)
Location Case Number: Date Filed:
Where Filed:
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Pending Bankruptcy Case Filed by any Spouse, Partner or Affiliate of this Debtor
(If more than one, attach additional sheet)
Name of Debtor: Case Number: Date Filed:
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District: Relationship: Judge:
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Signatures
Signature(s) of Debtor(s) Exhibit A
(Individual/Joint) (To be completed if debtor is required
I declare under penalty of perjury that to file periodic reports (e.g., forms
the information provided in this 10K and 10Q) with the Securities and
petition is true and correct. Exchange Commission pursuant to
[If petitioner is an individual whose Section 13 or 15(d) of the Securities
debts are primarily consumer debts and Exchange Act of 1934 and is requesting
has chosen to file under chapter 7] I relief under chapter 11)
am aware that I may proceed under
chapter 7, 11, 12 or 13 or title 11, [ ] Exhibit A is attached and make a
United States Code, understand the part of this petition.
relief available under each such ---------------------------------------
chapter, and choose to proceed under Exhibit B
chapter 7 (To be completed if debtor is an
I request relief in accordance with the individual whose debts are primarily
chapter of title 11, United States Code, consumer debts)
specified in this petition. I, the attorney for the petitioner
named in the foregoing petition,
X _____________________________________ declare that I have informed the
Signature of Debtor petitioner that [he or she] may
proceed under chapter 7, 11, 12, or
X _____________________________________ 13 of title 11, United States Code,
Signature of Joint Debtor and have explained the relief
available under each such chapter.
X _____________________________________ X ____________________________________
Telephone Number (If not represented (Signature of Attorney for Date
by attorney Debtor(s)
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_____________________________________ Exhibit C
Date Does the debtor own or have possession
of any property that poses or is
- ----------------------------------------- alleged to pose a threat of imminent
Signature of Attorney and identifiable harm to public health
or safety?
X _____________________________________ [ ] Yes, and Exhibit C is attached
Signature of Attorney for Debtor(s) and made a part of this petition.
[ ] No
_____________________________________ ---------------------------------------
Printed Name of Attorney for Debtor(s) Signature of Non-Attorney
Petition Preparer
_____________________________________
Firm Name I certify that I am a bankruptcy
petition preparer as defined in 11
_____________________________________ U.S.C. Sect. 110, that I prepared
Address this document of compensation, and
_____________________________________ that I have provided the debtor with
a copy of this document.
_____________________________________
Telephone Number ____________________________________
Printed Name of Bankruptcy Petition
_____________________________________ Preparer
Date
- ----------------------------------------- ____________________________________
Signature of Debtor Social Security Number
(Corporation/Partnership
I declare under penalty of perjury that ____________________________________
the information provided in this Address
petition is true and correct, and that
I have been authorized to file this ____________________________________
petition on behalf of the debtor. Names and Social Security numbers
of all other individuals who
The debtor requests relief in prepared or assisted in preparing
accordance with the chapter of title this document:
11, United States Code, specified in
this petition.
X /s/ John Dawe X ____________________________________
------------------------------------- Signature of Bankruptcy Petition
Signature of Authorized Individual Preparer
John Dawe ____________________________________
------------------------------------- Date
Printed Name of Authorized Individual
A bankruptcy petition preparer's
VP Finance failure to comply with the provisions
------------------------------------- of title 11 and the Federal Rules of
Title of Authorized Individual Bankruptcy Procedure may result in
fines or imprisonment of both 11
August 24, 2002 U.S.C. Sect. 110; 18 U.S.C. Sect. 156
-------------------------------------
Date
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