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B8 (Form 8) (12/08)

In re

Robert Edward Hayner
Jane E Hayner

United States Bankruptcy Court

Northern District of California

Debtor(s)

Case No.
Chapter

7

CHAPTER 7 INDIVIDUAL DEBTOR'S STATEMENT OF INTENTION

PART A - Debts secured by property of the estate. (Part A must be fully completed for EACH debt which is secured by

property of the estate. Attach additional pages if necessary.)

Property No. 1

Creditor's Name:
Chase

Describe Property Securing Debt:
810 Meadow Valley Road, Mt. Shasta, CA

Property will be (check one):

? Surrendered

? Retained

If retaining the property, I intend to (check at least one):

? Redeem the property
? Reaffirm the debt
? Other. Explain Subject to Loan Modification (for example, avoid lien using 11 U.S.C. § 522(f)).

Property is (check one):

? Claimed as Exempt

Property No. 2

Creditor's Name:
Chase

? Not claimed as exempt

Describe Property Securing Debt:
Location: 4179 Crest Road, Pebble Beach CA 93953

Property will be (check one):

? Surrendered

? Retained

If retaining the property, I intend to (check at least one):

? Redeem the property
? Reaffirm the debt
? Other. Explain Subject to loan modification (for example, avoid lien using 11 U.S.C. § 522(f)).

Property is (check one):

? Claimed as Exempt

? Not claimed as exempt

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Best Case Bankruptcy

Case: 11-51102 Doc# 7 Filed: 02/04/11 Entered: 02/04/11 17:13:00 Page 1 of 2

B8 (Form 8) (12/08)
Property No. 3

Creditor's Name:
Chase

Page 2

Describe Property Securing Debt:
Location: 4179 Crest Road, Pebble Beach CA 93953

Property will be (check one):

? Surrendered

? Retained

If retaining the property, I intend to (check at least one):

? Redeem the property
? Reaffirm the debt
? Other. Explain Subject to loan modification (for example, avoid lien using 11 U.S.C. § 522(f)).

Property is (check one):

? Claimed as Exempt

Property No. 4

Creditor's Name:
Monterey County Bank

Property will be (check one):

? Surrendered

? Not claimed as exempt

Describe Property Securing Debt:
Location: 4179 Crest Road, Pebble Beach CA 93953

? Retained

If retaining the property, I intend to (check at least one):

? Redeem the property
? Reaffirm the debt
? Other. Explain Subject to loan modification (for example, avoid lien using 11 U.S.C. § 522(f)).

Property is (check one):

? Claimed as Exempt

? Not claimed as exempt

PART B - Personal property subject to unexpired leases. (All three columns of Part B must be completed for each unexpired lease.
Attach additional pages if necessary.)

Property No. 1

Lessor's Name:
Salinas Valley Memorial Hospital

Describe Leased Property:
Guaranty of Biobank USA Lease

Lease will be Assumed pursuant to 11
U.S.C. § 365(p)(2):
? YES

? NO

I declare under penalty of perjury that the above indicates my intention as to any property of my estate securing a debt
and/or personal property subject to an unexpired lease.

Date February 4, 2011

Date February 4, 2011

Signature

/s/ Robert Edward Hayner
Robert Edward Hayner
Debtor

Signature

/s/ Jane E Hayner
Jane E Hayner
Joint Debtor

Software Copyright (c) 1996-2010 CCH INCORPORATED - www.bestcase.com

Best Case Bankruptcy

Case: 11-51102 Doc# 7 Filed: 02/04/11 Entered: 02/04/11 17:13:00 Page 2 of 2