Exhibit 99.1
B 5 (Official Form 5) (12/07) FORM 5. INVOLUNTARY PETITION
UNITED STATES BANKRUPTCY COURT | INVOLUNTARY PETITION | |||
IN RE (Name of Debtor – If Individual: Last, First, Middle) Medizone International, Inc. | ALL OTHER NAMES used by debtor in the last 8 years (Include married, maiden, and trade names.) | |||
Last four digits of Social-Security or other Individual's Tax-I.D. No./Complete EIN (If more than one, state all.): 87-0412648 | ||||
STREET ADDRESS OF DEBTOR (No. and street, city, state, and zip code) 350 E. Michigan Ave., Ste. 500 Kalamazoo, MI 49007 COUNTY OF RESIDENCE OR PRINCIPAL PLACE OF BUSINESS Kalamazoo | MAILING ADDRESS OF DEBTOR (If different from street address) Medizone International, Inc. c/o The Corporation Trust Co. of Nevada 701 S. Carson St., Ste. 200 Carson City, NV 89701 | |||
LOCATION OF PRINCIPAL ASSETS OF BUSINESS DEBTOR (If different from previously listed addresses) | ||||
CHAPTER OF BANKRUPTCY CODE UNDER WHICH PETITION IS FILED Chapter 7 ■ Chapter 11 | ||||
INFORMATION REGARDING DEBTOR (Check applicable boxes) | ||||
Nature of Debts (Check one box.) Petitioners believe: □ Debts are primarily consumer debts ■ Debts are primarily business debts | Type of Debtor (Form of Organization) □ Individual (Includes Joint Debtor) ■ Corporation (Includes LLC and LLP) □ Partnership □ Other (If debtor is not one of the above entities, check this box and state type of entity below.) _________________________________________ | Nature of Business (Check one box.) □ Health Care Business □ Single Asset Real Estate as defined in 11 U.S.C. § 101(51)(B) □ Railroad □ Stockbroker □ Commodity Broker □ Clearing Bank ■ Other | ||
VENUE ■ Debtor has been domiciled or has had a residence, principal place of business, or principal assets in the District for 180 days immediately preceding the date of this petition or for a longer part of such 180 days than in any other District. □ A bankruptcy case concerning debtor's affiliate, general partner or partnership is pending in this District. | FILING FEE (Check one box) ■ Full Filing Fee attached □ Petitioner is a child support creditor or its representative, and the form specified in § 304(g) of the Bankruptcy Reform Act of 1994 is attached. [If a child support creditor or its representative is a petitioner, and if the petitioner files the form specified in § 304(g) of the Bankruptcy Reform Act of 1994, no fee is required.] | |||
PENDING BANKRUPTCY CASE FILED BY OR AGAINST ANY PARTNER OR AFFILIATE OF THIS DEBTOR (Report information for any additional cases on attached sheets.) | ||||
Name of Debtor | Case Number | Date | ||
Relationship | District | Judge | ||
ALLEGATIONS (Check applicable boxes) 1. ■ Petitioner (s) are eligible to file this petition pursuant to 11 U.S.C. § 303 (b). 2. ■ The debtor is a person against whom an order for relief may be entered under title 11 of the United States Code. 3.a. ■ The debtor is generally not paying such debtor's debts as they become due, unless such debts are the subject of a bona fide dispute as to liability or amount; or b. □ Within 120 days preceding the filing of this petition, a custodian, other than a trustee receiver, or agent appointed or authorized to take charge of less than substantially all of the property of the debtor for the purpose of enforcing a lien against such property, was appointed or took possession. | COURT USE ONLY |
B 5 (Official Form 5) (12/07) – Page 2
Name of Debtor Medizone International, Inc. Case No.____________________________
TRANSFER OF CLAIM Check this box if there has been a transfer of any claim against the debtor by or to any petitioner. Attach all documents that evidence the transfer and any statements that are required under Bankruptcy Rule 1003(a). | ||
REQUEST FOR RELIEF Petitioner(s) request that an order for relief be entered against the debtor under the chapter of title 11, United States Code, specified in this petition. If any petitioner is a foreign representative appointed in a foreign proceeding, a certified copy of the order of the court granting recognition is attached. Petitioner(s) declare under penalty of perjury that the foregoing is true and correct according to the best of their knowledge, information, and belief. x /s/ Edwin G. Marshall Signature of Petitioner or Representative (State title) Edwin G. Marshall April 15, 2018 Name of Petitioner Date Signed Address of Individual c/o Meyers Law Group, P.C. Signing in Representative 44 Montgomery St., Ste. 1010 Capacity San Francisco, CA 94104 | x /s/ Merle C. Meyers 4-16-18 Signature of Attorney Date Merle C. Meyers, Esq. Name of Attorney Firm (If any) Meyers Law Group, P.C. 44 Montgomery St., Ste. 1010 San Francisco, CA 94104 Address Telephone No. (415) 362-7500 | |
x /s/ Jill C. Marshall M.D Signature of Petitioner or Representative (State title) Dr. Jill C. Marshall April 15, 2018 Name of Petitioner Date Signed Name & Mailing Dr. Jill C. Marshall Address of Individual c/o Meyers Law Group, P.C. Signing in Representative 44 Montgomery St., Ste. 1010 Capacity San Francisco, CA 94104 | x /s/ Merle C. Meyers 4-16-18 Signature of Attorney Date Merle C. Meyers, Esq. Name of Attorney Firm (If any) Meyers Law Group, P.C. 44 Montgomery St., Ste. 1010 San Francisco, CA 94104 Address Telephone No. (415) 362-7500 | |
x [illegible] VP Signature of Petitioner or Representative (State title) Ushio America, Inc. 4/12/2018 Name of Petitioner Date Signed Address of Individual 5440 Cerritos Ave. Signing in Representative Cypress, CA 90630 Capacity | x______________________________________________________ Signature of Attorney Date Name of Attorney Firm (If any) _______________________________________________________ Address Telephone No. | |
PETITIONING Name and Address of Petitioner Edwin G. Marshall c/o Meyers Law Group, P.C. Attn: Merle C. Meyers, Esq. 44 Montgomery St., Ste. 1010 San Francisco, CA 94104 | CREDITORS Nature of Claim Promissory Note | Amount of Claim 1,118,448.00 |
Name and Address of Petitioner Dr. Jill C. Marshall c/o Meyers Law Group, P.C. Attn: Merle C. Meyers, Esq. 44 Montgomery St., Ste. 1010 San Francisco, CA 94104 | Nature of Claim Promissory Note | Amount of Claim 466,812.00 |
Name and Address of Petitioner Ushio America, Inc. 5440 Cerritos Ave. Cypress, CA 90630 | Nature of Claim Trade Debt | Amount of Claim 6,750.00 |
Note: If there are more than three petitioners, attach additional sheets with the statement under penalty of perjury, each petitioner's signature under the statement and the name of attorney and petitioning creditor information in the format above. | Total Amount of Petitioners' Claims 1,620,915.42 |
1 continuation sheets attached
B 5 (Official Form 5) (12/07) – Page 2
Name of Debtor Medizone International, Inc.
Case No.____________________________
TRANSFER OF CLAIM Check this box if there has been a transfer of any claim against the debtor by or to any petitioner. Attach all documents that evidence the transfer and any statements that are required under Bankruptcy Rule 1003(a). | ||
REQUEST FOR RELIEF Petitioner(s) request that an order for relief be entered against the debtor under the chapter of title 11, United States Code, specified in this petition. If any petitioner is a foreign representative appointed in a foreign proceeding, a certified copy of the order of the court granting recognition is attached. Petitioner(s) declare under penalty of perjury that the foregoing is true and correct according to the best of their knowledge, information, and belief. x /s/ Taras Worona (CEO) Signature of Petitioner or Representative (State title) Engineering CPR, Inc. 2018.04.14 Name of Petitioner Date Signed Address of Individual 6891 Edwards Blvd. Signing in Representative Mississauga, Ontario Capacity CANADA L5T 2T9 | x____________________________________________________ Signature of Attorney Date Name of Attorney Firm (If any) _____________________________________________________ Address Telephone No. | |
x_____________________________________________ Signature of Petitioner or Representative (State title) Name of Petitioner Date Signed Name & Mailing Address of Individual ______________________ Signing in Representative Capacity ______________________ | x_____________________________________________________ Signature of Attorney Date Name of Attorney Firm (If any) ______________________________________________________ Address Telephone No. | |
x_____________________________________________ Signature of Petitioner or Representative (State title) Name of Petitioner Date Signed Name & Mailing Address of Individual ______________________ Signing in Representative Capacity ______________________ | x____________________________________________________ Signature of Attorney Date Name of Attorney Firm (If any) _____________________________________________________ Address Telephone No. | |
PETITIONING Name and Address of Petitioner Engineering CPR, Inc. Attn: Taras Worona 6891 Edwards Blvd. Mississauga, Ontario CANADA L5T 2T9 | CREDITORS Nature of Claim Trade Debt | Amount of Claim 28,905.42 |
Name and Address of Petitioner | Nature of Claim | Amount of Claim |
Name and Address of Petitioner | Nature of Claim | Amount of Claim |
Note: If there are more than three petitioners, attach additional sheets with the statement under penalty of perjury, each petitioner's signature under the statement and the name of attorney and petitioning creditor information in the format above. | Total Amount of Petitioners' Claims 1,620,915.42 |
1 of 1 continuation sheets attached