Official Form 201 Voluntary Petition for Non-Individuals Filing for Bankruptcy page 1 

Official Form 201

Voluntary Petition for Non-Individuals Filing for Bankruptcy 04/20

If more space is needed, attach a separate sheet to this form. On the top of any additional pages, write the debtor’s name and the case 

number (if known). For more information, a separate document, Instructions for Bankruptcy Forms for Non-Individuals, is available.

1. Debtor’s name ______________________________________________________________________________________________________

2. All other names debtor used

in the last 8 years

Include any assumed names,

trade names, and doing business

as names

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

3. Debtor’s federal Employer

Identification Number (EIN) ______________________________________

4. Debtor’s address Principal place of business

______________________________________________

Number Street

______________________________________________

______________________________________________ 

City State ZIP Code 

______________________________________________

County 

Mailing address, if different from principal place 

of business

_______________________________________________

Number Street

_______________________________________________

P.O. Box

_______________________________________________ 

City State ZIP Code

Location of principal assets, if different from 

principal place of business

_______________________________________________

Number Street

_______________________________________________

_______________________________________________ 

City State ZIP Code

5. Debtor’s website (URL) ____________________________________________________________________________________________________

6. Type of debtor  Corporation (including Limited Liability Company (LLC) and Limited Liability Partnership (LLP))

 Partnership (excluding LLP)

 Other. Specify: __________________________________________________________________

 Check if this is an

amended filing

United States Bankruptcy Court for the:

____________________ District of _________________

(State) 

Case number (If known): _________________________ Chapter you are filing under:

 Chapter 7 

 Chapter 11

 Chapter 12

 Chapter 13

 Fill in this information to identify your case:

Miami FL Miami Beach FL

✔

33132 33140

61-1773430

Southern District of Florida

✔

Miami-Dade County

340 Biscayne Owner LLC

340 Biscayne Boulevard 4045 Sheridan Avenue

Case 21-17203 Doc 1 Filed 07/26/21 Page 1 of 5
Debtor _______________________________________________________ Case number (if known)_____________________________________ Name

Official Form 201 Voluntary Petition for Non-Individuals Filing for Bankruptcy page 2

7. Describe debtor’s business

A. Check one:

 Health Care Business (as defined in 11 U.S.C. § 101(27A))

 Single Asset Real Estate (as defined in 11 U.S.C. § 101(51B))

 Railroad (as defined in 11 U.S.C. § 101(44))

 Stockbroker (as defined in 11 U.S.C. § 101(53A))

 Commodity Broker (as defined in 11 U.S.C. § 101(6))

 Clearing Bank (as defined in 11 U.S.C. § 781(3))

 None of the above

B. Check all that apply:

 Tax-exempt entity (as described in 26 U.S.C. § 501)

 Investment company, including hedge fund or pooled investment vehicle (as defined in 15 U.S.C.

§ 80a-3)

 Investment advisor (as defined in 15 U.S.C. § 80b-2(a)(11))

C. NAICS (North American Industry Classification System) 4-digit code that best describes debtor.

See http://www.naics.com/search/ .

_________

8. Under which chapter of the

Bankruptcy Code is the

debtor filing?

Check one:

9. Were prior bankruptcy cases

filed by or against the debtor

within the last 8 years?

If more than 2 cases, attach a

separate list.

 No

 Yes. District _______________________ When _______________ Case number _________________________

MM / DD / YYYY

District _______________________ When _______________ Case number _________________________

MM / DD / YYYY

10. Are any bankruptcy cases

pending or being filed by a

business partner or an

affiliate of the debtor?

List all cases. If more than 1,

attach a separate list.

 No

 Yes. Debtor _____________________________________________ Relationship _________________________

District _____________________________________________ When __________________ 

MM / DD / YYYY 

Case number, if known ________________________________

A debtor who is a “small business 

debtor” must check the first subbox. A debtor as defined in 

§ 1182(1) who elects to proceed

under subchapter V of chapter 11

(whether or not the debtor is a

“small business debtor”) must

check the second sub-box.

 Chapter 7

 Chapter 9

 Chapter 11. Check all that apply:

 The debtor is a small business debtor as defined in 11 U.S.C. § 101(51D), and its

aggregate noncontingent liquidated debts (excluding debts owed to insiders or

affiliates) are less than $2,725,625. If this sub-box is selected, attach the most

recent balance sheet, statement of operations, cash-flow statement, and federal

income tax return or if any of these documents do not exist, follow the procedure in

11 U.S.C. § 1116(1)(B).

 The debtor is a debtor as defined in 11 U.S.C. § 1182(1), its aggregate

noncontingent liquidated debts (excluding debts owed to insiders or affiliates) are

less than $7,500,000, and it chooses to proceed under Subchapter V of

Chapter 11. If this sub-box is selected, attach the most recent balance sheet,

statement of operations, cash-flow statement, and federal income tax return, or if

any of these documents do not exist, follow the procedure in 11 U.S.C.

§ 1116(1)(B).

 A plan is being filed with this petition.

 Acceptances of the plan were solicited prepetition from one or more classes of

creditors, in accordance with 11 U.S.C. § 1126(b).

 The debtor is required to file periodic reports (for example, 10K and 10Q) with the

Securities and Exchange Commission according to § 13 or 15(d) of the Securities

Exchange Act of 1934. File the Attachment to Voluntary Petition for Non-Individuals Filing

for Bankruptcy under Chapter 11 (Official Form 201A) with this form.

 The debtor is a shell company as defined in the Securities Exchange Act of 1934 Rule

12b-2.

 Chapter 12

Regalia Units Owner LLC

7011

✔

Affiliate

✔

Southern District of Florida 05/27/2020

20-15747-LMI

340 Biscayne Owner LLC

Case 21-17203 Doc 1 Filed 07/26/21 Page 2 of 5
Debtor _______________________________________________________ Case number (if known)_____________________________________ Name

Official Form 201 Voluntary Petition for Non-Individuals Filing for Bankruptcy page 3

11. Why is the case filed in this

district?

Check all that apply:

 Debtor has had its domicile, principal place of business, or principal assets in this 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.

12. Does the debtor own or have

possession of any real

property or personal property

that needs immediate

attention?

 No

 Yes. Answer below for each property that needs immediate attention. Attach additional sheets if needed.

Why does the property need immediate attention? (Check all that apply.)

 It poses or is alleged to pose a threat of imminent and identifiable hazard to public health or safety.

What is the hazard? _____________________________________________________________________

 It needs to be physically secured or protected from the weather.

 It includes perishable goods or assets that could quickly deteriorate or lose value without

attention (for example, livestock, seasonal goods, meat, dairy, produce, or securities-related

assets or other options).

 Other _______________________________________________________________________________

Where is the property?_____________________________________________________________________

Number Street

____________________________________________________________________

_______________________________________ _______ ________________

City State ZIP Code 

Is the property insured?

 No

 Yes. Insurance agency ____________________________________________________________________

Contact name ____________________________________________________________________

Phone ________________________________ 

Statistical and administrative information

13. Debtor’s estimation of

available funds

Check one:

 Funds will be available for distribution to unsecured creditors.

 After any administrative expenses are paid, no funds will be available for distribution to unsecured creditors.

14. Estimated number of

creditors

 1-49

 50-99

 100-199

 200-999

 1,000-5,000

 5,001-10,000

 10,001-25,000

 25,001-50,000

 50,001-100,000

 More than 100,000

15. Estimated assets

 $0-$50,000

 $50,001-$100,000

 $100,001-$500,000

 $500,001-$1 million

 $1,000,001-$10 million

 $10,000,001-$50 million

 $50,000,001-$100 million

 $100,000,001-$500 million

 $500,000,001-$1 billion

 $1,000,000,001-$10 billion

 $10,000,000,001-$50 billion

 More than $50 billion

✔

Lauren Mintzer

✔

Willis Towers Watson Northeast, Inc.

Miami

✔

FL

212-309-0968

✔

✔

✔

33132

✔

340 Biscayne Boulevard

340 Biscayne Owner LLC

Case 21-17203 Doc 1 Filed 07/26/21 Page 3 of 5
Debtor _______________________________________________________ Case number (if known)_____________________________________ Name

Official Form 201 Voluntary Petition for Non-Individuals Filing for Bankruptcy page 4

16. Estimated liabilities

 $0-$50,000

 $50,001-$100,000

 $100,001-$500,000

 $500,001-$1 million

 $1,000,001-$10 million

 $10,000,001-$50 million

 $50,000,001-$100 million

 $100,000,001-$500 million

 $500,000,001-$1 billion

 $1,000,000,001-$10 billion

 $10,000,000,001-$50 billion

 More than $50 billion

Request for Relief, Declaration, and Signatures

WARNING -- Bankruptcy fraud is a serious crime. Making a false statement in connection with a bankruptcy case can result in fines up to 

$500,000 or imprisonment for up to 20 years, or both. 18 U.S.C. §§ 152, 1341, 1519, and 3571.

17. Declaration and signature of

authorized representative of

debtor

The debtor requests relief in accordance with the chapter of title 11, United States Code, specified in this

petition.

I have been authorized to file this petition on behalf of the debtor.

I have examined the information in this petition and have a reasonable belief that the information is true and

correct.

I declare under penalty of perjury that the foregoing is true and correct. 

Executed on _________________

MM / DD / YYYY

8_____________________________________________ _______________________________________________

Signature of authorized representative of debtor Printed name

Title _________________________________________ 

18. Signature of attorney 8_____________________________________________ Date _________________

Signature of attorney for debtor MM / DD / YYYY

_________________________________________________________________________________________________

Printed name

_________________________________________________________________________________________________

Firm name

_________________________________________________________________________________________________

Number Street

____________________________________________________ ____________ ______________________________

City State ZIP Code 

____________________________________ __________________________________________

Contact phone Email address

______________________________________________________ ____________

Bar number State

ljackson@pardojackson.com

FL

Miami

Pardo Jackson Gainsburg, PL

843164

FL 33131

3053581001

✔

Linda Jackson

200 SE 1st Street Suite 700

340 Biscayne Owner LLC

Cristiane Bomeny

Manager

Type text here

Case 21-17203 Doc 1 Filed 07/26/21 Page 4 of 5
Official Form 201 Voluntary Petition for Non-Individuals Filing for Bankruptcy

Debtor _ Case number (if known)

First Name Middle Name Last Name

Continuation Sheet for Official Form 201 

340 Biscayne Owner LLC

10) Pending Bankruptcies

Regalia Beach Southern District 05/27/2020 20-15748-LMI

Developers LLC of Florida

Case 21-17203 Doc 1 Filed 07/26/21 Page 5 of 5