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Form B4 11/92

UNITED STATES BANKRUPTCY COURT DISTRICT OF

In re Debtor

, Case No. Chapter

LIST OF CREDITORS HOLDING 20 LARGEST UNSECURED CLAIMS Following is the list of the debtor's creditors holding the 20 largest unsecured claims. The list is prepared in accordance with Fed. R. Bankr. P. 1007(d) for filing in this chapter 11 [or chapter 9] case. The list does not include (1) persons who come within the definition of "insider" set forth in 11 U.S.C. § 101, or (2) secured creditors unless the value of the collateral is such that the unsecured deficiency places the creditor among the holders of the 20 largest unsecured claims. (1)
Name of creditor and complete mailing address including zip code

(2)
Name, telephone number and complete mailing address, including zip code, of employee, agent, or department of creditor familiar with claim who may be contacted

(3)
Nature of claim (trade debt, bank loan, government contract, etc.)

(4)
Indicate if claim is contingent, unliquidated, disputed or subject to setoff

(5)
Amount of claim [if secured also state value of security]

Date:

Debtor
[Declaration as in Form 2]