Free Reports on Ballots - Connecticut

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United States Bankruptcy Court District of Connecticut In re: Case No:________________

Debtor(s)

Chapter 11 REPORT ON BALLOTS AND ADMINISTRATIVE EXPENSES

Impaired or unimpaired

Number Eligible

Number Voting

Amount Voting

Number Accept

Amount Accept

Number Reject

Amount Reject

Number Needed For Conf.

Amount Needed For Conf.

Class 1:__________ __________ __________ __________ __________ __________ __________ __________ __________ Class 2:__________ __________ __________ __________ __________ __________ __________ __________ __________ Class 3:__________ __________ __________ __________ __________ __________ __________ __________ __________ Class 4:__________ __________ __________ __________ __________ __________ __________ __________ __________ Class 5:__________ __________ __________ __________ __________ __________ __________ __________ __________ Class 6:__________ __________ __________ __________ __________ __________ __________ __________ __________ Class 7:__________ __________ __________ __________ __________ __________ __________ __________ __________ Class 8:__________ __________ __________ __________ __________ __________ __________ __________ __________ Class 9:__________ __________ __________ __________ __________ __________ __________ __________ __________ Class 10:_________ __________ __________ __________ __________ __________ __________ __________ __________

__________ __________ __________ __________ __________ __________ __________ __________ __________ __________

Class 11:_________ __________ __________ __________ __________ __________ __________ __________ __________ _____________ Class 12:_________ __________ __________ __________ __________ __________ __________ __________ __________ _____________

Class_________:Stockholders: Total number__________ Number Voting _____________ Number Accepts_____________ PLEASE INDICATE ABOVE, UNDER EACH CLASS, WETHER SECURED, PRIORITY, OR UNSECURED

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