Free Plan Ballot Summary - Iowa

Attorney or Party Name, Address, Telephone and Fax Number, and IASB ID No.

FOR COURT USE ONLY

Attorney for

UNITED STATES BANKRUPTCY COURT SOUTHERN DISTRICT OF IOWA
In re: CHAPTER ________ CASE NUMBER DATE: TIME: Debtor. COURTROOM:

PLAN BALLOT SUMMARY
(NOTE: The Plan Proponent must file a Plan Ballot Summary at least two(2) Court days prior to the Confirmation Hearing.) 1. Proponent of Plan (Specify name): 2. Are any competing plans filed with the Court? 3. Is a cramdown requested? 4. Unimpaired Classes (Specify Class Numbers): 5. Impaired Classes (Specify Class Numbers): 6. Has any impaired class approved the Plan? (If YES, specify which class or classes):

q q

Yes Yes

q q

No No

q

Yes

q

No

7. The following is the voting summary by creditor class: ACCEPTING
Number Class 1 Class 2 Class 3 Class 4 Class 5 Class 6 % Amount % Number

REJECTING
% Amount %

Other Classes: Dated: By: ________________________________________

q

See attached Continuation Page

Firm Name: __________________________________________ Name: ______________________________________________ Attorney for Plan Proponent

IASB-BALLOT_SUM [4/14/00]