Official Form 14 (12/03)
Form 14. CLASS [ ] BALLOT FOR ACCEPTING OR REJECTING PLAN OF REORGANIZATION [Caption as in Form 16A] CLASS [ ] BALLOT FOR ACCEPTING OR REJECTING PLAN OF REORGANIZATION
[Proponent] filed a plan of reorganization dated [Date] (the "Plan") for the Debtor in this case. The Court has [conditionally] approved a disclosure statement with respect to the Plan (the "Disclosure Statement"). The Disclosure Statement provides information to assist you in deciding how to vote your ballot. If you do not have a Disclosure Statement, you may obtain a copy from [name, address, telephone number and telecopy number of proponent/proponent's attorney.] Court approval of the disclosure statement does not indicate approval of the Plan by the Court. You should review the Disclosure Statement and the Plan before you vote. You may wish to seek legal advice concerning the Plan and your classification and treatment under the Plan. Your [claim] [equity interest] has been placed in class [ ] under the Plan. If you hold claims or equity interests in more than one class, you will receive a ballot for each class in which you are entitled to vote. If your ballot is not received by [name and address of proponent's attorney or other appropriate address] on or before [date], and such deadline is not extended, your vote will not count as either an acceptance or rejection of the Plan. If the Plan is confirmed by the Bankruptcy Court it will be binding on you whether or not you vote.
ACCEPTANCE OR REJECTION OF THE PLAN [At this point the ballot should provide for voting by the particular class of creditors or equity holders receiving the ballot using one of the following alternatives;] [If the voter is the holder of a secured, priority, or unsecured nonpriority claim:]
The undersigned, the holder of a Class [ ] claim against the Debtor in the unpaid amount of Dollars ($ [or, if the voter is the holder of a bond, debenture, or other debt security:]
The undersigned, the holder of a Class [ ] claim against the Debtor, consisting of Dollars ($ ) principal amount of [describe bond, debenture, or other debt security] of the Debtor (For purposes of this Ballot, it is not necessary and you should not adjust the principal amount for any accrued or unmatured interest.) [or, if the voter is the holder of an equity interest:] The undersigned, the holder of Class [ ] equity interest in the Debtor, consisting of ______ shares or other interests of [describe equity interest] in the Debtor
Official Form 14 continued (12/03)
[In each case, the following language should be included:] (Check one box only) [ ] ACCEPTS THE PLAN Dated: ___________________ Print or type name: _________________________ Signature: _________________________________ Title (if corporation or partnership) _____________ Address: _____________________________ _____________________________ RETURN THIS BALLOT TO: [Name and address of proponent's attorney or other appropriate address] [ ] REJECTS THE PLAN