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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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