UNITED STATES BANKRUPTCY COURT DISTRICT OF OREGON In re ) ) ) ) ) ) Impaired or Unimpaired* Case No. ________________ SUMMARY OF ACCEPTANCES AND REJECTIONS (NOTE: Prepare Per Local Form (LBF) #1181.2) % of Dollar Amt. Accepting** % of Number Accepting**
Debtor(s) Class
Total No. of Ballots Filed
This Summary consists of ______ pages. I certify under penalty of perjury that this Summary completely and accurately reflects all ballots received; the tabulations are correct to the best of my knowledge; all ballots received are separated and assembled by acceptances and rejections by class; I have retained the originals; I will provide copies to an interested party upon written request, and upon objection to the accuracy of this Summary I will introduce the originals at the hearing of such objection for possible admission to the official court record; and a copy of it was served on any Creditors' Committee AND the U.S. Trustee on the date below.
Date: __________
_________________________________________ Signature (OSB# if attorney) _________________________________________ TYPE OR PRINT SIGNER'S NAME
*If any class is designated as unimpaired, explain on an attached sheet why the class is unimpaired, or refer to the portion of the disclosure statement that provides such an explanation. **When calculating percentages, count only the allowed amount of those claims voting. 1181 (7/29/04)