R.I. Bankr. Form I See R.I. LBRs 3018-1 and 3020-1 UNITED STATES BANKRUPTCY COURT DISTRICT OF RHODE ISLAND ) ) BK No. ) ) REPORT ON BALLOTS CHAPTER 11 PLAN CREDITORS BALLOTS VOTING CLASS OF CREDITORS
Class NUMBER I. II. III. IV. V. VI. VII. DESCRIPTION QUANTITY DOLLAR VALUE QUANTITY
IN RE: Debtor(s)
YES
DOLLAR VALUE ***
NO
QUANTITY
*** Ballots voting YES represent at least one-half (1/2) in quantity and more than two-thirds (2/3) in dollar value of the allowed claims voting in this Class. Check the above box (***) if this applies.
Use additional sheet if necessary.
Complete the Form for as many Classes as appropriate.
PAGE TWO OF REPORT ON BALLOTS: IN RE: Debtor(s) ) ) ) ) )
BK No.
List separately any ballots filed after the ballot deadline showing the same information as above.
(Debtor's Name)
____________________________ (Attorney's Name) State Bar No. (Address) (TEL:) (FAX:) Dated: