Form B14 – Fill Out and Use This PDF

FORM B14 - (REV. 7/98)	1998 USBC, CENTRAL DISTRICT OF CALIFORNIA
Attorney or Party Name, Address, Telephone & FAX Numbers, and California State Bar Number	FOR COURT USE ONLY

ΘAttorney for Plan Proponent ______________________________

[Insert name and capacity (e.g., Debtor in Possession, Creditors’ Committee, Debtor XYZ, etc.)]

UNITED STATES BANKRUPTCY COURT	CHAPTER 11
CENTRAL DISTRICT OF CALIFORNIA	CASE NO.:
In re:	DATE:
	TIME:
	Debtor.
	CTRM:

BALLOT FOR ACCEPTING OR REJECTING PLAN

1.Proponent of Plan [specify name] ________________________________ has filed a Plan of Reorganization (“Plan”) on [date] _______________ for the Debtor in this case. By this ballot you will vote to accept or reject this Plan.

2.The Court has approved a Disclosure Statement with respect to the Plan. 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 the proponent or proponent’s attorney at the address set forth above. Court approval of the Disclosure Statement does not indicate approval of the Plan by the Court.

3.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 [check one box only] ” claim ” equity interest has been placed in Class [insert Class] ___ under the Plan. If you hold claim(s) or equity interest(s) in more than one Class, you will receive a ballot for each Class in which you are entitled to vote.

4.If your ballot is not received by the proponent’s attorney or other party [insert other party’s name and address]

__________________________________________________________________ on or before _______________, and such deadline is not extended, your vote will not count as either an acceptance or rejection of the Plan, unless the Judge otherwise determines that a non-vote will be treated as a rejection of the plan.

5.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

6. Complete the appropriate line below that describes your claim or equity interest [select only one]:

‘ 6.1	The undersigned is the holder of a Class [insert Class] ___	[check one]	” secured ” priority ” unsecured
	nonpriority claim against the Debtor in the unpaid amount of $ ____________.
‘ 6.2	The undersigned is the holder of a Class [insert Class] ___	[check one]	” bond ” debenture ” debt security
	claim against the Debtor, consisting of $____________, principal amount of [describe bond, debenture, or other debt
	security] ____________________________________________________ of the Debtor. (For purposes of this
	Ballot, you should not adjust the principal amount for any accrued or unmatured interest.)

‘6.3 The undersigned is the holder of a Class [insert Class] ___ equity interest in the Debtor, consisting of [number of shares] ____ or other interests [describe equity interest] ____________________________________ in the Debtor.

Other Classes:

” See Attached Continuation Page

Rev. 7/98

FORM B14

FORM B14 (CONTINUED) - (REV. 7/98)

1998 USBC, CENTRAL DISTRICT OF CALIFORNIA

Ballot for Accepting or Rejecting Plan - Page Two of Three

Debtor. CASE NO.:

7.The undersigned [check one box only]:

‘ ACCEPTS THE PLAN

‘

REJECTS THE PLAN

Dated:_______________
Name [Print or type]:	__________________________________________
Signature:	__________________________________________
Title [if corporation or partnership]:	__________________________________________
Address:	__________________________________________
	__________________________________________
	__________________________________________
Telephone No.:	__________________________________________
Fax No.:	__________________________________________

RETURN THIS BALLOT TO:

[Type in name and address of proponent’s attorney or other appropriate party]

Rev. 7/98

FORM B14

FORM B14 (CONTINUED) - (REV. 7/98)

1998 USBC, CENTRAL DISTRICT OF CALIFORNIA

Ballot for Accepting or Rejecting Plan - Page Three of Three

Debtor. CASE NO.:

PROOF OF SERVICE

STATE OF CALIFORNIA

COUNTY OF ____________________________

1.I am employed in the County of ____________________________, State of California. I am over the age of 18 and not a party to the within action. My business address is as follows:

2.Regular Mail Service:

On [insert date] _________________, I served the document described as: BALLOT FOR ACCEPTING OR REJECTING PLAN on the interested parties at their last known address in this action by placing a true and correct copy thereof in a sealed envelope with postage thereon fully prepaid in the United States Mail at

_______________________, California, addressed as set forth below.

qAddresses continued on attached page

I declare under penalty of perjury, under the laws of the United States of America, that the foregoing is true and correct.

Dated:

________________________________________	___________________________________________
Type Name	Signature

Rev. 7/98

FORM B14