Appendix F

List of Creditors Holding 20 Largest

Unsecured Claims

 

Form B4

11 /92

UNITED STATES BANKRUPTCY COURT

_______________________ DISTRICT OF ____________________

 

In re ____________________________________,

Debtor Case No. _____________

Chapter ______________

 

LIST OF CREDITORS HOLDING 20 LARGEST UNSECURED CLAIMS

Following is the list of the debtor's creditors holding the 20 largest unsecured claims. The list is prepared in accordance with Fed. R. Bankr. P. 1007(d) for filing in this chapter 11 [or chapter 9] case. The list does not include (1) persons who come within the definition of "insider" set forth in 11 U.S.C. § 101, or (2) secured creditors unless the value of the collateral is such that the unsecured deficiency places the creditor among the holders of the 20 largest unsecured claims.

 

(1) (2) (3) (4) (5)

Name of creditor Name, telephone number and Nature of claim Indicate if claim Amount of claim

and complete complete mailing address, (trade debt, is contingent, [ifsecured also

mailing address including zip code, of bank loan, gov- unliquidated, state value of

including zip employee, agent, or department ernment contract, disputed or security]

code of creditor familiar with etc) subject to setoff

claim who may be contacted

 

 

 

 

Date ____________

 

 

____________________________________

Debtor

 

 

 

 

 

 

 

 

 

 

 

[Declaration as in Form 2J