Fill and Sign the Creditors Who Have Unsecured Claims United States Courts Form

B4 (Official Form 4) (12/07)Unit ed St at es Bankrupt cy Court_______________ Dist rict Of ______________ In re ___________________________________, Case No. ___________________ Debtor 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 th e collateral is such that the unsecured deficiency places the creditor among the holders of the 20 largest unsecured claims. If a minor child is one of the creditors holding the 20 largest unsecured claims, state the child's initials and the name and address of the child's parent or guardian, such as "A.B., a minor child, by John Doe, guardian." Do not disclose the child's name. See, 11 U.S.C. §112 and Fed. R. Bankr. P. 1007(m). ______________________________________________________________________________ (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, bank is contingent, [if secured also mailing address, including zip code, of loan, government unliquidated, state value of including zip employee, agent, or department contract, etc.) disputed or security] code of creditor familiar with subject to setoff claim who may be contacted _______________________________________Debtor [Declaration as in Form 2]