Current assets

$1,875,000

Accounts payable

$375,000

Fixed assets

1,875,000

Notes payable

750,000

Subordinated debentures

750,000

Total debt

$1,875,000

Common equity

1,875,000

Total assets

$3,750,000

Total liabilities and equity

$3,750,000

1. Proceeds from sale of assets

$ ______

2. First mortgage, paid from sale of assets

$ ______

3. Fees and expenses of administration of bankruptcy

$ _______

4. Wages due workers earned within 3 months
prior to filing of bankruptcy petition

$ ________

5. Taxes

$ ________

6. Unfunded pension liabilities

$ ________

7. Available to general creditors

$ ______

Claims of
General
Creditors

Claim
(1)

Application of 100%
Distribution
(2)

After
Subordination
Adjustment
(3)

Percentage of
Original Claims Received
(4)

Notes payable

$ ________

$ ________

$ ________

________ %

Accounts payable

$ ________

$ ________

$ ________

________ %

Subordinated debentures

$ ________

$ ________

$ ________

________ %

Total

$ ________

$ ________

$ ________