Class [#] [name or identity of Class]: This class is impaired, has balloted upon the Plan, and [ACCEPTS/REJECTS] the Plan. Class [#] Ballots Claims in terms of $ Total in class [# [$ of ballots distributed] amount of allowed claims] # filed [# [(% [$ [(% of ballots] of total)] amount] of total)] for Plan [# [(% [$ [(% of ballots] of total)] amount] of total)] against Plan [# [(% [$ [(% of ballots] of total)] amount] of total)] [Provide as many additional summary paragraphs as necessary.] Certification I certify that the [Plan Proponent] retains the voted ballots and will, upon request of the Court, the debtor-in-possession, the case trustee (if any), and/or the U.S. Trustee, produce copies of all such ballots. I further certify that the above summary report is an accurate summary of all classes, all allowed claims, and all ballots voted, and that this summary complies with Vt. LBR 3018-3. Dated: _______________ Authorized Agent of Plan Proponent By: ______________________________ Printed name of signatory Address E-mail address Telephone number
Class [#] [name or identity of Class]: This class is impaired, has balloted upon the Plan, and [ACCEPTS/REJECTS] the Plan. Class [#] Ballots Claims in terms of $ Total in class [# of ballots distributed] [$ amount of allowed claims] # filed [# of ballots] [(% of total)] [$ amount] [(% of total)] for Plan [# of ballots] [(% of total)] [$ amount] [(% of total)] against Plan [# of ballots] [(% of total)] [$ amount] [(% of total)] [Provide as many additional summary paragraphs as necessary.] Certification I certify that the [Plan Proponent] retains the voted ballots and will, upon request of the Court, the debtor-in-possession, the case trustee (if any), and/or the U.S. Trustee, produce copies of all such ballots. I further certify that the above summary report is an accurate summary of all classes, all allowed claims, and all ballots voted, and that this summary complies with Vt. LBR 3018-3. Dated: _______________ Authorized Agent of Plan Proponent By: ______________________________ Printed name of signatory Address E-mail address Telephone number
14%20-%20FORM%20G%20-%20Summary%20Ballot%20Report%20Certification.docx