COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. FOR COURT USE ONLY Attorney or Party Name, Address, Telephone and Fax Number, and IASB ID No. : Plaintiff(s) -against- : JUDICIAL SUBPOENA : : Attorney for UNITED STATES BANKRUPTCY COURT SOUTHERN DISTRICT OF IOWA In re: Calendar No. : Defendant(s) : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .CHAPTER ________ .. CASE NUMBER DATE: THE PEOPLE OF THE STATE OF NEW YORK TIME: Debtor. TO COURTROOM: PLAN BALLOT SUMMARY (NOTE: The Plan Proponent must file a Plan Ballot Summary at least two(2) GREETINGS: Court days prior to the Confirmation Hearing.) 1. Proponent of Plan (Specify name): that all business and excuses being laid aside, you and each of you attend before WE COMMAND YOU, , the Honorable at Court q the Yes q No located at County of q Yes , at q No 3. Is incramdown requested? a room , on the day of , 20 o'clock in the noon, and at any recessed or adjourned date, (Specify Class Numbers): as a witness in this action on the part of the to testify and give evidence 4. Unimpaired Classes 2. Are any competing plans filed with the Court? 5. Impaired Classes (Specify Class Numbers): q Yes q No 6. Has any impaired class approved the Plan? Your failure to comply with (If YES, specify which class or classes): this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a 7. The following is the votingcomply. by creditor class: result of your failure to summary ACCEPTING Witness, Honorable Court in day of Number County, % Amount REJECTING , one of the Justices of the , %20 Number % Amount % Class 1 Class 2 (Attorney must sign above and type name below) Class 3 Class 4 Attorney(s) for Class 5 Class 6 Other Classes: q See Office and P.O. Address attached Continuation Page Dated: Firm Name: __________________________________________ By: ________________________________________ Telephone No.: Name: ______________________________________________ FacsimileAttorney for Plan Proponent No.: E-Mail Address: Mobile Tel. No.: IASB-BALLOT_SUM [4/14/00] American LegalNet, Inc. www.USCourtForms.com