Attorney or Party Name, Address, Telephone & FAX Numbers, and California State Bar Number FOR COURT USE ONLY Attorney for UNITED STATES BANKRUPTCY COURT CENTRAL DISTRICT OF CALIFORNIA In re CHAPTER ________ CASE NUMBER DATE: TIME: Debtor. COURTROOM: PLAN BALLOT SUMMARY (NOTE: The Plan Proponent must file a Plan Ballot Summary at least one (1) day prior to the Confirmation Hearing.) 1. Proponent of Plan (Specify name): 2. Are any competing plans filed with the Court? Yes No 3. Is a cramdown requested? Yes No Yes No 4. Unimpaired Classes (Specify Class Numbers): 5. Impaired Classes (Specify Class Numbers): 6. Has any impaired class approved the Plan? (If YES, specify which class or classes): 7. The following is the voting summary by creditor class: ACCEPTING Number % Amount REJECTING % Number % Amount % Class 1 Class 2 Class 3 Class 4 Class 5 Class 6 Other Classes: See attached Continuation Page Dated: Firm Name: ____________________________________________ By: ________________________________________ Name: ________________________________________________ Attorney for Plan Proponent This form is optional. It has been approved for use by the United States Bankruptcy Court for the Central District of California. December 2009 F 3018-2 F 3018-2 Plan Ballot Summary- Page 2 In re CHAPTER Debtor. CASE NUMBER NOTE: When using this form to indicate service of a proposed order, DO NOT list any person or entity in Category I. Proposed orders do not generate an NEF because only orders that have been entered are placed on a CM/ECF docket. PROOF OF SERVICE OF DOCUMENT I am over the age of 18 and not a party to this bankruptcy case or adversary proceeding. My business address is: A true and correct copy of the foregoing document described as ______________________________________________ ___________________________________________________________________________________ will be served or was served (a) on the judge in chambers in the form and manner required by LBR 5005-2(d), and (b) in the manner indicated below: I. TO BE SERVED BY THE COURT VIA NOTICE OF ELECTRONIC FILING (“NEF”) - Pursuant to controlling General Order(s) and Local Bankruptcy Rule(s) (“LBR”), the foregoing document will be served by the court via NEF and hyperlink to the document. On ________________________ I checked the CM/ECF docket for this bankruptcy case or adversary proceeding and determined that the following person(s) are on the Electronic Mail Notice List to receive NEF transmission at the email addressed indicated below: G Service information continued on attached page II. SERVED BY U.S. MAIL OR OVERNIGHT MAIL (indicate method for each person or entity served): On _________________________ I served the following person(s) and/or entity(ies) at the last known address(es) in this bankruptcy case or adversary proceeding by placing a true and correct copy thereof in a sealed envelope in the United States Mail, first class, postage prepaid, and/or with an overnight mail service addressed as follows. Listing the judge here constitutes a declaration that mailing to the judge will be completed no later than 24 hours after the document is filed. G Service information continued on attached page III. SERVED BY PERSONAL DELIVERY, FACSIMILE TRANSMISSION OR EMAIL (indicate method for each person or entity served): Pursuant to F.R.Civ.P. 5 and/or controlling LBR, on _______________________ I served the following person(s) and/or entity(ies) by personal delivery, or (for those who consented in writing to such service method) by facsimile transmission and/or email as follows. Listing the judge here constitutes a declaration that personal delivery on the judge will be completed no later than 24 hours after the document is filed. G Service information continued on attached page I declare under penalty of perjury under the laws of the United States of America that the foregoing is true and correct. _________________________________________________________ Date Type Name _____________________________________ Signature This form is optional. It has been approved for use by the United States Bankruptcy Court for the Central District of California. December 2009 F 3018-2