UNITED STATES BANKRUPTCY COURT SOUTHERN DISTRICT OF FLORIDA www.flsb.uscourts.gov In re: Case No. Chapter 11 Debtor / CERTIFICATE OF PROPONENT OF PLAN ON ACCEPTANCE OF PLAN, REPORT ON AMOUNT TO BE DEPOSITED, CERTIFICATE OF AMOUNT DEPOSITED AND PAYMENT OF FEES The undersigned attorney for the debtor certifies the following: 1. I have examined the court files in this proceeding, particularly as to claims, schedules and ballots filed. ballots were filed on or before the deadline date of , set 2. A total of by court order dated . Exhibit A is a summary of ballots submitted by class. Exhibit B is a list of all ballots filed. Class[es] are unimpaired and a ballot was not required. 3. Exhibit C lists each creditor to be paid pursuant to the plan. Exhibit D lists disputed, contingent or unliquidated claims included in Exhibit C. Below is a summary of the amount of money to be deposited for confirmation pursuant to plan: CLASS DOLLAR AMOUNT NEEDED FOR CONFIRMATION TOTAL: $ 4. The amount of $ is available in my trust account for confirmation. 5. All fees required by 28 U.S.C. §1930 have been paid. DATED [Attorney for Proponent of Plan] EXHIBIT A SUMMARY OF BALLOTS LF-34 (rev. 12/01/09) Page 1 of 6 American LegalNet, Inc. www.FormsWorkFlow.com CLASS: Total Acceptances in Dollar Amount Total Rejections in Dollar Amount Total # of Acceptances Filed Total # of Rejections Filed CLASS: Total Acceptances in Dollar Amount Total Rejections in Dollar Amount Total # of Acceptances Filed Total # of Rejections Filed CLASS: Total Acceptances in Dollar Amount Total Rejections in Dollar Amount Total # of Acceptances Filed Total # of Rejections Filed CLASS: Total Acceptances in Dollar Amount Total Rejections in Dollar Amount Total # of Acceptances Filed Total # of Rejections Filed CLASS: Total Acceptances in Dollar Amount Total Rejections in Dollar Amount Total # of Acceptances Filed Total # of Rejections Filed CLASS: Total Acceptances in Dollar Amount Total Rejections in Dollar Amount Total # of Acceptances Filed Total # of Rejections Filed CLASS: Total Acceptances in Dollar Amount Total Rejections in Dollar Amount Total # of Acceptances Filed Total # of Rejections Filed $ $ % of total = $ % of total = $ % of total = % of total = $ $ % of total = $ % of total = $ % of total = % of total = $ $ % of total = $ % of total = $ % of total = % of total = $ $ % of total = $ % of total = $ % of total = % of total = $ $ % of total = $ % of total = $ % of total = % of total = $ $ % of total = $ % of total = $ % of total = % of total = $ $ % of total = $ % of total = $ % of total = % of total = LF-34 (rev. 12/01/09) Page 2 of 6 American LegalNet, Inc. www.FormsWorkFlow.com EXHIBIT B LIST OF ALL BALLOTS FILED BALLOT # CLASS NAME OF CREDITOR AMOUNT SCHEDULED OR CLAIMED DATE BALLOT FILED WITH COURT ACCEPTS REJECTS SHOULD BE ALLOWED TO VOTE IF NOT, WHY? LF-34 (rev. 12/01/09) Page 3 of 6 American LegalNet, Inc. www.FormsWorkFlow.com EXHIBIT C LIST OF CREDITORS TO BE PAID PURSUANT TO THE PLAN The following is a list of creditors as provided for by the plan under consideration. These creditors are indicated by class and amount as scheduled or claimed. The dividend to be paid pursuant to the plan is indicated. (Indicate claim number as reflected in the claims register). Total each individual class. CLASS NAME OF CREDITOR CLAIM NUMBER SCHEDULED AND/OR CLAIMED AMOUNT FIRST DIVIDEND TO BE PAID PURSUANT TO PLAN (if more space needed use continuation sheet) LF-34 (rev. 12/01/09) Page 4 of 6 American LegalNet, Inc. www.FormsWorkFlow.com EXHIBIT C LIST OF CREDITORS TO BE PAID PURSUANT TO THE PLAN (CONTINUATION SHEET) CLASS NAME OF CREDITOR CLAIM NUMBER SCHEDULED AND/OR CLAIMED AMOUNT FIRST DIVIDEND TO BE PAID PURSUANT TO PLAN LF-34 (rev. 12/01/09) Page 5 of 6 American LegalNet, Inc. www.FormsWorkFlow.com EXHIBIT D LIST OF DISPUTED, CONTINGENT OR UNLIQUIDATED CLAIMS The following is a list of disputed, contingent or unliquidated claims which are also included in Exhibit C. Note: If a claim was filed and is still in dispute, indicate claim number as is reflected in the claims register and give status of dispute (e.g. objection pending, etc.). Until there is an order on an objection, you must have enough money in the trust account to cover these creditors. If a person was listed in the schedules as disputed and they did not file a claim by the deadline date to file claims, you need not list them below or have money in your trust account to cover them. They are automatically taken off the case as creditors. SCHEDULED AND/OR CLAIMED AMOUNT STATUS OF CLAIM CLASS NAME OF CREDITOR CLAIM # LF-34 (rev. 12/01/09) Page 6 of 6 American LegalNet, Inc. www.FormsWorkFlow.com