UNITED STATES BANKRUPTCY COURT DISTRICT OF NEW JERSEY In re: , Case No. Hon. Debtor. Chapter 11 , U.S.B.J. INDIVIDUAL DEBTOR'S CHAPTER 11 COMBINED PLAN OF REORGANIZATION [OR LIQUIDATION] AND DISCLOSURE STATEMENT This Combined Plan of Reorganization and Disclosure Statement is presented to you to inform you of the proposed Plan for restructuring the debt [or liquidating the assets] of [Debtor], and to seek your vote to accept the Plan. You are encouraged to carefully review the full text of this document, including all exhibits and attachments, before deciding how to vote on the Plan. To assist you in your review, please note that a list of definitions and a section of frequently asked questions appear at the end of this document. IN ADDITION TO CASTING YOUR VOTE TO ACCEPT OR REJECT THE PLAN, YOU MAY OBJECT TO THE ADEQUACY OF THE DISCLOSURES MADE IN THIS DOCUMENT, OR YOU MAY OBJECT TO THE TERMS OF THE PROPOSED PLAN. IF YOU WISH TO OBJECT TO THE ADEQUACY OF THE DISCLOSURES OR TO THE TERMS OF THE PROPOSED PLAN, YOU MUST DO SO BY [OBJECTION DATE/TIME]. YOUR BALLOT STATING HOW YOU ARE VOTING ON THE PLAN MUST BE RETURNED BY [DEADLINE]. THE BALLOT MUST BE MAILED TO THE FOLLOWING ADDRESS: [DEBTOR'S COUNSEL'S ADDRESS] A HEARING ON THE CONFIRMATION OF THE PLAN IS SCHEDULED FOR [HEARING DATE/TIME] IN COURTROOM NO._____ AT THE [INSERT COURTHOUSE NAME AND FULL COURT ADDRESS, CITY, STATE, ZIP CODE] Your rights may be affected by this Combined Plan and Disclosure Statement. You should consider discussing this document with an attorney. [DATE] [COUNSEL FOR DEBTOR] [CONTACT INFORMATION FOR COUNSEL FOR DEBTOR] American LegalNet, Inc. www.FormsWorkFlow.com TABLE OF CONTENTS [Insert Table of Contents pursuant to D.N.J. LBR 3016-1(c)(2)] SUMMARY OF THE PLAN AND DISTRIBUTIONS TO CREDITORS [A concise summary of the Plan, describing with particularity the treatment of each class of Creditors and the source of funding for the Plan, should be stated here.] ARTICLE 1 BACKGROUND OF THE DEBTOR. 1.1. Filing of the Debtor's Chapter 11 Case. On [the Petition Date], the Debtor filed a voluntary petition for relief under the Bankruptcy Code. The Chapter 11 case is pending in the Bankruptcy Court in (Camden)(Newark)(Trenton), New Jersey. 1.2. All Sources of the Debtor's Income. [Describe all Sources of the Debtor's Income here.] 1.3. Past, Current and Projected Income and Expenses. A. Past Income. [Set forth the Debtor's gross annual income during the two calendar years preceding the filing of the bankruptcy case. Explain any significant changes in past and current income or expenses.] B. Current Income. [Attach Schedules I & J reflecting current income and expenses. Summarize below.] Total Net Monthly Income: Total Monthly Expense: C. Projected Income and Expenses. $ __________ $ __________ [Explain any anticipated changes in the debtor's income and expenses over the course of the Chapter 11 plan.] D. Where the Debtor is/was self-employed, or has/had an interest in a business in the last two years, provide the following information: 1. 2. 3. 4. Business Name Nature of Business Business Type: (e.g., sole proprietorship, LLC, Corp.) Debtor's percentage of ownership interest. 2 American LegalNet, Inc. www.FormsWorkFlow.com Attach copies of the balance sheets, income statements and cash flow statements for the business for the two years preceding the bankruptcy filing. 1.4. Debtor's Assets. [Detail the identity and fair market value of the estate's assets either in this section or in an attached Exhibit. Identify the source and basis for valuation.] 1.5. Debtor's Liabilities. [Identify the secured Claims, naming the collateral for such debts, priority Claims and unsecured Claims against the estate either in this section or in an attached Exhibit.] 1.6. Other Relevant Financial Data. Describe any other relevant financial data pertaining to the debtor. 1.7. Events Leading to the Filing of the Bankruptcy Case. [Describe what problems compelled the filing of the Chapter 11 petition and, if applicable, how the Debtor has cured those problems for his/her successful rehabilitation] 1.8. Significant Events During the Bankruptcy Case. [Describe significant events during the Debtor's bankruptcy case, which may include: Any asset sales outside the ordinary course of business, debtor-in-possession financing, or cash collateral orders. The identity of professionals approved by the Bankruptcy Court. Any adversary proceedings that have been filed or other significant litigation that has occurred (including contested claim disallowance proceedings), and any other significant legal or administrative proceedings that are pending or have been pending during the case in a forum other than the Bankruptcy Court. Any steps taken to increase income or reduce expenses of the Debtor. Other events as appropriate.] 1.9. Projected Recovery of Avoidable Transfers [Choose option] The Debtor does not intend to pursue preference, fraudulent conveyance, or other avoidance actions. OR The Debtor estimates that up to $ ______ may be realized from the recovery of fraudulent, preferential or other avoidable transfers. While the results of litigation cannot be predicted with certainty and it is possible that other causes of action may be identified, the following is a summary of the preference, fraudulent conveyance and other avoidance actions filed or expected to be filed in this case: 3 American LegalNet, Inc. www.FormsWorkFlow.com Transaction Defendant Amount Claimed OR [If the Debtor does not yet know whether it intends to pursue avoidance actions] The Debtor has not yet completed [his/her] investigation with regard to prepetition transactions. The Debtor anticipates completing [his/her] investigation by ________________. If you received a payment or other transfer of property within 90 days of bankruptcy, the Debtor may seek to avoid such transfer. ARTICLE 2 THE PLAN. The Debtor's Plan must describe how [his/her] Creditors will be paid. Certain Claims are entitled to specific treatment under the Bankruptcy Code and are not placed in a class for purpose of payment. For example, Administrative Expenses and Priority Tax Claims are not classified. As required by the Code, the Plan places Claims in various classes and describes the treatment each class will receive. The Plan also states whether each class of Claims is impaired or unimpaired. A Claim can be impaired if the Plan alters the legal, equitable or contractual rights to which the holder of t