FORM 104 () ADVERSARY PROCEEDING COVER SHEET(Instructions on Reverse)ADVERSARY PROCEEDING NUMBER(Court Use Only)PLAINTIFFSDEFENDANTSATTORNEYS (Firm Name, Address, and Telephone No.)ATTORNEYS (If Known)PARTY (Check One Box Only) DebtorU.S. Trustee/Bankruptcy Admin CreditorTrusteeOther PARTY (Check One Box Only) DebtorU.S. Trustee/Bankruptcy Admin CreditorTrusteeOther CAUSE OF ACTION (WRITE A BRIEF STATEMENT OF CAUSE OF ACTION, INCLUDING ALL U.S. STATUTES INVOLVED)NATURE OF SUIT(Number up to five (5) boxes starting with the lead cause of action as 1, first alternative cause as 2, second alternative cause as 3, etc.) FRBP 7001(1) 226 Recovery of Money/Property 11 - Recovery of money/property - 247 542 turnover of property 12 - Recovery of money/property - 247 547 preference 13 - Recovery of money/property - 247 548 fraudulent transfer 14 - Recovery of money/property - other FRBP 7001(2) 226 Validity, Priority or Extent of Lien 21 - Validity, priority or extent of lien or other interest in property FRBP 7001(3) 226 Approval of Sale of Property 31 - Approval of sale of property of estate and of a co-owner - 247 363(h) FRBP 7001(4) 226 Objection/Revocation of Discharge 41 - Objection/revocation of discharge - 247 727(c), (d), (e) FRBP 7001(5) 226 Revocation of Confirmation 51 - Revocation of confirmation FRBP 7001(6) 226 Dischargeability 66 - Dischargeability - 247 523(a)(1), (14), (14A) priority tax claims 62 - Dischargeability - 247 523(a)(2), false pretenses, false representation, actual fraud 67 - Dischargeability - 247 523(a)(4), fraud as fiduciary, embezzlement, larceny (continued next column) FRBP 7001(6) 226 Dischargeability (continued) 61 - Dischargeability - 247 523(a)(5), domestic support 68 - Dischargeability - 247 523(a)(6), willful and malicious injury 63 - Dischargeability - 247 523(a)(8), student loan 001 (other than domestic support)64 - Dischargeability - 247 523(a)(15), divorce or separation obligation 65 - Dischargeability - other FRBP 7001(7) 226 Injunctive Relief 71 - Injunctive relief - imposition of stay 72 - Injunctive relief - other FRBP 7001(8) 226 Subordination of Claim or Interest 81 - Subordination of claim or interest FRBP 7001(9) 226 Declaratory Judgment 91 - Declaratory judgment FRBP 7001(10) 226 Determination of Removed Action 01 - Determination of removed claim or cause Other SS-SIPA Case - 15 U.S.C. 247247 78aaa et. seq. 02 - Other (e.g. other actions that would have been brought in state court if unrelated to bankruptcy case) Check if this case involves a substantive issue of state law Check if this is asserted to be a class action under FRCP 23 Check if a jury trial is demanded in complaint Demand $Other Relief Sought American LegalNet, Inc. www.FormsWorkFlow.com FORM 104 (), Page 2 BANKRUPTCY CASE IN WHICH THIS ADVERSARY PROCEEDING ARISESNAME OF DEBTORBANKRUPTCY CASE NO.DISTRICT IN WHICH CASE IS PENDINGDIVISION OFFICENAME OF JUDGERELATED ADVERSARY PROCEEDING (IF ANY)PLAINTIFFDEFENDANTADVERSARY PROCEEDING NO.DISTRICT IN WHICH ADVERSARY IS PENDINGDIVISION OFFICENAME OF JUDGESIGNATURE OF ATTORNEY (OR PLAINTIFF)DATEPRINT NAME OF ATTORNEY (OR PLAINTIFF)INSTRUCTIONSThe filing of a bankruptcy case creates an "estate" under the jurisdiction of the bankruptcy court which consists of all ofthe property of the debtor, wherever that property is located. Because the bankruptcy estate is so extensive and the jurisdictionof the court so broad, there may be lawsuits over the property or property rights of the estate. There also may be lawsuitsconcerning the debtor222s discharge. If such a lawsuit is filed in a bankruptcy court, it is called an adversary proceeding. A party filing an adversary proceeding must also must complete and file Form 104, the Adversary Proceeding Cover Sheet,if it is required by the court. In some courts, the cover sheet is not required when the adversary proceeding is filed electronicallythrough the court's Case Management/Electronic Case Files (CM/ECF) system. (CM/ECF captures the information on Form 104as part of the filing process.) When completed, the cover sheet summarizes basic information on the adversary proceeding. Theclerk of court needs the information to process the adversary proceeding and prepare required statistical reports on court activity. The cover sheet and the information contained on it do not replace or supplement the filing and service of pleadings orother papers as required by law, the Bankruptcy Rules, or the local rules of court. The cover sheet, which is largely self-explanatory, must be completed by the plaintiff222s attorney (or by the plaintiff if the plaintiff is not represented by an attorney).A separate cover sheet must be submitted to the clerk for each complaint filed. Plaintiffs and Defendants. Give the names of the plaintiffs and defendants exactly as they appear on the complaint. Attorneys. Give the names and addresses of the attorneys, if known. Party. Check the most appropriate box in the first column for the plaintiffs and the second column for the defendants.Demand. Enter the dollar amount being demanded in the complaint.Signature. This cover sheet must be signed by the attorney of record in the box on the second page of the form. If the plaintiffis represented by a law firm, a member of the firm must sign. If the plaintiff is pro se, that is, not represented by an attorney,the plaintiff must sign. American LegalNet, Inc. www.FormsWorkFlow.com