UNITED STATES COURT OF APPEALS FOR THE SECOND CIRCUIT COVER SHEET FOR DIRECT APPEAL OF A BANKRUPTCY COURT DECISION Case Caption [caption as described in Fed. R. Bankr. P. 7010 or 9004(b), as applicable]: Bankruptcy Court Case No: Bankruptcy Judge: Bankruptcy Adversary Proceeding No. [if applicable]: District Judge [if applicable]: District Court Civil No. [if applicable]: Date and Document Number of Notice of Appeal Filed in [ ] Adversary Proceeding or [ ] Bankruptcy Case: Date and Document Number of Bankruptcy Court Judgment, Order or Decree in [ ] Adversary Proceeding or [ ] Bankruptcy Case: [To answer questions below, place “X” on lines where appropriate:] 1. Who is certifying the direct appeal? ___Certification by Court (indicate below which court is certifying) ___Certification by Bankruptcy Court – district: ____________________ ___Certification by District Court – district: _______________________ ___ At request of one or more parties ___ On court’s own initiative ___ Court is required to make certification under 28 U.S.C. § 158(d)(2)(B) ___Certification by All Parties using Official Form 24 – district from which appeal is taken: _________________ 2. Which paragraph of section 158(a) is applicable [28 U.S.C. § 158(a)]? ___28 U.S.C. § 158(a)(1): appeal of a final judgment, order or decree ___28 U.S.C. § 158(a)(2): appeal of an interlocutory order or decree issued under 11 U.S.C. § 1121(d) ___28 U.S.C. § 158(a)(3): appeal of an interlocutory order or decree [other than one issued under 11 U.S.C. § 1121(d)] requiring leave of the court [indicate below whether leave has been granted] ___ District Court has not yet granted leave ___ District Court has already granted leave [provide civil proceeding name and civil number, date of order, name of judge, etc., in space provided below] ___________________________________________________________________________ 3. Indicate basis for direct appeal [select one of the following]: ___ The judgment, order or decree involves a question of law as to which there is no controlling decision of the court of appeals for this circuit or of the Supreme Court of the United States, or involves a matter of public importance. ___ The judgment, order or decree involves a question of law requiring resolution of conflicting decisions. ___ An immediate appeal from the judgment, order or decree may materially advance the progress of the case or proceeding in which the appeal is taken. Page 1 of 2 American LegalNet, Inc. www.USCourtForms.com 4. Indicate whether appellant has obtained a stay pending appeal and provide pertinent information pertaining to stay (date of issuance, etc.): Granted ______ Yes ______ No Date and Court of Issuance:_________________________________ 5. Provide below a brief description of the matter decided by the bankruptcy judge [example: Order Confirming Chapter 11 Plan]: ______________________________________________________________________________ 6. Bankruptcy Judge: __________________________________________________________________ [For notifying bankruptcy judges, staff of the court of appeals should refer to the circuit clerk’s list of e-mail addresses.] Date: ____________ Submitted by: ________________________________ Name ________________________________ Title/Firm or Court Page 2 of 2 American LegalNet, Inc. www.USCourtForms.com