UNITED STATES BANKRUPTCY COURT WESTERN DISTRICT OF NEW YORK In Re Chapter: 11 Case No. Tax ID: Debtor(s) DEBTOR'S STATEMENT THAT CHAPTER 11 PLAN HAS BEEN SUBSTANTIALLY CONSUMMATED AND MOTION FOR FINAL DECREE The statement and motion of , debtor herein, respectfully represents; 1. That on , this Court duly entered its order confirming the plan of reorganization proposed by the debtor and directing the execution and consummation of said plan. 2. Said plan has been substantially consummated in that: (Set forth facts to show substantial consummation of the plan) WHEREFORE, the debtor prays that this Court make and enter its final decree closing this case. Dated: _________________________________ Signature _________________________________ Printed Name and Title (Rev. 4/05) American LegalNet, Inc. www.USCourtForms.com UNITED STATES BANKRUPTCY COURT WESTERN DISTRICT OF NEW YORK In Re Case No. Chapter 11 Tax ID: Debtor(s) DEBTOR'S FINAL/POST CONFIRMATION REPORT AND ACCOUNT IN A CHAPTER 11 CASE shows and alleges that: The (Post-Confirmation) (Final) Report and Account of 1. PRIORITY PAYMENTS OF NON-OPERATING ADMINISTRATIVE EXPENSES §507(a) (1) Paid to Date Balance Due A. Trustee (Chapter 11) Commissions $ $ B. Accountant's Fees C. Attorney's Fees for Creditors Committee D. Auctioneer's Fees E. Attorney Fees for Chapter 11 Trustee F. Attorney Fees for Debtor G. Other Attorney Fees (specify) H. Taxes, Fines, Penalties, etc. (§503(b) (1) (B) & (C) I. Other Non-Operating Expenses of Administration (specify) J. Clerk, U.S. Bankruptcy Court - CONTACT COURT FOR AMOUNT DUE K. Appraiser's Fees TOTAL GROSS RECEIPTS II. OTHER PRIORITY EXPENSES % payment pro- Total amount Paid to Date of claims allowed vided in plan Balance A. Post involuntary Petition, PreRelief, etc. claims [§507 (a)(2)] $ $ B. Wages, Etc. [§507 (a)(3)] $ $ C. Contributions to Employee Benefit Plans [§507 (a)(4)] $ $ D. Deposits for Undelivered Service of Property [§507 (a)(5)] $ $ E. Taxes [§507 (a)(6)] $ $ American LegalNet, Inc. www.USCourtForms.com III. PAYMENTS TO CREDITORS A. % payment provided in plan Total amount of claims allowed Paid to Date Balance Due Holders of Secured Claims: (1) Class (2) Class (3) Other (specify) B. Holders of Unsecured Claims: (1) Class (2) Class (3) Other C. D. Exemptions Claimed by Debtor and not disallowed E. Other Distributions F. IV. Attach statement listing each class of equity holders and amount(s) paid to each and every class of equity holders. If no equity holders, please indicate such. Surplus Returned to Debtor TRUSTEE DISBURSEMENTS A. B. V. Portion of Total Distribution other than surplus (III-F), exemptions, or other monies paid to the debtor disbursed by Chapter 11 Trustee Operating Expenses Disbursed by Chapter 11 Trustee VALUE OF CERTAIN ABANDONED OR EXEMPT PROPERTY Value of Abandoned Property or property set apart as exempt on which a security was attached. VI. $ ESTIMATED DATE OF FINAL PAYMENT UNDER PLAN: (month) VII. (year) SPECIFY OTHER RELEVANT ACTION TAKEN AND PROGRESS MADE IN CONSUMMATION OF PLAN BELOW AND ON ATTACHMENTS: CERTIFICATION , (title) of (for debtor), certify under penalty of perjury that the information I, contained in the [Post-Confirmation] [Final] Report is truthful, complete and accurate to the best of my knowledge; and that this report has been duly transmitted to the court as required by the Local Rules of the Court. Dated: [Rev. 4/05] Signed: Printed Name and Title:___________________________________________________ Business Phone: American LegalNet, Inc. www.USCourtForms.com