CACB — Schedule E/F: Creditors Who Have Unsecured Claims

CACB — 206EF.pdf¶

Source: https://www.cacb.uscourts.gov/sites/cacb/files/documents/forms/206EF.pdf

Page 1¶

Fill in this information to identify the case:

Debtor __________________________________________________________________

United States Bankruptcy Court for the: ______________________ District of __________
(State)
Case number ___________________________________________
(If known)
Check if this is an
amended filing

Official Form 206E/F Schedule E/F: Creditors Who Have Unsecured Claims 12/15 Be as complete and accurate as possible. Use Part 1 for creditors with PRIORITY unsecured claims and Part 2 for creditors with NONPRIORITY unsecured claims. List the other party to any executory contracts or unexpired leases that could result in a claim. Also list executory contracts on Schedule A/B: Assets - Real and Personal Property (Official Form 206A/B) and on Schedule G: Executory Contracts and Unexpired Leases (Official Form 206G). Number the entries in Parts 1 and 2 in the boxes on the left. If more space is needed for Part 1 or Part 2, fill out and attach the Additional Page of that Part included in this form.

Part 1: List All Creditors with PRIORITY Unsecured Claims

Do any creditors have priority unsecured claims? (See 11 U.S.C. § 507). No. Go to Part 2. Yes. Go to line 2.
List in alphabetical order all creditors who have unsecured claims that are entitled to priority in whole or in part. If the debtor has more than 3 creditors with priority unsecured claims, fill out and attach the Additional Page of Part 1. Total claim Priority amount

2.1 Priority creditor’s name and mailing address As of the petition filing date, the claim is: $______________________ $_________________ __________________________________________________________________ Check all that apply. Contingent ___________________________________________ Unliquidated ___________________________________________ Disputed Date or dates debt was incurred Basis for the claim: __________________________________ _________________________________

Last 4 digits of account Is the claim subject to offset?
number ___ ___ ___ ___ No
Yes
Specify Code subsection of PRIORITY unsecured
claim: 11 U.S.C. § 507(a) (_____)

2.2 Priority creditor’s name and mailing address As of the petition filing date, the claim is: $______________________ $_________________ __________________________________________________________________ Check all that apply. Contingent ___________________________________________ Unliquidated ___________________________________________ Disputed Date or dates debt was incurred Basis for the claim: __________________________________ _________________________________

Last 4 digits of account Is the claim subject to offset?
number ___ ___ ___ ___ No
Yes
Specify Code subsection of PRIORITY unsecured
claim: 11 U.S.C. § 507(a) (_____)qqqqq

2.3 Priority creditor’s name and mailing address As of the petition filing date, the claim is: $______________________ $_________________ __________________________________________________________________ Check all that apply. Contingent ___________________________________________ Unliquidated ___________________________________________ Disputed Date or dates debt was incurred Basis for the claim: __________________________________ _________________________________

Last 4 digits of account Is the claim subject to offset?
number ___ ___ ___ ___ No
Yes
Specify Code subsection of PRIORITY unsecured
claim: 11 U.S.C. § 507(a) (_____)

Official Form 206E/F Schedule E/F: Creditors Who Have Unsecured Claims page 1 of ___

Exceptions & meaning →

Page 2¶

Debtor _______________________________________________________ Case number (if known)_____________________________________ Name

Part 1. Additional Page

Copy this page if more space is needed. Continue numbering the lines sequentially from the previous page. If no additional PRIORITY creditors exist, do not fill out or submit this page. Total claim Priority amount

2._ Priority creditor’s name and mailing address $______________________ $_________________ As of the petition filing date, the claim is: Check all that apply. _________________________________________________________________ Contingent Unliquidated ___________________________________________ Disputed ___________________________________________ Date or dates debt was incurred Basis for the claim: __________________________________ _________________________________

Last 4 digits of account Is the claim subject to offset?
number ___ ___ ___ ___ No
Yes
Specify Code subsection of PRIORITY unsecured
claim: 11 U.S.C. § 507(a) (_____)

2._ Priority creditor’s name and mailing address $______________________ $_________________ As of the petition filing date, the claim is: Check all that apply. Contingent _________________________________________________________________ Unliquidated ___________________________________________ Disputed ___________________________________________ Date or dates debt was incurred Basis for the claim: __________________________________ _________________________________

Last 4 digits of account Is the claim subject to offset?
number ___ ___ ___ ___ No
Yes
Specify Code subsection of PRIORITY unsecured
claim: 11 U.S.C. § 507(a) (_____)

2._ Priority creditor’s name and mailing address As of the petition filing date, the claim is: $______________________ $_________________ Check all that apply. _________________________________________________________________ Contingent ___________________________________________ Unliquidated Disputed ___________________________________________ Date or dates debt was incurred Basis for the claim: __________________________________ _________________________________

Last 4 digits of account Is the claim subject to offset?
number ___ ___ ___ ___ No
Yes
Specify Code subsection of PRIORITY unsecured
claim: 11 U.S.C. § 507(a) (_____)

Official Form 206E/F Schedule E/F: Creditors Who Have Unsecured Claims page __ of ___

Exceptions & meaning →

Page 3¶

Debtor _______________________________________________________ Case number (if known)_____________________________________ Name

Part 2: List All Creditors with NONPRIORITY Unsecured Claims

List in alphabetical order all of the creditors with nonpriority unsecured claims. If the debtor has more than 6 creditors with nonpriority unsecured claims, fill out and attach the Additional Page of Part 2. Amount of claim

3.1 Nonpriority creditor’s name and mailing address As of the petition filing date, the claim is: Check all that apply. $________________________________ ____________________________________________________________ Contingent Unliquidated ____________________________________________________________ Disputed ____________________________________________________________ Basis for the claim: ________________________

Date or dates debt was incurred ___________________ Is the claim subject to offset?
No
Last 4 digits of account number ___ ___ ___ ___ Yes

3.2 Nonpriority creditor’s name and mailing address As of the petition filing date, the claim is: Check all that apply. $________________________________ ____________________________________________________________ Contingent Unliquidated ____________________________________________________________ Disputed ____________________________________________________________ Basis for the claim: ________________________ Date or dates debt was incurred ___________________ Is the claim subject to offset? No Last 4 digits of account number ___ ___ ___ ___ Yes

3.3 Nonpriority creditor’s name and mailing address As of the petition filing date, the claim is: Check all that apply. $________________________________ ____________________________________________________________ Contingent Unliquidated ____________________________________________________________ Disputed ____________________________________________________________ Basis for the claim: ________________________ Date or dates debt was incurred ___________________ Is the claim subject to offset? No Last 4 digits of account number ___ ___ ___ ___ Yes

3.4 Nonpriority creditor’s name and mailing address As of the petition filing date, the claim is: $________________________________ Check all that apply. ____________________________________________________________ Contingent Unliquidated ____________________________________________________________ Disputed ____________________________________________________________ Basis for the claim: ________________________

Date or dates debt was incurred ___________________ Is the claim subject to offset?
No
Last 4 digits of account number ___ ___ ___ ___ Yes

3.5 Nonpriority creditor’s name and mailing address As of the petition filing date, the claim is: $________________________________ Check all that apply. ____________________________________________________________ Contingent Unliquidated ____________________________________________________________ Disputed ____________________________________________________________ Basis for the claim: ________________________ Date or dates debt was incurred ___________________ Is the claim subject to offset? No Last 4 digits of account number ___ ___ ___ ___ Yes

3.6 Nonpriority creditor’s name and mailing address As of the petition filing date, the claim is: $________________________________ Check all that apply. ____________________________________________________________ Contingent Unliquidated ____________________________________________________________ Disputed ____________________________________________________________ Basis for the claim: ________________________ Date or dates debt was incurred ___________________ Is the claim subject to offset? No Last 4 digits of account number ___ ___ ___ ___ Yes

Official Form 206E/F Schedule E/F: Creditors Who Have Unsecured Claims page __ of ___

Exceptions & meaning →

Page 4¶

Debtor _______________________________________________________ Case number (if known)_____________________________________ Name

Part 2: Additional Page

Copy this page only if more space is needed. Continue numbering the lines sequentially from the Amount of claim previous page. If no additional NONPRIORITY creditors exist, do not fill out or submit this page.

3.__ Nonpriority creditor’s name and mailing address As of the petition filing date, the claim is: Check all that apply. $________________________________ ___________________________________________________________ Contingent Unliquidated Disputed ___________________________________________________________ Liquidated and neither contingent nor disputed ___________________________________________________________ Basis for the claim: ________________________

Date or dates debt was incurred ___________________ Is the claim subject to offset?
No
Last 4 digits of account number ___ ___ ___ ___ Yes

___________________________________________________________
Basis for the claim: ________________________
Date or dates debt was incurred ___________________ Is the claim subject to offset?
No
Last 4 digits of account number ___ ___ ___ ___ Yes

3.__ Nonpriority creditor’s name and mailing address As of the petition filing date, the claim is: $________________________________ Check all that apply. ___________________________________________________________ Contingent Unliquidated ___________________________________________________________ Disputed ___________________________________________________________ Basis for the claim: ________________________ Date or dates debt was incurred ___________________ Is the claim subject to offset? No Last 4 digits of account number ___ ___ ___ ___ Yes

Official Form 206E/F Schedule E/F: Creditors Who Have Unsecured Claims page __ of ___

Exceptions & meaning →

Page 5¶

Debtor _______________________________________________________ Case number (if known)_____________________________________ Name

Part 3: List Others to Be Notified About Unsecured Claims

List in alphabetical order any others who must be notified for claims listed in Parts 1 and 2. Examples of entities that may be listed are collection agencies, assignees of claims listed above, and attorneys for unsecured creditors. If no others need to be notified for the debts listed in Parts 1 and 2, do not fill out or submit this page. If additional pages are needed, copy the next page.

Name and mailing address On which line in Part 1 or Part 2 is the Last 4 digits of related creditor (if any) listed? account number, if any

4.1. ___________________________________________________________________________________________________ Line _____ _________________________________________________________________ Not listed. Explain ________________ ___ ___ ___ ___ _________________________________________________________________ _________________________________

4.2. ___________________________________________________________________________________________________ Line _____ _________________________________________________________________ Not listed. Explain ________________ ___ ___ ___ ___ _________________________________________________________________ _________________________________

4.3. ___________________________________________________________________________________________________ Line _____ _________________________________________________________________ Not listed. Explain ________________ ___ ___ ___ ___ _________________________________________________________________ _________________________________

4.4. ___________________________________________________________________________________________________ Line _____ _________________________________________________________________ Not listed. Explain ________________ ___ ___ ___ ___ _________________________________________________________________ _________________________________

4.5. ___________________________________________________________________________________________________ Line _____ _________________________________________________________________ Not listed. Explain ________________ ___ ___ ___ ___ _________________________________________________________________ _________________________________

4.6. ___________________________________________________________________________________________________ Line _____ _________________________________________________________________ Not listed. Explain ________________ ___ ___ ___ ___ _________________________________________________________________ _________________________________

4.7. ___________________________________________________________________________________________________ Line _____ _________________________________________________________________ Not listed. Explain ________________ ___ ___ ___ ___ _________________________________________________________________ _________________________________

4.8. ___________________________________________________________________________________________________ Line _____ _________________________________________________________________ Not listed. Explain ________________ ___ ___ ___ ___ _________________________________________________________________ _________________________________

4.9. ___________________________________________________________________________________________________ Line _____ _________________________________________________________________ Not listed. Explain ________________ ___ ___ ___ ___ _________________________________________________________________ _________________________________

4.10. ___________________________________________________________________________________________________ Line _____ _________________________________________________________________ Not listed. Explain ________________ ___ ___ ___ ___ _________________________________________________________________ _________________________________

4.11. ___________________________________________________________________________________________________ Line _____ _________________________________________________________________ Not listed. Explain ________________ ___ ___ ___ ___ _________________________________________________________________ _________________________________

4.12. Line _____ ___________________________________________________________________________________________________ Not listed. Explain ________________ ___ ___ ___ ___ _________________________________________________________________ _________________________________ _________________________________________________________________

Official Form 206E/F Schedule E/F: Creditors Who Have Unsecured Claims page __ of ___

Exceptions & meaning →

Page 6¶

Debtor _______________________________________________________ Case number (if known)_____________________________________ Name

Part 3: Additional Page for Others to Be Notified About Unsecured Claims

Name and mailing address On which line in Part 1 or Part 2 is the Last 4 digits of
related creditor (if any) listed? account number,
if any

4.__ ___________________________________________________________________________________________________ Line _____ _________________________________________________________________ Not listed. Explain ________________ ___ ___ ___ ___ _________________________________________________________________ _________________________________

Official Form 206E/F Schedule E/F: Creditors Who Have Unsecured Claims page __ of ___

Exceptions & meaning →

Page 7¶

Debtor _______________________________________________________ Case number (if known)_____________________________________ Name

Part 4: Total Amounts of the Priority and Nonpriority Unsecured Claims

Add the amounts of priority and nonpriority unsecured claims.

Total of claim amounts

5a. Total claims from Part 1 5a. $_____________________________

$_____________________________5b. Total claims from Part 2 5b. +

5c. Total of Parts 1 and 2 5c. $_____________________________ Lines 5a + 5b = 5c.

Official Form 206E/F Schedule E/F: Creditors Who Have Unsecured Claims page __ of ___

Exceptions & meaning →