Expression, For Chapter 11 Cases: The List of Creditors Who Have the 20 Largest Unsecured Claims Against You Who Are Not Insiders (non-individuals)

• Court: United States Federal Court
• Legal Form Number: B 204
• Section: United States Federal Court

Official Form 204 Chapter 11 or Chapter 9 Cases: List of Creditors Who Have the 20 Largest Unsecured Claims page 1

Official Form 204

Chapter 11 or Chapter 9 Cases: List of Creditors Who Have the 20 Largest

Unsecured Claims and Are Not Insiders 12/15

A list of creditors holding the 20 largest unsecured claims must be filed in a Chapter 11 or Chapter 9 case. Include claims w hich the debtor

disputes. Do not include claims by any person or entity who is an insider, as defined in 11 U.S.C. § 101(31). Also, do not include claims by

secured creditors, unless the unsecured claim resulting from inadequate collateral value places the creditor among the holders of the 20

largest unsecured claims.

Name of creditor and complete

mailing address, including zip code Name, telephone number, and

email address of creditor

contact

Nature of the claim

(for example, trade

debts, bank loans,

professional

services, and

government

contracts)

Indicate if

claim is

contingent,

unliquidated,

or disputed

Amount of unsecured claim

If the claim is fully unsecured, fill in only unsecured

claim amount. If claim is partially secured, fill in

total claim amount and deduction for value of

collateral or setoff to calculate unsecured claim.

Total claim, if

partially

secured

Deduction for

value of

collateral or

setoff

Unsecured

claim

1

2

3

4

5

6

7

8

 Check if this is an

amended filing

Debtor name __________________________________________________________________

United States Bankruptcy Court for the: ______________________ District of _________

(State)

Case number (If known): _________________________

Fill in this information to identify the case: