UNITED STATES BANKRUPTCY COURT
DISTRICT OF NEW HAMPSHIRE
In re:
_____________________________________, Bk. No. ____-_________-____
Debtor Chapter 11
Hearing Date and Time:_______________
CERTIFICATE OF VOTE
___________________________________, the Plan Proponent, by and through attorney
___________________________________, hereby certify the voting by the holders of claims in
Class ____, an impaired class entitled to vote, as follows:
Number Voting Percentage Dollar Amount Percentage
Accept
Reject
Total
Date: ______________________ ____________________________________
Signature
____________________________________
Print Name
Address_____________________________
____________________________________
Tel. No._____________________________
LBF 3018-2 (Eff. 12/1/09)
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