UNITED STATES COURT OF APPEALS FOR THE SECOND CIRCUIT

# 

# COVER SHEET FOR DIRECT APPEAL OF A BANKRUPTCY COURT DECISION

+---------------------------+---------------------+--------------------+
| Case Caption \[*caption   | Bankruptcy Court    | Bankruptcy Judge:  |
| as described in Fed. R.   | Case No:            |                    |
| Bankr. P. 7010 or         |                     | District Judge     |
| 9004(b), as               | Bankruptcy          | \[*if              |
| applicable*\]:            | Adversary           | applicable*\]:     |
|                           | Proceeding No.      |                    |
|                           | \[*if               |                    |
|                           | applicable*\]:      |                    |
|                           |                     |                    |
|                           | District Court      |                    |
|                           | Civil No. \[*if     |                    |
|                           | applicable*\]:      |                    |
+---------------------------+---------------------+--------------------+
|                           | Date and Document   | Date and Document  |
|                           | Number of Notice of | Number of          |
|                           | Appeal Filed in \[  | Bankruptcy Court   |
|                           | \] Adversary        | Judgment, Order or |
|                           | Proceeding or \[ \] | Decree in \[ \]    |
|                           | Bankruptcy Case:    | 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.

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