<table>
<colgroup>
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<col style="width: 1%" />
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<col style="width: 1%" />
<col style="width: 12%" />
<col style="width: 2%" />
<col style="width: 1%" />
<col style="width: 1%" />
<col style="width: 1%" />
<col style="width: 1%" />
<col style="width: 3%" />
<col style="width: 12%" />
<col style="width: 1%" />
<col style="width: 1%" />
<col style="width: 1%" />
<col style="width: 4%" />
<col style="width: 1%" />
<col style="width: 2%" />
<col style="width: 1%" />
<col style="width: 4%" />
<col style="width: 2%" />
<col style="width: 6%" />
<col style="width: 1%" />
<col style="width: 3%" />
<col style="width: 1%" />
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<col style="width: 7%" />
<col style="width: 2%" />
<col style="width: 1%" />
<col style="width: 1%" />
<col style="width: 0%" />
<col style="width: 2%" />
</colgroup>
<tbody>
<tr class="odd">
<td></td>
<td colspan="25">Number range CHAPTER<strong>✎B100BX</strong> (Rev.
8/91) <strong>SUPPLEMENTAL BANKRUPTCY CLOSING REPORT</strong></td>
<td colspan="7"><strong>DOCKET NUMBER</strong></td>
</tr>
<tr class="even">
<td rowspan="6"></td>
<td colspan="14"></td>
<td colspan="7">DIST. NO.</td>
<td colspan="4">OFF. NO.</td>
<td colspan="7">YR-NUMBER</td>
</tr>
<tr class="odd">
<td colspan="14"><em>Forward this form to:</em></td>
<td colspan="6" rowspan="2"></td>
<td rowspan="2">1</td>
<td colspan="3" rowspan="2"></td>
<td rowspan="2">2</td>
<td colspan="6" rowspan="2"></td>
<td rowspan="2">3</td>
</tr>
<tr class="even">
<td colspan="14"><strong>Administrative Office of the United States
Courts</strong></td>
</tr>
<tr class="odd">
<td colspan="14"><strong>Attn: Statistics
Division—Bankruptcy</strong></td>
<td colspan="7">DATE PETITION FILED</td>
<td colspan="4">REOPENED</td>
<td colspan="7">CHECK IF APPLICABLE</td>
</tr>
<tr class="even">
<td colspan="14"><strong>Washington, D.C. 20544</strong></td>
<td colspan="7" rowspan="2"></td>
<td colspan="3" rowspan="2"></td>
<td rowspan="2">4</td>
<td colspan="2" rowspan="2"></td>
<td rowspan="2">▼</td>
<td colspan="4">Joint</td>
</tr>
<tr class="odd">
<td colspan="14"></td>
<td colspan="4">Petition</td>
</tr>
<tr class="even">
<td rowspan="14"><strong>DEBTOR</strong></td>
<td colspan="14">NAME OF DEBTOR (Last, First, Middle)</td>
<td colspan="18">NAME OF JOINT DEBTOR</td>
</tr>
<tr class="odd">
<td colspan="14"></td>
<td colspan="18"></td>
</tr>
<tr class="even">
<td colspan="14">AKA/DBA</td>
<td colspan="18">AKA/DBA</td>
</tr>
<tr class="odd">
<td colspan="14"></td>
<td colspan="18"></td>
</tr>
<tr class="even">
<td colspan="14"></td>
<td colspan="18"></td>
</tr>
<tr class="odd">
<td colspan="14"></td>
<td colspan="18"></td>
</tr>
<tr class="even">
<td colspan="14">SS or EMPLOYER TAX ID NO.</td>
<td colspan="18">SS or EMPLOYER TAX ID NO.</td>
</tr>
<tr class="odd">
<td colspan="14"></td>
<td colspan="18"></td>
</tr>
<tr class="even">
<td colspan="14">ADDRESS OF DEBTOR</td>
<td colspan="18">ADDRESS OF JOINT DEBTOR</td>
</tr>
<tr class="odd">
<td colspan="14"></td>
<td colspan="18"></td>
</tr>
<tr class="even">
<td colspan="14"></td>
<td colspan="18"></td>
</tr>
<tr class="odd">
<td colspan="14"></td>
<td colspan="18"></td>
</tr>
<tr class="even">
<td colspan="10">NAME OF COUNTY</td>
<td colspan="4">COUNTY CODE</td>
<td colspan="7">NAME OF JUDGE</td>
<td colspan="4">JUDGE CODE</td>
<td colspan="7">TRUSTEE CODE</td>
</tr>
<tr class="odd">
<td colspan="10"></td>
<td colspan="4"></td>
<td colspan="7"></td>
<td colspan="3"></td>
<td>5</td>
<td colspan="6"></td>
<td>6</td>
</tr>
<tr class="even">
<td rowspan="44"></td>
<td colspan="13"><strong>DISPOSITION</strong> (CHECK ONE)</td>
<td>7</td>
<td colspan="17" rowspan="3"><p><strong>TERMINATED UNDER</strong></p>
<p>(CHECK ONE)</p></td>
<td rowspan="3">8</td>
</tr>
<tr class="odd">
<td colspan="4"></td>
<td colspan="10">1. Discharge Granted</td>
</tr>
<tr class="even">
<td colspan="4" rowspan="2"></td>
<td colspan="10" rowspan="2">2. Discharge Denied</td>
</tr>
<tr class="odd">
<td colspan="5" rowspan="2"></td>
<td colspan="4" rowspan="2">1. Ch. 7</td>
<td colspan="3" rowspan="2"></td>
<td colspan="6" rowspan="2">9. Ch. 12</td>
</tr>
<tr class="even">
<td colspan="4"></td>
<td colspan="10">3. Discharge Waived/Revoked</td>
</tr>
<tr class="odd">
<td colspan="4"></td>
<td colspan="10">4. Discharge Not Applicable</td>
<td colspan="5" rowspan="2"></td>
<td colspan="4" rowspan="2">4. Ch. 9</td>
<td colspan="3" rowspan="2"></td>
<td colspan="6" rowspan="2">7. Ch. 13</td>
</tr>
<tr class="even">
<td colspan="4" rowspan="2"></td>
<td colspan="10" rowspan="2">5. Petition Dismissed</td>
</tr>
<tr class="odd">
<td colspan="5" rowspan="2"></td>
<td colspan="4" rowspan="2">5. Ch. 11</td>
<td colspan="3" rowspan="2"></td>
<td colspan="6" rowspan="2">8. Sec. 304</td>
</tr>
<tr class="even">
<td colspan="4"></td>
<td colspan="10">6. Transferred to Another District</td>
</tr>
<tr class="odd">
<td colspan="32"><strong>COMPLETE FOR CHAPTER 11 CASES
ONLY</strong></td>
</tr>
<tr class="even">
<td colspan="7"></td>
<td colspan="7"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="14"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="2"></td>
<td colspan="4"></td>
<td colspan="4"></td>
<td colspan="3"></td>
<td></td>
<td rowspan="3"></td>
<td></td>
<td></td>
<td colspan="11" rowspan="3">Check box if future payments are
contemplated under Chapter 11 Plan but percentage dividend is not
determinable.</td>
<td colspan="3"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="2">□</td>
<td>1</td>
<td colspan="3">Plan Confirmed</td>
<td></td>
<td colspan="3"></td>
<td colspan="3">% Dividend to Be</td>
<td></td>
<td></td>
<td></td>
<td colspan="3"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="2">□</td>
<td>2</td>
<td colspan="2">Plan Not Confirmed</td>
<td>9</td>
<td></td>
<td colspan="3"></td>
<td>Paid</td>
<td colspan="2">10</td>
<td></td>
<td></td>
<td><strong>1</strong></td>
<td colspan="3">11</td>
</tr>
<tr class="even">
<td colspan="7"></td>
<td colspan="7"></td>
<td colspan="18"></td>
</tr>
<tr class="odd">
<td colspan="14">REPORT PREPARED BY (Name)</td>
<td colspan="8">DATE REPORT PREPARED</td>
<td colspan="8">DATE CASE CLOSED</td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="14"></td>
<td colspan="8"></td>
<td colspan="8"></td>
<td colspan="2">12</td>
</tr>
<tr class="odd">
<td colspan="2"></td>
<td colspan="4"></td>
<td colspan="26"></td>
</tr>
<tr class="even">
<td colspan="2">13</td>
<td colspan="2" rowspan="2"><strong>$</strong></td>
<td rowspan="2"></td>
<td rowspan="2"></td>
<td colspan="26"></td>
</tr>
<tr class="odd">
<td colspan="2"></td>
<td colspan="26"></td>
</tr>
<tr class="even">
<td colspan="14"></td>
<td colspan="18"></td>
</tr>
<tr class="odd">
<td colspan="32" rowspan="2"></td>
</tr>
<tr class="even">
</tr>
<tr class="odd">
<td colspan="9"></td>
<td colspan="23"><strong>FEES AND EXPENSES</strong></td>
</tr>
<tr class="even">
<td colspan="32"></td>
</tr>
<tr class="odd">
<td colspan="4">$</td>
<td></td>
<td></td>
<td colspan="3"></td>
<td colspan="23">2. Trustee Compensation</td>
</tr>
<tr class="even">
<td colspan="32"></td>
</tr>
<tr class="odd">
<td colspan="4">$</td>
<td></td>
<td></td>
<td colspan="3"></td>
<td colspan="23">3. Fee for Attorney for Trustee</td>
</tr>
<tr class="even">
<td colspan="32"></td>
</tr>
<tr class="odd">
<td colspan="4">$</td>
<td></td>
<td></td>
<td colspan="3"></td>
<td colspan="23">4. Other Professional Fees and All Expenses (Including
Fee for Attorney for Debtor)</td>
</tr>
<tr class="even">
<td colspan="32" rowspan="2"></td>
</tr>
<tr class="odd">
</tr>
<tr class="even">
<td colspan="9"></td>
<td colspan="23"><strong>DISTRIBUTIONS</strong></td>
</tr>
<tr class="odd">
<td colspan="32"></td>
</tr>
<tr class="even">
<td colspan="4">$</td>
<td></td>
<td></td>
<td colspan="3"></td>
<td colspan="23">5. Secured Creditors</td>
</tr>
<tr class="odd">
<td colspan="32"></td>
</tr>
<tr class="even">
<td colspan="4">$</td>
<td></td>
<td></td>
<td colspan="3"></td>
<td colspan="23">6. Priority Creditors</td>
</tr>
<tr class="odd">
<td colspan="32"></td>
</tr>
<tr class="even">
<td colspan="4">$</td>
<td></td>
<td></td>
<td colspan="3"></td>
<td colspan="23">7. Unsecured Creditors</td>
</tr>
<tr class="odd">
<td colspan="32"></td>
</tr>
<tr class="even">
<td colspan="4">$</td>
<td></td>
<td></td>
<td colspan="3"></td>
<td colspan="23">8. Equity Security Holders</td>
</tr>
<tr class="odd">
<td colspan="32"></td>
</tr>
<tr class="even">
<td colspan="4">$</td>
<td></td>
<td></td>
<td colspan="3"></td>
<td colspan="23">9. Other Distributions (Including Payments to
Debtor)</td>
</tr>
<tr class="odd">
<td colspan="32"></td>
</tr>
</tbody>
</table>