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# Caption

** Download Form (pdf, 7.24 KB)

Form Number: B 416A

Category: Bankruptcy Forms

Effective onDecember 1, 2015

	This is an Official Bankruptcy Form. Official Bankruptcy Forms are approved by the Judicial Conference and must be used under Bankruptcy Rule 9009.

## Committee Notes

** Download Committee Notes (pdf, 153.19 KB)

## Services & Forms

          - Forms             - Caption
            - Attorney Forms
            - Bankruptcy Forms
            - Superseded Bankruptcy Forms
            - Civil Forms
            - Criminal Forms
            - Court Reporter Forms
            - CJA Forms
            - Human Resources Forms
            - Jury Forms
            - Other Forms

## Notification

This form is derived from Official Form 16A

## **About Federal Courts

        - Federal Courts & the Public
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        - Governance & the Judicial Conference
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## **Judges & Judgeships

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## **Services & Forms

        - Forms
        - Bankruptcy
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## **Court Records

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## **Statistics & Reports

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## **Rules & Policies

        - Current Rules of Practice & Procedure
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        - Proposed Amendments Published for Public Comment
        - About the Rulemaking Process
        - Records of the Rules Committees
        - Judiciary Policies

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