FORM 104 (10/06)

ADVERSARY PROCEEDING COVER SHEET

(Instructions on Reverse)

ADVERSARY PROCEEDING NUMBER 

(Court Use Only) 

PLAINTIFFS DEFENDANTS 

ATTORNEYS (Firm Name, Address, and Telephone No.) ATTORNEYS (If Known)

PARTY (Check One Box Only) 

□ Debtor □ U.S. Trustee/Bankruptcy Admin

□ Creditor □ Other

□ Trustee

PARTY (Check One Box Only) 

□ Debtor □ U.S. Trustee/Bankruptcy Admin

□ Creditor □ Other

□ Trustee

CAUSE OF ACTION (WRITE A BRIEF STATEMENT OF CAUSE OF ACTION, INCLUDING ALL U.S. STATUTES INVOLVED)

NATURE OF SUIT

(Number up to five (5) boxes starting with lead cause of action as 1, first alternative cause as 2, second alternative cause as 3, etc.) 

□ Check if a jury trial is demanded in complaint Demand $ 

Other Relief Sought 

 FRBP 7001(1) – Recovery of Money/Property 

□ 11-Recovery of money/property - §542 turnover of property 

□ 12-Recovery of money/property - §547 preference 

□ 13-Recovery of money/property - §548 fraudulent transfer 

□ 14-Recovery of money/property - other 

 FRBP 7001(2) – Validity, Priority or Extent of Lien 

□ 21-Validity, priority or extent of lien or other interest in property 

 FRBP 7001(3) – Approval of Sale of Property 

□ 31-Approval of sale of property of estate and of a co-owner - §363(h) 

 FRBP 7001(4) – Objection/Revocation of Discharge 

□ 41-Objection / revocation of discharge - §727(c),(d),(e) 

 FRBP 7001(5) – Revocation of Confirmation 

□ 51-Revocation of confirmation 

 FRBP 7001(6) – Dischargeability 

□ 66-Dischargeability - §523(a)(1),(14),(14A) priority tax claims 

□ 62-Dischargeability - §523(a)(2), false pretenses, false representation, 

 actual fraud 

□ 67-Dischargeability - §523(a)(4), fraud as fiduciary, embezzlement, larceny 

(continued next column) 

 FRBP 7001(6) – Dischargeability (continued) 

□ 61-Dischargeability - §523(a)(5), domestic support 

□ 68-Dischargeability - §523(a)(6), willful and malicious injury 

□ 63-Dischargeability - §523(a)(8), student loan 

□ 64-Dischargeability - §523(a)(15), divorce/sep property settlement/decree 

□ 65-Dischargeability - other

FRBP 7001(7) – Injunctive Relief 

□ 71-Injunctive relief – reinstatement of stay 

□ 72-Injunctive relief – other 

FRBP 7001(8) Subordination of Claim or Interest 

□ 81-Subordination of claim or interest 

FRBP 7001(9) Declaratory Judgment 

□ 91-Declaratory judgment 

FRBP 7001(10) Determination of Removed Action 

□ 01-Determination of removed claim or cause 

Other 

□ SS-SIPA Case – 15 U.S.C. §§78aaa et.seq.

□ 02-Other (e.g. other actions that would have been brought in state court if 

unrelated to bankruptcy case) 

□ Check if this case involves a substantive issue of state law □ Check if this is asserted to be a class action under FRCP 23 

Case: 12-01120-JMD Doc #: 1-2 Filed: 11/29/12 Desc: Adversary Proceeding Cover Sheet

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FORM 104 (10/06), Page 2 

INSTRUCTIONS 

The filing of a bankruptcy case creates an "estate" under the jurisdiction of the bankruptcy court which consists 

of all of the property of the debtor, wherever that property is located. Because the bankruptcy estate is so extensive and 

the jurisdiction of the court so broad, there may be lawsuits over the property or property rights of the estate. There also 

may be lawsuits concerning the debtor’s discharge. If such a lawsuit is filed in a bankruptcy court, it is called an 

adversary proceeding. 

A party filing an adversary proceeding must also must complete and file Form 104, the Adversary Proceeding 

Cover Sheet, if it is required by the court. In some courts, the cover sheet is not required when the adversary proceeding 

is filed electronically through the court's Case Management/Electronic Case Files (CM/ECF) system. (CM/ECF 

captures the information on Form 104 as part of the filing process.) When completed, the cover sheet summarizes basic 

information on the adversary proceeding. The clerk of court needs the information to process the adversary proceeding 

and prepare required statistical reports on court activity. 

The cover sheet and the information contained on it do not replace or supplement the filing and service of 

pleadings or other papers as required by law, the Bankruptcy Rules, or the local rules of court. The cover sheet, which is 

largely self-explanatory, must be completed by the plaintiff’s attorney (or by the plaintiff if the plaintiff is not 

represented by an attorney). A separate cover sheet must be submitted to the clerk for each complaint filed. 

Parties. Give the names of the parties to the adversary proceeding exactly as they appear on the complaint. Give the 

names and addresses of the attorneys if known. 

Signature. This cover sheet must be signed by the attorney of record in the box on the second page of the form. If the 

plaintiff is represented by a law firm, a member of the firm must sign. If the plaintiff is pro se, that is, not presented by 

an attorney, the plaintiff must sign. 

ADVERSARY PROCEEDING NO. 

RELATED ADVERSARY PROCEEDING (IF ANY) 

BANKRUPTCY CASE IN WHICH THIS ADVERSARY PROCEEDING ARISES 

NAME OF DEBTOR BANKRUPTCY CASE NO. 

DISTRICT IN WHICH CASE IS PENDING DIVISIONAL OFFICE NAME OF JUDGE 

PLAINTIFF DEFENDANT 

DISTRICT IN WHICH ADVERSARY IS PENDING DIVISIONAL OFFICE NAME OF JUDGE 

DATE PRINT NAME OF ATTORNEY (OR PLAINTIFF) 

SIGNATURE OF ATTORNEY (OR PLAINTIFF) 

Case: 12-01120-JMD Doc #: 1-2 Filed: 11/29/12 Desc: Adversary Proceeding Cover Sheet

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