Official Local Form 3 - Chapter 13 Plan Cover Sheet Page 6
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10C. Non-Dischargeable Unsecured Claims:
Creditor
Description of Claim
Amount of Claim
__________________
_________________________
$_______________
__________________
_________________________
$_______________
__________________
_________________________
$_______________
Total of Unsecured Claims (A + B + C):
$_______________
D. Multiply total by percentage:
$_______________
(Example: Total of $38,500.00 x .22 dividend = $8,470.00)
E. Separately classified unsecured claims (co-borrower, etc.):
Creditor
Description of Claim
Amount of Claim
__________________
_________________________
$_______________
__________________
_________________________
$_______________
__________________
_________________________
$_______________
Total amount of separately classified claims payable at _____%:
$_______________
VI. OTHER PROVISIONS:
A. Liquidation of assets to be used to fund plan: ______________________________________
______________________________________________________________________________.
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