Form F 701 - Request For Assignment To Mediation Program Page 2

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5.
Fraudulent transfer
6.
Lien avoidance
7.
Dischargeability
Specify
grounds:
8.
Other. Please specify:
Amount of money at issue in Matter:
1.
$0 to $1,000
2.
$1,001 to $10,000
3.
$10,001 to $50,000
4.
$50,001 to $100,000
5.
$100,001 to $500,000
6.
$500,001 to $1,000,000
7.
$1,000,001 to $5,000,000
8.
$5,000,001 to $10,000,000
9.
If more than $10,000,000,
state amount: $
10.
Money not at issue.
This form is optional. It has been approved for use by the United States Bankruptcy Court for the Central District of California.
F 701
Page 2
May 2011

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