Ballot For Accepting Or Rejecting Plan Of Reorganization {15-3}

OLF 15-3 (Official Local Form 15-3) UNITED STATES BANKRUPTCY COURT DISTRICT OF MASSACHUSETTS In re Debtor BALLOT FOR ACCEPTING OR REJECTING PLAN OF REORGANIZATION [Proponent] filed a Plan of Reorganization for Small Business Debtor dated [Date] (the "Plan") for the Debtor in this case. The Court has conditionally approved a disclosure statement with respect to the Plan (the "Disclosure Statement"). The Disclosure Statement provides information to assist you in deciding how to vote your ballot. If you do not have a Disclosure Statement, you may obtain a copy from [name, address, telephone number and telecopy number of proponent/proponent's attorney.] The Court's conditional approval of the Disclosure Statement does not indicate approval of the Plan by the Court. You should review the Disclosure Statement and the Plan before you vote. You may wish to seek legal advice concerning the Plan and your classification and treatment under the Plan. Your [claim] [equity interest] has been placed in class [ ] under the Plan. If you hold claims or equity interests in more than one class, you will receive a ballot for each class in which you are entitled to vote. If your ballot is not received by [name and address of proponent's attorney or other appropriate address] on or before [date], and such deadline is not extended, your vote may not count. If the Plan is confirmed by the Bankruptcy Court, it will be binding on you whether or not you vote, even if you vote to reject the Plan. 1. Vote. Acceptance or Rejection of the Plan [At this point the ballot should provide for voting by the particular class of creditors or equity holders receiving the ballot using one of the following alternatives:] [If the voter is the holder of a secured, priority, or unsecured nonpriority claim:] The undersigned, the holder of a Class [ ] claim against the Debtor in the unpaid amount of Dollars ($ )[or, if the voter is the holder of a bond, debenture, or other debt security:] The undersigned, the holder of a Class [ ] claim against the Debtor, consisting of Dollars ($ ) principal amount of [describe bond, debenture, or other debt security] of the Debtor (For Chapter 11 Case No. American LegalNet, Inc. www.FormsWorkFlow.com purposes of this Ballot, it is not necessary and you should not adjust the principal amount for any accrued or unmatured interest.) [or, if the voter is the holder of an equity interest:] The undersigned, the holder of Class [ ] equity interest in the Debtor, consisting of ______ shares or other interests of [describe equity interest] in the Debtor. [In each case, the following language should be included:] Check one box only __ Accepts the Plan 2. Authorization. By return of this Ballot, the undersigned certifies that it is the holder of a claim in Class _____ to which this Ballot pertains (or an authorized signatory therefor) and has full power and authority to vote to accept or reject the Plan. The undersigned further certifies that it has received a copy of the Disclosure Statement (including the appendices and exhibits thereto) and understands that the solicitation of votes for the Plan is subject to all the terms and conditions set forth in the Disclosure Statement. No fees, commissions, or other remuneration will be payable to any person for soliciting votes on the Plan. Dated: ___________________ Signature: _________________________________________________________________ ___________________________________________________________ __Rejects the Plan Print or type name: Title (if corporation or partnership): _________________________________________________ Address: ______________________________________________________________________ ______________________________________________________________________________ Return this Ballot to: [Name and address of proponent's attorney or other appropriate address] American LegalNet, Inc. www.FormsWorkFlow.com