Stock in trade, as per List G, estimated at
Book debts, as per List H, estimated to produce
C.
AD. 1891.
BANKRUPTCY.
FORM NO. 11.
Statement of Affairs of Debtor
(TITLE.)
NB—You are required to fill up carefully and accurately the several Forms A, B, C, D, E, F, G, and H, and such Forms, when filled up, will constitute your Statement of Affairs.
Preferential creditors for rent, rates, taxes, wages, etc., as per List A
Unsecured creditors other than preferential creditors, as per List B
Total Assets
Creditors fully secured, as per List C
Estimated value of securities
Surplus to contra account $
Creditors partly secured, as per List D Less estimated value of securities Other liabilities, as per List E $
of which it is expected will rank against the estate for dividend...
Liabilities on bills other than the debtor's own acceptances, as per List F $ of which it is expected will rank against the estate for dividend
***
...
Cash at bankers
Cash in hand
Household Furniture, estimated at
***
Other property, as per List G, estimated to produce Surplus from securities in the hands of creditors fully secured per contra
A.B.
The above statement and the several lists hereunto annexed are, to the best of my knowledge and belief, full, true, and complete. (Signed.)
Sworn, etc.
Total Debts $9
[No. 7.
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