(s. 16.]
*
C.
632
No. 7 of 1891.
BANKRUPTCY.
FORM NO. 11.
Statement of affairs of debtor.
(TITLE.)
N.B. You are required to fill up carefully and accurately the several Lists A, B, C, D, E, F, G, and H, and such Lists, 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,
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
C.
Stock in trade, as per List G, estimated at,.. Book debts, as per List H, estimated to produce,...
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,
Total Assets.......................
The above statement and the several lists hereunto annexed are, to the best of my knowledge and belief, full, true, and complete. Sworn, etc.
* As amended by Law Am. Ord., 1923.
(Signed.)
A.B.
Total debts...
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,..
Page 55
Page 56