Bankruptcy.
B.
CREDITORS FULLY SECURED.
Date
Estim- Estim-
Name Address
when
No.
of and Amount credi occupa- of debt.
tor. tion.
contracted.
Con- sidera-
tion.
Partic- ulars
Date
ated ated
value
surplus
of secu-
when given.
Month. Year.
rity.
of
secu-
from
rity.
secu- rity.
$
Dated this
day of
C.
CREDITORS PARTLY SECURED.
Name Address
No.
of
tor.
and Amount credi-occupa- of debt
tion.
No.
(Signature)
19 >
Date
when
contracted.
Con- sidera-
tion.
Partic- ulars
Month and
year
Month. Year.
of secu- when
rity.
Estim- ated value of
secu-
Balance
of debt
given.
un-
secured.
rity.
Dated this
day of
D.
(Signature)
19
LIABILITIES OF DEBTOR on bills discounted other than his own acceptances for value.
Acceptor's
name, address and occupation.
Whe-
Amount.
as drawer or in- dorser.
ther liable Date
when due.
Accom-
modation bills.
Other bills.
$
$
Dated this
day of
435
,
Holder's
name, address and occupation (if known).
Amount expected
to rank against estate for dividend.
19
(Signature)
[CAP. 6
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