CAP. 6]

(a) 1st or as the case may be.

Bankruptcy.

FORM 137.

[s. 94; rule 169.]

STATEMENT TO ACCOMPANY APPLICATION FOR RELEASE.

(Title.)

Statement showing position of estate at date of application for release.

Dr.

Receipts.

Estim-. ated to produce

Cr.

Pay- ments.

per

$ ¢

debtor's

By court fees

state- ment.

$

Law costs of petition

Other law costs

To re- total receipts from date of ceiving order, viz-

[State particu- lars under the several head- ings specified in the debtor's statement affairs.]

Trustee's remuneration, viz-

per cent on $ assets realized

per cent on $ of

Receipts per trad- ing account

Other receipts

Less-

Deposit

Total returned to petitioner

Payments to re- deem securities

Costs of execution.

Payments per trad- ing account ...... $

Net realization $ assets

... distributed in dividend $

Special manager's charges Person appointed to assist debtor under section 78 of the Bankruptcy Ordinance

Auctioneer's charges as taxed

Other taxed costs Costs of possession Costs of notices in Gazette and local papers

Incidental outlay

Total cost of realiza- tion

Allowance to debtor.

(a) dividend now declared of $ per cent on $

Dividends previ- ously declared

Balance 494

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