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SCHEDULE A. (2)

Creditors holding securities.

(N. B.- Particulars of securities held, with dates of same, and when they were given, to be stated under the names of the several creditors, and also particulars concerning each debt, as required by acts of Congress relating to bankruptcy, and whether contracted as partner or joint contractor with any other person; and if so, with whom.]

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Creditors whose claims are unsecured. [N. B.-When the name and residence (or either) of any drawer, maker, indorser or holder of any

bill or note, etc., are unknown, the fact must be stated, and also the name and residence of the last holder known to the debtor. The debt due to each creditor must be stated in full, and any claim by way of set-off stated in the schedule of property.)

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SCHEDULE A. (4) Liabilities on notes or bills discounted which ought to be paid by the drawers,

makers, acceptors or indorsers. (N. B.-The dates of the notes or bills, and when due, with the names, residences, and the business or occupation of the drawers, makers, or acceptors thereof, are to be set forth under the names of the holders. If the names of the holders are not known, the name of the last holder known to the debtor shall be stated, and his business and place of residence. The same particulars as to notes or bills on which the debtor is liable as indorser.]

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Total....

Petitioner.

SCHEDULE A. (5)

Accommodation paper. [N. B.- The dates of the notes or bills, and when due, with the names and residences of drawers, makers, and acceptors thereof, are to be set forth under the names of the holders; if the bankrupt be liable as drawer, maker, acceptor, or indorser thereof, it is to be stated accordingly. If the names of the holders are not known, the name of the last holder known to the debtor should be stated, with his residence. Same particulars as to other commercial paper.)

Amount

Total....

Petitioner,

SS.

OATH TO SCHEDULE A. UNITED STATES OF_AMERICA,

District of On this — day of A. D. 18—, before me personally came the person mentioned in and who subscribed to the foregoing schedule, and who, being by me first duiy sworn, did declare the said schedule to be a statement of all his debts, in accordance with the acts of congress relating to bankruptcy. Subscribed and sworn to before me this

-, A. D. 18– (Official character.]

day of

SCHEDULE B.-STATEMENT OF ALL PROPERTY OF

BANKRUPT.
SCHEDULE B. (1)

Real estate

Location and description of Incumbrances Statement of all real estate owned by thereon, if any,

Estimated particulars re

value. debtor, or held by him. and dates lating thereto.

thereof.

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a.

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e.

Cash on hand..... b.— Bills of exchange, promissory notes, or securities of any de

scription (each to be set out separately).. C. - Stock in trade, in business of

at of the value of d. - Household goods and furniture, household stores, wearing

apparel and ornaments of the person, viz... -Books, prints, and pictures, viz.... f.- Horses, cows, sheep, and other animals (with number of

each), viz... g.- Carriages and other vehicles, viz. h.– Farming stock and implements of husbandry, viz. 1- Shipping, and shares in vessels, viz... k.- Machinery, fixtures, apparatus, and tools used in business,

with the place where each is situated, viz... 1.- Patents, copyrights, and trade-marks, viz.. - Goods or personal property of any other description, with

the place where each is situated, viz...

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Total....

Petitioner.

SCHEDULE B. (3)

Choses in action.

Dollars. Cents.

a.- Debts due petitioner on open account....
6.- Stocks in incorporated companies, interest in joint-stock

companies, and negotiable bonds....
C.- Policies of insurance.
d.- Unliquidated claims of every nature, with their esti-

mated value... 6.- Deposits of money in banking institutions and elsewhere

Total.,

Petitioner.

SCHEDULE B. (4) Property in reversion, remainder, or expectancy, including property held

in trust for the debtor or subject to any power or right to dispose of or

to charge. (N. B.- A particular description of each interest must be entered. It all or any of the debtor's property has been conveyed by deed of assignment, or otherwise, for the benefit of creditors, the date of such deed should be stated, the name and address of the person to whom the property was conveyed, the amount realized from the proceeds thereof, and the disposal of the same, as far as known to the debtor.)

General interest.

Particular description. Supposed value

of my interest.

Total......

Interest in land ...
Personal property.
Property in money, stock, shares,

bonds, annuities, etc...... Rights and powers, legacies and

bequests. Property heretofore conveyed for

benefit of creditors. What portion of debtor's property

has been conveyed by deed of assignment, or otherwise, for benefit of creditors; date of such deed, name and address of party to whom conveyed; amount realized therefrom, and disposal of same, so far as

known to debtor .. What sum or sums have been

paid to counsel, and to whom, for services rendered or to be rendered in this bankruptcy....

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SCHEDULE B. (5)

A particular statement of the property claimed as exempted from the oper.

ation of the acts of Congress relating to bankruptcy, giving each item of property and its valuation; and, if any portion of it is real estate, its location, description, and present use.

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Military uniform, arms, and equipments.....
Property claimed to be exempted by State laws; its valu.

ation; whether real or personal; its description and
present use; and reference given to the statute of the
State creating the exemption

Total....

Petitioner.

SCHEDULE B. (6)

BOOKS, PAPERS, DEEDS, AND WRITINGS RELATING TO BANK

RUPT'S BUSINESS AND ESTATE

The following is a true list of all books, papers, deeds, and writings relating to my tradę, business, dealings, estate, and effects, or any part thereof, which, at the date of this petition, are in my possession or under my custody and control, or which are in the possession or custody of any person in trust for me, or for my use, benefit or advantage; and also of all others which have been heretofore, at any time, in my possession, or under my custody or control, and which are now held by the parties whose names are hereinafter set forth, with the reason for their custody of the

same.

Books.

Deeds.

Papers.

Petitioner.

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