Form 4 Version 3

PART A SAMPLE FORM 4 Version 3, Effective for Cases Filed After 10/17/05

Distribution Report for Closed Asset Cases

Case No. 3990165432 Trustee Name: Jenny Ward

Case Name: John L. & Sally B. Doe Date Submitted: 12/31/06

Date Filed/Converted to Ch. 7: 11/01/05



$ AMOUNT

RECEIVED

% OF

RECEIPTS

GROSS RECEIPTS $1,000,000.00 100.00%
Less:
Funds Paid to Debtor
Exemptions 3,400.00 0.34%
Excess Funds 0.00 0.00%
Funds Paid to 3rd Parties 0.00 0.00%
NET RECEIPTS $996,600.00 99.66%


$ CLAIMS
$ AMOUNT

PAID

% OF

RECEIPTS

SECURED CLAIMS:
Real Estate $400,000.00 $400,000.00 40.00%
Personal Property & Intangibles 33,000.00 33,000.00 3.30%
Internal Revenue Service Tax Liens 0.00 0.00 0.00%
Other Governmental Tax Liens 3,000.00 3,000.00 0.30%
TOTAL SECURED CLAIMS $436,000.00

$436,000.00

43.60%

PRIORITY CLAIMS:
CHAPTER 7 ADMINISTRATIVE FEES ァァ 507(a)(1)(C) and (2), and
CHARGES under Title 28, Chapter 123:
Trustee Fees 47,330.00 47,330.00 4.73%
Trustee Expenses 2,000.00 2,000.00 0.20%
Legal Fees & Expenses:
Trustee's Firm Legal Fees 0.00 0.00 0.00%
Trustee's Firm Legal Expenses 0.00 0.00 0.00%
Other Firm's Legal Fees 25,000.00 25,000.00 2.50%
Other Firm's Legal Expenses 1,500.00 1,500.00 0.15%
Accounting Fees and Expenses
Trustee's Firm Accounting Fees 0.00 0.00 0.00%
Trustee's Firm Accounting Expenses 0.00 0.00 0.00%
Other Firm's Accounting Fees 4,000.00 4,000.00 0.40%
Other Firm's Accounting Expenses 0.00 0.00 0.00%
Real Estate Commissions 25,000.00 25,000.00 2.50%
Auctioneer/Liquidator Fees 20,000.00 20,000.00 2.00%
Auctioneer/Liquidator Expenses 10,000.00 10,000.00 1.00%
Other Professional Fees/Expenses 1,000.00 1,000.00 0.10%
Expenses of Operating Business in Chapter 7 0.00 0.00 0.00%
Other Expenses 5,700.00 5,700.00 0.57%
Income Taxes - Internal Revenue Service 5,000.00 5,000.00 0.50%
Other State or Local Taxes 0.00 0.00 0.00%
U.S. Trustee Fees 0.00 0.00 0.00%
Court Costs 800.00 800.00 0.08%
TOTAL CHAPTER 7 ADMINISTRATIVE FEES & EXPENSES $147,330.00 $147,330.00 14.73%
TOTAL PRIOR CHAPTER ADMINISTRATIVE FEES ァァ 507(a)(1)(C) and (2)
(From attached Part B) 0.00 0.00 0.00%
DOMESTIC SUPPORT OBLIGATIONS ァ 507(a)(1)(A) & (B) 4,600.00 4,600.00 0.46%
WAGES ァ 507(a)(4) 9,200.00 9,200.00 0.92%
CONTRIBUTIONS: EMPLOYEE BENEFIT PLANS ァ 507(a)(5) 900.00 1,900.00 0.09%
CLAIMS OF GOVERNMENTAL UNITS ァ 507(a)(8) 25,000.00 25,000.00 2.50%
OTHER ァ 507 (a)(3), (6), (7), (9) & (10) 0.00 0.00 0.00%
TOTAL PRIORITY CLAIMS ァ 507(a)(1)(A) & (B), TO ァ 507(a)(3), to ァ 507 (a)(10) $39,700.00 $39,700.00 3.97%
GENERAL UNSECURED CLAIMS $1,200,000.00 $373,570.00 37.36%
TOTAL DISBURSEMENTS $1,823,030.00 $996,600.00 99.66%




PART B SAMPLE FORM 4 Draft Version 3, 10/17/05

Distribution Report for Closed Asset Cases



Case No. 3990165432 Trustee Name: Jenny Ward

Case Name: John L. & Sally B. Doe Date Submitted: 12/31/06

Date Filed/Converted to Ch. 7: 11/01/05



$ CLAIMS
$ AMOUNT

PAID

% OF

RECEIPTS

PRIOR CHAPTER ADMINISTRATIVE FEES ァァ 507(a)(1)(C) and (2)
Trustee Fees $0.00 $0.00 0.00%
Trustee Expenses 0.00 0.00 0.00%
Legal Fees & Expenses:
Trustee's Firm Legal Fees 0.00 0.00 0.00%
Trustee's Firm Legal Expenses 0.00 0.00 0.00%
Other Firm's Legal Fees 0.00 0.00 0.00%
Other Firm's Legal Expenses 0.00 0.00 0.00%
Accounting Fees and Expenses
Trustee's Firm Accounting Fees 0.00 0.00 0.00%
Trustee's Firm Accounting Expenses 0.00 0.00 0.00%
Other Firm's Accounting Fees 0.00 0.00 0.00%
Other Firm's Accounting Expenses 0.00 0.00 0.00%
Real Estate Commissions 0.00 0.00 0.00%
Auctioneer/Liquidator Fees 0.00 0.00 0.00%
Auctioneer/Liquidator Expenses 0.00 0.00 0.00%
Other Professional Fees/Expenses 0.00 0.00 0.00%
Income Taxes - Internal Revenue Service 0.00 0.00 0.00%
Other State or Local Taxes 0.00 0.00 0.00%
Operating Expenses 0.00 0.00 0.00%
Other Expenses 0.00 0.00 0.00%
TOTAL PRIOR CHAPTER ADMINISTRATIVE FEES $0.00 $0.00 0.00%
Updated May 7, 2015

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