SCHEDULE A-STATEMENT OF ALL DEBTS OF BANKRUPT. Statement of all creditors to whom priority is secured by the act. 4-Wages due workmen, -Taxes due and owing to (2) Rent owing to a accrued within pancy. Total...... Petitioner. Claims which have priority. SCHEDULE A-STATEMENT OF ALL DEBTS OF BANKRUPT-Continued 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 the Act of Congress relating to bankruptcy, and whether contracted as partner or joint contractor with any other person; and if so, with whom.] When and where debts Whether claim is contracted, and were nature and considera tion thereof. stated.) contingent, unliquidated or disputed. Value of Amount due or claimed. Total.... Petitioner. 341 SCHEDULE A.-STATEMENT OF ALL DEBTS OF BANKRUPT-Continued [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.] Petitioner. SCHEDULE A.-STATEMENT OF ALL DEBTS OF BANKRUPT-Continued 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, acceptors, or indorsers 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 shall be stated as to notes or bills on which the debtor is liable as indorser.] Bankruptcy Act Anno. 5th Ed.-23 Form 1, Sched. A-4 Nature and consideration of liability, whether same was contracted as partner or joint contractor, with any other person;| and, if so, with whom. or Total.. Petitioner. SCHEDULE A.-STATEMENT OF ALL DEBTS OF BANKRUPT-Continued SCHEDULE A-5. Accommodation paper. [N. B.-The dates of the notes or bills, and when due, with the names and residences of the drawers, makers, acceptors, and indorsers thereof, are to be set forth under the names of the holders; if the debtor 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. as to other commercial paper.] Reference to Names of holders. known, that fact Residences (if unmust be stated). Names and residences Place where Whether claim of persons accommodated. is disputed. contracted. ledger ог voucher. Give same particulars State of 1, =}ss. OATH TO SCHEDULE A the person who subscribed to the foregoing schedule, do hereby make solemn oath that the said schedule is a statement of all my debts, in accordance with the Act of Congress relating to bankruptcy, according to the best of my knowledge, information, and belief. Subscribed and sworn to before me this day of -, 19 |