Adversary Proceeding Cover Sheet

The use of the following cover sheet is required with local court rules and general orders. This cover sheet was issued in accordance with bankruptcy rule 9009.

Extracted Text for Proper Search

B1040 ( FORM 104 0) (12/15)  	
ADVERSARY PROCEEDING COVER SHEET	 	
(Instructions on Reverse)  	
 	
ADVERSARY PROCEEDING NUMBER	 	
(Court Use Only) 	
PLAINTIFFS	 	DEFENDANTS	 	
 	
ATTORNEYS 	(Firm Name, Address, and Telephone No.)	 	
 	
ATTORNEY	S (If Known)	 	
PARTY 	(Check One Box Only)	 	
□ Debtor □ U.S. Trustee/Bankruptcy Admin  
□ Creditor  □ Other  
□ Trustee	 	
PARTY 	(Check One Box Only)	 	
□ Debtor 	□ U.S. Trustee/Bankruptcy  Admin	 
□ 	
Creditor  	□ Other	 	
□ Trustee	 	
CAUSE OF ACTION	 (WRITE A BRIEF STATEMENT OF CAUSE OF ACTION, INCLUDING ALL U.S. STATUTES INVOLVED)	 	
 
 	
NATURE OF SUIT	 	
(Number up to five (5) boxes starting with lead cause of action as 1, first alternative cause as 2, second alternative cause as 3, etc.)  	
 	FRBP 7001(1) 	– Recovery of Money/Property 	 	
□	 11 -Recovery of money/property -  §542 turnover of property  	
□	 12 -Recovery of money/property -  §547 preference  	
□	 13 -Recovery of money/property -  §548 fraudulent transfer  	
□	 14 -Recovery of money/property -  other  
 
  FRBP 7001(2)  – Validity, Priority or Extent of Lien  	
□	 21 -Validity, priority or extent of lien or other  interest in property  
 
  FRBP 7001(3)  – Approval of Sale of Property  	
□	 31 -Approval of sale of property of estate and of a co -owner  - §363(h)  
 
  FRBP 7001(4)  – Objection/Revocation of Discharge  	
□	 41 -Objection / revocation of discharge -  §727(c),(d),(e) 
 
  FRBP  7001(5)  – Revocation of Confirmation  	
□	 51 -Revocation of confirmation 
 
  FRBP 7001(6)  – Dischargeability  	
□	 66 -Dischargeability  - §523(a)(1),(14),(14A) priority tax claims  	
□	 62 -Dischargeability  - §523(a)(2), false pretenses, false representation,   
  actual fraud 	
□	 67 -Dischargeability  - §523(a)(4), fraud as fiduciary, embezzlement, larceny  
  (continued next column)  	
FRBP 7001(6) 	– Dischargeability (continued)	 	
□	 61 -Dischargeability  - §523(a)(5), domestic support  	
□	 68 -Dischargeability  - §523(a)(6), willful and malicious injury  	
□	 63 -Dischargeability  - §523(a)(8), student loan  	
□	 64 -Dischargeability  - §523(a)(15), divorce  or separation obligation   
            (other than domestic support)  	
□	 65 -Dischargeability  - other	 	
FRBP 7001(7)  – Injunctive Relief  
□	  71 -Injunctive relief –  imposition  of stay  	
□	  72 -Injunctive relief –  other  
 
FRBP 7001(8) Subordination of Claim or Interest  	
□	  81 -Subordination of claim or interest  
 
FRBP 7001(9) Declaratory Judgment  	
□	  91 -Declaratory judgment  
 
FRBP 7001(10) Determination of Removed Action  	
□	  01 -Determination of removed claim or cause  
 
Other  	
□	  SS-SIPA Case –  15 U.S.C. §§78aaa et.seq.  	
□	  02 -Other (e.g. other actions that would have been brought in state court 	
if unrelated to bankruptcy case)	 	
□ Check if this case involves a substantive issue of state law	 	□ Check if this is asserted to be a class action under FRCP 23	 	
□ Check if a jury 	trial is demanded in complaint	 	Demand  $	 	
Other Relief Sought

B1040 (FORM 104 0) (12/15)  	
BANKRUPTCY CASE IN WHICH THIS ADVERSARY PROCEEDING ARISES	 	
NAME OF DEBTOR	 	BANKRUPTCY CASE NO.	 	
DISTRICT IN WHICH CASE IS PENDING	 	DIVISION OFFICE	 	NAME OF JUDGE	 	
RELATED ADVERSARY PROCEEDING 	(IF ANY)	 	
PLAINTIFF	 	DEFENDANT	 	ADVERSARY 
PROCEEDING NO.  	
DISTRICT IN WHICH ADVERSARY IS PENDING	 	DIVISION OFFICE	 	NAME OF JUDGE	 	
SIGNATURE OF ATTORNEY (OR PLAINTIFF)	 	
 
 
DATE	 	PRINT NAME OF ATTORNEY (OR PLAINTIFF)	 	
 	
 	
INSTRUCTIONS 
 
The filing of a bankruptcy case creates an  “estate ” under the jurisdiction of the bankruptcy court which consists of 
all of the property of the debtor, wherever that property is located.  Because the bankruptcy estate is so extensive and the 
jurisdiction o f the court so broad, there may be lawsuits over the property or property rights of the estate.  There also may be 
lawsuits concerning the debtor’s discharge.  If such a lawsuit is filed in a bankruptcy court, it is called an adversary 
proceeding.  
 
A party  filing an adversary proceeding must also must complete and file Form 104 0, the Adversary Proceeding 
Cover Sheet, unless the party files the adversary proceeding electronically through the court’s Case Management/Electronic 
Case Filing  system (CM/ECF).  (CM/ECF captures the information on  Form 1040  as part of the filing process.)  When 
completed, the cover sheet summarizes basic information on the adversary proceeding.  The clerk of court needs the 
information to process the adversary p roceeding and prepare required statistical reports on court activity.  
 
The cover sheet and the information contained on it do not replace or supplement the filing and service of pleadings 
or other papers as required by law, the Bankruptcy Rules, or the loc al rules of court.  The cover sheet, which is largely self-
explanatory, must be completed by the plaintiff’s attorney (or by the plaintiff if the plaintiff is not represented by an 
attorney).  A separate cover sheet must be submitted to the clerk for each complaint filed.  
 
P laintiffs  and Defendants .  Give the names of the plaintiffs and defendants  exactly as they appear on the complaint.   
 
Attorneys.   Give the names and addresses of the attorneys, if known.  
 
Party .  Check the most appropriate box in the first column for the plaintiffs and the second column for the defendants.  
 
Demand.  Enter the dollar amount being demanded in the complaint.  
 
Signature.   This cover sheet must be signed by the attorney of record in t he box on the second page of the form.  If the 
plaintiff is represented by a law firm, a member of the firm must sign.  If the plaintiff is pro se, that is, not re presented by an 
attorney, the plaintiff must sign.