DEBT SETTLEMENT PLAN
NAME OF COMMITTEE
CITY, STATE AND ZIP CODE
ADDRESS
PART I — COMMITTEE SUMMARY INFORMATION
15. AFTER DISPOSING OF ALL THE COMMITTEE‘S DEBTS AND OBLIGATIONS, WILL THERE BE ANY RESIDUAL FUNDS?
YES
NO
IF YES, HOW WILL THE FUNDS BE DISBURSED?
14. HAS THE COMMITTEE FILED PREVIOUS DEBT SETTLEMENT PLANS?
YES
NO
13. DOES THE COMMITTEE HAVE SUFFICIENT FUNDS TO PAY THE TOTAL AMOUNT INDICATED IN THIS PLAN?
YES
NO
IF NO, WHAT STEPS WILL BE TAKEN TO OBTAIN THE FUNDS?
12. IF THIS IS AN AUTHORIZED COMMITTEE, DOES THE CANDIDATE HAVE OTHER AUTHORIZED COMMITTEES?
YES
NO
IF YES, LIST BELOW.
11. IS THE COMMITTEE TERMINATING ITS ACTIVITIES?
YES
NO
IF YES, WHEN DOES THE COMMITTEE EXPECT TO FILE A TERMINATION REPORT? IF NO, COMMITTEE IS NOT ELIGIBLE TO FILE A DEBT
SETTLEMENT PLAN (SEE INSTRUCTIONS).
1. CASH ON HAND AS OF __________________
2. TOTAL ASSETS TO BE LIQUIDATED
3. TOTAL (ADD 1 AND 2)
4. YEAR TO DATE RECEIPTS
5. YEAR TO DATE DISBURSEMENTS
6. TOTAL AMOUNT OF DEBTS OWED BY THE COMMITTEE
7. TOTAL NUMBER OF CREDITORS OWED
8. NUMBER OF CREDITORS IN PART II OF THIS PLAN
9. TOTAL AMOUNT OF DEBTS OWED TO THE CREDITORS
IN PART II OF THIS PLAN
10. TOTAL AMOUNT TO BE PAID TO CREDITORS IN PART II
OF THIS PLAN
DATE
I certify, to the best of my knowledge, that the information contained in this Debt Settlement Plan is true, correct and complete.
SIGNATURE OF
TREASURER OF
COMMITTEE
➢
FEC I.D. NUMBER
FEC FORM 8
(Revised 1/2001)
FE1AN061.PDF
DEBT SETTLEMENT PLAN
PART II
NAME OF COMMITTEE
FEC I.D. NUMBER
PAGE
OF
AMOUNT
OFFERED IN
SETTLEMENT
AMOUNT OWED
TO CREDITOR
DATE INCURRED
FULL NAME AND MAILING ADDRESS OF CREDITOR
CREDITOR SUMMARY INFORMATION
(FILL OUT FOR EACH CREDITOR IN PLAN)
DATE
As a representative of the creditor, I hereby accept the settlement offer made to me by the committee and upon payment agree to consider
the debt satisfied (or attach a copy of the signed settlement).
SIGNATURE OF
CREDITOR OR
REPRESENTATIVE
➢
INCORPORATED
COMMERCIAL VENDOR
UNINCORPORATED
COMMERCIAL VENDOR
CANDIDATE
COMMITTEE EMPLOYEE
OTHER