B1040 (FORM 1040) (12/15)

ADVERSARY PROCEEDING COVER SHEET ADVERSARY PROCEEDING NUMBER

(Court Use Only)
(Instructions on Reverse)

PLAINTIFFS DEFENDANTS

ATTORNEYS (Firm Name, Address, and Telephone No.) ATTORNEYS (If Known)

PARTY (Check One Box Only) PARTY (Check One Box Only)
□ Debtor □ U.S. Trustee/Bankruptcy Admin □ Debtor □ U.S. Trustee/Bankruptcy Admin
□ Creditor □ Other □ Creditor □ Other
□ Trustee □ 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.)

□ 11-Recovery of money/property - §542 turnover of property □

FRBP 7001(1) – Recovery of Money/Property FRBP 7001(6) – Dischargeability (continued)

□ 12-Recovery of money/property - §547 preference □

61-Dischargeability - §523(a)(5), domestic support

□ 13-Recovery of money/property - §548 fraudulent transfer □

68-Dischargeability - §523(a)(6), willful and malicious injury

□ 14-Recovery of money/property - other □

63-Dischargeability - §523(a)(8), student loan
64-Dischargeability - §523(a)(15), divorce or separation obligation

□
(other than domestic support)

□ 21-Validity, priority or extent of lien or other interest in property

FRBP 7001(2) – Validity, Priority or Extent of Lien 65-Dischargeability - other

□
FRBP 7001(7) – Injunctive Relief

□
FRBP 7001(3) – Approval of Sale of Property
□
71-Injunctive relief – imposition of stay
31-Approval of sale of property of estate and of a co-owner - §363(h) 72-Injunctive relief – other

□ 41-Objection / revocation of discharge - §727(c),(d),(e)

FRBP 7001(4) – Objection/Revocation of Discharge
□ 81-Subordination of claim or interest
FRBP 7001(8) Subordination of Claim or Interest

□ 51-Revocation of confirmation
FRBP 7001(5) – Revocation of Confirmation
□ 91-Declaratory judgment
FRBP 7001(9) Declaratory Judgment

□ 66-Dischargeability - §523(a)(1),(14),(14A) priority tax claims

FRBP 7001(6) – Dischargeability
□
FRBP 7001(10) Determination of Removed Action

□ 62-Dischargeability - §523(a)(2), false pretenses, false representation, 01-Determination of removed claim or cause

□ 67-Dischargeability - §523(a)(4), fraud as fiduciary, embezzlement, larceny □ SS-SIPA Case – 15 U.S.C. §§78aaa et.seq.
actual fraud Other

(continued next column) □ 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 1040) (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 of 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 1040, 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 proceeding 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 local 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.

Plaintiffs 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 the 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 represented by an
attorney, the plaintiff must sign.