[Confirmation of Resolution.]

In the District Court of the United States,

Whereas, a majority in number and three-fourths in value of the creditors of said who were assembled, either in person or by proxy, at a meeting of the creditors held on the____day of____187____, at the office of____one of the registers in bankruptcy of said court, No____street, in the city of county of and state of____, and district aforesaid, did resolve to accept a composition then proposed by the said____which is as follows, to wit: [here set forth the terms of composition.]

Now we, the undersigned, being two-thirds in number and one-half in value of all the creditors of said____, having proved our debts respectively, do hereby, by our respective signatures, confirm the resolution so passed as aforesaid.