2016-01-12_GENERAL DOCUMENTS - P2012007

• Permit No: P2012007
• IBM Index Class Name: General Documents
• Doc Date: 1/12/2016
• Doc Name: Order Establishing Bar Date for Filing Proofs of Claim
• From: US Bankruptcy Court CO
• To: DRMS
• Email Name: LJW
• Email Name: GRM
• Media Type: D
• Archive: No

Fill in this information to identify the case:
Debtor 1
Debtor 2
(Spouse, if filing)
United States Bankruptcy Court for the: District of
Case number
(State)
Official Form 410
Proof of Claim
12/15
Read the instructions before filling out this form. This form is for making a claim for payment in a bankruptcy case. Do not use this form to
make a request for payment of an administrative expense. Make such a request according to 11 U.S.C. § 503.
Filers must leave out or redact information that is entitled to privacy on this form or on any attached documents. Attach redacted copies of any
documents that support the claim, such as promissory notes, purchase orders, invoices, itemized statements of running accounts, contracts, judgments,
mortgages, and security agreements. Do not send original documents; they may be destroyed after scanning. If the documents are not available,
explain in an attachment.
A person who files a fraudulent claim could be fined up to $500,000, imprisoned for up to 5 years, or both. 18 U.S.C. §§ 152, 157, and 3571.
Fill in all the information about the claim as of the date the case was filed. That date is on the notice of bankruptcy (Form 309) that you received.
Part 1:
Identify the Claim
1.
Who is the current
creditor?
Name of the current creditor (the person or entity to be paid for this claim)
Other names the creditor used with the debtor
2.
Has this claim been
acquired from
someone else?
❑ No
❑ Yes. From whom?
3.
Where should notices
and payments to the
creditor be sent?
Federal Rule of
Bankruptcy Procedure
(FRBP) 2002(g)
Where should notices to the creditor be sent?
Where should payments to the creditor be sent? (if
different)
Name
Name
Number Street
Number Street
City State ZIP Code
Contact phone
City State ZIP Code
Contact phone
Contact email
Contact email
Uniform claim identifier for electronic payments in chapter 13 (if you use one)
4.
Does this claim amend
one already filed?
❑ No
❑ Yes. Claim number on court claims registry (if known)
Filed on
MM / DD / YYYY
5.
Do you know if anyone
else has filed a proof
of claim for this claim?
❑ No
❑ Yes. Who made the earlier filing?
Official Form 410
Proof of Claim
page 1