2016-01-12_GENERAL DOCUMENTS - P2012007

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Part 2: Give Information About the Claim as of the Date the Case Was Filed 6. Do you have any number you use to identify the debtor? ❑ No U Yes. Last 4 digits of the debtor's account or any number you use to identify the debtor: — — 7. How much is the claim? $ . Does this amount include interest or other charges? ❑ No ❑ Yes. Attach statement itemizing interest, fees, expenses, or other charges required by Bankruptcy Rule 3001(c)(2)(A). 8. What is the basis of the claim? Examples: Goods sold, money loaned, lease, services performed, personal injury or wrongful death, or credit card. Attach redacted copies of any documents supporting the claim required by Bankruptcy Rule 3001(c). Limit disclosing information that is entitled to privacy, such as health care information. 9. Is all or part of the claim secured? ❑ No ❑ Yes. The claim is secured by a lien on property. Nature of property: U Real estate. If the claim is secured by the debtor's principal residence, file a Mortgage Proof of Claim Attachment (Official Form 410-A) with this Proof of Claim. ❑ Motor vehicle ❑ Other. Describe: Basis for perfection: Attach redacted copies of documents, if any, that show evidence of perfection of a security interest (for example, a mortgage, lien, certificate of title, financing statement, or other document that shows the lien has been filed or recorded.) Value of property: $ Amount of the claim that is secured: $ Amount of the claim that is unsecured: $ (The sum of the secured and unsecured amounts should match the amount in line 7.) Amount necessary to cure any default as of the date of the petition: $ Annual Interest Rate (when case was filed) % ❑ Fixed ❑ Variable 10. Is this claim based on a lease? ❑ No U Yes. Amount necessary to cure any default as of the date of the petition. $ 11. Is this claim subject to a right of setoff? ❑ No ❑ Yes. Identify the property: Official Form 410 Proof of Claim page 2