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Your claim can be filed electronically on KCC 's website at lotps://epoe.kccllc.net/peabody. <br />1 our unique login information is: <br />ID: 23597921 PIN:y09gov2U <br />Indicate the Debtor against which you assert a claim by listing it below <br />(You may only indicate one Debtor per claim form.) <br />Debtor Peabody Western Coal Company, <br />United States Bankruptcy Court for the Eastern District of Missouri <br />Case number 16-42644 <br />The Debtor has listed your claim as Contingent and Unliquidated on Schedule F (F./F Part 2) as a General Unsecured <br />claim. Il'you believe that you have a claim against the Debtor, please complete and return this form accordingly. <br />Official Form 410 <br />Proof of Claim 04/16 <br />Read the instructions before filling out this form. This form is for making a claim for payment in a bankruptcy case. Other than a claim under <br />11 U.S.C. § 503(b)(9), this form should not be used to make a claim for an administrative expense arising after the commencement of the case. <br />Filers must leave out or redact Information that Is entitled to privacy on this form or on any attached documents. Attach redacted copies or any <br />documents that support the claim, such as promissory notes, purchase orders, Invoices, Itemized statements of running accounts, contracts, judgments, <br />mortgages, and security agreements Do not send original documents; they may be destroyed after scanning. If the documents are not available, <br />explain In an attachment <br />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 <br />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. <br />® Identify the Claim <br />NamelD 12767016 <br />1 Who is the current <br />U.S. DI PARTMENT OI' TIII•: INTERIOR, OFFICE OI' SURFACE MINING RECLAMATION AND FNFORCEMENT <br />creditor? <br />Name of the current creditor (the person or entity to be pard for this claim) <br />Other names the creditor used with the debtor <br />2 Has this claim been <br />❑ No <br />acquired from <br />someone else? <br />❑ Yes From whom? <br />3. Where should <br />Where should notices to the creditor be sent? <br />Where should payments to the creditor be sent? (if <br />notices and <br />U.S. DEPAR"I MINT OF Tl IF INTERIOR, OFI ICl? <br />different) <br />payments to the <br />OF SURFACE MINING RECLAMA HON AND <br />creditor be sent? <br />1:N1`0RCliMFN'l' <br />Name <br />1313 SI IERMAN S"FREE F, ROOM 21 <br />Federal Rule of <br />1)I:NVFR, CO 80203 <br />Number Street <br />Bankruptcy Procedure <br />(FRBP) 2002(g) <br />City State ZIP Code <br />Country <br />Contact phone <br />Contact phone <br />Contact email <br />Contact email <br />Uniform claim identifier for electronic payments in chapter 13 (if you use one) <br />------------------------ <br />4. Does this claim <br />❑ No <br />amend one already <br />filed? <br />❑ Yes. Claim number on court claims registry (if known) <br />Filed on <br />MM / DD / YYYY <br />5. Do you know if <br />❑ No <br />anyone else has filed <br />a proof of claim for <br />❑ Yes Who made the earlier filing? <br />this claim? <br />Official Form 410 Proof of Claim 1111111 III II 11 I IIIII III II111111 11111 11111111111'1"111 <br />page 1 1642644160620183342010891 <br />