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Fill in this information to identify the case: <br /> Debtor 1 <br /> Debtor 2 <br /> (Spouse,((Ming) <br /> United States Bankruptcy Court for the: District of Utah <br /> Case number <br /> Official Form 410 <br /> Proof of Claim 04116 <br /> 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 <br /> make a request for payment of an administrative expense.Make such a request according to 11 U.S.C.§503. <br /> 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 <br /> documents that support the claim,such as promissory notes,purchase orders,invoices,itemized statements of running accounts,contracts,Judgments. <br /> mortgages,and secunty agreements.Do not send original documents;they may be destroyed alter 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 /> Mil Identify the Claim <br /> 1. Who Is the current <br /> creditor? <br /> Name of the current creditor(the person or entity to be paid for this claim) <br /> Other names the creditor used with the debtor <br /> 2 Has this claim been ❑ No <br /> acquired from <br /> someone else? U Yes From whom? <br /> =3 Where should notices Where should notices to the creditor be sent? Where should payments to the creditor be sent?(if <br /> and payments to the different) <br /> creditor be sent? <br /> Federal Rule of Name Name <br /> Bankruptcy Procedure <br /> (FRBP)2002(g) <br /> Number Street Number Street <br /> City State ZIP Code City State ZIP Code <br /> Contact phone Contact phone <br /> Contact email Contact email <br /> i <br /> I Uniform claim identifier for electronic payments in chapter 13(if you use one) <br /> 4. Does this claim amend U No <br /> one already filed? U Yes. Claim number on court claims registry Of known)_ Filed on <br /> MM /DD /YYYY <br /> 15 Do you know if anyone ❑ No <br /> 1 else has filed a proof ❑ Yes. Who made the earlier filing? <br /> I of claim for this claim? <br /> L —------ <br /> Official Form 410 Proof of Claim page 1 <br /> 046762 72304046808026 <br />