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Case 1:20-bk-12043 Doc 621 Filed 02/24/21 Entered 02/24/2114:52:42 Desc Main
<br /> Document Page 32 of 40
<br /> United States Bankruptcy Court for Ohio-Southern District
<br /> Hopedale Mining LLC Claims Processing Center
<br /> c/o Eptq Corporate Restructuring,LLC You F M a f i C l 5 a ec tont S 1 95 a0 l 6
<br /> P.O,Box 4421
<br /> Beaverton,OR 9707"21
<br /> Name otDebtor: CAM MINING LLC
<br /> Case Nurri 20-12069(GRH)
<br /> For Gourt Use Onav,
<br /> N
<br /> BAW231 MAILID GUGf 79S64016
<br /> kEriviET4 COLE
<br /> C/O SAMIUEL HANNA
<br /> 0 COX 23 i i
<br /> Your claim is schedufled by the DeDtOr a-S
<br /> CHARLES1 ON,ItN 25328
<br /> UNSECURED
<br /> UbILIQUIDATED, DISPUTED
<br /> CONTINGENT UNDETERMINE0
<br /> Proof of Claim (Oftial Form 410) 04119
<br /> c
<br /> Read the instructions before Filling out this form,This form is for rrkaking a claim for payment in a bankruptcy case. With the exception of claims
<br /> I under S03(b)(9),do not use this form to make a request for payment of an administrative expense.Make such a request according to I I U.S.C,§503.
<br /> Filers must leave out or redact lnforma Uon that is entitled to privacy on this form of 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,ant;security agreements.Do not send original documents;they may be destroyed after scatumnif.if the documents are not available,
<br /> explain in an attachment.
<br /> A person who foes a fraudulent claim could be fined up to 5500,0U-1.imprisoned to up to 5 years,or troth, IS U.S.C.§§152,157,and 35
<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 /> F 001 _Fden the i
<br /> L Who is the current creditor?
<br /> Narne of the current crod,tor(the-cren,00+.or ennty to he icisd iof Me cljirrii Kenneth Cole
<br /> Other names the creditor used with the otor
<br /> 2- Has this claim been acquired from someone else? r-1 Fin' 0' fes F'orn svbam�
<br /> 3. Wfaffle should notices and Payments to the creditor be sent?Federal Rule of Bankruptcy Procedure If RBP)2002(g) 4. Does this claim amend one already filed?
<br /> Where should notices to the urd'tor be sent? Where should payments to the creditor be sent? 0'No
<br /> Pierson Legal Services Kenneth Cole C)'O Samuel I lanna 0 Ver Ciaq�oumoer on coon
<br /> kno-1
<br /> i Name Ndme
<br /> P,O� Box 2241 P.O. flux 23 1 f F.fed on
<br /> N.rmner sUttei number :trees "yY
<br /> Charleston, WV 25328 Charleston, WV 25329
<br /> S. Da you luxtrailf anyone else teas fileda
<br /> C'ry State lip Code Cls, State Z'P Code
<br /> proof of claim for this claim?
<br /> 0
<br /> counift,bf Na
<br /> i 0 Yes- Who maje the eadief fd,og?
<br /> 304-925-2400 '04-342-2 13 7
<br /> ,Ontjc I 0.�-Ius,
<br /> contjarmaa jpj erson-��i erson legal com i —Shanna6d)hannala%vwv.corn'
<br /> Give Inf rmah.ri About the Claim as of the Crate the'C.;e Was Filed
<br /> ta. Do you have any numb"you use to 7. Now much Is the claim? S. Virtar is the basis of the claim?
<br /> iderifitV the debtor?
<br /> hka 500,000.00 Examples Goods sold,money loaned,lease,s e,v Kes pprformest.
<br /> personal trijury or wrongful death,or credit card Attack reclacted
<br /> Does this amount Include Interest or other c opres of any class u ment s supporting the claim required by Bank rust cv
<br /> I'aV 4 if,gr'S of fhe i1cistor'Y aocount or int, ; Ruk,3001(c). Limit c4sclirsintimformanon that,s entitled Co privacy,
<br /> charges?
<br /> ll.mb,Y',=yo, 10 ths,itebtcr such as health care information.
<br /> 0 Yes Attach.statemerj,zemtt�og,me,ev,fees, See Attached Civil Complaint
<br /> expenses,o,wh,,rcNrg,s required bV
<br /> Bankruptcy Rule 3001(cl(2RAj,
<br />
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