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Case 1:20-bk-12043 Doc 621 Filed 02/24/21 Entered 02/24/21 14:52:42 Desc Main <br /> Document Page 35 of 40 <br /> L Bankruptcy Coun for Ohio-Southern District <br /> Fed States <br /> -- <br /> j Hopedale Mining tt C Claims Processing Center <br /> 4 { <br /> P. Epiq Corporate Restructuring,LtC Your Mail lD is as follows 1795641016 <br /> i P.D.Box 4g21 <br /> a , Beaverton,OR 57076-4422 i <br /> !Name of Debtor: CAM MINING LLC � <br /> Case!Number: 20�12069(GRH) [ j <br /> t ` <br /> .... _`for Court use Only <br /> I III�IIII III IIIIII III ,I II I <br /> BAR(23)MAILID 000179564016"` <br /> I HiLLiE CG'i_E 3 <br /> SAMUEL HANNA l <br /> a 0ALE TO t <br /> i�AF?CE G 1 Your Claim is schpdu! u by the Debtor as. <br /> STJIV,Rrt 25 2d UNSECURED <br /> UNLIQUiDATED DISPUTED <br /> `CONTINGENT UNDETERMINED <br /> K <br /> Proof of Ciall1l (Offidat Ferret 410) <br /> Read the instructions befo0-4/19 <br /> re filling out this forin.This form is for making a claim for payment in a bankruptcy case. With the except ern of claims <br /> under S03(b)19(,do not use this form to make a request for payment of an administrative expens€,Make such a requetst according to 21 U.S.C.;503. <br /> €tars must leave Out or redact u,formation that is entitled to privacy an this form or on any attached documents.Attach redacted copies of any <br /> documents that support the etaim,such as promissory motes,Purchase orders,invoices,itemited statements of running accounts.Wfitratls,judgments. <br /> mortgages,and sectritY agreements.Do not send original documents,they maybe destroyed after scarrr:ri^.If top documents are not available, <br /> explain in an attachment. <br /> A person who files a fraudulent claim could'-e fined up to S5N,DW.imprisoned for up m S years,or troth_ <br /> f €ill 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 /> the Claim <br /> PWIdentily <br /> e current cred#torT <br /> t Name of the current creditor(the person or entry to be pad for this claim) Kl;mnetit..Cole <br /> j <br /> i Other names the cmd4or used with the debtor <br /> 2 Has this claim been acquired fromsomeonirelse? fit No 0 yes from,whore? .�. <br /> 3 e should notices arict payments to the creditor be sent?federal flute of Bankruptcy Procedure if RBpl 2002{g= Does this claim amend one already FiAd? <br /> Where should notices to the creditor be sent? I Where should payments to the creditor be sent? j t_1 No <br /> r <br /> i (ifdiffererr) I <br /> Pierson Legal Services � Kenneth Cole C' Samuel (fauna ( C; Yes CWtnnumberancourt <br /> I <br /> Name game <br /> j dairnsreg'ste-fitkno.nj <br /> � <br /> P.O. $tax 2291 P.O. Box 231!- <br /> I Filed on <br /> ? Number sweet -~� t Number Street .._. haM J CQ (t}YY <br /> f Charleston, WV 25328 Chat lesion WV 25328 i f f, <br /> 5. Oo you know if anyone else has tiled a <br /> City state lip Cade City State Zip Code proof of claim for this claim? <br /> ❑Country(if intemahonai) �Country(it International) No <br /> Cantata Phone 304-925-2400 � 304.342 ` 137 EJ Yes. WY c,mme the eado,fnrng) <br /> ( - CiNCar?Pl14nt <br /> Ctnlacsema=;: ,jpierso�iersonle�aLeom Contartemati _Sharma(a)hannaiar��+v.ct>rrt� <br /> Give information About the Claim as of the Date the Case Was Filed <br /> � k. Eb You have any number you use to l 7. Mow mucfi is the dorm? ! g, µthat fs the bash of the tlaimT �ul <br /> identify the debtor? <br /> %No � S 5W006.00 examples-Goods sold,money loaned,lease,services pt+rlormed, <br /> i_,'t yrs. Personal injury or wrongful death,or credit card. Omer redacred <br /> Does this amount intrude interest or other `-oPoes of any documents supporting the cPaim required at Bankrup`'r <br /> tau 4 drg2s of the debtors de <br /> or any � charges? � Rule 3001(c}. Limit disclosing information that:s entitled°o Rrivac y. <br /> nurntser'tov use to Identify the d debtor. ff{ such ashealth care information. <br /> 0 No <br /> Attach sta?ement rterr,�tinginte[c-5t.fees. See Attached Civil Complaint <br /> eaPenses,ur other ciw[ges required by -- ------ --- <br /> Basrkrtiptty Rum 3IX3i(cl(2lIA;. <br /> I <br />