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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 36 of 40 <br /> .Is all or part of the chasm red? ; to. is this ttairn ba ott <br /> 11, is this claim subject to a right at scroll? <br /> i <br /> )(Na No t NO <br /> C. Yes The Claim is secured by alien can property_ j ��Yes. t rice ty to cure t�"]yea. r4entefy the prnperil. <br /> Nature of property: i any default as of the date of petition ! <br /> i Real estate if the 03im is secartil by the debtw's principal <br /> t residence.file a a4tort90 Frrrxr(ojt sin AttoCbment Softectal Form i 12, is all or part of the claim entitled to priority A twins may be ant <br /> k Y p Y p'icatltyam ! <br /> t <br /> 41tbA)-ith this Yroaf of Clai,. j under 11 U.S.C.§S07(a)7 <br /> V-M}y nGe`pri6rli y. fear Cx3ff-tgie. f` <br /> L; Motor vehicle f Nosome categories,the taw limits the <br /> amount entitled tJ prrority <br /> 0 Other. Describe; ��Yes. ak-okme � <br /> Amount entitled to ktrty,e <br /> basis for perfection: _V I E)QomestK support obligations(including alimony a" $ <br /> �( thud support}under 11 U.S.C.§S07(a)#1}(A)or(a}(1)(B) <br /> Attach cede led copies of documents,if any,that shot evufence of i# Up to$3.075x of deposits toward purchase,lease,or S <br /> ! perfection of ec.nty riterest(for example,a mortgage,Irian, rental of property or services for personal,fa 0y,or <br /> rCrtrfi€ale of title,financing statement,or other,document that , household use.11 U.S.C.§507(aj(7j. <br /> t slaws the lien has been feed or recorded j <br /> Wages,salaries,or commissions tup to$13,650*1 <br /> f dale of Property: $ earned within 1#?0 days lic4or€the bars,,uptc.Y petition is <br /> find Or the debtors business en h�ends,wchev er is earlier <br /> Amount of the claim riser is secured: S i i US C <br /> Amount of the claim that is unsecured;# vases or penalties owed to governmer:tai units <br /> (The sure.of the secured and unsecured amounts stwutd match the 507(a)f8l. <br /> amount in t+re 7 t I cont,;buttors to an employee benefit plan.11 tt.S.0 § $� <br /> Amoutnt notesse- <br /> I to cs re any $ <br /> detaAsasof the dateat the petition $ tither. SPOON subsect run of1tIVS.C.5507(ay( t -- <br /> 1 ! that applies <br /> Annual interest Rate(when case was h'ad) l Amounts—t sublet,to adjustment an 4101122 a«G eve 3 <br /> every years r-�r that for canes <br /> ( rtxeQ t, Variable ` after the date of adjustment <br /> 13.t5oes risk ciai^,a quality as an�ominictrattvc Etgsensa under 11 U.S.C.§503(b}(4}7 <br /> No <br /> o res Jussouric that quattffes as an Administrative Expense under l l U.S.C.§SO3(b}(9)Sip :$ <br /> Sel <br /> low <br /> l The person Completing Cheek the appropriate baY� <br /> this picot of claim must ; i <br /> 1 err.the creditor. <br /> SiP and dale ft. FR!}F <br /> S SSttS[h}- I iv7 f am i�+e Creditor's attnrney or authorsed agent. l <br /> !am the trustee,or the debtor,or their authorised agent. 83nkruptry Rule 3004. <br /> if you.file this claim <br /> electronically,FRBp Ll I am a guarantor,surety,endorser,or other co-debtor_ Barkruptey Rule 30D5 <br /> 52R75#ajf3}autha@.es !u @2raland that an authorired signature on-leis proof of Clufm serves as an ar,knossfedgment that when calculai rug the amount of the claim, f <br /> courts to establish total the creditor gave the debtor credit for any payments received toward the debt. <br /> rules specifying what a i <br /> Signature is ' i have examined the information in this um0/C` Cfatrn and have a reasonabie hetief that the Fnforrnatron is true anu correct <br /> i <br /> A Rnm who files a { 1 declare under penalty of perjury that the foregoing is tr creel. <br /> frauduietrt claim uufd be F <br /> l tgt to SS00,0W, Executed or,date 1-4-r <br /> Imprisoned for up to S { Mh(00 1 YYYY i sore �----- -. <br /> ye^or batk to u.s.C. <br /> 4#IS2i ts7,and 3571. Front the7ZePers0nwhO <br /> itcampiet fining this rf it.,1 <br /> xirst name <br /> t,aFddle naa <br /> Last name <br /> Tale <br /> Company <br /> tlfy the Corporate sefvicLt as the company if the authorized agent i€a ae viler. <br /> ben <br /> Street <br /> ! <br /> r <br /> City _._..��_ i <br /> Z=P Cede <br /> Contact phon <br /> '�.L'-/'f �/ ( d 7,7 <br /> T .I' Email � 4i lam( ''_,ti`fr�-'t'"%'fCt,' '> •� <br /> J <br />