2021-03-29_GENERAL DOCUMENTS - C1980004

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Case 1:20-bk-12043 Doc 621 Filed 02/24/21 Entered 02/24/21 14:52:42 Desc Main Document Page 32 of 40 { United States Bankruptcy Court for Ohlo-Southern District •v r, r I.•- Hopedale Mining L1C Claims Processing Center 4idr,yp c/o Epiq Corporate Restructuring,LLC your Mail iC is as folio., 1 7956:016 P.O.Boa aa21 i Beaverton,OR 9707E-4121 Name of Debtor• CAM MINING LLC I Case Number; 20.12069(GRN) 1 For Court Use Ontr ; BAR(23)MAILID"'0001795Es4016"' kENNETH COLE CIO SAMUEL MANNA _ P O BOX 231 1 Vour claim m scheduled by the Denlor as CHARLESTON,Wv 25328 UNSECURED UNLIOUIOATED DISPUTED CONTINGENT UNDETERMINED Proof of Claim (Official Form 410) 04/19 Read the instructions before filling out this form.This form is for making a claim for payment in a b-rkruptcy case. With the exception of claims l iii under 503(b)19),do not use this form to make a request for payment of an administrative expense.Make such a request according to 11 U.S.C.§503. filers mugs 1*4ve out or redact information that is entitled to privacy on this form or on any attached documents.Attach redacted copies of any documents that support the claim,such as promissory notes,purchase orders,invoices,itemized statements of running accounts,contracts,Judgments, mortgages,and security agreernenb Donot sendonginal documents,they may be destroyed after scanning it the documents are not available, 4)# explain in an attachment. A perso.1 who files a fraudulent claim could be fined up to 5500,000.imprisoned for up to y years,or both. 18 U.S C §§i52,157,also 357, fill in ail the information about the claim as of the date the case was filed. That date is on the notice of bankruptcy Norm 309)that you received.—__ Identify the Claim 1. Who is the tunmt creditor? Name of the current creditor(the person or entity to be pad for this daml Kenneth Cole _ 1 01hei names the creditor used with the debtor ! 2- Has this claim been acquired from someone else? No C] yes fromwhcm? l 3.^ Wssere should notices And payments to the creditor be sent?fade rat Pule of Bankruptcy procedure if RSPI 2002(g) I a.Doe,this claim amend one aireacy filed.? ! fWhere should notices to the veditor he serifs Where should payments to the creditor be sent? Q No hfddte•cntl ves Clavn number on court Pierson Legal Services Kenneth Cole CI'O Samuel Ilanna � !7 ( Name i Name i claims register(d Anown)�� i P.O. Box 2291 P.O. Box 231 1 Filed on — — —- i Number St,eef - -`� l Number Street —_ 1 ._y^_ MM-/1JD /w'y ' Charleston, WV 25328 I Charleston, %VV 25329 _ _ 1 S. Do you know If anyone else has filed a 7 Giy State 11P Code City State Pip Code , proof of claim for this claim? I t I 1 CouMryfit lntemafionatl" - - -,- _ i Country ptfn!ernabn l0Nooal)• 1 t 304-925-2400 304-342-2137 EJ Yes. Who made the earlier filing? j Contari chone Ccntart phone __-�- ( l contact email j�±ierson�iersonlegal.eom _ eontactesiail Shannara)hannalauwv.com! --- ---"--- 1 -- I �_1 Give Information About the Claim as of the Date the Case Was filed 6. Do you have any number vow we to ) 7. No much is tfse c1slm? _ 'l6 What is the bans of the claim? - �— identity the debtor? i X No 500.000.00 i Examples,Goods sold,money loaned.lease,services performed, S I personal injury or wrongful death,or credit card Attacr redacted Yr i I copies of any documents Supporting the claim required by Sankrupscy r !Ye- Does this amount Include Interest or other Ls s(4 d�gres of the Acbmr's account or any i charges l e Ruse 3001(c). omit WscbSing information that is entitled to pnvxy. } numbe,eo,use to identify the debtor such as health ore reformation. f I D No I l --- Gres Atta Ch.Statement,tenibngmtefest,fees, See Attached Civil Complaint expenses,or other Ow rgrt requ,md by -----"-`-- -'•-••— .ankruptcy Rule 3001(Ci(211A). i k i