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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 33 of 40
<br /> 9.Is an of part of the clams secured? 1 is it is cUm-based on a fraset l I.ss this claim wbtect to a right of setoff)
<br /> a.(No ', 700 .�,sro
<br /> 'l❑'`Yet The claim it secured by a lien on property J Yes Amount necessary to(ure L�Yes identify the Prrpfrty
<br /> any default as of the date of petition
<br /> kature of property i
<br /> Neal estate tI the claim,s secured by the debtors principal S - IIII
<br /> resrd cocci(ilea Mortlyoge Proof of dorm AnOchmMt(dtfrcus Farm 12. Is all or part of the claim entttled tc priority A claim Maybe partly pnordy and
<br /> aid Al w¢h inn oc(af C1orn under 11 U.S.G I S07(a)7 panty nonpnomy For ,examp,r.m
<br /> some catrgo"I .t^.e law limits ii,e
<br /> ❑motor vehicle '") No zmcunt enacted to dnonty
<br /> j (]other Describe ,_,�. ❑YK. Chrxk one
<br /> Amount entitled to prior"
<br /> ❑ Domestic support obligations I(ricludsng simony and
<br /> Bases for Isenc-Wbn. child support)under 11 U 5 C.4 S07p1(1)(A)of(a}(1)IBr
<br /> Attach redacted copies of documents.If any,that show evidence of ❑ Up to 53,025'of deposits toward purchase,lease,or S� �_......_.
<br /> perfection of wunly interest(for example,a mortgage,hen, j rcntalof propertyorservrcesfor personal,family,or
<br /> cert,ficate of bite,fmarKng statement,or other documtnt that 1 hbusch.use lI U S.C.4 501(a)(7J,
<br /> slows the teen has been hied or reco•ded 1 _
<br /> ❑Wages,salaries,or commissions!up to$33,650') S
<br /> Value o}prs�erff: S earred within 190 days before the bankruptcy petition is
<br /> filed or the debtor's business ends, fiKheve is earlier
<br /> Amount of the dalrrs that Is secured: S 111 U 5 C 9 50713114)• S�
<br /> ? ❑ Taxes or perrallres owed to itmemmental units
<br /> Amount of the dotm that Is unsecured:S I I U.5 C.Ii 507(a118).
<br /> I l (The sum of the soured and unsecured amounts should mate•the S
<br /> i[ amoun!,n line 7) ❑Conotbuhons to an employeebenefd plan 11 U.S C.4
<br /> SO7(al{51
<br /> Amount rtecitVarrY to cure any S
<br /> rle(ault as of the date c;the pelltlam S O Other, S;tofy subwct do of I1 U.S r:-111507(a1L1
<br /> } that applies.
<br /> ' Annual Intnest gate(when case was hied) % j ' AmOunts are subfecl to adjustment on 4/01;2?and"m 3 years Aflrr that for rises eetur,of or
<br /> l after the date of adjustment '
<br /> t--`_ D F,aed ❑Variable )
<br /> , 13. Doest�-�dalmqualdyasanAdmintstntiveEscpenseundaritU.S.C. 5036 9 t ##
<br /> No 1
<br /> U Yes.Amount that qualifies as an Administrative Expense under I I U.S.C.3 S0 1a)(9) S j
<br /> e
<br /> !! SIBn Below ------- ._,.-_.. -•--•-----=----_.._—_...�..
<br /> the peson completing Check the appropriate box
<br /> ON,proof of dalm must ! (�I am the creditor [
<br /> sips and date h, Map r j
<br /> 9011;b). ❑ j am the creditor's atlorneycr authonted agent.
<br /> r rl can the trustee.or the debtor,or their authonred agent-Bankruptcy Rule 3004
<br /> rf You file this claim
<br /> electraucally,FROP ❑ tam a guarantor,surety,endorser,or other co-debtor Bankruptcy Rule3005 4 4f
<br /> swsfal(2)authorizes I understand that an authon ofred signature on this Pro of Claim serves as an acknowledgment that when calculating the amount of the claim
<br /> courts to estabt,sh local the cfedl torgavethe debtor credit for any payments received toward the debt 1
<br /> rules specifying what a
<br /> signature is , I have examined the mlormat)on In this Proof el C/arm and have a reasonable belief that the,nlorrnatron B true and correct
<br /> I declare under penalty of perjury that the foregoing,%u nett
<br /> A person strhp files a
<br /> frvAdulant claim could be l ! �I0 D
<br /> Anted up to SSWOW, Executed on date
<br /> Imprisoned for up to S MM/ DD J YYYY rune
<br /> I Years,or both.1t1 U.S.C. )
<br /> + 0 1A 31,and 3571. j "t the nBmt7pf the Person who is complettiin"nd fi gnlrig this c1aMn.
<br /> cast name Middle man ^ Last name is
<br /> title
<br /> ComoanY
<br /> t ti( the corporate
<br /> y porate serwcer a Ne iompinV I the authonred agent,s a service,
<br /> _
<br /> �K7, 1
<br /> Address �CJX��
<br /> City ZIP Code i
<br /> ' r
<br /> Contact Email Pho-i
<br /> t
<br /> ( -- —' ---tact--- � ----
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