1992-02-26_GENERAL DOCUMENTS - C1981017

• Permit No: C1981017
• IBM Index Class Name: GENERAL DOCUMENTS
• Doc Date: 2/26/1992
• Doc Name: Case No. 92-11658 Order and Notice of Bankruptcy Case Under Chapter 11 of the Bankruptcy Code
• Permit Index Doc Type: General Correspondence
• Media Type: D
• Archive: No

United States Bankruptcy Court• PROOF OF CLAIM
District of Colorado
10 re(Name of Debtor) Case Number
NOTE This form should not be used to make a claim for an administrative expense arising after the commencement of the
case.A"request"of payment of an administrative expense may be filed pursuant to 11 U.&C§503.
Name of Creditor CI1e Pm=or col ay rO tirham the debtor ores tawny or popery) — —
❑Check box if you are aware that anyone
else has filed a proof of claim relating
Name and Addfesm W em Notices Should be Sent to Your claim.Attach copy of statement
giving particulars.
❑Check box if you have never received
any notices from the bankruptcy court
in this case.
❑Check box if the address differs from the
address on the envelope sent to you by THIS SPACE IS FOR
Telephone No. the court- COURT USE ONLY
Account or other number by which creditor identifies debtor. ---]Check here if this claim ❑replaces ❑amends a previously filed claim,
dated:
I. BASIS FOR CLAIM
❑Goods sold ❑Retiree benefits as defined in I 1 U.S.C.§1114(a)
❑Services performed ❑Wages,salaries,and compensations(Fill out below)
❑Money loaned Your social security number
❑Personal injury/wrongful death Unpaid compensations for services performed
❑Taxes from
❑Other(Describe briefly) (date) to (date)
2. DATE DEBT UAS INCURRED 3. IF COURT JUDGMENT,DATE OBTAINED:
1. CLASSIFICATION OF CLAIM. Under the Bankruptcv Code all claims are classified as one or more of the following (1)Unsecured nonpriorit% (2)Unsecured
Priority.(3)Secured.It is possible for pan of a claim to be in one category and part in another.CHECK THE APPROPRIATE BOX OR BOXES that best describe sour
claim and STATE THE AMOUNT OF THE CLAIM.
❑UNSECURED PRIORITY CLAIMS
❑SECURED CLAIMS Specify the priority of the claim.
Attach evidence of perfection of security interest
ref Description of Collateral: ❑Wages,salaries,or commissions(up to S2000),earned not more than 90 days
Real Estate LJ Motor Vehicle ❑Other(Describe briefly) before filing of the bankruptcy petition or cessation of the debtor's business,
whichever is earlier—I 1 U.S.C.§507(a)(3)
❑Contributions to an employee benefit plan—U.S C.§507(ax4)
Amount of arrange and other charges included in secured claim above, ❑Up to S900 of deposits toward purchase,lease.or rental of property or services for
if any S personal,family,or household use—1 I U.S.C.§507(a)(6)
❑UNSECURED NONPRIORITY CLAIM S ❑Taxes or penalties of governmental units— 1 I U.S.C.§507(a)(7) `
A claim is unsecured if there is no collateral or lien on property of the
debtor securing the claim or to the extent that the value of such property ❑Other— I I U.S.C.§§507(ax2),(05)—(Describe briefly)
is Less than the amount of the claim.
S. TOTAL AMOUNT
OF CLAI.It1 AT TUNE
CASE FILED: S Unsecured Secured
S S
Secured Pnonty TOTAL
❑Check this box if claim includes prepetition charges in addition to the principal amount of the claim.Attach itemized statement of all additional charges
6. CREDITS AND SETOFFS:The amount of all payments of this claim has been credited and deducted for the purpose THIS SPACE IS FOR
of making this proof of claim.in filing this claim,claimant has deducted all amounts that claimant owes to debtor. COURT USE ONLY
7. SUPPORTING DOCUMENTS:Attach copies of supporting documents such as promissory notes,purchase orders,
invoices,itemized statements of running accounts,contracts,court judgments,or evidence of security interests.If the
documents are not available,explain.If the documents are voluminous,attach a summary.
8. TIME-STAMPED COPY:To receive an acknowledgment of the filing of your claim,enclose a stamped,self-addressed -
envelope and copy of this proof of claim.
Date Sign and print the name and title,if any,of the creditor or other person authorized to tilt
this claim(attach copy of poser of attorney,if any).
Finally for presenting fraudulent claim-Fine of up to$500.000 or imprisonment for up to 5 years.or both 08 U S C 4 152 and 3571)
PROOF OF CLAIM Bradford Publishing,1743 Watee St,Denver.CO 80202—[phone]—7.91