1993-10-25_GENERAL DOCUMENTS - C1981017 ‎(2)‎

• Permit No: C1981017
• IBM Index Class Name: GENERAL DOCUMENTS
• Doc Date: 10/25/1993
• Doc Name: Order fixing time within file proof of claim
• From: US District Court
• To: Mid-Continent Resources, Inc.
• Permit Index Doc Type: General Correspondence
• Media Type: D
• Archive: No

United States Bankruptcy Court I
PROOF OF CLAIM
District of Colorado
In re(frame of Debtor) Case Number
Mid—Continent Resources, Inc. 92-11658 PAC
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 I I U.S.C.J 503.
Name of Creditor rTbe Pmoe a easy to whom the"m o es mmey or property)
Check box if you are aware that anvone
else has filed a proof of claim relating
Name and Addresses H here Notices Should be Sent
giv to vour claim.Attach copy of statement
ing particulars.
❑Check box if you have never received
any notices from the bankruptcy x:oun
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 iocnuhcs Debtor. I Check here if this claim O replaces ❑amends a previous)),filed claim,
dated:
1. BA-SIS FOR CLAIM
❑Goods sold ❑Retiree benefits as defined in I l U.S.0§1114(a)
❑Services performed CJ Wages,salaries,and compensations(Fill out below)
❑Money loaned Your social security number
❑Personal injury/wrongful death Unpaid compensations for services performed
❑Taxes
from to
❑Other(Describe briefly) (oa1L) (riate)
2. DATE DEBT WAS INCURRED 3. IF COURT JUDGMENT,DATE OBTAINED:
4. CLASSIFICATION OF CLAIM. Under the Banlxupicy Code all claims are classified as one or more of the following:(I)Unsecured nonpriority,(2)Unsecured
Priorit),.(3)Secured.It is possible for pan of a claim to be in one category and pan in another.CHECK THE APPROPRIATE BOX OR BOXES that best describe your
claim and STATE THE AMOUNT OF THE CLAIM.
❑UNSECURED PRIORITY CLAIM S
0 SECURED AIM S Specify the priority of the claim.
Auacb evidence of perfection of secunry rntems
Brier Description of Collateral: U Wages,salaries,or commis ions(up to S2000).earned not more than 90 days
O Real Estate l J Motor Vehicle G Other(Describe briefly) before filing of the bankruptcy petition or cessation of the debtor's business,
whichcycr is earlier—I 1 U.S.0§507(a)(3)
Contributions to an employee benefit plan—U.S.0§507(a)(4)
Amount of arrearage and other charges included in secured claim above, CJ Up to S900 of deposits toward purchase,lease,or rental of property or services for
ifany S personal,family,or household use—I I U.S.C.§507(a)(6)
❑UNSECURED NON'PRIORITY CLAIM S ❑Taxes Or penalties of govcnmcnW units—I I U.S.C.E 507(a)(7)
A claim is unsecured if there is no collateral or hen on propcm•of the U��—I I U.S.C. 507(a;2, a 5
debtor securing the claim or to the anent that the value of such propem §E ) ) ( )( )—(Describe briefly)
is less than the amount of the claim.
5.TOTAL AMOUNT
OF CLAIM AT TIME
CASE FILED: S Lhnwwed S seemed S TOTAL
Che3 this box if claim includes preperition 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 on 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 runmag accounts,contracts,coup luogm xim or evidence of security interest.If the
documents art;not available,explain.If the documents arc voluminous.attach a summary.
L TINICE-STAMPED COPY:To receive an acknowledgment of the filing of your claim,enclose a stumped,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 file
this claim(attach copy of power of attorney,if any).
!tufty for Pn== E frauauieut cans Flue of up to S500.000 or imprisonment for up to 5 years,or both.0 8 US.0§¢152 and 3571)
Igo.B.O.F.10.Rev.8-9I. PROOF OF CL.AINt Bradford Publishing.1743 Wazee St..Denver.CO 8020 —[phone]—7-91