2020-11-02_GENERAL DOCUMENTS - C1980004

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United States Bankruptcy Court for Ohio—Southern District To submit your form online please go to[https//epigworkflow com/cases/rno] Use Hopedale Mining LLC Claims Processing Center your Mail ID for access c/o Epiq Corporate Restructuring,LLC Your Mail ID is as follows: 179568654 P.O.Box 4421 Beaverton,OR 97076-4421 Name of Debtor: Case Number: III III III 111111111 II I II IIIIIIIII I IIIIIIIII(IIIIIIIII II IIIIIIIIIIIII II III For Court Use Only BAR(23)MAILID***000179568654--- COLORADO 00179568654***COLORADO DIVISION OF RECLAMATION l MINING&SAFETY NOV 0 L 2020 1313 SHERMAN ST.,RM 215 DENVER,CO 80203 DIVISION OF 6:ECLAMIATION fv91(vl(�G 1%i,,'D AFETY PPOOf 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 bankruptcy case. With the exception of claims under 503(b)(9),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 must leave 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 agreements.Do not send original documents;they may be destroyed after scanning.If the documents are not available, explain in an attachment. A person who files a fraudulent claim could be fined up to$500,000,imprisoned for up to 5 years,or both. 18 U.S.C.§§152,157,and 3571. Fill in all the information about the claim as of the date the case was filed. That date is on the notice of bankruptcy(Form 309)that you received. Identify the Claim 7ame Who is the current creditor? of the current creditor(the person or entity to be paid for this claim): Other names the creditor used with the debtor: 2. Has this claim been acquired from someone else? ❑ No ❑ Yes. From whom? 3. Where should notices and payments to the creditor be sent?Federal Rule of Bankruptcy Procedure(FRBP)2002(g) 4. Does this claim amend one already filed? Where should notices to the creditor be sent? Where should payments to the creditor be sent? ❑ No (If different) ❑ Yes. Claim number on court claims register(If known) Name Name Filed on Number Street Number Street MM /DD /YYYY 5. Do you know if anyone else has filed a City State ZIP Code City State ZIP Code proof of claim for this claim? ❑ No Country(if International): Country(if International): ❑ Yes. Who made the earlier filing? Contact phone: Contact phone: Contact email: Contact email: Give Information About the Claim as of the Date the Case Was Filed 6. Do you have any number you use to 7. How much is the claim? 8. What is the basis of the claim? identify the debtor? ❑ No Examples: Goods sold,money loaned,lease,services performed, $ personal injury or wrongful death,or credit card. Attach redacted ❑ Yes. Does this amount include interest or other copies of any documents supporting the claim required by Bankruptcy Last 4 digits of the debtor's account or any charges? Rule 3001(c). Limit disclosing information that is entitled to privacy, number you use to identify the debtor: such as health care information. ❑ No — —— ❑ Yes. Attach statement itemizing interest,fees, expenses,or other charges required by Bankruptcy Rule 3001(c)(2)(A)