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B10 (OfficialForm10)(43/01) ]VN/X  V1 ]  7UNITEDSTATESBANKRUPTCYCOURT#7 #7 GV6$V G <2$"V < =3! =  DISTRICTOF GV6$  G  EV2$ V  E HVVb3!V  H HVVe3!V  H FVV3!V  F&f% PROOFOFCLAIM #%&f # rVVV_@"nn  VVb  L&r @6$ VVV& @&f% XVVE&  L  X#%&f #7NameofDebtor IV6$0 VV ICaseNumber: IV6$0 V I rVVV_@0    V  r IVV6$p "VVV I @6$p"VV @ ZVVVbE&p   h&Z ZVVVeE&|   h&Z XVVVE&|   h&XNOTE:Thisformshouldnotbeusedtomakeaclaimforanadministrativeexpensearisingafterthecommencementofthecase.A requestforpaymentofanadministrativeexpensemaybefiledpursuantto11U.S.C.503. @6$PVVVb& @ XVVE&` h   XNameofCreditor(Thepersonorotherentitytowhomthedebtorowesmoneyorproperty): MC5 (|| VV M =3!  =&f%7x%&f&#&f%x# @6$   @  7%&fCheckboxifyouareawarethatanyone   elsehasfiledaproofofclaimrelatingtoyourclaim.Attachcopyofstatementgivingparticulars. ZVVG5   Z ND2  VV N OE&    O 7-d 7 @6$d @ @V-d @ 7-dV 7 XVVVE&d   X QG5T"33VVV Q @6$T @ @V-T @ 7-TV 7 J@&T   J 7- 7 @6$   @  ZVG5!LL   Z 7-!V 7 E;!!  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ZVG5 0/V  Z 7- 0V 7 XVVE& 0   X 7-| $ 0VV 7 @6$| $ 1 @ @V-| $ 1 @ 7-| $ 1V 7 VVVE&| $ 1   VTelephonenumber: IVV6$ 2VV I GV6$ 3VV G GV6$ 4V G @VV- 4V @ @VV- 4VV  @ >7ThisSpaceisforCourtUseOnly#7 h_$# >7 aVVN/ 5  VV  aAccountorothernumberbywhichcreditoridentifiesdebtor: <2$ p 6VV < =3! p 7 =Checkhere 7-$ p 8 7x &  _# x7&#_  AV. p 9 Areplaces aVVN/ p :  V <a ZVG5d ;"ZZ2VV Z aVVN/d < < V a 3)H <VV 3 =3!H = =ifthisclaim @6$H > @x &# x(# @6$H ? @amendsapreviouslyfiledclaim,dated: GV6$H @ G EV2$H A"V E ^VVVK,H B  V <^ IVV6$8 CVVV I aVVN/8 D < VV 1ax &f%x 1.BasisforClaim #x%&f5+# aVVN/t E  VV1 <1a ]VN/4 F < VV1 ] @6$pGV @& @6$pH @Goodssold @6$pI @& IV6$pJ IRetireebenefitsasdefinedin11U.S.C.1114(a) aVVN/pK  V <1a ]VN/8L < VV1 ] @6$tMV @& @6$tN @Servicesperformed @6$tO @& IV6$tP IWages,salaries,andcompensation(filloutbelow) ]VN/tQ  V <] IV6$<RV I ]VN/<S < V ] @6$x TV @& @6$x U @Moneyloaned @6$x V @ @6$x W @YourSS#: GV6$x X G <2$x Y"V < DV3!x Z D <2$x ["V < DV3!x \ D IV6$x ]"V  I ]VN/x ^   V <] IV6$@_V I ]VN/@` < V ] @6$|$aV @& @6$|$b @Personalinjury/wrongfuldeath @6$|$c @ IV6$|$d IUnpaidcompensationforservicesperformed ]VN/|$e  V <] IV6$DfV I ]VN/Dg < V ] @6$(hV @& @6$(i @Taxes @6$(j @ <2$(k <from DV3!(l  D @ @6$(m"V  @Ѐto GV6$(n G IV6$(o"V  I ]VN/(p   V <] @6$HqV @ @6$Hr @7x  (date)#x79# QG5Hs LL  Q @6$Ht @7x  (date)#x7:# Hu 7x @, #x7;# ZVG5v  Z ]VN/Hw < V ] @6$,xV @& @6$,y @Other GV6$,z G @6$,{V @ @6$,| @ <2$,} < =3!,~ =7x 7-,~ 7#x7=# @6$, @ @V-, @ aVVVN/,  V <1a ]VN/L < VVV1  ]&f%x 2.Datedebtwasincurred: IV6$0V   I @6$0"V  @ 3.Ifcourtjudgment,dateobtained: #x%&f?# IV6$0  I _VVN/0"  V  < _ IVV6$HVV   I GV6$HVV  G IVV6$HV I ]VN/H < VV ]&f%x 4.TotalAmountofClaimatTimeCaseFiled: #x%&fB# <2$,V <&f%x$ DV3!,  D#x%&f7ThisSpaceisforCourtUseOnly#7 hs{# ]VN/&D$   V  ] @V-D'$V @2| @V-D'$V @ nV_@D'$     V  n @V-'% V @@} 7-'% V 7 TVE&'%    T @V-(<& V @+~ 7-(<& V 7 TVE&(<&    T @V-<)& V @ 7-<)& V 7 TVE&<)&    T @V-)' V @ 7-)' V 7 TVE&)'    T @V-*4( V @ 7-*4( V 7 TVE&*4(    T @V-4+( V @ׁ 7-4+( V 7 TVE&4+(    T @V-+) V @‚ 7-+) V 7 TVE&+)    T @V-,,* V @ 7-,,* V 7 OE&,,*    O <VV),-*  < =3!,-* VV = XVVE&,-*      XDate @6$-u+  VV  @Signandprintthenameandtitle,ifany,ofthecreditororotherpersonauthorizedtofilethisclaim(attachcopyofpowerofattorney,ifany): ZVG5i.,   Z ND2e. ,ffF V N XVVE&-u+     X QG5/,"G VV  Q @V-e. , @܇ 7-e. ,V 7 XVVVE&e. ,   X 7-.,VVV 7 7-.,VVV 76 IV6$., I 7-.,V 7 UVVVVB&.,   Z1U  Penaltyforpresentingfraudulentclaim:Fineofupto$500,000orimprisonmentforupto5years,orboth.18U.S.C.152and3571. i_@/- NN8J Z VVVV1 i VVE&M0-   l1V B10 (OfficialForm10)(4/01)(Reverse) `V@1.NN@L l V1 `2   TRX3' LetterX3' Letter3' Letter3'Th   2   TRX3' LetterX3' Letter3' Letter3'Th   XVVVE&X   1XXaX7  INSTRUCTIONSFORPROOFOFCLAIMFORM `V@N dvvBN  VVV1 ` VVVE&>   V#7XXa# XVG5 LLDPVV -XTheinstructionsanddefinitionsbelowaregeneralexplanationsofthelaw.Inparticulartypesofcasesorcircumstances,suchasbankruptcycasesthatarenotfiled   voluntarilybyadebtor,theremaybeexceptionstothesegeneralrules. ZVVG5PV- Z `V@ LL  VV ` .$h . .$h . VVVE&h   V XVG5tLLFRVV -X&f%7  " DEFINITIONS "#7%&f# ZVVG5t ppGRV- Z `V@tLLHR  VV ` .$d  .&f%7 .$d  . TVE&d    T#7%&fV# @6$| V @&f%7 Debtor #7%&fZ# <2$|  < =3!|   =&f%7SecuredClaim#7%&f!# <2$|   < =3!|  =&f%7UnsecuredClaim#7%&f# IV6$|  I&f%7 XVI/|   V X#7%&f# @6$V @7Theperson,corporation,orotherentity  thathasfiledabankruptcycaseiscalledthedebtor.#7]#7 b   #7#&f%7Creditor#7%&f#7  =  Acreditorisanyperson,corporation,or  1  otherentitytowhomthedebtorowedadebtonthedatethatthebankruptcycasewasfiled. #7̙#&f%7ProofofClaim#7%&f#7    Aformtellingthebankruptcycourthowmuchthedebtorowedacreditoratthetimethebankruptcycasewasfiled(theamountofthecreditorsclaim).Thisformmustbefiledwiththeclerkofthebankruptcycourtwherethebankruptcycasewasfiled.#7?#7 <2$p$ < =3!%  =Aclaimisasecuredclaimtotheextentthatthecreditorhasalienonpropertyofthedebtor(collateral)thatgivesthecreditortherighttobepaidfromthatpropertybeforecreditorswhodonothaveliensontheproperty.Examplesofliensareamortgageonrealestateandasecurityinterestinacar,truck,boat,televisionset,orotheritemofproperty.Alienmayhavebeenobtainedthroughacourtproceedingbeforethebankruptcycasebegan;insomestatesacourtjudgmentisalien.Inaddition,totheextentacreditoralsoowesmoneytothedebtor(hasarightofsetoff),thecreditorsclaimmaybeasecuredclaim.(SeealsoUnsecuredClaim.) <2$J7  < =3!8 =Ifaclaimisnotasecuredclaim,itisanunsecuredclaim.Aclaimmaybepartlysecuredandpartlyunsecuredifthepropertyonwhichacreditorhasalienisnotworthenoughtopaythecreditorinfull. #7#&f%7UnsecuredPriorityClaim#7%&fs#7   ? Certaintypesofunsecuredclaimsaregivenpriority,sotheyaretobepaidinbankruptcycasesbeforemostotherunsecuredclaims(ifthereissufficientmoneyorpropertyavailabletopaytheseclaims).Themostcommontypesofpriorityclaimsarelistedontheproofofclaimform.UnsecuredclaimsthatarenotspecificallygivenprioritystatusbythebankruptcylawsareclassifiedasUnsecured  I NonpriorityClaims.#7͡#Ԁ IV6$uJ  I 7 ZVVI*K  V <Z GV6$fLVV G CV2$fMV C DV3!fNV  D CV2$fOV  C DV3!fPV D IVV6$fQV I aVVVN/fR < VV 61a#7 I#&f%7  ITEMSTOBECOMPLETEDINPROOFOFCLAIMFORM(IFNOTALREADYFILLEDIN) #7%&f# XVI/JS  6 VVV1 X @6$TV @&f%7 Court,NameofDebtor,andCaseNumber: #7%&f# 7 [V *],] XX*#7 ѫ#70 @ Fillinthenameofthefederaljudicialdistrictwherethe 7W bankruptcycasewasfiled(forexample,CentralDistrictofCalifornia),thenameofthedebtorinthebankruptcycase,andthebankruptcycasenumber.Ifyoureceivedanoticeofthecasefromthecourt,allofthisinformationisnearthetopofthenotice. @x@x  &f%InformationaboutCreditor:#%&fƪ# w^ 0 @ Completethesectiongivingthename,address,andtelephone S_ numberofthecreditortowhomthedebtorowesmoneyorproperty,andthedebtorsaccountnumber,ifany.Ifanyoneelsehasalreadyfiledaproofofclaimrelatingtothisdebt,ifyouneverreceivednoticesfromthebankruptcycourtaboutthiscase,ifyouraddressdiffersfromthattowhichthecourtsentnotice,orifthisproofofclaimreplacesorchangesaproofofclaimthatwasalreadyfiled,checktheappropriateboxontheform. @x@x b (Eh83b&f% 3   32Eh  1  .3  0 @   BasisforClaim:#%&f# 3C݌%.#i@x@x Ќ  0 @ Checkthetypeofdebtforwhichtheproofofclaimisbeingfiled.Ifthetypeofdebtisnotlisted,check Otherandbrieflydescribethetypeofdebt.Ifyouwereanemployeeofthedebtor,fillinyoursocialsecuritynumberandthedatesofworkforwhichyouwerenotpaid. @x@x &f% 3   32Eh  2  .3  0 @   DateDebtIncurred:#%&fl# 3˰݌*=(p@x@x Ќ  0 @ Fillinthedatewhenthedebtfirstwasowedbythedebtor. @x@x &f% 3   312Eh  3  .3  0 @   CourtJudgments:#%&f# 31q݌,L*s@x@x Ќ  0 @ Ifyouhaveacourtjudgmentforthisdebt,statethedatethecourtenteredthejudgment. J@.@.+u@x@x J @6$v @b (5h88b&f%  3   3ʴ25h  4  .3  0 t   TotalAmountofClaimatTimeCaseFiled:#%&f# 3ʴ݌[xt%t% Ќ    0 t Fillinthetotalamountoftheentireclaim.Ifinterestorotherchargesinadditiontotheprincipalamountoftheclaimareincluded,checktheappropriateplaceontheformandattachanitemizationoftheinterestandcharges.&f% w|t%t%  3   3W25h  5  .3  0 t   SecuredClaim: #%&f#3W݌b~t%t% Ќ    0 t Checktheappropriateplaceiftheclaimisasecuredclaim.Youmuststatethetypeandvalueofpropertythatiscollateralfortheclaim,attachcopiesofthedocumentationofyourlien,andstatetheamountpastdueontheclaimasofthedatethebankruptcycasewasfiled.Aclaimmaybepartlysecuredandpartlyunsecured.(SeeDEFINITIONS,above). t%t% &f% 3   3>25h  6  .3  0 t   UnsecuredPriorityClaim:#%&f# 3>l݌!1t%t% Ќ  0 t Checktheappropriateplaceifyouhaveanunsecuredpriorityclaim,andstatetheamountentitledtopriority.(SeeDEFINITIONS,above).Aclaimmaybepartlypriorityandpartlynonpriorityif,forexample,theclaimisformorethantheamountgivenprioritybythelaw.Checktheappropriateplacetospecifythetypeofpriorityclaim. t%t% &f% 3   325h  7  .3  0 t   Credits:#%&f# 33݌&@$t%t% Ќ  0 t Bysigningthisproofofclaim,youarestatingunderoaththatincalculatingtheamountofyourclaimyouhavegiventhedebtorcreditforallpaymentsreceivedfromthedebtor. t%t% &f% 3   325h  8  .3  0 t   SupportingDocuments:#%&f# 3E݌'*'t%t% Ќ  0 t Youmustattachtothisproofofclaimformcopiesofdocumentsthatshowthedebtorowesthedebtclaimedor,ifthedocumentsaretoolengthy,asummaryofthosedocuments.Ifdocumentsarenotavailable,youmustattachanexplanationofwhytheyarenotavailable. 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