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B 10 (Onida! Fonn 10) (12108)- Cont.
INSTRUCTIONS FOR PROOF OF CLAIM FORM
The instructions and definitions below are general e.\planations of the 1mI'. 1n certain circumstances. slich as bankruptcy cases not filed vo/untarizv by the debtor. there
"'l9' be exceptions to these general rules.
Items to be eompleted iB Proof ol Claim lorm
Court, Name olDebtor, and Case Nnmber: 4. Seeured Claim:
Fill in the federal judicial district where the bankruptcy case was filed (fur Check the appropriate box and provide the requested infurmation if
example, Central District of Califomia), the bankruptcy debtor's name, and the the claim is fully or partially secured. Skip this section if the claim is
bankruptcy case number. If the creditor received a notice of the case ftom the entirely unsecured. (See DEFINITIONS, below.) State the type and
bankruptcy court, all of this information is located at the top of the notice. the value of property that secures the claim, attach copies of lien
documentation, and state annual interest rate and the amount past due
Creditor's Nllme IInd Address: on the claim as of the date of the bankruptcy filing.
Fill in the name of the person or entity asserting a claim and the name and address
of the person who should receive notices issued during the bankrup1cy case. A s. Amount or Claim Entitled to Priority Under 1l U.S.C. §507(a).
separate space is provided furthe payment address if it diffi:rs from the notice If any portion ofyonT claim tails in one or more of the listed
address. The creditor has a continuing obligation to keep the court informed of its categories, check the appropriate box(es) and state the amount
current address. See Federal Rule of Bankruptcy Procedure (FRBP) 2002(g). entitled to priority. (See DEFINITIONS, below.) A claim may be
partly priority and partly non-priority. For example, in some of the
1. Amount olClaim as of Date Case Filed: categories, the law limits the amount entitled to priority.
State the total amount owed to the creditor on the date of the
Bankruptcy fIling. Follow the instructions concerning whether to 6. Credits:
complete items 4 and 5. Check the box if interest or other charges are An authorized signature on this proof of claim serves as an acknowledgment
included in the claim. that when calculating the amount of the claim, the creditor gave the debtor
credit fur any payments received toward the debt.
2. Basis for Claim:
State the type of debt or how it was incurred. Examples include 7. Documents:
goods sold, money loaned, services performed, personal Attach to this proof of claim form redacted copies documenting the existence
injury/wrongful death, car loan, mortgage note, and credit card. If the claim is of the debt and of any lien securing the debt. You may also attach a summary.
based on the delivery of health care goods or services, limit the disclosure of You must also attach copies of documents that evidence perft:ction of any
the goods or services so as to avoid embarrassment or the security interest. You may also attach a smnmary. FRBP 3001 (c) and (d).
disclosure of confidential health care infurmation. You may be required If the claim is based on the delivery of health care goods or services, see
to provide additional disclosure if the trustee or another party in interest instruction 2. Do not send original documents, as attachments may be
files an objection to your claim. destroyed after scanning.

3. Last Four Digits of ABY Number by Which Creditor Identifies Date and Signature:
Debtor: The person filing this proof of claim must sign and date it. FRBP 9011. If the
State only the last fuur digits of the debtor's account or other number claim is filed electronically, FRBP 5OO5(aX2), authorizes courts to establish
used by the creditor to identitY the debtor. local rules specifYing what constitutes a signature. Print the name and title, if
any, of the creditor or other person authorized to file this claim. State the
3a. Debtor May Have SelieduIed Accout As: filer's address and telephone number ifit dit1ers from the address given on the
Use this space to report a change in the creditor's name, a transferred top of the form for purposes of receiving notices. Attach a complete copy of
claim, or any other infurmation that clarifies a diffurence between this any power ofattomey. Criminal penalties apply fur making a mise statement
proof of claim and the claim as scheduled by the debtor. on a proof of claim.

____ -DEFINITIONS _ __ INFORMATION __

Debtor
A debtor is the person, corpoflltion, or other entity that
has filed a bankruptcy case.
Creditor
A creditor is a person, cotpOration, or other entity owed a
debt by the debtor that arose on or before the date of the
bankruptcy filing. See II U.S.c. §101 (10)
Claim
A claim is the creditor's right to receive payment on a
debt owed by the debtor that arose on the date of the
bankruptcy filing. See II U.S.C. §101 (5). A claim may
be secured or unsecured.
Proof oeCIaim
A proof of claim is a fonn used by the creditor to
indicate the amount of the debt owed by the debtor on
the date of the bankruptcy filing. The creditor must file
the form with the clerk of the same bankruptcy court in
which the bankruptcy case was filed.
Secured Claim Under 11 U.s.c. §506(a)
A secured claim is one backed by a lien on property of
the debtor. The claim is secured so long as the creditor
has the right to be paid from the property prior to other
creditors. The amount of the secured claim cannot
exceed the value of the property. Any amount owed to
the creditor in excess of the value of the property is an
unsecured claim. Examples of liens on property include
a mortgage on real estate or a security interest in a car.
A lien may be voluntarily gnmted by a debtor or may be
obtained through a court proceeding. In some states, a
court judgment is a lien. A claim also may be secured if
the creditor owes the debtor money (has a right to setoff).
Uasecared Claim
An unsecured claim is one that does not meet the
requirements of a secured claim. A claim may be partly
unsecured if the amount of the claim exceeds the value
of the property on which the creditor has a lien.
Claim Entitled to Priority UDder lJ U.S.C. §S07(a)
Priority claims are certain categories of unsecured claims
that are paid from the available money or property in a
bankruptcy case before other unsecured claims.
Redacted
A document has been redacted when the person riling it
has masked" edited out, or otherwise deleted, certain
infonnation. A creditor should redact and use only the
last four digits of any social-security, individual's tax-
identification, or financial-account number, all but the
initials of a minor's name and only the year of any
person's date of birth.
Evideuce of Perfection
Evidence of perfection may include a mortgage, lien,
certificate of title, financing statement, or other
document showing that the lien has been filed or
recorded.
Admowledgment of Filing of Claim
To receive acknowledgment of your filing, you may
either enclose a stamped self-addressed envelope and a
copy of this proof of claim or you may access the court's
PACER ,)stem ( ) for a
small fee to view your filed pmof of claim.
Offers to Pnrehllse a Claim
Certain entities are in the business of purchasing claims
tor an amount less than the face value of the claims. One
or more of these entities may contact the creditor and
offer to purchase the claim. Some of the written
communications from these entities may easily be
confused with official court documentation or
communications from the debtor. These entities do not
represent the bankruptcy court or the debtor. The
creditor has no obligation to sell its claim. However, if
the creditor decides to sell its claim, any transfer of such
claim is subject to FRBP 3001 (e), any applicable
provisions of the Bankruptcy Code (ll U.S.c. § 101 et
seq.), and any applicable orders of the bankruptcy court.