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B10(Official Form 10)(12107) ,UNITED STATES BANKRUPTCY COURT Eastern District of California PROOF OF CLAIM Name of Debtor:Coppetford,LLC Case Number: 08-36148-A-11 NOTE:This form should not be used to make a claim for an administrative expense arising after the cotnntencetttem of the case.A 'request"for payment of an administrative expense may be filed pursuant to 11 U.S.C. §503. Name of Creditor(Ole person or other easily to whom the debtor Owes money or property): OCheck this box o indicate that this claim Office of Emergency Seryices amends a previously filed claim. Name and address when notices should be sem: Cort Cham Number Office of Emergency Services Of kmwn) Room 610 Courthouse 222 E Weber Ave Stockton CA 95202-2709 Filed on-.— Telephone n:Tel ne number. Mame and address where payment should be sent(if differeas from above): OCheck this hour if you are aware that anyone else has filed a proof of claim relating to your claim.Attach copy of statement giving Particulars. OCheck this box if you are the debtor or imstee fetephone number. in this case. 1.Amount of Claim as of Dale Case Filedt $ S.Amount of Claim Entitled to Priority under 11 U.S.C.007W. If any pordea of If a0 or part of your claim is secured,complete item 4 below:however,if all of your claim is unsecured,do not your claim faits in ore of the following complete item 4. categories,check the box will slate the amount. If all or pan of your claim is entitled to priority,complete item 5. OCheck this box if claim includes interest or other charges in addition to the principal amount of claim.Attach Specify the priority of the claim itemized statement of interest Or charges. ODomestic support obligations under 11 2.Basis for Chlmt _ ____., U.S.C.§507(a)(I HA)or(01)(11). (Sec.instruction 82 co reverse side.) 3.Last four digits of any number by which creditor identifies debtor: O Wages,salaries,or commissions(up o _ _-- $10,9.50+)earned within 180 days before 3a.Debtor may have scheduled wreouot mi . — tiling of One bankruptcy petition or cessation (Sot instruction 03a on reverse side.) of the debtor's business,whichever is earlier- 11 17.S.C. §507(a)(4). 4.Secured Claim(See instruction#4 on reverse side.) Check the appropriate box if your claim is secured by a Eea on property or a right of seolt and provide the OCORbIbUdons to an employee benefit plan- 11 U.S.C.§507(a)(5). requested information. Nature of property ur right of aefottr O Real Fatale O Motor Vehicle O Other OUp to$2,425'of deposits toward purchase, Describe; personal, or rental of property Or services for personal,family,or household use-11 U.S.C. Value of Property:$ Annual Interest Itute—% §507(a)(7). .Amount of arrearage and other charges as of War ease filet included in secured claim, O'faxes or penalties owed to governmental o units- 1 11'.S.C.§577(a)(8). U any:$ Basis for perfections_,_ OOther-Specify applicable paragraph of I l Amount of Seemed Claims$ Amount Umermselt$ U.S.C. §507(a)(_). 6.Credits:The amount of all payments on this claim has been credited for the purpose of making this proof of claim Amount entitled to priority: 7.Documental Attach redacted copies of any documents dol support the claim,such as promissory notes,purchase $ orders,invoices,itemized statements actuating accounts,contracts,judgments,mortgages,and security agreements. You may also attach a summary.Attach redacted copies of documents providing evidence of perfection of a security •fin,are subject to adjustment on 4/1110 interest.You may also&mach a summary.(See defini tan of"redacled"on reverse side.) and every 3 years thermifier with respect to DO N(Yr SEND ORIGINAL IoCUMENTS.ATTACDED DOCUMENTS MAY OR DESTROYED AFTER SCANNING cases cam mazwed ars oraffer the date of adjustment. If the documents are not available,please explain: FOR COURT USE ONLY Hater Sigoature:71te lesson filing this claim must sign it.Sign and print name and title,if any,of the creditor or other person authorized o file this claim and slate address and telephone number if different from the notice mldnam above.Attach copy of power of attorney,if any. Pimalryforpmsemuigfiamdalem claim:Fine of up to$500,000 or imprisonment for up to 5 years,or both.18 U.S.rTrSr"—TnTr- 023605