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nittd ttatts anhruptq ( curt 8093312 27 3 Trl� =: SlcRiti DISTRICT OF CALIFD ' 6 ' IN RE: �is ELA,7I0 Z ALICE MARZ INEZ .- 1a'J1 ArpROVETON STAY CASE NiUA5E'Z 90-93312 ' NC GES TOe PROOF OF CLAIM - - --- - 1. This proof is made for the claimant named below by the undersigned individual who slates that: (check appropriate box) The claimant is a Corporation and the Under The claimant is a partnership and He or she Is agent or attorney He or she is the signed is an authorized officer of such Corpora- the undersigned is a member for the claimant F1 Claimant P tion thereof (INDICATE THE STATE OF INCORPORATION.NAME OF PARTNERS,OR SUCH OTHER DESCRIPTION OF rHECLAIMANT AS MAYBE APPROPRIATE) (Please supply(or verily)your account number for this debtor) 2. The undersigned represents that he or she is duly authorized to make this proof of claim' (it appropriate,and to accept the plan)on behalf of the claimant. CAQ 9331 Z — 2 7 —3 A y 3. The correct past office address of the claimant to which all notices and distribution checks hr should be mailed is stated low. SAN JOAQUIN COUNTY Py PUCo Bo HEALTH OP � KTO 2009 aT�CKTONs CA: 9520i J I name or ad=s. as printed, is not correct please IntllGBte COfre 4. This claim is based upon:(check appropriate box) name and add to which checks and notices shoo Id be deliver¢ A note, contract, or other writing. The original or complete duplicate copies of all documents are attached, (or are not attached for the reason set forth in the statement attached hereto). An open account.An itemized statement showing the date due is attached. if CALCULATION OF BALANCE DUE Other consideration(or ground of liability).Explain. c PRINCIPAL $1,504 . 00 AMOUNT S. No judgment has been rendered upon the claim,except Penalties None ADDITIONAL 600 . 00 CHARGES 8. The debtor was at the time of the filing of the petition initialing the case,and still is.indebted(or liable) to this claimant(after giving full credit for all payments,setoffs.and counterclaims)as follows: Attached TOTAL $2 , 104 . 00 LESS PAYMENTS (Itemise all charges in addition to principal amount of debt. stale basis for inclusion and computation, AND CMITS 00 . 00 and set forth any other consideration relevant to the legality Of any charge.) Exclude any interest ONACCDUNi accrued after the date the case was commenced. PRESENT PRINCIPALQ� AMOUNT ENT 2T1D4 . DD 7. This claim Is free from any charge forbidden by applicable law and excludes allunmalured Interest (PAYOFF BALANCE) 8. This claim Is a general unsecured claim,except to the extent that the security Interest,it any,described below Is sufficient to satisfy the claim.(Ii priority is claimed,state the amounts and the basis thereof:) 9. NO SECURITY INTEREST IS HELD FOR THIS CLAIM EXCEPT: None (11 security interest in property of the debtor is claimed). The security interest is claimed under the writing referred to in Paragraph 4 hereof (or under a separate writing which (or a duplicate of which) is attached hereto, or under a separate writing which cannot be attached hereto for the reason set forth in the statement attached hereto.)Evidence of perfection of such security interest is also attached hereto. 10. The fair market value of the property on which the claimant has a lien(secured portion of claim)Is ................................ $ N/A 7-!E PLAN PRCPOSES IPAYMiNT$ TO THE TRUSTEE OF $1079.00 MONTHLY UNSECURED CREDITORS TO BE PAID NOTHING Tn TS CLFtI.4 IS LI.:iTEO AS. UNSECUR O GROUP 6 - A f • DATED: ........ .. .._. _ ^ _� —.._—_.-. . . .._..... 9093312 27— —131p I SIGNED FILE U.Se 3ANKRU?TCY COURT INAME OF INDIVIDUAL AGENT.OFFICER.ON FIATNEA SIGNING 1H1a GU1M1 CLAIM- n WITH:r.,:. L3-)X 5376 •1QOtSTO CA 95352 1 " 0 Presenting Fraudulent Claim }Y a � Fin of more than 55000 or imprisonment for not more than 13 (2-83) eu clAl n,fol lnArc. 5years orboth--Title 18,U.S.C.,$152