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t : nited tttfes + ttnkruptrp Tourt ►, r�1.. s31z—z� is 9L„ I l.Jr t-ALSol IN RE: cCLAt710 6 ALICE HAY3i INEZ It-CIL t;RUNE;TCIN WAY -` -:)- 1. This proof is made for the claimant named below by the undersigned individual who states that: (check appropriate box) He or she is the The claimant is a Corporation and the Untler The claimant is a partnership and He or she is agent or attorney Claimant ❑ Sigrned is an authorized officer of such Corpora- ❑ thhe e undersigned is a member❑ for the claimant (INDICATE THE STATE OF INCORPORATION,NAME OF PARTNERS,OR SUCH OTHER DESCRIPTION OF THE CLAIMANT AS MAYBE APPROPRIATE) Missile 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 (if appropriate,and to accept the plan)on behalf Of the claimant. 3. The correct post office address of the claimant to which all notices and distribution checks Cf.�a�� I6 „� � _ should be mailed is stated below. SAN ,�i}Aq U I N COUNTY Y 1 S A.14 PUOL1C NEAL,TH" P 0 BOX 400 STOCKTONO CA —';e(IC 4. This claim is based upon: check a If name or address, as printed, is not correct please indicate correct P ( box) name and address to h' h h k d otic appropriate should be delivered. 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. CALCULATION OF BALANCE DUE Other consideration for ground of liability).Explain. PRINCIPAL S. No judgment has been rendered upon the claim,except AMOUNT ADDITIONAL CHARGES 6. The debtor was at the time of the filing of the petition initiating the case,and still is,indebted(or liable) to this claimant(atter giving full credit for all payments,set-offs,and counterclaims)as follows: TOTAL (Itemize ell charges in addition to principal amount of debt, state basis for -inclusion and computation, LESS PAYMENTS and set forth any other consideration relevant to the legality of any charge.) Exclude any interest U'DCCEDDITS accrued after the date the case was commenced. OUNT PRESENT PRINCIPAL 7. This cfalm Is free from any charge forbidden by applicable law and excludes all unmatured Interest. AMOUNT C ❑UE W (PAYOFF BALANCE) 8. This claim is a general unsecuclaimed, s claim,except to the extent that the security interest,if any,described below is sufficient to satisfy the claim.(If priority is claimed,state the amounts and the basis thereof:) 9. NO SECURITY INTEREST IS HELD FOR THIS CLAIM EXCEPT: pt security interest in property of the debtor is claimed). The security interest is claimed under the writing referred to in Paragraph 4 hereof (or untler 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 fah market value of the property on which the claimant has a Ileo(secured portion of claim)Is ................................ T+iC P9_ N Pat(�' f}i�5FS PAYMeNTS TO TH TkUSTEE OF S1-r5.7Q*Oa MONITHC.Y UN3E,C.UI E CREtlITURS Til :SL QpiCi NOT iNU Tin TS CL. XM IS l I Tw i) As- JkflSKUAF'U DATER :...._-. FILE �'I9kj�.I'.y3 it 27- —3 SIGNED CLAIMS I,eIia )X ' 537 RUPTCY Ci�UK� (NAME OF INDIVIDUAL.AGENT.OFFICER OR PARTNER SIGNING THIS CLAIMI _/kAt WITH.�a:t♦ ST��K ' ��Jl♦J TO CA 9 y��I 2 P alty For Presenting Fraudulent Claim 13 (2-83) FILE IN DUPLICATE • Fine ofn re loan$5000 or imprisonmentfornot more than 5 years or both--Title 18,U.S.C..§152