BILLING_PRE 2019 - Laserfiche WebLink

Home Browse Search

Xcited ;$itates '+ ztnkruptcq (Lourt 'g093312-27 3 THEWTERN 0,1ST2rCT CF CALIFO IN RE'! ELA310 Z ALICE :HAAT INEZ 1G'JL GROVETON WAY CASE NUMSER 90-93312 MCOESTOt PROOF OFCLAIM 1. This proof I$ made for the claimant named below by the undersigned individual who States that: (Check appropriate box) The claimant 13 a Corporation and the Under The claimant is a partnership and He or she is agent or attorney such Cor He or she is the signed is an authorized officer of P.,:_ the undersigned is a member for the claimant ClaimantP tion 11 thereof 11 IINDICATE THE STA TIE OF INCORPORATION.NAME 00 PARTNERS,OR SUCH OTHER DESCRIPTION OF THE CLAIMANT AS MAY BE APPROPRIATE) (Pleat,Supply for werity)your account number Is,this debtor) 2. The undersigned represents that he or she is duty authorized to make this proof of clairri (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 90933LZ - 27 -3 SAN should be mailed is stated below. SAN JOAQUIN COUNTY PUaLIC HEALTH P J 5ax 2009- '.STCCKTONq CA: 95201. 0 address, as printed. is not Correct please ri corre This claim is based upon:(Check appropriate box) name 0 which checks and notice$ Should be dalhve,e 4. n.. and address I PA 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(or ground of liability).Explain. PRINCIPAL $1,504 . 00 AMOUNT S. No judgment has been Tendered upon the claim.except Penalties None ADDITIONAL 600 . 00 CHARGES S. The debtor was at the time of the riling of the petition initiating the Case,and still is.Indebted(or liable) TOTAL $2 , 104 . 00 to this claimant(after giving full Credit for all payments,sal-offs,and counterclaims)as follows: Attached LESS PAYMENTS (itemize all charges in addition to principal amount of debt, state basis for inclusion and computation. AND CREDITS and set forth any other consideration raiment to the legality of any charge.) Exclude any interest ONACCOUNT C 00 . 00 accrued after the date the case was commenced. PRESENT PRINCIPAL DUE [$ 2,104 .00 7. This claim Is free from any charge forbidden by applicable law and excludes all unmerited Interest (PAYOFF BALANCE) 8. This claim is a general unsecured 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: None (if 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 mason set forth in the statement attached hereto.)Evidence of perfection Of such security interest is also attached hereto. 10. The[air market value of the property on which the claimant has a lien(secured portion of claim)Is ................................1$ N/A T-tE PLAN PCPJSES PAYMj-ZNTS TO THE: TRUSTEE Or �L,573.00 MONTHLY UN; ECUREO CREDITORS TO BL PAID NOTHING T;-t IS CLo.1.4 IS LISTED .AS. UNSECURED �4. GROUP 6 DATED: 9093312 27- -3 SIGNED FILE U.S. 3ANKRUPTCY COURT EA.OR PARTNER SIGNING�'S CLA..) CLAIMp -. 1ITH:lijo'OE 30X 5376 4 Ity _F:,r Presenting Fraudulent Claim &NO STO CA 95352 1� S or F, imprisonment for not more then 13 (2-831 cr nl Al 5years of both--Title 18.U.S.C.. 152