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`a(TEO STATES BANKRUPTCY COUR-, NC HERN DISTRICT OF CALIFORNI. P-00319 CHAPTER: 11 CRAIG C. JOHNSON 8604157 — IN RE : CASE NUMBER: 4-86-04157 W P . O. BOX 1421 SSN/ID: 560-76-8033 PLEASANTON, CA 94566 PROOF OF CLAIM F'TLE D I. This Proof is made for the Claimant named below by the undersigned Indlvidlnl who resides at pand who also %totes that he or she is duly authorized to make this Osie on behalf of the claimant. which Is: AN INDIVIDUAL p A PARTNERSHIP A CORPORATION ® p OTHER Off 9 1986 (INDICATE THE STATE OF INCORPORATION, NAME OF PARTNERS, OR SUCH OTHER DESCRIPTION OF THE CLAIMANT AS MAY BE APPROPRIATEI 1. The pilot office address of the claimant and the address to which all rwticu to this claimant should be addresRAfjKRUPTCY COURT if name or add,.,., e. printed. is hot Correct PI..se inditet. co,reCI OAKLAND, CALIFORNIA name and address to which checks and nonce& should be delivered. 8604157 — 22 SAN SAN JOAQUIN LOCAL HEALTH .. 1601 E . HAZELTON AVE . - -- ft STOCKTON, CA 95201 i. The debtor was, of the time PI the llling Of the volition Initiating this cue, and still Is Indebted W liable) to this Clalmam, (excluding all unmaured interestl in the sum of---•••---..--..•-------------„ t a. The Consideration for this debt for pound of liability) 1. as follows; 220.0' 8. III the claim is founded On writingl The writing on which this Claim is founded lot • doplicsta thereof) Is attached hereto for Cannot be attached ter the reason got forth in the statement attached hereto). a. 111 sPixoyriatel This claim Is f0moed on an open account which patents, lar will become) dw on as shown bythe Homiied statement attached hereto. Unless it Is attached hereto or its absence Is explains,d in on, attached statement, a tote or other negotiable Instrument has been received for the account or any part of It. 7. No judgment hat been rendered on this claim except a. The anounlof ell payments on this claim has been credited and deducted for the puroose Of making this proof of claim. a. This claim Is awl subject to any set-off or counterclaim except 10. No security interest la held for this claim except (1( Security Interest in property of the debtor is claimed). The security Interest la claimed trader the writing referred to in Paragraph S hereof lot under a Separate writing which lot a duplicate of which) is attached hereto, or under • Separate writing which cannot be attached hereto for the reason wt forth in the statement attached hereto). Evidence of p.tf.c Ym. of such secunty interest is also attached hereto. 11. This claim is a general unsecured claim, .xCopt to the extent that the security interest, it any, described in paragraph 10 is sufficient to Satisfy the Claim- (11 priority is claimed, $tate the amount and the basis thereo Ll 12. If this claim is for salon es, wages, commi.smna or employee benefits entitled to priority as permitted by 115071a)(3) andlor 115071aiull of the Bankruptcy Coda, indicate the detaa and the nature of the services performed, the rates of Compensation and claimant's Social Security Number. SSM -SEND STAMPED SELF—ADDRESSED ENVELOPE FOR RETURN OF CONFORMED COPY OF CLAIM . ORIGINAL CLAIM FORM REQUIRES ORIGINAL SIGNATURE . NO CHARGE FOR FILING CLAIM . LEIN DUPLICATE WITH. U . S . BANKRUPTCY COURT DATED P- 0. BLDG . 13 & JACKSON P. O. BOX 2070 OAKLAND , CA 94604 SIGNED theme of mdiridual, a t, officer or Partner signing this claim) -. eCYat 1V .,.0 Yela.s,.. ...".."a