Fillable Form B10 - Proof Of Claim - 2005 (Page 2 of 2) in pdf

B 10 (Official Form 10) (10/05)

INSTRUCTIONS FOR PROOF OF CLAIM FORM

The instructions and definitions below are general explanations of the law. In particular types of cases or circumstances, such as bankruptcy cases

that are not filed voluntarily by a debtor, there may be exceptions to these general rules.

DEFINITIONS

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Debtor

Secured Claim

Unsecured Claim

The person, corporation, or other entity that has

A claim is a secured claim to the extent that the

If a claim is not a secured claim it is an

filed a bankruptcy case is called the debtor.

creditor has a lien on property of the debtor

unsecured claim. A claim may be partly

(collateral) that gives the creditor the right to be

secured and partly unsecured if the property on

paid from that property before creditors who do

which a creditor has a lien is not worth enough

Creditor

not have liens on the property.

to pay the creditor in full.

A creditor is any person, corporation, or other

entity to whom the debtor owed a debt on the

Examples of liens are a mortgage on real estate

Unsecured Priority Claim

date that the bankruptcy case was filed.

and a security interest in a car, truck, boat,

television set, or other item of property. A lien

Certain types of unsecured claims are given

may have been obtained through a court

priority, so they are to be paid in bankruptcy

Proof of Claim

proceeding before the bankruptcy case began;

cases before most other unsecured claims (if

A form telling the bankruptcy court how much

in some states a court judgment is a lien. In

there is sufficient money or property available

the debtor owed a creditor at the time the

addition, to the extent a creditor also owes

to pay these claims). The most common types

bankruptcy case was filed (the amount of the

money to the debtor (has a right of setoff), the

of priority claims are listed on the proof of

creditor’s claim). This form must be filed with

creditor’s claim may be a secured claim. (See

claim form. Unsecured claims that are not

the clerk of the bankruptcy court where the

also Unsecured Claim.)

specifically given priority status by the

bankruptcy case was filed.

bankruptcy laws are classified as Unsecured

Nonpriority Claims.

Items to be completed in Proof of Claim form (if not already filled in)

Court, Name of Debtor, and Case Number:

filed. A claim may be partly secured and partly unsecured. (See

Fill in the name of the federal judicial district where the bankruptcy case

DEFINITIONS, above).

was filed (for example, Central District of California), the name of the

debtor in the bankruptcy case, and the bankruptcy case number. If you

Unsecured Priority Claim:

received a notice of the case from the court, all of this information is near

Check the appropriate place if you have an unsecured priority

the top of the notice.

claim, and state the amount entitled to priority. (See

DEFINITIONS, above). A claim may be partly priority and partly

Information about Creditor:

nonpriority if, for example, the claim is for more than the amount

Complete the section giving the name, address, and telephone number of

given priority by the law. Check the appropriate place to specify

the creditor to whom the debtor owes money or property, and the debtor’s

the type of priority claim.

account number, if any. If anyone else has already filed a proof of claim

relating to this debt, if you never received notices from the bankruptcy

Unsecured Nonpriority Claim:

court about this case, if your address differs from that to which the court

Check the appropriate place if you have an unsecured nonpriority

sent notice, or if this proof of claim replaces or changes a proof of claim

claim, sometimes referred to as a “general unsecured claim.” (See

that was already filed, check the appropriate box on the form.

DEFINITIONS, above.) If your claim is partly secured and partly

unsecured, state here the amount that is unsecured. If part of your

Basis for Claim:

claim is entitled to priority, state here the amount not entitled to

Check the type of debt for which the proof of claim is being filed. If

priority.

the type of debt is not listed, check “Other” and briefly describe the

type of debt. If you were an employee of the debtor, fill in the last

Total Amount of Claim at Time Case Filed:

four digits of your social security number and the dates of work for

Fill in the total amount of the entire claim. If interest or other

which you were not paid.

charges in addition to the principal amount of the claim are

included, check the appropriate place on the form and attach an

itemization of the interest and charges.

Date Debt Incurred:

Fill in the date when the debt first was owed by the debtor.

Credits:

Court Judgments:

By signing this proof of claim, you are stating under oath that in

If you have a court judgment for this debt, state the date the court

calculating the amount of your claim you have given the debtor

entered the judgment.

credit for all payments received from the debtor.

Classification of Claim:

Supporting Documents:

Secured Claim:

You must attach to this proof of claim form copies of documents

Check the appropriate place if the claim is a secured claim. You

that show the debtor owes the debt claimed or, if the documents are

must state the type and value of property that is collateral for the

too lengthy, a summary of those documents. If documents are not

claim, attach copies of the documentation of your lien, and state the

available, you must attach an explanation of why they are not

amount past due on the claim as of the date the bankruptcy case was

available.

Form B10 - Proof Of Claim - 2005 Page 2

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