Proof Of Claim (Page 3 of 5) in pdf

PROOF OF CLAIM

Claimant name:_________________________________________________________________

Address:____________________________________________________________________

Email:______________________________________________________________________

Telephone number:___________________________________________________________

Contact name (including counsel): _________________________________________________

Address:____________________________________________________________________

Email:______________________________________________________________________

Telephone number:___________________________________________________________

[ ]

Check this box if you agree that communications and any objection to your Proof of

Claim may be transmitted by the Receiver to you via email at the Contact name above.

Account No. (if any) or other identifying Sunwest number: ______________________________

If a legal action is pending relating to your Claim, please state the date it was commenced, the

Court, where it is pending, the Case No., and attach a copy of the complaint:

______________________________________________________________________________

If a Judgment has been obtained, please state the Date of the Judgment and attach a

copy:________________________________________________________________________

Amount Claimed: $__________________________________________________

(total as of the date of submittal of the Proof of Claim Form).

Amount received since January 1, 2006 (for any reason):________________________________

Please check all boxes that apply to you and provide the requested information at

the end of this Proof of Claim Form or attach separate sheets:

[ ] Administrative Claim. (For example, new funds paid during the Harder Bankruptcy Case or

Receivership Case to pay for debt service, property taxes, operations, or repairs of a Holdco,

Divestco or Trustco Property.) Please provide amounts, dates, and any documents that evidence

the payments and purpose. Attach additional sheets if necessary.

Investor Claims.

A. [ ] Tenant In Common. (For example, payment of money or providing of other value in

order to obtain a Tenant in Common interest in a Sunwest-affiliated real estate asset). Please

provide the amount of payment or other description of value provided, the date, the name of

the Sunwest facility or other related asset, the date and amount of the last payment on account

of the Tenant In Common interest, what you assert you are owed, including for example, for

PROOF OF CLAIM FORM

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Proof Of Claim Page 3