Form B10 - Proof Of Claim

ADVERTISEMENT

B 10 (Modified Official Form 10) (4/13)
U
S
B
C
, DISTRICT OF DELAWARE
PROOF OF CLAIM
NITED
TATES
ANKRUPTCY
OURT
Indicate Debtor against which you assert a claim by checking the appropriate box below (Check only one Debtor per claim form):
x
 RadioShack Corporation (Case No. 15-10197)
 RS Ig Holdings Incorporated (15-10208)
 RSIgnite, LLC (Case No. 15-10209)
Atlantic Retail Ventures, Inc.
(Case No. 15-10199)
 Ignition L.P. (Case No. 15-10200)
 SCK, Inc. (Case No. 15-10210)
 ITC Services, Inc. (Case No. 15-10201)
 Tandy Finance Corporation (Case No. 15-10211)
 Merchandising Support Services, Inc. (Case No. 15-10202)
 Tandy Holdings, Inc. (Case No. 15-10212)
 RadioShack Customer Service LLC (Case No. 15-10203)
 Tandy International Corporation (Case No. 15-10213)
 RadioShack Global Sourcing Corporation (Case No. 15-10204)
 TE Electronics LP (Case No. 15-10214)
 RadioShack Global Sourcing Limited Partnership (Case No. 10206)
 Trade and Save LLC (Case No. 15-10215)
 RadioShack Global Sourcing Inc. (Case No. 15-10207)
 TRS Quality, Inc. (Case No. 15-10217)
NOTE: Do not use this form to make a claim for an administrative expense that arises after the bankruptcy filing.
COURT USE ONLY
You may file requests for payment of an administrative expense according to 11 U.S.C. § 503.
Name and Address of Creditor (the person or other entity to whom the debtor owes money or property):
David Verderame as Class Representative on Behalf of Himself,
the Certified Class of 569 Individuals Listed in the Attached Table,
and the Court-Appointed Class Counsel.
❐ Check this box if this claim amends a
x
c/o Christopher D. Loizides, Esquire
previously filed claim.
LOIZIDES, P.A., 1225 King Street, Ste. 800, Wilmington, DE 19801
7528
Court Claim Number:______________
(If known)
Telephone number: (302) 654-0248
email:
July 10, 2015
Filed on:_____________________
Name and address where payment should be sent (if different from above):
❐ Check this box if you are aware that
anyone else has filed a proof of claim relating
to this claim. Attach copy of statement giving
particulars.
Telephone number:
email:
7,369,517.44
1. Amount of Claim as of Date Case Filed:
$_____________________________
If all or part of the claim is secured, complete item 4. If all or part of the claim is entitled to priority, complete item 5.
x
❐Check this box if the claim includes interest or other charges in addition to the principal amount of the claim. Attach a statement that itemizes interest or charges.
Pennsylvania Minimum Wage Act of 1968
2. Basis for Claim: _________________________________________________________________
(See instruction #2)
3. Last four digits of any number
3a. Debtor may have scheduled account as:
3b. Uniform Claim Identifier (optional):
by which creditor identifies debtor:
__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
_____________________________
___ ___ ___ ___
(See instruction #3a)
(See instruction #3b)
Amount of arrearage and other charges, as of the time case was filed,
4. Secured Claim (See instruction #4)
included in secured claim, if any:
Check the appropriate box if the claim is secured by a lien on property or a right of
setoff, attach required redacted documents, and provide the requested information.
$__________________
Nature of property or right of setoff: ❐Real Estate ❐Motor Vehicle ❐Other
Basis for perfection: _______________________________________
Describe:
Amount of Secured Claim:
$__________________
Value of Property: $________________
Amount Unsecured:
$__________________
Annual Interest Rate_______% ❐Fixed or ❐Variable
(when case was filed)
5. Amount of Claim Entitled to Priority under 11 U.S.C. § 507 (a). If any part of the claim falls into one of the following categories, check the box specifying
the priority and state the amount.
❐ Domestic support obligations under 11
❐ Wages, salaries, or commissions (up to $12,475*)
❐ Contributions to an
U.S.C. § 507 (a)(1)(A) or (a)(1)(B).
earned within 180 days before the case was filed or the
employee benefit plan –
debtor’s business ceased, whichever is earlier –
11 U.S.C. § 507 (a)(5).
Amount entitled to priority:
11 U.S.C. § 507 (a)(4).
$______________________
❐ Up to $2,775* of deposits toward
❐ Taxes or penalties owed to governmental units –
❐ Other – Specify
purchase, lease, or rental of property or
11 U.S.C. § 507 (a)(8).
applicable paragraph of
services for personal, family, or household
11 U.S.C. § 507 (a)(__).
use – 11 U.S.C. § 507 (a)(7).
*Amounts are subject to adjustment on 4/1/16 and every 3 years thereafter with respect to cases commenced on or after the date of adjustment.

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Legal
Go
Page of 2