Official Form 410 - Proof Of Claim - United States Bankruptcy Court Page 4
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5Official Form 410
Instructions for Proof of Claim
United States Bankruptcy Court
12/15
These instructions and definitions generally explain the law. In certain circumstances, such as bankruptcy cases that debtors
do not file voluntarily, exceptions to these general rules may apply. You should consider obtaining the advice of an attorney,
especially if you are unfamiliar with the bankruptcy process and privacy regulations.
A person who files a fraudulent claim could be fined up
to $500,000, imprisoned for up to 5 years, or both.
18 U.S.C. §§ 152, 157 and 3571.
How to fill out this form
A Proof of Claim form and any attached documents
must show only the last 4 digits of any social security
Fill in all of the information about the claim as of the
number, individual’s tax identification number, or
date the case was filed.
financial account number, and only the year of any
See Bankruptcy Rule 9037.
person’s date of birth.
Fill in the caption at the top of the form.
For a minor child, fill in only the child’s initials and the
full name and address of the child’s parent or
If the claim has been acquired from someone else,
For example, write A.B., a minor child (John
guardian.
who owned the
then state the identity of the last party
Doe, parent, 123 Main St., City, State). See Bankruptcy
claim or was the holder of the claim and who transferred
Rule 9037.
it to you before the initial claim was filed.
Attach any supporting documents to this form.
Confirmation that the claim has been filed
Attach redacted copies of any documents that show that the
debt exists, a lien secures the debt, or both. (See the
To receive confirmation that the claim has been filed, either
definition of redaction on the next page.)
enclose a stamped self-addressed envelope and a copy of this
Also attach redacted copies of any documents that show
form or go to the court’s PACER system
perfection of any security interest or any assignments or
( ) to view the filed form.
transfers of the debt. In addition to the documents, a
summary may be added. Federal Rule of Bankruptcy
Procedure (called “Bankruptcy Rule”) 3001(c) and (d).
Understand the terms used in this form
Generally, an expense that arises
Administrative expense:
Do not attach original documents because
after a bankruptcy case is filed in connection with operating,
attachments may be destroyed after scanning.
liquidating, or distributing the bankruptcy estate.
11 U.S.C. § 503.
If the claim is based on delivering health care goods
or services, do not disclose confidential health care
A creditor’s right to receive payment for a debt that the
Claim:
information. Leave out or redact confidential
debtor owed on the date the debtor filed for bankruptcy. 11
information both in the claim and in the attached
documents.
U.S.C. §101 (5). A claim may be secured or unsecured.
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