Official Form 410 - Proof Of Claim

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United States Bankruptcy Court for the Western District of Pennsylvania
Indicate Debtor against which you assert a claim by checking the appropriate box below. (Check only one Debtor per claim form.)
☐ rue21, inc (Case No. 17-22045)
☐ r services, llc (Case No. 17-22047)
☐ Rhodes Holdco, Inc. (Case No. 17-22046)
☐ rue services corporation (Case No. 17-22048)
Official Form 410
Proof of Claim
04/16
Read the instructions before filling out this form. This form is for making a claim for payment in a bankruptcy case. Other than a claim under
11 U.S.C. § 503(b)(9), this form should not be used to make a claim for an administrative expense arising after the commencement of the case.
Filers must leave out or redact information that is entitled to privacy on this form or on any attached documents. Attach redacted copies or any
documents that support the claim, such as promissory notes, purchase orders, invoices, itemized statements of running accounts, contracts, judgments,
mortgages, and security agreements. Do not send original documents; they may be destroyed after scanning. If the documents are not available,
explain in an attachment.
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.
Fill in all the information about the claim as of the date the case was filed, May 15, 2017.
Part 1:
Identify the Claim
1. Who is the current
creditor?
Name of the current creditor (the person or entity to be paid for this claim)
Other names the creditor used with the debtor
2. Has this claim been
No
acquired from
someone else?
Yes.
From whom?
3. Where should
Where should notices to the creditor be sent?
Where should payments to the creditor be sent? (if
notices and
different)
payments to the
creditor be sent?
Name
Name
Federal Rule of
Number
Street
Number
Street
Bankruptcy Procedure
(FRBP) 2002(g)
City
State
ZIP Code
City
State
ZIP Code
Country
Country
Contact phone
Contact phone
Contact email
Contact email
Uniform claim identifier for electronic payments in chapter 13 (if you use one):
___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___
4. Does this claim
No
amend one already
filed?
Yes.
Claim number on court claims registry (if known)
Filed on
MM
/
DD
/
YYYY
5. Do you know if
No
anyone else has filed
a proof of claim for
Yes. Who made the earlier filing?
this claim?
Official Form 410
Proof of Claim
page 1

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