Bankruptcy Proof Details

A Bankruptcy B10 Proof of Claim Form is the form that must be submitted to the court in order for a creditor to claim any assets. This blog post will explain what this form is, how it works, and how you can fill one out. The bankruptcy process has many steps and parties involved in it which often leads to confusion about what forms are needed when. The Bankruptcy B10 Proof of Claim Form is an important document in the bankruptcy process so understanding it's purpose will help serve as guide through the process.

Here, you'll discover quite a few information about bankruptcy b10 proof of claim form PDF. It's definitely worth finding the time to read through this prior to starting filling out your document.

QuestionAnswer
Form NameBankruptcy B10 Proof Of Claim Form
Form Length3 pages
Fillable?Yes
Fillable fields41
Avg. time to fill out9 min 1 sec
Other namesbankruptcy lawyers, bankruptcy court proof claim, proof of claim form, bankruptcy proof of claim form

Form Preview Example

B10 (Official Form 10) (04/13)

UNITED STATES BANKRUPTCY COURT

__________ District of __________

PROOF OF CLAIM

 

 

 

 

 

Name of Debtor:

 

 

Case Number:

 

 

 

 

NOTE: Do not use this form to make a claim for an administrative expense that arises after the bankruptcy filing. You

 

may file a request for payment of an administrative expense according to 11 U.S.C. § 503.

 

 

 

Name of Creditor (the person or other entity to whom the debtor owes money or property):

 

 

 

 

 

COURT USE ONLY

Name and address where notices should be sent:

 

 

Check this box if this claim amends a

 

 

 

 

previously filed claim.

 

 

 

 

Court Claim Number:______________

 

 

 

 

(If known)

Telephone number:

email:

 

 

 

 

 

 

 

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:

 

 

 

 

 

 

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.

 

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.

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:

 

 

 

Value of Property: $________________

 

Amount of Secured Claim:

$__________________

Annual Interest Rate_______% Fixed

or Variable

Amount Unsecured:

$__________________

(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).

 

 

11 U.S.C. § 507 (a)(4).

 

Amount entitled to priority:

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 4/01/16 and every 3 years thereafter with respect to cases commenced on or after the date of adjustment.

6. Credits. The amount of all payments on this claim has been credited for the purpose of making this proof of claim. (See instruction #6)

4. Secured Claim:
Check whether the claim is fully or partially secured. Skip this section if the

B10 (Official Form 10) (04/13)

2

7.Documents: Attached are redacted copies of any documents that support the claim, such as promissory notes, purchase orders, invoices, itemized statements of running accounts, contracts, judgments, mortgages, security agreements, or, in the case of a claim based on an open-end or revolving consumer credit agreement, a statement providing the information required by FRBP 3001(c)(3)(A). If the claim is secured, box 4 has been completed, and redacted copies of documents providing evidence of perfection of a security interest are attached. If the claim is secured by the debtor's principal residence, the Mortgage Proof of Claim Attachment is being filed with this claim. (See instruction #7, and the definition of “redacted”.)

DO NOT SEND ORIGINAL DOCUMENTS. ATTACHED DOCUMENTS MAY BE DESTROYED AFTER SCANNING.

If the documents are not available, please explain:

8.Signature: (See instruction #8) Check the appropriate box.

I am the creditor.

I am the creditor’s authorized agent.

I am the trustee, or the debtor,

I am a guarantor, surety, indorser, or other codebtor.

 

 

or their authorized agent.

(See Bankruptcy Rule 3005.)

 

 

(See Bankruptcy Rule 3004.)

 

I declare under penalty of perjury that the information provided in this claim is true and correct to the best of my knowledge, information, and reasonable belief.

Print Name: _________________________________________________

Title: _________________________________________________

Company: _________________________________________________

Address and telephone number (if different from notice address above):

(Signature)

(Date)

_________________________________________________

 

 

_________________________________________________

 

 

_________________________________________________

 

 

Telephone number:email:

Penalty for presenting fraudulent claim: Fine of up to $500,000 or imprisonment for up to 5 years, or both. 18 U.S.C. §§ 152 and 3571.

INSTRUCTIONS FOR PROOF OF CLAIM FORM

The instructions and definitions below are general explanations of the law. In certain circumstances, such as bankruptcy cases not filed voluntarily by the debtor,

exceptions to these general rules may apply.

Items to be completed in Proof of Claim form

Court, Name of Debtor, and Case Number:

claim is entirely unsecured. (See Definitions.) If the claim is secured, check the

Fill in the federal judicial district in which the bankruptcy case was filed (for

box for the nature and value of property that secures the claim, attach copies of lien

example, Central District of California), the debtor’s full name, and the case

documentation, and state, as of the date of the bankruptcy filing, the annual interest

number. If the creditor received a notice of the case from the bankruptcy court,

rate (and whether it is fixed or variable), and the amount past due on the claim.

all of this information is at the top of the notice.

 

 

 

5. Amount of Claim Entitled to Priority Under 11 U.S.C. § 507 (a).

Creditor’s Name and Address:

If any portion of the claim falls into any category shown, check the appropriate

Fill in the name of the person or entity asserting a claim and the name and

box(es) and state the amount entitled to priority. (See Definitions.) A claim may

address of the person who should receive notices issued during the bankruptcy

be partly priority and partly non-priority. For example, in some of the categories,

case. A separate space is provided for the payment address if it differs from the

the law limits the amount entitled to priority.

notice address. The creditor has a continuing obligation to keep the court

 

 

informed of its current address. See Federal Rule of Bankruptcy Procedure

6.

Credits:

(FRBP) 2002(g).

An authorized signature on this proof of claim serves as an acknowledgment that

 

when calculating the amount of the claim, the creditor gave the debtor credit for

1. Amount of Claim as of Date Case Filed:

any payments received toward the debt.

State the total amount owed to the creditor on the date of the bankruptcy filing.

 

 

Follow the instructions concerning whether to complete items 4 and 5. Check

7.

Documents:

the box if interest or other charges are included in the claim.

Attach redacted copies of any documents that show the debt exists and a lien

 

secures the debt. You must also attach copies of documents that evidence perfection

2. Basis for Claim:

of any security interest and documents required by FRBP 3001(c) for claims based

State the type of debt or how it was incurred. Examples include goods sold,

on an open-end or revolving consumer credit agreement or secured by a security

money loaned, services performed, personal injury/wrongful death, car loan,

interest in the debtor’s principal residence. You may also attach a summary in

mortgage note, and credit card. If the claim is based on delivering health care

addition to the documents themselves. FRBP 3001(c) and (d). If the claim is based

goods or services, limit the disclosure of the goods or services so as to avoid

on delivering health care goods or services, limit disclosing confidential health care

embarrassment or the disclosure of confidential health care information. You

information. Do not send original documents, as attachments may be destroyed

may be required to provide additional disclosure if an interested party objects to

after scanning.

the claim.

 

 

 

8.

Date and Signature:

3. Last Four Digits of Any Number by Which Creditor Identifies Debtor:

The individual completing this proof of claim must sign and date it. FRBP 9011.

State only the last four digits of the debtor’s account or other number used by the

If the claim is filed electronically, FRBP 5005(a)(2) authorizes courts to establish

creditor to identify the debtor.

local rules specifying what constitutes a signature. If you sign this form, you

 

declare under penalty of perjury that the information provided is true and correct to

3a. Debtor May Have Scheduled Account As:

the best of your knowledge, information, and reasonable belief. Your signature is

Report a change in the creditor’s name, a transferred claim, or any other

also a certification that the claim meets the requirements of FRBP 9011(b).

information that clarifies a difference between this proof of claim and the claim

Whether the claim is filed electronically or in person, if your name is on the

as scheduled by the debtor.

signature line, you are responsible for the declaration. Print the name and title, if

 

any, of the creditor or other person authorized to file this claim. State the filer’s

3b. Uniform Claim Identifier:

address and telephone number if it differs from the address given on the top of the

If you use a uniform claim identifier, you may report it here. A uniform claim

form for purposes of receiving notices. If the claim is filed by an authorized agent,

identifier is an optional 24-character identifier that certain large creditors use to

provide both the name of the individual filing the claim and the name of the agent.

facilitate electronic payment in chapter 13 cases.

If the authorized agent is a servicer, identify the corporate servicer as the company.

 

Criminal penalties apply for making a false statement on a proof of claim.

 

 

 

B10 (Official Form 10) (04/13)

3

__________DEFINITIONS__________

______INFORMATION______

Debtor

A debtor is the person, corporation, or other entity that has filed a bankruptcy case.

Creditor

A creditor is a person, corporation, or other entity to whom debtor owes a debt that was incurred before the date of the bankruptcy filing. See 11 U.S.C. §101 (10).

Claim

A claim is the creditor’s right to receive payment for a debt owed by the debtor on the date of the bankruptcy filing. See 11 U.S.C. §101 (5). A claim may be secured or unsecured.

Proof of Claim

A proof of claim is a form used by the creditor to indicate the amount of the debt owed by the debtor on the date of the bankruptcy filing. The creditor must file the form with the clerk of the same bankruptcy court in which the bankruptcy case was filed.

Secured Claim Under 11 U.S.C. § 506 (a)

A secured claim is one backed by a lien on property of the debtor. The claim is secured so long as the creditor has the right to be paid from the property prior to other creditors. The amount of the secured claim cannot exceed the value of the property. Any amount owed to the creditor in excess of the value of the property is an unsecured claim. Examples of liens on property include a mortgage on real estate or a security interest in a car. A lien may be voluntarily granted by a debtor or may be obtained through a court proceeding. In some states, a court judgment is a lien.

A claim also may be secured if the creditor owes the debtor money (has a right to setoff).

Unsecured Claim

An unsecured claim is one that does not meet the requirements of a secured claim. A claim may be partly unsecured if the amount of the claim exceeds the value of the property on which the creditor has a lien.

Claim Entitled to Priority Under 11 U.S.C. § 507

(a)

Priority claims are certain categories of unsecured claims that are paid from the available money or property in a bankruptcy case before other unsecured claims.

Redacted

A document has been redacted when the person filing it has masked, edited out, or otherwise deleted, certain information. A creditor must show only the last four digits of any social-security, individual’s tax-identification, or financial-account number, only the initials of a minor’s name, and only the year of any person’s date of birth. If the claim is based on the delivery of health care goods or services, limit the disclosure of the goods or services so as to avoid embarrassment or the disclosure of confidential health care information.

Evidence of Perfection

Evidence of perfection may include a mortgage, lien, certificate of title, financing statement, or other document showing that the lien has been filed or recorded.

Acknowledgment of Filing of Claim

To receive acknowledgment of your filing, you may either enclose a stamped self-addressed envelope and a copy of this proof of claim or you may access the court’s PACER system (www.pacer.psc.uscourts.gov) for a small fee to view your filed proof of claim.

Offers to Purchase a Claim

Certain entities are in the business of purchasing claims for an amount less than the face value of the claims. One or more of these entities may contact the creditor and offer to purchase the claim. Some of the written communications from these entities may easily be confused with official court documentation or communications from the debtor. These entities do not represent the bankruptcy court or the debtor. The creditor has no obligation to sell its claim. However, if the creditor decides to sell its claim, any transfer of such claim is subject to FRBP 3001(e), any applicable provisions of the Bankruptcy Code

(11 U.S.C. § 101 et seq.), and any applicable orders of the bankruptcy court.

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official form claim fields to complete

Make sure you submit the data within the area Name and address where payment, ❐ Wages, ❐ Contributions to an employee, Amount entitled to priority:, ❐ Other – Specify applicable, and ❐ Up to $2.

step 2 to completing official form claim

The system will ask for more details with the intention to effortlessly prepare the field I declare under penalty of perjury, Print Name: Title: Company: , email:, (Signature), (Date), Penalty for presenting fraudulent, The instructions and definitions, INSTRUCTIONS FOR PROOF OF CLAIM, exceptions to these general rules, Items to be completed in Proof of, Court, and claim is entirely unsecured.

official form claim I declare under penalty of perjury, Print Name:  Title:  Company: , email:, (Signature), (Date), Penalty for presenting fraudulent, The instructions and definitions, INSTRUCTIONS FOR PROOF OF CLAIM, exceptions to these general rules, Items to be completed in Proof of, Court, and claim is entirely unsecured blanks to complete

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