Form 410 PDF Details

Form 410 is the annual report that public companies must file with the United States Securities and Exchange Commission (SEC). It contains financial information and other disclosures about a company's operations. The form is due within 60 days of the company's fiscal year-end. Companies can request an automatic five-day extension from the SEC. Form 410 is also known as a 10-K, which is short for Annual Report on Form 10-K. Public companies have been filing Form 410 since 1934. The form was initially called Registration Statement Number 1, but it was later renamed to10-K. In 1975, Congress passed the Emergency Energy Crisis Act, which required all publicly traded energy companies to file their annual reports with the SEC using Form 410 instead of Schedule 13G. Form 410 is one of several forms that companies can use to file annual reports with the SEC. Other forms include: 10-Q (quarterly report), 8-K (current event report), and 11-K (statutory plan under section 382 of the Interna

QuestionAnswer
Form NameForm 410
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other namesbankruptcy 410a instructions, bankruptcy creditor claim form, claim form b410, bankruptcy proof of claim form 410

Form Preview Example

Fill in this information to identify the case:

Debtor 1 __________________________________________________________________

Debtor 2 ________________________________________________________________

(Spouse, if filing)

United States Bankruptcy Court for the: __________ District of __________

Case number ___________________________________________

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. Do not use this form to make a request for payment of an administrative expense. Make such a request according to 11 U.S.C. § 503.

Filers must leave out or redact information that is entitled to privacy on this form or on any attached documents. Attach redacted copies of 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. That date is on the notice of bankruptcy (Form 309) that you received.

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

Yes. From whom? ______________________________________________________________________________________________________

someone else?

 

3.Where should notices and payments to the creditor be sent?

Where should notices to the creditor be sent?

Where should payments to the creditor be sent? (if different)

Federal Rule of

_____________________________________________________

_____________________________________________________

Name

 

 

Name

 

 

Bankruptcy Procedure

 

 

 

 

 

 

 

 

 

 

(FRBP) 2002(g)

______________________________________________________

______________________________________________________

 

Number

Street

 

Number

Street

 

 

______________________________________________________

______________________________________________________

 

City

State

ZIP Code

City

State

ZIP Code

 

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 amend

No

 

 

 

one already filed?

Yes.

Claim number on court claims registry (if known) ________

Filed on ________________________

 

 

 

 

 

 

MM / DD / YYYY

 

 

 

 

 

5.

Do you know if anyone

No

 

 

 

else has filed a proof

Yes.

Who made the earlier filing? _____________________________

 

 

of claim for this claim?

 

 

 

Official Form 410

Proof of Claim

page 1

Part 2: Give Information About the Claim as of the Date the Case Was Filed

6. Do you have any number

No

you use to identify the

Yes. Last 4 digits of the debtor’s account or any number you use to identify the debtor: ____ ____ ____ ____

debtor?

 

7.How much is the claim? $_____________________________. Does this amount include interest or other charges?

No

Yes. Attach statement itemizing interest, fees, expenses, or other charges required by Bankruptcy Rule 3001(c)(2)(A).

8.What is the basis of the claim?

Examples: Goods sold, money loaned, lease, services performed, personal injury or wrongful death, or credit card.

Attach redacted copies of any documents supporting the claim required by Bankruptcy Rule 3001(c).

Limit disclosing information that is entitled to privacy, such as health care information.

 

______________________________________________________________________________

 

 

9. Is all or part of the claim

No

secured?

Yes. The claim is secured by a lien on property.

Nature of property:

Real estate. If the claim is secured by the debtor’s principal residence, file a Mortgage Proof of Claim Attachment (Official Form 410-A) with this Proof of Claim.

Motor vehicle

Other. Describe:

_____________________________________________________________

Basis for perfection:

_____________________________________________________________

Attach redacted copies of documents, if any, that show evidence of perfection of a security interest (for example, a mortgage, lien, certificate of title, financing statement, or other document that shows the lien has been filed or recorded.)

Value of property:

$__________________

Amount of the claim that is secured:

$__________________

Amount of the claim that is unsecured: $__________________(The sum of the secured and unsecured

amounts should match the amount in line 7.)

Amount necessary to cure any default as of the date of the petition:

$____________________

Annual Interest Rate (when case was filed)_______%

 

Fixed

 

Variable

 

10.Is this claim based on a lease?

No

Yes. Amount necessary to cure any default as of the date of the petition.

$____________________

11.Is this claim subject to a right of setoff?

No

Yes. Identify the property: ___________________________________________________________________

Official Form 410

Proof of Claim

page 2

12.Is all or part of the claim entitled to priority under 11 U.S.C. § 507(a)?

A claim may be partly priority and partly nonpriority. For example, in some categories, the law limits the amount entitled to priority.

No

Yes. Check one:

Amount entitled to priority

 

 

Domestic support obligations (including alimony and child support) under

11 U.S.C. § 507(a)(1)(A) or (a)(1)(B).

$____________________

 

Up to $2,850* of deposits toward purchase, lease, or rental of property or services for

personal, family, or household use. 11 U.S.C. § 507(a)(7).

$____________________

Wages, salaries, or commissions (up to $12,850*) earned within 180 days before the

bankruptcy petition is filed or the debtor’s business ends, whichever is earlier.

$____________________

11 U.S.C. § 507(a)(4).

 

Taxes or penalties owed to governmental units. 11 U.S.C. § 507(a)(8).

$____________________

Contributions to an employee benefit plan. 11 U.S.C. § 507(a)(5).

$____________________

Other. Specify subsection of 11 U.S.C. § 507(a)(__) that applies.

$____________________

*Amounts are subject to adjustment on 4/01/19 and every 3 years after that for cases begun on or after the date of adjustment.

Part 3: Sign Below

The person completing this proof of claim must sign and date it.

FRBP 9011(b).

If you file this claim electronically, FRBP 5005(a)(2) authorizes courts to establish local rules specifying what a signature is.

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.

Check the appropriate box:

I am the creditor.

I am the creditor’s attorney or authorized agent.

I am the trustee, or the debtor, or their authorized agent. Bankruptcy Rule 3004.

I am a guarantor, surety, endorser, or other codebtor. Bankruptcy Rule 3005.

I understand that 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 any payments received toward the debt.

I have examined the information in this Proof of Claim and have a reasonable belief that the information is true and correct.

I declare under penalty of perjury that the foregoing is true and correct.

Executed on date _________________

MM / DD / YYYY

8________________________________________________________________________

Signature

Print the name of the person who is completing and signing this claim:

Name

_______________________________________________________________________________________________

 

First name

Middle name

Last name

Title

_______________________________________________________________________________________________

Company

_______________________________________________________________________________________________

Identify the corporate servicer as the company if the authorized agent is a servicer.

Address

_______________________________________________________________________________________________

 

Number

Street

 

 

 

_______________________________________________________________________________________________

 

City

 

State

ZIP Code

Contact phone

_____________________________

Email

____________________________________

Official Form 410

Proof of Claim

page 3

How to Edit Form 410 Online for Free

It is possible to fill out proof of claim easily with our online tool for PDF editing. We are committed to giving you the ideal experience with our editor by continuously adding new features and upgrades. With these updates, working with our tool becomes easier than ever before! To get the process started, go through these easy steps:

Step 1: Press the "Get Form" button in the top part of this page to open our PDF tool.

Step 2: With our handy PDF editor, it is easy to do more than just fill out blank fields. Try all of the functions and make your docs look sublime with custom textual content incorporated, or modify the file's original content to perfection - all comes with the capability to incorporate any type of photos and sign the PDF off.

Concentrate when filling in this document. Ensure every blank is filled in properly.

1. To start off, while filling in the proof of claim, beging with the area that includes the following fields:

Writing part 1 of form b410

2. Soon after this part is completed, go on to type in the relevant details in these: Who is the current, creditor, Name of the current creditor the, Other names the creditor used with, Has this claim been, acquired from someone else, No Yes From whom, Where should notices, Where should notices to the, Where should payments to the, and payments to the creditor be, Federal Rule of Bankruptcy, Name, Name, and Number.

form b410 completion process explained (stage 2)

3. The next part should be relatively straightforward, Does this claim amend, one already filed, No Yes Claim number on court, Filed on, YYYY, Do you know if anyone, else has filed a proof of claim, No Yes Who made the earlier, Official Form, Proof of Claim, and page - these form fields must be completed here.

How you can fill in form b410 stage 3

Always be extremely careful while filling in Do you know if anyone and Filed on, since this is the section in which most users make mistakes.

4. This next section requires some additional information. Ensure you complete all the necessary fields - Part Give Information About the, Do you have any number, you use to identify the debtor, No Yes Last digits of the, How much is the claim, Does this amount include interest, No Yes Attach statement, charges required by Bankruptcy, What is the basis of the, Examples Goods sold money loaned, claim, Attach redacted copies of any, Limit disclosing information that, Is all or part of the claim secured, and No Yes The claim is secured by a - to proceed further in your process!

Completing segment 4 of form b410

5. Finally, the following last part is what you should finish before closing the PDF. The blanks at this stage are the next: Basis for perfection, Attach redacted copies of, Value of property, Amount of the claim that is secured, Amount of the claim that is, amounts should match the amount in, Amount necessary to cure any, Annual Interest Rate when case was, Is this claim based on a, lease, No Yes Amount necessary to cure, Is this claim subject to a, and No Yes Identify the property.

form b410 writing process described (part 5)

Step 3: Ensure that the information is right and press "Done" to conclude the project. Try a 7-day free trial plan at FormsPal and get direct access to proof of claim - downloadable, emailable, and editable from your FormsPal account page. FormsPal guarantees your data privacy with a secure method that never records or distributes any type of sensitive information used. Be confident knowing your paperwork are kept safe when you use our tools!

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