Legal Proof of Claim

LEGAL PROOF OF CLAIM

Claimant Name:    Claimant Entity Type: Individual Corporation Other

Claimant Address:

Debtor Name:    Case Number:

RECITALS

WHEREAS, Claimant asserts that Debtor is indebted to Claimant in the aggregate principal amount of $ (the "Claim"), arising from the transaction(s) described below; and

WHEREAS, Claimant submits this Legal Proof of Claim to assert and preserve all rights, claims, liens, security interests, setoffs, and remedies available under applicable law and contract; and

WHEREAS, the parties wish to record the basis, classification and supporting documentation for the Claim in a manner intended to be relied upon for administrative and adjudicative proceedings.

NOW, THEREFORE, in consideration of the mutual covenants and representations contained herein, Claimant and Debtor agree as follows:

1. CLAIM DESCRIPTION AND AMOUNT

1.1 Claim Basis: Claimant asserts the Claim is based upon the following legal and factual grounds: .

1.2 Itemization: The components of the Claim are itemized as follows:

1.3 Total Claimed Amount (inclusive of principal, accrued interest, fees and costs to date): $

2. PRIORITY, SECURITY AND SET-OFF

2.1 Classification: Claimant asserts that the Claim is (select all applicable):   Unsecured   Secured   Priority

2.2 Security: If secured, provide the collateral description, and the date of creation of the security interest: ; Date:

2.3 Setoff: Claimant asserts any right of setoff or recoupment as described here:

3. SUPPORTING DOCUMENTATION

Claimant certifies that the following documents are attached or available upon request (check all that apply):

Invoice   Contract or Agreement   Promissory Note   Judgment   Other:

4. OBJECTIONS AND PROCEDURE

4.1 Objections: Any party asserting an objection to the Claim must state the basis for the objection in writing and serve opposing counsel or the filing party within the time provided by applicable rules. The parties agree that objections shall specify legal grounds, disputed amounts, and supporting evidence.

4.2 Reservation: Claimant expressly reserves the right to amend or supplement this Proof of Claim to correct classification, amounts, or to add supporting documentation as may be necessary to preserve rights.

5. REPRESENTATIONS, WARRANTIES AND CERTIFICATION

5.1 Representations: Claimant represents and warrants that the information set forth in this Proof of Claim is true and correct to the best of Claimant's knowledge and that Claimant is the lawful owner of the Claim or is duly authorized to file on behalf of the owner.

5.2 Certification: By signature below, Claimant certifies, under penalty of perjury, that the foregoing is true and correct and that the amounts claimed are accurate and reflect Claimant's good faith calculation of the indebtedness as of the date indicated.

6. NOTICES

6.1 All notices and communications under this Proof of Claim shall be in writing and delivered to the addresses provided herein or to such other address as a party may designate in writing. Notice is effective upon receipt.

7. AMENDMENTS, WAIVER AND COUNTERPARTS

7.1 Amendment: This Proof of Claim may be amended only by a written instrument signed by Claimant and, where required by law, acknowledged by Debtor or the authorized representative.

7.2 Waiver: No failure or delay by any party in exercising a right or remedy will operate as a waiver of that right. A waiver must be in writing and signed by the waiving party to be effective.

7.3 Counterparts: This Proof of Claim may be executed in counterparts, each of which will be an original and all of which together will constitute one instrument. Facsimile or electronic copies of signatures will be binding.

8. GOVERNING LAW; ENTIRE AGREEMENT; SEVERABILITY

8.1 Governing Law: This Proof of Claim will be governed by and construed in accordance with the substantive laws of the jurisdiction governing the underlying obligation, without regard to principles of conflicts of law.

8.2 Entire Agreement: This document, together with any written attachments and schedules, constitutes the entire statement of Claimant's claim as to the matters asserted herein and supersedes any prior written or oral statements with respect to the subject matter hereof.

8.3 Severability: If any provision of this Proof of Claim is held invalid or unenforceable, the remainder of this Proof of Claim will not be affected and each provision will be enforceable to the fullest extent permitted by law.

9. DECLARATION AND SIGNATURES

The undersigned declare under penalty of perjury under applicable law that the foregoing statements are true and correct, that the amounts claimed are justly due and owing, and that the claimant possesses the authority to file this Proof of Claim.

Sign Now