Official Form 410 Proof of Claim

Transcription

1 Claim #33 Date Filed: 4/7/208 Fill in this information to identify the case: Full Throttle Films, LLC Debtor United States Bankruptcy Court for the: District of Delaware (State) Case number Official Form 40 Proof of Claim 04/6 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 U.S.C 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. f 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. 8 U.S.C. 52, 57, and 357. 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 : dentify the Claim. Who is the current creditor? Clark Wire and Cable 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 acquired from someone else? 3. Where should notices and payments to the creditor be sent? Where should notices to the creditor be sent? Federal Rule of Bankruptcy Procedure (FRBP) 2002(g) Yes. From whom? Clark Wire and Cable 408 Washington Blvd Name Mundelein, L 60060, USA Number Number State Contact phone Contact Name Street City Where should payments to the creditor be sent? (if different) ZP Code 847/ patti.collins@clarkwire.com Street City State ZP Code Contact phone Contact Uniform claim identifier for electronic payments in chapter 3 (if you use one): 4. Does this claim amend one already filed? Yes. Claim number on court claims registry (if known) Filed on MM 5. Do you know if anyone else has filed a proof of claim for this claim? Official Form 40 / DD / YYYY Yes. Who made the earlier filing? Proof of Claim q(e2 #^« page

2 Part 2: Give nformation About the Claim as of the Date the Case Was Filed 6. Do you have any number you use to identify the debtor? Yes. Last 4 digits of the debtor s account or any number you use to identify the debtor: How much is the claim? 4, Does this amount include interest or other charges? Yes. Attach statement itemizing interest, fees, expenses, or other charges required by Bankruptcy Rule 300(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 300(c). Limit disclosing information that is entitled to privacy, such as health care information. Goods Sold 9. s all or part of the claim secured? Yes. The claim is secured by a lien on property. Nature or property: Real estate: f the claim is secured by the debtor s principle residence, file a Mortgage Proof of Claim Attachment (Official Form 40-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 amount should match the amount in line 7.) Amount necessary to cure any default as of the date of the petition: Annual nterest Rate (when case was filed) % Fixed Variable 0. s this claim based on a lease? Yes. Amount necessary to cure any default as of the date of the petition.. s this claim subject to a right of setoff? Yes. dentify the property: Official Form 40 Proof of Claim page 2

3 2. s all or part of the claim entitled to priority under U.S.C. 507(a)? Yes. Check all that apply: Amount entitled to priority A claim may be partly priority and partly nonpriority. For example, in some categories, the law limits the amount entitled to priority. Domestic support obligations (including alimony and child support) under U.S.C. 507(a)()(A) or (a)()(b). Up to 2,850* of deposits toward purchase, lease, or rental of property or services for personal, family, or household use. U.S.C. 507(a)(7). Wages, salaries, or commissions (up to 2,850*) earned within 80 days before the bankruptcy petition is filed or the debtor s business ends, whichever is earlier. U.S.C. 507(a)(4). es or penalties owed to governmental units. U.S.C. 507(a)(8). Contributions to an employee benefit plan. U.S.C. 507(a)(5). Other. Specify subsection of U.S.C. 507(a)( ) that applies. 3. s all or part of the claim pursuant to U.S.C. 503(b)(9)? * Amounts are subject to adjustment on 4/0/9 and every 3 years after that for cases begun on or after the date of adjustment. Yes. ndicate the amount of your claim arising from the value of any goods received by the debtor within 20 days before the date of commencement of the above case, in which the goods have been sold to the Debtor in the ordinary course of such Debtor s business. Attach documentation supporting such claim Part 3: Sign Below The person completing this proof of claim must sign and date it. FRBP 90(b). f 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. 8 U.S.C. 52, 57, and 357. Check the appropriate box: am the creditor. am the creditor s attorney or authorized agent. am the trustee, or the debtor, or their authorized agent. Bankruptcy Rule am a guarantor, surety, endorser, or other codebtor. Bankruptcy Rule understand that an authorized signature on this Proof of Claim serves as an acknowledgement that when calculating the amount of the claim, the creditor gave the debtor credit for any payments received toward the debt. have examined the information in this Proof of Claim and have reasonable belief that the information is true and correct. declare under penalty of perjury that the foregoing is true and correct. Executed on date 04/7/208 MM / DD / YYYY /s/patricia Collins Signature Print the name of the person who is completing and signing this claim: Name Patricia Collins First name Middle name Last name Title Company CEO Clark Wire and Cable dentify the corporate servicer as the company if the authorized agent is a servicer. Address Number Street City State ZP Code Contact phone Official Form 40 Proof of Claim page 3

4 Debtor: Full Throttle Films, LLC District: District of Delaware Creditor: Clark Wire and Cable 408 Washington Blvd Mundelein, L, USA Phone: 847/ Phone 2: Fax: 847/ patti.collins@clarkwire.com Other Names Used with Debtor: Basis of Claim: Goods Sold Amount of Claim: 4,52.48 Has Priority Claim: Has Secured Claim: Amount of 503(b)(9): Yes: Based on Lease: Subject to Right of Setoff: Submitted By: Patricia Collins on 7-Apr-208 :26:7 p.m. Eastern Time Title: CEO Company: Clark Wire and Cable Has Supporting Documentation: Yes, supporting documentation successfully uploaded Related Document Statement: Has Related Claim: Related Claim Filed By: Filing Party: Creditor Amends Claim: Acquired Claim: Last 4 Digits: Uniform Claim dentifier: Yes ncludes nterest or Charges: Priority Under: Nature of Secured Amount: Value of Property: Annual nterest Rate: Arrearage Amount: Basis for Perfection: Amount Unsecured:

5 CLARK 408 Washington Blvd., Mundelein, L (847) Sold FULL THROTTLE FLMS, LLC DBA VDEO EQUPMENT RENTALS A/P 757 W. California Ave Bldg #4 Ship Video Equipment Rentals Dallas Attn: Jeff Werner/PO Hurd Drive rving TX (972) Terms Customer Net 30 Days Product,000 FT 08 ESFR50BK-YS.S"FLAME RETARD-YELLOW TRACE Discount Handling 6.2 PO Number FT,000 Fees

6 CLARK 408 Washington Blvd., Mundelein, L (847) FULL THROTTLE FLMS LLC DBA VDEO EQUPMENT RENTALS A/P 757 W. California Ave Bldg #4 Sold 200 FT Video Equipment Rentals Dallas Attn: Tim O'Flaherty 775 Hurd Drive rving TX (24) Ship HST-5/8-CL 2: 5/8" CLR POLYOLEFN HT FT Pro #: Z6E Product 4 Discount Handling Fees

7 <: LA RK 408 Washington Blvd., Mundelein, l (847) FULL THROTTLE FLMS, LLC Sold Video Equipment Rentals Ship PO Alp 757 W. California Ave Repair 757 W. Ca.liforniaAve Bldg #4..- Ship Via ~ F.O.B. Terms FedEx,000 FT Customer PO Number i~nieitzt3io[[da~~i~l<i<~~2~0~03i2i5i5~~i~ MND~-PPA DBA VDEO EQUPMENT RENTALS ~i~~~/.:== CN424C5TF Ultra-Flex TACTCAL CAT5E, FT Pro #: Product Handling Fees!Discount!

8 c LA RK 408 Washington Blvd., Mundelein, l (84~7) Sold FULL THROTTLE FLMS, LLC DBA VDEO EQUPMENT RENTALS A/P 757 W. California Ave Bldg #4 Ship Video Equipment Rentals PO /Bryant Scott 757 W. California Ave LA MAN/ Repair Dept Bldg#6 Customer PO Number,05 FT CN424C5TF Ultra-Flex,05 TACTCAL FT CAT5E Pro #: Product Discount Handling Fees

9 <::LARK 408 Washington Blvd., Mundelein, (84~7) Sold L FULL THROTTLE FLMS, LLC DBA VDEO EQUPMENT REtTALS Ship Alp 757 W. C lifornia Ave Bldg #4 Ship Via FedEx Ground ~~~~ % Terms V'iDLN -PPA Net 30 Days.>"m~4~e~/: 30 F.O.B. CWC-255B DC. PLUG 3. 3MM X 5. 5MM VER'C;:6LAMAN Repair Dept Bldg#6 757 W. California Ave Attn: Bryant Scott customer PO Number Pro #: Product Handling!Discount Fees o

10 c LA RK 408 Washington Blvd., Mundelein, l (84~7) Sold Ship FULL THROTTLE FLMS, LLC DBA VDEO EQUPMENT RENTALS A/P 757 W. California Ave Bldg #4 Via F.O,B Video Equipment Rentals Elizabeth Myers/Jonathan 2630 Old Hickory Blvd. Antioch TN 3703 Customer Net 30 Days 0 2 Terms FedEx Ground Ship ~~ LEV-6D24-UG MALE CAM TYPE-2/0-4/0 GREEN LEV-6D24-UW MALE CAM TYPE-2/0-4/0 WHTE LEV-6D24-UE MALE CAM TYPE-2/0-4/0 BLACK LEV-6D24-UR MALE CAM TYPE-2/0-4/0 RED LEV-6D24-UB MALE CAM TYPE-2/0-4/0 BLUE LEV-6D33-UG FEMALE CAM TYPE-2/0-4/0 GREEN LEV-6D33-UW FEMALE CAM TYPE-2/0-4/0 WHTE LEV-6D33-UE FEMALE CAM TYPE-2/0-4/0 BLACK LEV-6D33-UR FEMALE CAM TYPE-2/0-4/0 RED LEV-6D33-UB FEMALE CAM TYPE-2/0-4/0 BLUE wilso (65) PO Number ili~> :>< '~ /]' Pro #: Pro #: Pro #: Product 95 Discount Handling 89.6 nvoice Fees