ADVANCED FIRE & SAFETY, LLC STE com 219 SANDHURST LAFAYETTE.

Transcription

1 B io Modified (Official Form 10) {12/11) PRF UNITED STATES BANKRUPTCY COURT, SOUTHERN DisTRia* OF TEXAS Name of Debtor: ATP Oil & Gas Coiporatiot) Case Number PROOF OF CLAIM NO i E: Do not use tills form to make a claim for an administrative expense that arises after the bankruptcyfiling. You mo)^file a request for payment of an adminislraiive e.xpeme according toll U.S.C. 503, ADVANCED FIRE & SAFETY, LLC Name mid address vvfiere notices should be sent: CADE A. EVANS ALLEN & GOOCH 2000 KALISTE SALOOM RD. LAFAYETTE LA Telephone number -j^-j^q _yq-\ _- fifio Nameanda4i«v,er p^.m,t^^^^^^ 219 SANDHURST LA LAFAYETTE. Teliphone number: l\ Amount of Claim as of Date Case Filed: $ 151, If a!i or part of the claim is secured, complete item 4, If all or part of the claim is entitled to priority, complete item 5, STE. 400 cadeevans@allengooch com TtiikeOadvanf s. com Check tliis box if the claim includes interest or other charges in addition to the principal oniount of ihe claim. Attach a statement that itemizes O Checkfliisbox tf this claim amends a previously filed claim. Court Claim Number: {IfknoMm) Filed on: O 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. 5..Amount ofclaim Entitled to Priority under n U.S.C, S07(a). Ifany part of the c/aim falls into one of the following categories, check the box specifying the priorif)' and state the amount. 2. Basis for Claim: Goods and services provided to ATP for wells {Secinstmction#2)(3,escribed on attached invoices 3. Ij,5tfonrdigits of any number by which creditor identifies debtor: 3a, Debtor may have sdicilulcd account as: 3b. Unifonii Claim Identifier (optional); (See instniction #3a) (See instniction #3b) 4. Secured Claim (See instnictibii #4) Ch&k the appropriate box if the claim is secured by a lien on property or arightof setofl'. attach required redacted documents, and provide the requested information. Nature ofpropcrty or right of setoff: SiReal Estate OMotor Vehicle OOther Describe: ATP' s interests in wells (see attached) Vatiic of Property: sunknown. Annual Interest Rate legal % OFi,«d gvariable (when case was filed) Amount of arrearage and other charges, as of the time case was filed, included in secured claim, ifativ:$ total Basis for perfection: Liens filed & recorded Amount of Secured Claim: S $151, Amount Unsecured: S Credits. The amount of all payments on this claim has been credited for the puipose of making this proof of claim. (See in.struction #6) 7, CHicumcnte: Attached arc redacted copies of any; documents that support the claiiii, such as promissor>' notes, purchase orders, invoices, itemized statements of running accounts, contracts, judgments, mortgages, and security agreements. 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, (See instruction #7, and the defmilionofredmled".) DO NOT SEND ORIGINAL DOCUMENTS. ATTACHED DOCUMENTS MAY BE DESTROYED AFTER SCANNING. If the documents are not available, please explain: 8. Signature: (See instruction #S) Check the appropriate box. O 1 [jm llie creditor. IXI am the creditor's authorized agent. (Attach copy of power of attorney, ifany.) OI am tlie trustee, or the debtor, or their authorized agent. (See Bankruptcy Rule 3004.) OI am a guarantor, surety, indonser, or other codebtor. (See Bankruptcy Rule 3005.) O Domestic support obligations under II U.S.C, 507{a)(l)(A)or{a)(lXB). O Wages, salaries, or commissions (up to $11,725*) earned witliin 180 days before the case was filed or the debtor's business ceased, vvliichever is earlier -11 U.S.C. 507 (a)c4). O Conliibutions to an employee benefitplan-llu,s,cp07 (ax5). Up to $2,600* of deposits toward purchase, lease, or rental ofpropcrty orser\'ices for personal, family, or household use -11 U.S.C. 507 (a)(7). O Taxes or penalties owed to governmental units- UU.S.C. 507 (a)(8). O Other-Specify applicable paragraph of 11 U.S.C, 507 (n)lj. Amount entitled to priority: $ * Amounts are subject to adjustment an 4/1/13 and every 3 years thereafter with respect to cases commenced on or after tlie date ofadjustment. 1 declare under penalty of perjury that the information provided in this claim is ti reasbnable belief, Cade A. Evans Print Namo:_ At;t:orney TidA Company: _ Allen & Gooch (Signature) Address and telephone number (if different from notice address above): Telephone number: Penaltyfor presenting fraudulent claim: Fine of up to 5500,000 or imprisonment for up to 5 years, or boili, 18 U.S.C, 152 and COURT USE ONLY

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