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(Spouse, if filing) United States Bankruptcy Court for the: District of (State) Case number Official Form 410 Proof of Claim 12/15 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 red.

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How to fill out the Official Form 410a online

Filling out the Official Form 410a is an important step in making a claim for payment in a bankruptcy case. This guide will provide clear, step-by-step instructions to help you complete the form accurately and efficiently, ensuring you understand each section and field.

Follow the steps to complete Official Form 410a online

  1. Click ‘Get Form’ button to obtain the form and open it in the editor.
  2. In the first section, identify the case by providing the names of the debtors. Fill in the information for Debtor 1 and, if applicable, Debtor 2 (spouse) in the designated fields. Ensure to include the United States Bankruptcy Court district and case number.
  3. Move to Part 1: Identify the Claim. Fill in the name of the current creditor, any other names they used with the debtor, and indicate if the claim has been acquired from someone else. Specify where notices and payments to the creditor should be sent.
  4. In Part 2, provide information about the claim as of the filing date. State if you have a number to identify the debtor, the amount of the claim, and the basis of the claim. Ensure to disclose if the claim is secured, its value, and the amount necessary to cure any default.
  5. Continue to fill in details regarding the priority of the claim under 11 U.S.C. § 507(a), checking all applicable boxes and providing amounts entitled to priority.
  6. Finally, sign the form in Part 3. Check the appropriate box indicating your role, complete the date, and provide your signature. Fill in your printed name, title, company (if applicable), address, contact phone, and email.
  7. Once you have completed the form, save your changes. You can download, print, or share the filled form as needed.

Complete your documents online today to ensure your claim is processed efficiently.

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A Withdrawal of Claim must be signed by the filing party. The document must specify which claim is being withdrawn, using the Court claim number (this can be located in CM/ECF by going to Reports > Claims Register).

A proof of claim may be filed using the Official 410 Proof of Claim form available on the court's website and mailed back to the court in time to ensure that it is received on or before the deadline contained in the Meeting of Creditors notice.

At the top of the form, there is a box to identify the debtor by name, the pending case number, and the bankruptcy court in which the case is pending. You can determine the name of the bankruptcy court and the case number by looking at the other documents you have received from the court or the clerk.

Mortgage Proof of Claim Attachment (Official Form 410A) This Official Form 410A must be attached to a proof of claim in an individual debtor's bankruptcy case where the claim is secured by a security interest in the debtor's principal residence.

You, the plaintiff, must file a “Statement of Claim” form, available at your Clerk's office. This must be fully completed and signed to receive a pre-trial conference date. If your claim is based upon written documentation, attach a copy of the contract to the Statement of Claim form. You may file by mail or in person.

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.

A personal representative's proof of claim shall state: (1) the basis for each claim; (2) the amount claimed; (3) the name and address of the claimant; (4) the security for the claim, if any; (5) whether the claim is matured, unmatured, contingent, or unliquidated; (6) whether the claim has been paid or is to be paid; ...

Completing a Proof of Claim Form Name of debtor: ... Case number: ... Name of creditor: ... Name and address where notices should be sent: ... Account or other number by which creditor identifies debtor: ... If this claim replaces or amends a previously filed claim:

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