B10(OfficialForm10)(12/11)

UNITEDSTATESBANKRUPTCYCOURT «USBANKRUPTCYCOURT» / PROOFOFCLAIM
NameofDebtor:
«NAME» / CaseNumber:
«CASENUMBER» / COURTUSEONLY
NOTE:Donotusethisformtomakeaclaimforanadministrativeexpensethatarisesafterthebankruptcyfiling.You
mayfilearequestforpaymentofanadministrativeexpenseaccordingto 11U.S.C.§503.
NameofCreditor(thepersonorotherentitytowhomthedebtorowesmoneyorproperty):
CornerStone Education Loan Services on behalf of the Department of Education
Nameandaddresswherenoticesshouldbesent:
PO Box 145123
Salt Lake City, UT 84114-5123
Telephonenumber: (801) 321-7236email: / ❐Checkthisboxifthisclaimamendsa previouslyfiledclaim.
CourtClaimNumber:
(Ifknown)
Filedon:
Nameandaddresswherepaymentshouldbesent(ifdifferentfromabove):
Telephonenumber:email: / ❐Checkthisboxif youareawarethat anyoneelsehasfiledaproofofclaim
relatingtothisclaim.Attachcopyof
statementgivingparticulars.
1. AmountofClaimasofDateCaseFiled:$«AMOUNTOFCLAIM»
Ifallorpartoftheclaimissecured,completeitem4.
Ifallorpartoftheclaimisentitledto priority,completeitem5.
Checkthisboxiftheclaimincludesinterestorotherchargesinadditiontotheprincipalamountof theclaim.Attachastatementthatitemizesinterestorcharges.
2. BasisforClaim: Student/Educational Loans
(Seeinstruction#2)
3. Lastfourdigitsofanynumber bywhichcreditoridentifiesdebtor:
«IDENTIFIER» / 3a.Debtormayhavescheduledaccountas:
(Seeinstruction#3a) / 3b.UniformClaimIdentifier(optional):
(Seeinstruction#3b)
Amountofarrearageandothercharges,asofthetimecasewasfiled,
4.SecuredClaim(Seeinstruction#4)includedinsecuredclaim,ifany:
Checktheappropriateboxiftheclaimissecuredbyalienonpropertyorarightof
setoff,attachrequiredredacteddocuments,andprovidetherequestedinformation.$
Natureofpropertyorrightofsetoff:❐RealEstate ❐MotorVehicle ❐OtherBasisforperfection: Describe:
ValueofProperty:$AmountofSecuredClaim:$
AnnualInterestRate_%❐Fixed or ❐VariableAmountUnsecured:$(when casewasfiled)
5.AmountofClaimEntitledto Priorityunder11U.S.C.§507(a).If anypartoftheclaimfallsintooneofthefollowingcategories,checktheboxspecifying thepriorityandstatetheamount.
❐Domesticsupportobligationsunder11 ❐Wages,salaries,orcommissions(upto$11,725*) ❐Contributionstoan
U.S.C.§507(a)(1)(A)or(a)(1)(B). earnedwithin180daysbeforethecasewasfiledorthe employeebenefitplan–
debtor’sbusinessceased,whicheverisearlier–11U.S.C.§507(a)(5).
11U.S.C.§507(a)(4).Amountentitledtopriority:
❐Upto$2,600*ofdepositstoward ❐Taxesorpenaltiesowedtogovernmentalunits– ❐Other–Specify $
purchase,lease,orrentalofpropertyor 11U.S.C.§507(a)(8). applicableparagraphof servicesforpersonal,family,orhousehold 11U.S.C.§507(a)( ). use–11U.S.C.§ 507(a)(7).
*Amountsaresubjecttoadjustmenton4/1/13andevery3yearsthereafterwithrespecttocasescommencedonorafterthedateofadjustment.
6.Credits.Theamountofallpaymentsonthisclaimhasbeencreditedforthepurposeof makingthisproofofclaim.(Seeinstruction#6)

7.Documents:Attachedareredactedcopiesofanydocumentsthatsupporttheclaim,suchaspromissorynotes,purchaseorders,invoices,itemizedstatementsof runningaccounts,contracts,judgments,mortgages,andsecurityagreements. Iftheclaimissecured,box4hasbeencompleted,andredactedcopiesofdocuments providingevidenceofperfectionofasecurityinterestareattached.(Seeinstruction#7,andthedefinitionof “redacted”.)

DONOTSENDORIGINALDOCUMENTS.ATTACHEDDOCUMENTSMAYBEDESTROYEDAFTERSCANNING. Ifthedocumentsarenotavailable,pleaseexplain:

8.Signature:(Seeinstruction#8)

Checktheappropriatebox.

❐Iamthecreditor.Iamthecreditor’sauthorizedagent. (Attachcopyofpowerofattorney,if any.)

❐Iamthetrustee,orthedebtor, ortheirauthorizedagent.

(SeeBankruptcyRule3004.)

❐Iamaguarantor,surety,indorser,orothercodebtor. (SeeBankruptcyRule3005.)

Ideclareunderpenaltyofperjurythattheinformationprovidedinthisclaimis trueandcorrecttothebestof myknowledge,information,andreasonablebelief.

PrintName: Title: Company:

Addressandtelephonenumber(ifdifferentfromnoticeaddressabove):

«CURRENTDATE»

(Signature)(Date)

Telephonenumber:email:

Penaltyforpresentingfraudulentclaim:Fineofupto $500,000orimprisonmentforupto5 years,orboth.18U.S.C.§§152and3571.

INSTRUCTIONSFORPROOFOFCLAIMFORM

Theinstructionsanddefinitionsbelowaregeneralexplanationsofthelaw.In certaincircumstances,suchasbankruptcycasesnotfiledvoluntarilybythedebtor,

exceptionstothesegeneralrulesmayapply.

Itemstobecompletedin ProofofClaimform

Court,NameofDebtor,andCaseNumber:

Fillinthefederaljudicialdistrictinwhichthebankruptcycasewasfiled(for

example,CentralDistrictofCalifornia),thedebtor’sfullname,andthecase number.Ifthecreditorreceiveda noticeofthecasefromthebankruptcycourt,

allofthisinformationis atthetopofthenotice.

Creditor’sNameandAddress:

Fillinthenameofthepersonorentityassertingaclaimandthenameand

addressofthepersonwhoshouldreceivenoticesissuedduringthebankruptcy case.Aseparatespaceisprovidedforthepaymentaddressifitdiffersfromthe

noticeaddress.Thecreditorhasacontinuingobligationto keepthecourt informedofitscurrentaddress.SeeFederalRuleofBankruptcyProcedure

(FRBP)2002(g).

1.AmountofClaimasofDateCaseFiled:

Statethetotalamountowedtothecreditoronthedateofthebankruptcyfiling.

Followtheinstructionsconcerningwhethertocompleteitems4and5.Check theboxifinterestorotherchargesareincludedintheclaim.

2.BasisforClaim:

Statethetypeofdebtorhowitwasincurred.Examplesincludegoodssold,

moneyloaned,servicesperformed,personalinjury/wrongfuldeath,carloan, mortgagenote,andcreditcard.Iftheclaimisbasedondeliveringhealthcare

goodsorservices,limitthedisclosureofthegoodsorservicessoastoavoid embarrassmentorthedisclosureofconfidentialhealthcareinformation.You

mayberequiredtoprovideadditionaldisclosureifaninterestedpartyobjectsto theclaim.

3.LastFourDigitsofAnyNumberbyWhichCreditorIdentifiesDebtor: Stateonlythelastfourdigitsofthedebtor’saccountorothernumberusedbythe creditortoidentifythedebtor.

3a.DebtorMayHaveScheduledAccountAs:

Reportachangeinthecreditor’sname,atransferredclaim,oranyother informationthatclarifiesadifferencebetweenthisproofofclaimandtheclaim

asscheduledbythedebtor.

3b.UniformClaimIdentifier:

If youuseauniformclaimidentifier,youmayreportithere.Auniformclaim

identifierisanoptional24-characteridentifierthatcertainlargecreditorsuseto facilitateelectronicpaymentinchapter13cases.

4. SecuredClaim:

Checkwhethertheclaimisfullyorpartiallysecured.Skipthissectionif theclaim

isentirelyunsecured.(SeeDefinitions.) Iftheclaimissecured,checktheboxfor thenatureandvalueofpropertythatsecurestheclaim,attachcopiesoflien

documentation,andstate,asofthedateofthebankruptcyfiling,theannualinterest rate(andwhetheritisfixedorvariable),andtheamountpastdueontheclaim.

5. AmountofClaimEntitledto PriorityUnder11U.S.C.§507(a).

Ifanyportionoftheclaimfallsintoanycategoryshown,checktheappropriate

box(es)andstatetheamountentitledtopriority.(SeeDefinitions.)Aclaimmay bepartlypriorityandpartlynon-priority.Forexample,insomeofthecategories, thelawlimitstheamountentitledtopriority.

6. Credits:

Anauthorizedsignatureonthisproofofclaimservesas anacknowledgmentthat

whencalculatingtheamountoftheclaim,thecreditorgavethedebtorcreditfor anypaymentsreceivedtowardthedebt.

7. Documents:

Attachredactedcopiesof anydocumentsthatshowthedebtexistsandalien

securesthedebt.Youmustalsoattachcopiesofdocumentsthatevidenceperfection ofanysecurityinterest.You mayalsoattachasummaryinadditiontothe

documentsthemselves.FRBP3001(c)and(d).Iftheclaimis basedondelivering healthcaregoodsorservices,limitdisclosingconfidentialhealthcareinformation. Donotsendoriginaldocuments,asattachmentsmaybedestroyedafterscanning.

8. DateandSignature:

Theindividualcompletingthisproofofclaimmustsignanddateit. FRBP9011.

Iftheclaimisfiledelectronically, FRBP5005(a)(2)authorizescourtstoestablish localrulesspecifyingwhatconstitutesasignature.Ifyousignthisform,you declare under penaltyofperjurythattheinformationprovidedistrueandcorrectto thebestofyourknowledge,information, andreasonablebelief. Yoursignatureis also a certification that the claim meets the requirements of FRBP 9011(b). Whethertheclaimisfiledelectronically orinperson,ifyournameisonthe signatureline,youareresponsibleforthedeclaration. Printthenameandtitle,if any,ofthecreditororotherpersonauthorizedtofilethisclaim. Statethefiler’s addressandtelephone numberifitdiffersfrom theaddressgivenonthetopofthe formforpurposesofreceivingnotices.Iftheclaimisfiledbyanauthorized agent, attachacompletecopyofanypowerofattorney, andprovideboththenameofthe individual filingtheclaimandthenameoftheagent.Iftheauthorized agentisa servicer,identifythecorporateservicerasthecompany.Criminalpenaltiesapply formakingafalsestatementonaproofofclaim.

DEFINITIONS

INFORMATION

Debtor

Adebtoristheperson,corporation,orotherentity

thathasfiledabankruptcycase.

Creditor

Acreditorisaperson,corporation,orotherentityto

whomdebtorowesadebtthatwasincurredbefore thedateofthebankruptcyfiling.See11U.S.C.

§101(10).

Claim

Aclaimisthecreditor’srighttoreceivepaymentfor

adebtowedbythedebtoronthedateofthe bankruptcyfiling.See11U.S.C.§101(5).Aclaim

maybesecuredorunsecured.

ProofofClaim

Aproofofclaimis aformusedbythecreditorto

indicatetheamountofthedebtowedbythedebtor onthedateofthebankruptcyfiling.Thecreditor

mustfiletheformwiththeclerkofthesame bankruptcycourtinwhichthebankruptcycasewas filed.

SecuredClaimUnder11U.S.C.§ 506(a)

Asecuredclaimis onebackedbyalienonproperty

ofthedebtor.Theclaimissecuredso longasthe creditorhastherighttobepaidfromtheproperty

priortoothercreditors.Theamountofthesecured claimcannotexceedthevalueoftheproperty.Any

amountowedtothecreditorin excessofthevalueof thepropertyis anunsecuredclaim.Examplesof

liensonpropertyincludea mortgageonrealestateor

asecurityinterestinacar. Alien maybevoluntarily grantedbyadebtorormaybeobtainedthrougha court proceeding.Insomestates,a courtjudgmentis a lien.

Aclaimalsomaybesecuredifthecreditorowesthe debtormoney(hasarighttosetoff).

UnsecuredClaim

Anunsecuredclaimisonethatdoesnotmeetthe

requirementsofasecuredclaim.A claimmaybe partlyunsecurediftheamountoftheclaimexceeds thevalueofthepropertyonwhichthecreditorhasa lien.

ClaimEntitledto PriorityUnder11U.S.C.§507 (a)

Priorityclaimsarecertaincategoriesof unsecured

claimsthatarepaidfromtheavailablemoneyor propertyinabankruptcycasebeforeotherunsecured

claims.

Redacted

Adocumenthasbeenredactedwhenthepersonfiling

ithasmasked,editedout,orotherwisedeleted, certaininformation.Acreditormustshowonlythe

lastfourdigitsof anysocial-security,individual’s

tax-identification,orfinancial-accountnumber,only theinitialsofa minor’sname,andonlytheyearof

anyperson’sdateofbirth.Iftheclaimisbasedonthe deliveryofhealthcaregoodsorservices,limitthe disclosureofthegoodsorservicessoastoavoid

embarrassmentorthedisclosureofconfidential healthcareinformation.

Evidenceof Perfection

Evidenceofperfectionmayincludea mortgage,lien,

certificateoftitle,financingstatement,orother documentshowingthatthelienhasbeenfiledor

recorded.

AcknowledgmentofFilingofClaim

Toreceiveacknowledgmentof yourfiling,youmay

eitherencloseastampedself-addressedenvelopeand acopyofthisproofofclaimor you mayaccessthe court’sPACERsystem

( forasmallfeetoview yourfiledproofofclaim.

Offersto PurchaseaClaim

Certainentitiesareinthebusinessofpurchasing

claimsforanamountlessthanthefacevalueofthe claims.Oneormoreoftheseentitiesmaycontactthe

creditorandoffertopurchasetheclaim.Someofthe writtencommunicationsfromtheseentitiesmay

easilybeconfusedwithofficialcourtdocumentation orcommunicationsfromthedebtor.Theseentities donotrepresentthebankruptcycourtorthedebtor.

Thecreditorhasnoobligationtosellitsclaim. However,ifthecreditordecidestosellitsclaim,any transferofsuchclaimissubjectto FRBP3001(e),

anyapplicableprovisionsoftheBankruptcyCode (11U.S.C.§101etseq.),andanyapplicableorders ofthebankruptcycourt.