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Assignment for the Benefit of Creditors of:
Name of Assignor: Animal Supply, Co.
Name of Assignee: ASC Liquidation Services, LLC
Date of Assignment: October 3, 2024
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PROOF OF CLAIM
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Name of Creditor (the person or entity to whom Assignor owes money or property):
Social Security or Tax I.D.#:
Name and address where notices should be sent:
Contact Name:
Email Address:
Mailing Address: , ,
Phone Number:
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Addition Information:
[ ] Address differs from the address on the envelope sent to you on behalf of the Assignee.
[ ] Claim amends a previously filed claim.
- Claim number:
- Date claim mailed:
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THIS SPACE FOR OFFICE USE ONLY
DATE RECEIVED:
CLAIM NO:
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1. Amount of Claim (as of assignment date): $
[ ] All or part of claim is secured.
[ ] All or part of claim is entitled to priority.
[ ] All or part of amount is for equity interest.
[ ] Claim includes interest or other charges in addition to the Principle amount of the claim. Amount: $
In addition, attach statement that itemizes interest or charges.
Date debt was incurred:
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2. Basis for Claim:
Other (Describe briefly):
If Court Judgment, date Judgment obtained:
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3. Last four digits of any number by which creditor identifies assignor:
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3a. Assignor may have scheduled account as:
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4. Secured Claim:
Check the appropriate box if the claim is secured by a lien on property or a right or setoff. Attach all documents that support the contention that the claim is secured.
Nature of property or right to setoff:
[ ] Real Estate [ ] Personal Property [ ] Motor Vehicle [ ] Other
Describe:
Value of Property: $
Annual Interest Rate:
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Amount of arrearage and other charges as of the time of the assignment, included in secured claim, if any: $
Basis for perfection:
Amount of Secured Claim: $
Amount Unsecured: $
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5. Priority Claim: Amount of claim entitled to priority and the basis on which such a priority is claimed.
Amount entitled to priority $
Basis for priority (describe):
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7. Documents: Attach copies of any documents that support the claim, such as promissory notes, purchase orders, invoices, itemized statements of running accounts. contracts. judgments. mortgages. and security agreements. If the claim is secured, and box 4 has been completed, attach copies of documents providing evidence of perfection of a security interest. DO NOT SEND ORIGINAL DOCUMENTS. ATTACHED DOCUMENTS MAY BE DESTROYED AFTER SCANNING. If the documents are not available, please explain.
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8. DATE-STAMPED COPY: To receive an acknowledgement of the filing of your claim. Send a stamped, self-addressed envelope and copy of this proof of claim.
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BY MY SIGNATURE BELOW, I DECLARE UNDER PENALTY OF PERJURY, UNDER THE LAWS OF THE STATE OF CALIFORNIA, THAT THE INFORMATION PROVIDED HEREIN AND ATTACHED HERETO IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF.
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Print Name: Title: Company:
Telephone Number: Email Address: