Proof Of Claim For Wages Salary Or Commissions
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Proof Of Claim For Wages Salary Or Commissions Form. This is a District Of Columbia form and can be use in USBC District Of Columbia Federal.
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Tags: Proof Of Claim For Wages Salary Or Commissions, BOF 20, District Of Columbia Federal, USBC District Of Columbia
BOF 20
(8/83)
United States Bankruptcy Court
For the_______________District of ______________
In re
Case No._______________
Debtor*
PROOF OF CLAIM FOR
WAGES, SALARY, OR COMMISSIONS
1. The undersigned, claimant herein, resides at**
and has social security number
2. The debtor owes the claimant
, computed as follows:
(a) wages, salary or commissions for services performed from the
day of
, 20
, to the
day of
, 20
, at the
following rate or rates of compensation
____________________
(b) allowances and benefits, such as vacation, severance and sick
leave pay (specify)
____________________
___________________________________
Total Amount Claimed
3. The claimant demands priority to the extent permitted by 11 U.S.C. § 507(a)(3).
4. The claimant has received no payment, no security, and no check or other evidence of this debt except as follows:
Claim Number
(For Office Use Only)
Dated:
Signed: __________________________________________,
Claimant
Penalty for Presenting Fraudulent Claim. Fine of not more than $5,000 or imprisonment for not more than 5 years or both—Title 18, U.S.C.
§ 152.
*Include all names used by debtor with in last 6 years. **State post office address.
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