Filer's Name, Address, Phone, Fax, Email: UNITED STATES BANKRUPTCY COURT DISTRICT OF HAWAII 1132 Bishop Street, Suite 250 Honolulu, Hawaii 96813 hib_3004-1 (12/09) Debtor: Joint Debtor: (if any) Case No.: Chapter: NOTICE OF CLAIM FILED ON BEHALF OF CREDITOR TO: [Attach a copy of the proof of claim to this notice and serve on creditor.] [Name and address of creditor]: NOTICE IS HEREBY GIVEN that a proof of claim on your behalf has been filed by the debtor or the trustee in this case. Under Local Bankruptcy Rule 3004-1, you may file an amended proof of claim which supersedes the amount, type of claim, or other information stated in the proof of claim filed on your behalf. Such an amended proof of claim must be filed not later than 30 days after the date of service of this notice. Deadline to File Amended Proof of Claim: An amended proof of claim may be filed with the court at the address below and should also be mailed to the name and address in the upper left corner of this document. United States Bankruptcy Court District of Hawaii 1132 Bishop Street, Suite 250 Honolulu, HI 96813 If you mail an amended proof of claim to the court for filing, you must mail it early enough so the court will receive it on or before the date noted above. Dated: ____________________________ /s/ _________________________________________ Debtor / Attorney / Trustee American LegalNet, Inc. www.FormsWorkFlow.com