U.S. Courthouse UNITED STATES BANKRUPTCY COURT 1716 Spielbusch Avenue NORTHERN DISTRICT OF OHIO - WESTERN DIVISION Rm 411 Toledo, Ohio 43604 IN RE: CASE NO.: JUDGE: DEBTOR(S): CHAPTER: Last four digits of Social Security Number or Individual Tax-payer Identification ((ITIN) No(s.,(if any): Employer222s Tax Identification (EIN) No(s). (if any): NOTICE OF OBJECTION TO CLAIM has filed an objection to your claim in this bankruptcy case. Your claim may be reduced, modified, or eliminated. You should read these papers carefully and discuss them with your attorney, if you have one. If you do not want the Court to eliminate or change your claim, then on or before , you or your lawyer must: File with the court a written response at: Clerk, U.S. Bankruptcy Court 1716 Spielbusch Avenue Room 411 Toledo, Ohio 43604 If you mail your request/response to the Court for filing, you must mail it early enough so the Court will receive it on or before the date stated above. You must also send a copy to: objector222s attorney222s name and address names and addresses of others to be served Attend the hearing on the objection, to be separately scheduled by the court if you timely file a written response to the objection. If you or your attorney do not take these steps, the Court may decide that you do not oppose the objection to your claim. Dated: Signature: Name: Address: American LegalNet, Inc. www.FormsWorkFlow.com Certificate of Service This is to certify that a copy of the Notice of Objection to Claim was sent to the following list of parties on in accordance with Bankruptcy Rule 3007(a). Date: Signature: List of Parties Served American LegalNet, Inc. www.FormsWorkFlow.com