VTB Form Y-6 09/10 IN THE UNITED STATES BANKRUPTCY COURT FOR THE DISTRICT OF IN RE: John Q. Debtor, Debtor. ) ) ) ) ) ) Chapter 13 Case # ______________ NOTICE OF TRANSFER OF CLAIM (Other than for Security) (no hearing required) A Proof of Claim has been filed in this case. The transferee hereby evidences, by way of documentation attached hereto, that the referenced claim has been transferred, other than for security, as is referenced in this Notice. This Notice must be used when any of the original payment information in a Proof of Claim changes. However, it should not be used for an amendment to the amount of the claim. For changes in the amount of the claim or the arrears only, an Amended Proof of Claim must be filed. Original Claim Information: Name of Claimant: Name of Payee [if different from claimant]: Payment Address: Last 4 digits of Account #: Claim # on Claims Register: Amount of Claim: Transferee Information: Name of Claimant: Name of Payee [if different from claimant]: Payment Address: Name/Address for Notices [if different from payment address]: Phone #: Last 4 digits of Account #: I, , do hereby declare under penalty of perjury that the information provided in this Notice is true and accurate to the best of my knowledge. I hereby declare that a copy of this Notice has been mailed to the Transferor and that proof of the transfer is annexed thereto. By: Transferee/Agent of Transferee Date: [Or date of entry of Order allowing claim] [Total debt] [Arrears] The penalty for making a false statement or claim includes a fine or imprisonment for up to five years, or both, 18 U.S.C. Sec. 152. 92 American LegalNet, Inc. www.FormsWorkFlow.com