024

FORM 24.

Proof of Claim for Wages, Salary, or Commission

UNITED STATES BANKRUPTCY COURT FOR THE CENTRAL DISTRICT OF CALIFORNIA In re DEBTOR INC. Bankruptcy 98-1111 Debtor (include here all names used by bankrupt/debtor within last 6 years) PROOF OF CLAIM FOR WAGES, SALARY, OR COMMISSION 1. The debtor owes the claimant $5,000.00 computed as follows: (a) wages, salary, or commission for services performed on April 1, 1998 to June 30, 1998, at the following rate or rates of compensation (if appropriate): $5,000.00 (b)

(specify)

allowances and benefits, such as vacation and severance pay

_________ Total amount claimed $5,000.00 2.

(a) 5)

The claimant demands priority to the extent permitted by Section 507

of the Bankruptcy Code. $4,000.00 3. The claimant has received no payment, no security, and no check or other evidence of the debt, except as follows: (state whether you were paid any money on this obligation, whether you retained any company property, such as a computer to offset the debt, etc.) Dated: Signed: JOHN DOE Claimant

Social Security Number:

Address: --Author's Note: The penalty for presenting fraudulent claims can be a fine of up to $5,000 or imprisonment for not more than five years or both.