Transfer Of Claim Other Than For Security {B2100A}

B 210A (Form 210A) (12/) UNITED STATES BANKRUPTCY COURT District Of In re ,Case No. TRANSFER OF CLAIM OTHER THAN FOR SECURITYA CLAIM HAS BEEN FILED IN THIS CASE or deemed filed under 11 U.S.C. 247 1111(a). Transfereehereby gives evidence and notice pursuant to Rule 3001(e)(2), Fed. R. Bankr. P., of the transfer, otherthan for security, of the claim referenced in this evidence and notice. Name of Transferee Name of TransferorName and Address where notices to transfereeCourt Claim # (if known): should be sent: Amount of Claim: Date Claim Filed: Phone: Phone: Last Four Digits of Acct #: Last Four Digits of Acct. #: Name and Address where transferee paymentsshould be sent (if different from above): Phone: Last Four Digits of Acct #: I declare under penalty of perjury that the information provided in this notice is true and correct to thebest of my knowledge and belief.By:Date:Transferee/Transferee222s AgentPenalty for making a false statement: Fine of up to $500,000 or imprisonment for up to 5 years, or both. 18 U.S.C. 247247 152 & 3571. American LegalNet, Inc. www.FormsWorkFlow.com