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Proof Of Claim For Wages Salary Or Commissions BOF 20 - District Of Columbia
|Proof Of Claim For Wages Salary Or Commissions Form. This is a District Of Columbia form and can be used in USBC District Of Columbia Federal .||
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BOF 20 (8/83) United States Bankruptcy Court For the_______________District of ______________ In re Case No._______________ Debtor* PROOF OF CLAIM FOR WAGES, SALARY, OR COMMISSIONS 1. The undersigned, claimant herein, resides at** and has social security number 2. The debtor owes the claimant , computed as follows: (a) wages, salary or commissions for services performed from the day of , 20 , to the day of , 20 , at the following rate or rates of compensation ____________________ (b) allowances and benefits, such as vacation, severance and sick leave pay (specify) ____________________ ___________________________________ Total Amount Claimed 3. The claimant demands priority to the extent permitted by 11 U.S.C. § 507(a)(3). 4. The claimant has received no payment, no security, and no check or other evidence of this debt except as follows: Claim Number (For Office Use Only) Dated: Signed: __________________________________________, Claimant § 152. Penalty for Presenting Fraudulent Claim. Fine of not more than $5,000 or imprisonment for not more than 5 years or both--Title 18, U.S.C. *Include all names used by debtor with in last 6 years. **State post office address. 2002 © American LegalNet, Inc.