Full text
Official Form 202
Declaration Under Penalty of Perjury for Non-Individual Debtors
Official Form 202
Declaration Under Penalty of Perjury for Non-Individual Debtors
12/15
An individual who is authorized to act on behalf of a non-individual debtor, such as a corporation or partnership, must sign and submit
this form for the schedules of assets and liabilities, any other document that requires a declaration that is not included in the document,
and any amendments of those documents. This form must state the individual’s position or relationship to the debtor, the identity of the
document, and the date. Bankruptcy Rules 1008 and 9011.
WARNING -- Bankruptcy fraud is a serious crime. Making a false statement, concealing property, or obtaining money or property by fraud in
connection with a bankruptcy case can result in fines up to $500,000 or imprisonment for up to 20 years, or both. 18 U.S.C. §§ 152, 1341,
1519, and 3571.
Declaration and signature
I am the president, another officer, or an authorized agent of the corporation; a member or an authorized agent of the partnership; or
another individual serving as a representative of the debtor in this case.
I have examined the information in the documents checked below and I have a reasonable belief that the information is true and correct:
Schedule A/B: Assets–Real and Personal Property (Official Form 206A/B)
Schedule D: Creditors Who Have Claims Secured by Property (Official Form 206D)
Schedule E/F: Creditors Who Have Unsecured Claims (Official Form 206E/F)
Schedule G: Executory Contracts and Unexpired Leases (Official Form 206G)
Schedule H: Codebtors (Official Form 206H)
Summary of Assets and Liabilities for Non-Individuals (Official Form 206Sum)
Amended Schedule ____
Chapter 11 or Chapter 9 Cases: List of Creditors Who Have the 20 Largest Unsecured Claims and Are Not Insiders (Official Form 204)
Other document that requires a declaration__________________________________________________________________________________
I declare under penalty of perjury that the foregoing is true and correct.
Executed on ______________
_________________________________________________________________________
MM / DD / YYYY
Signature of individual signing on behalf of debtor
________________________________________________________________________
Printed name
______________________________________
Position or relationship to debtor
Debtor Name __________________________________________________________________
United States Bankruptcy Court for the: ________________________________
Case number (If known):
_________________________
Fill in this information to identify the case and this filing:
2:19-bk-00787
Northern District of West Virginia
James Punelli
09/27/2019
/s/ James Punelli
Managing Member
Panthera Enterprises, LLC
X
Amended List of 20 Largest Unsecured Claims and are Not Insiders
No. 2:19-bk-00787 Doc 22 Filed 09/27/19 Entered 09/27/19 13:39:04 Page 1 of 3
Official Form 204
Chapter 11 or Chapter 9 Cases: List of Creditors Who Have the 20 Largest Unsecured Claims
page 1
Official Form 204
Chapter 11 or Chapter 9 Cases: List of Creditors Who Have the 20 Largest
Unsecured Claims and Are Not Insiders
12/15
A list of creditors holding the 20 largest unsecured claims must be filed in a Chapter 11 or Chapter 9 case. Include claims which the debtor
disputes. Do not include claims by any person or entity who is an insider, as defined in 11 U.S.C. § 101(31). Also, do not include claims by
secured creditors, unless the unsecured claim resulting from inadequate collateral value places the creditor among the holders of the 20
largest unsecured claims.
Name of creditor and complete
mailing address, including zip code
Name, telephone number,
and email address of
creditor contact
Nature of the claim
(for example, trade
debts, bank loans,
professional
services, and
government
contracts)
Indicate if
claim is
contingent,
unliquidated,
or disputed
Amount of unsecured claim
If the claim is fully unsecured, fill in only unsecured
claim amount. If claim is partially secured, fill in
total claim amount and deduction for value of
collateral or setoff to calculate unsecured claim.
Total claim, if
partially
secured
Deduction for
value of
collateral or
setoff
Unsecured
claim
1
2
3
4
5
6
7
8
Check if this is an
amended filing
Debtor name __________________________________________________________________
United States Bankruptcy Court for the:_______________________________
Case number (If known):
_________________________
Fill in this information to identify the case:
Panthera Enterprises, LLC
2:19-bk-00787
Monies Loaned /
Advanced
Monies Loaned /
Advanced
Sale Contract
Services
Insurance
Disputed
1,580,000.00
714,842.20
690,830.90
529,199.00
379,231.20
273,741.06
224,657.00
174,879.04
Northern District of West Virginia
Arthur J. Gallagher & Co.
4000 Midlantic Drive
Suite 200
Mount Laurel, NJ, 08054
Azadian Group, LLC
600 Madison Avenue
18th Floor
New York, NY, 10022
Midtown Resources
1518 Walnut Street
Suite 1400
Philadelphia, PA, 19102
Duncan Development Group, LLC
420 Park Street
Charlottesville, VA, 22902
SMI, LLC
c/o Timothy Kelsey
123 East Main Street, 5th Floor
Charlottesville, VA, 22902
Bill Neff Enterprises
3570 North Valley Pike
Harrisonburg, VA, 22802
A.L.L. Construction, Inc.
P.O. Box 232
Mount Storm, WV, 26739
Anthony McIntyre
4000 Midlantic Drive
Suite 200
Mount Laurel, NJ, 08054
856-675-2355
Tony_McIntyre@ajg.com
Jason Kitzmiller
304-693-7131
kitzmillerjason@msn.com
Bill Neff , Sr.
540-434-9593
neffenterprises@yahoo.com
Rob Duncan
434-906-2278
Michael Goldner
215-279-9090
mg@midtownresources.com
Raffi Azadian
646-434-0900
raffi@change.capital
Anthony McIntyre
856-482-9900
Tony_McIntyre@ajg.com
X
No. 2:19-bk-00787 Doc 22 Filed 09/27/19 Entered 09/27/19 13:39:04 Page 2 of 3
Debtor
_______________________________________________________
Case number (if known)_____________________________________
Name
Official Form 204
Chapter 11 or Chapter 9 Cases: List of Creditors Who Have the 20 Largest Unsecured Claims
page 2
Name of creditor and complete
mailing address, including zip code
Name, telephone number,
and email address of
creditor contact
Nature of the claim
(for example, trade
debts, bank loans,
professional
services, and
government
contracts)
Indicate if
claim is
contingent,
unliquidated,
or disputed
Amount of unsecured claim
If the claim is fully unsecured, fill in only unsecured
claim amount. If claim is partially secured, fill in
total claim amount and deduction for value of
collateral or setoff to calculate unsecured claim.
Total claim, if
partially
secured
Deduction for
value of
collateral or
setoff
Unsecured
claim
9
10
11
12
13
14
15
16
17
18
19
20
n8 Consulting LLC
PO Box 651163
Sterling, VA, 20165
Brian Riso
138 Woodridge Drive
Morehead City, NC, 28557
Dinsmore & Shohl, LLP
Accounts Receivable
PO Box 639038
Cincinnati, OH, 45263
Monies Loaned /
Advanced
United Health Care
185 Asylum Street
Hartford, CT, 06103
Monies Loaned /
Advanced
Sprectrum Consulting, LLC
11 Canal Center Plaza
Suite 300
Alexandria, VA, 22314
Monies Loaned /
Advanced
Parker, Ostovic & Associates
1940 Duke Street
Suite 200
Alexandria, VA, 22314
Services
Michael L. Cranston, CPA, Ltd.
4085 Chain Bridge Road
Suite 400
Fairfax, VA, 22030
Services
Services
Unity Technology Corporation
3001 Ward Kline Road
Myersville, MD, 21773
Services
Raymond Barbic
26098 Huntwick Glen Square
Aldie, VA, 20105
Panthera Enterprises, LLC
11,525.00
Insurance
James Michael Dowty
1477 Seaside Circle
Gulf Breeze, FL, 32566
Services
Tim Miller
440 Premier Circle
Suite 200
Charlottesville, VA, 22901
Monies Loaned /
Advanced
2:19-bk-00787
18,000.00
21,247.85
Income Taxes
Services
26,169.94
31,113.70
47,806.12
54,973.41
96,957.48
103,580.68
122,036.11
151,500.00
170,113.44
Disputed
434-882-0121
tmiller@meridianwbe.com
407-443-1427
302-379-7608
rvbarbic@gmail.com
Joe Dorsey
301-508-7065
joe.dorsey@unitytec.com
703-218-9818
mcranston@verizon.net
Rudy Ostovich, III
703-684-4421
rudy@parkerostovich.com
703-683-4222
Samantha Liappes
860-702-5403
samantha_liappes@uhc.com
513-977-8131
State of West Virginia/State Tax Dept.
397 Mid-Atlantic Pkwy
Suite 2
Martinsburg, WV, 25401
252-723-7897
phrogs364@gmail.com
Frank Chille
703-483-0037
frank.chille@n8-consulting.com
Jennifer Sikes
(304) 707-9513
Jennifer.M.Sikes@wv.gov
No. 2:19-bk-00787 Doc 22 Filed 09/27/19 Entered 09/27/19 13:39:04 Page 3 of 3