Pandemic Darlings The pandemic economy, in original documents
Home Source documents Withdrawal of Claim #2

Withdrawal of Claim #2

Date
2024-08-22

Summary

A Withdrawal of Claim filed July 11, 2025 as Doc 1116 in Case 24-11217-BLS in the United States Bankruptcy Court. The creditor, the Louisiana Department of Revenue, withdraws its claim against debtor Vyaire Medical Inc. The form lists the claim as filed 8/22/2024 in the total amount of $6,306.65. It is dated 7/9/2025, is signed by a revenue tax specialist for the creditor, authorizes the Clerk or the Claims Agent to reflect the withdrawal on the claims register, and includes the form's definitions and completion instructions.

Summary drafted by a model from the document's text below and checked by script against that text before publication. It is a navigation aid, not a reading of what the document proves. Where AI is used

Full text

Case 24-11217-BLS Doc1116 Filed07/11/25 Page1of1

United States Bankruptcy Court for the District

WITHDRAWAL OF CLAIM

Debtor Name and Case Number: Vyaire Medical Inc; 24-1 1 ?1 1

Louisiana Department of Revenue

Creditor Name and Address: | P.O. Box 66658
Baton Rouge, LA 70896-6658

Court Claim Number (if known): 1 67

Date Claim Filed: 8/22/2024
Total Amount of Claim Filed: $6,306.65

|, the undersigned, am the above-referenced creditor, or an authorized signatory for the above-referenced
creditor. | hereby withdraw the above-referenced claim and authorize the Clerk of this Court, or their
duly appointed Claims Agent, to reflect this withdrawal on the official claims register for the above-
referenced Debtor.

Hi Digitally signed by Ericka Matthews
Dated: 7/9/2025 Signature Ericka Matthews Date: 2025.07.09 10:59:28 -05'00"
Ericka Matthews

Revenue Tax Specialist

Print Name:

Title (if applicable):

DEFINITIONS

Debtor
The person, corporation, or other entity that has filed a bankruptcy case is called the debtor.

Creditor
A creditor is any person, corporation, or other entity to which the debtor owed a debt.

Proof of Claim
A form filed with the clerk of the bankruptcy court where the bankruptcy case was filed, to tell the bankruptcy court how much the debtor owed a
creditor (the amount of the creditor’s claim).

ITEMS TO BE COMPLETED ON THIS WITHDRAWAL OF CLAIM

Court, name of Debtor and Case Number:
Fill in the name of the federal judicial district where the bankruptcy was filed (for example, Central District of California), the name of the debtor in the
bankruptcy case, and the bankruptcy case number. If you received a notice of the case from the court, all of this information is near the top of the notice.

Information about Creditor:
Complete the section giving the name and address of the creditor that was listed on the previously filed Proof of Claim form.

Information identifying the Claim that is to be withdrawn:
Complete the section giving the court claim number, date claim was filed and total amount of claim filed to help identify the claim that is to be withdrawn

Sign and print the name and title, if any, of the creditor or other person authorized to file this withdrawal of claim (attach copy of power of attorney, if
any).

This form must be filed with the clerk of the bankruptcy court where the bankruptcy case was filed or, if applicable, with
their duly appointed Claims Agent as per any procedure approved by the court in the above-referenced bankruptcy
proceeding.

File and source

File
gov.uscourts.deb.193283.1116.0.pdf
Size
128,708 bytes
SHA-256
6dfc21d003133aaae1c94438570858b3593517783234b1feacba051505e6b498
Our copy
gov.uscourts.deb.193283.1116.0.pdf
Original
PACER (login required)
Back to top