Withdrawal of Claim — United States Bankruptcy Court

Summary

Withdrawal of claim form filed May 27, 2025 as Doc 1087 in Case 24-11217-BLS in the United States Bankruptcy Court. The undersigned, as the creditor or an authorized signatory for the creditor, withdraws the referenced claim and authorizes the clerk of the court or its duly appointed claims agent to reflect the withdrawal on the official claims register for the debtor. The instructions on the form define debtor, creditor and proof of claim, and ask for the court, debtor and case number, the creditor's name and address, and the claim number, filing date and amount of the withdrawn claim.

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Full text

United States Bankruptcy Court for the
WITHDRAWAL OF CLAIM
Debtor Name and Case Number:
Creditor Name and Address:
Court Claim Number (if known):
Date Claim Filed:
Total Amount of Claim Filed:
I, the undersigned, am the above-referenced creditor, or an authorized signatory for the above-referenced
creditor.  I 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.
Dated: ________________________

___________________________________

Print Name:  ________________________

Title (if applicable): __________________
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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 case 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Information identifying the Claim that is to be withdrawn: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.
Case 24-11217-BLS    Doc 1087    Filed 05/27/25    Page 1 of 1

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