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UNITED STATES BANKRUPTCY COURT DISTRICT OF OREGON In re ) ) ) ) ) ) )

Case No.________________

OBJECTION TO CLAIM, AND ORDER AND NOTICE THEREON

Debtor(s)

1. The undersigned objects to Claim No. _______, filed in the amount of $______________, by ___________ _________________________________________________________________________________________ _______________________________________________________________, whose current filed address is ________________________________________________________________________________________. 2. The undersigned objects to such claim on the ground(s) it (check all applicable sections): Duplicates Claim No. ________ filed by _____________________________________________________. Does not include a copy of the writing upon which it is based [NOTE: Do NOT use this for claims based on a statute (e.g., taxes)]. Does not include an itemized statement of the account. Does not include a copy of the underlying judgment. Does not include a copy of the security agreement and evidence of perfection. Fails to assert grounds for priority. Does not include a copy of the assignment(s) upon which it is based. Appears to include interest or charges accrued after the filing. Appears value of collateral exceeds debt. ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________

763.2 (8/8/08) Page 1 of 2

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3.

The undersigned recommends said claim be: (check ONE!) Disallowed in full. [NOTE: You MUST fill in EACH blank even if it is "$0"!] Allowed as a SECURED claim for $____________; a PRIORITY UNSECURED claim for $____________; AND a NONPRIORITY UNSECURED claim for $____________. THE UNDERSIGNED CERTIFIES THAT a copy of any Withdrawal of this Objection will be served on all parties that were served a copy of this Objection (i.e., the U.S. Trustee, any trustee, debtor(s), the creditor at the address shown above, and their respective attorneys; and, if the creditor is a federal agency, on the U.S. Attorney for the District of Oregon and the U.S. Attorney General).

4.

DATE: __________

_____________________________________________________________________
Objecting Party Signature AND Relation to Case

_____________________________________________________________________
Objecting Party Name AND Service Address (Type or Print)

_____________________________________________________________________
Objecting Party Phone Number

_____________________________________________________________________
Any Case Trustee's Name AND Service Address (Type or Print)

_____________________________________________________________________
(If Debtor is Objecting Party) Debtor's Address & Taxpayer ID#(s) (last 4 digits)

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