Proof of Claim Submission FormAMORTIZATION PROCEEDINGS CASE INFORMATIONWisconsin Court County(Required)Click to ChooseAdamsAshlandBarronBayfieldBrownBuffaloBurnettCalumetChippewaClarkColumbiaCrawfordDaneDodgeDoorDouglasDunnEau ClaireFlorenceFond du LacForestGrantGreenGreen LakeIowaIronJacksonJeffersonJuneauKenoshaKewauneeLa CrosseLafayetteLangladeLincolnManitowocMarathonMarinetteMarquetteMenomineeMilwaukeeMonroeOcontoOneidaOutagamieOzaukeePepinPiercePolkPortagePriceRacineRichlandRockRuskSaint CroixSaukSawyerShawanoSheboyganTaylorTrempealeauVernonVilasWalworthWashburnWashingtonWaukeshaWaupacaWausharaWinnebagoWoodCase Number(Required)Date Case Was Filed(Required) MM slash DD slash YYYY Debtor / Account Holder Name(Required)CREDITOR INFORMATIONCreditor Name(Required)Debtor's Account Number(Required)Your Address for Correspondence(Required) Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Your Address for Payments(Required) Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP CREDITOR AVERS AS FOLLOWS:1) On the date the petition was filed, the debtor was indebted to the creditor on the account identified above in the amount entered below. (Required)Amount(Required)If nothing is owed, and/or this account has been paid, indicate here. (Required)Nothing Owed(Required)NeitherNothing OwedAccount Paid in Full2) No judgment has been rendered relating to this debt, except the case indicated below.Wisconsin Court CountyClick to ChooseAdamsAshlandBarronBayfieldBrownBuffaloBurnettCalumetChippewaClarkColumbiaCrawfordDaneDodgeDoorDouglasDunnEau ClaireFlorenceFond du LacForestGrantGreenGreen LakeIowaIronJacksonJeffersonJuneauKenoshaKewauneeLa CrosseLafayetteLangladeLincolnManitowocMarathonMarinetteMarquetteMenomineeMilwaukeeMonroeOcontoOneidaOutagamieOzaukeePepinPiercePolkPortagePriceRacineRichlandRockRuskSaint CroixSaukSawyerShawanoSheboyganTaylorTrempealeauVernonVilasWalworthWashburnWashingtonWaukeshaWaupacaWausharaWinnebagoWoodCase Number3) The claim identified herein is included in the Affidavit of Debts.4) No interest, late charges, fees or penalties have been added after the filing date of the debtor's petition.Documentation of Balance ClaimedAccepted file types: pdf, Max. file size: 4 MB.Please attach a payment ledger, the latest prepetition statement or other documentation of the balance claimed.Your Name (person completing fom)(Required)Telephone Number(Required)Title(Required)Email Address(Required) Is this is an amended submission?(Required)NoYesIf you've submitted this proof of claim before and now you're re-submitting it, please choose Yes. Otherwise choose No.Anti SpamWhen you submit this form, it will generate a PDF document and email it to us. You may contact us with any questions at (414) 258-5787.CommentsThis field is for validation purposes and should be left unchanged.
