ned Staten Bankrupt Cout for he istic Delaware Se a RTT ST FOTW DCR STZ CS SS CT DET 2 Paragon Ofshor Ding LLC (Cas No 16-1988) 1 Paragon Duchess Lit (Case No 16-1098) 1 Paragon Ofthore pl (Cate No 16-1088) 1 Paragon (Mise Ea) Lied (Case No. 16-0900) (O Paragon Dang Serica 7 LLC (Cate No. 16-10987) (Paragon Oehore (usiembourg) Sr. (Case No 16-0400) G Paragon Ofer Finance Company (Case No 16-1388) 1D Paragon Hong NCS 2S. (Care No 61040) 1D Paragon Ofsere Lessing ntenland) GBH (Cse No, 10-1098) Paragon Leona Jones LC (Case No, 1-142) 1 Paragon Ofshre do Brest Lica (Case No 16-1038) 1 GN Ofehre Dring (Maiayia Stn he (Case No, 1610405) 1 Paegonterntonal nanos Company (Case No, 11091) 1 Paragon ore (Neder) BV. (ase No, 18-1404) 1 Pagan Asset ME) Ls, (ase No. 16-10352) 1 Paragon Otehore Contacing Gri (Case Ne, 16-0405) 5 Paragon Ofhre Holsngs US ine (Caso No 16-1908) 1 Paragon Oehre(Labuer le. Li (Case No 16-1405) 1 Paragon Ast (UK) Lid (Cate No 16-1096) 1 Paragon Holding SCS2 Us (Casa No 16:10807) 1 Pargon FOR Hotdnge i. (Cane No 181008) 1 Paragon Asset Compary Lid. (Case Ne. 16-0406) 1 Paragon Ofshoe iterations Ld (Case No 16-1099) 1D Paragon Hling SCS 1 Ls (Case No 6-10408) 1 Paragon Ofte (Noth Sa Li (Case No. 16-1367) 1 Paragon Otehre Lean (usembourg) 6. (Case No. 140410) Official Form 410 Proof of Claim oats, Read the instructions before filing out this form. This form Is for making a claim for payment in a bankruptcy case. Other than a clalm under 41 US.C. § 503(b)(), this form should not be used to make a claim for an administrative expense arising after the commencement of the case. Fillers must leave out or redact information that i entitled to privacy on tis form or on any attached documents. Attach redacted copies or any {documents that suppor the clam, such 28 promissory notes, purchase orders, invoices, lemized statements of running accounts, contracts, judgments, ‘mortgages, and securty agreements. Do not send original documents; they may be destroyed after scanning. Ifthe documents are not available, ‘explain in an attachment 'A parson wh fles a fraudulent claim could be fined upto $500,000, imprisoned for upto 5 years, or both. 18 U.S.C. §§ 152, 187, and 9671, Fill in all tho information about the claim as ofthe date the case was filed. Ea Identity the Claim NaelD: 12429898 1. Wha the curent Carios Henrique Moreira da Fonseca Nave the ret cede (hs pean ot Be SETS) ter nares he crestor used wih he etter 2, Has this claim been] no acquired from someone else? DD ves. Fromwhom? 5. Where shouta Where should notices to the creitor be sent? ‘mere should payments tothe creditor be sont? (¢ notices and Carlos Henrique Moreira da Fonseca Le foctvidrdpbie Rua Plinio Moscoso i Ed, Mar De Ibiza Apt 301 Nene 180 fra bieat Salvador, Bahia 40155800 eee (REP) 2002(6) Brazil Py or Pad Coan flue Cont pheno Contactema Contact erat ‘Untorm ct dentro laconic payments in capt 18 ityou use on 4 Does this claim finteneateady EL No ‘ea? 1 vex clan number on court line reget (known) Fedon aT 5. Doyou know it No ieee proof of claim for [] Yes. Who made the eatler fling? this claim? fal Fom 0 root or clam TINIMETIIUU IONE TI U1) 0 TEE rent role 201612150648505317Ea Give Information About the Claim as ofthe Date the Caso Was Filed 16. Doyou have any number [1] No You use to deny the debtor? ves. Last 4 digits of the debtors account or any number you use to identity the debtor: 7. How muchisthe claim? $s tis amount include Interest or other charges? Ow» 1 Ves. atch sitementtomicng nierest fees, expenses, o other charges required by Bankruptcy Rule 3001(6¥2)9) 2. Whatie me tasis ofthe” Examples: Gods sol, mone leaned, ease, sanicas performed, personal injuyor wrongful death, or ered card eee ‘Altach redacted copies of any documents supporting the claim requied by Bankruptcy Rule 3001(c), Limit iscosing information that sented to privacy, uch as heath car information ©. tsallor part of the claim = EL] No. secured? 1 Yes. The claim is secured by @ lien on property. Natur of property: Real tate: the cloimie secures by he debtor’ principal residence le @ Mortgage Poof of lain tachment (OF Form 410-4) wth this Proof of Cin. 1 Wotorvehicie 1 other. Describe: ‘ais for perfection: ‘tach redacod copies of documents, itary, thal show evaence of perfection ofa scutes for example, a morgage, ln, cerifcats of te, inane satomentoroher document hat shows the fan has ben fled orecarod) Value of property: 8 Amount ofthe claim thats secured: § Amount ofthe claim thats unsecured: §_________(The sum ofthe secured and unsocured ‘mount shu atch te aout ine 7.) Amount necessary to cure any default as ofthe date ofthe petition: Annual Interest Rate (when case was fled), % DF rea OF vatabie 10. tts cat based ona Ne lease? Oo 1 Yes. amount necessary to cure any daault as ofthe date ofthe petition, §, 1. tetis claim subject to a Fight of soto? Ow 1 Yes. erty the property Offical Fon 410 oot or tam TUTTE I TTM INT IN IIL ETNA 1 oon HOUeDs Seb 7 121512, Isa or part of tho claim entitled to priority undor AVUS.C. § 507(0)? ‘Aclaim may be partly Priorty and party nonproriy. For example, in some categories, the Taw limits the amount ented to priory. 13, Isallor part ofthe claim pursuant to 11 US.C. § 503(0)9)? O wo D1 Yes. Check al that apply: Amount entitled to priority 1 Domestic support obligations (incucing alimony and child support) under ATUSC. § 507(0X1)(A) oF (aK). C1 Upto $2,860" of deposits toward purchase, lease, oF rental of property or ‘serveas for personal, famiy, or household use. 11 U.S.C. § 60717) 1 wages, salaries, or commissions (up to $12,850%) eamed within 180 days before the bankrupicy petition is filed or the debtor’s business ends, $ whichever is earlier. 11 U.8.C. § 507(a}(4). 1 Taxes or penalties owed to governmental units. 11 U.S.C. § 507(aX8). 8 1 Contributions to an employee benefit plan. 11 U.S.C. § 507(aX8). 8 1 other. specify subsection of 11 U.S.C. § 607(@)(__) that applies. 8. Amounts ar sbjcttoadusenton 401/19 and evey 3 years er hat for eases begun one itr he date agement. No oo ‘Yes. Indicate the amount of your claim arising from the value of any goods received by the debtor within 20, {days before the date of commencement ofthe stove case, in which te goede have been sod o the Debtor in the ordinary course of such Debior’s business. Attach documentation supporting such calm. 8. ‘The person completing this proof of claim must ‘sign and date it. FREP 9011(b) Hf you fe this claim ‘ebctronicaly, FRBP 5005(a)@2) authorizes cours to estabish local ules speciving what a signature s ‘A person who files a ‘fraudulent claim could ‘ined up to $500,000, Imprisoned for up to 5 ‘years, or both. 48 U.S.C. §§ 182, 187, and 3674. eo: Check the appropriate ox: 1 tamtre creditor. 1 amthe creditors attomey or authorized agent. 1 Jame trustee, orthe debtor, or their authorized agent. Bankruptcy Rule 3004, 1 tama guarantor, surety, endorser, or other codebtor. Bankruptoy Rule 3005, | understand that an authotized signature on this Proof of Gaim serves as an acknowledgement that when calculating ‘the amount of he claim, the crector gave the debtor ced fr any payments received toward the deb | have examined the information in ths Proof of Claim and have reasonable beet that the information is rue and cored. | declare under penalty of perjuy thal the foregoing is tue and correct, Executed on date ae Print the name of the person who Is completing and signing this calm: Name Fratrare Ta ae Tata Ti Company ‘ley corporate servi as he carpany tie atiorzad agra en Ades w oa Tt Coa ‘Coract phone mal Offelal Form 410 mar mA AOU N01 AM 18620161215054850