Case:12-24882-ABC Doc#:571 Filed:11/02/12 Entered:11/02/12 10:51:39 Page1 of 1

Nov 01 12 09:23a Jay Folk

Deb: Acq uisition Company of Amcr:cn V, LLC
! 565 Hotel Circle Suite 310
San Diego, CA 92JCS
Pb. 6 I 9-210-H900/ Fax 6 I 9-220-8 I 12
(303) 797-2086
Ut--"ITED STATES 8ANKRUPTCY COURT
D1STRICT OF COLORADO
In rc:
COIU ILLERJ\ GOLf CLCB, LLC
Debtor
CHAP f ER I 1
No. I 2-24882-ABC
OF TRANSFER OF CLAI I\1
OTHER THAN FOR SECURITY AND
\VAJ\I' ER OF :'\'OTIC I!.
Bankn!ptcy Rule 300 J(e)(2)
p.1
PLEASE TA:<E NOTICE U1:11 the fil ed c:o.im of AR.'\PA II OE PUMPII''G YSTEMS JNC
(''Transferor") agaim the Debtor in of $6,038. 15 ( Claim No. 25), as listed within the Claims Register,
and all other claim5 of Tra:ufcrur have anC. <1ssi;ped ot1er for security to Debt Acquisition
Cor:1pzny o f A::te rica ("DACA ''). T he si gna tJre o f the Transferor on this docurr. c nt is e \idence ofLl-J e t ransfer of
the claims and all rights tht:n:: u.nder. T:-ansfcror hereby to waive notice as descri:>ed by Bar.kru?tcy Rut..:
3001(e)(2).
[, the undersigned "';"ransfernr o:thc hereby ass: gn and tr:!nsfer m}' clai ms ana all
rights L: nder to DACA upQn terms set forth and in L'1t:: offer le:ter received. I represent and war rant
that :he ::I aim is :: ol :css than $t'i,OJ 8. :5 and has no! been to, soiJ , or satisfied. Upon
not:fi : a:ion by DACA, I agree to DAC\ a p:m ion of the purchase ;mce if the claim is : .:duced, objected
to, ur disa: lowcd in whole or in ;JCHt by the Debtor. SJd t reimburseme:J.L \.Vculd be calcul ated as !'ollows: dollar
of claim reduction multip: icd hy the rate. Other !han a s stated ubov.:. DACA assumes all r isks
asso..:iat.:d with the debtor's a bi lity to distribute funds. 1 agn::e l<.) deliver to DJ\CA a ny correspondence or payrr.e:JIS
rece:vcc to the date of th is agreement and Dt\CA to take the s teps necessar y 11.:: cransfer litis
clai::t and all claims we hold against <1hLwe dehror into their nu: nc. The cler k o!' tbe court is authorized to change
the address :e:;ard ir.g t.1e claim of the Tmusfe ror to that of tlte Tra:nferee l:sted be low.
TRANSFEROR
PUl\1P1NG SYSTEMS lNC
PO BOX 3482 U TTLE.TO . CO 80 161
\() . \ Ti tle Print '\lame
_ _ _ _ o,, I I r I ll L_ ___ _
Updatec ( if - --- --- - -----------
TRANSFEREE:
Debt Acquis ition Compan y of Am<'riea V, LLC
I 565 Hotel Circl e South, Suite 3 10, Sa n Diego, CA 9::!1 08
Signature

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