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Case 8:17-bk-11961-CB Claim 1-6 Filed 10/10/17 Desc Main Document Page 1 of 5

Fill in this information to identify the case:

Debtor 1 EAGAN AVENATTI LLP


Debtor 2
(Spouse, if filing)

United States Bankruptcy Court for the: CENTRAL District of CALIFORNIA


(State)

Case number 8:17-BK-11961-CB

Official Form 410


Proof of Claim 04/16

Read the instructions before filling out this form. This form is for making a claim for payment in a bankruptcy case. Do not use this form to
make a request for payment of an administrative expense. Make such a request according to 11 U.S.C. § 503.

Filers must leave out or redact information that is entitled to privacy on this form or on any attached documents. Attach redacted copies of any
documents that support the claim, such as promissory notes, purchase orders, invoices, itemized statements of running accounts, contracts, judgments,
mortgages, and security agreements. Do not send original documents; they may be destroyed after scanning. If the documents are not available,
explain in an attachment.

A person who files a fraudulent claim could be fined up to $500,000, imprisoned for up to 5 years, or both. 18 U.S.C. §§ 152, 157, and 3571.

Fill in all the information about the claim as of the date the case was filed. That date is on the notice of bankruptcy (Form 309) that you received.

Part 1: Identify the Claim

1. Who is the current Department of the Treasury - Internal Revenue Service


creditor? Name of the current creditor (the person or entity to be paid for this claim)

Other names the creditor used with the debtor

2. Has this claim been No


acquired from Yes. From whom?
someone else?

3. Where should notices Where should notices to the creditor be sent? Where should payments to the creditor be sent? (if
and payments to the different)
creditor be sent?
Internal Revenue Service Internal Revenue Service
Federal Rule of Name Name
Bankruptcy Procedure
(FRBP) 2002(g) P.O. Box 7346 1919 SMITH STREET M/S 5024 HOU
Number Street Number Street

Philadelphia PA 19101-7346 HOUSTON TX 77002


City State ZIP Code City State ZIP Code

Contact phone 1-800-973-0424 Contact phone (346) 227-6543

Contact email Contact email

Creditor Number: 37807065

Uniform claim identifier for electronic payments in chapter 13 (if you use one)

__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

4. Does this claim amend No


one already filed? Yes. Claim number on court claims registry (if known) Filed on: 04/07/2017
1
MM / DD / YYYY

5. Do you know if anyone No


else has filed a proof
of claim for this claim? Yes. Who made the earlier filing?
Case 8:17-bk-11961-CB Claim 1-6 Filed 10/10/17 Desc Main Document Page 2 of 5
Part 2: Give Information About the Claim as of the Date the Case Was Filed

6. Do you have any number No


you use to identify the Yes. Last 4 digits of the debtor's account or any number you use to identify the debtor: See Attachment
debtor?

7. How much is the claim? $ 2,357,201.56 Does this amount include interest or other charges?
No
Yes. Attach statement itemizing interest, fees, expenses, or other
charges required by Bankruptcy Rule 3001(c)(2)(A).

8. What is the basis of the Examples: Goods sold, money loaned, lease, services performed, personal injury or wrongful death, or credit card.
claim?
Attach redacted copies of any documents supporting the claim required by Bankruptcy Rule 3001(c).

Limit disclosing information that is entitled to privacy, such as health care information.

Taxes

9. Is all or part of the claim No


secured?
Yes. The claim is secured by a lien on property.
Nature of property:
Real Estate. If the claim is secured by the debtor's principal residence, file a Mortgage Proof of Claim
Attachment (Official Form 410-A) with this Proof of Claim.

Motor Vehicle
Other. Describe: *All of debtor(s) right, title and interest to property - 26 U.S.C. §6321.

Basis for perfection: See Attachment


Attach redacted copies of documents, if any, that show evidence of perfection of a security interest (for
example, a mortgage, lien, certificate of title, financing statement, or other document that shows the lien has
been filed or recorded.)

Value of Property: $

Amount of the claim that is secured: $ 677,410.24

Amount of the claim that is unsecured: $ 1,679,791.32 (The sum of the secured and unsecured
amounts should match the amount in line 7.)

Amount necessary to cure any default as of the date of the petition: $

Annual Interest Rate (when case was filed) 4 %


Fixed
Variable

10. Is this claim based on a No


lease?
Yes. Amount necessary to cure any default as of the date of the petition. $

11. Is this claim subject to a No


right of setoff?
Yes. Identify the property See Attachment
Case 8:17-bk-11961-CB Claim 1-6 Filed 10/10/17 Desc Main Document Page 3 of 5

12. Is all or part of the claim No


entitled to priority under Yes. Check all that apply:
11 U.S.C. §507(a)? Amount entitled to priority
Domestic support obligations (including alimony and child support) under
A claim may be partly 11 U.S.C. § 507(a)(1)(A) or (a)(1)(B).
priority and partly $
nonpriority. For example,
in some categories, the Up to $2,850* of deposits toward purchase, lease, or rental of property or services for
law limits the amount personal, family, or household use. 11 U.S.C. § 507(a)(7).
$
entitled to priority.
Wages, salaries, or commissions (up to $12,850*) earned within 180 days before the
bankruptcy petition is filed or the debtor's business ends, whichever is earlier. $
11 U.S.C. § 507(a)(4).

Taxes or penalties owed to governmental units. 11 U.S.C. § 507(a)(8). $ 1,259,354.52

Contributions to an employee benefit plan. 11 U.S.C. § 507(a)(5). $

Other. Specify subsection of 11 U.S.C. § 507(a)(__) that applies. $

*Amounts are subject to adjustment on 4/01/19 and every 3 years after that for cases begun on or after the date of adjustment.

Part 3: Sign Below

The person completing this Check the appropriate box:


proof of claim must sign
I am the creditor.
and date it.
FRBP 9011(b). I am the creditor's attorney or authorized agent.

If you file this claim I am the trustee, or the debtor, or their authorized agent. Bankruptcy Rule 3004.
electronically, FRBP
5005(a)(2) authorizes courts I am a guarantor, surety, endorser, or other codebtor. Bankruptcy Rule 3005.
to establish local rules
specifying what a signature I understand that an authorized signature on this Proof of Claim serves as an acknowledgment that when calculating the
is. amount of the claim, the creditor gave the debtor credit for any payments received toward the debt.

A person who files a I have examined the information in this Proof of Claim and have a reasonable belief that the information is true
fraudulent claim could be and correct.
fined up to $500,000,
imprisoned for up to 5 I declare under penalty of perjury that the foregoing is true and correct.
years, or both.
18 U.S.C. §§ 152, 157, and
3571. Executed on date 10/09/2017
MM / DD / YYYY

/s/ MARIA R GALVAN


(Signature)

Print the name of the person who is completing and signing this claim:

Name MARIA R GALVAN


First name Middle name Last name

Title Bankruptcy Specialist

Company Internal Revenue Service


Identify the corporate servicer as the company if the authorized agent is a servicer.

Address
1919 SMITH STREET M/S 5024 HOU
Number Street

HOUSTON TX 77002
City State ZIP Code

Contact Phone (346) 227-6543 Email:


Case 8:17-bk-11961-CB Claim 1-6 Filed 10/10/17 Desc Main Document Page 4 of 5

Proof of Claim for Form 410


Attachment
Internal Revenue Taxes
Department of the Treasury/Internal Revenue Service Case Number
8:17-BK-11961-CB
In the Matter of: EAGAN AVENATTI LLP
520 NEWPORT CENTER DR #1400 Type of Bankruptcy Case
NEWPORT BEACH, CA 92660 CHAPTER 11
Date of Petition
03/01/2017
Amendment No. 5 to Proof of Claim dated 04/07/2017.

The United States has not identified a right of setoff or counterclaim. However, this determination is based on available data and is not
intended to waive any right to setoff against this claim debts owed to this debtor by this or any other federal agency. All rights of setoff
are preserved and will be asserted to the extent lawful.

Secured Claims (Notices of Federal tax lien filed under internal revenue laws before petition date)
Taxpayer Tax Date Tax Penalty to Interest to Notice of Tax Lien Filed:
ID Number Kind of Tax Period Assessed Tax Due Petition Date Petition Date Date Office Location

XX-XXX0824 PTRSHP 12/31/2011 09/14/2015 $0.00 $4,700.00 $255.48 11/19/2015 CALIFORNIA


XX-XXX0824 PTRSHP 12/31/2012 11/10/2014 $0.00 $7,020.00 $571.58 10/29/2015 CALIFORNIA
XX-XXX0824 WT-FICA 06/30/2014 08/11/2014 $0.00 $4,740.91 $0.00 10/29/2015 CALIFORNIA
XX-XXX0824 WT-FICA 12/31/2014 05/18/2015 $49,956.43 $22,062.81 $3,961.70 10/29/2015 CALIFORNIA
XX-XXX0824 WT-FICA 03/31/2015 07/06/2015 $194,545.35 $71,401.50 $12,904.19 10/29/2015 CALIFORNIA
XX-XXX0824 WT-FICA 06/30/2015 02/22/2016 $191,738.69 $88,298.89 $11,177.89 05/12/2016 CALIFORNIA
XX-XXX0824 WT-FICA 09/30/2015 02/22/2016 $0.00 $14,074.82 $0.00 04/05/2016 CALIFORNIA
04/01/2016 ORANGE COUNTY
$436,240.47 $212,298.93 $28,870.84

Total Amount of Secured Claims: $677,410.24

Unsecured Priority Claims under section 507(a)(8) of the Bankruptcy Code


Taxpayer Interest to
ID Number Kind of Tax Tax Period Date Tax Assessed Tax Due Petition Date

XX-XXX0824 WT-FICA 12/31/2015 05/08/2017 $25,034.36 $1,061.99


XX-XXX0824 ADDTL. ASSMT 10/16/2017 $447,405.82 $23,963.14
XX-XXX0824 FUTA 12/31/2015 08/28/2017 $1,813.98 $94.26
XX-XXX0824 WT-FICA 03/31/2016 05/08/2017 $48,408.91 $1,641.63
XX-XXX0824 ADDTL. ASSMT 10/16/2017 $150,668.51 $6,856.17
XX-XXX0824 WT-FICA 06/30/2016 05/08/2017 $49,619.14 $1,169.47
XX-XXX0824 ADDTL. ASSMT 10/16/2017 $106,405.92 $3,397.95
XX-XXX0824 WT-FICA 09/30/2016 05/08/2017 $50,859.63 $677.93
XX-XXX0824 ADDTL. ASSMT 10/16/2017 $64,373.31 $1,225.10
XX-XXX0824 WT-FICA 12/31/2016 05/08/2017 $52,131.11 $165.93
XX-XXX0824 ADDTL. ASSMT 10/16/2017 $114,830.69 $416.99
XX-XXX0824 FUTA 12/31/2016 08/28/2017 $3,192.00 $12.60
XX-XXX0824 WT-FICA 01/01/2017 - 03/01/2017 09/18/2017 $103,927.98 $0.00

$1,218,671.36 $40,683.16

Total Amount of Unsecured Priority Claims: $1,259,354.52

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Case 8:17-bk-11961-CB Claim 1-6 Filed 10/10/17 Desc Main Document Page 5 of 5

Proof of Claim for Form 410


Attachment
Internal Revenue Taxes
Department of the Treasury/Internal Revenue Service Case Number
8:17-BK-11961-CB
In the Matter of: EAGAN AVENATTI LLP
520 NEWPORT CENTER DR #1400 Type of Bankruptcy Case
NEWPORT BEACH, CA 92660 CHAPTER 11
Date of Petition
03/01/2017
Amendment No. 5 to Proof of Claim dated 04/07/2017.

Unsecured General Claims


Taxpayer Interest to
ID Number Kind of Tax Tax Period Date Tax Assessed Tax Due Petition Date
XX-XXX0824 PTRSHP 12/31/2014 1 NOT FILED $0.00 $0.00
XX-XXX0824 PTRSHP 12/31/2015 1 NOT FILED $0.00 $0.00
XX-XXX0824 PTRSHP 12/31/2016 1 NOT FILED $0.00 $0.00

$0.00 $0.00

Penalty to date of petition on unsecured priority claims (including interest thereon) . . . . . . $415,561.80
Penalty to date of petition on unsecured general claims (including interest thereon) . . . . . . $4,875.00

Total Amount of Unsecured General Claims: $420,436.80

1 THE ABOVE LIABILITY HAS BEEN LISTED AS A POTENTIAL LIABILTITY FOR THE DEBTOR BECAUSE THE RETURN HAS NOT BEEN FILED. AS SOON AS THE DEBTOR FILES THE RETURN WITH THE IRS AS RE-
QUIRED BY LAW THIS CLAIM WILL BE ADJUSTED TO REFLECT THE ASSESSED LIABILITY.

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