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DE-172
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, s ‘ar number, and address): TELEPHONE AND FAX NOS
CAPITAL ONE BANK (USA), N.A. VENTURE 7 FOR COURT USE ONLY
17601 PENN AVE SOUTH, SUITE A650
IMINNEAPOLIS, MN 55423 F
|ATTORNEY FOR: PERIGREDITOR NE: 234-11 Fax: (877) 326-5689 D
STREET ADDRESS: 400 MCALLISTER ST #103
MAILING ADDRESS: 400 MCALLISTER ST #103
CITY AND ZIP CODE: SAN FRANCISCO, CA 94102 JAN 0 4 2021
BRANCH NAME: CLERK OF JHE)COURT
ESTATE OF (NAME): HUSAM MOUSA QANA Deputy Cork
SUPERIOR COURT OF CALIFORNIA, COUNTY OF: SAN FRANCISCO San Francisco County Superior Court
CASE NUMBER
CREDITOR’S CLAIM PES-20-303794
You must file this claim with the court clerk at the court address above before the LATER of (a) four months after the date
this claim to the personal representative. A proof of service is on the reverse.
and mail or deliver a copy to the personal representative and his or her attorney.
letters (authority to act for the estate) were first issued to the personal representative, or (b) thirty days after the date Notice of
Administration was given to the creditor, if notice was given as provided in Probate Code section 9051. Mail or deliver a copy of
WARNING: Your claim-will in most instances be invalid if you do not properly complete this form, file it on time with the court,
1. Total amount of the claim is: $2,316.69
2. Claimant (name): CAPITAL ONE BANK (USA), N.A. VENTURE
. (1 an individual. ‘
. [J an individual or entity doing business under the fictitious name of (specify):
sf
C apartnership. The person signing has authority to sign on behalf of the partnership.
a corporation. The person signing has authority to sign on behalf of the corporation.
other (specify): CAPITAL ONE BANK (USA), N.A. VENTURE
g20
3. “Address of claimant (specify) : °
CAPITAL ONE BANK (USA), N.A. VENTURE
7601 PENN AVE SOUTH, SUITE A650
MINNEAPOLIS, MN 55423
4. Claimantis ] the creditor Ml a person acting on behalf of creditor (state reason):
Authorized Representative for
CAPITAL ONE BANK (USA), N.A. VENTURE
5, Claimant is ] the personal representative [_] the attorney for the personal representative.
(Claims against the estate by the personal representative and the attorney for the personal representative must be filed
within the claim period allowed in Probate Code section 9100. See the notice box above.)
6. lam authorized to make this claim which is justly due or may become due. All payments on or offsets to the claim have been
credited. Facts supporting the claim are [_] on reverse [J attached. .
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date: DECEMBER 30, 2020
Alison M. Vahl
Authorized Representative e.x., Lente
(TYPE OR PRINT NAME AND TITLE) (SIGNATURE OF CLAIMANT) Authorized Representative
INSTRUCTIONS TO CLAIMANT
A. On the reverse, itemize the claim and show the date the service was rendered or the debt incurred. Describe the item or service in
detail, and indicate the amount claimed for each item. Do not include debts incurred after the date of death, except funeral claims.
If the claim is not due or contingent, or the amount is not yet ascertainable, state the facts supporting the claim.
If the claim is secured by a note or other written instrument, the original or a copy must be attached (state why original is
Op
unavailable). If secured by mortgage, deed of trust, or other lien on property that is of record, it is sufficient to describe the security
and refer to the date or volume and page, and county where recorded. (See Probate Code section 9152.)
Mail or take this original claim to the court clerk's office for filing. If mailed, use certified mail, with return receipt requested.
Mail or deliver a copy to the personal representative. Complete the Proof of Mailing or Personal Delivery on the reverse.
The personal representative will notify you when your claim is allowed or rejected.
ammo
claim period allowed in the Probate Code section 9100. See the notice box above.
(Continued on reverse)
Form approved by the Probate Code §§ 9000 et seq. 9153
Judicial Council of California CREDITOR’S CLAIM
DE-172 [Revision January 1, 1998] (Probate)
Claims against the estate by the personal representative and the attorney for the personal representative must be filed within theESTATE OF (NAME): CASE NUMBER:
HUSAM MOUSA GANA PES-20-303794
FACTS SUPPORTING THE CREDITOR’S CLAIM
TH sce attachment (if space is insufficient)
Date of item Item and Supporting Facts Amount claimed
See attached claim detail for basis of claim.
TOTAL § $| 2,316.69
PROOF OF Il MAILING [] PERSONAL DELIVERY TO PERSONAL REPRESENTATIVE
(Be sure to mail or take the original to the court clerk’s office for filing)
[am the creditor or a person acting on behalf of the creditor. At the time of mailing or delivery I was at least 18 years of age.
2. My residence or business address is (specify):
CAPITAL ONE BANK (USA), N.A. VENTURE.
7601 PENN AVE SOUTH, SUITE A650
MINNEAPOLIS, MN.55423
3. I mailed or delivered a copy of this Creditor’s Claim to the personal representative as follows (check either a or b below):
a Mail. | am a resident of or employed in the county where the mailing occurred.
(1)! enclosed a copy in an envelope AND
(a) L] deposited the sealed envelope with the United States Postal Service with the postage fully prepaid.
(b) 7 | placed the envelope for collection and mailing on the date and at the place shown in items below following our
ordinary business practices. | am readily familiar with the business’ practice for collecting and processing
correspondence for mailing. On the same day that correspondence is placed for collection and mailing, it is
deposited in the ordinary course of business with the United States Postal Service in a sealed envelope with
postage fully prepaid.
(2) The envelope was addressed and mailed first-class as follows:
(a) Name of personal representative served: KAREN L FISHER
(b) Address on envelope: C/O: LEE L KASTER
1806 BONANZA ST
WALNUT CREEK, CA 94596
C 30 2020
(d) Place of mailing (city and state): MINNEAPOLIS, MN 55423,
b. (] Personal delivery. | personally delivered a copy of the claim to the personal representative as follows:
(1) Name of personal representative served:
(2) Address where delivered:
(3) Date delivered:
(4) Time delivered:
1 declare-under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date: DEC 3 0 2020
CAPITAL ONE BANK (USA), N.A. VENTURE
(c) Date of mailing:
Alison M. Vahl”
Aaa terrtt
(TYPE OR PRINT NAME OF CLAIMANT) (SIGNATURE OF CLAIMANT) Authorized Representative
DE-172 [Rev. January 1, 1998] CREDITOR’S CLAIM Page two
(CA SF_Default R20190315 (Probate)Claim Detail .
CL1365994
IN RE THE ESTATE OF: HUSAM MOUSA QANA
CASE NUMBER: PES-20-303794
PEREFERENCE NO: CL1365994
Claim detail is as follows:
RERKEREREREEQOI GT
CAPITAL ONE BANK (USA), N.A. VENTURE
$2,316.69
UNSECURED.
THE DECEDENT PURCHASED GOODS AND/OR SERVICES IN THE AMOUNT OF $2,316.69,
EVIDENCED BY ACCOUNT NUMBER **#*##*###*#*9361,
Claim Balance: $2,316.69
CAPITAL ONE REFERS TO EITHER CAPITAL ONE N.A. OR CAPITAL ONE BANK USA,
(Claim Details CAPONE_R20200224
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DE-172 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, s ‘ar number, and address): TELEPHONE AND FAX NOS CAPITAL ONE BANK (USA), N.A. VENTURE 7 FOR COURT USE ONLY 17601 PENN AVE SOUTH, SUITE A650 IMINNEAPOLIS, MN 55423 F |ATTORNEY FOR: PERIGREDITOR NE: 234-11 Fax: (877) 326-5689 D STREET ADDRESS: 400 MCALLISTER ST #103 MAILING ADDRESS: 400 MCALLISTER ST #103 CITY AND ZIP CODE: SAN FRANCISCO, CA 94102 JAN 0 4 2021 BRANCH NAME: CLERK OF JHE)COURT ESTATE OF (NAME): HUSAM MOUSA QANA Deputy Cork SUPERIOR COURT OF CALIFORNIA, COUNTY OF: SAN FRANCISCO San Francisco County Superior Court CASE NUMBER CREDITOR’S CLAIM PES-20-303794 You must file this claim with the court clerk at the court address above before the LATER of (a) four months after the date this claim to the personal representative. A proof of service is on the reverse. and mail or deliver a copy to the personal representative and his or her attorney. letters (authority to act for the estate) were first issued to the personal representative, or (b) thirty days after the date Notice of Administration was given to the creditor, if notice was given as provided in Probate Code section 9051. Mail or deliver a copy of WARNING: Your claim-will in most instances be invalid if you do not properly complete this form, file it on time with the court, 1. Total amount of the claim is: $2,316.69 2. Claimant (name): CAPITAL ONE BANK (USA), N.A. VENTURE . (1 an individual. ‘ . [J an individual or entity doing business under the fictitious name of (specify): sf C apartnership. The person signing has authority to sign on behalf of the partnership. a corporation. The person signing has authority to sign on behalf of the corporation. other (specify): CAPITAL ONE BANK (USA), N.A. VENTURE g20 3. “Address of claimant (specify) : ° CAPITAL ONE BANK (USA), N.A. VENTURE 7601 PENN AVE SOUTH, SUITE A650 MINNEAPOLIS, MN 55423 4. Claimantis ] the creditor Ml a person acting on behalf of creditor (state reason): Authorized Representative for CAPITAL ONE BANK (USA), N.A. VENTURE 5, Claimant is ] the personal representative [_] the attorney for the personal representative. (Claims against the estate by the personal representative and the attorney for the personal representative must be filed within the claim period allowed in Probate Code section 9100. See the notice box above.) 6. lam authorized to make this claim which is justly due or may become due. All payments on or offsets to the claim have been credited. Facts supporting the claim are [_] on reverse [J attached. . I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: DECEMBER 30, 2020 Alison M. Vahl Authorized Representative e.x., Lente (TYPE OR PRINT NAME AND TITLE) (SIGNATURE OF CLAIMANT) Authorized Representative INSTRUCTIONS TO CLAIMANT A. On the reverse, itemize the claim and show the date the service was rendered or the debt incurred. Describe the item or service in detail, and indicate the amount claimed for each item. Do not include debts incurred after the date of death, except funeral claims. If the claim is not due or contingent, or the amount is not yet ascertainable, state the facts supporting the claim. If the claim is secured by a note or other written instrument, the original or a copy must be attached (state why original is Op unavailable). If secured by mortgage, deed of trust, or other lien on property that is of record, it is sufficient to describe the security and refer to the date or volume and page, and county where recorded. (See Probate Code section 9152.) Mail or take this original claim to the court clerk's office for filing. If mailed, use certified mail, with return receipt requested. Mail or deliver a copy to the personal representative. Complete the Proof of Mailing or Personal Delivery on the reverse. The personal representative will notify you when your claim is allowed or rejected. ammo claim period allowed in the Probate Code section 9100. See the notice box above. (Continued on reverse) Form approved by the Probate Code §§ 9000 et seq. 9153 Judicial Council of California CREDITOR’S CLAIM DE-172 [Revision January 1, 1998] (Probate) Claims against the estate by the personal representative and the attorney for the personal representative must be filed within theESTATE OF (NAME): CASE NUMBER: HUSAM MOUSA GANA PES-20-303794 FACTS SUPPORTING THE CREDITOR’S CLAIM TH sce attachment (if space is insufficient) Date of item Item and Supporting Facts Amount claimed See attached claim detail for basis of claim. TOTAL § $| 2,316.69 PROOF OF Il MAILING [] PERSONAL DELIVERY TO PERSONAL REPRESENTATIVE (Be sure to mail or take the original to the court clerk’s office for filing) [am the creditor or a person acting on behalf of the creditor. At the time of mailing or delivery I was at least 18 years of age. 2. My residence or business address is (specify): CAPITAL ONE BANK (USA), N.A. VENTURE. 7601 PENN AVE SOUTH, SUITE A650 MINNEAPOLIS, MN.55423 3. I mailed or delivered a copy of this Creditor’s Claim to the personal representative as follows (check either a or b below): a Mail. | am a resident of or employed in the county where the mailing occurred. (1)! enclosed a copy in an envelope AND (a) L] deposited the sealed envelope with the United States Postal Service with the postage fully prepaid. (b) 7 | placed the envelope for collection and mailing on the date and at the place shown in items below following our ordinary business practices. | am readily familiar with the business’ practice for collecting and processing correspondence for mailing. On the same day that correspondence is placed for collection and mailing, it is deposited in the ordinary course of business with the United States Postal Service in a sealed envelope with postage fully prepaid. (2) The envelope was addressed and mailed first-class as follows: (a) Name of personal representative served: KAREN L FISHER (b) Address on envelope: C/O: LEE L KASTER 1806 BONANZA ST WALNUT CREEK, CA 94596 C 30 2020 (d) Place of mailing (city and state): MINNEAPOLIS, MN 55423, b. (] Personal delivery. | personally delivered a copy of the claim to the personal representative as follows: (1) Name of personal representative served: (2) Address where delivered: (3) Date delivered: (4) Time delivered: 1 declare-under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: DEC 3 0 2020 CAPITAL ONE BANK (USA), N.A. VENTURE (c) Date of mailing: Alison M. Vahl” Aaa terrtt (TYPE OR PRINT NAME OF CLAIMANT) (SIGNATURE OF CLAIMANT) Authorized Representative DE-172 [Rev. January 1, 1998] CREDITOR’S CLAIM Page two (CA SF_Default R20190315 (Probate)Claim Detail . CL1365994 IN RE THE ESTATE OF: HUSAM MOUSA QANA CASE NUMBER: PES-20-303794 PEREFERENCE NO: CL1365994 Claim detail is as follows: RERKEREREREEQOI GT CAPITAL ONE BANK (USA), N.A. VENTURE $2,316.69 UNSECURED. THE DECEDENT PURCHASED GOODS AND/OR SERVICES IN THE AMOUNT OF $2,316.69, EVIDENCED BY ACCOUNT NUMBER **#*##*###*#*9361, Claim Balance: $2,316.69 CAPITAL ONE REFERS TO EITHER CAPITAL ONE N.A. OR CAPITAL ONE BANK USA, (Claim Details CAPONE_R20200224