Proof of Claim Form

Palm Beach Resort and Beach Club Condominium Association, Inc.

Case No. 21-15555-BKC-EPK

PROOF OF OWNER OF UNIT WEEK INTEREST IN CONDOMINIUM
The undersigned hereby certifies that the party listed below is the holder of a tenant in common interest in one or more unit week interests in the units located at 3031 S. Ocean Boulevard, Palm Beach, Florida as of June 4, 2021 in the Unit(s) and ownership percentages indicated below:
Name of Holder:*
Address of Holder:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Unit Number *
Week Number*
Percentage Owned for each Unit:*
I declare under penalty of perjury that the foregoing is true and correct.
Signature*

Clear
Legal Name*

First NameMiddle Name (If Applicable)Last Name
Title:*
Date*

MonthDayYear
Date
Each proof of Owner of Unit Week Interest Form, including any supporting documentation, must be submitted electronically on this form, on or before November 30, 2021.
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