PROOF OF CLAIM DECLARATION

This form is to be submitted by creditors, employees, or anyone else who believes they are owed money by PSW Real Estate, LLC or any of its affiliates or subsidiaries identified on the last page of this form (referred to as the “Receivership Entities”).

Important Note: Only those creditors who submit this form and do so accurately can become eligible to receive distributions from the recoveries and liquidation of assets of the Receivership Entities. Please submit this form within 90 days after receipt. A Claims Bar Date will be set by the Court.

INSTRUCTIONS

Instructions for completing this form (Please read these instructions carefully and follow them closely):

1. You must complete and submit a separate Proof of Claim Declaration form for each of the Receivership Entities you believe owe you money.
2. Complete all sections of this form and provide copies of all supporting documents such as contracts, check copies (front and back), wire transfer documents, and correspondence that show the amounts you believe you are owed.
3. If a particular item does not apply to you, write “not applicable.” If you do not know the answer to a particular item, write “not known.” Please do not leave a question blank.
4. You must certify the accuracy of the Proof of Claim Declaration on the final page.
5. The Receiver reserves the right to request additional information from you.
6. The Receiver may reject any claim that has not been completed accurately or completely or that is not supported by documentation.
7. In the event that any information provided in this Proof of Claim Declaration changes or becomes inaccurate or incomplete, you are obligated to advise the Receiver. Failure to do so would make your Proof of Claim Declaration inaccurate or misleading. It is your responsibility to notify the Receiver if your address changes.
8. The fact that you have received this Proof of Claim Declaration from the Receiver, or that the Receiver accepts your return of the form, does not constitute a determination by the Receiver that you are in fact an eligible claimant to share in any distributions from the Initials Receivership Estate. The Receiver will review the claims received and compare the information you submit to the records of the Receivership Entities. Final approval of claims and distributions, if any, are dependent upon the procedures established by, and orders of, the Court. You will receive notice from the Receiver if your claim is rejected or disputed in whole or in part. If the Receiver rejects the validity or amount of your claim, you will be given an opportunity to provide additional information or evidence and to obtain a hearing from the Court. Distributions will be made after Court approval
9. Privacy. The information submitted in this form will only be used to verify claims, for any tax reporting required, to comply with any other legal reporting requirements, and for other permissible legal uses.
10. The Receiver and his attorneys cannot give you personal legal advice concerning your Proof of Claim Declaration; any such advice must come from your own attorney or other advisor. Likewise, information communicated by you to the Receiver or his attorneys is not confidential and will be utilized by the Receiver in administering the Receivership Estate, including the resolution of any claim you may make against the Receivership Estate.
11. A summary of your claim will be emailed to you upon your successful completion of this form. Please keep a copy of this summary for your file.
12. Please submit all claims in United States Dollars (“USD”). Claims will be paid in USD. The exchange rate to be applied to your claim will be the rate existing on the date of your contribution if such contributions were made in anything other than USD.
13. Please submit a W-9.

If you have questions, please email storybuilt@stapletoninc.com or call (213) 823-1788.

Receivership Entities

SB-George Holdings, LLC
PSW Seattle Real Estate, LLC
Pinehurst Land, LP
PSW Land Acquisitions, LLC
SB-Ozzie Holdings, LLC
SB Builders, LLC
SB-Ozzie, LLC
SB-Frank Condo, LLC
PSW-Springdale Manager, LLC
PSW 900 Eastline, LP
Frank West Builder, LLC
PSW Urban Homes, LP
SB Austin SF Holdings, LLC
George 116-Austin, L.P.
900 South First GP, LLC
SB Webberville Road, LLC
Storybuilt Temporary, LLC