Claims This field is hidden when viewing the formNext Steps: Sync an Email Add-OnTo get the most out of your form, we suggest that you sync this form with an email add-on. To learn more about your email add-on options, visit the following page (https://www.gravityforms.com/the-8-best-email-plugins-for-wordpress-in-2020/). Important: Delete this tip before you publish the form.Name of Claimant(Required) First Last Name of Person submitting Form (if different from Claimant):Address for Notices Street Address Address Line 2 City ZIP Code Preferred Method of ContactEmailPhoneYour Email Address(Required) Email Address Confirm Email Address Your Phone(Required)Were you or any member of your immediate family an employee or contractor of Reliable One Resources, Quantum Filtration, or any of their affiliates Yes No Amount of ClaimDescribe Nature of Claim (e.g., services provided, money loaned, investment, etc.):Entity You Assert a Claim Against (check all that apply): Reliable One Resources, Inc. Pinta Dome Joint Venture, LLC Geoenhanced Technologies, Inc Yucca Valley Sand & Gravel, LLC Benwood Processing, LLC Reliable Energy, Inc. Quantum Filtration, Inc Pinta Dome Operating, LLC PDH Management, LLC Helios Extraction Limited Phoenix Exploration, LLC Reliable Enterprises, Inc. (f/k/a Reliable Oil and Gas, Inc. REO Disposal & Receyle #2, LLC REO Injection Well Joint Venture, LLC Sand Creek Development Yucca Minerals & Mining Earth-Wise Minerals & Mining Company, LLC Earth-Wise Joint Venture Endowment Fund Earthwise Mining Earthwise Organics GSET Management Please attach any documentation you have that supports your claim, including signed contracts or subscription agreements, invoices, and/or proof of transfer of funds. Please feel free to redact any sensitive information, such as social security numbers, birthdates, or bank account numbers. Please do not submit any documentation that does not reflect Claimant’s specific information concerning the existence or value of a claim. Drop files here or Select files Max. file size: 30 MB. I, the undersigned, hereby declares that all the information provided in this Proof of Claim, including all attachments to the Proof of Claim, are true and correct and that I am authorized to make this Claim. By submitting this Proof of Claim to the Receiver, I consent to notices being provided to me at the address stated in the Proof of Claim. I acknowledge and agree that submitting this Proof of Claim by electronic means (e-mail or submission through the Receiver’s website) shall constitute a valid signature [seem redundant to me, and it might be necessary to be redundant. I understand I do not undertand