EXHIBIT D-1 

Case:17-03283-LTS Doc#:19995-8 Filed:02/02/22 Entered:02/02/22 17:51:17 Desc:

Exhibit D-1 Celia P. Santiago En Page 1 of 6
Proof of Claim Number: 179439

Claimant: Santiago Ortiz, Celia Pilar

Certified to be a correct and true translation from the source text in Spanish to the target language English.

20/DECEMBER/2021 - Andreea I. Boscor ATA-certified Spanish-English #525556

By Targem Translations Inc.

INFORMATION REQUESTED TO PROCESS YOUR CLAIM

Instructions

Please answer all four (4) questions and any applicable sub-questions. Please include as much 

detail as possible in your responses. Your answers should provide more information than the 

initial proof of claim. For example, if you previously wrote as the basis for your claim “Act 96,” 

please elaborate as to the specific laws on which you are purporting to rely, the year the law at 

issue was enacted, and how and why you believe such particular law provides a basis for your 

claim. Additionally, if available and applicable to your claim, please provide: 

• Copy of an initial pleading, such as a Complaint or an Answer; 

• Any unpaid judgment or settlement agreement; 

• Written notice of intent to file a claim with proof of mailing; 

• Any and all documentation you believe supports your claim. 

Please send the completed form and any supporting documents via email to 

PRClaimsInfo@primeclerk.com, or by mail or hand delivery to the following address: 

By Mail Hand Delivery or Overnight Mail Service 

Commonwealth of Puerto Rico Supplemental 

Information Processing Center 

c/o Prime Clerk, LLC 

Grand Central Station, PO Box 4708 

New York, NY 10163-4708 

Commonwealth of Puerto Rico Supplemental 

Information Processing Center 

c/o Prime Clerk LLC 

850 Third Avenue, Suite 412 

Brooklyn, NY 11232 

Questionnaire

1. What is the basis of your claim? 

□ A pending or closed legal action with or against the Puerto Rican government 

□ Current or former employment with the Government of Puerto Rico 

□ Other (Provide as much detail as possible below. Attach additional pages if needed.)

2. What is the amount of your claim (how much money do you claim to be owed): 

$ 37,200.00

✓

Case:17-03283-LTS Doc#:19995-8 Filed:02/02/22 Entered:02/02/22 17:51:17 Desc:

Exhibit D-1 Celia P. Santiago En Page 2 of 6
Proof of Claim Number: 179439

Claimant: Santiago Ortiz, Celia Pilar

Certified to be a correct and true translation from the source text in Spanish to the target language English.

20/DECEMBER/2021 - Andreea I. Boscor ATA-certified Spanish-English #525556

By Targem Translations Inc.

3. Employment. Does your claim relate to current or former employment with the 

Government of Puerto Rico?

□ No. Please continue to Question 4. 

□ Yes. Answer Questions 3(a)-(d).

3(a). Identify the specific agency or department where you were or are employed: 

Department of Education

3(b). Identify the dates of your employment related to your claim: 

From July 2002 until December 2018

3(c). Last four digits of your social security number: 2713 

3(d). What is the nature of your employment claims (select all that apply): 

□ Retirement 

□ Unpaid Wages 

□ Sick Days 

□ Union Grievance 

□ Vacation 

□ Other (Provide as much detail as possible. Attach additional pages if necessary). 

4. Legal Action. Does your claim relate to a pending or closed legal action? 

□ No. 

□ Yes. Answer Questions 4(a)-(f).

4(a). Identify the department or agency that is a party to the action. 

Department of Education

4(b). Identify the name and address of the court or agency where the action is pending: 

Federal Court of Puerto Rico, Calle Chardón, Hato Rey

4(c). Case number: 17-BK 03283

4(d). Title, Caption, or Name of Case: 

Commonwealth of Puerto Rico

✓

✓

Case:17-03283-LTS Doc#:19995-8 Filed:02/02/22 Entered:02/02/22 17:51:17 Desc:

Exhibit D-1 Celia P. Santiago En Page 3 of 6
Proof of Claim Number: 179439

Claimant: Santiago Ortiz, Celia Pilar

Certified to be a correct and true translation from the source text in Spanish to the target language English.

20/DECEMBER/2021 - Andreea I. Boscor ATA-certified Spanish-English #525556

By Targem Translations Inc.

4(e). Status of the case (pending, on appeal, or concluded): 

 Pending resolution

4(f). Do you have an unpaid judgment? Yes / No (Circle one) 

If yes, what is the date and amount of the judgment?

 From July 2002 until December 2018

1) Act 96 of July 2002

2) Act 109 of July 2008

For a total owed of 37,200 by the Puerto Rico Department of Education

Case:17-03283-LTS Doc#:19995-8 Filed:02/02/22 Entered:02/02/22 17:51:17 Desc:

Exhibit D-1 Celia P. Santiago En Page 4 of 6
Certified to be a correct and true translation from the source text in Spanish to the target language English.

20/DECEMBER/2021 - Andreea I. Boscor ATA-certified Spanish-English #525556

By Targem Translations Inc.

Case:17-03283-LTS Doc#:19995-8 Filed:02/02/22 Entered:02/02/22 17:51:17 Desc:

Exhibit D-1 Celia P. Santiago En Page 5 of 6
TRANSLATOR’S CERTIFICATE OF TRANSLATION

Translation from: Spanish (Puerto Rico) into English (US)

TARGEM Translations Inc.

I, Andreea I. Boscor, ATA-certified Spanish-English #525556, acting as translator at TARGEM Translations Inc., a NEW 

YORK City corporation, with its principal office at 185 Clymer Street, Brooklyn, NY, 11211, USA, certify that:

the English translated document is a true and accurate translation of the original Spanish and has been translated to 

the best of my knowledge.

Original Document Name: Claim No. 179439

 

Signed this 20th day of December, 2021 

__________________________ 

 Andreea I. Boscor

Case:17-03283-LTS Doc#:19995-8 Filed:02/02/22 Entered:02/02/22 17:51:17 Desc:

Exhibit D-1 Celia P. Santiago En Page 6 of 6