Information And Documentation Required For Petition For Unclaimed Funds (Page 4 of 6) in pdf

Information And Documentation Required For Petition For Unclaimed Funds Page 4

EXAMPLE ONLY - DO NOT FILL IN THE BLANK

UNITED STATES BANKRUPTCY COURT

NORTHERN DISTRICT OF GEORGIA

___________________ DIVISION

IN THE MATTER OF:

Case No. ___________

Chapter _______

Debtor(s)

Judge ______________

PETITION FOR PAYMENT OF UNCLAIMED FUNDS

A dividend check in the amount of $_______________ was issued in the above-styled

bankruptcy case to __[Insert name of original owners of record of the funds]

whose mailing address at the time of issue was ______________________________________

_____________________________________________________________________________.

Because that check was not cashed by said payee, pursuant to 11 U.S.C. §347(a), on

____________________, 200____, the trustee paid those unclaimed funds to the Clerk, U.S.

Bankruptcy Court.

Application is hereby made to pay these unclaimed funds to [type or print Claimant’s

name] at

[insert Claimant’s current address]

. [Insert any further facts or information

necessary to establish Claimant’s rights to the Unclaimed Funds.]

This ___ day of _______________, 20__.

___________________________________

Signature of Claimant

___________________________________

Social Security or Tax ID number

Sworn to and subscribed to before

me this ___ day of ________, 20__.

If applicable, affix

Corporate Seal

________________________________

Notary Public in and for the

State of _________________________

My commission expires ____________

Information And Documentation Required For Petition For Unclaimed Funds Page 4