Information And Documentation Required For Petition For Unclaimed Funds Page 5

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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 ______________
CERTIFICATE OF SERVICE
The undersigned [type or print name]________________________________________
of [type or print address]________________________________________________________
_____________________________________________________________________________
hereby certifies:
That I am, and at all times hereinafter mentioned, was more than 18 years of age, and that
on the ____ day of ________________, 20____, I served a copy of the foregoing Petition for
Payment of Unclaimed Funds, upon the parties listed below by First Class Mail:
G
United States Attorney
1800 Richard Russell Federal Building
75 Spring Street, SE
Atlanta, Georgia 30303
G
[insert name and address of all other parties served]
Executed ______________________
By: ____________________________________
(Date)
(Signature)

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