UNITED STATES BANKRUPTCY COURT
EASTERN DISTRICT OF CALIFORNIA
FORM FOR UNCLAIMED FUNDS
I, ___________________________________________, hereby allege that I am the owner of unclaimed funds deposited with
the court in the above-named case and request payment of my unclaimed funds.
Current Phone No.
Social Security No.
Previous Mailing Address
Current Mailing Address
Driver’s License No.
0r other State issued Identification No
Signature of Alleged Owner *
* Attach copy of Driver’s License or other State issued Identification. In the case where a “fund locator service” has purchased/been assigned the claim, or
purchased the assets of the business originally entitled to the funds, documents evidencing the transfer of claim or documentation which provides proof of
the purchase/sale of the assets (such as the contract of sale) must be attached.
, COUNTY OF
before me, personally appeared (insert name and title of signer)
personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are
subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized
capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the
person(s) acted, executed the instrument. WITNESS my hand and official seal.
My commission expires on
To ensure payment to the proper party, please fill out the identification portion of this form and submit together with an Application for Payment of Unclaimed
Funds (EDC 3-950) and supporting documentation to:
United States Bankruptcy Court
Eastern District of California
501 I Street, Suite 3-200
Sacramento, CA 95814
EDC 3-951 (New 11/01)