Identification Form For Unclaimed Funds (Individual)
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1RESET FORM
UNITED STATES BANKRUPTCY COURT
FOR THE SOUTHERN DISTRICT OF IOWA
110 E. Court Avenue, Ste 300
Des Moines, Iowa 50309
In the Matter of:
Case No.
IDENTIFICATION FORM FOR UNCLAIMED FUNDS
INDIVIDUAL
I, _________________________________, hereby state that I am a _________________
in the above-named case and request payment of my unclaimed funds.
Address:
Social Security Number: XXX-XX _________
Signature:
Name:
Address:
Telephone:
ATTACH A PHOTOCOPY OF A GOVERNMENT ISSUED
PHOTO-IDENTIFICATION CARD
(i.e. Driver's License)
J:\Web\Forms\PDF Files\ID Ind Unclaimed Funds 7/13/10
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Parent category: Legal