Identification Form For Unclaimed Funds (Corporate/business)

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RESET 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
CORPORATE/BUSINESS
I, _________________________________________, hereby state that I am the
__________________________________, of ________________________________________
(Title)
(Business Name)
and I am authorized to request payment of the unclaimed funds referenced in the attached
Motion. I am enclosing the attached document(s), including but not limited to corporate
documents (if applicable) showing proof of ownership of funds through amendment (such as a
name change), assignment, assumption, merger, and/or dissolution, and proper authority to act
on behalf of the corporation (if applicable), that substantiate(s) my authorization.
Signature:
Name:
(CORPORATE
SEAL)
Address:
Telephone:
ATTACH A PHOTOCOPY OF A BUSINESS CARD
J:\Web\Forms\PDF Files\ID Corp Unclaimed Funds.pdf 7/13/10

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