American LegalNet, Inc. www.FormsWorkFlow.com UNITED STATES BANKRUPTCY COURTAFFIDAVIT FOR REIMBURSEMENTNORTHERN DISTRICT OF ALABAMAOF UNCLAIMED FUNDS BY INDIVIDUAL************************************************************************************************************** SWORN PETITION FOR PAYMENT OF FUNDS HELD IN THE REGISTRY OF THE COURT, TITLE 28, U. S. C. S., 2472042, WITHDRAWALThe undersigned files this petition under oath for the purpose of inducing the payment of the sum of $ . Petitioner avers that his/her name is , and resides at , city of , State/Zip Petitioner is over the age of 21 years and is one and the same person as the person described in the matter of , in the Bankruptcy Case Number ,as a , and is entitled to the dividend or other monies (Case Number) (Creditor or other party)awarded him/her in the said case. Petitioner states that he/she duly filed their claim which was thereafter duly allowed. That the said claim has not been sold or assigned and is still the property of deponent. It is therefore requested that the Clerk of this Court pay to (Name of Claimant) the sum of $ . Social Security No. (Signature of Claimant)Sworn to and subscribed to before me the day of , 20 . Notary Public(Affix Seal)