Application For Payment Of Unclaimed Funds
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Application For Payment Of Unclaimed Funds Form. This is a New York form and can be use in Bankruptcy Court Federal.
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Tags: Application For Payment Of Unclaimed Funds, 67, New York Federal, Bankruptcy Court
UNITED STATES BANKRUPTCY COURT
NORTHERN DISTRICT OF NEW YORK
In re
[Set forth here all names including married, maiden, and trade
names used by debtor within last 8 years.]
Debtor
Employer's Tax Identification No(s). [if any]
Last four digits of Social Security No(s):
)
)
)
)
)
)
)
)
)
)
Case No.
Chapter
APPLICATION FOR PAYMENT OF UNCLAIMED FUNDS
of
(Name of Claimant)
(Address)
, being duly sworn, deposes
(SSN or Tax ID No.)
(Telephone No.)
and says:
That he/she is a creditor of the above named debtor.
was duly adjudged a debtor in the United
That
States Bankruptcy Court for the Northern District of New York.
That said creditor duly filed his/her claim, which was thereafter duly allowed.
remain unpaid.
That dividends amounting to the sum of
That the said claim has not been sold or assigned, and that it is still the property of the
deponent.
That the deponent is not aware of any dispute regarding the claim at Issue.
It is therefore requested that the Clerk of the Court pay to
(Name of Claimant)
(Signature of Claimant)
SUBSCRIBED AND SWORN to before
me this
day of
Affix Seal
F:67(10/02/2006 )
Notary Public
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