ALMB UC Funds (rev. 7/14) UNITED STATES BANKRUPTCY COURT MIDDLE DISTRICT OF ALABAMA APPLICATION FOR PAYMENT OF UNCLAIMED FUNDS FOR INDIVIDUAL OWNER OF RECORD Comes now the undersigned, to make application for an order directing payment of unclaimed funds now on deposit in the Treasury of the United States. Claimant is a creditor debtor (check one) in the above-referenced bankruptcy case and on whose behalf these funds were deposited. 1. Name of Claimant(s) 2. Current Mailing Address 3. Telephone Number 4. Amount Being Claimed Itate under penalty of perjury that I am legally entitled to claim the funds described above. I certify to the best of my knowledge that all information submitted in support of this claim is true and correct. Date Claimant Signature Joint Claimant Signature Subscribed and sworn to before me this day of . Notary Public In and for the State of My commission expires In Re: ) ) Case No.: ) ) Debtor(s) ) ) American LegalNet, Inc. www.FormsWorkFlow.com Instructions for Filing the Application for Payment of Unclaimed Funds for Individual Owner of Record The court will only disburse unclaimed funds to the rightful owner upon full proof of the right to claim the funds. The following forms and documentation are required: 1. An Application for Payment of Unclaimed Funds, including the case name and number a. The application is a fillable form and should be typed, if possible. b. The applicant must be the owner of record, i.e., the person in whose name the unclaimed funds were remitted to the court. c. If the funds were deposited for joint claimants, both claimants must sign the application. d. The claimant222s signature(s) must be notarized. 2. IRS Form W-9. The name on the W-9 must match the claimant222s name as shown on the application. 3. Mail the original application and Form W-9 to the following address: U.S. Bankruptcy Court Attn: Financial Dept. One Church Street Ground Floor Montgomery, AL 36104 Applications received which do not comply with the above requirements may be denied by the court. Claims will be processed as soon as possible and in the order they are received. If you do not hear anything in 60 days, please call (334) 954-3800. American LegalNet, Inc. www.FormsWorkFlow.com