UNITED STATES BANKRUPTCY COURT NORTHERN DISTRICT OF CALIFORNIA ) ) Case No____________ ) ) ______________________________ ) Chapter_______ Debtor(s) ) ) ) AFFIDAVIT OF SERVICE __________________________________________) Notice is hereby given to the court that on (date)_________ a copy of this application claiming funds in the amount of $_________, on behalf of (creditor/claimant)_________________ ___________________, was mailed to the U.S. Attorney for the Northern District of California, 450 Golden Gate Avenue, P.O. Box 36055, San Francisco, CA 94102. I certify under penalty of perjury under the laws of the United States of America that the foregoing is true and correct. ___________________________ Signature of Petitioner ____________________________ Date ____________________________ Type or Print Name of Petitioner ____________________________ Mailing Address American LegalNet, Inc. www.USCourtForms.com