CSD 4014 [06/19/97] Name, Address, Telephone No. & I.D. No. UNITED STATES BANKRUPTCY COURT SOUTHERN DISTRICT OF CALIFORNIA 325 West F Street, San Diego, California 92101-6991 In Re BANKRUPTCY NO. Debtor. APPLICATION FOR RETURN OF TENDERED FUNDS COMES NOW , Applicant, stating: 1. That on , there was tendered to the above-entitled Court the sum of $ belonging to but being undeliverable. 2. That the applicant is entitled to said sum. 3. That said monies so tendered were deposited by the Clerk of the above-entitled Court with the United States Treasury as indicated by Receipt No. dated and remain unclaimed. 4. [if applicable] The undersigned is the lawful agent of the applicant and authorized to execute this application on behalf of the applicant. 5. I understand that, pursuant to 18 U.S.C. § 152, I shall be fined not more than $5,000, or imprisoned not more than five years, or both, if I have knowingly and fraudulently made any false statements in this document or accompanying supporting documents. WHEREFORE, your applicant prays for an order requiring the Clerk of the above-entitled Court to take the necessary steps so that the United States Treasury will return said tendered money to your applicant. DATED this day of , 20 . Signed: , Applicant/Agent Printed Name: Mailing Address: (Street) (City, State, ZIP) I, , the applicant or authorized agent for the applicant named in the foregoing application, do hereby certify under penalty of perjury that the foregoing is true and correct. Executed on Applicant APPROVED AS TO FORM: Financial Administrator, U.S. Bankruptcy Court ORDER IT IS SO ORDERED. DATED: CSD 4014 Judge, United States Bankruptcy Court 2002 © American LegalNet, Inc.