CSD 4026 [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. PROOF OF RIGHT TO PAYMENT OF DIVIDEND FROM UNCLAIMED FUNDS I, [Name of Person Filing Application] of [Address of Person Filing Application] [City, State, ZIP Code] on behalf of , the Claimant on the within APPLICATION FOR RETURN OF TENDERED FUNDS, file this Proof of Right to Payment of Dividend from Unclaimed Funds. In support of the Application, the undersigned has attached a sworn affidavit attesting to the identity of the person, or officer of the entity entitled to the unclaimed funds, the tax identification number or social security number of the creditor, and certifying that the person or entity on whose behalf this application is made, is a creditor in this bankruptcy case and is the rightful and exclusive claimant of the unclaimed funds for which application is made. The claimant represents a corporation and provides evidence consisting of Certificate(s)/Article(s) of Incorporation, Certificate(s)/Article(s) of mergers or Successor Corporations, Declarations or Reports from the Secretary of State for the state wherein incorporation occurred, invoices and/or statements sent to the Debtor for payment of debts owed to the creditors. The claimant is an individual and provides evidence consisting of documents(s) which substantiate the claimant's creditor relationship with the debtor, a photocopy of the applicant's current driver's license or, in place of a driver's license, other identification containing the applicant's photograph and current address. (IF ASSISTED IN THIS APPLICATION, CHECK THIS BOX ALSO) The undersigned has entered into an agreement or otherwise represents that the undersigned is the Claimant and is being assisted in this Application. A limited power of attorney has been completed and is attached to the within APPLICATION FOR RETURN OF TENDERED FUNDS. The undersigned certifies, under penalty of perjury, that the attachments submitted in support of this Proof of Right to Unclaimed Funds are filed in good faith and are intended to recover funds rightfully owned by the Creditor. Dated: Creditor's Signature Printed Creditor's Name CSD 4026 2001 © American LegalNet, Inc.