UNITED STATES BANKRUPTCY COURT FOR THE SOUTHERN DISTRICT OF IOWA 110 E. Court Avenue, Ste 300 Des Moines, Iowa 50309 www.iasb.uscourts.gov In the Matter of: Case No. LIMITED POWER OF ATTORNEY To: (name address of agent/attorney-in-fact) The undersigned claimant hereby authorizes you to act as attorney-in-fact for the undersigned only to collect uncollected, undistributed, or unclaimed funds held by the court and owing to _________________________________________(name of claimant) in the amount of $______________. Dated: Signature: Name: Address: Telephone: Social Security Number: XXX-XXAcknowledged before me on the ________ day of __________________, 20_____, by _________________________________, who says that he/she is the person name above and is authorized to execute this power of attorney. Signature_________________________________ Notary Public J:\Web\Forms\PDF Files\POA Unclaimed Funds.pdf 7/19/13 American LegalNet, Inc. www.FormsWorkFlow.com