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Application, Affidavit And Order For Payment Of Unclaimed Funds With Instructions (Claimant) Form. This is a Michigan form and can be use in USBC Western Federal.
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Tags: Application, Affidavit And Order For Payment Of Unclaimed Funds With Instructions (Claimant), Michigan Federal, USBC Western
United States Bankruptcy Court
Western District of Michigan
One Division Ave. NW, Room 200
Grand Rapids, MI 49503
Daniel M. LaVille
Clerk’s Office
(616) 456-2693- Tel.
(616) 456-2919- Fax.
CLAIMANT’S
NOTICE OF REQUIREMENTS REGARDING
RELEASE OF UNCLAIMED FUNDS
1.
To apply for the release of unclaimed funds, an original Application and proposed Order to
Release Unclaimed Funds must be sent to the United States Bankruptcy Court (samples
attached). The Application shall contain the claimant’s name, address, and name and
phone number of a person knowledgeable about the claim. If the claimant is someone
other than the creditor who is listed in the bankruptcy schedules, such as a successor-ininterest or an heir to the original claimant, sufficient documentation must be provided to
allow the Court satisfactory assurance that the funds are being released to or on behalf of
the legal owner.
2.
Page 2 of the Application contains an Affidavit in which the claimant must declare that
they are legally entitled to such funds. The Affidavit shall be signed by the claimant
declaring that they are the person or authorized representative of a corporation purported to
be owed the funds.
3.
The signature of the claimant on the Application and on the Affidavit must be signed
under oath in the presence of a notary public and the notary’s signature and seal affixed to
the documents.
4.
Pursuant to 28 U.S.C. Section 2042, a copy of the completed 2-page Application which
includes the Affidavit must be served (by first-class mail) upon the United States Attorney,
P.O. Box 208, Grand Rapids, MI 49501-0208. The Proof of Service at the bottom of page
2 of the Application (see sample attached on bottom of Affidavit) must be completed
stating the United States Attorney has been served the Application.
5.
After mailing the copy of the Application to the United States Attorney, the original,
signed documents (2-page Application and proposed Order, along with any supporting
documentation) shall be filed (by first-class mail or in person) with the United States
Bankruptcy Court, One Division Ave. NW, Room 200, Grand Rapids, Michigan 49503.
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6.
Approximately 20 days after your documents are received, the court docket and file will be
reviewed for any objections to the release. If no objections have been received, the
proposed Order will be forwarded to the judge for signature and a voucher for payment
will be prepared. A check will be sent to the claimant directly by the United States District
Court (disbursing agent for the United States Bankruptcy Court).
Please note that all applications are reviewed and any indications of fraud will be turned over to
the Federal Bureau of Investigation and the U.S. Attorney for investigation. Proper
documentation should be attached to identify the claimant of the funds. This may include a
photocopy of photo identification such as a driver’s license or passport, a letter of administration
or probated will, or corporate documents showing proof of ownership of the funds through
amendment, merger, or dissolution.
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United States Bankruptcy Court for the
Western District of Michigan
IN RE:
Case No.
Debtor(s)
_____________________________________/
APPLICATION FOR RELEASE OF UNCLAIMED FUNDS
IT APPEARING THAT a dividend check in the amount of $________________ was issued by
the trustee to _____________________________________________________, claimant in the
above-referenced case.
IT ALSO APPEARING THAT said check was not negotiated by said payee and the trustee,
pursuant to 11 U.S.C. Section 347(a), delivered the unclaimed funds to the Clerk, United States
Bankruptcy Court. These funds are currently being held by the United States Treasury.
IT ALSO APPEARING THAT this application includes a signed and notarized affidavit of
claimant which states that the undersigned is the legal owner of such funds.
IT ALSO APPEARING THAT the United States Attorney for the Western District of Michigan
has been provided a copy of this application allowing 20 days from the date of service to file an
objection to payment of these funds. A proof of service is made part of this application.
THEREFORE, an application is made for an order directing the Clerk of Court to pay said
unclaimed funds to the order of _______________________________________________,
claimant, and mail said check to the following address:
______________________________________________________________________.
Dated:________________
_________________________________________
Claimant
Subscribed and Sworn Before Me this _____ day of _______________.
SEAL
My commission expires:_______________
________________________________
Notary Public in and for the State of
_______________
Page 1 of 2
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AFFIDAVIT OF CLAIMANT
I, ___________________________, do hereby state that I am the claimant to the unclaimed funds
referenced in this application and that I am, to the best of my knowledge, the legal owner of these
funds. My mailing address and phone number are
_______________________________________________________________________________
_______________________________________________________________________________
Dated:________________
___________________________________
Claimant (or Representative of Corporation)
Subscribed and Sworn Before Me this _____ day of _______________________.
SEAL
My Commission Expires:______________
___________________________________
Notary Public In and For the State of
____________________
PROOF OF SERVICE OF APPLICATION ON UNITED STATES ATTORNEY
Notice is hereby given that on ___________________ a copy of the Application for Release of
Unclaimed Funds with Affidavit was served on the United States Attorney for the Western District
of Michigan, P.O. Box 208, Grand Rapids, MI 49501-0208 by United States Mail.
Dated:________________
___________________________________
Claimant
Page 2 of 2
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United States Bankruptcy Court for the
Western District of Michigan
IN RE:
Case No.
Debtor(s)
_______________________________________/
ORDER FOR RELEASE OF UNCLAIMED FUNDS
IT APPEARING THAT the amount of $________________ constituting unclaimed funds due to
______________________________________, claimant in the above-referenced case, are on
deposit with the United States Treasury.
IS ALSO APPEARING THAT _______________________________________, claimant, has
furnished the required documentation for release of unclaimed funds and has complied with the
provisions of 28 U.S.C. Section 2042.
THEREFORE, IT IS HEREBY ORDERED THAT the Clerk of Court shall pay the unclaimed
funds in the amount of $___________ to the order of ___________________________, claimant,
and mail the check to_____________________________________________________________.
Dated:______________________
___________________________________
United States Bankruptcy Judge
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