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. American LegalNet, Inc. www.FormsWorkFlow.com American LegalNet, Inc. www.FormsWorkFlow.com 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. American LegalNet, Inc. www.FormsWorkFlow.com 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 American LegalNet, Inc. www.FormsWorkFlow.com 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 American LegalNet, Inc. www.FormsWorkFlow.com 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 American LegalNet, Inc. www.FormsWorkFlow.com