P4-TC09/2018UNITED STATES BANKRUPTCY COURTDISTRICT OF MINNESOTAIn re:Case No.Debtor(s).PETITION FOR RELEASE OF FUNDS FROM COURT REGISTRY ACCOUNTIn support of this Petition, I, , declare under penalty of perjurythe following:1.On , the trustee in the above-referenced case deposited with the Clerk ofBankruptcy Court for the District of Minnesota the sum of $ , representing theamount of an uncashed dividend check payable to and sent to the following address:Street Address: City, State, Zip Code: 2.I am the transferee of the original claimant of the funds referred to in paragraph 1 and asproof thereof, have attached to this petition:a.Proof of identity of the original claimant in the form of a photo copy of the originalclaimant222s driver222s license or other government-issued identification bearing theclaimant222s signature;b.Documentation evidencing the transfer of the claim to me, in the form of ; andc.Proof of my identity in the form of a photo copy of my driver222s license or othergovernment-issued identification bearing my signature. 3.My current address is: Street Address: City, State, Zip Code: Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com P4-TC09/20184.I have served a copy of this petition and attachments on the U.S. Attorney for the Districtof Minnesota at 300 South 4th Street, Suite 600, Minneapolis, MN 55415.5.I request entry of an order authorizing the release to me of $ from the court222sregistry fund account.Date: (Signature of transferee claimant) (Printed name of transferee claimant) (Telephone number of transferee claimant)STATE OF MINNESOTACOUNTY OF This instrument was acknowledged before me on the day of ,20 by: . (Signature of notarial officer) (Title) My commission expires: dd/mm/yyyy Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com