P5-D 0 UNITED 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 perjury thefollowing:1.On , the trustee in the above-referenced case deposited with theClerk of Bankruptcy Court for the District of Minnesota the sum of $ representing the amount of an uncashed dividend check payable to and sent to the following address:Street Address: City, State, Zip Code: 2.I am the administrator/executor/representative of the estate of the original claimant, nowdeceased, of the funds referred to in paragraph 1 and as proof thereof, have attached tothis 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.Certified copies of probate documentation establishing my authority to act onbehalf of the decedent222s estate; 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 P5-D 0 4.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 thecourt222s registry fund account.Date: (Signature ofAdministrator/Executor/Representative of claimant) (Printed name ofAdministrator/Executor/Representative of claimant) (Telephone number ofAdministrator/Executor/Representative of 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