Affidavit For Reimbursement Of Unclaimed Dividends
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Affidavit For Reimbursement Of Unclaimed Dividends Form. This is a Nevada form and can be use in Bankruptcy Court Federal.
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Tags: Affidavit For Reimbursement Of Unclaimed Dividends, Nevada Federal, Bankruptcy Court
UNITED STATES BANKRUPTCY COURT
DISTRICT OF NEVADA
IN RE:
DEBTOR
)
)
)
)
)
BKAFFIDAVIT FOR REIMBURSEMENT OF
UNCLAIMED DIVIDENDS
STATE OF:
COUNTY OF:
SOCIAL SECURITY NO/TAX ID:
of
(NAME OF CREDITOR/DEBTOR) (ADDRESS)
being duly sworn, deposes and says:
(PHONE NUMBER)
That he/she is a creditor of the above-named bankrupt/debtor or is the debtor. That
(Name of Debtor/Bankrupt) was duly adjudged a debtor/bankrupt in the United
States Bankruptcy Court for the District of Nevada. That said creditor duly filed his/her claim,
which claim was thereafter duly allowed or is the debtor in the above named case.
Dividends amounting to the sum of $
remain unpaid.
That the said claim has not been sold or assigned, and that it is still the property of the
deponent.
It is therefore requested that the Clerk of this Court pay to
sum of $
the
.
(Signature)
Sworn and subscribed to before
day of
me this
(Notary Public)
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