NM LF 347-5 UNITED STATES BANKRUPTCY COURT DISTRICT OF NEW MEXICO In re: Case No. Debtor(s). REPORT OF SMALL DIVIDENDS DEPOSITED IN THE COURT REGISTRY Pursuant to 11 U.S.C. 247 347(a) and Fed. R. Bankr. P. 3010, the undersigned trustee will deposit $ with the Clerk of Court for transmission to the United States Treasury. These funds represent small dividends in this case. All known names and addresses of the claimants and the amounts they are entitled to be paid are: Name Address City, State, zip code $ Name Address City, State, zip code $ Total: $ Signature Name: Address: Telephone: Email: I certify that a true copy of the above was mailed to the United States trustee on , 20. Signature American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTIONS Use this report when a dividend to a creditor is less than $5.00. Identify claimants by name, address and distribution amount. Electronically file this document. Then, mail your check to the clerk. The clerk will verify the total of your check with the total amount listed in the filed report. If there are no discrepancies, the funds will be accepted and the clerk will provide you with a receipt. American LegalNet, Inc. www.FormsWorkFlow.com