NM LF 347 UNITED STATES BANKRUPTCY COURT DISTRICT OF NEW MEXICO In re: Case No. Debtor(s). REPORT OF UNCLAIMED FUNDS DEPOSITED INTO THE COURT REGISTRY Pursuant to 11 U.S.C. 247 347(a) and Bankruptcy Rule 3011, the undersigned will deposit $ of unclaimed funds with the Clerk of Court for transmission to the United States Treasury. All known names and addresses of the claimants and the amounts to which they are entitled 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 dividends are unclaimed. 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