Date: Lisa B. Beaser, Clerk of Court United States Bankruptcy Court, WDNY (Check the applicable box and submit to the Buffalo or Rochester Clerks Office, where the case is venued) U.S. Bankruptcy Court, WDNY, 14202 U.S. Bankruptcy Court, WDNY, 100 State Street, Rochester, NY 14614 Case Name Case No. Request to Deposit Unclaimed Funds into the United States Treasury Dear Clerk of Court: Enclosed please find my Trustee222s check in the amount of $ . I request that the Clerk of Court deposit said funds, in the name of the cs and in the amounts listed below, with the U.S. Treasury as 223unclaimed funds.224 I have made a diligent effort to locate the claimant(s) for said funds and have been unable to locate the claimant(s), or The funds represent dividend payment(s) of less than $5.00 to the affected c and are required to be treated as unclaimed funds by Bankruptcy Rule 3010(a). Claimant Amount $ Claims Register # Last Known Address Claimant Amount $ Claims Register # Last Known Address Claimant Amount $ Claims Register # Last Known Address Claimant Amount $ Claims Register # Last Known Address Claimant Amount $ Claims Register # Last Known Address Trustee Name Signature American LegalNet, Inc. www.FormsWorkFlow.com