Identification Form For Unclaimed Dividends (Individual) Download Free Print-Only PDF OR Purchase Interactive PDF Version of this Form
Identification Form For Unclaimed Dividends (Individual) Form. This is a Rhode Island form and can be use in Bankruptcy Court Federal.
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Tags: Identification Form For Unclaimed Dividends (Individual), F.1, Rhode Island Federal, Bankruptcy Court
R.I. Bankr. Form F.1
See R.I. LBR 3011-1(b)
(Rev. 8/23/10)
UNITED STATES BANKRUPTCY COURT
FOR THE DISTRICT OF RHODE ISLAND
IDENTIFICATION FORM FOR UNCLAIMED DIVIDENDS
Case Name
Case No.
Amount of dividend/refund
A dividend/refund check was previously issued in your name in accordance with an
Order of this Court, however said check was not cashed and has been deposited with the United
States Treasury Account.
In order to insure payment to the proper party, fill out the identification portion on this
form and either electronically file (see LBR 3011-1), or mail the form to: U.S. Bankruptcy
Court, 380 Westminster St., Providence, RI 02903, Attn: Financial Dept. Upon receipt of the
completed document, your request for payment of unclaimed funds held by the Court will be
processed.
===============================================================
I, ____________________________________, hereby state that I am a creditor/debtor in the
above-named proceeding and request payment of my unclaimed dividend/refund check. The
below information must be fully completed and match the former address on file with the
Clerkâs office. Failure to complete this information will cause the petition and this form to
be considered defective and stricken.
Old Address ______________________________________
Current Address ___________________________________
Driver=s license No. ________________, State ______________
Social Security Number ___________________________
___________________________
(Signature)
Subscribed and sworn to before me in
This
Day of
(City/Town)
.
(State)
___________________________
(Notary Public)
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