COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : BTXN 127 (rev. 4/04) Index No. Calendar No. UNITED STATES BANKRUPTCY COURT NORTHERN DISTRICT OF : TEXAS JUDICIAL SUBPOENA Plaintiff(s) -against- : In Re: § : § Case No.: § : Debtor(s) § Defendant(s) § : ...................................................... § APPLICATION FOR PAYMENT THE PEOPLE OF THE STATE OF NEW YORK OF DIVIDEND UNCLAIMED FUNDS TO Comes now the undersigned, to make application for an order directing payment of unclaimed funds now on deposit in the Treasury of the United States. Claimant is a creditor debtor (check one) in the above captioned bankruptcy case and on whose behalf these funds were deposited. GREETINGS: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Name of Claimant , the Honorable at the Court Name of Business Entity located at County of in Title of Officer/Representative (if claimant is, a business entity)o'clock in the room , on the day of 20 , at noon, and at any recessed or Mailing Address testify and give evidence as a witness in this action on the part of the adjourned date, to City State Zip Telephone Number: Home ( ) Work ( ) SS# Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to Tax ID# (for all business entities) the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a Amount Being Claimed result of your failure to comply. I, Witness, Honorable ,do hereby state under penalty of perjury thatof am legally , one of the Justices I the entitled in claim these funds for whom the unclaimed ,funds were deposited into the treasury in the above Court to County, day of 20 referenced bankruptcy case. I certify to the best of my knowledge that all information submitted in support of this claim is true and correct. (Attorney must sign above and type name below) Date Claimant Signature Subscribed and Sworn to Before Me this Co-Claimant Signature Attorney(s) for day of . Office and P.O. Address Notary Public In and for the State of Telephone No.: My commissionFacsimile No.: expires E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : Index No. Calendar No. : Instructions for filing the Application for PaymentJUDICIAL SUBPOENA of Unclaimed Funds Plaintiff(s) -against- : To file an application for payment of unclaimed funds, you must: : 1. Submit a notarized Application for Payment of Unclaimed Funds. a. If the funds were deposited for joint claimants, both must sign the application : b. The applicant must have legal standing to make the claim Defendant(s) : ...................................................... 2. Include legible copies of supporting documents establishing the final address of record at time of the bankruptcy case (a copy of proof of claim, correspondence from the court, tax forms, telephone or water bill). THE PEOPLE OF THE STATE OF NEW YORK 3. If claiming on behalf of a deceased party, please include a copy of: a. Active estate 1. A death certificate 2. Letter designating an executor for the estate b. Inactive estate GREETINGS: 1. A death certificate 2. Copy YOU, will WE COMMAND of the that all business and excuses being laid aside, you and each of you attend before TO , the Honorable at the Court County of identification issued located at 4. Photo by a government agency (copy of current driver’s license or inpassport for eachon the room , claimant). day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the 5. If the original business entity claimant changed as a result of a merger, buyout or name change, please include supporting documents which substantiate your interest in the claim (documents from the Secretary of this subpoena is punishable as a contempt of court and will make you liable to Your failure to comply with State in which claimant is incorporated). the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a resultActive corporate entities must submit: 6. of your failure to comply. a. Current franchise tax corporate status in state of incorporation Witness, Honorable , one of the Justices of the b. A current list of officers and directors Articles Court in c. Copy of County, of Incorporation day of , 20 d. An imprint of the corporate seal e. Business card reflecting claimants’ name, officer or representative’s name and title attached to company letterhead stationery (Attorney must sign above and type name below) Inactive corporate entities must submit: a. Current franchise tax corporate status in state of incorporation Attorney(s) for b. A final list of officers and directors c. Copy of Articles of Incorporation d. Articles of Dissolution e. Date and list of final distribution of assets Office and P.O. Address f. Final income tax return Sole proprietorship entity must submit: Telephone No.: a. Appropriate federal income tax return Facsimile No.: b. Document showing business address at the time of theAddress: E-Mail bankruptcy case (copy of invoice, a sales tax permit, business license) Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : Index No. Calendar No. : Partnership entities must submit: Plaintiff(s) JUDICIAL SUBPOENA a. Federal income tax return including schedule K-1 for all partners -against: b. Written documentation from all partners authorizing the representative to claim the funds on their behalf : 7. Mail the original plus two copies of the application and three sets of attachments to the : following address: Defendant(s) : ...................................................... U.S. Bankruptcy Court Financial Section 1100 Commerce St., RM 1254 THE PEOPLE OFTX 75242 Dallas, THE STATE OF NEW YORK TO The court will serve the U.S. Attorney with a copy of the application pursuant to 28 U.S.C. 8. §2042. If no objection is filed within 20 days from the date of notice, the proper order and voucher will be executed to pay these funds. GREETINGS: 9. Applications received which do not comply with the above requirements will be returned to the applicant. WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. Witness, Honorable Court in County, , one of the Justices of the day of , 20 (Attorney must sign above and type name below) Attorney(s) for Office and P.O. Address Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com