9/06 UNITED STATES BANKRUPTCY COURT DISTRICT OF UTAH ______________________________________________________________________________ In re: _______________________________ Case No. ____________ _______________________________ Chapter _____ Debtor(s). ______________________________________________________________________________ APPLICATION FOR UNCLAIMED FUNDS _______________________________hereby petitions the Court for $_____________ being held in the Registry of the Clerk, United States Bankruptcy Court, as unclaimed funds which are due to petitioner. The petitioner did not receive the dividend check in the above case for the following reason: _____________________________________________________________________________ _____________________________________________________________________________ The petitioner’s current mailing address is: _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ I/We hereby certify that on _____________ I/we mailed a true and correct copy of this application for unclaimed funds to the United States Attorney at 185 South State Street, Suite 400, Salt Lake City, Utah 84111 Dated: ________________ ___________________________________ Petitioner ___________________________________ Co-Petitioner (if applicable) A COPY OF A PHOTO IDENTIFICATION CARD SHOWING PETITIONER’S SIGNATURE IS REQUIRED. American LegalNet, Inc. www.FormsWorkflow.com UNITED STATES BANKRUPTCY COURT DISTRICT OF UTAH In re: _______________________________ _______________________________ Case No: ______________ Chapter ____ Debtor(s) ORDER TO PAY UNCLAIMED FUNDS It appearing that the check made payable to ________________________________, in the amount of $_________________ was not charged against the bank account of the debtor’s estate within the 90-day limit pursuant to 11 U.S.C. §347 and an unclaimed money report was filed on _________________ to close the account and transfer the monies into the registry of the Clerk, United States Bankruptcy Court, and It further appearing that __________________________________ now claims the above monies in the petition attached hereto, IT IS ORDERED that the Clerk of the Bankruptcy Court pay the sum of $_____________, to __________________________________. ---------------------------------------------------END OF DOCUMENT--------------------------------------------------- Rev. 4/06 American LegalNet, Inc. www.FormsWorkflow.com