UNITED STATES BA NKRUPTCY COURT EASTERN DISTRICT OF VIRGINIA Division In re C ase No. Debtor(s) Chapter REPORT OF DEPOSIT OF SMALL DIVIDEND ________________________________________________________________________ Pursuant to Federal Rule of Bankruptcy Procedure 3010 and 11 U.S.C. 347, the trustee submits a check payable to Clerk, United States Bankruptc Court representing smy all dividends to be deposited by the Clerk of Court into the Treasury of the United States. Said funds are subject to withdrawal as provided by 28 U.S.C. 2042 and shall not escheat under any state law. The small dividends represent the dividend(s) due and payable to: Creditors Name and Address Amount of Dividend ontinued [If applicable: Continued Date: __________________ ____________________________________ (Signature of Trustee) ____________________________________ (Typed Name of Trustee) ____________________________________ (State Bar Number) ____________________________________ (Address) ____________________________________ (Telephone Number) [rsmdivid ver. R. 04/03] American LegalNet, Inc. www.USCourtForms.com