CLEAR FORM
UNITED STATES BANKRUPTCY COURT FOR THE SOUTHERN DISTRICT OF IOWA
P.O. Box 9264 Des Moines, Iowa 50306-9264 www.iasb.uscourts.gov
In the Matter of:
Case No.
LIMITED POWER OF ATTORNEY To: (name address of agent/attorney- in- fact)
The undersigned claimant hereby authorized you to act as attorney- in- fact for the undersigned only to collect uncollected, undistributed, or unclaimed funds held by the court and owing to _________________________________________(name of claimant) in the amount of $______________.
Dated:
Signature: Name: Address: Telephone: Social Security Number: XXX-XX-
07 Acknowledged before me on the ________ day of __________________, 20_____, by _________________________________, who says that he/she is the person name above and is authorized to execute this power of attorney.
Signature_________________________________ Notary Public
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